Tabloski ch24 lecture

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THIRD EDITION
CHAPTER
24
Caring for Frail
Older Adults with
Comorbidities
Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.
All Rights Reserved

Learning Objectives
1. Describe age-related changes that
affect overall health and function and
that contribute to frailty.
2. State the impact of age-related
changes, including organ function and
presence of comorbidities.
Gerontological Nursing, Third Edition
Patricia A. Tabloski

Learning Objectives
3. Identify risk factors of health for the
older person at risk for acute care
hospitalization.
4. Describe causes and unique
presentation of frailty in the older
person.

Learning Objectives
5. Design appropriate nursing
interventions directed toward assisting
older adults with frailty to regain
baseline function.
6. Formulate and implement appropriate
nursing interventions to care for the
older person with multisystem
problems.

Introduction
• The purpose of this chapter is to
describe special needs of frail older
persons with multiple comorbidities, the
risk factors associated with functional
decline, problems encountered during
hospitalization, and methods to avoid
these problems and improve care.

Introduction
• The medical comorbidities complicate
the nursing assessment and treatment
of medical conditions.

Introduction
• Frailty has also been defined as the
presence of three or more of the
following criteria:
–Unplanned weight loss (10 lbs in the last
year)
–Weakness and exhaustion
– Poor endurance and energy

Introduction
• Frailty has also been defined as the
presence of three or more of the
following criteria:
–Decline in grip strength and gait speed
–Slowness
– Low activity

Risks of Frailty
• A frail older person is at high risk for
dependency, institutionalization, falls,
injuries, hospitalization, slow recovery
from illness, and mortality.
• The frail older adult is most in need of,
and most likely to benefit from
specialized geriatric services.

Risks of Frailty
• Often, the frail older person will suffer a
rapid decline and decompensation as a
result of acute illness or worsening of a
chronic condition.

The Paths to Frailty
• Older persons can become frail by one
or more of three pathways:
–Changes of aging and loss of organ
reserve and function in the very old
– Diagnosis with several chronic illnesses,
each of which alone and in combination
with others can cause harmful effects on
overall physiological function

The Paths to Frailty
• Older persons can become frail by one
or more of three pathways:
–Chronic use of medications that can
impair immunity
– Existence in harmful social and
psychological environments

Cumulative Effect of Comorbidities
• Often, a frail older person will be
diagnosed with several underlying
chronic conditions and develop an acute
condition that disrupts the stability of
the chronic conditions.
• The frail older person is more at risk for
poor treatment outcomes and even
death because of the interaction
between normal changes of aging and
common illnesses associated with age.

Trajectories of Functional Decline
• Frail older adults and individuals at the
end of life exhibit four distinct
trajectories of functional decline:
–Sudden death
– Diagnosis with a terminal illness
–Organ failure
– Frailty

Trajectories of Functional Decline
• Those who experience entry and
reentry trajectories and frailty are likely
to require, but may not have access to,
supportive services because of steadily
diminishing reserve capacity to cope
with inevitable but unpredictable acute
health challenges.

Frailty and Emotional Health
• The focus of health care for the frail
older person will move beyond the
medical model to include how to
mobilize necessities for daily care,
including medications, provision of
nutritious meals, transportation to
healthcare appointments, and home
maintenance and safety.

Frailty, Comorbidities, and
Functional Status
• Many older people who have chronic
conditions and disabilities lead active,
productive lives, but some are more
disabled and require assistance with
activities of daily living.

Frailty, Comorbidities, and
Functional Status
• Evidence-based therapies, sophisticated
levels of interprofessional care, and
careful coordination characterize the
health care that is necessary to provide
the quality care needed by persons with
heart failure, cancer, and Alzheimer’s
disease as well as other chronic
illnesses.

Long-term Care
• Nurses should address problem
behaviors using social and
environmental modifications and
creative activities, thereby preserving
independence and self-esteem.

Long-term Care
• Drugs for behavioral control should be
used cautiously.
• Behavioral approaches include training
caregivers in therapeutic responses to
resistance to care.

Acute Illness and Hospitalization
• Common causes of hospitalization
include pneumonia, influenza, heart
failure, ischemic heart disease, urinary
tract infection, hip fracture, digestive
disorders, and dehydration. Heart
failure and pneumonia are the most
common conditions associated with
rapid readmissions.

Acute Illness and Hospitalization
• Hospital care is associated with
increased use of medications, invasive
procedures, diagnostic testing requiring
food and fluid restriction, nosocomial
infections, and occurrence of adverse
events and poor outcomes to
hospitalized older patients.

Palliative Care
• The use of valuable social and financial
resources on inappropriate or futile
medical care depletes healthcare
resources, drives up costs, and results
in less money that could be spent on
providing appropriate healthcare
treatment and quality-of-life
enhancement for older persons who
may improve as a result of such
treatment.

Palliative Care
• Palliative care improves the quality of
life of older persons and their families
when facing the problems associated
with life-threatening illness.
• This is achieved through prevention
and relief from suffering; early
identification, impeccable assessment,
and treatment of pain; and recognition
and treatment of other physical,
psychosocial, and spiritual problems.

Conclusion
• Gerontological nurses have the potential to
improve the quality of life across settings by
conducting effective and holistic nursing
assessments, facilitating access to programs and
services, educating and empowering older
persons and their families, participating in and
leading multidisciplinary health teams, serving as
advocates and influencing the development of
public policy and reform of legislation to improve
long-term health care, and conducting and
applying research related to aging.

Conclusion
• Nurses in all settings should practice
according to the following guidelines:
– Be aware of drug interactions.
–Remember that the presentation of
illness is less dramatic and more vague
than in other age groups.
–Conduct holistic nursing assessments
when caring for frail older adults and
those with comorbidities.

Conclusion
–Seek to access and provide the most
intensive services to those considered
the most frail and those diagnosed with
multiple comorbidities.
– Practice ethically according to
professional standards.
– Promote healthy aging in all clinical
settings.

Conclusion
–Recognize and treat pain in older
persons.
– Become expert at providing end-of-life
care.
–Seek continuing education programs
and pursue advanced degrees.

Tabloski ch24 lecture

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