Frailty and FIT Team in ED Flashcards
Frailty definition
A medical syndrome with multiple causes and contributors that is characterised by diminished strength, endurance and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death
list the 5 frailty syndrome domains described by the British Geriatric Society
Falls
Immobility
Delirium
Incontinence
ADR -susceptible to side effects of medication
What is frailty a strong predictor of
falls
mortality
institutionalisation
hospitalisation
what is the fried frailty definition
unintentional weight loss
impaired grip strength <30kg men < 20kg women
self-reported exhaustion
slow gait speed
low physical activity
considered frail if it individual fits into at least of these characteristics
how does the cumulative deficit model define frailty
an accumulation of deficits ranging from hearing loss, low mood, tremor, through various diseases e.g. dementia can occur with age and in combination with inc/ frailty index increase risk of adverse outcome
examples of frailty screening tools
Frailty Index (research gold standard)
Rockwood Clinical Frailty Scale
Edmonton Frail Scale
Identification of Seniors at Risk (ISAR)
PRISMA 7 Questions – recommended by British Geriatric Society
Think Frailty
Gait speed / TUG
what is the hand grip a good predictor for?
predictor of all-cause mortality
predictor validity for decline in cognition, mobility, functional status
associated with frailty
what is walking speed predictive of
Functional dependence
Frailty
Mobility disability
Cognitive decline
Falls
what is the gold standard for frailty
comprehensive geriatric assessment
what is the comprehensive geriatric assessment
a multi-dimensional, multi-disciplinary diagnostic and therapeutic process conducted to determine the medical, mental, functional and social needs of older people with frailty so that a co-ordinated, holisticand integrated plan for treatment and follow-up can be developed.
list domains of comprehensive geriatric assessment
function and ability
disease severity and comorbidity
support networks and needs
mental health and cognition
describe FITT
Frailty intervention therapy teams
beaumont hospital FITT in 2015
MDT approach
describe the Home FIRsT pathway
tries to screen all patients above 70 for frailty presenting to the ED from 8:00 to 18:00 Mon to Fri
identify frailty syndromes in ED
triaged by ED nurse
HSCP -interdisciplinary Ax of physical, cognitive, functional and social care
time - timely decision-making and commencement of appropriate treatment/referral pathway
relative members of teM ANP, OT, PT, MSW
4AT
ALertness
AMT4 - age, DOB, place, YEAR
Attention - list months of year backwards
Acute change or fluctuating change
what are the domains of comprehensive geriatric assessment
function and ability
disease severity and comorbidity
support networks and needs
mental health and cognition
describe the manchester triage score
1 = immediate resuscitation - pt. needs immediate Tx to save their life
2 = very urgent - seriously ill or injured, lives not in immediate danger
3 = urgent - v/ serious problems but stable condition
4 = standard - standard case w/o immediate danger
5 = non-urgent - conditions are not true accidents or emergencies
what population is at high risk of developing delirium
people with dementia
what types of delirium are there
hyperactive
hypoactive
explain hyperactive delirium
agitated behaviour
confusion
hallucinations
describe hypoactive delirium
new sleepy
drowsy
what identification tool can be used to assess delirium
4AT
LIST the clinical frailty scale
1 = very fit (active, energetic, fittest amongst age group)
2= fit (no active disease symptoms , not active)
3 = managing well (well controlled medical problems, not regularly active)
4 = v/ mild frailty (previously vulnerable, symptoms limit activities but still managing independently)
5 = mild frailty (need help with heavy housework, impars shopping, meal prep)
6 = moderate frailty (need help w/ outside ADL and keeping house, difficulty climbing stairs, needs help bathing)
7 = severe frailty (completely dependent for personal care, seem stable, not high risk of dying)
8 = severe frailty (completely dependent for personal care, approach end of life)
9 = terminally ill (approaching end of life, not severe frailty, life expectancy <6/12)
list the fall risk factors that must be discussed with the patient during the clinical assessment
– Fear of falling, difficulty with walking / balance, footwear, walking aids
what would be considered in the emergency dept
Imaging reviewed / reported
Weight-bearing status clarified
Optimal pain relief
Appropriate gait aid – RZF / crutches / stick
Simulation of home environment - stairs, rails
Transport home
Follow-up: Orthopaedic apt, PCCC PT/OT
