Intro And Frailty Flashcards

1
Q

What is the definition of frailty?

A

A state of increased vulnerability to poor resolution of homeostasis after a stressor event (so a high risk of deterioration)

Multisystem dysregulation

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2
Q

What are some tests/measures of frailty?

A

Gait speed
Timed up to go
Clinical Frailty Score (CFS)
ISAR

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3
Q

When do you score somebody with the Clincal Frailty Score?

A

2 weeks before they became unwell

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4
Q

How does dementia affect the clincal frailty score?

A

Someone with severe dementia will have a High clinical frailty score even if they are mobile since they require high levels of care

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5
Q

What is a CGA?

A

Comprehensive Geriatric Assessment

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6
Q

What is the definition of a CGA (Comprehensive Geriatric Assessment?

A

Multidimensional holistic assessment considering patient health and wellbeing

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7
Q

Who do we do a CGA (comprehensive Geriatric Assessment) on?

A

All patients over 85
Or
65+ with other factors

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8
Q

What other factors do patients who are over 65 have to qualify for a CGA?

A

Cognitive impairment
Falls
Decline in activities of daily living (ADL)
Care home resident
Parkinsonism

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9
Q

How can you assess a patient for postural hypotension?

A

Lying to standing blood pressure is taken

Drop in more than 20mmHg suggest postural hypotension

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10
Q

What are some factors that contribute to causing frailty?

A

Ageing
Chronic inflammation
Hormonal changes
Sarcopenia (loss of muscle mass)
Comorbidities
Medications
Lifestyle factors:
-inactive
-social isolation
-malnutrition
-drinking
-smoking

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11
Q

What are the 5 Geriatric Giants/Frailty syndromes?

A

Falls
Immobility
Delirium
Incontinence
Polypharmacy

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12
Q

Does frailty cause disability?

A

Frailty may be the cause of disability or the consequence of disability

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13
Q

What is meant by immobility in terms of frailty syndromes?

A

Any change/reduction in mobility status

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14
Q

Why is immobility a problem with frailty?

A

Can lead to further decline
Can reduce patients confidences and motivation
Can be the sole presentation in acute illness

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15
Q

What are some causes of incontinence in relation to frailty syndrome?

A

Congestive heart failure
COPD
Diabetes
Medicine side effects
Constipation and overflow diarrhoea

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16
Q

Describe delirium in terms of:
-time of onset
-starting point
-reversibility
-memory effect
-speech effect

A

Acute onset
Defined starting point
Temporary and reversible
Difficulty paying attention
Slow and slurred speech

17
Q

Describe dementia in terms of:
-time of onset
-starting point
-reversibility
-memory effect
-speech effect

A

Gradual onset of
Uncertain start point
Permanent and worsened
Difficulty reme,Bering
Forgetfulness of words

18
Q

What are the 3 main management steps to Falls?

A

Diagnose and treat traumatic injuries
Identify and manage cause of fall and risk factors
Prevent complications of falls in the future

19
Q

What is the most important cause of fall that must be considered?

A

Syncopal falls (cardiovascular cause)

20
Q

What are some causes of non syncopal falls?

A

Infections
Hyponatraemia
Delirium
Postural hypotension
Cognitive impairment
Medications
Sensory impairment
Continence problems
Footwear/mobility aids

21
Q

What are some medications (poly pharmacy) that increase the risk of falls in frail patients?

A

Long acting benzodiazepines (Diazepam, prazepam, flurazepam)
Sulphonylureas (Gliclazide)
Sedatives and hypnotics (Zopiclone)

22
Q

What are some medications that can cause cognitive impairment, confusion/delirum?

A

Anti Muscarinic (for incontinence)

Opioids like codeine and morphine (can cause constipation)

23
Q

What serious side effect can NSAIDs have?

A

Renal impairment

24
Q

What medication can increase risk of falls by causing hyponatraemia?

A

Bendroflumethiazide (anti hypertensive thiazide)

25
Q

What medication often causes a cough and also postural hypotension?

How can we try and address the postural hypotension?

A

ACE-i

Move the doses to evening/night