FRAILTY

Frailty in older adults is a sign of deterioration.

It is the stage in older adults between functional independence and death.

Frailty has a substantial negative effect on older adults.

The effect impacts on daily activities and quality of life.

There are two ways to view and model frailty.

The first is the phenotypic model.

This is where frailty consists of five variables: unintentional weight loss, self-reported exhaustion, low-energy expenditure, slow gait speed, and weak grip strength.

The second model is deficit accumulation.

It views frailty as a result of cumulative decline across multiple physiological systems.

Both models have value in viewing how frailty affects older adults.

And frailty increases the likelihood of fracture.

Fracture is a leading cause of mortality in older people.

It is obviously a burden upon the patient.

And it is also an increasing burden and cost upon the health care system as the population ages

Hip fractures are the most common fractures in older adults.

50% of individuals who fracture a hip will die within a year following a fracture.

Preventing fractures requires identification of the risk factors.

It is important to recognise the implications and consequences of frailty given the prevalence and significance in caring for older adults.

There are few validated tools that screen for frailty.

On the Victorian Government website, there are four assessment scales that measure frailty.

It describes the pros and cons of each scale.

After identifying frailty, timely and effective support and treatments are required to reduce the risk of fracture.

The problem is that there is no consensus about what are the interventions that best address frailty.

Potential treatments for consideration include exercise, protein supplements, vitamin D and reducing polypharmacy.

What is known is the type of person that is most at risk for fractures.

Fracture risk increases as the degree of frailty increase.

Frail individuals have the highest risk followed by prefrail individuals.

Prefrail is where one or two criteria of frailty are present which leads to a high risk of progressing to frailty.

This means that individuals are already predisposed to increased fracture risks when they are entering the first stage of frailty.

Identifying individuals in early frailty or prefrail and providing proactive and preventative nursing care could result in a reduction in morbidity and mortality of fractures.

One way this could happen is with an assessment that reviews the individual’s gender, physical activity, muscular strength, balance, perceived energy and gait speed.

These traits are effective predictors of fracture risks in older adults.

Females aged 55 or older, females aged 65 or older with a hip fracture, and all adults aged 65 or older have a higher fracture risk if they are frail.

There is a relationship between frailty and poor prognosis outcomes in females.

If the patient is robust then there is less of a risk of fracture than those that are prefrail.

If a patient is prefrail then there is less of a risk of fracture than those that are frail.

To learn more about frailty,

Chen, Kuo‐Wei, Shu‐Fang Chang, and Pei‐Ling Lin. “Frailty as a Predictor of Future Fracture in Older Adults: A Systematic Review and Meta‐Analysis.” Worldviews on Evidence‐Based Nursing (2017).

Identify Frailty (Victorian Government)

Kojima, Gotaro. “Frailty significantly increases the risk of fractures among middle-aged and older people.” Evidence-Based Nursing (2017): ebnurs-2017.