frailty Flashcards
what is the definition of frailty?
A distinctive health state related to the aging process in which multiple body systems gradually lose their in built reserves.
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
what are the concerns in frailty groups?
– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death
how does someone with frailty often present?
– Falls – Immobility – Delirium
– Incontinence – Susceptibility to side-effects of medications
what are the screening tools for frailty?
- Electronic Frailty Index (eFI) – Enables GP’s to screen patients for frailty and its severity – An evidence based intervention to improve outcome
- Rockwood Clinical Frailty Scale – Used with a hospital setting
what does a comprehensive geriatric assessment consist of?
Multidisciplinary assessment of physical, psychological, functional and environmental factors
key- medication review
how is polypharmacy clasified?
– Appropriate: prescribing for a patient with multiple conditions where
medication use is optimised and prescribed according to best
evidence
– Problematic: prescribing multiple medications inappropriately or
where the intended outcome of the medication is not achieved
what is deprescribing? how does one stop it?
Process to ensure safe and effective withdrawal of inappropriate medication
tools:
STOP/START/STOPIT
NOTEARS
BEERS critera
why do we worry about anticholinergic burden?
– Sedation – Constipation – Urinary retention – Blurred vision – All of these can increase the risk of confusion/delirium/falls in an
older patient.
what effect may beta blockers have in a person with diabetes?
frequent hypoglycaemic episodes- there is a risk of masking hypoglycaemic symptoms
what can thiazide diuretics mask?
exacerbating gout
what should you do with digoxin with impaired renal function?
At doses ˃125 microgram per day with impaired renal funcƟon (eGFR ˂50ml/minute). Can be increased levels of toxicity (e.g. nausea, diarrhoea, arrhythmias)
what dose of apixiban should be given in the elderly?
The recommended dose of apixaban is 2.5 mg taken orally twice daily in patients with NVAF and at least two of the following characteristics: age ≥ 80 years, body weight ≤ 60 kg, or serum
creatinine ≥ 133µmol/L
what are some high risk combinations to avoid with NSAIDS?
– +ACE and ARB (+diuretic = ‘triple
whammy’) –
+existing renal disease –
+diagnosis of heart failure –
+warfarin –
+age >75 without PP
what are some high risk drug combinations to avoid with warfarin?
– +antiplatelet
– HOWEVER check as may
be a genuine indication
– +NSAID
– +Macroline
– +Quinolone
– +Metronidazole
– +Azole antifungal
what should be avoided following a heart failure diagnosis?
– +Glitazone
– +NSAID
– +Tricyclic antidepressant
what drugs may it be necessary to withold in those who are dehydrated due to the risk of renal function?
– NSAIDs
– ACE/ARB
– Diuretics (take specialist advice if heart failure)
– Metformin
– This can be restarted when the patient improves
give examples of drugs that are poorly tolerated in frail older people?
- Digoxin in higher doses (i.e. over 250mcg)
- Antipsychotics
- Tricyclic antidepressants
- Benzodiazepines
- Antimuscarinics i.e solifenacin
- Phenothiazines i.e. proclorperazine
- Combination pain killers i.e. co-codamol
what practical points are there relating to constipation in frail?
– Adequate fluid intake, diet, movement to reduce risk
– Ispaghula husk preparations should not be prescribed to patients with limited
mobility- risk of faecal impaction (adequate fluid intake also needed)
– Movicol has a high sodium content
– Excessive use of stimulant laxatives can cause electrolyte disturbance (low
potassium)
what practical points are there relating to respiratory disease in frail?
– Ensure older patients can use their inhaled devices
– Ensure vaccination status up to date
what key practical points is there relating to dementia?
– In general antipsychotics should not be used for behavioural and psychological
symptoms of dementia
– If antipsychotics are to be used in older people ensure appropriate dosage reduction
what practical points are there for depression?
– Antidepressant should be continued for 6 weeks in order to determine the
effectiveness
– All antidepressants can cause hyponatraemia – this should be considered in all
patients who develop drowsiness, confusion or convulsions – SSRIs increase GI bleeding risk when prescribed with NSAIDs/steroids and other drugs with increase risk
what key practical points should be given about bone health?
– Patients prescribed bisphosphonates should be prescribed calcium
and vitamin D
– check calcium levels to avoid hypercalcaemia – Consider vitamin D deficiency in all patients – therapeutic dose is
800mg/400iu daily
– Consider preferred formulations to increase compliance
– Revise how to counsel a patient on taking a bisphosphonate
what key practical points should be given about hypertension?
– Target (without diabetes or CKD) is less than 150/90mmHg for people
over 80 years old
– CCB preferred (without diabetes) consider thiazide like diuretic if
have heart failure (or high risk of) or develops ankle oedema
– Initiate at lower doses and titrate slowly to avoid postural
hypotension
– Caution re ACE inhibitors and renal function – risk of AKI
what should you look out for in thyroid disorders?
– Look out for the symptoms of over or under replacement
what are the key practical points about pain?
– Consider risks and benefits carefully – Increased risks of opioid medication in older people
– Paracetamol – remember dose reduction if patient less than 50kg
what key points are there about PD?
– Medications used to treat can contribute to confusion, constipation
and postural hypotension – monitoring and careful dosage
adjustment
– Remember the importance of timing of doses ‘get it in time’ rules
what are they key points relating to urinary problems?
– Older people more prone to the antimuscarinic side effects of drugs
used to treat urinary incontinence
– People of child-bearing age should not handle finasteride or dutasteride tables/capsules – caution re dispensing and dosette
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