OP: Falls and Frailty Flashcards Preview

Year 3 Medicine Block > OP: Falls and Frailty > Flashcards

Flashcards in OP: Falls and Frailty Deck (23)
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1
Q
A
2
Q

Patient’s PC: a fall.
What would you ask in Hx?

A

WHO saw you fall?
WHEN did you fall?
WHERE did you fall?
WHAT happened before/during/after?
WHY do you think you fell?
HOW many times have you fallen?

Meds taken? How do they mobilise usually?

3
Q

What PMH may be relevant in fall Hx?

A

CVS - arrhythmia, CVD
Resp - COPD
Neuro - Parkinson’s, peripheral neuropathy, stroke, dementia
GU - UTIs, incontinence
GI - Diverticulitis, chronic D-, ALD
MSK - Arthritis, chronic pain, fractures

4
Q

Why review meds in OP who has had a fall?

A

Polypharmacy is RF for falls. Meds have SE for increasing risk of falls.

5
Q

Name meds that increase risk of falls in OP

A

BBlockers
DM meds
HTN meds
Benzodiazepines
Abx

6
Q

What bloods do you need to request for a confusion screen for your patient? And what looking for?

A

FBC (e.g. infection, anaemia, malignancy)

U&Es (e.g. hyponatraemia, hypernatraemia)

LFTs (e.g. liver failure with secondary encephalopathy)

Coagulation/INR (e.g. intracranial bleeding)

TFTs (e.g. hypothyroidism)

Calcium (e.g. hypercalcaemia)

B12 + folate/haematinics (e.g. B12/folate deficiency)

Glucose (e.g.
hypoglycaemia/hyperglycaemia)

Blood cultures (e.g. sepsis)

7
Q

What score can we use in a clinical setting to evaluate for frailty?

A

Rockwood clinical frailty score >65yrs

8
Q

Some steps to prevent delirium?

A

avoid drugs that cause: opiates / benzodiazepines

asses factors that cause: pain control / drugs

Identify those at risk and monitor

use supportive and environmental management approaches for all patients

9
Q

Bedside investigations for OP that has Hx of fall?

A

Vital signs - BP, HR, RR, O2 sats, temp
Lying and standing BP (orthostatic hypotension)
Urine dip (blood ++ in rhabdo)
ECG - bradycardia, arrythmia
Cognitive screen
Blood glucose (Hypoglycaemia)

10
Q

Blood investigations to do for OP w/ Hx of fall?

A

FBC
U+Es - dehydrated, electrolyte abnorm, rhabdo
LFTs - chronic alcohol use
Bone profile - Ca levels in malignancy, over supplementation of Ca

11
Q

Imaging investigations for Op w/ Hx of fall?

A

CXR
CT head
Echo

12
Q

Use surgical sieve / systems review to AR causes of falls in OP

A

CVS - arrhythmia, ortho hypoT, Bradycardia, valvular heart disease

Neuro - Stroke, peripheral neuropathy

GU - Incontinence, UTI

Endocrine - Hypoglycaemia

MSK - Arthritis, Disuse atrophy

ENT - BPPV, ear wax

13
Q

How are OP who have fallen assessed?

A

Falls risk assessment
- ID people over 65 who have had 1+ falls in last 12/12.
- Take full Hx
- note RF
- assess gait and balance - use Timed Up and Go test +/- Turn 180deg test.

See CKS Nice guidance - falls risk assessemnt

14
Q

Commonly offered interventions for OP with recent falls Hx?

A

Strength and balance training
Home hazard assessment and intervention
Vision assessment
Medication review

15
Q

What is frailty?

A

Frailty is a syndrome of age-associated declines in physiologic reserve and function across multiorgan systems. This leads to increased vulnerability for adverse health outcomes

16
Q

Is frailty a disease?

A

NO- frailty it is the inability to withstand physical / psychological stressors.

can occur on a background of natural ageing or be triggered by disease.

17
Q

What are the common features of frailty (Frailty Phenotype)?

A

Weakness - measure grip strength
slowness (walking speed)
low level of physical activity
Feeling of exhaustion
unintentional weight loss >5kg in 1 year.

18
Q

What patient groups is it useful to assess for frailty?

A

Surgical patients
Cardiovascular disease
cancer
HIV

19
Q

What are pts with frailty more at risk of?

A

Falls
Anxiety
depression
unplanned hospital admissions

20
Q

What are the two models of frailty ?

A

Frailty Phenotype - features e.g. weight loss, exhaustion etc.

Rockwood - looks at accumulation of deficits (e..g loss of hearing, dementia, tremor) which combine to increase ‘ frailty index’

21
Q

How do you prevent frailty?

A

Physical activity (resistance exercise) to counteract loss of skeletal muscle function - sarcopenia.

Diet - enough protein / calories

Vitamin D - ensure not deficient

22
Q

What are the 5 frailty syndromes- raise suspicion that pt has frailty (prev: Geriatric Giants)

A

Falls

Immobility (e.g. sudden change ‘stuck in toilet’)

Delirium

Incontinence (change / new onset / worsening)

Susceptibility drug side effects (e.g. confusion with codeine, hypotension with antidepressants).

23
Q

After you have recognised a patient with frailty, how should they be managed?

A

A comprehensive Geriatric Assessment

A holistic review looking at:
Optimising current illnesses
Individual Goal setting
Drug review
Care planning - personalised escalation, end of life care, advanced planning

Multidisciplinary team members:
Geriatrician
Occ therapist / community carer
Mental health / social worker
Specialist nurse

Decks in Year 3 Medicine Block Class (56):