Learning Objectives

Candidates will be able to:

Understand the concept of frailty as a long term condition where there is increased vulnerability to minor stressors.
Understand the phenotype model of frailty as consisting of at least 3 of : reduced strength, reduced physical activity, fatigue, slow walking speed and unintentional weight loss
Understand the concept of frailty where deficits are accumulated to put people at higher risk of adverse outcomes than other people of the same age
Understand that assets may offset deficits and help build resilience
Understand the concept of frailty syndromes and how these might present: delirium, falls, reduced mobility, new or worsening incontinence, medication side effects

Candidates will be able to:

Understand how to identify frailty with specific reference to the electronic frailty index and clinical frailty scale
Understand that frailty should be assessed based upon a person’s baseline state, how they were before they became acutely ill
Understand what comprehensive geriatric assessment is, and the evidence for improved outcomes
Outline the components of comprehensive geriatric assessment and understand how to act on findings

Candidates will be able to:

Understand that acute confusion is an indicator of delirium and may be a sign of acute illness
Understand how to assess for delirium using the 4AT
Diagnose delirium with reference to the DSM V Criteria
Understand common risk factors and precipitants for delirium
Outline what tests are necessary for investigation of delirium
Understand how to prevent and manage delirium using a multicomponent plan
Understand the links between dementia and delirium

Candidates will be able to:

Define the umbrella term dementia and how it differs from memory problems that can occur with ageing
Recognise early, middle and late stages of dementia
Understand the benefits of early diagnosis of dementia
Outline how dementia is assessed and diagnosed
Understand why some people may not seek a dementia diagnosis, or actively resist it
Understand how to live well with dementia including staying, active, maintaining independence for as long as possible and planning for the future
Outline the most common causes of dementia and differences in presentation between them
Understand why a person with dementia may exhibit distress and how behaviours in dementia may be a means of communicating an unmet need
Outline commonly used drugs for treatments of dementia and be able to describe the degree of benefit
Understand helpful techniques to communicate better with people who live with dementia and techniques to engage co-operation when care is required
Understand the role of person centred care in caring for someone with dementia, including when providing rehabilitation services

Candidates will be able to:

Identify people who are at high risk of falls
Understand that an acute increase in falls or an acute reduction in mobility can be a sign of acute illness
Understand the causes of reduced mobility or increase in falls
Describe a multifactorial intervention to reduce falls
Understand the common medications which may increase risk of falls
Identify common gait disorders
Understand how to manage orthostatic hypotension using lifestyle measures and medications
Describe the role of therapy assessments and interventions to reduce risk of falls
Understand the importance of fracture risk reduction as part of a falls management plan

Candidates will be able to:

Be aware that older people with frailty are more likely to develop side effects from medications
Be aware that changes in body composition, or liver and kidney function that can happen with ageing, increases the risk of side effects
Understand that medication side effects are a frailty syndrome that can result in acute illness, including hospital admission
Understand that medication side effects may increase risk of falls, immobility and delirium,
Describe a person centred approach for prescribing where a person has multiple co-morbidities
Identify medications that should always be continued
Identify medications that often cause harm
Know how to identify medications that are likely to benefit patients in a timeframe meaningful for them
Describe the use of shared decision making to come to an appropriate medication regimen for an individual person

Candidates will be able to:

Understand that people living with frailty may not recognise that term and be able to assess and manage frailty with sensitivity
Understand barriers to communication for people living with frailty and common techniques to facilitate better communication
Understand how to effectively use a “what matters to you?” approach to provide person centred care
Understand the role of patient stories in understanding illness and treatment
Describe the use of a person centred approach to help inform decisions about tests and treatments, including at the end of life

Candidates will be able to:

Understand the importance of eliciting a person’s values and preferences at all stages of care
Understand how to encourage people to express their wishes about their future care by using a person centred approach
Describe how a person’s wishes for their future care may be recorded and the role of advance care plans, advance decisions to refuse treatment, advance statements
Understand that advance care planning can be done at any stage of a person’s life and that wishes and preferences may change over time
Recognise health events and trajectories of illness that may trigger a meaningful conversation about a person’s advance care plan
Understand trajectories of illness in frailty compared to other health conditions, and when a person with frailty might be approaching the end of their life

Candidates will be able to:

Understand the range of community services that may be involved in a person’s care including health care, social care, community care, voluntary care housing support, mental health services
Understand the role of community services in providing acute care

Candidates will be able to:

Understand the socioeconomic as well as health causes of frailty
Understand approaches that can be used to prevent, delay or reverse frailty
Understand the use of a “making every contact count” model to provide interventions that can improve the health of older people to prevent, delay or reverse frailty

Candidates will be able to:

Understand what it means to be a carer
Signpost what support services and resources are available for carers
Understand that a person may be eligible for benefits
Be aware of mechanisms that can support the interests of a person living with frailty such as lasting power of attorney
Describe how to access a carer’s assessment and further support

Candidates will be able to:

Understand the five key principles of the mental capacity act
Understand the role of advance decisions and lasting power of attorneys to help make decisions where a person loses capacity
Understand how to assess capacity and know how to participate in a best interests decision for those lacking capacity
Negotiate dilemmas that may occur between duty of care and an individual’s rights and carers wishes

Candidates will be able to:

Understand the common causes of urinary incontinence
Describe the wide range of factors including eyesight, medications, physical function, co-morbidities, cognition and mobility that can affect continence
Understand the importance of integrating physical, functional and cognitive assessment to treat continence problems
Understand the role of medications, exercises and surgery for treating incontinence
Understand the role of containment devices to manage continence