Geriatric Frailty

Geriatric Frailties
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National Guideline for Geriatric Frailties
The British of Columbia’s Ministry of Health Advance Care Planning (2008) developed the frailty care guideline to address various frailty issues. Among the issues addressed in this guideline included identification and management of individuals with frailty or those who are at risk of this condition. The document also provides guidelines on the management care plan for frailty patients sixty years and above. According to the authors, the guidelines are supposed to improve personal management plan for those who are exposed either to frailty, or at risk for this condition. In addition, the guideline provides strategies that could be employed in the implementation process. Moreover, the patient centered strategies in this guideline are aimed to curb the decline in functionality especially during the transition process in management.
The guideline provides the procedure in identifying the individuals with Frail condition and those who are at risk for Frailty. According to this procedure, patients should be involved in the personalized care plan and a consistent follow up on their progress to be considered. The patients may share a number of concerns, which could lead the physician in identifying this condition among them. Such concerns may include but not limited to: unexpected weight loss, difficulty in managing daily activities, fatigue, loss of memory, the families concern about them, and constant fear of falling.
There is also a scale in this guideline in identifying individuals with frail condition. These includes: very fit group, consisting of people who are robust and very active, well, which involves those who are alright but not as fit as those who are very fit, those who are fit but with comorbid condition, those who are apparently vulnerable, those with mild frail, moderate frail, and finally severe frail.
Other contents in this work include further assessment areas in the care plan. These areas as identified in the plan include but not limited to weight loss, impaired vision, inappropriate behavior, altered mental status, increasing consumption of alcohol, irrational fears, and increased number of falls and so forth.
Another element in this guideline is the criteria for implementing this care plan. According to this element, the care plan ought to be developed by first noting the concerns as raised by the patient. Other consideration in the implementation process includes support management for these patients, patient rehabilitation potential, and proper prevention schemes. The follow up, monitoring and re-evaluations process to be done consistently by the health practitioners. This review and monitoring process should follow a specific schedule, when the patient requests, or when there is any transitional change such as the change in the caregiver, change in the care locations, and insignificant change in the patient’s health.
The rationale behind this guideline is based on the assumption that, while many patients with frail condition may appear active and robust, their capacity in responding to stress is low. In addition, these are normally exposed to high risk of morbidity and or death. Therefore, it is very crucial to identify early frailty patients especially those who are older and respond appropriately either to eliminate or reduce risks associated with this condition. Therefore, it is necessary in designing a common approach, which will enable health practitioners to evaluating patients with frail condition. This common approach will enable practitioners to do the evaluations based on the level of actual risks and prioritize the medical needs of these patients. Additionally, this will enable practitioners to deduce whether, the patients would require additional care or support in their care location. Finally, the approach taken will enable the health workers in identifying frail patients or those who are at risk, and refer them for further assessment as may be required.
Historical Timeline for the management of frailty
In most cases, sufficient time is required in assessing the elderly patients to obtain the facts on their condition. This is because some of the patient’s characteristics may hinder the evaluation process. The following elements according to Merck Manual of health care professional (2012) are essential when assessing patients with frailty condition.
Sensory deficits: If the patient has a history of sensory problems, sensory aids such as eyeglasses, dentures and so on to be provided if the patient does not have them already.
Misreporting of the symptoms: There are some frail symptoms, which may be ignored by elderly patients as they consider them part of their normal aging. Therefore, practitioners should be keen in considering all of these symptoms and establish the connection with the frail condition.
Uncommon manifestations of a disorder: Among the elderly, the manifestation of this disorder may not be specific. Instead, these symptoms may be general, for instance, weight loss, confusion, fatigue, and so on.
Functional decline: Frailty disorder may manifest in functional decline. In such a case, standardized interviewing may not apply. Queries on the period of function decline for the patient for instance, “for how long have you been unable to do your regular activities?” can provide clinicians with essential information to identify their first stages of frail development.
Difficulty recalling: Patients with this condition have difficulties recalling past incidences such as their hospitalizations, past illnesses, drug use, operations. This means that the practitioners may have to obtain this kind of information from other places or people.
Fear: The patient may be reluctant on reporting the symptoms because of fear of hospitalization or dying.
Age-related disorders and problems: Depression, which is mostly associated with the elderly plus the discomfort, related with this disorder, might make the patient reluctant to divulge their personal information, which may be related to the condition, thus impeding the clinician’s assessment process.
Depression: The patients may refuse to either give information or omit them but these can be noted by their subdued enthusiasm, tears, or lowered voice.
Physical and mental health: What they reveal about their appetite or sleep may be informative to the clinician on this condition.
Weight gain or loss: The practitioners should be able to detect any weight change on the patient.
Clinicians should record the information acquired from the patient in his or her medical record. The practitioner’s knowledge concerning the patient’s social circumstance, daily activities, emotional state, mental status and his or her health status should guide the interview process. In addition, the clinician should ask the patient to describe his or her daily activities. This will elicit information concerning the physical and mental health status. Additionally, they should also ask the patients whether they have specific health concerns. This will help the clinician to have a better understanding of their condition (Merck Manual of health care professional, 2012).
Modern Treatment for Frail Patients
Treatment: Treatment measures for frail patients include plans and follow up by nursing, speech therapy, mental health practitioner, physical and or occupational therapy, registered dietician, basic medical provider and Interdisciplinary assessment.
Medications: Common medication includes megestrol acetat, mirtazapine, Vitamin D 800 IU, CalciumCreatine, as well as DHEA.
Meals on WheelsM medication effectsE Emotional issues, such as stress and depressionA Anorexia nervosa, alcoholismL Late-life paranoia problems of swallowingO Oral issues (poor cavities, fitting dentures)N No finance W Wandering and other dementia related issues H hypothyroidism or Hyperthyroidism, E Enteric disorders
Eating disorders
L Low-salt, and low cholesterol foods S Social problems, (e.g., isolation, inability to obtained preferred foods), gallstones
Non-nutrition interventions such as physical exercises and increased activities (American Dietetic Association, 2009).
Although there had been other earlier definitions and measures of frailty, Fried et al is widely recognized for developing the famous frailty measures. According to him, five indicators represented frail. One to two indicators depicted pre-frail and zero fit (Bergman FerrucciL, Guralnik, 2007). The five measure...