Frailty Flashcards
What is frailty? Physiological definition
NOT just about age:
Clinically recognizable state of increased vulnerability resulting from ageing associated decline in reserve and function across multiple body systems so that the ability to cope with everyday acute stressors is compromised
Phenotypic definition of frailty
- Low grip strength
- Low energy
- Slowed walking speed
- Low physical activity
- Weight loss - unintentional
Frailty simple definition
Ageing related physiological changes across multiple body systems
Loss of physiological reserve
Increased vulnerability to a wide range of stressors - eg COVID19, constipation
How can we grade frailty?
Clinical Frailty Scale - 1=very fit, 8=severly frail, 9=end of life without frailty
What are geriatric giants?
Things that can happen to older people when unwell - can be symptoms of underlying acute disease but unusual symptoms not usually associated with disease
5 geriatric giants
Immobility
Instability
Incontinence
Impaired memory - dementia, delirium
Iatrogenesis - caused by us
What is the relevance of ‘non specific’ presentations in frail people?
Frail people can present with unusual symptoms not usually associated with a particular disease - don’t have the ‘common’ symptoms so diagnosis can be difficult
Why is physiological decompensation important in frail people?
In young, fit and healthy non frail people they have lots of physiological reserve so only decompensate at very late stage serious illness
In older people there is less reserve so they physiologically decompensate more easily meaning they are more vulnerable to disease that we are ok with
What often comes alongisde frailty?
Polypharmacy
Co-morbidities
= lots of drug interactions
How does frailty affect outcomes after stressor?
Normal non frail people will recover back to baseline of before
Frail people dip sharper and take longer to recover and are more likely to leave more dependent on others than before - do not recover back to baseline
What is one very important side effect of many drugs?
Lots have anticholinergic effects - opposite SLUDGE
This increases drowsiness and increases risk of confusionand decompensation
This risk is higher with polypharmacy - must weight up risks and benefits of a medication
What should you write to ensure you treat a patient holistically and see them in context of wider picture and not just their acute presentation?
Write differential diagnosis list and problem list - problem list includes all current problems too
How does person centered decision making differ from disease centred?
Pay attention to whole person and their situation
Striking balance between person centred and disease centred
What are ReSPECT forms?
Personal preferences of what you prioritise when it comes to end of life - sustaining life vs comfort?
Do not attempt resuscitations are on here
What is a CGA?
Comprehensive geriatric assessment - allows a care plan to be generated from taking into account a frail persons medical, psychological and functional capabilities
