Frailty Flashcards by X X

what is frailty

a state of increased vulnerability resulting from ageing

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what scores on the Rockwood Clinical Frailty Scale indicate death within 6 months

7-9

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at which point on Rockwood is the px completely dependent for personal care?

7 - severely frail

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frailty, disabiility and X overlap

multimorbidity

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what is the issue with strictly following guidelines with patients with frailty and multimorbidity?

dont provide guidance on multimorbidity so need to use clinical judgement

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what is multimorbidity?

co-existence of 2+ chronic conditions where 1 is not necessarily more central than others w disctinctive cumulative effects for each px

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what is multimorbidity assoc with?

inc rate of death, disability, AEs, use of healthcare resources, dec QoL

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comorbidities can be divided into what 3 groups

clinically dominant
synegistic
coincidental

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what is an example of a clinically dominant comorbidity

dementia trumps heart disease

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what is an example of a synergistic comorbidity

COPD and heart disease

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clinical reasoning and X are essential to managing comorbidity

shared decision making.
weight risks and benefits

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what is the pathophysiology of frailty

increasing sarcopenia with age, loss of function and reduced physiological reserve. vulnerability can lead to sudden deterioration

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what are the 5 frailty syndromes?

instability, immobility, delirium, incontinence, susceptibility to SE

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give examples of susceptibility to SE of meds

confusion w codeine
hypotension w antidepressants

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how to communicate frailty, avoid what?

labelling

say things like it can take longer to bounce back and vulnerability, lack of robustness, lack of resilience (dont sau complex sitch)

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what score of the EFS means that a patient needs a full MDT assessment to prevent frailty?

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what are the 2 comprehensive geriatric assessments to assess frailty

AMT
EFS

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aim of comprehensive geriatric assessment

to make a coordinated integrated plan for Tx and long term support

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what to ask px for EFS

on 5+ meds on regular basis
adherence + concordance
….

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what interventions can we make for frailty?

med revs, identify and reverse diagnoses, nutritional support, exercises, home first

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patients with a higher CFS are twice as likely to experience an ADR, true or false

true - frailty linked with increased risk AE

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5 main reasons of problematic pharmacy

no evidence based indication
meds prexc to treat SE of other meds
meds fail to acheive therap obj
meds cause unacceptable ADRs
demands of med taking are unacceptable to px/ px cant maintain adherence

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what are some of the worst tolerated meds in frailty?

NSAIDS,
long acting benzos,
sulphonylureas,
anticholinergics,
sedatives,
hypnotics

what is the prescribing cascade

when ADR is misinterpreted as a medical condition and new medicines are started

what is the prescribing vortex

when each medication causes a SE that is caused by the next

give an example of presc vortex with oral bisphosphonate at start

oral bisphosp -> GI SE -> PPI -> increased fracture risk -> back to start

is increased ACB (anticholinergic burden) score associated with increased morbidity

yes

what score on the ACB means that a MAP review is needed (meds, alternatives, px monitoring)

name 6 anticholinergic SEs

urinary retention dry throat, mouth, constipation feel hot, sweat tachcardia blurry vision, dry eyes sedation, dizzy, confusion

What is MAP

medicines - is it essential alternatives patient monitoring - symptoms and SE

name 2 meds w highest ACB score

amitryptyline chlorphenamine

what should be avoided with NSAIDs as they are high risk combinations?

ACEi/ARB, existing renal disease, HF, warfarin, no PPI and age over 75

what are high risk combinations with warfarin

antiplatelet (some exceptions), NSAID, macrolide, quinolone, metronidazole, azole antifungal

if someone has HF, what should be avoided

glitazones, NSAIDs, tricyclic antidepressants

which drugs are associated with rapid symptomatic decline if stopped or require cautious stepwise withdrawal

ACEi in HF, diuretics in HF, rate/rhythm control, opioids, antidepressants. antipsychotics, antiepileptics

what is delerium caused by

acute illness or drug toxicity, often reversible and affects attention

pts with dementia are not at increased risk of delirium, true or false

false

what condition: typically caused by anatomic changes in brain, slower onset, generally irreversible and affects memory

dementia

2 diagnostic tools for delirium

AMT CAM

Pinch me acronym - causes of delirium

pain, infection, nutrition, constipation, hydration, medication, environment

what is hyperactive delirium

heightened arousal, restless, agitated, aggressive

what is hypoactive delirium

apathy, quiet confusion often confused w depression

Who is at risk of falling?

visual impairment, cognitive impairment, physically frail, alcohol, mutilple meds, fear of falling

multifactorial falls risk assessment may include what?

identification of falls hx assess gait, balance, mobility, muscle weakness OP risk visual impairment urinary incontinence ...

how to measure a postural BP

lie for 5 mins then measure when standing measure at 1,3 and 5 mins remain standing!

postural hypotension = inability to maintain BP on upright position from supine, leading to drop of what mmHG?

at least 20/10 drop

important risk factors of post hypo

ageing (assoc w physical deconditioning) meds affecting sympathetic tone (tamsulosin, antihypers, antideppressants SSRIs TCAs) dehydration

what is reflex tachycardia

blood pressure lowers and the body compensates by increasing HR which increases blood pressure

which medicines cause postural hypotension

diuretics nitrates sildlenafil ethanol levodopa TCA antideps SSRIs anti epileptics carbamazepine anti psycho anti musc opiates

what is diabetes HbA1C target for someone with an advanced stage of frailty

over 70mmol/L (use clinical judgement) CFS 8, will pass away in next 6 months

should aspirin be used for primary prevention

lifestyle advice for postural hypotension

2L water, increase salt intake, get up slowly and clench muscles, not take hot baths, drink caffeinated drinks

pharmacological management of postural hypotension

fludrocortisone, midodrine

why must you not start risperidone/lorazepam in acute delirium in the elderly

increased fall risk

why is lactulose not a great choice for constipation

need lots of water to make it work and can cause abdominal discomfort

why should constipation be treated in the elderly

can lead to cognitive impairment and urinary retention

why would you not start a bisphosphonate in a pt with a CFS score of 7