Frailty + frailty score + nutrition Flashcards
What is the physiological definition of frailty?
Clinically recognisable state of increasing vulnerability resulting from ageing - associated decline in reserve + function across multiple physiologic systems such that the ability too cope with everyday stressors is comprised
What is the phenotypic definition of frailty?
Low grip strength
Low energy
Slowed walking speed
Low physical activity
Unintentional weight loss
What can be used to assess frailty?
Clinical frailty scale
1-9
Outline the clinical frailty score (just the names of each)
1 - very fit
2 - well
3 - managing well
4 - vulnerable
5 - mildly frail
6 - moderately frail
7 - severely frail
8 - very severely frail
9 - terminally ill
Outline the clinical frailty score with detail
1 - very fit: healthy + exercise regularly
2 - well: no active disease symptoms + exercise occasionally but less fit than category 1
3 - managing well: medical problems are well controlled but not regularly active beyond walking
4 - vulnerable: independent but limited activities (slowed down/fatigued)
5 - mildly frail: need help for activities e.g. shopping, walking alone outside, chores + increasing slowness
6 - moderately frail: help needed with all outside activities + house work - need help with stairs + dressing
7 - severely frail: completely dependent for personal care
8 - very severely frail: completely dependent, approaching end of life, unlikely to recover from minor illness
9 - terminally ill: approaching end of life <6 month life expectancy
How do you score frailty in people with dementia?
the degree of frailty corresponds to the degree of dementia
- mild dementia: forgetting details of recent events but remember the event itself, repeating stories/questions, social withdrawal
- moderate dementia: very impaired recent memory, can do personal care with prompting
- severe dementia: cannot do personal care without help
What are the 5 Is of geriatric giants?
- immobility
- instability
- incontinence
- impaired memory
- iatrogenesis
What is involved in intrinsic ageing?
- chronological ageing
- DNA damage
- biochemical degenerative process
- changes in cortisol + hormone levels
- telomere shortening
- oxidative stress
What is involved in extrinsic ageing?
- biochemical processes
- environment
- mechanical
- lifestyle
- behaviour
Skin changes related to age
- progressive structural + functional degeneration:
-atrophy of epidermis
-destruction to dermal-epidermal junctions
-dermis thickness decreases due to: collagen fragmentation + elastin degradation - prone to conditions + diseases
Respiratory changes related to age
- ^RV
- ^FRc
- v VC
- increased lung compliance but decreased elastic recoil
- infection susceptibility
- hyperinflation
CVS changes related to age
myocardial structural change:
- ventricular hypertrophy
- interventricular septal hypertrophy
- sympathetic innervation
- aortic sclerosis
.
myocardial functional change:
- diastolic dysfunction
- decreased CO
- decreased maximal HR
- increased cardiac workload
- baroreceptors response
.
electrophysiological:
- SAN atrophy
- prolonged AP
.
vascular changes:
- large arteries dilate
- artery walls thicken
GI changes related to age
- Decreased peristalsis > delayed transit time
- Decreased relaxation of lower oesophageal sphincter on swallowing
- atrophic gastritis
- decreased intestinal motility in colon > diverticulosis
Neurological changes related to age
- some parts of brain shrink (especially areas related to learning + complex mental activities)
- ventricular enlargement
- cortical thinning
- volume loss
- sulcal widening
Renal changes related to age
- decrease in volume + weight of kidneys
- decline in glomeruli number
- ^ urinary incontinence
- decline in tubular function > glucosuria > ^ UTI risk
