7 - Clinical Frailty and Multimorbidity Flashcards
What is frailty?
- Syndrome
- Physiological decline
- Late life
- Causes inc vulnerability to stressors
What percentage of over 80s have frailty?
50%
What is the phenotype model of frailty?
The Phenotype model, describes a group of patient characteristics (unintentional weight loss, reduced muscle strength, reduced gait speed, self-reported exhaustion and low energy expenditure) which, if present, can predict poorer outcomes.
Generally individuals with three or more of the characteristics are said to have frailty (although this model also allows for the possibility of fewer characteristics being present and thus pre-frailty is possible).
What are the characteristics of frailty under the phenotype model?
Unintentional weight loss
Exhaustion
Muscle weakness
Slow gait
Low levels of activity
How many criteria in the phenotype model should be met to identify as pre-frailty?
2 or more
What is the cumulative deficit model of frailty?
Cumulative Deficit model assumes an accumulation of deficits (ranging from symptoms e.g. loss of hearing or low mood, through signs such as tremor, through to various diseases such as dementia) which can occur with ageing and which combine to increase the ‘frailty index’ which in turn will increase the risk of an adverse outcome.
What index is an example of the cumulative deficit model of frailty?
Electronic Frailty Index (eFI)
The electronic frailty index (eFI) is a tool that can be used to identify people as they progress through different levels of frailty, and is based upon a person’s needs, rather than their service use.
The eFI uses a cumulative deficit model to identify and score frailty based on routine interactions with their GP. As individuals interact with GPs, their GP records accumulate a list of read codes and community prescriptions. The eFI uses a subset of these read codes to interpret any number of up to 36 potential deficits. The number of deficits that an individual is considered to have is then divided by the total (36) to produce a score. This score determines whether a person is considered fit, mildly frail, moderately frail, or severely frail and nearing the end of their life. This can be calculated for an individual or for a whole GP practice.population over 65 years of age.
Which scale is a hybrid of the Cumulative Deficit Model and the Phenotype Model?
Rockwood Clinical Frailty Scale
Which Rockwood scale would describe a P who needed help with medications, meal preparation and public transport?
RWS 5
Which app is used to diagnose frailty and help support decision making in their care?
The Clinical Frailty Score App
Which syndromes are classed as frailty syndromes?
Falls
Delirium
Immobility
Incontiennce
Polypharmacy + side effects
Care home residents / large package of care
What does severe frailty increase a P’s risk of?
Hospital admission
Care home placement
Death
Falls
Hospital associated infections
Delirium acquired in hospital
Pressure damage
Incorrect diagnosis
Adverse drug reactions
Mortality
Inc Length of stay
How should a P with frailty be managed?
Do a CGA
Treat co-morbidities
Review polypharmacy and deprescribe where appropriate
Ensure Vit D is checked and replaced if low
Advice on exercise and nutrition
Initiate advanced care planning discussions
What is the benefit of identifying frailty?
Ensures Ps are managed according to functional status and not chronological age
Identifies those at risk of hospital admission, care home placement or death - can proactively target these Ps
Identify Ps who will benefit most from geriatric specialist input
When a P presents to hospital - what should be used to calculate their Clinical Frailty Score - pre-morbid or morbid status?
Pre-morbid
