Ica Frality And Ageing

Question 1

• Learn the definition of frailty

• Be able to describe several specific clinical consequences of frailty

Answer 1

• Physiological:
• Clinically recognizable state of increased vulnerability resulting from aging.
Associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised.

• Phenotypic definition:
• Low grip strength, low energy, slowed waking speed, low physical activity, and/or unintentional weight loss.

Question 2

• Be aware of how frailty can be measured
Notion

Question 3

• Be able to list several indicators which clinicians can use to detect frailty

Answer 3

Geriatric giants
• Immobility
• Instability (Falls)
• Incontinence
• Impaired memory (Dementia, Delirium)
• Iatrogenesis (Caused by us!)

Question 4

• Be able to discuss how moderate to severe frailty should impact the management plan for the patient

• Be able to describe component parts of Comprehensive Geriatric Assessment

Question 5

To be aware of common changes associated with ageing across key body systems and how such changes can have an impact on pharmacokinetics and safe prescribing

Skin

Answer 5

Sk in
- Atrophy of the epidermis
- Destruction to dermal-epidermal junction
- Dermis thickness decreases
- Collagen fragmentation
- Elastin degradation
- Prone to diseases

Question 6

•
CVS

Answer 6

CVS
structural change
- Ventricular hypertrophy
- Interventricular septal hypertrophy
- Aortic sclerosis

functional change
- Diastolic dysfunction
- Decreased cardiac output
- Decreased maximal heart rate
- Increase cardiac workload
- Baroreceptor response

Electrophysiological
- SA node atrophy
- Action potential prolongation

Vascular structure
- Large arteries dilate
- All arterial walls thicken

Vascular function
- Decrease arterial compliance
- Endothelial vasodilation is impaired

Question 7

Resp

Answer 7

Respiratory
- Chest wall compliance
- Lung Volume: ↑ RV, ↑ FRC, ↓ VC
- Structure of the lungs
- Senile hyperinflation
- Lung compliance
- Infection susceptibility

Question 8

Neurology

Answer 8

Some parts shrink – particularly areas related to
learning and complex mental activities
- Brain volume
- Neuronal density reduces by almost 1/3 by the
age of 80

Question 9

Renal

Answer 9

• Decrease in the volume and weight of the kidneys
• Decline in the total number of glomeruli per kidney
• Tubular function -
  Urinary incontinence -
  Prostate hyperplasia

Question 10

Gi

Answer 10

Oesophagus
- Decrease peristalsis
- Delayed transit time
- Decreased relaxation of the lower sphincter on swallowing

Stomach
- Atrophic gastritis

• Colon
• Decreased intestinal motility
• Diverticulosis

Question 11

To be broadly aware of the problem of malnutrition in older patients and be familiar with the MUST Nutritional Tool.

Answer 11

MUST
- Identify patients who may be at nutritional risk
or potential risk - 5 step screening process

BMI (18.5-20=1, <18.5=2)
Weight loss (5-10%=1)
Acutely ill and no nutritional intake for >5days = 2
Overall - 2 or more = high risk
Management