Presentations
- Accelerated bone loss
- Carer stress
- Cognitive decline
- Concerned family members or carers
- Deconditioning
- Dehydration
- Deteriorating mobility
- Difficulty managing personal activities of daily living (pADLs) and instrumental activities of daily living (iADLs)
- Dysphagia
- Electrolyte derangement
- Falls
- Fatigue
- Fractures, e.g. neck of femur
- Frequent infections
- Functional decline, e.g. increase in level of need of assistance / decrease in independence
- Incontinence
- Isolation
- Malnutrition and vitamin / micronutrient deficiencies
- Non-specifically unwell
- Polypharmacy
- Poor energy
- Recurrent hospital admissions
- Review regarding need for residential care
- Skin pressure injuries and ulcers
- Skin tears
- Weight loss
Conditions
- Chronic cardiac diseases including exacerbations, e.g. cardiac failure
- Chronic respiratory conditions including exacerbations, e.g. chronic obstructive pulmonary disease (COPD)
- Delirium
- Depression
- Diabetes
- Frailty
- Malignancy
- Multimorbidity / chronic health conditions, including exacerbations
- Osteoarthritis
- Parkinson disease
- Polymyalgia rheumatica (PMR)
- Rheumatoid arthritis (RA)
- Sarcopenia
- Sarcopenic obesity
- Visual deterioration
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Other rheumatological conditions, e.g. ANCA-associated vasculitis (AAV), giant cell arteritis (GCA), scleroderma, systemic lupus erythematosus (SLE)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Incidence and prevalence of frailty
- Demographic transition of population ageing and associated impacts on hospitals and aged care facilities
- Pathophysiology, clinical course, and impact of the disease on patients and family or carers
Assessments
- ACAT assessment (Australia)
- Carer burden scales, e.g. caregiver strain index
- Cognitive screening tests, e.g. mini-ACE, MoCA
- Comprehensive geriatric assessment
- Falls risk assessment, e.g. MORSE
- Malnutrition assessment, e.g. MUST
- InterRAI assessment
- Pressure injury risk assessment, e.g. Waterlow score
- Screening assessment scales
- Clinical Frailty Scale (Rockwood)
- Frailty Phenotype (Fried)
- Swallow assessment, e.g. bedside versus instrumented
Examinations
- Berg balance scale
- Full physical examination, including skin
- Gait speed
- Grip strength
- Joint range of motion, e.g. shoulders, hips, and knees
- Timed up and go
- Weight
Investigations
- 25 hydroxy (OH) Vitamin D, DEXA bone scan
- Inflammatory markers, e.g. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
- Iron studies
- Routine biochemistry, e.g. electrolytes, renal and liver function, albumin, pre-albumin, cholesterol tests
- Routine haematology
- Thyroid function tests
- Tumour markers, e.g. myeloma screen
- Vitamin B12 and folate levels
- Advance care planning (ACP)
- Ageism and how patients are perceived and treated because they are frail
- Carer stress
- Differentiate between frailty and reversible causes of chronic inflammation, e.g. infections
- Early intervention programs for older people that aims to reverse and/or slow functional decline and improve wellbeing
- interventions including resistance training and a protein-rich diet
- Frailty rating scales and their inherent disadvantages
- Goal setting
- Healthcare and individual cost associated with frailty / functional decline
- Interventions to target or prevent frailty for an individual patient, e.g. medication review, dietary modifications / supplementation
- Importance of advocacy on the individual patient and population level
- Management of underlying comorbidities, including person-centred management, how to best manage the interplay between comorbidities (which may have competing management plans) to meet personal or functional goals
- Multidisciplinary team roles in the management of frailty, including physiotherapy, dieticians, occupational therapy, speech language therapy
- Pre-frail patients and evidence-based ways to reverse
- Programs that address frailty on an individual and population level
- Promotion of healthy ageing on a population basis
- Recognise the link between frailty and vulnerability, e.g. in pre-operative assessment and how it may impact on patients
- Risk of residential care as a consequence of frailty
- Role of inpatient and community-based rehabilitation in the assessment and management of frailty
- Role of medications in frailty management, assessment of polypharmacy and deprescribing
- Screening for elder abuse
- Socioeconomic and environmental issues
