13/15

Case Study Week 5
Jena Boen
Lakeview College of Nursing
Gerontology
N309

February 15, 2012

Case Study Week 5
1.	Compare and contrast the definitions of frailty, disability, and comorbidity.
Frailty is a “general decline in the physical function of older adults that can cause vulnerability to illness and decline” (Mauk, 2010, p. 304).  The characteristics of this can be an unintentional weight loss, exhaustion, slow walking speed, low physical activity.  Frailty is more common in women past age 65 than men.  (Mauk, 2010)
Disability is a physical impairment that can affect communication of an older adult.  Disability affects the way a person receives or sends information and can lead to people having to modify how they communicate with that person. (Mauk, 2010)  Comorbidity is when a person has a primary disease accompanied by the presence of one or more other disorders.  As long as the person has symptoms, the disorders are said to be “comorbid”. 
2.	Explain why frailty is considered a syndrome.
Frailty is a syndrome because there are many different signs and symptoms that can lead a health care provider to determine that’s what the problem is.  There are things such as weight loss, grip weakening, slow walking and a “slow caloric expenditure” during any physical activities.  (Mauk, 2010, p. 304)  Frailty can be a predictor of several different outcomes and acute illnesses.  (Benefield, & Higbee, 2011)
3.	View the frailty assessment tool and determine Mrs. Gibson’s actual score.
Mrs. Gibson’s score is a 3 which is frail.  I got this score because she had a 14 pound weight loss unintentionally which would count as 1 component.  She also was fatigued causing her to use a wheelchair which was another component.  Also, she has withdrawn verbally which would be another component.  (Benefield, & Higbee, 2011)
4.	Differentiate primary versus secondary frailty
Primary frailty is frailty that has no cause.  There are no underlying factors that cause primary frailty.  However, with secondary frailty something underlying caused it to occur.  (Benefield, & Higbee, 2011)
5.	What criteria comprise the six physiologic-based risk factors for frailty?
The six physiologic-based risk factors for frailty are very complex.  Activated inflammation is one of the risk factors because frail people were found to have increased inflammation and coagulation.  Immune system dysfunction leads to activated inflammation.  Anemia results from activated inflammation as well.  Endocrine system alteration causes decreased hormones which in turn decrease muscle mass.  Frail individuals can also be overweight or underweight and this is related to the decreased muscle mass.  As people age, their body always decreases it’s mechanisms. (Espinaza, & Fried, 2007)
6.	Discuss the sociodemographic and psychological risk factors presented in the article.
Sociodemographic risk factors are very influencing when it comes to frailty.  It is said that a lower socioeconomic status leads to frailty faster than high socioeconomic status.  It is also found that females are more likely than males to become frail.  Also, people that were non-white were also said to have more instances of becoming frail.  With psychological factors, the article really focused on the correlation between depression and frailty.  When someone is depressed they stop caring about what their body looks like or if they are taking good care of it which can lead them to become frail faster than a person who is not depressed.  It was also said that when an individual self-reports their health declining they had a higher risk of becoming frail. (Espinaza,  & Fried, 2007)
7.	Which of the risk factors reviewed for frailty would not be modifiable?
Risk factors that would not be modifiable when it comes to frailty are very important to recognize.  Some of these risk factors would include a person’s gender, race and age.  Also, you could say that a person’s activated inflammation, endocrine function and all of the physiologic factors could not be changed, especially if the person is older and doesn’t understand all of those factors.
 Gender, race, age, and socioeconomic status
8.	Nutritional supplements as an alternative medicine intervention for frailty includes the following:  Carotenoids, Vitamin D, Creatine and Dehydroepiandrosterone (DHEA).
9.	Using the same internet source, discuss how tai chi may be an appropriate intervention.  
Tai Chi may be an appropriate intervention because of its ability to focus on weakness, a slow walking speed and low physical activity.  Tai Chi would be beneficial to improve a person’s strength and posture but there is really no correlation to improving a person’s fall risk.  It is also helpful with patients with osteoarthritis which could be an underlying disease with the frailty.  (Cherniak, Florez, & Troen, 2007)
10.	What are specific examples used in facilities/agencies which implement universal design?
A specific example of functional and attractive would be putting all of the appliances in the kitchen near one another so the person doesn’t have to walk around the kitchen to get things. By doing this, the person doesn’t notice but it still makes for functionality.  With the aging person, the bathtubs that have the doors on the side are very helpful because they don’t have to lift their legs which can be difficult.  Also, bath chairs are helpful getting them in and out of the tub.  
Everything should be at waist level and adjustable so the person doesn’t have to bend.  Also, the cabinets and the entire house should be organized so everything is in the same spot.  ("Universal Design," 2011)

References
Benefield, PhD,RN,FAAN, L. E., & Higbee, BSN,RN, R. L. (2011). Frailty and its implications for care. Retrieved from http://consultgerirn.org/topics/frailty_and_its_implications_for_care_new/want_to_know_more
Cherniak, P., Florez, H. J., & Troen, B. R. (2007). Emerging therapies to treat frailty syndrome in the elderly. Retrieved from http://findarticles.com/p/articles/mi_m0FDN/is_3_12/ai_n27421818/pg_12/?tag=content;col1
Espinaza, MD, S. E., & Fried, MD, MPH, L. P. (2007). Risk factors for frailty in the older adult. Retrieved from http://www.imsersomayores.csic.es/documentos/boletin/2007/numero-52/art-07-07-01.pdf
Mauk, K. L. (2010). Gerontological Nursing  (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.
UPMC.com. (2011). Universal design: Helping older adults maintain their independence . Retrieved from http://www.upmc.com/healthatoz/pages/healthlibrary.aspx?chunkiid=13462