Frailty and Death Flashcards

1
Q

How does frailty affect someones ability to deal with external stressors e.g. minor illness or injury?

A

The frailer a person is, the less likely they are to return to their basline level of function

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2
Q

What is one of the main side effects of anticholinergic drugs when used in the elderly? (e.g. ACE inhibitors, Furosemide, Oxybutynin, Digoxin, Apixiban)

A

Urinary retention

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3
Q

What causal pathways lead to ineffective and inefficient care and what is the consequence of this?

A
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4
Q

What assessment tool is used to help create a care plan for elderly patients?

A

Comprehensive Geriatric Assessment

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5
Q

What factors are assessed in the comprehensive geriatric assessment?

A
  1. Environment
  2. Medical
  3. Psychological/cognitive
  4. Functional ability
  5. Social networks/ support
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6
Q

List some of the differential diagnosis of why an elderly person may present with delirium

A
  • 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
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7
Q

How would manage a patient with mild frailty?

A

Treat as usual

Address reversible issues: nutrition, social prescribing

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8
Q

How would you manage a patient with moderate frailty?

A

Actively seek out and manage geriatric syndromes e.g. falls, congnitive impairment, continence, polypharmacy , perform comprehensive geriatric assessment

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9
Q

How would you manage severe frailty?

A
  • Think about supportive care vs cure
  • Advance care planning
  • Recognise that enhanced supportive care is an effective intervention
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10
Q

What are some of the challenges to achieving a good death?

A
  • Truthfullness with patients
  • Enabiling informed consent
  • Allowing time to prepare
  • Avoiding isolation
  • Overcoming a wall of silence
  • Maintaining hope
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11
Q

What are the psychological stages of dying? (Kubler-Ross Grief curve)

A
  1. Anger
  2. Denial
  3. Bargaining
  4. Depression
  5. Acceptance (or Resignation)
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12
Q

What factors contribute to a ‘good death’?

A
  • 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
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13
Q

What should doctors consider about the ‘informal carer’?

A
  • 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
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14
Q

What are the key principles of a good death? (12)

A
  • 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
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