FTT

Question 1

How many people 65 and older are considered frail?

Answer 1

• 10-25% of persons

- % increases w/ age

Question 2

Definition of frailty?

Answer 2

• a state of age-related physiologic vulnerability resulting from impaired homeostatic reserve and a reduced capacity to withstand stress
• the physiologic decline occurs across multiple systems
• syndrome that results from multi-system reduction in reserve to the extent that a number of physiological systems are close to or past the threshold of sx clinical failure
• as a result, the frail person is at increased risk of disability and death

Question 3

Characteristics of frailty?

Answer 3

• frail older adult is ID by one or more of the following characteristics:
  extremes of old age
  frailty=unstable disability
• fxn fluctuates w/ minor stressors
• multiple chronic diseases and/or geriatric syndromes

Question 4

What is the study of osteoporotic fractures (SOF) index?

Answer 4

• wt loss of 5% or more over 2 yrs
• inability to stand from a chair 5x w/o using arms to push up
• negative response to the question: “do you feel full of energy?”
• 2/3 positives considered a predictor of risk of falls, disability, fractures, and death

Question 5

Outcome risks of frailty?

Answer 5

• falls
• acute illness
• hospitalizations
• disability
• dependency
• institutionalization
• death

Question 6

What are the key components of frailty?

Answer 6

• musculoskeletal fxn: strength
• cog/integrative neuro fxn: dementia
• nutrional reserve
• aerobic capacity

Question 7

Signs and sxs of frailty?

Answer 7

- sxs:
weakness
fatigue
anorexia
inactivity
- signs:
wt loss/malnutrition
decreased muscle mass
decreased bone mass
anemia

Question 8

Contributing factors of frailty?

Answer 8

• heavy drinking
• cigarette smoking
• physical inactivity
• depression
• social isolation
• multiple chronic medical problems
• poor perceived health

Question 9

Triggering events lead to frailty? Causes of blocked recovery time?

Answer 9

-triggering events:
chronic disease
inactivity
infection
hip fracture

-blocked recovery time:
depression
med interactions
malnutrition
fear of falling
underlying cognitive status
underlying fxnl status

Question 10

FTT definition?

Answer 10

• near irreversible end of natural hx of syndrome of frailty
• national institute of aging definition: syndrome of wt loss, decreased appetite and poor nutrition and inactivity
  often accompanied by:
  dehydration
  depressive sxs
  impaired immune fxn
  low cholesterol

Question 11

Components of FTT?

Answer 11

• physical frailty
• disability
• impaired neuropsych fxn

Question 12

Factors of of FTT?

Answer 12

• meds: effects/interactions
• comorbidities: COPD/CHF, malignancy, DM, arthritis
• psychosocial factors:
  isolation, grief, financia, abuse/neglect

Question 13

Definition of disability? Assessing this?

Answer 13

• defined as difficulty or dependency in completing tasks essential for self-care and independent living
• objective assessments:
  ADLs
  IADLs

Question 14

What is impaired neuropsychiatric fxn?

Answer 14

• delirium, depression, and dementia are MC conditions affecting cognitive status in older adults:
  may be result of medical comorbidities
  med effects
  can contribute to development of disability, malnutrition and frailty

Question 15

What may cause disability to develop?

Answer 15

• may develop slowly due to progressive co-morbidities and frailty, or acutely due to catastrophic events (stroke)
• disability is an independent RF for mortality, hospitalization, and need for long term care

Question 16

What is sarcopenia?

Answer 16

• 0.5-1% loss per yr after the age of 25
• implicated as one of several contributors of FTT
• loss of muscle w/ age
• loss of lean body mass
• diminishes the acute phase response to phsyiological stress
• decreases immune competence

Question 17

What kind of wt loss is correlated w/ decline and mortality?

Answer 17

• muscle loss

- BMI is significant predictor of subsequent nursing home placement

Question 18

Signs and sxs of FTT?

Answer 18

• impaired physical fxning
• malnutrition
• depression
• cognitive impairment
• a useful working definition reqrs that 3 criteria be met:
  biopsychosocial failure
  wt loss or undernutrition
  and no immediate explanation for the condition (no underlying terminal disease)

Question 19

importance of H and P for eval pt w/ FTT?

Answer 19

• key in establishing the onset of condition and uncovering potential triggers
• R/O acute medical problems:
  infection
  constipation
  exacerbation of chronic diseases: CHF, COPD, CAD, uncontrolled endocrine disorder, cancer, TB, dementia, depression

Question 20

Impt of drug review during H and P?

Answer 20

• more women than men at risk
• pt using more than 14 rxs in a year
• ETOH ingestion and its potential influence on meds
• how is pt taking the meds and when is pt taking the meds?

Question 21

Impt of Psychosocial hx?

Answer 21

• increased memory loss?
• change in social structure?
  death of person or pet
  moving away of friend or family member
  caregiver burnout
  recent enviro change
  finanacial concerns
  access to approp. food, means to prepare and eat them

Question 22

What should be included in physical exam?

Answer 22

• vitals: wt and BMI
• hearing defects
• eyes/vision
• oral health
• swallowing
• JVD
• breast mass
• abdominal exam
• skin
• motor
• mental status

Question 23

Labs for eval of FTT?

Answer 23

• CBC: anemia, vit deficiency, infection, hematopoietic or lymphoproliferative disorder
• serum lytes, BUN, creatinine, Ca:
  hyper-hyponatremia, acid base disorder, osmolality, renal fxn, dehydration
• glucose: diabetes, hypoglycemia
• serum bili and transaminanse levels: liver failure, hepatitis
• albumin and cholesterol (markers for malnutrition)
• TSH
• fecal occult blood
• U/A
• vit B12, and D levels
• ESR
• PPD

Question 24

Once a dx of FTT is made then what should be done?

Answer 24

• life expectancy of pt should be assessed
• are sxs/conditions reversible?
• risk-benefit assessment should be included in all interventions
• provider, pt, and family should collaborate
• as medical interventions become more limited, palliative measures can be initiated
• maintain a therapeutic relationship w/ the pt and family beyond the time medical therapies are effective

Question 25

Team approach for FTT? What needs to be done for the pt?

Answer 25

- address advanced directives - eliminating, substituting or chaning admin time of drugs may reveal if SEs are contributing to the problem - consultation w/ PharmD and utilize specialists by phone or referral to optimize chronic disease managements - social services - caregiver education and support/respite - concerns about abuse and neglect need to be discussed openly and frankly w/ family and caregiver - nutritional consult