Frailty

Question 1

Define frailty

Answer 1

Loss of: ST EN PH

Medical syndrome with multiple causes characterised by

• Diminished strength, endurance and physiological function

Increases an individuals vulnerability for developing dependency or death

10% people aged 65+ have frailty

25-50% are 85+

Question 2

What is polypharmacy?

Answer 2

4+ medications long term

Question 3

What is sarcopenia?

Answer 3

Degenerative loss of skeletal muscle mass, quality and strength associated with ageing

Question 4

What are the contributors to frailty?

Answer 4

Sarcopenia - major contributor

Diet/ vitamin D deficiency

Obesity

Congnitive, psychological and social aspects

Question 5

How can frailty be measured?

Answer 5

Phenotype model: defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss (WEak SLOW INactive EXHAUSTED SKINny)

Cumulative deficit model: the more things wrong with a patient the more likely they are to be frail - each aspect e.g. hearing loss, tremor, congitive changes, are given points which are added together to give a score

Question 6

What are frailty syndromes?

Answer 6

Syndromes that, if a patient has them, makes them more likely to be frail

• Falls
• Immobility
• Delirium and dementia
• Incontinence
• Susceptibility to side effects of medication

Question 7

Why is it important to recognise frailty?

Answer 7

• Frail older people are especially vulnerable to seemingly minor insults
• Higher risk of harm from hospitalisation, surgery, iatrogenic harm

Question 8

What advice can be given to patients with incontinence?

Answer 8

Don’t be afraid to drink during the day - concentrated urine irritates the bladder

• Last drink >2hrs before bed
• Spend longer on toilet
• Avoid caffeine (diuretic)
• Pelvic floor exercises

Question 9

Outline discharge planning

Answer 9

Begins long before patient is medically optimised for discharge

Destinations: home, rehab, residential home, nursing home, hospice

Successful discharge planning requires early info about all aspects of the patient’s life: how far can they walk, can they wash, can they feed themselves, any family/ support?

Question 10

What does successful discharge planning require?

Answer 10

Information regarding all aspects of the patient’s life

• Can they complete ADLs?
• Support?
• Housing suitable?

Question 11

What assessments are included in discharge planning?

Answer 11

• Joint ROM
• Ability to transfer from bed - chair - toilet etc
• Mobility
• Stairs
• Personal care
• Domestic tasks
• Cognitive assessments

Question 12

What are SMART goals?

Answer 12

Specific

Measurable 📏

Achievable

Realistic

Timely 🕒🕔🕖

Question 13

What interventions can be done before discharge?

Answer 13

• ROM exercises
• Strengthening exercise
• Transfer practice
• Mobility work
• Balance rehab
• Activity group work

Question 14

What is fast track discharge?

Answer 14

Patient within last 6 weeks of life

Medical decision to deem them fast track which allows for funding to be sought to allow patient to be discharged to a place they want to die

Point of access is the palliative care team in the hospital

Question 15

Who to contact regarding fast track discharge?

Answer 15

Palliative care team

This is for patients who are believed to be within 6 weeks of death

Question 16

What is multi morbidity?

Answer 16

Presence of 2+ complex conditions

• Often co-exists with frailty but can occur in isolation

Question 17

What does frailty increase the risk of?

Answer 17

• Hospitalisation 🏥
• Care home admission
• Death 🏜

Question 18

What is the electronic frailty index?

Answer 18

Index used by GPs to identify patients at risk of frailty

Prompts:

• Falls assessment
• Review of medication

Question 19

What are the 5 frailty syndromes?

Answer 19

IM INSTA INTELLECTUAL IN-CONTINENTal doctors

• Immobility 🦽
• Instability
• Intellectual impairment 🧠
• Incontinence
• Iatrogenic (medication, hospitalisation etc) 💊

Patients presenting with any of the above are more likely to be frail

Question 20

Discuss the MDT geriatric assessment

Answer 20

Massively reduces morbidity

• Falls assessment + fear of falling
• Assess mobility, gait and balance
• Osteoporosis risk
• Vision
• Cognition
• Incontinence
• Home hazards
• CV examination
• Med review

Question 21

Physiological changes that occur with ageing

Answer 21

Think of all the systems affected by ageing

Vision: reduced acuity, slower dark adaptation

Balance: loss of labyrinthe hair cells so redcued vestibular input

Mechanical: sarcopenia, osteoporosis

Neurological: reduced reaction time, reduced walking speak, cognitive impairment, reduced proprioception