S5 L2 Healthcare and Older People Flashcards
Define fraility?
Slightly different ones
Physiological → clinically recognisable state of increased vulnerability resulting from aging- associated decline in reserve and function across multiple physiological systems such that the ability to cope with everyday or acute stressors is compromised
Phenotypic → Low grip strength, low energy, slowed walking speed, low physical activity, and/or intentional weight loss
What is important to remember about fraility?
Not just about age
Older people can be very fit and independent
Some young people can become severely frail and dependent at a young age
Why is it important to recognise frailty?
Risk and opportunity
Risk → stressor - acute admission is a moment where someone can become frail
Opportunity → identify - deterioration and further decline in health and function can be slowed or prevented
Affects treatment and management plans
How can frailty be detected?
Clinical frailty scale - can be completed by anyone
Frailty phenotype
What is the clinical frailty scale?
Determines the level of frailty in a patient
1. Very fit - 9- very severely frail
Can be completely by anyone
Useful for developing best and most appropriate management plans
What are the Geriatric giants?
Hyperacute frailty syndrome
- Immobility and pressure sores
- Instability (falls and fractures)
- Incontinence and dipstick (+ve UTI)
- Impaired memory (dementia, delirium)
- Iatrogenesis
What is the risk of determining a diagnosis for a frail patient?
- Potential to miss important key information underpinning the frailty related syndrome
- Normally about 5 different causes of frailty related syndrome
- Leads to treatment failure
- Better to write a problem list
What is the risk of determining a diagnosis for a frail patient?
- Potential to miss important key information underpinning the frailty related syndrome
- Normally about 5 different causes of frailty related syndrome
- Leads to treatment failure
- Better to write a problem list
How is frailty linked to outcomes?
If frailty not identified underlying causes will not be identified
→ Ineffective and inefficient care
→ ↑length of stay, ↑readmission, ↑institutionalisation, ↑mortality
(identification can help to predict and prognosticate)
What is the anticholinergic burden?
- Different medication can cause anticholinergic effects
- Medications given a score of 1, 2, or 3 and total score determines how at risk they are
- Potential causes the symptoms associated e.g. delirium
- Other side effects
→ Drowsiness, lowering BP and lowering blood glucose - Balancing risk and benefit
Why should we review medication that patients are on?
Frail older people are vulnerable to ‘iatrogenic’ harm
How can we manage frail older patients?
Comprehensive geriatric assessment
- Evidence based treatments
- Holistic care- whole patient
- Medical, psychological/cognitive, functional, social networks and environmental
Underpinned by geriatric competences e.g. differentiate delirium from dementia etc….
How does the severity of frailty affect managment?
Fit/Mild frailty → care as usual but address reversible issues
Moderate frailty → actively seek out and manage geriatric syndromes- falls, cognitive impairment, incontinence, polypharmacy (use Comprehensive geriatric assessment)
Severe frailty → think about supportive care vs cure, advance care planning, recognition that enhanced supportive care is an active intervention in itself offering improved QoL, sometimes quantity of life
What is the implications of frailty in practice?
Use frailty to differentiate and prognosticate
Tailor and management accordingly- person (not condition) centred care, shared decision making
Frailty complex, solutions will need to be complex…. comprehensive geriatric assessment
