End of life

Question 1

Define frailty

Answer 1

consists of mutisystem dysregulation, leading to loss of physiological reserve, resulting in a state of increased vulnerability to stressors

Definition given in her lecture: a distinct health state characterised by a reduction in physiological reserve resulting in adverse outcomes following minor stressor events such as infection, fall or change in environment

Question 2

What are the two main types of frailty scoring?

Answer 2

Phenotype model - Fried

Cumulative deficit model - eg clinical frailty score, electronic frailty index

Question 3

What is the phenotype model of frailty?

Answer 3

Patients with 3 or more of the following are said to be frail:

1. unintentional weight loss
2. reduced grip strength (weakness)
3. reduced gait speed
4. self-reported exhaustion
5. low energy expenditure/physical activity

If you meet two of the criteria, then you are classed as pre-frail

Question 4

What is the cumulative deficit model of frailty?

Answer 4

Frailty is associated with an accumulation of deficits e.g. 1. disease state: arthritis, diabetes, heart disease etc

2. symptoms/signs: polypharmacy, dizziness, SOB, incontinence, sleep disturbance
3. disability: housebound, blindness, hearing loss
4. Abnormal lab values: anaemia

Question 5

What is the strongest risk factor for frailty?

Answer 5

Age

Question 6

Define palliative care

Answer 6

Treatment that recognises the irreversible nature of the underlying disease process. Includes holistic care and symptom control

Question 7

WHat is end of life care?

Answer 7

Describes care in the last 12 months of life

Question 8

Art what opoint might you think that someone is reachign the end of life?

Answer 8

Progression is less reversible and is relentless (irreversible delcine). Treatment benefits are waning

Question 9

Define advance care planning

Answer 9

A process of discussion about goals of care and a means of recording preferences of care of patients who may lose capacity or ability to communicate in the future

Question 10

What does advance care planning include?

Answer 10

• LPA
• Advance statements
• Advance directives
• Preferred place of care/death
• Treatment options acceptable to patient and suitable for patient
• Specific plan for complex scenarios eg for predictable events
• DNACPR

Question 11

What are the advantages of advance care planning?

Answer 11

Open ended - allows for uncertainty eg pt getting worse or better, changing their mind
Improves coordination of care
Patient centred
Avoids futile disease oriented treatment

Question 12

What is the trajectory of frail patients?

Answer 12

Steady decline over time, unpredictable death

Question 13

What is the trajectory of patients with organ failure?

Answer 13

Acute dips in function, never regaining baseline function after each dip

Question 14

What is the trajectory of patients with cancer?

Answer 14

At baseline function for a while due to compensation, but then sudden deterioration and death