Frailty and End of Life Care

Question 1

What is physiological definition of frailty?

Answer 1

Increased vulnerability resulting from ageing-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday acute stressors is compromised

Question 2

What is the phenotypic definition of frailty?

Answer 2

Low grip strength, low energy, slowed walking speed, low physical activity and/or unintentional weight loss

Question 3

What are the geriatric giants (5Is)?

Answer 3

Immobility
Instability
Incontinence
Impaired memory
Iatrogenesis

Question 4

What are 6 take home messages about frailty?

Answer 4

1. It’s not just about age
2. Write a problem list
3. You can recognise and quantify frailty
4. Frailty can help you predict and prognosticate
5. Frail older people are vulnerable to ‘iatrogenic’ harm
6. Person-centred, individualised care is vital

Question 5

What form can be used to help guide someone’s clinical care ?

Answer 5

ReSPECT form

Question 6

What is the comprehensive geriatric assessment (CGA)?

Answer 6

Allows a care plan to be generated that can modify trajectories - multidimensional, interdisciplinary, diagnostic

Question 7

What 5 things does the GCA take into account?

Answer 7

• Environment
• Medical
• Psychological/cognitive
• Functional
• Social networks

Question 8

How can frailty be measured

Answer 8

Using the clinical frailty score

Question 9

What are some clinical consequences of frailty?

Answer 9

• Risk of cholinergic burden
• Polypharmacy
• More hospital admissions, but at more risk in hospitals
• Need aids
• More likely to have more severe responses to conditions, trauma, etc

Question 10

What are some of the key objectives of palliative care?

Answer 10

• Make the patient comfortable
• Reduce symptoms
• Allow socialising with family, friends, etc where possible
• Provide any other services they need - religious, etc
• Allow for saying goodbye

Question 11

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

Answer 11

• Fear of talking about it
• Misuse of words/using other words to make it sound less serious by doctors or patients
• 5 stages of grief
• People not understanding what palliative care is
• Angry/upset family members

Question 12

Define a good death

Answer 12

• Truthfulness
• Informed consent
• Avoiding isolation
• Maintaining hope at home

Take physical, psychological, emotional, social and spiritual care into account

Question 13

What are the 5 stages of anticipatory grief?

Answer 13

Anger
Denial
Bargaining
Depression
Acceptance/resignation

Question 14

What is euthanasia?

Answer 14

Act of deliberately ending someone’s life to relieve suffering

Question 15

What is the stance of euthanasia in the UK?

Answer 15

Assisted suicide is illegal

Only allowed when e.g. turning off a support machine with consent and discussion with the family and patient prior to them being in this state, same with DNR

Passive and consented legal

Question 16

What are the key ethical principles in debates about euthanasia?

Answer 16

• For - relieves suffering, a person has a right to their choice
• Against - patient may have lost capacity in their current state, doctors must do no harm (non-maleficence)

Question 17

What are several services/interventions offered to patient in UK hospices with life-limiting illness?

Answer 17

• Spiritual care
• Community nurses
• Counselling and psychological support
• Compassionate neighbours volunteers - someone to talk to
• Enablement team - OT, PT
• Day therapy
• Living at home or in a hospice (inpatient/outpatient)
• Relieving symptoms with treatment e.g. ventilators, lymphoedema specialists, etc