Frailty Flashcards
Define frailty
Loss of: ST EN PH
Medical syndrome with multiple causes characterised by
- Diminished strength, endurance and physiological function
Increases an individuals vulnerability for developing dependency or death
10% people aged 65+ have frailty
25-50% are 85+
What is polypharmacy?
4+ medications long term
What is sarcopenia?
Degenerative loss of skeletal muscle mass, quality and strength associated with ageing
What are the contributors to frailty?
Sarcopenia - major contributor
Diet/ vitamin D deficiency
Obesity
Congnitive, psychological and social aspects
How can frailty be measured?
Phenotype model: defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss (WEak SLOW INactive EXHAUSTED SKINny)
Cumulative deficit model: the more things wrong with a patient the more likely they are to be frail - each aspect e.g. hearing loss, tremor, congitive changes, are given points which are added together to give a score
What are frailty syndromes?
Syndromes that, if a patient has them, makes them more likely to be frail
- Falls
- Immobility
- Delirium and dementia
- Incontinence
- Susceptibility to side effects of medication
Why is it important to recognise frailty?
- Frail older people are especially vulnerable to seemingly minor insults
- Higher risk of harm from hospitalisation, surgery, iatrogenic harm
What advice can be given to patients with incontinence?
Don’t be afraid to drink during the day - concentrated urine irritates the bladder
- Last drink >2hrs before bed
- Spend longer on toilet
- Avoid caffeine (diuretic)
- Pelvic floor exercises
Outline discharge planning
Begins long before patient is medically optimised for discharge
Destinations: home, rehab, residential home, nursing home, hospice
Successful discharge planning requires early info about all aspects of the patient’s life: how far can they walk, can they wash, can they feed themselves, any family/ support?
What does successful discharge planning require?
Information regarding all aspects of the patient’s life
- Can they complete ADLs?
- Support?
- Housing suitable?
What assessments are included in discharge planning?
- Joint ROM
- Ability to transfer from bed - chair - toilet etc
- Mobility
- Stairs
- Personal care
- Domestic tasks
- Cognitive assessments
What are SMART goals?
Specific
Measurable 📏
Achievable
Realistic
Timely 🕒🕔🕖
What interventions can be done before discharge?
- ROM exercises
- Strengthening exercise
- Transfer practice
- Mobility work
- Balance rehab
- Activity group work
What is fast track discharge?
Patient within last 6 weeks of life
Medical decision to deem them fast track which allows for funding to be sought to allow patient to be discharged to a place they want to die
Point of access is the palliative care team in the hospital
Who to contact regarding fast track discharge?
Palliative care team
This is for patients who are believed to be within 6 weeks of death
