Frailty and Comprehensive Geriatric Assessment

Question 1

Define frailty [1]

Answer 1

“a distinct clinical state in which there is decline in multiple physiological systems”

Frailty is not an inevitable part of ageing

Frailty is a distinct clinical entity from ageing, but it is related to the ageing process. It consists of multi-system dysregulation leading to a loss of physiological reserve. This loss of reserve means that the individual living with frailty is in a state of increased vulnerability to stressors meaning they are more likely to suffer adverse effects from treatments, diseases or infections.

Question 2

Name some risk factors for frailty [5]

Answer 2

Female
Lower SES
Lower education levels
Multimorbidity
Extremes of BMI

Question 3

Describe the cycle of frailty [1]

Answer 3

Multiple stressors decrease physical reserve. Once depleted enough, a simple stressor (e.g. fall / infection) have a much more steep decline in functional abilities and a slower improvement. May not return to previous base line.

Whilst improving (slowly); get impacted by another stressor, which causes a cycle of frailtly

Question 4

Describe different frailty models [2]

Answer 4

FRAILTY PHENOTYPE
* Weight loss
* Reduced grip strength
* Slow walking speed
* Low levels of activity
* Self reported exhaustion

FRAILTY INDEX
* Defines frailty as a cumulative effect of individual deficits
* 92 variables
* acute illness
* chronic conditions
* difficulty with activities of daily living physical signs

NB mainly research tools; may be used in GPs

Question 5

What are red flags for frailty? [5]

Answer 5

Patients having:
- delirium
- falls
- medication side effects
- immobility
- incontinence

Question 6

Which clinical frail scale is used within NHS hospitals? [1]

Answer 6

Rockwood clinical frail scale (CFS)

Question 7

Describe the different levels of Rockwood clinical frail scale (CFS)

Answer 7

1. Active
2. Is pre-frail
   5 -7 are different levels of frailty
   8-9 More palliative and symptom management

NB: acutely unwell patients are meant to be score pre-illness

Question 8

How do you scale someone using CFS who has dementia? [1]

Answer 8

Based on how severe their dementia inhibits them

Question 9

Answer 9

5

Question 10

Answer 10

7

Question 11

What is COMPREHENSIVE GERIATRIC ASSESSMENT (CGA)? [1]

Answer 11

Multidomain assessment (medical, functional, psychological & social)

Develop goal orientated patient centred plan

Involves doctors, therapists, nurses, pharmacists & community services

Question 12

1. What is Joans CSF? [1]
2. What are her acute and chronic problems?

Answer 12

1. CSF: 6
2. ## Acute problems:

Question 13

Solifenacin can be used for bladder incontinence. What is an important AE of this drug? [1]

Answer 13

cognitive decline

Question 14

Frailty should be specifically assessed through the evaluation of gait speed, self-reported health status, or the [] questionnaire

Answer 14

Frailty should be specifically assessed through the evaluation of gait speed, self-reported health status, or the PRISMA-7 questionnaire