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Case Study #5
Kalyn Madej
Lakeview College of Nursing 
N309: Nursing of the Gerontological Client
Aline Davis / Mary Edwards
February 17,2012

Case Study #5
1.	The terms frailty, disability and comorbidity are interrelated and can over-lap. Frailty is considered the change in physiological state and the inability to maintain homeostasis. Comorbidity is defined as the occurrence of two or more different disease processes in a person. Disability is defined as the inability to carry out activities of daily living. Disability however can arise from a dysfunction of a single system or from a variety of systems. Frailty always is related to multisystem dysfunction. Frailty is considered a high vulnerability which includes disability in the definition. (Benefield, & Higbee, 2007).
2.	While on the website Frailty and its Implications for Care it states, “frailty is a syndrome associated with reduced functional reserve, impairment in multiple physiological systems, and reduced ability to regain physiological homeostasis” (Benefield & Higbee, 2007).
3.	The assessment tool is used to identify the person as being frail. If there is a presence of three of more of the components the person is considered frail. The scoring ranges from 0 which is robust, 1-2 intermediate or pre-frail and then 3 which is frail. The components considered are shrinking or an unintentional weight loss of 10 or more pounds in the past year, exhaustion with lack of energy or the presence of fatigue or tiredness, strength with the loss of physical robustness and skeletal muscle soundness, slowness with a lethargic and unsteady unbalance gait, and lastly a low physical activity or inactiveness. (Benefield, & Higbee, 2007).When determining Mrs. Gibson’s actual score she had experienced a weight loss of 14 pounds, had become fatigued with physical activity, and requires a wheelchair for mobility. Since there were more than three components that Mrs. Gibson qualified in she would have a score of 3 which would be considered frail.
4.	When discussing frailty a person can have primary frailty and secondary frailty. Primary frailty means there are no underlying, pathological causing factors. Secondary frailty comes from an underlying, pathological factor. (Benefield, & Higbee, 2007).
5.	There are six physiologic based risk factors that can be associated with frailty. Those risk factors include activated inflammation, immune system dysfunction, anemia, endocrine system alterations, underweight or overweight, and age. There have been studies done and found that persons classified as frail by the criteria had an increased in a marker of inflammation. Having an altered immune function has also been seen with frailty which can lead to the activation of inflammation. Frail individuals are also more likely to be anemic which can be a result from the activated inflammation also. In frail patients they are more likely to have a decreased level of insulin like growth factor-I. Along with weight loss, inadequate nutrition also is recognized with frailty. Aging also causes a decline in physiologic system. The physiologic alterations are complex and are interactions between specific systems that can increase the risk of frailty. With increased mobility and muscle strength there may be an opportunity to break the cycle of frailty. (Espinoza, & Fried, 2007). 
6.	Other possible risk factors for frailty are sociodemographic and psychological. These would classified by female gender, low socioeconomic status, race and ethnicity, and depression.  Women are more likely to be considered frail due to women having less muscle mass which is one of the risk factors for developing frailty. When a person is considered to have a low socioeconomic status and frailty has been seen with lifestyle factors. Things such as ethnicity, tobacco use, alcohol use, self reported health and comorbid conditions. When depression symptoms are seen they normally lead to frailty with the loss of weight, becoming less active, loss of muscle mass, strength and exercise tolerance is reduced. (Espinoza, & Fried, 2007).
7.	When looking at the risk factors for frailty there are some that may not be modifiable. Race and the socioeconomic status are the major risk factors classified with this since there is not much a person can do about these two factors. (Espinoza, & Fried, 2007).
8.	When searching for nutritional supplements potential benefits for frail elders would include the use of Vitamin D, carotenoids, creatine, dehydroepiandostreone (DHEA). The use of Vitamin D can help decrease the risk of falls and protects against fractures. It also helps improve balance. In patients the use of carotenoids as an antioxidant and to improve physical performance. Creatine can be supplemented as an amino acid which helps turn ADP to ATP which is found in skeletal muscles. Creatine can help improve strength and increased lower body power, along with improving gait and balance. DHEA has been used for the treatment for cardiovascular and neuropsychiatric disorders, diabetes, adrenal insufficiency, cancer, and systemic lupus erythematosis. (Cheniak, Florez, & Troen, 2007). 
9.	Tai chi is a type of exercise consisting of a variety of stylized movements where there is continuously change in posture. Tai chi may address weakness, slow walking speed and low physical activity. It can be used to improve balance and strength; it can also be beneficial to people who have a reduced ambulatory capacity or in patients who have an increased tendency to fall. With the use of tai chi as an intervention there was a significant reduction in the patients fear in falling. (Cheniak, Florez, & Troen, 2007).
10.	There are a variety of ways that facilities and agencies can implement universal design. The facility can increase the assessment of frailty in all of the care settings. The facility should make sure they are using a prompt and accurate referral for evaluation of frailty. There should also be a noted decrease in morbidity and mortality rates that are associated with the functional decline of the patients. An increase in prevalence of the patient who leaves the hospital care facility of for homecare with baseline or improved functional status. A support of institutional policies programs should be used to promote function of the patient. There should also be evidence of continued interdisciplinary assessments and evaluation of the patients care. (Benefield, & Higbee, 2007). 

Resources

Benefield, PhD, RN, FAAN, Lazelle E., & Rachel L. Higbee, BSN, RN. "Geriatric Nursing 
Resources for Care of Older Adults :: Frailty and its implications for are. Geriatric Nursing Resources for Care of Older Adults. N.p., n.d. Web. 17 Feb. 2012. http://consultgerirn.org/topics/frailty_and_its_implications_for_care_new/want_to_know_more

Cherniack, E. Paul, Hermes J. Florez, and Bruce R. Troen. "Emerging therapies to treat frailty 
	syndrome in the elderly | Alternative Medicine Revie                                                                                                                                                   w | Find Articles." Find Articles | 
	News Articles, Magazine Back Issues & Reference Articles on All Topics. N.p., n.d. Web. 
	17 Feb. 2012. 	<http://findarticles.com/p/articles/mi_m0FDN/is_3_12/ai_n27421818/?tag=content;col1

E. Espinoza, MD, Sara, and Linda P. Fried, MD, MPH. "Risk factors for frailty in the older 
	adult." Geriatric Syndromes. N.p., 6 June 2007. Web. 17 Feb. 2012. 
	<www.imsersomayores.csic.es/documentos/boletin/2007/numero-52/art-07-07-01.pdf>.