Frailty Flashcards by Davitika Sharma

What is the state of increased vulnerability in the body called?

Frailty

Frailty is characterized by a loss of inbuilt reserve in body systems.

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What factors can contribute to frailty?

Ageing and decline in health

External stressors can also worsen frailty.

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What are the associated risks of frailty?

Increased risk of deterioration and acute hospital or care home admission

This is due to the body’s increased vulnerability.

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Which scales can be used to assess frailty?

Rockwood Clinical Frailty Scale and 4AT

A medication review may also be conducted to determine correlation.

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What is multimorbidity?

Co-existence of 2 or more chronic conditions

Multimorbidity leads to higher death rates and decreased quality of life.

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What impacts does multimorbidity have on patients?

Higher death rates
Increased disability
Adverse events
Decreased quality of life

Involvement of friends or family in healthcare decisions is essential.

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How does the severity of chronic conditions change over time?

Severity, prognosis, and symptom burden worsen due to ageing

Clinically dominant conditions may overshadow others.

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What are some common symptoms of frailty?

Instability/falls
Immobility
Impaired cognition
Incontinence
Adverse drug reactions (ADRs)

Other symptoms include slowness, weakness, and weight loss.

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What communication approach should be used when discussing frail patients?

Positive communication and avoid labelling

Negative words should be avoided when explaining or identifying a frail patient.

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What is the purpose of a geriatric assessment?

To determine medical, physiological, and functional capability

The goal is to develop an integrated plan for support and treatment.

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What is polypharmacy?

Use of multiple medications for multiple conditions

It can be beneficial if medications are appropriately prescribed.

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What can worsen frailty symptoms?

Polypharmacy

Particularly when there is no evidence-based prescribing.

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What is the significance of deprescribing?

It should become a regular process

This is to avoid adverse drug reactions and optimize treatment.

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How does delirium differ from dementia?

Delirium is acute and lasts for days/weeks; dementia has a gradual onset and deteriorates over years

Assessing cognitive impairment is crucial in differentiating between the two.

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What are the types of delirium?

Hyperactive delirium
Hypoactive delirium
Mixed delirium

Each type has distinct characteristics in terms of patient behavior.

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What is the prescribing cascade?

When an adverse drug reaction (ADR) is misinterpreted as a new condition

This leads to further prescriptions and potential side effects.

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What is the anti-cholinergic medication burden?

Chronic use can make cognitively intact individuals appear demented

It increases mortality risk; an ACB score >3 indicates the need for a medication review.

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How is postural hypotension measured?

By having the patient lying down for 5 minutes

A significant drop in blood pressure indicates postural hypotension.

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What symptoms can result from postural hypotension?

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Nausea
Dizziness
Vision loss
Lethargy
Fatigue

Certain medications can cause postural hypotension.

What can frailty be caused by?

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Delirium, increased risk due to cognitive impairment or dementia

Cognitive impairment or dementia can exacerbate the risk of delirium, leading to frailty.

What tests are used to confirm a diagnosis for delirium?

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Urinalysis
Sputum culture
FBC
Folate and B12
Calcium
U&E
HbA1c
LFTs
TFT
ECG
Chest X-ray
AMT or CAM test
Drug levels (toxicity of lithium or digoxin)
Infection and inflammatory markers (CRP)

These tests help identify underlying causes of delirium.

What are some differential diagnoses for delirium?

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Depression
Thyroid disease
Charles Bonnet syndrome
Epilepsy

It is important to differentiate delirium from these conditions to provide appropriate treatment.

What does the acronym PINCH ME stand for in delirium diagnosis and symptom analysis?

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P: Pain
I: Infection
N: Nutrition
C: Constipation
H: Hydration
M: Medication
E: Environment analysis

This acronym helps healthcare professionals remember key areas to assess when diagnosing delirium.

What medication should be stopped due to the risk of falls?

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Risperidone

According to the STOPP criteria, risperidone is inappropriate for patients at risk of falls.

What medication should also be stopped for patients prone to falls?

Lorazepam ## Footnote Lorazepam is contraindicated in patients at risk of falls due to its sedative effects.

What medication can be added for constipation in patients?

Senna or Movicol ## Footnote These medications help relieve constipation, which is a common issue in elderly patients.

What should be added to a dementia patient's medication regimen?

Memantine ## Footnote Memantine is used to treat symptoms of dementia.

What lifestyle advice is recommended to avoid dehydration?

Encourage adequate fluid intake of 2 litres per day ## Footnote Proper hydration is crucial for preventing complications in elderly patients.

What is the recommended blood pressure target for patients over 80?

<150/90 mmHg ## Footnote Older patients have different blood pressure management goals to reduce the risk of falls.

What can anti-cholinergic drugs inhibit?

Action of acetylcholine at the CNS and PNS ## Footnote This inhibition can lead to several side effects, including cognitive impairment and increased risk of falls.

What is the pharmacological treatment for postural hypotension?

Fludrocortisone 50-100 mcg OD to a maximum of 300 mcg daily; caution in heart failure patients ## Footnote Fludrocortisone helps increase blood volume and blood pressure.

True or False: Docusate should be added if a patient is constipated.

True ## Footnote Docusate is a laxative that can help manage constipation.

What medication should be stopped if there are no clear indications for its use?

Amitriptyline ## Footnote This medication is often inappropriate for elderly patients without specific indications.

What should be done with atorvastatin in elderly patients?

Can be stopped as it may have no use at the patient's age ## Footnote Age-related considerations can affect the necessity of certain medications.

What should be monitored post-discharge for patients with changes in medication?

* Blood pressure * TFTs 4-6 months after dose change * CFS and CAM test * Nutrition * Hydration * Carer support ## Footnote These factors are essential for ensuring a safe transition post-discharge.

What should be done with medications that worsen symptoms?

Reduce dose or discontinue ## Footnote Regular medication reviews are crucial to avoid adverse effects in elderly patients.

What lifestyle change can help reduce constipation?

Eat a high-fiber diet ## Footnote A high-fiber diet supports digestive health and helps in preventing constipation.

What is a main reason for not prescribing medication?

No evidence based indication, indication has expired or dose is too high ## Footnote This highlights the importance of evidence-based medicine in prescribing practices.

What is a reason for prescribing medicines that is considered problematic?

Medicines are being prescribed to treat side effects of other medicines ## Footnote This can lead to a cycle of polypharmacy, where patients take multiple medications that may interact negatively.

Fill in the blank: Medicines fail to achieve _______.

intended therapeutic objectives ## Footnote This indicates that some medications do not work as intended for the patient.

What is a consequence of medicines causing unacceptable adverse drug reactions?

Patients may discontinue use or seek alternative treatments ## Footnote Adverse drug reactions can significantly impact patient safety and quality of life.

What can make the demands of medicine-taking unacceptable for patients?

The patient is unable to maintain adherence ## Footnote Factors such as complex dosing schedules or side effects can affect adherence to medication regimens.

Name 3 worst medicines for frailty patients to be taking?

1. benzodiazepines; more sensitive to CNS depressants and have slower clearance; leads to sedation, falls, delirium 2. anticholinergics; worsen cognitive impairment and delirium; ACB effect 3. opioids; lower renal function and CNS sensitivity makes pt more prone to sedation, falls or delirium

what drugs should you withhold for patients who are severely dehydrated?

- ACEi - NSAIDs - metformin - diuretics -> can be restarted once pts condition is improved -> can lead to volume depletion; can further lead to AKI

what symptoms can postural hypotension cause?

- nausea and dizziness - falls - blurred vision - lethargy and weakness - neck pain

drugs that can cause postural hypotension?

- alpha blockers - antihypertensives - any anticholinergic medicine / antihistamines also have ACB - loop/thiazide diuretic

Frailty Flashcards

(46 cards)