Frailty and falls

Question 1

What is frailty?

Answer 1

Clinical state of vulnerability with inherent risks for adverse clinical outcomes

Question 2

what is the NHS definition of frailty?

Answer 2

Progressive, long term health condition characterised by a loss of physical and/or cognitive resilience

Question 3

why is frailty important?

Answer 3

Frailer individuals more likely to experience poorer outcome following injury infection, introduction or change in medication
some ppl’s only LTC is frailty so may not be known to health services
Used to look at larger holistic picture
Identification key to prevent continuation

Question 4

what is the epidemiology of frailty

Answer 4

3%% of population aged 65+ in England have severe frailty
local data reflects national data ~10,000 ppl severely frail in staffordshire and stoke
Women > men (16% vs 12%)
Prevalence and severity increase with age, 6.5% those aged 60-69 to 65% in those aged 90 or over

Question 5

What is the economic impact of frailty

Answer 5

Average cost per pt per year for NHS is £975 for fit >65 yo rises to £4189 for a severely ill pt

Question 6

what are some socioeconomic stats that can impact on frailty

Answer 6

huge inequalities in life expectancy across England:
- child from Blackpool expected to live till 74
- child from Westminster can expect to live till 85

People living in wealthiest areas have 2x as many disability-free years of life expected after age 65

Question 7

what are screening methods for frailty

Answer 7

Rockwood scoring system (most common)
NICE suggests using eFI, PRISMA-7, gait speed and self-reported health status
eFI score has been associated with several predictive outcomes including mortality, hospitalisation and nursing home admission

Question 8

what are the levels of the Rockwood scoring system

Answer 8

Very fit: people who are robust, active, energetic + motivated. Commonly exs regularly and among fittest for age.

Well: ppl who have no active disease symptoms but less fit. Often exercise or are very active occasionally e.g. seasonally

Managing well: people whose medical problems are well controlled but not regularly active beyond routine walking

Vulnerable: while not dependent on others for daily help, often symptoms limit activities

Severely frail: completely dependent on care fir whatever cause but are stable

Very severely frail: completely dependent and approaching end of life, will not recover from minor illness

Terminally ill: approaching end of life with expectancy <6 months life

Question 9

what are classic signs of frailty

Answer 9

delirium
acute or subacute decline in mobility
not managing at home
recurrent attendances / frequent contact with services
not eating and drinking
sleep disorders and sensory deficits
incontinence
falls
pressure ulcers
fatigue
dizziness
weight loss

Question 10

what are tell tale signs of frailty

Answer 10

no food or drink in fridge
out of date meds
clothes that don’t fit
uncleanliness
pile of incontinence pads

Question 11

what is a fall

Answer 11

“falls is a sudden, unintentional change in position which causes an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of a sudden onset of paralysis, epileptic seizure or overwhelming external force”

Question 12

What is required for the body to maintain upright?

Answer 12

Vision
vestibular function
BP
muscle strength
sensation
central processing
HR
joint stability
proprioception
balance

Question 13

what are the physical consequences of falling?

Answer 13

hypothermia
muscle wasting
deawth
sprains and strains
immobility
incontinence
fracture
soft tissue injuries
pneumonia / chest infections
head injuries
dislocations
pressure sores
dehydration
lacerations

Question 14

what are psychological consequences of falls

Answer 14

increased dependency
emotional distress
loss of control
social isolation
withdrawal
fear of further falls
low self esteem
embarrassment
anxiety
depression
carer stress
feelings of uselessness

Question 15

What are factors around fear of falling

Answer 15

30% of older adults fear falling
fear level is greater than fear of being mugged
psychological barrier to exs
reduced participation in ADL’s and meaningful activity
leads to increased risk of sarcopenia and deconditioning

Question 16

what are intrinsic risk factors for falls

Answer 16

hx of falls
fear of falling
age related changes
medication
poor vision
weakness
gait deficit
hearing impairment
cog. impairement

Question 17

what are extrinsic risk factors for falls

Answer 17

environmental hazards
inappropriate walking aids/footwear
poor lighting
clutter
clothing
floor covering
low furniture

Question 18

What are the most common causes of dizziness

Answer 18

Postural hypotension
Inner ear problems
problems with HR or rhythm
dehydration
prone to black outs, fainting or LOC

Question 19

how does postural hypotension relate to falls in LTC

Answer 19

drop in BP when getting up from lying or sitting
can be caused by dehydration, ageing, circulation, medical conditions such as Parkinson’s + heart conditions

Question 20

what are possible inner ear problems that may lead to falls

Answer 20

acute neuritis
benign paroxysmal positional vertigo (BPPV)

Question 21

what may make someone prone to black outs, fainting or LOC

Answer 21

bradycardia
tachycardia
AF

Question 22

what a possible foot problems that increase risk of falls

Answer 22

corns
calluses
bunions
ingrown or thicks nails and ulcerations
footwear
numbness in feet (loss of proprioception)

Question 23

what can falls be a warning sign for?

Answer 23

new + temporary health conditions linked to falls:
- constipation
- infection
- dehydration
- sudden confusion

Question 24

what are evidence based falls intervention

Answer 24

medication managment
vision ax
environmental ax
strength and balance ax

Question 25

what are medication risk factors for falls

Answer 25

polypharmacy
psychotic drugs
e.g. sleeping tabs, sedatives, antidepressants and anti-psychotics
hypotensive drugs and diuretics
medication compliance

Question 26

what actions can be carried out to reduce medication risk?

Answer 26

medication needs to be considered and r/w
monitor for side effects such as dizziness, drowsiness and confusion

Question 27

what are the environmental risk factors for falls

Answer 27

hazards e.g. clutter
rugs
loose wires
raised thresholds
poor lighting
wet flooring
low temperatures

Question 28

what actions can be carried out to mitigate environmental risks to falling?

Answer 28

improve natural lighting and add night lights
Flooring should avoid swirling patterns and changes in texture
set out everyday items to prevent overreaching
ensure area is hazard + clutter free
ensure bedclothes/ nightwear doesn’t trail
ensure they can safely get on/ off bed chair and toilet

Question 29

how can exercise reduce risk of falls?

Answer 29

Dose of at least 50 hours of exs required to reduce falls
= 2hrs strength and balance training per week over 6 month period
tailored exs is key to reduce falls by up to 54%

Question 30

what are recommended exercises for reducing falls

Answer 30

tailored gait, balance and strength exs
tai chi
functional exs

Question 31

what alterations in relation are important to reduce falls

Answer 31

annual eye tests
sensory impairments/ vision issues
should recommend ophthalmology and referral to visual impairment officer

Question 32

what are the 3 questions recommended by the world falls guidance

Answer 32

have you experienced 1 or more falls in past year
do you feel unsteady when standing or walking
do you have worries about falling

Question 33

what can be done according to world falls guidance?

Answer 33

identify those who are falling
perform environmental ax
observe mobility and gait
medication check
use ‘top tips’ leaflets
make onwards referrals

Question 34

How should multi morbidity be managed?

Answer 34

minimise disease-specific treatment plans and consider the whole individual, including interactions between conditions
engage with clients to negotiate priorities and set meaningful goals
provide clear communication between healthcare settings to streamline the continuum
consider motivational and environmental factors contributing to their goal adherence

Question 35

What are the principles that take multimorbidity into account?

Answer 35

how the person’s health conditions + their treatments interact and how this affects quality of life
person’s individual needs, preferences for treatments, health priorities, lifestyle and goals
benefits and risks of following recommendations from guidance on single health conditions
improving QoL by reducing treatment burdens, adverse events and unplanned care
improving coordination of care across services

Question 36

What are key areas that physios can manage in multimorbidity

Answer 36

physical and functional decline
increased hospitalisation
reduced participation in daily roles
reduced quality of life
psychological and social impairments
barriers to physical activity

Question 37

What does care need to be to prevent issues with multimorbidity?

Answer 37

should be proactive and anticipatory, taking a life cycle approach and including preventive care for those at risk of developing multiple conditions