FTT

Question 1

What is the definition of frailty?

Answer 1

A state of age-related physiologic vulnerability resulting from impaired homeostatic reserve and a reduced capacity to withstand stress

Question 2

The frail older adult is identified by one or more of the following characteristics:
4

Answer 2

1. Extremes of old age
2. Frailty = unstable disability
3. Function fluctuates with minor stressors!
4. Multiple chronic diseases and/or geriatric syndromes

Question 3

Study of Osteoporotic Fractures (SOF) index:
3

What is considered a predictor of risk of falls, disability, fractures and death?

Answer 3

1. Weight loss of 5% or more over 2 years
2. Inability to stand from a chair 5 times without using arms to push up
3. Negative response to the question: “Do you feel full of energy?”

2 of 3 positives considered a predictor of risk of falls, disability, fractures and death

Question 4

Fratility Outcome Risks

7

Answer 4

1. Falls
2. Acute illness
3. Hospitalizations
4. Disability
5. Dependency
6. Institutionalization
7. Death

Question 5

Key components of Frailty

4

Answer 5

1. Musculoskeletal Function
2. Cognitive/Integrative Neurological Function
3. Nutritional Reserve
4. Aerobic Capacity

Question 6

Frailty - A clinical syndrome
1. Symptoms? 4

2. Signs? 4

Answer 6

1. Symptoms
   - Weakness
   - Fatigue
   - Anorexia
   - Inactivity
2. Signs
   - Weight loss/malnutrition
   - Decreased muscle mass
   - Decreased bone mass
   - Anemia

Question 7

Contributing factors to frailty?

7

Answer 7

1. Heavy drinking
2. Cigarette smoking
3. Physical inactivity
4. Depression
5. Social isolation
6. Multiple chronic medical problems
7. Poor perceived health

Question 8

Triggering events for frailty? 4

What leads to a blocked recovery time? 6

Answer 8

1. Triggering events:
   - Chronic disease
   - Inactivity
   - Infection
   - Hip fracture
2. Blocked recovery time:
   - Depression
   - Medication interactions
   - Malnutrition
   - Fear of falling
   - Underlying cognitive status
   - Underlying functional status

Question 9

Definition of Failure to Thrive?

Answer 9

The near irreversible end of the natural history of the syndrome of frailty.

National Institute of aging definition: A syndrome of weight loss, decreased appetite and poor nutrition and inactivity

Question 10

Failure to Thrive

Components? 3

Answer 10

1. Physical frailty
2. Disability
3. Impaired neuropsychiatric function

Question 11

FTT: Often accompianed by? 4

Answer 11

1. Dehydration
2. Depressive symptoms
3. Impaired immune function
4. Low cholesterol

Question 12

1. Disability definition? 2

2. Examples of Impaired neuropsychiatric function? 2

Answer 12

1. • Defined as difficulty or dependency in completing tasks essential for self-care and independent living
   • loss of >1 ADL
2. • Depression
   • Cognitive Impairment

Question 13

Disability is assessed by? 2

Answer 13

ADLs

IADLs

Question 14

Katz ADL scale assesses basic life skills are?

6

Answer 14

the patient’s ability to

1. bathe,
2. dress,
3. toilet themselves,
4. transfer,
5. feed themselves, and
6. maintain continence

Question 15

Impaired Neuropsychiatric Function
1. What are the most common conditions affecting cognitive status in older adults? 3

2. May be a result of what? 2

Answer 15

1.

• Delirium,
• depression, and
• dementia

2. • May be a result of medical comorbidities
   • Medication effects

Question 16

Disability is an _________ risk factor for mortality, hospitalization, and need for long-term care

Answer 16

independent

Question 17

What does sarcopenia call?

4

Answer 17

1. Loss of muscle with age
2. Loss of lean body mass
3. Diminishes the acute phase response to physiological stress
4. Decreases immune competence

Question 18

How much muscle do we lose per year after the age of 25?

Answer 18

0.5-1% loss per year after the age of 25

Question 19

FTT: Signs and Symptoms? 4

A useful working definition requires that three criteria be met? 3

Answer 19

1. Impaired physical functioning
2. Malnutrition
3. Depression
4. Cognitive impairment
5. Biopsychosocial failure
6. Weight loss or undernutrition
7. And no immediate explanation for the condition (no underlying terminal disease)

Question 20

Underlying Principles: Several caveats bear review

1. Baseline functional data are the foundation of elder care and should be obtained ___________ on all elders
2. Although function declines predictably over time, it does so at a variable rate based on known age-associated metabolic parameters such as what? 3
3. FTT can occur from organic or non-organic causes, thus necessitating an approach that includes which approaches? 4

FTT initiated by a “trigger” event that impacts all four domains sets a framework for the evaluation and management of

Answer 20

1. annually
2. • FEV1,
   • BMR and
   • GFR
3. • medical,
   • psychological,
   • functional and
   • social

Question 21

History and Physical

Start by R/O acute medical problems such as? 3

Answer 21

1. Infection
2. Constipation
3. Exacerbation of chronic diseases:

Question 22

Exacerbation of chronic diseases that could cause FTT?

8

Answer 22

1. CHF
2. COPD
3. CAD
4. Uncontrolled endocrine disorder
5. Cancer
6. TB
7. Dementia
8. Depression

Question 23

1. Psychosocial history? 1
2. Change in social structure?
   6

Answer 23

1. Psychosocial history:
   - Increased memory loss
2. Change in social structure:
   - Death of a person or pet
   - Moving away of a friend or family member
   - Caregiver burnout
   - Recent environmental change
   - Financial concerns
   - Access to appropriate food, means to prepare and eat them.

Question 24

Comprehensive physical exam:

11

Answer 24

1. Vitals (Including weight and BMI)
2. Hearing defects
3. Eyes/vision
4. Oral health
5. Swallowing
6. JVD (could signify CHF)
7. Breast mass
8. Abdominal exam
9. Skin
10. Motor
11. Mental status

Question 25

Standard labs to evaluate FTT? 13 Three big ones?

Answer 25

1. CBC 2. Serum lytes 3. BUN Creatinine 4. Calcium 5. Glucose 6. Serum bilirubin and transaminase levels: 7. Albumin and cholesterol 8. TSH 9. Fecal occult blood 10. U/A 11. Vitamin B12, and D levels 12. ESR 13. PPD 1. CBC 2. CMP 3. TSH

Question 26

What might the following labs show: 1. CBC? 5 2. CMP? 5 3. Glucose? 2 4. Serum bilirubin and transaminase levels? 2 5. Albumin and cholesterol? 1

Answer 26

1. CBC: - Amemia, - vitamin deficiency, - infection, - hematopoietic or - lymphoproliferative disorder 2. Serum lytes, BUN, Creatinine, Calcium: - Hyper-hyponatremia - Acid base disorder - Osmolality - Renal function - Dehydration 3. Glucose: - Diabetes, - hypoglycemia 4. - Liver failure, - hepatitis 5. (markers for malnutrition)

Question 27

Once diagnosis of FTT is made: What needs to be assessed? | 6

Answer 27

1. Life expectancy of the patient should be assessed 2. Are symptoms/conditions reversible? 3. Risk-benefit assessment should be included in all interventions 4. Provider, patient and family should collaborate 5. As medical interventions become more limited, palliative measures can be initiated 6. Maintain a therapeutic relationship with the patient and family beyond the time medical therapies are effective!