Intro And Frailty Flashcards
What is the definition of frailty?
A state of increased vulnerability to poor resolution of homeostasis after a stressor event (so a high risk of deterioration)
Multisystem dysregulation
What are some tests/measures of frailty?
Gait speed
Timed up to go
Clinical Frailty Score (CFS)
ISAR
When do you score somebody with the Clincal Frailty Score?
2 weeks before they became unwell
How does dementia affect the clincal frailty score?
Someone with severe dementia will have a High clinical frailty score even if they are mobile since they require high levels of care
What is a CGA?
Comprehensive Geriatric Assessment
What is the definition of a CGA (Comprehensive Geriatric Assessment?
Multidimensional holistic assessment considering patient health and wellbeing
Who do we do a CGA (comprehensive Geriatric Assessment) on?
All patients over 85
Or
65+ with other factors
What other factors do patients who are over 65 have to qualify for a CGA?
Cognitive impairment
Falls
Decline in activities of daily living (ADL)
Care home resident
Parkinsonism
How can you assess a patient for postural hypotension?
Lying to standing blood pressure is taken
Drop in more than 20mmHg suggest postural hypotension
What are some factors that contribute to causing frailty?
Ageing
Chronic inflammation
Hormonal changes
Sarcopenia (loss of muscle mass)
Comorbidities
Medications
Lifestyle factors:
-inactive
-social isolation
-malnutrition
-drinking
-smoking
What are the 5 Geriatric Giants/Frailty syndromes?
Falls
Immobility
Delirium
Incontinence
Polypharmacy
Does frailty cause disability?
Frailty may be the cause of disability or the consequence of disability
What is meant by immobility in terms of frailty syndromes?
Any change/reduction in mobility status
Why is immobility a problem with frailty?
Can lead to further decline
Can reduce patients confidences and motivation
Can be the sole presentation in acute illness
What are some causes of incontinence in relation to frailty syndrome?
Congestive heart failure
COPD
Diabetes
Medicine side effects
Constipation and overflow diarrhoea
Describe delirium in terms of:
-time of onset
-starting point
-reversibility
-memory effect
-speech effect
Acute onset
Defined starting point
Temporary and reversible
Difficulty paying attention
Slow and slurred speech
Describe dementia in terms of:
-time of onset
-starting point
-reversibility
-memory effect
-speech effect
Gradual onset of
Uncertain start point
Permanent and worsened
Difficulty reme,Bering
Forgetfulness of words
What are the 3 main management steps to Falls?
Diagnose and treat traumatic injuries
Identify and manage cause of fall and risk factors
Prevent complications of falls in the future
What is the most important cause of fall that must be considered?
Syncopal falls (cardiovascular cause)
What are some causes of non syncopal falls?
Infections
Hyponatraemia
Delirium
Postural hypotension
Cognitive impairment
Medications
Sensory impairment
Continence problems
Footwear/mobility aids
What are some medications (poly pharmacy) that increase the risk of falls in frail patients?
Long acting benzodiazepines (Diazepam, prazepam, flurazepam)
Sulphonylureas (Gliclazide)
Sedatives and hypnotics (Zopiclone)
What are some medications that can cause cognitive impairment, confusion/delirum?
Anti Muscarinic (for incontinence)
Opioids like codeine and morphine (can cause constipation)
What serious side effect can NSAIDs have?
Renal impairment
What medication can increase risk of falls by causing hyponatraemia?
Bendroflumethiazide (anti hypertensive thiazide)
What medication often causes a cough and also postural hypotension?
How can we try and address the postural hypotension?
ACE-i
Move the doses to evening/night
What are the 5 Components to a CGA?
Medical management
Functional management (ADLs priorities)
Mental health assessment + dementia screening
Social (family life, home support)
Environmental (housing situation and occupational support)
