Frailty and Death Flashcards
How does frailty affect someones ability to deal with external stressors e.g. minor illness or injury?
The frailer a person is, the less likely they are to return to their basline level of function
What is one of the main side effects of anticholinergic drugs when used in the elderly? (e.g. ACE inhibitors, Furosemide, Oxybutynin, Digoxin, Apixiban)
Urinary retention
What causal pathways lead to ineffective and inefficient care and what is the consequence of this?
What assessment tool is used to help create a care plan for elderly patients?
Comprehensive Geriatric Assessment
What factors are assessed in the comprehensive geriatric assessment?
- Environment
- Medical
- Psychological/cognitive
- Functional ability
- Social networks/ support
List some of the differential diagnosis of why an elderly person may present with delirium
- Aspiration pneumonia
- Anticholinergics (Burden score of 6)
- Urinary retention
- Constipation
- Acute on chronic kidney injury
- Underlying vascular dementia
- Polypharmacy
- Anaemia on NSAIDs & DOAC
- Swallowing difficulties
- Approaching end of life
How would manage a patient with mild frailty?
Treat as usual
Address reversible issues: nutrition, social prescribing
How would you manage a patient with moderate frailty?
Actively seek out and manage geriatric syndromes e.g. falls, congnitive impairment, continence, polypharmacy , perform comprehensive geriatric assessment
How would you manage severe frailty?
- Think about supportive care vs cure
- Advance care planning
- Recognise that enhanced supportive care is an effective intervention
What are some of the challenges to achieving a good death?
- Truthfullness with patients
- Enabiling informed consent
- Allowing time to prepare
- Avoiding isolation
- Overcoming a wall of silence
- Maintaining hope
What are the psychological stages of dying? (Kubler-Ross Grief curve)
- Anger
- Denial
- Bargaining
- Depression
- Acceptance (or Resignation)
What factors contribute to a ‘good death’?
- Avoiding medicalisation (thus prolonging dying process)
- Avoiding situation of being medically captive
- Making an agreed care plan to avoid ‘managed states’
- Ability to die one’s own death
- Adequate symptom control
What should doctors consider about the ‘informal carer’?
- Often unintentioanlly neglected by professional carers
- A lot of support and input required
- Are there any opportunities for respite care?
- Grief before and after death
- Make sure they don’t feel guilty of having ‘failed’ their loved one
What are the key principles of a good death? (12)
- To be warned when death is coming and learn what can be expected
- To be able to retain control over what happens
- To be afforder dignity and privacy
- To have control over pain relief and other symptom control
- To have a choice over where death occurs
- To have access to information and expertise of any kind necessary
- To have access to any spiritual or emotional need
- To have access to hospice care
- To have control over who is present in the end
- To be able to issue advanced directives to ensure their wishes are respected
- To have time to say goodbye
- To be able to leave when it’s a good time to go, and not have life prolonged pointlessly