Frailty Flashcards
1
Q
what has the population of England and Wales continued to do since 2011? what does it cause?
A
- continued to age
- causes a challenge
2
Q
how many people aged 65 years and older in 2011 compared to 2021?
A
2011= 9.2 million
2021= over 22 million
3
Q
what did the proportion of people aged 65 years and older rise to?
A
- 16.4% to 18.6%
4
Q
does life expectancy vary across England?
A
- yes, someone living in Westminster can expect to live until 85 years whereas someone from Blackpool can expect to live to 74
5
Q
what is the link between wealthier areas and years of disability?
A
- wealthier areas have almost twice as many years of disability
- free life ahead of them
6
Q
what is frailty? - definition by NHS England
A
- progressive, long term health condition characterised by a loss of physical (physiology/ anatomy) and/ or cognitive resilience
7
Q
what does being frail increase risk for?
A
- inherent risks for adverse clinical outcomes
8
Q
what is frailty known as due to the fact lots of factors contribute?
A
- geriatric syndrome
9
Q
what do frail individuals have a poor reserve of? what does this mean?
A
- poor functional reserve
- small insults results in large, steep, sudden decline in function and/ or cognition
10
Q
what are the failing systems that contribute to frailty? (7)
A
- cardiovascular system
- vestibular system
- endocrine system
- renal system
- central nervous system
- respiratory system
- musculoskeletal system
11
Q
what happens if a frail individual enters the hospital?
A
- could come out worse than before
12
Q
what do frail individuals also normally have?
A
- normally have other long term conditions such as diabetes or heart failure
13
Q
how do you describe the decline in older adults?
A
- cascade of functional decline in older adults from independence, through to frailty and disability in the absence of intervention
14
Q
why are older people more likely to become frail? (5)
A
- physiological changes
- isolated
- reduced sensation of thirst
- reduced renal function
- reduced hormonal response to dehydration
15
Q
what are the 13 risk factors of frailty?
A
- 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
16
Q
what are the 7 main consequences of falling?
A
- increased hospitalisation and mortality
- affects mental performance and increases fatigue
- mental functions affected
- pressure ulcers and skin conditions
- constipation
- risk of UTIs
- falls
17
Q
how much increase is there in the mortality of stroke patients?
A
- two fold increase in the mortality of stroke patients has been reported
18
Q
what mental functions are affected by frailty?
A
- memory
- attention
- concentration
- reaction time
19
Q
why does the risk of urinary tract infections increase with frailty?
A
- inadequate hydration is one of the main causes of acute kidney injury
20
Q
what are the 8 assessments you would do in a comprehensive geriatric frailty assessment?
A
- medical
- functional
- psychological
- social
- environment
- advice care planning
- spirituality
- sexuality and intimacy
21
Q
what do people with frailty have a poor level of? what does this mean?
A
- poor functional disease
- small insults result in sudden decline e.g., stress increases dementia
22
Q
what does the more frail an individual mean regarding outcomes? when does this happen?
A
- the more frail an individual means the more likely they will experience a poorer outcome
- following illness, injury, infection, introduction or change in medication
23
Q
if frail individuals go to hospital what happens? when does frailty usually present in people?
A
- could come out worse than before
- often present in people with other LTC conditions such as diabetes or heart failure
24
Q
what are the four stages of functional decline in older adults?
A
- robustness
- pre frailty
- frailty
- disability
25
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
26
what happens if an elderly person falls?
- they may develop fear of falling
27
how much of the population in England 65 years and older suffer with severe frailty?
- around 3% of the population suffer with severe frailty
28
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
29
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
30
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
31
what is alot of NHS money spent on?
- huge amount spent on resources for frailty
32
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
33
what are the bodily signs of frailty? (3)
- wrinkled skin (lost elasticity)
- sunken eyes
- dryness of mouth, lips and tongue
34
how do pressure ulcers form in frail individuals?
- due to decreased mobility and sensation so skin breaks down and becomes red and blistered
35
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
36
what is the most used screening method? what does it measure?
- Rockwood Clinical Frailty Scale
- measures vulnerability to poor outcomes
37
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
38
what are the four screening methods for frailty that NICE suggests in the community?
- eFI
- PRISMA- 7
- gait speed
- self reported health
39
what does the eFI stand for?
- electronic frailty index
40
what does the eFI identify?
- identifies people with frailty using existing electronic health records
41
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
42
what predictive outcomes was eFI score associated with? (3)
- mortality
- hospitalisation
- nursing home admission
43
what does PRISMA stand for?
- Program on Research for Integrating Services for Maintenance of Autonomy
44
how many questions does the PRISMA involve? how does the patient answer?
- GP asks individual 7 questions
- answer with yes or no
45
when is frailty indicated in PRISMA test?
- indicated by 3 or more positive answers
46
what is the clock drawing test used for?
- used for cognitive dysfunction secondary to dementia, delirium or range of neurological and psychiatric illness
47
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
48
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
49
when is cognitive impairment likely?
- score of under 8
50
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
51
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
52
what gait speed indicates frailty?
- gait speed of longer than 5 seconds
53
what is the MMSE?
- mini mental state exam
54
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
55
what does the MMSE test?
- tests multiple cognitive domains including orientation, repetition, verbal recall, attention, language & visual construction
56
what score indicates dementia in the MMSE?
- score below 24 indicates dementia
57
what are the two functional assessments?
- barthel index
- lawton instrumental ADL
58
what is the barthel index?
- assessment of functional independence in the domains of personal care and mobility
59
how many activities does the barthel index include? what are some examples?
- 10 activities
- feeding, personal toileting, bathing, dressing and undressing, etc
60
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
61
what score on the barthel index indicates some disability?
- score of 14 indicates some disability
- compatible with level of support found in the home
62
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
63
what is the lawton instrumental ADL test?
- assessment of instrumental activities of daily living
64
how many items does the Lawton Instrumental ADL contain? what is the scoring?
- eight items
- 0 = low function to 8= high function
65
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
66
what would a dependent individual score on the Lawton instrumental ADL?
- total score of 0
- low function, dependent
