Fraility and Delerium

Question 1

What is frailty?

Answer 1

Problem of older people due to loss of reserve in multiple body systems

10% of >65yrs
25% of >85yrs

Question 2

Detection of frailty?

Answer 2

Questionaires
Walking speed
Up and Go test

Comprehensive geriatric assessment

Question 3

Frailty syndromes

Answer 3

Falls
Immobility
Delirium
Incontinence
Medication side effects
Social isolation

Question 4

Management of frailty

Answer 4

Resistance training and physical exercise

Address common associated problems

Question 5

Clinical features of Delirium

Answer 5

Attention disturbance
Changes in alertness
Diffuse cognitive changes
Acute onset and fluctuate course
Alterations in psychomotor behaviour - hyper and hypo alertness

Usually multifactorial trigger

Recovery often incomplete

Question 6

Delirium epidemiology

Answer 6

1/3-2/3 cases missed by treating physician

Increase length of hospital stay x2.2
2x risk of hospital acquired complications
3-7x risk of admission to residential care
Increased post-discharge costs

15-30% mortality

Question 7

Delirium Pathophysiology

Answer 7

Reduced reserve

Reduced cerebral blood flow
Neuronal loss
Reduced neurotransmitters

Question 8

Delirium risk factors

Answer 8

Cognitive impairment
Visual impairment
Severe illness
Dehydration
Hearing impairment
Psychoactive drug use

Question 9

In hospital delirium risk factors

Answer 9

Use of restraints
Malnutrition
Addition of 3+ medications in previous 24 hours
Insertion of IDC
Any iatrogenic event

Question 10

Aetiology of delerium

Answer 10

Metabolic encephalopathies
Drugs
Sepsis
Neurological

Question 11

Management of delirium

Answer 11

Manage underlying cause

Provide familiarity

Avoid complications - dehydration, malnutrition, pneumonia, pressure areas, constipation

Small dose anti-psychotics - haloperidol