Frailty

Question 1

What are the different levels of frailty (1-10 using the Clinical Frailty Scale)?

Answer 1

1. Very fit
2. Well (no active disease symptoms)
3. Managing Well (not regularly active)
4. Vulnerable (not dependent on others, symptoms limit activities)
5. Mildly Frail (more evident slowing, high order LADLs)
6. Moderately Frail (help for outside activities + house keeping, bathing + minimal assistance with dressing)
7. Severely Frail (complete dependency for carer)
8. Very Severely Frail (approaching end of life)
9. Terminally Ill (Life expectancy <6 months)

Question 2

What is the CURB-65 scoring system?

Answer 2

Used to asses Pneumonia Severity
High score = low prognosis
Used on >65yrs

C = new mental confusion
U = urea >7 mmol/L
R = respiratory rate >30 per min
B = blood pressure (systolic BP <90 / diastolic BP <60)

Question 3

SCENARIO…

50 yr old man presents with right lower chest wall pain - pleuritic, breathlessness + haemoptysis. Has fever, bronchial breathing and dullness to percussion at the right base.

CXR = cloudy lungs seen

What is the diagnosis?

Answer 3

Pneumonia

Question 4

What is the treatment?

Answer 4

CURB-65
Antibiotics
Stop smoking
Follow up CXR

Question 5

How would we expect a recovery of pneumonia to be following treatment?

Answer 5

1 week: fever should have resolved
4 weeks: chest pain and sputum production should have been substantially reduced
6 weeks: cough and breathlessness should have substantially reduced
3 months: most symptoms should have resolved but fatigue may still be present
6 months: most people will feel back to normal

Question 6

What are the the manifestations of frailty?

Answer 6

• Delirium
• Falls + Fractures
• Immobility + pressure sores
• Incontinence + dipstick +ve UTI
• Iatrogenesis (injury caused by medication)

Question 7

What are characteristics that can be used to describe a ‘good death’?

Answer 7

• Avoiding medicalisation and thus prolongation of the dying process
• Avoid the situation of ‘medical captivity’ of being a frightened patient
• An agreed care plan
• Adequate symptom control

Question 8

What are the principles of a ‘good death’?

Answer 8

• To be warned when death is coming and learn what can be expected
• To be able to retain control of what happens
• To be afforded dignity and privacy
• To have control over pain relief and other symptom control
• To have choice and control over where death occurs
• To have access to information and expertise of whatever kind is necessary
• To have access to any spiritual or emotional support required
• To have access to hospice care
• To have control over who is present and who shares the end
• To be able to issue advance directives which ensure wishes are respected
• To have time to say goodbye, and control over other aspects of timing
• To be able to leave when is is time to go and not have life prolonged pointlessly