GERIATRIC FRAILTY SYNDROME: LITERATURE REVIEW

GERIATRIC FRAILTY SYNDROME: LITERATURE REVIEW Name: Course title: Professor: Institution: Date Due:  Introduction This is a literature review that examines the relation of frailty to Osteoporosis, depression and social isolation in frailty patients. In this review, qualitative approach was used in finding common literature in a partial sampling of the related literature that dealt with research objectives. Literatures on Osteoporosis, depression and social isolation in relation to frailty condition, frailty were systematically reviewed. In addition, the relevant model and theory in this study was also examined. Most of the literature used in this study was accessed from peer-reviewed journals such as Academic Search Premier, JSTOR, Business Source Premier and Medline. These were identified from 2004 to 2013 and the reference list was pearled. The researcher extracted descriptive information on study populations, frailty research criteria, and outcomes from the selected papers, and quality rankings were assigned. Of the 1500 articles retrieved from the searches and 10 articles retrieved from the pearling, 10 of them met study inclusion criteria. In the 10 articles, the link between Osteoporosis, depression and social isolation to frailty were used to find out how the components are related with each other. The prevalence of frailty ranged from 5% to 58%. Once the articles were accessed, they were stratified with regard to the study variables. Afterwards, analysis of the main themes was conducted by employing counts of specific key terms. The results indicate a positive linkage between Osteoporosis, depression and social isolation to frailty. Conceptual Framework The conceptual framework of this study is outlined in figure 1.1 Figure 1.1 Conceptual Framework indicating the relation of frailty to depression, social isolation, and osteoporosis
As indicated in the figure, geriatric frailty is related with among other factors, depression, social isolation and osteoporosis. In other words, geriatric syndrome is the cause of social isolation, osteoporosis syndrome, and depression among the elderly. Studies such as those conducted by Taenzer and Melzack, (2008) found a positive relation between depression and frailty. People with this condition are likely to have poor attitudes concerning their own health. Depression could lead to low mobility and a persistent feeling of fatigue. In addition, it slows down the thinking process of these individuals. It is also the main cause of other illnesses such as myocardial infarction, anorexia and weight loss among the elderly. Osteoporosis is a disorder among the elderly that is caused by the frailty condition. This condition is related to the fragility of the structures that subsequently reduces daily activities of the patients as well as increasing the fracture risks. Consequently, the patient’s quality of life is subsequently hampered. As Srivastava et al (2002) observes, osteoporosis is a common syndrome among the elderly and a public health concern worldwide. The condition is normally depicted by miccroarchitectural deterioration of bone tissues as well as low level of bone mass. Unless preventive measures are undertaken, the incidence of hip fractures, low level of bone mass, and microarchtectural deterioration commonly associated with Osteoporosis increases with age. Mitnitsk, (2008) posts that geriatric frailty also leads to social vulnerability. This subsequently results into high mortality rates in frail patients. As the age of individuals continues to increase and as they become more vulnerable, the social situations greatly influence their health. The social environment, social isolation and inequalities, social economic status, social cohesion, and social capital are all related with the health status. Review of Studies Frail older persons are at higher risk of disabilities, hospitalization, Institutionalization, and death, compared with their age-matched non-frail counterparts(Storey, 2004).1–3 in scenarios that predict future health service delivery in the Western world, the rapid increase in frail older persons is seen as one of the major challenges to health care (Hooi and Bergman, 2005). There has been an exponential rise in the use of the term ‘frailty’ in the literature. Markle-Reid and Brown, (2003) reported substantial disagreement in the literature as to how frailty is defined and measured. The debate has focused on whether frailty should be defined purely in terms of biomedical factors or whether psychosocial factors should be included as well. From their literature reviews, Levers et al, and (2006) Aminzadeh et al (2002) conclude that most definitions of Frailty does include the idea of loss of age-related reserve capacity, though differences exist regarding other factors contributing to frailty. Most studies on frailty condition acknowledge that the capacity of frail patients in responding to stress is low. In addition, these patients are normally exposed to high risk of morbidity, depression, social isolation and or mortality rates and other biological factors. Therefore, it is very crucial to identify early frailty patients especially those who are older and respond appropriately. This will assist in either eliminating or reducing the 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 (British of Columbia, 2008). 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. Management and Interventions Despite a lack of consensus about the definition of frailty, a growing number of intervention studies for frail older persons are reported. This implies that interventions can be targeted at frail older persons independent of specific diseases. Disability, defined as experienced difficulty in performing activities in any domain of life is generally considered as one of the major adverse outcomes of frailty (Jette, 2006). Prevention of disability in frail older persons is seen as a priority for research in geriatrics and can lead to the maintenance of quality of life and reduced health care costs (Cutler, 2003). Several systematic reviews are available that focus on specific categories of interventions for frail older persons e.g. comprehensive geriatric assessment, after-care or respite care. Rudolph (2010) conducted an assessment to identify the modern studies associated with the use of appetite stimulants in the management and care of frail patients. The literature review was conducted from 1956 to 2010 with an emphasis on long term care, weight loss and appetite stimulants. The findings observed from this evaluation were that, the common approaches employed in addressing these phenomena included: comprehensive nutritional assessment, the use of appetites stimulants to encourage eating among the patients and the use of oral supplements. These have included medication such as oxandrolone, mirtazepine, megesterol acetate and dronabinol. In this perspective, caregivers and health practitioners are encouraged to provide a comprehensive approach to the management of unintentional weight loss among the frail individuals in addition to considering appetite stimulants. An assessment was carried out on older people’s views in relation to risk of falling and need for intervention: a meta-ethnography by McInnes, Seers and Tutton (2011). In this study, eleven quality articles were selected and six concepts were recognized. These included rationalizing, personal control, identity, life change and salience, self management and taking control. The synthesis in this line of argument described how the frail patients approached their self appraisal of the risk in falls and the necessary intervention measures required. In addition, it also describes how they these people adapt to the risk of falls and would be the intervention measures. Results of the evaluation indicated that some of these people prefer adapting to this reality by taking control of themselves and implementing strategies that are tailored to their self management. Health service providers understand that some of these people prefer preserving their identity as independent people while in this condition.  HYPERLINK "/researcher/38462370_Esther_Coker/" \o "Esther Coker" Coker,  HYPERLINK "/researcher/39185508_Sharon_Kaasalainen/" \o "Sharon Kaasalainen" Kaasalainen, and  HYPERLINK "/researcher/2006676919_Anita_Fisher/" \o "Anita Fisher" Fisher (2013) observed that an inclusive care program for the elderly whereby the patient’s community care centers receive basic care from an interdisciplinary team would be very much beneficial. This team may include a specialist in geriatric medicine, therapists (both physical and occupational), nurses and social workers. The patient centered services for these people will include: occupational and physical therapy, home nursing, transportation, adult day care, home adult aid services and adult care. The goal is to overcome the environmental challenges, enhance function, and prevent institutionalization. In her “evaluating the Attributed Dignity Scale”, Jacelon, (2011) points out that physical exercises for these people would be very advantageous even to those patients who are in the chronic phase. She also adds that individuals beyond the age of 75 should be compensated by the government around the decreasing reserves in preserving the well being and functioning in these patients. The postulation for exercises is also supported by Diana, (2008), who additionally advocates for the use of Nonpharmacological modalities in the management of frailty. This author observed that the use of Nonpharmacological modalities was a very crucial component in the management of frail patients. This is because; it helps the patients in coping with suffering and pain alongside improving their quality of life and functioning. Such modalities include psycho behavioral therapies, physical therapy, social and pastoral work consultations. Primary Care Frailty patients are a challenge to healthcare practitioners who find themselves overwhelmed by their health and physical complexities. Apparently, family health providers are in a deal position in incorporating the frailty concept into their practical aspects. They harbor the necessary skill and propensity that lends itself to the patient centered care. This also considers the patient’s individual subtleties of the patient’s health in their social context. Tools and equipments of frailty identification are not fully developed. However, some practical measures could be considered in the identification of frailty in the clinical setting and start addressing on how its identification may influence clinical care (Rockwood, and Lacas, 2012). Literature review on basic care for frail patients indicates that the topic has not been explored in the perspective of primary care, family medicine or frailty in general. The researcher searched for articles concerning primary care for frail patients specifically in pub med. Key words employed included frailty, primary care in frailty and family medicine for frail patients. The review was limited to frail patients, adult with 70 years and above. The studies sought were from 2002 to the current year 2013. The researcher employed the abstracts of the searched articles that were relevant to primary care, and family medicine. In particular, the articles were selected on the basis of primary care setting; the interventions were conducted by a primary care provider and the population was frail patients with the targeted conditions. Relevant articles were reviewed and analyzed. Majority of the studies which fell on frailty and primary care employed screening tools which were not applicable at least directly with a family health provider’s office or those that are still in the early stages of development. Many of these are still in the identification stages in factors which could be employed in frailty identification but which fail to test the primary care application Melzelthin et al (2010) . Other studies have extrapolated conditions and recommend the feasibility of family medicine setting. Many other studies employ different methods of screening frailty including questionnaires and other frailty mechanisms as away of identifying frailty patients for intervention measures (Li et al, 2010). Studies reveal that identification of frail patients early enough will enhance the outcomes of clinical care that is at the same time cost effective. Another aspect in primary care as Monteserin et al (2010) posts is the aspect of preventive medicine. These authors explain that preventive medicine is very much crucial with regard to primary care and family medicine. They further recommend that preventive medicine ought to be incorporated in the extant framework of preventive medicine. These aspects is equally applicable to both secondary and tertiary prevention, particularly with regard to increased rate of severe outcomes that emanates when complex interventions are considered for individuals whose functional status could be identified (Aaldriks et al, 2011). In addition to the treatment and management functions, nurse practitioners are also mandated to undertake a number of intervention measures that are aimed at preventing or managing the adverse effects caused by Geriatric frailty. Some of these interventions include prevention of falls that are commonly experienced by these people. They also undertake the evaluation of people who are at risk of falls and also residents who at risk at the nursing homes with referrals. In essence, there main role in preventive measures is to identify, evaluate and modify the risk factors in frail patients and provide the hip protectors to those who are at higher risk. In addition to these measures, they as well ensure that, the patients are subjected to e...