The document discusses health issues faced by the frail elderly population. It defines frailty as a decline in functioning across physiological systems that increases vulnerability to stressors. The frail elderly are at higher risk for complications. Neurodegeneration is linked to frailty, with cognitive decline increasing with age. Urinary and fecal incontinence in frail elders is related to reduced muscle mass. The frail elderly also have greater risk of pressure injuries and adverse impacts from polypharmacy. Elder abuse disproportionately affects the frail. Nurse practitioners play an important role in geriatric screening and assessments. Future technologies may help support independence for the frail elderly.

1. Created by: Christan Black
9/4/2020.
Health Issues of the Frail Elderly.

2. What is Frailty?
 The course of frailty is characterized by a decline in functioning across multiple
physiological systems, accompanied by an increased vulnerability to stressors and poor
health outcomes.
 Hirdes (2006) agrees that frailty comprises of weakness, slow gait, decreased physical
activity, weight loss ,and exhaustion.
 An individual is defined as frail when three or more of the above features are present.
 The frail elderly are at increased risk for complications with surgery and other invasive
therapies.
 Of present, there is no treatment or preventive management for frailty. It can be assessed
quickly and simply using the Clinical Frailty Scale.
(Hirdes, 2006)

3. Neuro-degeneration Impact on Frailty
 The link to neuro-degeneration and frailty has
been proved and repeatedly demonstrated.
 The prevalence of dementia, Alzheimer’s, and
Parkinson doubles every 5 years in the older
population.
 The statistics have shown 30-50% cognitive
decline at the age 0f 85 years.
 Depression and delirium co-exist and are the
major cause of confusion and mood disorders.
 According to the USPSTF there is no empirical
evidence to screen the elderly for cognitive
impairment.
 The Medicare Annual Wellness disagrees and
mandates that the elderly patient is being
assessed for cognitive impairment.
(Burt, Godin, Filion, & Monlero, 2019)

4. Sphincter Incontinence vs Frailty
 Urinary and Fecal incontinence is one of the biggest
problems faced by the elderly population.
 Incontinence has immense repercussions on the quality
of life, independence, and autonomy.
 A longitudinal cohort study was done that shows that a
reduction in muscle mass and extremity weakness due
to frailty leads to urinary and fecal incontinence.
 Behavioral and antimuscarinics are a more effective
treatment for the frail patient especially in the elderly
male who suffers from benign prostatic hyperplasia
and detrusor overactivity.
(Betiolli, Lenardi, Moraes, & Setlik, 2019)

5. The Relationship between Pressure
Injury and the Frail Elderly.
 A Meta‐regression Analysis study found that elderly frail patients have a greater incidence
of pressure injuries which significantly increased the risk of death.
 The National Pressure Ulcer Advisory Panel argues that pressure injury increases mortality in the elderly
and is related to reduced sensory loss, moisture, and poor nutritional status.
 The Braden Scale is an assessment tool widely used to assess the elderly patient's risk of pressure injury.
 A cross-sectional study was also done and states that pressure injury in the frail patients is related to
decrease functional capacity or dependence level. The inclusion criteria for this study were men and women
being 60 years old or more, hospitalized for at least 24 hours, having urinary and fecal incontinence.
(Elsawy & Higgins, 2011)

6. Pharmacotherapy and Polypharmacy
Impact on the Frail Elderly.
 A recent cross-sectional study in Scotland looked at 1 751 841
patients and explored the relationship between age, socio-
economic status, and multiple morbidities.
 The research shows that polypharmacy and pharmacotherapy can
have a significant impact on the aging population.
 Outcomes of the research show that the frail elderly are vulnerable
to increase the side effects of medications, drug interactions, non-
adherence, and geriatric syndrome.
 A prospective study also shows evidence that elderly patient has
decreased functional ability and inability to performed ADLS due
to over-prescribed medications.
(Cartley, Glyn, & Barton, 2016)

7. Elder Abuse
 1 in 10 aged 60+ Americans have experienced abuse. Over 5 million elders are abuse each
year.
 The National Council of Aging reports that the frail elderly that are abuse are at high risk
of death and disability.
 The US Department of Justice argues that Elder Abuse is an intentional or negligent act by
a person that results in harm to the older adult.
 The Elder Justice Coalition also advocates for the elderly and is increasing public
awareness, building support, and developing legislation against elder abuse, neglect, and
financial exploitation.
 The Ageless Alliance is developing Elder Justice Policies that can halt elder abuse and
neglect.
(National Council Of Aging [NCOA], 2020)

8. The Role of NP’s in Geriatric Care
 Developing effective Assessment tool and screening programs such as Functional screening, identification
of Senior Risk and PRISMA_7 screening tool.
 The U.S. Preventive Services Task Force has advised routinely screening women 65 years and older for
osteoporosis with dual-energy x-ray absorptiometry of the femoral neck.
 The Centers for Medicare and Medicaid Services encourages the use of the Beers criteria as part of an older
patient's medication assessment to reduce adverse effects.
 The Tinetti Balance and Gait Evaluation is a useful tool to assess a patient's fall risk.
 The USPSTF recommends screening adults for depression if systems of care are in place. Of the several
validated screening instruments for depression, the Geriatric Depression Scale and the Hamilton Depression
Scale are the easiest to use and most widely accepted.
 The Mini-Cognitive Assessment Instrument is the preferred test for the family physician because of its
speed, convenience, and accuracy use to evaluate cognition.
(Elsawy & Higgins, 2011)

9. The Future of the Frail Elderly.
 The Task Fall Detector are waterproof watch-like device that is used to detect a person when they fall and
send signal to get emergency contact.
 A walk-Joy is a non-invasive device used to restore balance for the older patient with peripheral neuropathy.
 The TV EARS are devices that elderly patients with hearing loss hear the television clearly without turning
up the volume and provide them with the entertainment required for there social and psychological health.
 The CLICK N DIG OBJECT locater is a technology used for patient with early cognitive impairment which
uses transmitter to locate loss items for the elderly.
 The Pill Reminder Pro are apps that is downloaded in smart phones to assist the elderly to locate time and
dosage of medication. It also provides reminds when patient may forget medication timing.
(The Medical Futurist [TMF], 2016)

10. How Does Evidence Affect Practice
 The care of the frail older patient requires knowledge and skill, as well as empathy, emotional reserve and common
sense.
 Caring for the Frail patient requires the capacity of the multidisciplinary team.
 The British Geriatric Society recommends that "Any interaction between an older person and a health or social care
professional should include an assessment which helps to identify if the individual has frailty". This will be
incorporated in the patient plan of care.
 Methods use to identify frailty will be based on the presence of indicators which includes unintentional weight
loss; feelings of exhaustion; weakness; slow walking speed and low levels of physical activity.
 NP’s should identify frail older people in their area of practice using validated screening and assessment tools and
direct patients and cares to supportive services and interventions.
(Elsawy & Higgins, 2011)

11. References
 Betiolli, S., Lenardi, M., Moraes, D., & Setlik, C. (2019, ). Physical frailty and urinary incontinence of
elderly in ambulatory care. Cogitare . https://doi.org/10.1016/j.jamda.2
 013.03.022.
 Burt, J., Godin, J., Filion, J., & Monlero, M. (2019, Dec.7). Frailty prevalence in the COMPASS-ND study
of neurodegenerative disorders. Canadian Geriatrics Journal , 23(12). https://doi.org/10.5770/cgj.22.392
 Cartley, A., Glyn, T., & Barton, N. (2016, Feb 5). Polypharmacy in the elderly. Sage Journals, 8(2), 10-30.
https://doi.org/10.1177/1755738015614038
 Elder Justice Coalition. (2020). Elder Justice Coalition. Retrieved from
http://www.elderjusticecoalition.com/about

12. References
 Elsawy, B., & Higgins, K. (2011, Jan 1). The geriatric assessment. American Family Physician, 83(1), 48-
56. Retrieved from https://www.aafp.org/afp/2011/0101/p48.html
 Hirdes, J. P. (2006, July 4). Addressing the health needs of frail elderly people: Ontario's experience with an
integrated health information system. British Geriatrics Society , 35(5), 329-331.
https://doi.org/10.1093/ageing/afl036
 National Council of Aging. (2020). Elder Abuse Facts. Retrieved from https://www.ncoa.org/public-policy-
action/elder-justice/elder-abuse-facts/
 The Medical Futurist. (2016). The greatest technological developments for the elderly in healthcare.
Retrieved from https://medicalfuturist.com/the-greatest-technological-developments-for-the-elderly/