Domain – Disability care (Guiding topics)

Caring for patients with disability

The term disability refers to physical, sensory, intellectual, and psychological impairments that cause some level of restriction or limitation to activities or to an individual’s ability to participate in everyday activities.

• Understand the aetiology of common disabilities encountered in general practice:
  • cerebral palsy
  • spina bifida
  • autism spectrum disorder
  • chromosomal disorders; for example, Down’s syndrome, Di George syndrome
  • attention deficit hyperactivity disorder (ADHD)
  • neurological diseases such as multiple sclerosis (MS)
  • neurodegenerative diseases such as Alzheimer’s, Parkinson’s, and Huntington’s diseases
  • traumatic brain injury and spinal injuries.

• At every stage of caring for a patient with a disability understand and define the medico-legal implications of appropriate consent to treatment and to undertake preventive activities, specifically:
  • vaccination of high-risk populations
  • healthy lifestyle interventions; including diet, exercise and smoking cessation
  • reducing and/or preventing cardiometabolic risk factors
  • screening for carer stress
  • developing management plans, including managing sick days, for chronic conditions; such as asthma and type 2 diabetes
  • ensuring screening is always up to date; including cervical cytology, faecal occult blood test (FOBT), breast screening and screening for diabetes.

Disability in childhood

• Through a detailed history, examination and assessment, screen for childhood congenital, chromosomal or developmental disabilities:
  • during developmental assessments at the newborn stage and at every vaccination appointment
  • during antenatal screening, as appropriate, and monitor for physical and congenital disabilities in pre-term babies.
• Understand the importance of early intervention of allied health for certain developmental delays.
•  Formulate management plans and referrals to the National Disability Insurance Scheme (NDIS).

Disability in adolescents and young adults

• Screen for and manage mental health issues; including depression, anxiety and/or psychosis.
• Screen for and manage risk-taking behaviour around drugs, alcohol and sexual relationships.
• Consider the impact of the young person’s disability on education and employment opportunities.
• Consider and manage the impact of the person’s disability on their ability to drive a car or motorcycle.
• Consider issues around contraceptive use, consent, screening for sexually transmissible infections (STIs) and sexual/gender identity, if sexually active, and consider the impact of the young person’s medication(s) on this.
• Facilitate transition into adult services for the young person’s disability.

Area	Screening	Management
Mental Health Issues (Depression, Anxiety, Psychosis)	– Use standardized screening tools (e.g., PHQ-9 for depression, GAD-7 for anxiety, and screening questions for psychosis).	– Provide counselling or therapy (e.g., CBT). – Prescribe medication if necessary (e.g., SSRIs for depression/anxiety, antipsychotics for psychosis).<br>- Refer to mental health specialists if needed. – Ensure regular follow-up and support.
Risk-Taking Behavior (Drugs, Alcohol, Sexual Relationships)	– Conduct interviews and use questionnaires to assess substance use (e.g., AUDIT for alcohol, DAST for drugs). – Discuss sexual history and practices.	– Provide education on the risks of substance use and safe sexual practices. – Offer counselling or referral to substance use treatment programs. – Provide resources and support for safe sexual behaviour. – Monitor and support regularly.
Impact of Disability on Education and Employment	– Assess academic performance and vocational interests through interviews and questionnaires. – Evaluate the need for special education services.	– Collaborate with educators and vocational counsellors. – Develop individualized education plans (IEPs) or vocational rehabilitation plans. – Provide support and resources to access educational and employment opportunities.
Impact of Disability on Driving Ability	– Conduct assessments of physical, cognitive, and visual abilities relevant to driving. – Review medical history and medications.	– Refer to driving assessment programs and occupational therapists. – Recommend adaptive driving equipment if needed. – Advise on driving safety and legal requirements. – Regularly re-evaluate driving ability and safety.
Contraceptive Use, Consent, STIs, and Sexual/Gender Identity	– Discuss sexual activity, contraceptive use, and sexual health openly and respectfully. – Use questionnaires and screening tests for STIs.	– Provide education on contraception and sexual health. – Offer STI testing and treatment. – Discuss issues of consent and provide support for sexual/gender identity. – Monitor the impact of medications on sexual health. – Regular follow-up.
Transition to Adult Services	– Start transition planning early, ideally in adolescence. – Use transition readiness assessment tools. – Involve the patient and family in planning.	– Coordinate with adult healthcare providers to ensure a smooth transition. – Provide detailed medical records and care plans to the new providers. – Offer support and resources for independent living skills.<br>- Ensure continuity of care.

Disability in adults – congenital or acquired

• Understand the importance of specialised support services.
• Review referral pathways for respite and residential care.
• Screen for carer stress.
• Consider and help manage the impact of the person’s disability on accessibility to transport, their sexual activity and overall wellbeing.
• Screen for mental health issues; including depression and/or anxiety and be able to discuss the stigma the person may face in the community.
• Consider and help manage the person’s access to housing, employment and funding for services.
• If the condition is terminal, consider advance care planning or early utilisation of palliative care services.
• Screen for polypharmacy and understand the issues around safe prescribing of psychotropic medication to patients with intellectual disability.
• Competently conduct a yearly health assessment.
• Screen for the ability to perform activities of daily living.
• Screen for signs of cognitive decline through screening tools such as Mini-Mental State Examination (MMSE) or Addenbrooke’s Cognitive Examination-III (ACE-III), as well as through obtaining a history from carers/family.
• Be aware of a decline in the person’s self-care skills, memory, recognition of others, and ability to communicate and access the community.
• Consider the impact of the person’s disability/impaired cognition on their ability to drive.
• Be familiar with the Geriatric Depression Scale (GDS) and consider screening for mental health disorders; including depression and anxiety.
• Investigate the impact of isolation on the person’s mood and daily functioning.
• Be familiar with falls prevention and managing frailty.
• Learn about advance care directives, power of attorney legislation, medical decision-making and palliative care support for end-of-life planning.

Specialized Support Services

• Importance:
  • Specialized support services provide tailored care specific to the needs of individuals with disabilities, improving quality of life and enhancing independence.

Referral Pathways for Respite and Residential Care

• Contact Local Health Networks:
  • Engage with Primary Health Networks (PHNs) and Local Health Districts (LHDs) for information on available respite and residential care services.
• Utilize NDIS:
  • Use the National Disability Insurance Scheme (NDIS) to access funding and support options tailored for individuals with disabilities.
• Consult Social Workers and Case Managers:
  • Collaborate with social workers and case managers for guidance and assistance in navigating referral pathways.

Screening for Carer Stress

• Use Validated Tools:
  • Implement tools such as the Zarit Burden Interview (ZBI) or Caregiver Strain Index (CSI) to assess caregiver stress levels.
• Regular Check-ins:
  • Conduct regular check-ins with caregivers to discuss their well-being and identify signs of stress or burnout.
• Open Conversations:
  • Foster open communication about the challenges of caregiving and provide emotional support and resources.

Managing Impact on Accessibility and Well-Being

• Assess and Address Barriers:
  • Evaluate physical, social, and environmental barriers that affect the individual’s accessibility to transport, sexual activity, and overall well-being.
• Provide Resources:
  • Offer resources and support for accessible transport options, such as modified vehicles or community transport services.
  • Educate about safe sexual practices and provide sexual health resources.
• Holistic Approach:
  • Ensure a holistic approach that considers physical, emotional, and social aspects to enhance the individual’s quality of life.

Screening for Mental Health Issues and Discussing Stigma

• Use Screening Tools:
  • Utilize validated screening tools such as the DASS21 for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety.
• Open Discussions:
  • Encourage open discussions about mental health, addressing any stigma associated with mental illness in the community.
• Counseling and Support Services:
  • Provide or refer to counseling and mental health support services to manage identified issues.

Managing Access to Housing, Employment, and Funding

• Collaborate with Social Services:
  • Work with social services to identify appropriate housing options and support for independent living.
• Vocational Counselors:
  • Partner with vocational counselors to develop individualized employment plans and find suitable job placements.
• Navigate Funding Options:
  • Assist in navigating funding options, including NDIS, to secure financial support for housing, employment, and necessary services.

Advance Care Planning and Palliative Care for Terminal Conditions

• Early Conversations:
  • Initiate advance care planning discussions early to understand the individual’s preferences for end-of-life care.
• Document Preferences:
  • Document the patient’s goals of care, including advance care directives and power of attorney.
• Palliative Care Services:
  • Refer to palliative care services for symptom management, emotional support, and end-of-life care planning.

Screening for Polypharmacy and Safe Prescribing

1. Comprehensive Medication Review

• Medication History:
  • Collect a detailed medication history, including all prescribed medications, over-the-counter (OTC) drugs, and supplements.
  • Use resources such as My Health Record, electronic medical records (EMRs), and patient interviews to gather information.
• Brown Bag Review:
  • Encourage patients to bring all their medications in a “brown bag” to appointments for a visual and thorough review.

2. Identifying Polypharmacy

• Definition and Criteria:
  • Polypharmacy typically refers to the use of five or more medications. However, any number of medications can be problematic if inappropriate or unnecessary.
  • Identify potential overuse, underuse, or misuse of medications.

3. Use of Screening Tools

• Medication Appropriateness Index (MAI):
  • Evaluates each medication based on criteria such as indication, effectiveness, dosage, and potential drug-drug interactions.
• Beers Criteria:
  • Lists potentially inappropriate medications for older adults due to their high risk of adverse effects.
• STOPP/START Criteria:
  • STOPP (Screening Tool of Older Persons’ Prescriptions): Identifies potentially inappropriate prescriptions.
  • START (Screening Tool to Alert to Right Treatment): Highlights necessary medications that may be omitted.

4. Identifying Drug Interactions and Adverse Effects

• Drug Interaction Databases:
  • Use tools such as MIMS Online, Australian Medicines Handbook (AMH), and other drug interaction checkers to identify potential interactions.
• Adverse Drug Reaction Reporting:
  • Encourage reporting of adverse drug reactions to the Therapeutic Goods Administration (TGA) using the Australian Adverse Drug Reaction Reporting System.

5. Collaboration with Pharmacists

• Medication Management Reviews:
  • Home Medicines Review (HMR): Conducted by accredited pharmacists to review medications in the patient’s home.
  • Residential Medication Management Review (RMMR): Conducted for residents in aged care facilities.
• Pharmacist Involvement:
  • Collaborate with pharmacists for medication reconciliation during transitions of care (e.g., hospital discharge).

6. Deprescribing Process

• Assessment:
  • Evaluate the necessity, effectiveness, and safety of each medication.
  • Consider patient-specific factors such as age, comorbidities, life expectancy, and quality of life.
• Implementation:
  • Gradually reduce or discontinue medications that are deemed unnecessary or harmful.
  • Monitor closely for withdrawal effects or symptom recurrence.

7. Safe Prescribing Practices

• Guidelines and Protocols:
  • Follow evidence-based guidelines and protocols such as those from the Royal Australian College of General Practitioners (RACGP) and the National Prescribing Service (NPS) MedicineWise.
• Patient-Centered Approach:
  • Involve patients in decision-making, discussing the risks and benefits of each medication.
  • Provide clear instructions on medication use, including dosage, timing, and potential side effects.

8. Regular Monitoring and Follow-Up

• Scheduled Reviews:
  • Conduct regular medication reviews, especially after significant health changes or hospitalizations.
  • Use clinical reminders and alerts within EMRs to ensure timely reviews.
• Follow-Up Appointments:
  • Schedule follow-up appointments to assess the outcomes of deprescribing and adjust the medication regimen as needed.

9. Education and Training

• Healthcare Professional Training:
  • Provide ongoing education and training for healthcare providers on polypharmacy and safe prescribing practices.
• Patient Education:
  • Educate patients and caregivers about the importance of medication adherence, recognizing side effects, and the risks of polypharmacy.

10. Utilization of Technological Tools

• Electronic Prescribing:
  • Use electronic prescribing systems to reduce errors and facilitate comprehensive medication management.
• Clinical Decision Support Systems (CDSS):
  • Implement CDSS to provide real-time alerts and recommendations during prescribing.

Yearly Health Assessment for Disabled Person

• Comprehensive Review:
  • Conduct a thorough review of the patient’s medical history, current medications, and overall health status.
• Screen for Mental Health and Physical Health:
  • Screen for mental health issues, such as depression and anxiety, as well as physical health concerns like cardiovascular disease and diabetes.
• Use Standardized Tools:
  • Employ standardized assessment tools such as the Health of the Nation Outcome Scales (HoNOS) and involve a multidisciplinary team to address all aspects of the patient’s health.

Screening for Ability to Perform Activities of Daily Living (ADLs)

• Use Tools like Barthel Index or Katz Index:
  • Assess the patient’s ability to perform ADLs using validated tools such as the Barthel Index or Katz Index of Independence in ADLs.
• Evaluate Functional Abilities:
  • Evaluate the patient’s functional abilities and provide necessary support to maintain or improve their independence.

Screening for Cognitive Decline

1. Clinical History and Interview

• Medical History:
  • Obtain a thorough medical history, focusing on risk factors for cognitive decline such as age, family history of dementia, chronic diseases (e.g., diabetes, cardiovascular disease), and medications.
  • Review any changes in medical status, including new diagnoses or hospitalizations.
• Behavioral Changes:
  • Ask about changes in behavior, mood, or personality, which can be early indicators of cognitive decline.
  • Note any difficulties with daily activities or increased dependency on others.

2. Input from Caregivers or Family Members

• Observation Reports:
  • Collect detailed observations from caregivers or family members regarding the individual’s cognitive and functional abilities.
  • Inquire about specific concerns such as memory loss, confusion, disorientation, difficulty in communication, or changes in problem-solving abilities.

3. Use of Validated Cognitive Screening Tools

• Mini-Mental State Examination (MMSE):
  • A widely used tool that assesses various cognitive domains including orientation, registration, attention, calculation, recall, language, and visuospatial skills.
  • Scores range from 0 to 30, with lower scores indicating greater cognitive impairment.
• Montreal Cognitive Assessment (MoCA):
  • A more comprehensive tool that evaluates multiple cognitive domains, including attention, concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation.
  • Scores below 26 out of 30 suggest possible cognitive impairment.
• Addenbrooke’s Cognitive Examination-III (ACE-III):
  • A detailed assessment tool that examines attention, memory, verbal fluency, language, and visuospatial abilities.
  • Provides a comprehensive overview of cognitive function and is useful for detecting early stages of cognitive decline.
• General Practitioner Assessment of Cognition (GPCOG):
  • Specifically designed for use in general practice settings.
  • Consists of a cognitive assessment and an informant interview to provide a balanced view of the individual’s cognitive abilities.

4. Functional and Activities of Daily Living (ADLs) Assessment

• Barthel Index or Katz Index:
  • Use these tools to assess the individual’s ability to perform basic activities of daily living (ADLs) such as bathing, dressing, eating, toileting, and mobility.
  • Declines in ADLs can correlate with cognitive impairment.

Impact of Disability/Impaired Cognition on Driving

Austroads provides detailed guidelines for assessing fitness to drive, specifically focusing on medical standards for licensing. Here’s a step-by-step approach based on these guidelines:

Cognitive Assessment

1. History and Clinical Interview:
   • Conduct a thorough clinical interview to obtain the patient’s medical history, focusing on cognitive function.
   • Ask about any cognitive complaints, memory issues, attention deficits, or changes in daily functioning.
2. Screening Tools:
   • Use validated cognitive screening tools such as:
     • Mini-Mental State Examination (MMSE): Assesses various cognitive domains including orientation, memory, attention, calculation, language, and visuospatial skills.
     • Addenbrooke’s Cognitive Examination-III (ACE-III): A more comprehensive tool that evaluates attention, memory, verbal fluency, language, and visuospatial abilities.
     • Montreal Cognitive Assessment (MoCA): Another widely used tool that assesses multiple cognitive domains and is sensitive to mild cognitive impairment.
3. Functional Cognitive Tests:
   • Consider functional cognitive tests that simulate driving-related tasks:
     • Trail Making Test: Assesses visual attention and task switching.
     • Clock Drawing Test: Evaluates executive function and visuospatial abilities.
4. Specialist Referral:
   • Refer to a neuropsychologist for a more detailed assessment if initial screenings indicate significant cognitive impairment.

Physical Assessment

1. Medical History and Physical Examination:
   • Obtain a detailed medical history focusing on conditions that may affect physical ability to drive, such as musculoskeletal issues, cardiovascular health, and neurological conditions.
   • Conduct a thorough physical examination, including assessments of strength, coordination, and range of motion.
2. Vision Assessment:
   • Ensure that vision meets the required standards for driving, including visual acuity, peripheral vision, and depth perception.
   • Refer to an optometrist or ophthalmologist for a comprehensive eye exam if necessary.
3. Hearing Assessment:
   • Conduct a hearing assessment, as adequate hearing is important for detecting auditory cues while driving.
   • Refer to an audiologist for further evaluation if hearing impairment is suspected.
4. Motor Function Tests:
   • Perform tests to assess motor function, including:
     • Grip Strength Test: Evaluates hand strength.
     • Timed Up and Go (TUG) Test: Assesses mobility, balance, and walking speed.
     • Reaction Time Test: Measures the speed of response to stimuli.

Practical Driving Assessment

1. On-Road Driving Test:
   • Arrange an on-road driving test with an occupational therapist who specializes in driving assessments.
   • The test evaluates the individual’s ability to handle a vehicle safely in various traffic situations and road conditions.
2. Simulated Driving Assessment:
   • Use a driving simulator to assess reaction time, decision-making, and overall driving skills in a controlled environment.

Austroads Guidelines Specific Considerations

1. Medical Standards for Licensing:
   • Follow the Austroads “Assessing Fitness to Drive” guidelines, which outline specific medical standards for various conditions.
   • Ensure that the assessment covers all relevant aspects as per the guidelines, including cognitive, physical, and sensory abilities.
2. Periodic Review and Reporting:
   • Implement periodic reviews for individuals with progressive conditions or those on conditional licenses.
   • Report findings to the relevant licensing authority, including any recommendations for restrictions or modifications to the driving license.
3. Adaptations and Restrictions:
   • Recommend vehicle adaptations or driving restrictions if necessary (e.g., daylight driving only, mandatory use of corrective lenses).
   • Ensure the individual is aware of and complies with any restrictions or adaptations needed for safe driving.

Follow-Up and Ongoing Assessment

1. Regular Monitoring:
   • Schedule regular follow-up assessments to monitor changes in cognitive and physical abilities.
   • Adjust recommendations and licensing status based on ongoing evaluations.
2. Rehabilitation and Training:
   • Provide rehabilitation or driving retraining programs if appropriate to improve driving skills and safety.

By following these steps and adhering to the Austroads guidelines, healthcare providers can comprehensively assess an individual’s fitness to drive, ensuring safety for both the driver and the broader community.

Screening for Mental Health Disorders Using Geriatric Depression Scale (GDS)

• The Geriatric Depression Scale (GDS) is a screening tool used to identify depression in older adults. It is specifically designed to account for the typical symptoms of depression in the elderly, which can sometimes differ from those in younger individuals. The GDS is a self-report measure that is easy to administer and interpret.
• Versions of GDS
  • GDS-15:
    • A short form with 15 questions.
    • Commonly used due to its brevity and effectiveness.
  • GDS-30:
    • A longer form with 30 questions.
    • Provides a more comprehensive assessment but is less frequently used due to its length.
• Screening for Mental Health Disorders Using GDS
• Administering the GDS
  • Preparation:
    • Ensure a quiet and comfortable environment for the individual.
    • Explain the purpose of the screening and how it will be conducted.
  • Questionnaire Administration:
    • Provide the GDS questionnaire to the individual.
    • The GDS can be self-administered or administered by a healthcare provider if the individual requires assistance.
    • Questions are straightforward, requiring “Yes” or “No” answers based on how the individual felt over the past week.
  • Example Questions (from GDS-15):
    • Are you basically satisfied with your life?
    • Have you dropped many of your activities and interests?
    • Do you feel that your life is empty?
    • Do you often get bored?
    • Are you in good spirits most of the time?
    • Scoring and Interpretation
• Scoring the GDS-15:
  • Each “Yes” or “No” answer is scored according to the scoring key.
  • For the GDS-15, scores typically range from 0 to 15.
  • A score of 0-4 is considered normal, 5-8 indicates mild depression, 9-11 suggests moderate depression, and 12-15 signifies severe depression.
• Interpreting Results:
  • Analyze the total score to determine the level of depressive symptoms.
  • Higher scores indicate greater levels of depression.
  • Use clinical judgment to consider other factors such as recent life events, physical health, and overall functioning.
• Follow-Up and Management
  • Confirm Diagnosis:
    • Use the GDS as a screening tool, not a diagnostic tool.
    • Confirm the diagnosis of depression through a comprehensive clinical assessment.
  • Develop a Management Plan:
    • Collaborate with the individual to develop an appropriate treatment plan.
    • Consider non-pharmacological interventions such as psychotherapy (e.g., cognitive-behavioral therapy, counseling).
    • Pharmacological treatment (e.g., antidepressants) may be indicated based on severity and clinical evaluation.
  • Referral:
    • Refer to mental health professionals if needed (e.g., psychologists, psychiatrists).
    • Utilize multidisciplinary teams for comprehensive care, especially in complex cases involving co-morbid conditions.
  • Regular Monitoring:
    • Schedule regular follow-up appointments to monitor the individual’s progress.
    • Reassess depression severity periodically using the GDS or other appropriate tools.
• Address Stigma:
  • Discuss and address any stigma associated with mental health issues.
  • Provide education and support to both the individual and their family to promote understanding and reduce stigma.

Impact of Isolation on Mood and Functioning

• Evaluate Social Support and Engagement:
  • Assess the level of social support and engagement in the individual’s life.
• Address Isolation:
  • Provide community programs and support groups to reduce isolation.
• Monitor Mood and Functioning:
  • Regularly monitor mood and daily functioning to identify any issues.

Falls Prevention and Managing Frailty

• Implement Falls Risk Assessments:
  • Conduct falls risk assessments using tools such as the Timed Up and Go (TUG) test or Falls Risk for Older People in the Community (FROP-Com) tool.
• Promote Physical Activity:
  • Encourage physical activity and strength training exercises.
• Address Nutritional Needs:
  • Monitor and address nutritional needs to prevent frailty.

Advance Care Directives, Power of Attorney, and End-of-Life Planning

• Educate on Legal Aspects:
  • Provide education on advance care directives, power of attorney, and other legal aspects.
• Discuss and Document Preferences:
  • Discuss and document the patient’s medical decision-making preferences.
• Provide Palliative Care Resources:
  • Offer resources and support for palliative care and end-of-life planning.

Environmental and Social Risk Factors for Falls

Environmental Risk Factors

1. Home Hazards:
   • Cluttered living spaces
   • Poor lighting
   • Loose rugs or carpets
   • Slippery floors
   • Uneven flooring or steps
   • Lack of handrails in bathrooms and staircases
2. Outdoor Hazards:
   • Uneven sidewalks
   • Poorly maintained pathways
   • Inadequate lighting in outdoor areas
3. Assistive Devices:
   • Improper use or lack of assistive devices such as walkers, canes, or grab bars

Social Risk Factors

1. Social Isolation:
   • Living alone without regular check-ins or social support
   • Limited access to community resources and social interactions
2. Economic Factors:
   • Financial constraints that limit the ability to make home modifications or purchase assistive devices
3. Health Literacy:
   • Lack of awareness or understanding of fall prevention strategies and the importance of regular exercise and proper nutrition
4. Access to Healthcare:
   • Limited access to healthcare services and regular check-ups

Falls Prevention and Managing Frailty

Falls Prevention Strategies

1. Home Safety Assessment:
   • Conduct or refer for a home safety assessment to identify and address hazards.
   • Recommend modifications such as installing grab bars, securing loose rugs, improving lighting, and removing clutter.
2. Exercise Programs:
   • Encourage participation in strength and balance exercises such as Tai Chi, yoga, or specialized fall prevention exercise programs.
   • Prescribe physiotherapy for personalized exercise plans if needed.
3. Vision and Hearing:
   • Regularly check and correct vision and hearing impairments.
   • Refer to an optometrist or audiologist for assessment and treatment.
4. Medication Review:
   • Conduct regular reviews of medications to identify those that may increase the risk of falls (e.g., sedatives, antihypertensives).
   • Adjust or deprescribe medications where appropriate in collaboration with a pharmacist.
5. Assistive Devices:
   • Ensure the proper use and maintenance of assistive devices such as canes, walkers, and grab bars.
   • Refer to an occupational therapist for assessment and recommendations on assistive devices.
6. Footwear:
   • Advise on wearing appropriate, non-slip footwear that provides good support.
   • Address foot problems through referral to a podiatrist if necessary.
7. Hydration and Nutrition:
   • Promote adequate hydration and a balanced diet rich in calcium and vitamin D to maintain bone health and muscle function.
   • Consider nutritional supplements if dietary intake is insufficient.
8. Education:
   • Provide education on fall prevention strategies and the importance of regular exercise and home safety.
   • Distribute informational materials and resources on fall prevention.

Managing Frailty

1. Comprehensive Geriatric Assessment (CGA):
   • Perform or refer for a CGA to assess physical health, functional status, cognition, nutrition, and social circumstances.
   • Develop a personalized care plan based on the assessment findings.
2. Physical Activity:
   • Encourage regular physical activity to improve strength, balance, and overall physical fitness.
   • Tailor exercise recommendations to the individual’s capabilities and preferences.
3. Nutrition:
   • Ensure a balanced diet with adequate protein, vitamins, and minerals.
   • Address any nutritional deficiencies through dietary modifications or supplements.
4. Social Engagement:
   • Promote social activities and community engagement to reduce isolation and improve mental health.
   • Encourage participation in social clubs, support groups, or volunteer activities.
5. Healthcare Access:
   • Facilitate regular check-ups and access to healthcare services.
   • Coordinate care with other healthcare professionals, including physiotherapists, dietitians, and occupational therapists.

Advice to Patients as a GP

1. Home Safety:
   • “Keep your home free of clutter and ensure good lighting throughout.”
   • “Install grab bars in the bathroom and handrails on stairs.”
2. Exercise:
   • “Engage in regular strength and balance exercises like Tai Chi or yoga.”
   • “Consider joining a local exercise group or physiotherapy program.”
3. Vision and Hearing:
   • “Have your vision and hearing checked regularly and wear any prescribed glasses or hearing aids.”
4. Medication Review:
   • “Let’s review your medications regularly to minimize the risk of side effects that could cause falls.”
5. Assistive Devices:
   • “Use assistive devices like canes or walkers as recommended, and ensure they are properly adjusted for you.”
6. Footwear:
   • “Wear supportive, non-slip shoes both indoors and outdoors.”
7. Hydration and Nutrition:
   • “Stay hydrated and eat a balanced diet rich in calcium and vitamin D to support your bone health.”
8. Education and Support:
   • “Don’t hesitate to ask for help with home modifications or to join fall prevention programs.”

Caring for patients with disability in residential care

• Depending on the person’s age and cognition level, communicate with them appropriately and gather information from multiple sources; including carers and family members regarding health complaints.
• Understand the importance of appropriate communication, both verbal and written, between health professionals working at the facility and ensure management plans are clear and actionable with appropriate safety netting and follow-up.
• Recognise and manage polypharmacy, especially in the context of after-hours prescribing.
• Understand the principles of falls prevention.
• Understand and advocate for behavioural management strategies instead of psychotropic medications, wherever possible.