14.5/15 good job see comments

Module 5 Case Study 5.2
Caprice Hudson
Lakeview College of Nursing
N 309
February 17, 2012

1.	Compare and contrast the definitions for frailty, disability, and comorbidity.
Frailty, disability, and comorbidity are interrelated and they overlap. Frailty is the manifestations of change in the physiological state of a person and the inability to maintain homeostasis. Disability is, the inability to carry out activities of daily living. Comorbidity refers to the occurrence of 2 or more distinguishable disease process in a person (Benefield, & Higbee, 2007).  
2.	Explain why frailty is considered a syndrome.
Frailty is considered a syndrome because it is associated with reduced functional reserve, impairment in multiple physiological systems, and reduced ability to regain physiological homeostasis (Benefield, & Higbee, 2007). 
 A syndrome involves a set of symptoms occurring together. In the case of frailty, the syndrome entails reduced functional reserve, impairment in multiple physiological systems, and reduced ability to regain physiological homeostasis

3.	View the frailty assessment tool and determine Mrs. Gibson’s actual score.
Based on Mrs. Gibson’s weight loss of 14 lbs, being fatigued with any activity and requiring a wheelchair I would say her score is a 3.  
4.	Differentiate primary versus secondary frailty. 
Primary frailty has no underlying, pathological causative factors, while secondary factors have underlying, pathological causative factors (Benefield, & Higbee, 2007). 
5.	What criteria comprise the six physiologic-based risk factors for frailty?
The six physiologic based risk factors for frailty are activated inflammation, immune system dysfunction, anemia, endocrine system alteration, over or underweight and age.  Frail individuals are in a state of chronic up regulation inflammation making them more prone to coagulation (Espinoza, & Fried, 2007).  Altered immune system may lead to the activated inflammation seen in frail people. They have a decreased ability to proliferate their peripheral blood mononuclear cells when they are stimulated with endotoxin lip polysaccharides (Espinoza, & Fried, 2007). Anemia is due to the activated inflammation, which causes endocrine alterations including decreased insulin growth factors (Espinoza, & Fried, 2007). Nutritional status is thought to impact frailty because it decreases lean body mass predisposing individuals to frailty (Espinoza, & Fried, 2007). Age is associated with oxidative stress and cellular damage due to the generation of oxygen derived free radicals over time (Espinoza, & Fried, 2007).
6.	Discuss the sociodemographic and psychological risk factors presented in the article.
The female population may be more susceptible to frailty because they have less lean muscle mass, sarcopenia (Espinoza, & Fried, 2007). Lower socioeconomic populations are at higher risk for frailty. This risk is impacted by  lack of higher education and limited nutritional options based on income. 
 Sociodemographic and psychological risk factors include female gender, race/ ethnicity (nonwhite), socioeconomic status reflected by low annual income and education, and depression

7.	Which of the risk factors reviewed for frailty would not be modifiable?
According to Espinoza and Fried (2007), race and SES would not be modifiable (Espinoza & Fried).
 Gender, race, age, and socioeconomic status.
8.	Nutritional supplements as an alternative medicine intervention for frailty includes the following: 
•	Carotenoids
•	Vitamin D
•	Creatine
•	Dehydroepiandrosterone (DHEA)
9.	Using the same internet source, discuss how tai chi may be an appropriate intervention. Tai chi are stylized movements in which there is a continuous change in posture. This technique may indirectly affect Frailty syndrome in 3 areas; slow walking speed, low activity tolerance and weakness because it improves strength and balance and prevents falls (Cheniak, Florez, & Troen, 2007). 
10.	What are specific examples used in facilities /agencies which implement universal design? I would define universal design as an environment that is beneficial for elderly across the nation. These implementations would include increase in frailty assessment, prompt and accurate referral for frailty evaluation, decrease morbidity and mortality rates, increase in prevalence of functional status before being released from the hospital, or homecare facility; increased early utilization of rehabilitation services, support of programs that promote function and interdisciplinary evaluation of care (Benefield, & Higbee, 2007).
 Installing standard electrical receptacles higher than usual above the floor, so theyare 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
Benefield, L. E., & Higbee, R.L. (20070. Frailty and its implication for care. Hartford 	Institute for Geriatric Nursing. Retrieved from 	http://consultgerirn.org/topics/frailty_and_its_implications_for_care_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/?tag=content	;col1
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.p	df