Frailty In Older Adulthood

This article addresses an important issue on how to develop frailty assessment tools in older adults with musculoskeletal disorders. Why is this topic more essential? Frailty has found in various fields of chronic diseases not only in musculoskeletal disorders. I am interested in frailty; however, it is tricky to determine who present frail in older adults having physical function limitation. Therefore, the different among physical function limitation, immobility, and frailty are still hard to justification. For example, older adults having secondary or third osteoarthritis always presents with severe pain at the knee joint. This pain also interferes his/her physical function. The more joints movement, the greater pain emerge. Reducing severe

In order to identify a condition as a disease, it should fit certain criteria. One of the reasons that obesity is classified as a disease is because of its large comorbidity. Obesity is a risk factor for chronic diseases such as hypertension, dyslipidaemia, type 2 diabetes, cardiovascular disease, sleep apnoea, musculoskeletal disorders and some cancers (Rossner, 2002). According to Rossner (2002), the death rate from all causes, cardiovascular disease, cancer and other diseases increases among moderate and severe overweight men and women in all age groups. Therefore, obesity is

This essay aims to discover and analyse adult obesity as a challenging public health issue in England as it has a detrimental effect on the society. The rationale for choosing adult obesity as a public health issue is to comprehend and develop the knowledge of obesity and its impact on individual’s health and wellbeing to better meet the needs of an obese adult in clinical practice. Obesity will be defined, its trends and the biopsychosocial factors that contribute to an individual’s health and wellbeing will be discussed along with the health inequalities. Furthermore, this assignment will highlight relevant policies and legislation aimed at addressing the health risk and needs of an obese adult. Lastly, this essay will explain the role of a nurse in both promoting and assessing of the health requirements of obese adult and then the conclusion will be drawn summarising the key points of the essay.

1. In her speech, Jane Fonda spoke about aging and the effect that it can have on a person. Fonda talked about “Life’s Third act” or the last three decades of a person’s life. Fonda explained that the advances in medicine and technology enabled the human race to live longer than before (Fonda, 2012). According to Fonda, humans are living on average, thirty years longer than past generations. The human life span has been extended and humans are spending a great deal of their lives in older age (Fonda, 2012). Fonda explains that we should not accept aging as a decline to our mental and physical capacity. According to her, our spirits do not age but mature over time which explains why people over the age of fifty are generally happier, less

Frailty develops when an older adult experiences a stressor and is unable to achieve a normal homeostasis accompanied by a decrease in several physiologic systems over a period of time. With a decrease in different physiologic systems, homeostatic reserves become depleted, resulting in a minor stressor causing a change in health status that is disproportionate to the stressor. For example,

The WHO classifies an adult with a Body Mass Index (BMI) of 30 or above as being obese. The BMI tool is used globally, and is calculated by dividing a person’s body weight in kilograms by their height in inches. Bostram and Eliasson (2006) argue a serious weakness with BMI is that the measure cannot differentiate between fat and muscle mass, and that a change in girth or abdominal circumference is a better reflection on the onset of obesity among other associated problems such as type 2 diabetes. Obesity is one of the major public health issues affecting society and is fast becoming a major cause of death across the globe. Seidell & Halberstadt (2015) indicate that the prevalence of obesity is growing at an alarming rate, and over the last thirty years, overnutrition and obesity has transformed from a minor health issue which affected only the most affluent of societies, to being a major threat to public health throughout the world.

Frailty is a common clinical syndrome in older persons that carries an increased risk of poor health outcomes. Frailty has been described as “a physiologic state of increased vulnerability to stressors that decrease physiologic reservoirs, resulting from aging and decrease function of multiple physiologic organs (1). The overall prevalence of frailty in USA community dwelling aged 65 or older in the United States ranges 7-12%. The prevalence of frailty increased with age from 3.9% in the 65-74 age group to 25% in the 85+group, and was greater in women than men (8% vs. 5%) (2).

As we age, we start to lose muscle mass, otherwise known as sarcopenia. When muscle loss occurs, this can increase the risk of falls and bone injuries. Several reasons for this loss can be decreased physical activity, hormones, illnesses, and even our eating habits. Ambulation becomes difficult for seniors and nurses must teach safety in order to decrease risks that could result in a fall. Some of these conditions are stairs in the home, throw rugs, not having adequate lighting, pets, and even medications can cause dizziness or off balance episodes (Tabloski, 2014). Studies have shown that falls account for two-thirds of all injuries related to falls and around 30 to 40 percent of seniors in the community will have a fall-related accident (Landi

A condition of modern times, obesity is said to be the greatest epidemic currently facing humanity (WHO, 2003; Hill, 2007). Obesity is one of the most frequent causes of preventable death in developed nations (Bauer et al., 2014), with the United States being home to over 150 million overweight or obese individuals – 65% of the adult population (Flegel, 2002; US Census Bureau, 2010). Obesity is often caused by a mismatch between energy intake and usage, thus it is frequently seen in those who live a sedentary lifestyle (Hu, 2003), such as the patient in this scenario. Obesity is now a major public health concern and has recently been voted by the American Medical Association to be classified as a ‘disease’ (Dailey, 2013). Indeed, the cost of obesity to the United Kingdom’s economy was estimated to be £15.8 billion, with £4.2 billion in direct costs to the National Health Service (Public Health England, 2007).

Evidence reveals that sarcopenia is indubitably initiating factor to increase weakness and develop advanced processes of frailty42,58,89,90. Notably, older adults having MSK are prone to impaired mobility and decreased physical activity; these problems are the trigger points influencing functional decline, frailty, dependency, and lessened quality of life. Repeatedly suffering from MSK–pain, impaired mobility, inactivity, and sarcopenia–is, therefore, a vicious cycle of developing frailty91.

From our review, there are a few studies of frailty in orthopedic clinical settings. Also, frailty is complex with multidimensional components; there is not enough robust evidence to justify which frailty instrument has the edge over others in clinical settings. However, the reasons to consider for selecting clinical frailty instruments should be concerned with: clinical contexts, conceptual or theoretical framework, validity and reliability of frailty instruments, and predictability of health outcomes. Based on reasons as mentioned, the CHS (Fried’s Frailty Phenotype) and FI (Frailty Index) have more advantage than others. The FI has a strong predictability of the adverse health outcomes, but the cut points vary. Moreover, the comorbidity

According to the complexity of frailty, selecting frailty instrument to capture frail status accurately is a crucial way for providing better care in orthopedic. Thus, evaluating frailty measurement instruments applying in the clinical setting is essential to health care personnel. Although the cause of frailty remains unclear, choosing reliable and strong prediction is required especially in frail elderly with MSDs population. As we found the 8 frailty instruments currently used in orthopedic; the structural and components, clinical health outcomes, along with evaluation instrument psychometric properties of those frailty instruments will be described as

According to Castrejon-Perez et al. (2016), frailty syndrome is one of the main challenges that older adults face as they age. Frailty syndrome is defined as a physiological state of increased vulnerability which can lead to changes in disability, dependence, long-term care use and mortality (Castrejon-Perez et al., 2016). Since the Mexican population tends to have higher rates of obesity, diabetes and hypertension prevalence is high and can lead to hospitalization and mortality. Castrejon-Perez et al. (2016) set out to explore if there is a relationship between frailty with diabetes and/or hypertension in a representative sample of Mexican older adults. This study used the 2012 Mexican Health and Nutrition Survey to answer their research question.

Obesity among individuals 65 years old and above is notably on the rise. Ogden, Carroll, Fryar and Flegal, (2015) affirmed the prevalence of obesity in older adults aged 60 and over (37.0%) was higher than among younger adults aged 20–39 (32.3%) (p. 2). In a randomized controlled trial done by Villareal et al., (2011) pointed out “obesity exacerbates the age-related decline in physical function” which corresponds to a surge in skilled nursing home [SNF] admission secondary to frailty and inability to care for themselves (p. 1219). Because people who are considered obese and elderly are at higher disk of functional decline, the physical therapist [PT] should possess basic knowledge on nutritional wellness to educate and promote health and overall wellness in this particular population.

Fried’s Frailty Index is the original tool which was modified for specific purposes. Fried’s Frailty Index have five domains for measuring frailty: shrinking, exhaustion, slowness, weakness, and physical activity. Scores ranged from 0- 5. The score 0 is robust (not frail), score 1-2 is pre-frail, and the score of 3 or greater is frailty (Kistler et al., 2015; Kua et al.,