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Y4 - CCC & PC > Multimorbidity & Frailty > Flashcards

Multimorbidity & Frailty Flashcards

1
Q

What is meant by a long-term condition (chronic disease)?

How long does it last for?

A

a condition for which there is currently no cure

they can only be managed with drugs and other treatment

long-term conditions will be with the patient for a very long period of time and potentially for their entire life

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2
Q

What are some examples of long-term conditions?

A
  • COPD
  • hypertension
  • diabetes
  • arthritis
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3
Q

What is meant by multimorbidity?

A

the presence of 2 or more long-term health conditions

(can include both physical and mental health conditions)

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4
Q

What 5 different categories of conditions can be included as multimorbidities?

A
  • defined physical or mental health conditions
    • e.g. diabetes, generalised anxiety disorder, schizophrenia
  • ongoing conditions, such as learning disabilities
  • symptom complexes (a group of associated symptoms with no defined organic cause)
    • e.g. frailty, chronic pain syndrome, fibromyalgia, IBS
  • sensory impairments, such as hearing or sight loss
  • alcohol or substance misuse
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5
Q

What are the 5 most common long-term conditions in the UK?

What is significant about how these conditions occur?

A
  1. hypertension
  2. depression / anxiety
  3. chronic pain
  4. hearing loss
  5. irritable bowel syndrome
  • groups of conditions tend to occur in clusters
    • e.g. HTN associated with chronic pain, diabetes & hearing loss
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6
Q

Approximately what % of English people have 2 or more long-term conditions?

A
  1. 2%
    * more than 1/4 of the UK population live with multimorbidity
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7
Q

How is the incidence of multimorbidity linked to age?

Are there more younger or older people living with multimorbidity and why is this significant?

A

the incidence of multimorbidity increases substantially with age

  • over 50% of those with multimorbidity are <65
    • there are more younger people alive than older people
  • nearly 2/3 of those with a physical-mental health comorbidity are <65
  • this is significant as it affects people of working age
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8
Q

How is the onset of multimorbidity influenced by socioeconomic status?

A
  • onset of multimorbidity occurs 10-15 years earlier in people in areas of socioeconomic deprivation
  • people from this background have a shorter life expectancy and are more likely to become unwell with multiple longterm conditions at a younger age
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9
Q

How is the management of a patient with a longterm condition different?

A
  • often the patient will know more about living with the condition than the doctor
  • you are not trying to work out the diagnosis and treatment
  • you are there to listen to the problems the patient has and help to look for solutions
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10
Q

What are some of the common problems someone with multiple long-term conditions may struggle with?

A
  • polypharmacy means there is a higher risk of side effects and medications interacting with each other
  • can be confusing when there are multiple healthcare professionals involved, especially if there is lack of coordination between them
  • attending multiple appointments can be time-consuming and interfere with work
  • often unable to work / work reduced hours which can cause financial problems
  • mental health conditions are caused / exacerbated by long-term conditions and the impact on functioning / independence
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11
Q

What is the definition of frailty?

A

the clinically recognisable state of increased vulnerability resulting from age-associated decline in reserve and function across multiple systems

such that the ability to cope with everyday or acute stressors is compromised

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12
Q

What is a major problem with describing a patient as “frail”?

A
  • the dictionary definition of frail is very negative
    • easily shattered, morally weak, feeble, decrepit
  • this is demeaning / offensive to the patient
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13
Q

How do people with frailty recover from a minor health issue?

A
  • frailty means that even minor events can trigger disproportionate changes in health status
  • after these changes, the patient fails to return to their previous level of health
  • minor events include conditions such as UTIs and chest infections
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14
Q

How is frailty measured?

A
  • frailty is a spectrum that ranges from mild to severe frailty
  • it is measured using the Rockwood scale
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15
Q

Why is it important to define frailty in medicine?

A
  • frailty defines the group of older people who are at highest risk of adverse outcomes
  • such as falls, disability, admission to hospital, or the need for long-term care
  • it is important to identify these people to try and minimise the risk of adverse outcomes
  • not trying to improve their life expectancy, but reduce the burden that healthcare can carry for these people
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16
Q

Is ageing the same thing as frailty?

A
  • they are not the same thing, but are inherently linked
  • the older someone becomes, the more likely they are to become frail
  • an old person may still be living independently and active - they cannot be described as frail
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17
Q

What % of older people can be described as frail?

A
  • 10% of individuals over 65
  • 25-50% of individuals over 85
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18
Q

Do frail people always have multimorbidity?

A
  • often people with frailty will have multiple long-term health conditions
  • but people can become frail as they get older and not have any known long-term health conditions
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19
Q

What are the 5 main reasons why the concept of frailty is used?

A
  • active identification and individualised management can reduce the risk of adverse events
  • interventions can be put in place to help
    • medication reviews, exercise programmes, proactive case management, nutrition/protein
  • to reduce fragmentation of care
  • to stop the focus on individual conditions and focus on quality of life
  • to improve advanced care planning / end of life care
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20
Q

Why are medication reviews important in people with frailty?

A
  • these individuals are most likely to come to harm from polypharmacy and overmedicalisation
  • medication review looks at medications that may be causing more harm than good and reviews interactions
  • repeating on a regular basis can reduce risk of falls / hospital admission and improve quality of life
21
Q

What is meant by proactive case managment in people with frailty?

A
  • this usually involves a community matron overviewing the care of an individual
  • it prevents unnecessary overmedicalisation and coordinates healthcare
  • these individuals are likely to be under the care of multiple healthcare professionals and be overburdened with appointments
22
Q

What are the 6 ways in which primary care is involved in diagnosing and managing cancer?

A
  • prevention - e.g. advice for smoking cessation
  • screening for cervical, breast and bowel cancer
  • recognition of the symptoms and signs
  • referral for further investigation if suspicion is made
  • support / cancer care reviews and management of other coexisting conditions
  • palliative care for those at the end of their life
23
Q

What are the lifestyle factors that can increase and reduce the risk of breast cancer?

A

Increased risk:

  • smoking
  • obesity (BMI >30)
  • drinking 2 or more units of alcohol daily
  • combined hormone replacement therapy
  • combined oral contraceptive pill

Reduced risk:

  • oestrogen only HRT
  • 2.5 hours of moderate exercise weekly
24
Q

What are the 5 ways in which cancer may be detected?

A
  • through a screening programme
  • presentation with red flag symptoms and 2WW referral
  • monitoring of vague symptoms and signs / clinician intuition
  • incidental finding on imaging
  • emergency / late presentation
    • e.g. haematemesis, increasingly worsening headache
25
Q

What are “red flag” symptoms associated with cancer?

What is the appropriate next step for these patients?

A
  • red flag symptoms are those that have an increased risk of being associated with cancer
    • e.g. rectal bleeding, postmenopausal bleeding, haemoptysis
  • these patients are referred to secondary care urgently via the 2 week wait (WW) pathway
  • they should be seen within 2 weeks in a clinic that has the facilities to make a diagnosis (or exclusion) of cancer
26
Q

How would you manage a patient presenting with vague symptoms / signs that could be associated with cancer?

A
  • these patients are NOT eligible for referral via the 2WW pathway
  • often the patient is monitored to see if symptoms resolve / get worse
  • may consider some imaging
  • try to treat other causes of the symptom to see if it clears up or remains
27
Q

What guidelines are in place to assist GPs in knowing when to refer someone with suspected cancer?

28
Q

What is the difference between early diagnosis and screening programmes?

A

Early diagnosis:

  • aims to detect symptomatic patients at an early (treatable) stage
    • e.g. PSA testing in men with urinary tract symptoms

Screening:

  • the use of simple tests across a healthy population to identify the individuals who have a disease but do not yet have symptoms
    • ​e.g. cervical screening in all asymptomatic women aged >25
29
Q

What are the 3 different delays in cancer diagnosis and treatment?

A
  1. access delay
  2. diagnosis delay
  3. treatment delay
30
Q

What is meant by access delay?

In which group is this more prevalent and why?

A
  • people who have cancer symptoms but are not aware that they need to see a healthcare professional
  • they may be unaware that their symptoms are associated with cancer
  • or they may be unable to access healthcare services
  • more common in socioeconomically deprived areas as there is less education, lower availability of services and financial issues (cannot afford transport to hospital etc.)
31
Q

What is meant by diagnosis delay and why might this occur?

A
  • the delay between an individual presenting to a healthcare professional and being diagnosed with cancer
  • there may be difficulties with referral
  • it may be due to poor performance of the healthcare worker
  • or sometimes cancer can present with subtle symptoms / signs and it is difficult to make a diagnosis
32
Q

What is meant by treatment delay?

Why might this occur?

A
  • the delay between a patient being diagnosed with cancer and their first treatment
  • may be due to waiting lists or limited resources
  • less likely to occur in a developed country with a national health service
33
Q

What are the principles of a good screening programme?

A
  • important health problem where the prevalence is high enough to justify effort + costs of screening
  • there must be acceptable, readily available and effective treatments available
  • resources must be sufficient to cover nearly all of the target group
  • facilities exist for confirming the diagnosis and for treatment in those with abnormal results
  • there must be a suitable latent and symptomatic stage
  • the screening test must be demonstratibly effective
34
Q

Why does referral for colonoscopy after bowel screening differ between countries?

A
  • bowel screening looks at the levels of haemoglobin in stool samples
  • if Hb is above a certain threshold, the patient is offered diagnostic colonoscopy
  • the threshold level of Hb to warrant referral is different across the world due to the availability of resources (colonoscopy) in that country
35
Q

What are the potential harms of a screening programme?

A

False positives:

  • describes people who do NOT have cancer but test positive through screening
  • result in additional testing, invasive diagnostic procedures and patient anxiety

False negatives:

  • describes people WITH cancer that is not detected through screening
  • false reassurance can result in delayed presentation / diagnosis when symptoms appear

Over diagnosis / treatment of preclinical cancers:

  • these are cancers that would have never caused symptoms or had a serious threat to the health of the patient
  • there is unnecessary treatment that injures the patient
36
Q

What are the screening programmes available in the UK?

A
  • breast
  • cervical
  • bowel - FIT testing
  • bowel - colonoscopy
  • lung - whole population
  • lung - targeted low dose CT screening
  • PSA testing
  • breast, cervical and FIT testing are offered across the UK to the relevant populations
37
Q

When may a PSA test be offered?

Why could the threshold for black men potentially become lower?

A

the rate of prostate cancer is 2x higher in black men compared to white men

  • in general, everyone is advised against having a PSA test if they do not have symptoms
  • this is due to the high rate of false negatives / positives
38
Q

How does coming from an area of socioeconomic deprivation affect life expectancy and disability?

A
  • people living in the poorest neighbourhoods die on average 7 years earlier than those in the wealthiest areas
  • the average difference in disability free life expectancy is 17 years
39
Q

How does the incidence of long-term conditions link to level of socioeconomic deprivation?

A
  • most individual long-term conditions are more common in people from lower socioeconomic groups
  • the conditions are often more severe
40
Q

How does socioeconomic deprivation affect cancer?

A
  • highest rates of cancer in low socioeconomic groups
  • higher rates of mortality after diagnosis in deprived areas
41
Q

Who is eligible for cervical screening?

A
  • all women and people with a cervix aged between 25 to 64
42
Q

What does cervical screening check for?

A
  • a speculum is inserted into the vagina and a small brush inserted to collect a sample of cells from the cervix
  • the sample is checked for certain types of human papillomavirus (HPV) that can cause changes to the cells of the cervix
  • if the “high risk” HPV is found, the sample is checked for any changes in the cells of the cervix
  • this allows for treatment before the abnormal cells turn into cervical cancer
43
Q

How does the breast screening programme work?

A
  • it involves a mammogram (X-rays) to look for cancers that are too small to see or feel
  • the breast is compressed between 2 pieces of plastic whilst the X-rays are taken
  • the X-ray machine is then tilted to one side and the process will be repeated on the side of the breast
44
Q

Who is eligible for breast screening?

A
  • anyone registered with a GP as a female will be invited every 3 years between the ages of 50 and 71
45
Q

Who is eligible for bowel screening?

A
  • anyone aged 60 to 74 years
  • it is expanding to become available to everyone aged 50 - 59 years
46
Q

How does the bowel screening programme work?

A
  • a faecal immunochemical test (FIT) is performed at home
  • a small sample of faeces is collected and sent to a lab to look for blood within it
  • blood can be a sign of cancer, or polyps, which can turn into cancer over time
  • if the test comes back positive, a colonoscopy may be required
47
Q

Why is there not a PSA prostate cancer screening programme?

A
  • there is a high risk of men being overdiagnosed and undergoing unnecessary treatment for cancers that would not have caused harm
  • this treatment may result in anxiety, complications, infections, sexual dysfunction and bowel control problems
  • the screening programme would not save any lives
48
Q
A

Y4 - CCC & PC (34 decks)

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