Other things to consider in frailty

Question 1

What is vascular Parkinsonism?

Answer 1

Parkinsonism caused by a series of small strokes rather than a gradual neurone loss

Question 2

What is the difference in presentation between vascular Parkinsonism and Parkinson’s disease?

Answer 2

Quicker symptom onset
Affect LL more - gait issue predominant symptom
Additional asymmetrical signs from other stroke caused damage
MRI and CT changes
Poor response to levodopa

Question 3

How is Vascular Parkinson’s managed?

Answer 3

Stroke risk factor management

Question 4

What are the main risk factors for malnutrition?

Answer 4

Living alone
Institutionalisation
People with severe learning difficulties/mental health issues
Diseases that affect appetite, eating/swallowing or GI function
Catabolic states

Question 5

What are malnourished people more at risk of?

Answer 5

Infection
Poor wound healing
Reduced cognition
Reduced muscle strength

Question 6

What is important to remember when managing a malnourished patient?

Answer 6

Refeeding syndrome!!

Fluid balance abnormalities
Hypokalaemia, phosphataemia and low thiamine

Question 7

How is malnourishment managed?

Answer 7

General nutritional advice

Use supplements

If unable to shop/prepare meals - social services/meals at home service/community dietician/local day centres

Improve palatability of meals

Find optimal time of day and location

OT - difficulty using utensils

Treat underlying pathology

Check for dehydration, anaemia and hypoglycaemia

Question 8

How do you avoid refeeding syndrome?

Answer 8

Re-feed at no more than 50% energy needs
Oral/IV K, Mg, Phosphate, calcium
Check electrolytes daily

Question 9

How would you assess for malnourishment?

Answer 9

MUST tool

Question 10

What is frailty?

Answer 10

Loss of resilience means people do not bounce back quickly after physical or mental illness, an accident or other stressful event

Body has lost its inbuilt reserves

Question 11

What is important in the management of frail individuals?

Answer 11

Plan of care should be made for their needs - specifically avoiding crises and crises management

Regular medication review
Coordinate care
Stop appointments and follow ups if no benefit
Diet advice
Pain management
Supporting carers

Question 12

When should frail people be assessed? How are they assessed?

Answer 12

Not when acutely unwell!

How do they get about?
Recent falls?
Confusion?
Help with every day tasks?

Question 13

What are the main causes of syncope?

Answer 13

Neurally mediated
Postural
Structural
Arrhythmias - Brady and occasionally tachyarrhythmias

Question 14

What is neurally mediated syncope?

Answer 14

Inappropriate autonomic response to a trigger

Question 15

What are the examples of neurally mediated syncope?

Answer 15

Vasovagal - common in young as emotional response, prolonged standing

Situational - specific triggers e.g. post-micturition

Carotid sinus hypersensitivity - mechanical manipulation of carotid sinus e.g. when moving head

Question 16

What is postural syncope?

Answer 16

Syncope dependent on standing up

Occur due to insufficient baroreceptor response

Question 17

What are the main examples of postural syncope

Answer 17

Autonomic failure secondary to drugs - antihypertensives, diuretics, antipsychotics, tricyclics

Hypovolaemic

Primary autonomic failure - parkinsons/Lewy body dementia

Secondary autonomic failure - diabetes, uraemia and spinal cord lesions

Question 18

What is structural syncope?

Answer 18

Mechanical obstruction to the LV inflow or outflow meaning stroke volume can’t compensate during exercise –> syncope

Question 19

Give examples of causes of structural syncope

Answer 19

Valvular - aortic stenosis
Mass - atrial myxoma
HOCM - hypertrophic cardiomyopathy
Constrictive pericarditis
Non-cardiac - PE/aortic dissection