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Geriatrics > FTT > Flashcards

FTT Flashcards

1
Q

What is the definition of frailty?

A

A state of age-related physiologic vulnerability resulting from impaired homeostatic reserve and a reduced capacity to withstand stress

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2
Q

The frail older adult is identified by one or more of the following characteristics:
4

A
  1. Extremes of old age
  2. Frailty = unstable disability
  3. Function fluctuates with minor stressors!
  4. Multiple chronic diseases and/or geriatric syndromes
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3
Q

Study of Osteoporotic Fractures (SOF) index:
3

What is considered a predictor of risk of falls, disability, fractures and death?

A
  1. Weight loss of 5% or more over 2 years
  2. Inability to stand from a chair 5 times without using arms to push up
  3. Negative response to the question: “Do you feel full of energy?”

2 of 3 positives considered a predictor of risk of falls, disability, fractures and death

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4
Q

Fratility Outcome Risks

7

A
  1. Falls
  2. Acute illness
  3. Hospitalizations
  4. Disability
  5. Dependency
  6. Institutionalization
  7. Death
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5
Q

Key components of Frailty

4

A
  1. Musculoskeletal Function
  2. Cognitive/Integrative Neurological Function
  3. Nutritional Reserve
  4. Aerobic Capacity
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6
Q

Frailty - A clinical syndrome
1. Symptoms? 4

  1. Signs? 4
A
  1. Symptoms
    - Weakness
    - Fatigue
    - Anorexia
    - Inactivity
  2. Signs
    - Weight loss/malnutrition
    - Decreased muscle mass
    - Decreased bone mass
    - Anemia
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7
Q

Contributing factors to frailty?

7

A
  1. Heavy drinking
  2. Cigarette smoking
  3. Physical inactivity
  4. Depression
  5. Social isolation
  6. Multiple chronic medical problems
  7. Poor perceived health
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8
Q

Triggering events for frailty? 4

What leads to a blocked recovery time? 6

A
  1. Triggering events:
    - Chronic disease
    - Inactivity
    - Infection
    - Hip fracture
  2. Blocked recovery time:
    - Depression
    - Medication interactions
    - Malnutrition
    - Fear of falling
    - Underlying cognitive status
    - Underlying functional status
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9
Q

Definition of Failure to Thrive?

A

The near irreversible end of the natural history of the syndrome of frailty.

National Institute of aging definition: A syndrome of weight loss, decreased appetite and poor nutrition and inactivity

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10
Q

Failure to Thrive

Components? 3

A
  1. Physical frailty
  2. Disability
  3. Impaired neuropsychiatric function
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11
Q

FTT: Often accompianed by? 4

A
  1. Dehydration
  2. Depressive symptoms
  3. Impaired immune function
  4. Low cholesterol
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12
Q
  1. Disability definition? 2

2. Examples of Impaired neuropsychiatric function? 2

A
    • Defined as difficulty or dependency in completing tasks essential for self-care and independent living
    • loss of >1 ADL
    • Depression
    • Cognitive Impairment
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13
Q

Disability is assessed by? 2

A

ADLs

IADLs

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14
Q

Katz ADL scale assesses basic life skills are?

6

A

the patient’s ability to

  1. bathe,
  2. dress,
  3. toilet themselves,
  4. transfer,
  5. feed themselves, and
  6. maintain continence
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15
Q

Impaired Neuropsychiatric Function
1. What are the most common conditions affecting cognitive status in older adults? 3

  1. May be a result of what? 2
A

1.

  • Delirium,
  • depression, and
  • dementia
    • May be a result of medical comorbidities
    • Medication effects
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16
Q

Disability is an _________ risk factor for mortality, hospitalization, and need for long-term care

A

independent

17
Q

What does sarcopenia call?

4

A
  1. Loss of muscle with age
  2. Loss of lean body mass
  3. Diminishes the acute phase response to physiological stress
  4. Decreases immune competence
18
Q

How much muscle do we lose per year after the age of 25?

A

0.5-1% loss per year after the age of 25

19
Q

FTT: Signs and Symptoms? 4

A useful working definition requires that three criteria be met? 3

A
  1. Impaired physical functioning
  2. Malnutrition
  3. Depression
  4. Cognitive impairment
  5. Biopsychosocial failure
  6. Weight loss or undernutrition
  7. And no immediate explanation for the condition (no underlying terminal disease)
20
Q

Underlying Principles: Several caveats bear review

  1. Baseline functional data are the foundation of elder care and should be obtained ___________ on all elders
  2. Although function declines predictably over time, it does so at a variable rate based on known age-associated metabolic parameters such as what? 3
  3. FTT can occur from organic or non-organic causes, thus necessitating an approach that includes which approaches? 4

FTT initiated by a “trigger” event that impacts all four domains sets a framework for the evaluation and management of

A
  1. annually
    • FEV1,
    • BMR and
    • GFR
    • medical,
    • psychological,
    • functional and
    • social
21
Q

History and Physical

Start by R/O acute medical problems such as? 3

A
  1. Infection
  2. Constipation
  3. Exacerbation of chronic diseases:
22
Q

Exacerbation of chronic diseases that could cause FTT?

8

A
  1. CHF
  2. COPD
  3. CAD
  4. Uncontrolled endocrine disorder
  5. Cancer
  6. TB
  7. Dementia
  8. Depression
23
Q
  1. Psychosocial history? 1
  2. Change in social structure?
    6
A
  1. Psychosocial history:
    - Increased memory loss
  2. Change in social structure:
    - Death of a person or pet
    - Moving away of a friend or family member
    - Caregiver burnout
    - Recent environmental change
    - Financial concerns
    - Access to appropriate food, means to prepare and eat them.
24
Q

Comprehensive physical exam:

11

A
  1. Vitals (Including weight and BMI)
  2. Hearing defects
  3. Eyes/vision
  4. Oral health
  5. Swallowing
  6. JVD (could signify CHF)
  7. Breast mass
  8. Abdominal exam
  9. Skin
  10. Motor
  11. Mental status
25
Q

Standard labs to evaluate FTT?

13

Three big ones?

A
  1. CBC
  2. Serum lytes
  3. BUN Creatinine
  4. Calcium
  5. Glucose
  6. Serum bilirubin and transaminase levels:
  7. Albumin and cholesterol
  8. TSH
  9. Fecal occult blood
  10. U/A
  11. Vitamin B12, and D levels
  12. ESR
  13. PPD
  14. CBC
  15. CMP
  16. TSH
26
Q

What might the following labs show:

  1. CBC? 5
  2. CMP? 5
  3. Glucose? 2
  4. Serum bilirubin and transaminase levels? 2
  5. Albumin and cholesterol? 1
A
  1. CBC:
    - Amemia,
    - vitamin deficiency,
    - infection,
    - hematopoietic or
    - lymphoproliferative disorder
  2. Serum lytes, BUN, Creatinine, Calcium:
    - Hyper-hyponatremia
    - Acid base disorder
    - Osmolality
    - Renal function
    - Dehydration
  3. Glucose:
    - Diabetes,
    - hypoglycemia
    • Liver failure,
    • hepatitis
  5. (markers for malnutrition)
27
Q

Once diagnosis of FTT is made: What needs to be assessed?

6

A
  1. Life expectancy of the patient should be assessed
  2. Are symptoms/conditions reversible?
  3. Risk-benefit assessment should be included in all interventions
  4. Provider, patient and family should collaborate
  5. As medical interventions become more limited, palliative measures can be initiated
  6. Maintain a therapeutic relationship with the patient and family beyond the time medical therapies are effective!

Geriatrics (16 decks)

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