Frailty and FIT Team in ED

Question 1

Frailty definition

Answer 1

A medical syndrome with multiple causes and contributors that is characterised by diminished strength, endurance and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death

Question 2

list the 5 frailty syndrome domains described by the British Geriatric Society

Answer 2

Falls
Immobility
Delirium
Incontinence
ADR -susceptible to side effects of medication

Question 3

What is frailty a strong predictor of

Answer 3

falls
mortality
institutionalisation
hospitalisation

Question 4

what is the fried frailty definition

Answer 4

unintentional weight loss
impaired grip strength <30kg men < 20kg women
self-reported exhaustion
slow gait speed
low physical activity
considered frail if it individual fits into at least of these characteristics

Question 5

how does the cumulative deficit model define frailty

Answer 5

an accumulation of deficits ranging from hearing loss, low mood, tremor, through various diseases e.g. dementia can occur with age and in combination with inc/ frailty index increase risk of adverse outcome

Question 6

examples of frailty screening tools

Answer 6

Frailty Index (research gold standard)
Rockwood Clinical Frailty Scale
Edmonton Frail Scale
Identification of Seniors at Risk (ISAR)
PRISMA 7 Questions – recommended by British Geriatric Society
Think Frailty
Gait speed / TUG

Question 7

what is the hand grip a good predictor for?

Answer 7

predictor of all-cause mortality
predictor validity for decline in cognition, mobility, functional status
associated with frailty

Question 8

what is walking speed predictive of

Answer 8

Functional dependence
Frailty
Mobility disability
Cognitive decline
Falls

Question 9

what is the gold standard for frailty

Answer 9

comprehensive geriatric assessment

Question 10

what is the comprehensive geriatric assessment

Answer 10

a multi-dimensional, multi-disciplinary diagnostic and therapeutic process conducted to determine the medical, mental, functional and social needs of older people with frailty so that a co-ordinated, holisticand integrated plan for treatment and follow-up can be developed.

Question 11

list domains of comprehensive geriatric assessment

Answer 11

function and ability
disease severity and comorbidity
support networks and needs
mental health and cognition

Question 12

describe FITT

Answer 12

Frailty intervention therapy teams
beaumont hospital FITT in 2015
MDT approach

Question 13

describe the Home FIRsT pathway

Answer 13

tries to screen all patients above 70 for frailty presenting to the ED from 8:00 to 18:00 Mon to Fri
identify frailty syndromes in ED
triaged by ED nurse
HSCP -interdisciplinary Ax of physical, cognitive, functional and social care
time - timely decision-making and commencement of appropriate treatment/referral pathway
relative members of teM ANP, OT, PT, MSW

Question 14

4AT

Answer 14

ALertness
AMT4 - age, DOB, place, YEAR
Attention - list months of year backwards
Acute change or fluctuating change

Question 15

what are the domains of comprehensive geriatric assessment

Answer 15

function and ability
disease severity and comorbidity
support networks and needs
mental health and cognition

Question 15

describe the manchester triage score

Answer 15

1 = immediate resuscitation - pt. needs immediate Tx to save their life
2 = very urgent - seriously ill or injured, lives not in immediate danger
3 = urgent - v/ serious problems but stable condition
4 = standard - standard case w/o immediate danger
5 = non-urgent - conditions are not true accidents or emergencies

Question 16

what population is at high risk of developing delirium

Answer 16

people with dementia

Question 17

what types of delirium are there

Answer 17

hyperactive
hypoactive

Question 18

explain hyperactive delirium

Answer 18

agitated behaviour
confusion
hallucinations

Question 19

describe hypoactive delirium

Answer 19

new sleepy
drowsy

Question 20

what identification tool can be used to assess delirium

Answer 20

4AT

Question 21

LIST the clinical frailty scale

Answer 21

1 = very fit (active, energetic, fittest amongst age group)
2= fit (no active disease symptoms , not active)
3 = managing well (well controlled medical problems, not regularly active)
4 = v/ mild frailty (previously vulnerable, symptoms limit activities but still managing independently)
5 = mild frailty (need help with heavy housework, impars shopping, meal prep)
6 = moderate frailty (need help w/ outside ADL and keeping house, difficulty climbing stairs, needs help bathing)
7 = severe frailty (completely dependent for personal care, seem stable, not high risk of dying)
8 = severe frailty (completely dependent for personal care, approach end of life)
9 = terminally ill (approaching end of life, not severe frailty, life expectancy <6/12)

Question 22

list the fall risk factors that must be discussed with the patient during the clinical assessment

Answer 22

– Fear of falling, difficulty with walking / balance, footwear, walking aids

Question 23

what would be considered in the emergency dept

Answer 23

Imaging reviewed / reported
Weight-bearing status clarified
Optimal pain relief
Appropriate gait aid – RZF / crutches / stick
Simulation of home environment - stairs, rails
Transport home
Follow-up: Orthopaedic apt, PCCC PT/OT

Question 24

characteristics of good interdisciplinary team

Answer 24

leadership
communication
personal rewards
appropriate resources
clarity of vision
quality and outcome of care

Question 25

benefits of interdisciplinary team

Answer 25

Avoid duplication for patient
Continuity of care during ED visit
Early discussion re. patient expectations
Early engagement with family
Integration with community services
Handover with assessment findings & plan to ward therapists if patient admitted