Frailty

Question 1

Feeding at risk

• Foods
• Drinks

Answer 1

Feeding at risk

• Foods
  7. Regular
  6. Soft & bite-sized
  5. Minced and moist
  4. Pureed
  3. Liquidised
• Drinks
  4. Extremely thick
  3. Moderately thick
  2. Mildly thick
  1. Slightly thick
  0. Thin

Question 2

Continence Assessments
- Hx
- Ex
- Ix

Answer 2

Continence Assessments

Hx
1. Detailed history
2. Bladder and bowel diary

Ex
3. Abdo exam
4. PR
5. External genitalia
- atrophic vaginitis

Ix
6. Urine dip and MSU
7. Post-mic bladder scan

Question 3

Incontinence
- Mx

Answer 3

Incontinence
- Mx

1. Oral intake
   - Decaf
   - Improved food
2. Bowel habits
   - Regular
   - Bladder retraining
3. Pelvic floor ex
4. Anticholinergics not good
   - eg oxybutynin

Question 4

Care homes

1. Nursing
2. Residential

Answer 4

Care homes

• Nursing
  1. Nurses and care assistants
• Residential
  2. Trained staff, not nurses

Question 5

Carer strain
- Effects

Answer 5

Carer strain
- Effects

1. 3/4 mental health effects
2. 60% physical health effect

Question 6

Falls history
- Features

Answer 6

Falls history
- Features

1. When
2. Where
3. What
   - before?
4. Who saw?
5. Black out?
   - “I must have tripped”
6. Frequency?
   - 12 month history

Question 7

Falls assessment
- Points

Answer 7

Falls assessment
- Points

1. Hx and Ex
   - gait
2. ECG
3. Lying/standing BP
4. Medication review
5. Bone health review
6. Functional assessment MDT
   - Exercise programme

Question 8

CGA
- Components

Answer 8

Comprehensive Geriatric Assessment
- CGA Components

1. Medical
2. Functional
3. Psychological
4. Social
5. Environmental

Question 9

CGA
- Medical components

Answer 9

CGA
- Medical components

1. Problem list
2. Co-morbidities
   3 . Medication
3. Nutrition

Question 10

CGA
- Functional components

Answer 10

CGA
- Functional components

1. Basic ADLs
2. Instrumental ADLs
3. Gait and balance
4. Exercises/activity

Question 11

Orthostatic hypotension
- Definition

Answer 11

Orthostatic BP
- Definition

1. 20 systolic
2. 10 diastolic

Question 12

Lying and standing BP test
- Process

Answer 12

Lying and standing BP test
- Process

1. 5 minutes lying down
   - measure BP
2. Stand up
   - measure at 1 min
   - measure again at 3 mins

Question 13

CGA
- Psychological components

Answer 13

CGA
- Psychological components

1. Cognitive status
2. Mood assessment

Question 14

CGA
- Social components
- Environmental components

Answer 14

CGA

• Social components
  1. Informal social support
• Environmental assessment
  1. Care resource eligibility/finances
  2. Home safety
  3. Transport access

Question 15

Clinical frailty score
- Scores

Answer 15

Clinical frailty score
- Scores

1 -2
- Very fit, well

3-4
- Managing well, vulnerable

5-6
Mildly frail - moderately frail

7-9
Severely frail, very severely frail, terminally ill

Question 16

Power of Attorney

1. When made?
2. Powers?
3. Office?
4. Court of protection?

Answer 16

Power of Attorney

1. When made?
   - When patient has capacity
2. Powers?
   - Health and welfare
   - Property and financial affairs
3. Office?
   - Public guardian
4. Court of protection?
   - When not in best interests

Question 17

Feeding at risk
- Definition

Answer 17

Feeding at risk
- Definition

1. Continues to eat and drink
   - despite risk
2. Quality of life is highest priority

Question 18

Feeding at risk
- When used?

Answer 18

Feeding at risk
- When used?

1. Advanced stage of illness
2. Swallow safety not likely to improve
3. Tube feeding declined or inappropriate

Question 19

Fragility fracture
- Definition

Answer 19

Fragility fracture
- Definition

1. Falling from standing height
   - or lower
2. Walking speed
   - or slower

Question 20

Fragility fractures
- Most common sites

Answer 20

Fragility fractures
- Most common sites

1. Spine
   -vertebrae
2. Hip
   - proximal femur
3. Wrist
   - distal radius

also
- Humerus, pelvis, ribs

Question 21

Osteoporosis
- Definition

Answer 21

Osteoporosis
- Definition

1. Low bone mass syndrome
2. Micro-architectural deterioration of tissue
3. Increased risk of fractures
4. Bloods normal

Question 22

Fragility fracture
- Risk factors

Answer 22

Fragility fracture
- Risk factors

1. Age
   - F65, M 75
2. Previous falls/ fractures
3. Steroids
4. Family Hx
5. Low BMI
6. Smoking & alcohol

Question 23

FRAX assessment
- Risk stratification

Answer 23

FRAX assessment
- Risk stratification

1. 10 year probability of fracture
2. Based on BMD

Question 24

Bisphosphonates

1. Blood tests
2. Drug choices
3. Contraindications

Answer 24

Bisphosphonates

1. Blood tests
   - Ca, D3, GFR
2. Drug choices
   - Risedronate/alendronate
   - IV Zolendronate
   - Denosumab
3. Contraindications
   - Achalasia/strictures
   - Ulcers

Question 25

IV Zolendronate - Indication - Dosing

Answer 25

IV Zolendronate - Indication 1. Non-compliant to oral - Dosing 1. 30 minutes, once yearly 2. 3 year

Question 26

Denosumab - Indications - ADRs

Answer 26

Denosumab - Indications 1. Unresponsive to IV bisphosphonate 2. Low GFR - ADRs 1. Skin infection 2. Stress fractures

Question 27

Pressure sores - Screening tools

Answer 27

Pressure sores - Screening tools 1. Bestshot 2. Waterlow

Question 28

Pressure sores - Sites

Answer 28

Pressure sores - Sites 1. Sacrum 2. Ankles 3. Head 4. Ears 5. Knees

Question 29

Pressure ulcers - Risk Factors

Answer 29

Pressure ulcers - Risk Factors 1. Build 2. Skin type 3. MUST 4. Continence 5. Mobility 6. Tissue malnutrition 7. Neurological deficit 8. Major surgery/trauma

Question 30

Pressure sores - Grading

Answer 30

Pressure sores - Grading 1 Skin 2 Deep skin 3 Fat 4 Bone

Question 31

Pressure sores - Mx

Answer 31

Pressure sores - Mx 0. Prevention 1. Wound - pain and tolerance - position - dressing change 2. Friction reduction 3. Nutrition 4. Pressure redistibution - 2-hourly turns - air mattress - repose boots 5. Antimicrobials

Question 32

IMCA - Role

Answer 32

Independent mental capacity assessor 1. Involved in 'best interest' decisions

Question 33

DOLS - Role

Answer 33

Deprivation of liberty safeguard 1. Protect rights of person - When they cannot consent 2. Deprive them of their liberties

Question 34

Role of OT

Answer 34

Role of OT 1. Support independence 2. Minimise carer strain 3. Reduce risk to self and others

Question 35

Cardiac drug - Thyroid complications

Answer 35

Cardiac drug - Thyroid complications 1. Amiodarone 2. Hyper(/hypo)

Question 36

Renal dialysis Indications AEIOU

Answer 36

Renal dialysis Indications 1. Acidosis E I ntoxication Oedema Uraemia

Question 37

Hearing impairment - Speaking to patients

Answer 37

Hearing impairment - Speaking to patients 1. Slow 2. Consonants - beginning - ending

Question 38

CKD - UTI drug

Answer 38

CKD - UTI drug 1. Trimethoprim can cause AKI 2. Don't give to CKD3 or below

Question 39

AKI - Stop the DAMN drugs

Answer 39

AKI D - iuretics A - CE inhibitors M - etformin N - SAIDs

Question 40

Frailty 5 Phenotypes

Answer 40

Frailty 5 Phenotypes 1. Weight loss 2. Weakness 3. Exhaustion 4. Slowness 5. Low physical activity

Question 41

Prisma 7 score

Answer 41

Prisma 7 score 1. 85+ 2. Male 3. Limited activities 4. Regular carer available 5. Regularly staying home for health 6. Someone close for help 7. Mobility aids

Question 42

Frailty - TUG Test

Answer 42

TUG Test - Timed up and go 1.

Question 43

Geriatric giants - Five Is

Answer 43

Geriatric giants - Five Is 1. Immobility 2. Instability 3. Incontinence 4. Impaired memory 5. Iatrogenesis

Question 44

Phenotypic frailty - Five Lows

Answer 44

Phenotypic frailty - Five Lows 1. Low grip 2. Low energy 3. sLowed walking 4. Low physical activity 5. Unintentional weight Loss

Question 45

Approaching end of life - Definition

Answer 45

Approaching end of life - Definition 1. Likely to die within 12 months - Including imminent 2. Advanaced, progressive, incurable 3. General frailty 4. Existing conditions - Possible crisis 5. Sudden catastrophic events