frailty

Question 1

what is the definition of frailty?

Answer 1

A distinctive health state related to the aging process in which multiple body systems gradually lose their in built reserves.

Question 2

what are the concerns in frailty groups?

Answer 2

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 2

what are the concerns in frailty groups?

Answer 2

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 2

what are the concerns in frailty groups?

Answer 2

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 3

what are the concerns in frailty groups?

Answer 3

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 3

what are the concerns in frailty groups?

Answer 3

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 4

what are the concerns in frailty groups?

Answer 4

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 5

what are the concerns in frailty groups?

Answer 5

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 5

what are the concerns in frailty groups?

Answer 5

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 5

what are the concerns in frailty groups?

Answer 5

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 6

what are the concerns in frailty groups?

Answer 6

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 6

what are the concerns in frailty groups?

Answer 6

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 7

what are the concerns in frailty groups?

Answer 7

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 8

what are the concerns in frailty groups?

Answer 8

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 8

what are the concerns in frailty groups?

Answer 8

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 8

what are the concerns in frailty groups?

Answer 8

– Increased risk of deterioration –Worse outcomes from illness –Higher risk of acute hospital admission – Increased length of hospital stay – Care home admission –Death

Question 9

how does someone with frailty often present?

Answer 9

– Falls – Immobility – Delirium
– Incontinence – Susceptibility to side-effects of medications

Question 10

what are the screening tools for frailty?

Answer 10

• Electronic Frailty Index (eFI) – Enables GP’s to screen patients for frailty and its severity – An evidence based intervention to improve outcome
• Rockwood Clinical Frailty Scale – Used with a hospital setting

Question 11

what does a comprehensive geriatric assessment consist of?

Answer 11

Multidisciplinary assessment of physical, psychological, functional and environmental factors
key- medication review

Question 12

how is polypharmacy clasified?

Answer 12

– Appropriate: prescribing for a patient with multiple conditions where
medication use is optimised and prescribed according to best
evidence
– Problematic: prescribing multiple medications inappropriately or
where the intended outcome of the medication is not achieved

Question 13

what is deprescribing? how does one stop it?

Answer 13

Process to ensure safe and effective withdrawal of inappropriate medication
tools:
STOP/START/STOPIT
NOTEARS
BEERS critera

Question 14

why do we worry about anticholinergic burden?

Answer 14

– Sedation – Constipation – Urinary retention – Blurred vision – All of these can increase the risk of confusion/delirium/falls in an
older patient.

Question 15

what effect may beta blockers have in a person with diabetes?

Answer 15

frequent hypoglycaemic episodes- there is a risk of masking hypoglycaemic symptoms

Question 16

what can thiazide diuretics mask?

Answer 16

exacerbating gout

Question 17

what should you do with digoxin with impaired renal function?

Answer 17

At doses ˃125 microgram per day with impaired renal funcƟon (eGFR ˂50ml/minute). Can be increased levels of toxicity (e.g. nausea, diarrhoea, arrhythmias)

Question 18

what dose of apixiban should be given in the elderly?

Answer 18

The recommended dose of apixaban is 2.5 mg taken orally twice daily in patients with NVAF and at least two of the following characteristics: age ≥ 80 years, body weight ≤ 60 kg, or serum creatinine ≥ 133µmol/L

Question 19

what are some high risk combinations to avoid with NSAIDS?

Answer 19

– +ACE and ARB (+diuretic = ‘triple whammy’) – +existing renal disease – +diagnosis of heart failure – +warfarin – +age >75 without PP

Question 20

what are some high risk drug combinations to avoid with warfarin?

Answer 20

– +antiplatelet – HOWEVER check as may be a genuine indication – +NSAID – +Macroline – +Quinolone – +Metronidazole – +Azole antifungal

Question 21

what should be avoided following a heart failure diagnosis?

Answer 21

– +Glitazone – +NSAID – +Tricyclic antidepressant

Question 22

what drugs may it be necessary to withold in those who are dehydrated due to the risk of renal function?

Answer 22

– NSAIDs – ACE/ARB – Diuretics (take specialist advice if heart failure) – Metformin – This can be restarted when the patient improves

Question 23

give examples of drugs that are poorly tolerated in frail older people?

Answer 23

* Digoxin in higher doses (i.e. over 250mcg) * Antipsychotics * Tricyclic antidepressants * Benzodiazepines * Antimuscarinics i.e solifenacin * Phenothiazines i.e. proclorperazine * Combination pain killers i.e. co-codamol

Question 24

what practical points are there relating to constipation in frail?

Answer 24

– Adequate fluid intake, diet, movement to reduce risk – Ispaghula husk preparations should not be prescribed to patients with limited mobility- risk of faecal impaction (adequate fluid intake also needed) – Movicol has a high sodium content – Excessive use of stimulant laxatives can cause electrolyte disturbance (low potassium)

Question 25

what practical points are there relating to respiratory disease in frail?

Answer 25

– Ensure older patients can use their inhaled devices – Ensure vaccination status up to date

Question 26

what key practical points is there relating to dementia?

Answer 26

– In general antipsychotics should not be used for behavioural and psychological symptoms of dementia – If antipsychotics are to be used in older people ensure appropriate dosage reduction

Question 27

what practical points are there for depression?

Answer 27

– Antidepressant should be continued for 6 weeks in order to determine the effectiveness – All antidepressants can cause hyponatraemia – this should be considered in all patients who develop drowsiness, confusion or convulsions – SSRIs increase GI bleeding risk when prescribed with NSAIDs/steroids and other drugs with increase risk

Question 28

what key practical points should be given about bone health?

Answer 28

– Patients prescribed bisphosphonates should be prescribed calcium and vitamin D – check calcium levels to avoid hypercalcaemia – Consider vitamin D deficiency in all patients – therapeutic dose is 800mg/400iu daily – Consider preferred formulations to increase compliance – Revise how to counsel a patient on taking a bisphosphonate

Question 29

what key practical points should be given about hypertension?

Answer 29

– Target (without diabetes or CKD) is less than 150/90mmHg for people over 80 years old – CCB preferred (without diabetes) consider thiazide like diuretic if have heart failure (or high risk of) or develops ankle oedema – Initiate at lower doses and titrate slowly to avoid postural hypotension – Caution re ACE inhibitors and renal function – risk of AKI

Question 30

what should you look out for in thyroid disorders?

Answer 30

– Look out for the symptoms of over or under replacement

Question 31

what are the key practical points about pain?

Answer 31

– Consider risks and benefits carefully – Increased risks of opioid medication in older people – Paracetamol – remember dose reduction if patient less than 50kg

Question 32

what key points are there about PD?

Answer 32

– Medications used to treat can contribute to confusion, constipation and postural hypotension – monitoring and careful dosage adjustment – Remember the importance of timing of doses ‘get it in time’ rules

Question 33

what are they key points relating to urinary problems?

Answer 33

– Older people more prone to the antimuscarinic side effects of drugs used to treat urinary incontinence – People of child-bearing age should not handle finasteride or dutasteride tables/capsules – caution re dispensing and dosette boxes