S5 L2 Healthcare and Older People Flashcards Preview

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Flashcards in S5 L2 Healthcare and Older People Deck (14)
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1
Q

Define fraility?

A

Slightly different ones
Physiological → clinically recognisable state of increased vulnerability resulting from aging- associated decline in reserve and function across multiple physiological systems such that the ability to cope with everyday or acute stressors is compromised
Phenotypic → Low grip strength, low energy, slowed walking speed, low physical activity, and/or intentional weight loss

2
Q

What is important to remember about fraility?

A

Not just about age
Older people can be very fit and independent
Some young people can become severely frail and dependent at a young age

3
Q

Why is it important to recognise frailty?

A

Risk and opportunity
Risk → stressor - acute admission is a moment where someone can become frail
Opportunity → identify - deterioration and further decline in health and function can be slowed or prevented
Affects treatment and management plans

4
Q

How can frailty be detected?

A

Clinical frailty scale - can be completed by anyone

Frailty phenotype

5
Q

What is the clinical frailty scale?

A

Determines the level of frailty in a patient
1. Very fit - 9- very severely frail
Can be completely by anyone
Useful for developing best and most appropriate management plans

6
Q

What are the Geriatric giants?

A

Hyperacute frailty syndrome

  • Immobility and pressure sores
  • Instability (falls and fractures)
  • Incontinence and dipstick (+ve UTI)
  • Impaired memory (dementia, delirium)
  • Iatrogenesis
7
Q

What is the risk of determining a diagnosis for a frail patient?

A
  • Potential to miss important key information underpinning the frailty related syndrome
  • Normally about 5 different causes of frailty related syndrome
  • Leads to treatment failure
  • Better to write a problem list
8
Q

What is the risk of determining a diagnosis for a frail patient?

A
  • Potential to miss important key information underpinning the frailty related syndrome
  • Normally about 5 different causes of frailty related syndrome
  • Leads to treatment failure
  • Better to write a problem list
9
Q

How is frailty linked to outcomes?

A

If frailty not identified underlying causes will not be identified
→ Ineffective and inefficient care
→ ↑length of stay, ↑readmission, ↑institutionalisation, ↑mortality
(identification can help to predict and prognosticate)

10
Q

What is the anticholinergic burden?

A
  • Different medication can cause anticholinergic effects
  • Medications given a score of 1, 2, or 3 and total score determines how at risk they are
  • Potential causes the symptoms associated e.g. delirium
  • Other side effects
    → Drowsiness, lowering BP and lowering blood glucose
  • Balancing risk and benefit
11
Q

Why should we review medication that patients are on?

A

Frail older people are vulnerable to ‘iatrogenic’ harm

12
Q

How can we manage frail older patients?

A

Comprehensive geriatric assessment
- Evidence based treatments
- Holistic care- whole patient
- Medical, psychological/cognitive, functional, social networks and environmental
Underpinned by geriatric competences e.g. differentiate delirium from dementia etc….

13
Q

How does the severity of frailty affect managment?

A

Fit/Mild frailty → care as usual but address reversible issues
Moderate frailty → actively seek out and manage geriatric syndromes- falls, cognitive impairment, incontinence, polypharmacy (use Comprehensive geriatric assessment)
Severe frailty → think about supportive care vs cure, advance care planning, recognition that enhanced supportive care is an active intervention in itself offering improved QoL, sometimes quantity of life

14
Q

What is the implications of frailty in practice?

A

Use frailty to differentiate and prognosticate
Tailor and management accordingly- person (not condition) centred care, shared decision making
Frailty complex, solutions will need to be complex…. comprehensive geriatric assessment