FTT Flashcards
1
Q
How many people 65 and older are considered frail?
A
- 10-25% of persons
- % increases w/ age
2
Q
Definition of frailty?
A
- a state of age-related physiologic vulnerability resulting from impaired homeostatic reserve and a reduced capacity to withstand stress
- the physiologic decline occurs across multiple systems
- syndrome that results from multi-system reduction in reserve to the extent that a number of physiological systems are close to or past the threshold of sx clinical failure
- as a result, the frail person is at increased risk of disability and death
3
Q
Characteristics of frailty?
A
- frail older adult is ID by one or more of the following characteristics:
extremes of old age
frailty=unstable disability - fxn fluctuates w/ minor stressors
- multiple chronic diseases and/or geriatric syndromes
4
Q
What is the study of osteoporotic fractures (SOF) index?
A
- wt loss of 5% or more over 2 yrs
- inability to stand from a chair 5x w/o using arms to push up
- negative response to the question: “do you feel full of energy?”
- 2/3 positives considered a predictor of risk of falls, disability, fractures, and death
5
Q
Outcome risks of frailty?
A
- falls
- acute illness
- hospitalizations
- disability
- dependency
- institutionalization
- death
6
Q
What are the key components of frailty?
A
- musculoskeletal fxn: strength
- cog/integrative neuro fxn: dementia
- nutrional reserve
- aerobic capacity
7
Q
Signs and sxs of frailty?
A
- sxs: weakness fatigue anorexia inactivity - signs: wt loss/malnutrition decreased muscle mass decreased bone mass anemia
8
Q
Contributing factors of frailty?
A
- heavy drinking
- cigarette smoking
- physical inactivity
- depression
- social isolation
- multiple chronic medical problems
- poor perceived health
9
Q
Triggering events lead to frailty? Causes of blocked recovery time?
A
-triggering events: chronic disease inactivity infection hip fracture
-blocked recovery time: depression med interactions malnutrition fear of falling underlying cognitive status underlying fxnl status
10
Q
FTT definition?
A
- near irreversible end of natural hx of syndrome of frailty
- national institute of aging definition: syndrome of wt loss, decreased appetite and poor nutrition and inactivity
often accompanied by:
dehydration
depressive sxs
impaired immune fxn
low cholesterol
11
Q
Components of FTT?
A
- physical frailty
- disability
- impaired neuropsych fxn
12
Q
Factors of of FTT?
A
- meds: effects/interactions
- comorbidities: COPD/CHF, malignancy, DM, arthritis
- psychosocial factors:
isolation, grief, financia, abuse/neglect
13
Q
Definition of disability? Assessing this?
A
- defined as difficulty or dependency in completing tasks essential for self-care and independent living
- objective assessments:
ADLs
IADLs
14
Q
What is impaired neuropsychiatric fxn?
A
- delirium, depression, and dementia are MC conditions affecting cognitive status in older adults:
may be result of medical comorbidities
med effects
can contribute to development of disability, malnutrition and frailty
15
Q
What may cause disability to develop?
A
- may develop slowly due to progressive co-morbidities and frailty, or acutely due to catastrophic events (stroke)
- disability is an independent RF for mortality, hospitalization, and need for long term care
16
Q
What is sarcopenia?
A
- 0.5-1% loss per yr after the age of 25
- implicated as one of several contributors of FTT
- loss of muscle w/ age
- loss of lean body mass
- diminishes the acute phase response to phsyiological stress
- decreases immune competence
17
Q
What kind of wt loss is correlated w/ decline and mortality?
A
- muscle loss
- BMI is significant predictor of subsequent nursing home placement
18
Q
Signs and sxs of FTT?
A
- impaired physical fxning
- malnutrition
- depression
- cognitive impairment
- a useful working definition reqrs that 3 criteria be met:
biopsychosocial failure
wt loss or undernutrition
and no immediate explanation for the condition (no underlying terminal disease)
19
Q
importance of H and P for eval pt w/ FTT?
A
- key in establishing the onset of condition and uncovering potential triggers
- R/O acute medical problems:
infection
constipation
exacerbation of chronic diseases: CHF, COPD, CAD, uncontrolled endocrine disorder, cancer, TB, dementia, depression
20
Q
Impt of drug review during H and P?
A
- more women than men at risk
- pt using more than 14 rxs in a year
- ETOH ingestion and its potential influence on meds
- how is pt taking the meds and when is pt taking the meds?
21
Q
Impt of Psychosocial hx?
A
- increased memory loss?
- change in social structure?
death of person or pet
moving away of friend or family member
caregiver burnout
recent enviro change
finanacial concerns
access to approp. food, means to prepare and eat them
22
Q
What should be included in physical exam?
A
- vitals: wt and BMI
- hearing defects
- eyes/vision
- oral health
- swallowing
- JVD
- breast mass
- abdominal exam
- skin
- motor
- mental status
23
Q
Labs for eval of FTT?
A
- CBC: anemia, vit deficiency, infection, hematopoietic or lymphoproliferative disorder
- serum lytes, BUN, creatinine, Ca:
hyper-hyponatremia, acid base disorder, osmolality, renal fxn, dehydration - glucose: diabetes, hypoglycemia
- serum bili and transaminanse levels: liver failure, hepatitis
- albumin and cholesterol (markers for malnutrition)
- TSH
- fecal occult blood
- U/A
- vit B12, and D levels
- ESR
- PPD
24
Q
Once a dx of FTT is made then what should be done?
A
- life expectancy of pt should be assessed
- are sxs/conditions reversible?
- risk-benefit assessment should be included in all interventions
- provider, pt, and family should collaborate
- as medical interventions become more limited, palliative measures can be initiated
- maintain a therapeutic relationship w/ the pt and family beyond the time medical therapies are effective
25
Q
Team approach for FTT? What needs to be done for the pt?
A
- address advanced directives
- eliminating, substituting or chaning admin time of drugs may reveal if SEs are contributing to the problem
- consultation w/ PharmD and utilize specialists by phone or referral to optimize chronic disease managements
- social services
- caregiver education and support/respite
- concerns about abuse and neglect need to be discussed openly and frankly w/ family and caregiver
- nutritional consult
