Good job see comments 14.75/15

Case Study 5.2
Brittany M. Hicks
Lakeview College of Nursing
N-309
February 16, 2012

Case Study 5.2
1.	Compare and contrast the definitions for frailty, disability, and comorbidity.
Many times frailty, disability, and comorbidity are used as interchangeably, but
they are different from each other just closely related. Frailty is where the body can’t maintain homeostasis due to a physiological process ((Fried, Ferrucci, Darer, Williamson, & Anderson, 2004). If someone is disabled, they can’t carry out daily living activities. This disability is not limited to one system, but may contain many systems (Rockwood, Hogan, & MacKnight, 2000). Comorbidity is the onset of two different diseases occurring in the body at one time (Fried et al. (2004). 
2.	Explain why frailty is considered a syndrome.
Frailty affects your mortality and overall decline in your health status. Frailty involves more than just one body system. Bartali (2006) explains frailty as a syndrome; inability to for the body to gain homeostasis, several physiological problems, and a reduction in functional storage (Bartali, B., Frongillo, E. A., Bandinelli, S., Laurentani, F., Semba, R. D., Fried, L.P., et al., 2006).
3.	View the frailty assessment tool and determine Mrs. Gibson’s actual score.
After reviewing the frailty assessment tool I believe that Mrs. Gibson’s actual score is a 3. She is considered to be at the highest level of frailty according to the assessment tool. The symptoms that she has that leads me to believe that he score is a 3 are: weight loss, fatigue, unbalanced gait (uses a wheelchair) and her cognitive withdrawal. 
4.	Differentiate primary versus secondary frailty.
Primary frailty has no causative pathological aspects. Secondary frailty is the exact
opposite, there is a primary pathological cause (Fried, Ferrucci, Darer, Williamson, & Anderson, 2004). 
5.	What criteria comprise the six physiologic-based risk factors of frailty?
The first physiologic based risk is activated inflammation (Espinoza & Fried, 2007). The second risk is immune system dysfunction. A dysfunction in the immune system can cause inflammation (Espinoza et al. (2007). The third risk is Anemia (Espinoza et al. (2007). The fourth risk is endocrine system alteration (Espinoza et. al (2007). The fifth risk is under or over weight individuals (Espinoza et al, (2007). Typically poor nutrition is associated with the weight fluctuation. The sixth risk is age (Espinoza et al. (2007). Frailty becomes more common over the age of 90 (Espinoza et al. (2007).
6.	Discuss the sociodemographic and physiological risk factors presented in this article. 
Frailty development is more common in the female population (Espinoza & Fried, 2007). Lower social economic status, consists of individuals with little education and who are low income. Some other health risk factors that may contribute to frailty are: alcohol abuse, tobacco use, comorbidities, BMI, and ethnicity (Espinoza et al. (2007). A psychological risk factor associated with frailty is depression (Espinoza et al. (2007). Individuals who have problems with depression sometimes age more rapidly, become less active, and lose weight. 
7.	Which risk factors reviewed for frailty would not be modifiable.
While many risk factors are modifiable such as exercise ability, comorbidities, and
disabilities some are not. The two risk factors that would not be modifiable are race and socioeconomic status (Espinoza & Fried, 2007). 
8.	Nutritional supplements as an alternative medicine intervention for frailty includes the following: (select all that apply)
a.	Carotenoids
b.	Vitamin D
c.	Probiotics
d.	Creatine
e.	Dehydroepiandrosterone (DHEA)
9.	Using the same internet source, discuss how tai chi may be an appropriate intervention.
Tai chi and cobblestone walking are a great way to exercise because is a low risk exercise and easy do adapt too (Cherniak, Forez, & Troen, 2007). It also improves strength and balance, which will prevent falls (Cherniak, Forez, & Troen, 2007).
10.	What are specific examples used in facilities/agencies which implement universal design.
Agencies that look at the needs of the elderly are using universal designs. Some of the characteristics of an agency who uses universal designs will likely be proactive with the assessment and evaluation of frailty (Cheniak, Forez, &Troen, 2007). They will also implement necessary rehabilitation services so that the individuals will have less functional declines and may be able to return home in a better health status (Cheniak et al. (2007). Agencies that care about the well- being of their patients will adapt a universal design that assesses and evaluates patients at risk for frailty.
 Installing standard electrical receptacles higher than usual above the floor, so they are in easy reach of everyone;
• Selecting wider doors, along with wider hallways; • Making flat entrances; • Installing handles for doors and drawers that require no gripping or twisting to operate—such as louver or loop handles; • Provide storage spaces within reach of both short and tall people; • Minimize the need for staircases; • Any and all procedures, equipment, and strategies promoting safety to avoid falls or injuries

References
Bartali, B., Frongillo, E. A., Bandinelli, S., Laurentani, F., Semba, R. D., Fried, L. P., et al.		 (2006). Low nutrient intake is an essential component of frailty in older persons. 	Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 61 (6), 589-	593.  If you got this from the internet need address
Benefield, L. E., & Higbee, R. L. (2007). Frailty and its implication for care. Hartford Institute 	for Geriatric Nursing. Retrieved from 	http://consultgerirn.org/topics/frailty_and_its_implications_for_are_new/want_to_know_	more
Cheniak, E. P., Forez, H. J., & Troen, B.R. (2007). Emerging therapies to treat frailty syndrome 	in the elderly. Alternative Medicine Review. Retrieved from 	http://findarticles.com/p/articles/mi_m0FDN/is_3_12/ai_n27421818/pg_7/?tag=content;c	ol1
Espinoza, S. E., & Fried, L. P. (2007). Risk factors for frailty in the older adult. John Hopkins 	Medicine. Retrieved from 	http://www.imsersomayores.csic.es/documentos/boletin/2007/numero-52/art-07-07-	01.pdf
Fried L. P., Ferrucci, L., Darer, J., Williamson, J.D., & Anderson, G. (2004). Untangling the 	concepts of disability, frailty, and comorbidity: Implications for improved targeting and 	care. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 59(3), 	255-263. Got from internet?