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  <head>
    <title>043-02 Physiological reserve, medication burden, function, and goal-concordant ageing care</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Reserve, medication burden, function, and goals">
      <outline text="Narrowed reserve and presentation">
        <outline text="Normal resting values, narrowed reserve">
          <outline text="Acute illness crosses several thresholds"/>
        </outline>
        <outline text="Falls, confusion, immobility, new dependence"/>
        <outline text="Baseline function as a diagnostic vital sign"/>
      </outline>
      <outline text="Frailty and function">
        <outline text="Reduced reserve and impaired recovery">
          <outline text="Distinct from age, comorbidity, disability"/>
        </outline>
        <outline text="Scores estimate population risk only"/>
        <outline text="Contributors are modifiable"/>
        <outline text="Minor insult triggers dependence cascade">
          <outline text="Prevent with early mobilisation from day one"/>
        </outline>
        <outline text="Ask specifically, not just &quot;independent&quot;"/>
        <outline text="Destination follows trajectory and goals"/>
      </outline>
      <outline text="Sarcopenia">
        <outline text="Low strength with reduced quantity or quality"/>
        <outline text="Grip, chair rise, gait speed reveal more"/>
        <outline text="Progressively loaded resistance exercise"/>
        <outline text="Protein cannot rebuild without mechanical load"/>
      </outline>
      <outline text="Cardiovascular ageing and orthostasis">
        <outline text="Stiffness, afterload, diastolic filling"/>
        <outline text="Reduced beta response limits compensation"/>
        <outline text="Many factors combine into orthostatic hypotension"/>
        <outline text="Measure after rest, several minutes standing"/>
        <outline text="Heart-rate response separates causes">
          <outline text="Neurogenic: small heart-rate rise"/>
          <outline text="Volume depletion: larger rise"/>
        </outline>
        <outline text="Symptom diary matches treatment to conditions"/>
      </outline>
      <outline text="Kidney and drug handling">
        <outline text="Low muscle mass overestimates filtration">
          <outline text="Trends, cystatin, measured clearance"/>
        </outline>
        <outline text="Less reserve for water, sodium, potassium"/>
        <outline text="Water-soluble loading dose gives higher level"/>
        <outline text="Pharmacodynamics often outweigh kinetics">
          <outline text="Delirium, falls, hypoglycaemia, bleeding"/>
        </outline>
      </outline>
      <outline text="Reconciliation and deprescribing">
        <outline text="Ask what is actually taken"/>
        <outline text="Cascade: new drug treats earlier adverse effect"/>
        <outline text="Deprescribing as a monitored therapeutic trial">
          <outline text="Prioritise duplicates, toxicity, no indication"/>
          <outline text="Judge prevention by absolute benefit and time"/>
        </outline>
        <outline text="Abrupt cessation risks withdrawal or rebound"/>
        <outline text="Change in stages with baseline values"/>
        <outline text="Success measured by function, not count"/>
      </outline>
      <outline text="Falls as events with mechanisms">
        <outline text="Ask before, during, and after"/>
        <outline text="Causes can coexist"/>
        <outline text="Treat identified contributors"/>
        <outline text="Inability to rise predicts harm">
          <outline text="Pressure injury, rhabdomyolysis, hypothermia"/>
        </outline>
        <outline text="Walking does not exclude fracture"/>
        <outline text="Not simply a mechanical fall"/>
        <outline text="Graded return avoids disuse"/>
      </outline>
      <outline text="Delirium and comprehensive assessment">
        <outline text="Acute network dysfunction in vulnerable host">
          <outline text="Dementia does not explain acute decline"/>
          <outline text="Quiet patient may have hypoactive delirium"/>
        </outline>
        <outline text="Remove causes, rebuild orientation and cues"/>
        <outline text="Assessment converts problems into one plan">
          <outline text="Effective only when implemented and owned"/>
        </outline>
      </outline>
      <outline text="Nutrition and continence">
        <outline text="Weight loss as disease and function"/>
        <outline text="Texture modification can reduce intake"/>
        <outline text="Albumin reflects inflammation and illness"/>
        <outline text="Continence depends on access and assistance"/>
        <outline text="Anticholinergics worsen cognition and falls"/>
        <outline text="Catheters need indication and removal plan"/>
      </outline>
      <outline text="Capacity and goal-concordant care">
        <outline text="Specific decision at a specific time"/>
        <outline text="Barriers can falsely appear as incapacity"/>
        <outline text="Record decision, options, own-words understanding"/>
        <outline text="Capacity is not all or nothing"/>
        <outline text="Substitute acts on the person&#x27;s values"/>
        <outline text="Best, worst, most likely functional outcomes"/>
        <outline text="Proportionate care, not less care"/>
        <outline text="Plan ranks priority goal and reassessment">
          <outline text="Palliation and rehabilitation used together"/>
        </outline>
      </outline>
    </outline>
  </body>
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