Fighting frailty in older patients
Joyce O. Hislop RN, OCN

February 2014 
Volume 44  Number 2
Pages 64 - 66
  PDF Version Available!

FRAILTY IS OFTEN thought of as a normal part of aging, but in reality it isn't.1 Most definitions describe frailty as a condition marked by a loss of function, strength, and physiologic reserve.1 Frailty can often predict the risk of falling and possibly result in a disability related to impaired mobility and restricted activities of daily living. Other adverse consequences include the possibility of hospitalization, rehabilitative therapy, and loss of independence.1-3 Any comorbidity may contribute to the condition of frailty, particularly cardiac disease and/or osteoporosis.4-6 Unaddressed frailty is associated with risk factors for disability and complications such as infection and prolonged recovery (for example, a hip fracture due to a fall can result in less mobility, leading to pneumonia), as well as a greater financial burden on the patient and family if institutional care is indicated.2,5,7 This article will look at how to assess patients for frailty and ways to help them improve their health.The five physical signs and symptoms of frailty include weakness marked by grip strength, weight loss of 5% or more body weight in the last year, exhaustion, slow walking speed (more than 6 to 7 seconds to walk 15 ft [4.6 m]), and decreased physical activity.1-3,8 When three of these five signs and symptoms are present in an older adult (age 65 or older) or a younger, chronically ill adult, they characterize frailty.1,2 Frailty can be a middle point between independence and a "pre-death" prognosis related to multisystem dysfunction and global decline, which can spiral to end-of-life complications.9 It's thought to be driven by inflammatory pathway activation and dysregulation of neuroendocrine systems, which leads to skeletal muscle decline.1Obesity, or even being overweight, may disguise a "core frailty" and a risk of sarcopenia (age-related decline in muscle function).1 A Finland study followed men and women ages 30 to 60 for 22 years (1978-2000) to assess the risk of

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