Katie We have gone over this several times  from now on grading will be much harder. You also need to watch copying directly without using quote marks and page numbers  11/15

Case Study 5.2 Frailty
Katie Sullivan
Lakeview College of Nursing 
Nursing of the Gerontological Client
Mary Edwards
February 19, 2012

1.	The terms frailty, disability and comorbidity are related and can overlap in their definitions. Frailty is considered the change in physiological state and the inability to maintain homeostasis. Disability is defined as the inability to carry out activities of daily living. Comorbidity is defined as the occurrence of two or more different disease processes in a person. Frailty always is related to multisystem dysfunction. A disability however can be a dysfunction of a single system or from a variety of systems. (Benefield & Higbee, 2007).
2.	Fraility is a syndrome having to do with impairment of multiple systems, reduced functional reserve, and reduced ability to regain homeostasis. (Benefield & Higbee, 2007).
3.	The assessment tool is used to identify if the person is frail. If there is a presence of three of more of the components the person is considered frail. The scoring ranges from 0 (robust), 1-2 (intermediate or pre-frail) and 3 (frail). The components considered are shrinking or an unintentional weight loss of 10 or more pounds in the past year, strength with the loss of physical robustness and skeletal muscle soundness, exhaustion with lack of energy or the presence of fatigue or tiredness, slowness with a lethargic and unsteady unbalance gait, and a low physical activity or inactiveness (Benefield & Higbee, 2007). Mrs. Gibson had experienced a weight loss of 14 pounds, became fatigued with physical activity, and required a wheelchair for mobility. Since there were three criteria that she was positive for, Mrs. Gibson would be considered frail. 
4.	A person can have primary frailty or secondary frailty. Both types are different. Secondary frailty comes from an underlying, pathological factor. Primary frailty means there are no underlying, pathological causing factors for the frailty. (Benefield & Higbee, 2007).
5.	There are six specific risk factors for frailty. The factors are activated inflammation, immune system dysfunction, anemia, endocrine system alterations, being underweight or overweight, and age. (Espinoza & Fried, 2007). 
6.	There are other non physiologic risk factors for frailty. Some of the factors are female gender, low socioeconomic status, race and ethnicity, and depression.  Women are more likely to be considered frail. This is because they have less muscle mass. Depression can lead to frailty because it involves weight loss, becoming less active, loss of muscle mass, and strength and exercise tolerance is reduced. (Espinoza & Fried, 2007).
7.	Race and the socioeconomic status are the major risk factors that are not modifiable. You can do things to change your health and lifestyle, but you can’t change your race or your social class (Espinoza & Fried, 2007).
Gender, race, age, and socioeconomic status
8.	These supplements have benefits for elderly Vitamin D, carotenoids, creatine, dehydroepiandostreone (DHEA). Vitamin D can help decrease the risk of falls and protects against fractures. 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. This improves skeletal muscles. Creatine helps improve strength, increases lower body power, and improves 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 exercise with a variety of stylized movements where there is continuously change in posture. Tai chi improves weakness, slow walking speed and low physical activity. It can improve lung function with its’ breathing exercises. It can also improve balance and strength. Tai chi can really reduce the risk of falls and the fear of falling (Cheniak, Florez & Troen, 2007).
10.	Facilities and agencies can implement universal design. The facility can increase the assessment of frailty. The facility should make sure they are using an accurate referral for evaluation of frailty. There should also be a decrease in morbidity and mortality rates that are associated with the functional decline of the patients. Institutional policy programs should be used to promote function of the patient. Also assessments should continue and the patient should be reevaluated often to see improvement or decline (Benefield & Higbee, 2007). 
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

Benefield, PhD, RN, FAAN, Lazelle E., and Rachel L. Higbee, BSN, RN. "Geriatric Nursing 
Resources for Care of Older Adults :: Frailty and its Implications for Care. 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 Review | 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>.