Frailty is an age-related clinical condition in which there is decreased reserve and resistance to stressors, leading to a progressive decline in multisystem dysfunction and hospital stays. The decrease in lean body mass, gait, and low activity, and several components must be clinically present to represent frailty. Observational results indicate that frailty includes a slowly progressive functional decline over five to 10 years in which there are many opportunities for early detection and diagnosis.
The improvement in knowledge and practical case-finding strategies enable clinicians to better understand whether they are vulnerable or frail patients. This will reduce the risk of health deterioration and loss of independence. This essay will describe how timely interventions are effective in maximizing patient frailty outcomes.
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The common tools used in clinical practice are judgment-based (e.g., the Clinical Frailty Scale), physical performance tools (e.g., Gait Speed), patient questionnaires (e.g., Program of Research to Integrate the Services for the Maintenance of Autonomy [PRISMA-7]), the electronic Frailty Index and multidimensional measures (e.g., Edmonton Frail Scale). The clinical frailty score is used to recognize Mrs Brown's frailty score which is 6 which means moderately frail.
It is vital to adopt a person-centered approach with the individuals recognized as frail or at high risk of frailty. They must be advised, according to circumstances, on care and support planning, medicine reviews, exercising, nutrients, and the need to strengthen social networks. The following subheadings will describe how medicine review, exercise, and nutrition support helped Mrs. Brown in her management of frailty.
Multiple medication use is considered a geriatric syndrome and is commonly seen in the elderly. Therefore, it is a major issue of concern as it is related to advanced outcomes which include advanced health outcomes like falls, prolonged hospitalization, adverse drug reactions, readmission impairment, and mortality ( Valencia.,2018).
The medication review is guided by the screening tool for older people prescriptions (STOPP), the screening tool to alert to the right treatment (START), or the American Geriatrics Society Beers criteria for frailty management is currently recommended by several guidelines. Mrs. Brown came with a fall and pain while mobilizing. On assessment, the patient's lying and standing blood pressure was taken she had a postal drop in blood pressure which led to a fall. Every year, about 30% of people aged 65 years have a fall which increases to 50% in people aged 80 years or older. There are many risk factors which are contributing to falls, the use of some medications that act on the central nervous system (eg antidepressants, anticonvulsants, neuroleptics, and benzodiazepines), antiarrhythmics and diuretics have been identified as risk factors for falls. Mrs. Brown's medication where reviewed hence some of the medication was stopped.
Physiotherapy sessions play a vital role in restoring the individual's mobility. It helps to improve their strength, flexibility, aerobic capacity, and balance control. The frail individual is usually scared to perform activities or denies doing them because it makes them tied. The lack of activity leads to increased frailty over time. Hence, this can cause a higher risk of falls, hospitalization, disability, and death. Inactivity can lead to an increase in body fat and reduce lean body mass. Mostly, the elderly population is more dependent on the activity of daily living and low physical activity. However, strength training showed improvement in physical performance, an increase in lean body mass, and a positive effect on self-reported activities of daily living.
A randomized controlled trial conducted by Cristiane Batista Ferreira et al (2018) aimed to see the effects of exercising training on biochemical, inflammatory, and anthropometric indices and functional performance in institutionalized frail elderly. The sample consisted of 37 elderly of both genders, elderly aged 76.1 ± 7.7 years, who had been randomly allotted into 2 groups: 13 individuals in the exercising group (EG) and 24 in the manage group (CG). Anthropometrics, clinical history, functional tests, and biochemical assessment were measured before and after the completion of a bodily exercising program, which lasted for 12 weeks. The 12-week exercising program for frail elderly in a long-term care facility was efficient in enhancing muscle strength, speed, agility, and biochemical variables, with a reversal of the frailty condition in a significant number. Also, a similar study by M. Sandlund et al. ' Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention' showed exercise sessions with challenging balance activity for more than 3 hours per week helped reduce falls by 21%. Mrs Brown lost her baseline mobility after the fall with continuous physiotherapy sessions during her hospital stay helped her regain her confidence and improve her muscle strength.
The elderly are greater at risk of undernutrition or malnutrition, because of age-associated physiological changes affecting appetite, meal consumption and metabolism, chronic diseases, functional impairment, and social and psychological factors. The increased prevalence of frailty with aging is also well known. Weight loss can be considered a hallmark of the frailty syndrome, in which low energy and protein consumption together with various vitamins make contributions to the components of the frailty syndrome which include fatigue, decline in strength and aerobic function, and multi-morbidity.
When figuring out and dealing with frailty it's a good practice to screen for malnutrition and take action based on NHS guidance which has been produced by or written in partnership with NHS dietitians. Mrs Brown has a loss of appetite and weight loss before hospitalization according to her daughter.
Elderly with moderate or severe frailty can be classified as being in the last year of life, but they may now no longer be imminently dying and therefore from a nutrition perspective should be treated in the same manner as any other patient. This means that their nutritional status has to be monitored using a validated screening tool (e.g. MUST or the Patients Association Nutrition Checklist) and efforts should continue to be made to work with them and their carers to meet their nutritional needs if possible. Meeting nutritional needs can help to maximize muscle strength, and maximise quality of life. Mrs Brown was screened for her nutritional assessment and overall malnutrition screen patient scored 3 hence dietitian referral was done.
Nutrient necessities may be met by tube needing parenteral nutrition hydration, but this doesn't always bring about an advanced prognosis. Moreover, different needs which include enjoyment of meals, the social factors of eating together, and simple human attention and interaction are not met by these routes of nutrition hydration and should not be neglected. Providing meals in a shape that is palatable to the patient (such as finger foods), providing snacks and frequent small meals rather than large meals, fortifying meals (such as adding skimmed milk powder or ground almonds to porridge and soups), and being attentive to the social factors of consuming (together with sitting round a desk and eating together) are all techniques that may enhance dietary consumption and leisure of meals. Mrs Brown has provided advice and help with food choices. Also provided finger foods, snacks small frequent meals, and skimmed milk. Moreover, her food chart is maintained for close monitoring of her nutrition, and the family is also involved in her meal choices.
Many elderly stay with frailty and its prevalence will increase with age. Frailty varies in severity and some interventions like exercise which improves strength and balance, medication review, and addressing nutritional deficiencies can help to reduce it.
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