Frailty Flashcards
WHAT IS FRAILTY?
i) how is it defined?
ii) name three things it can result in
iii) what can it underpin
i) defined as age related decline in multiple physiological systems
ii) at risk state, vulunerable to minor stressors, disproportionate change in health status (mobile to immobile, lucid to confused)
iii) underpins non specific nature of some medical presentation in older adults
PATHOPHYSIOLOGY
i) name an two intrinsic, two extrinsic insults that trigger loss of homeo reserve in organ systems
ii) is it the number of systems or the abnormalities within systemis that drive it more
i) intrinsic - oxidative stress, free radials, inflam, genetics, viruses
extrinisic - drugs, nutrition, exercise, social structures
ii) number of systems affected
SARCOPENIA
i) what is it? what muscle mass, quality and strength is seen?
ii) what is it associated with? (3)
iii) what is it if there is no underlying cause? what leads to overall loss of muscle mass
iv) when do muscles peak?
v) name three things that contribute to sarcopenia?
i) progressive and generalised skeletal muscle disorder - accelerated loss of muscle mass and function
- see low muscle mass and quality and low strength > failure and insuff
ii) assoc with increased adverse outcomes eg falls, func decline, frailty, mortality
iii) primary age related sarcopenia - can be acute or chronic
- overall loss = imbalance of anabolic and catabolic pathways
iv) in fourth decade then decline from here
v) nutritional (low intake), assoc with inactivity, disease, iatrogenic (drug related)
DECONDITIONING SYNDROME
i) what is it?
ii) who does it most commonly affect?
iii) name three physiological effects
iv) name three consequences
i) syndrome of physical, psychological and func decline resulting from prolonged bed rest/immob and assoc with loss of muscle strength - assoc with hospitalisation
ii) most commonly affects older people (but can aff younger people) - effecta re more rapid and severe
- it can become irreversible
iii) loss of muscle mass, loss of muscle strength, musc shortening and joint change (contracture), reduced circ vol, reduced VO2 max, reduced swallow strength, reduced skin integrity
iv) pressure ulcers, pneummonia, urinary incontinence, constip, falls, low mood, loss of confidence, loss of indep, care needs increase
FRAILTY SYNDROMES
i) name six ways patients can present ‘in crisis’
ii) name three ways frailty may be identified non specifically
iii) what needs to be identified?
iv) what is a frailty syndrome? name three ways they differ from classic syndromes
i) falls, immobility, delirium, incont, suscep to side effects of meds, functional decline
ii) fatigue, weight loss, frequent infections
iii) the stressor
iv) seen in older people and dont fit into discrete disease categories
- common
- can be defined by a single symptom eg a fall
- single cause can ppt multiple syndromes (pneum ppt falls and delirium)
- indiv syndrome can have multiple causes (delirium can be caused by infec, dehy, constip)
- older patients can have multiple at one time
THE FRAILTY PHENOTYPE
i) what are the five core clinical presentations in this model?
ii) what are three criticisms of it
i) shrinkage (unintentional weight loss), weakness, poor endurance, slowness in walking, low physical activity > score
ii) very physically focused, doesnt take into account indiv comorbids, doesnt include cognition or modd, not easy to use clinically
FRAILTY INDEX
i) what is it based on?
ii) why is this model favoured? (4)
iii) name two drawbacks
i) more deficits you have the more likely you are to be frail
ii) fits theory of declining physical reserve, idea that frailty is gradual, clear assoc of FI and worse outcomes, better predictor than actual age
iii) large mumber of items needed (30), cut offs can vary - where do you intervene
CLINICAL FRAILTY SCALE
i) what age is it used for?
ii) when is the baseline status taken from?
iii) who does it not perform well for
iv) from which number onwards is vulnerable
i) >65
ii) two weeks pre illness
iii) doesnt perform well for those with chronic disability
iv) five onwards
INTRINSIC CAPACITY - WHO
i) what is it? what two main things is it comprised of?
ii) who can it be applied to
iii) what are the five interacting domains
iv) how does it differ from frality?
i) multi dimensional indicator of individuals functional status
- comprised of indiv physical and mental capacity, resources one can access
ii) across the life course - any age > designed to be pro active but still theoretical
iii) locomotion, vitality (metab/biologic), sensory, cognition, psychological status
iv) frailty is defined by deficits and abnorms, IC is defined by resrves and residual capacities
OVERLAPS WITH FRAILTY
i) what is multimorbidity?
ii) what is disability?
i) presence of two or more long term health conditions (physical or mental)
ii) umbrella term covering impairments, activity limitation and participation restriction
RISK FACTORS FOR FRAILTY
i) name five
ii) which two can be addressed the most
iii) over what age are you screened for frailty in GP
iv) what can be done in mild frailty? mod frailty? severe frailty
i) alcohol misuse. cog impair, falls, func impair, mood disorder, poor nutritional status, physical inactive, obesity avoid, polypharmacy, smoking, social isolation
ii) address poor nutrition (healthy weight) and physical inactivity (strength and aerobic)
iii) over 65
iv) mild - supported self mx (optimise RFs)
mod - care and support planning
severe - comprehensive geriatric assess and adv care planning
COMPREHENSIVE GERIATRIC ASSESSMENT
i) what is it? what is produced?
ii) name six things that are included in the assessment?
iii) what is ultimately done?
i) inter disciplinary process that produces problems lists
ii) physical, socioeconomic/enviro, functional, mobility/balance, psychological/mental, medication review
iii) personalised care plan > intervention > planned review (usually through the GP)
CARE AND SUPPORT PLAN
i) what does it involve? (4)
i) named individual responsible for co-ordinating care
optimisation/maintenance plan, escalation plan, urgent care plan, advance care plan (end of life planning)
SUMMARY
i) is frailty an inevitable part of ageing?
ii) can people transition through frailty states?
iii) what should frailty identification lead to?
i) no
ii) yes
iii) should lead to a management plan
