Frailty Flashcards
what has the population of England and Wales continued to do since 2011? what does it cause?
- continued to age
- causes a challenge
how many people aged 65 years and older in 2011 compared to 2021?
2011= 9.2 million
2021= over 22 million
what did the proportion of people aged 65 years and older rise to?
- 16.4% to 18.6%
does life expectancy vary across England?
- yes, someone living in Westminster can expect to live until 85 years whereas someone from Blackpool can expect to live to 74
what is the link between wealthier areas and years of disability?
- wealthier areas have almost twice as many years of disability
- free life ahead of them
what is frailty? - definition by NHS England
- progressive, long term health condition characterised by a loss of physical (physiology/ anatomy) and/ or cognitive resilience
what does being frail increase risk for?
- inherent risks for adverse clinical outcomes
what is frailty known as due to the fact lots of factors contribute?
- geriatric syndrome
what do frail individuals have a poor reserve of? what does this mean?
- poor functional reserve
- small insults results in large, steep, sudden decline in function and/ or cognition
what are the failing systems that contribute to frailty? (7)
- cardiovascular system
- vestibular system
- endocrine system
- renal system
- central nervous system
- respiratory system
- musculoskeletal system
what happens if a frail individual enters the hospital?
- could come out worse than before
what do frail individuals also normally have?
- normally have other long term conditions such as diabetes or heart failure
how do you describe the decline in older adults?
- cascade of functional decline in older adults from independence, through to frailty and disability in the absence of intervention
why are older people more likely to become frail? (5)
- physiological changes
- isolated
- reduced sensation of thirst
- reduced renal function
- reduced hormonal response to dehydration
what are the 13 risk factors of frailty?
- older age
- residing in long- term care
- requiring assistance with food and fluids
- incontinence
- impaired functional status, swallowing difficulties
- inadequate numbers or appropriately trained staff to assist
- depression
- multiple medications, particularly diuretics an laxatives
- decreased thirst
- acute illness, diarrhoea and vomiting
- poor availability and access to fluids
- disabled person
- cognitive impairment e.g., dementia
what are the 7 main consequences of falling?
- increased hospitalisation and mortality
- affects mental performance and increases fatigue
- mental functions affected
- pressure ulcers and skin conditions
- constipation
- risk of UTIs
- falls
how much increase is there in the mortality of stroke patients?
- two fold increase in the mortality of stroke patients has been reported
what mental functions are affected by frailty?
- memory
- attention
- concentration
- reaction time
why does the risk of urinary tract infections increase with frailty?
- inadequate hydration is one of the main causes of acute kidney injury
what are the 8 assessments you would do in a comprehensive geriatric frailty assessment?
- medical
- functional
- psychological
- social
- environment
- advice care planning
- spirituality
- sexuality and intimacy
what do people with frailty have a poor level of? what does this mean?
- poor functional disease
- small insults result in sudden decline e.g., stress increases dementia
what does the more frail an individual mean regarding outcomes? when does this happen?
- the more frail an individual means the more likely they will experience a poorer outcome
- following illness, injury, infection, introduction or change in medication
if frail individuals go to hospital what happens? when does frailty usually present in people?
- could come out worse than before
- often present in people with other LTC conditions such as diabetes or heart failure
what are the four stages of functional decline in older adults?
- robustness
- pre frailty
- frailty
- disability
what would a stressor do for an individual classified as frail? what does this cause?
- once a person is classified as frail, a stressor can cause the individual to not be able to return to normal state
- causes individual to enter the dependent stage, which could potentially lead to disability stage
what happens if an elderly person falls?
- they may develop fear of falling
how much of the population in England 65 years and older suffer with severe frailty?
- around 3% of the population suffer with severe frailty
what gender does frailty occur more in? why?
- occurs more frequently in women than men (16% vs 12%)
- due to different biological, psychosocial and behaviour differences
what does the prevalence and severity increase with? - give percentages
- increases with age
- from 6.5% in those aged 60-69 years to 65% in those aged 90 or over
what does an average patient cost? what is this compared to frailty? what can frail individuals be seen as?
- average patient is around £970
- someone with severe frailty is around £4000
- frail individuals seen as burden on society
what is alot of NHS money spent on?
- huge amount spent on resources for frailty
what are the 16 main signs of frailty?
- delirium, confusion and disorientated
- acute or sub- acute decline in mobility
- not managing at home e.g., unclean
- recurrent attendances
- not eating and drinking = dehydration
- sleep disorders and sensory deficits e.g., don’t sleep for long time, repeatedly wake up
- falls
- incontinence
- pressure ulcers
- fatigue
- dizziness and light headed
- weight loss
- headache
- low blood pressure
- constipated
- strong scented urine and dark colour
what are the bodily signs of frailty? (3)
- wrinkled skin (lost elasticity)
- sunken eyes
- dryness of mouth, lips and tongue
how do pressure ulcers form in frail individuals?
- due to decreased mobility and sensation so skin breaks down and becomes red and blistered
what is the older people perspective of frailty?
- can be unaware
- slow walking due to hip pain and fatigue
- lacking confidence
- may need a wheelchair
what is the most used screening method? what does it measure?
- Rockwood Clinical Frailty Scale
- measures vulnerability to poor outcomes
what number indicates severe frailty in the Rockwood scale? what can we try to do?
7 to 9 indicates severe frailty
- can try to delay individual from reaching these stages
what are the four screening methods for frailty that NICE suggests in the community?
- eFI
- PRISMA- 7
- gait speed
- self reported health
what does the eFI stand for?
- electronic frailty index
what does the eFI identify?
- identifies people with frailty using existing electronic health records
what type of model does the eFI include? how does this measure frailty?
- cumulative deficit model
- measures frailty on the basis of the accumulation of a range of deficits
what predictive outcomes was eFI score associated with? (3)
- mortality
- hospitalisation
- nursing home admission
what does PRISMA stand for?
- Program on Research for Integrating Services for Maintenance of Autonomy
how many questions does the PRISMA involve? how does the patient answer?
- GP asks individual 7 questions
- answer with yes or no
when is frailty indicated in PRISMA test?
- indicated by 3 or more positive answers
what is the clock drawing test used for?
- used for cognitive dysfunction secondary to dementia, delirium or range of neurological and psychiatric illness
how do you complete the clock drawing test?
- administrator draws a circle, which represents the face of a clock
- patient asked to put numbers in so that it looks like a clock
- then asked to add arms that indicate a specific time
how do you calculate the score in the clock drawing test?
- clock divided into eights
- begin with line through number 12 and centre of circle
- one point for each number if at least half the area of the number is in the correct octant
- one point each for a correct short and long hand
when is cognitive impairment likely?
- score of under 8
what is the gait speed test? how do you set it up?
- patient walks 4 metres at normal pace
- asked to walk down a hallway through a 1 metre zone for acceleration, central 4 metre testing stone and 1 metre zone for deceleration
when do you start and stop the timer in the gait speed test?
- start the timer with the first footfall after the 0 metre line and stop the timer with the first footfall after the 4 metre line
what gait speed indicates frailty?
- gait speed of longer than 5 seconds
what is the MMSE?
- mini mental state exam
how many questions are in the MMSE? who is it used on?
- 11 point test to measure cognitive impairment
- used for individuals that may have dementia
what does the MMSE test?
- tests multiple cognitive domains including orientation, repetition, verbal recall, attention, language & visual construction
what score indicates dementia in the MMSE?
- score below 24 indicates dementia
what are the two functional assessments?
- barthel index
- lawton instrumental ADL
what is the barthel index?
- assessment of functional independence in the domains of personal care and mobility
how many activities does the barthel index include? what are some examples?
- 10 activities
- feeding, personal toileting, bathing, dressing and undressing, etc
what is each item rated like in the barthel index?
- each item rated in terms of whether the patient can perform the task independently, with some assistance or is dependent on help
what score on the barthel index indicates some disability?
- score of 14 indicates some disability
- compatible with level of support found in the home
what score on barthel index is compatible with discharge home in hospital/ care home facility?
- score of 10
- provided there is maximum support and a caretaker in attendance
what is the lawton instrumental ADL test?
- assessment of instrumental activities of daily living
how many items does the Lawton Instrumental ADL contain? what is the scoring?
- eight items
- 0 = low function to 8= high function
how is each ability in lawton instrumental ADL measured?
- measured by the scale
- relies on either cognitive or physical function though all require some degree of both
what would a dependent individual score on the Lawton instrumental ADL?
- total score of 0
- low function, dependent
