Session 5: Frailty

Question 1

Frailty indicators

Answer 1

Weakness

Fatigue

Weight loss

Low physical activity

Poor balance

Low gait speed

Visual impairment

Cognitive impairment

Question 2

Define frailty.

Answer 2

Frailty is most often defined as a syndrome of physiological decline in late life, characterized by marked vulnerability to adverse health outcomes.

Question 3

Different ways of measuring frailty.

Answer 3

Clinical frailty scale

Comprehensive geriatric assessment

CURB-65

Question 4

Give manifestations of frailty.

Answer 4

Delirium (dementia)

Falls and fractures

Immobility and pressure sores

Incontinence

+ve dipstick for UTI

Iatrogenesis

Question 5

Give the clinical relevance of frailty.

Answer 5

External stressors will have more of an impact on the baseline of the patient and recovery.

The more frail a patient is the more time it will take to recover and also the baseline will decrease.

Prognosis will be worse if a patient is frail and they might not respond to medication adequately.

Question 6

Clinical consequences of frailty.

Answer 6

Ineffective and inefficient care leading to:

Length of stay in hospital

Readmissions

Institutionalisation

Mortality

Question 7

Components of the comprehensive geriatric assessment.

Answer 7

Determines the medical, psychological and functional capabilities of a frail older person.

Environment

Social networks

Medical

Functional

Psychological/cognitive

Question 8

Why is the comprehensive geriatric assessment important?

Answer 8

In order to develop a coordinated and integrated plan for treatment and long-term follow up with clear and modifiable trajectories.

Question 9

How does moderate to severe frailty change the management plan for the patient?

Answer 9

In moderate frailty you actively seek out and manage geriatric syndromes such as falls, cognitive decline, continence, and polypharmacy.

In severe frailty you think about supportive care vs. cure.
Form an advance care planning with recognition that enhanced supportive care is an active intervention in itself offering improved QoL, sometimes quantity of life.

Question 10

Why is frailty important to consider in the treatment plan?

Answer 10

To differentiate and prognosticate.

To tailor management accordingly to the patient.