Care for older adults in hospitalization

What is frality

Common geriatric syndrome characterized by age-associated multisystem dysregulation & decreased physiological reserve, leading to increased vulnerability to adverse health conditions

With all the PT and OT we might only be able to get them back to 80% and that is their normal now so this is decreased physiological reserve (the extra capacity of a cell, tissue, organ, or body system to function above its normal resting (basal) level when faced with added physical or mental stress)

Cumulative decline with multisystem dysregulation lead to decrease physiological reserve & increase vulnerability for subsequent morbidity and mortality

• Dysregulation: sarcopenia, renal insufficiency, anemia, deficiencies in anabolic hormones, excess exposure to cortisol, insulin resistance, compromised altered immune function, micronutrient deficiencies, and oxidative stress

Frailty worsens with advancing age (older than 85), more common in older women, among those of lower SES, dependent in 1+ ADLs, and decrease hand grasp strength

Symptoms of frality

Unintentional weight loss- losing weight without trying

Weakness- decreased muscle strength and difficulty lifting objects

Fatigue/exhaustion- feeling tired or having little energy

Slow walking speed- taking longer to walk or having difficulty moving

Low physical activity- decreased exercise and difficulty completing daily activities

Some complications associated with frailty

Disability

Falls

Peri-operative complications

• Nutritional deficit increases wound closure which means more time for microbes to get in it and longer time for post surgical site infection, can also be pneumonia from aspiration

Increased length of hospital stay & 30 day readmission rate

Less likely to discharge home- more likely to needed skilled nursing (high frailty score)

Increased risk for mortality

Not getting out of bed

Causes muscle weakness, loss of strength, and decreased mobility

Poor nutrition

Not eating enough leads to weight loss, weakness, and slower healling

Poor pain management

Uncontrolled pain makes it harder to move, sleep, and participate in care

Unnecessary medications

Can cause side effects, confusion, falls, and other complications

Unnecessary procedures

Can increase the risk of complications

Sleep deprivation

Frequent nighttime interruptions and noisy environments can cause confusion and fatigue

Restricted movement

IV poles, oxygen equipment, and other attachment can limit mobility

Infection and dehydration

Can worsen existing health problems and lead to complications

Chronic conditions

Chronic conditions are long-term health problems that require ongoing management

Ex

• Diabetes

• Hypertension

• Heart failure

• Arthritis

• COPD

Important characteristics of chronic conditions

Older adults often have multiple chronic conditions at once (multimorbidity)

Chronic conditions can affect daily activities and quality of life

Patients needs ongoing self-management

Multiple conditions can interact and make each other worse

Multimorbidty

Having multiple chronic diseases at the same time

50% of older adults have 3 or more chronic diseases

Acute conditions

These are sudden illnesses or changes in health that develop quickly

ex

• Pneumonia

• UTI

• Stroke

• Heart attack

• Dehydration

Important characteristics for acute conditions

Can make existing chronic conditions worse

Older adults may not show typical symptoms

Symptoms may appear as confusion, weakness, falls, or changes in behavior instead of the expected symptoms

Medications can contribute to symptoms or complications

Look for unusual changes and invertigate possible underlying causes instead of assuming they are just normal aging

Encourage ambulation 3 times daily

Prevents weakness and muscle loss

Encourage independence with ADLs

Maintains ability to care for themselves

Encourage physical activity

Improves strength and mobility

Implement fall precautions

Prevents injuries without unnecessarily restricting movements

Promote cognitive activity

Helps maintain mental function

Monitor for delerium

Allows early recognition and treatment of confusion

Prevent pressure injuries

Reposition and assess skin regularly

Prevent DVTs

Encourage movement and use prescribed prevention measures

Provide adequate nutrition

Supports healing and strength

Maintain oral hygiene

Prevent oral health problems

Review medications daily

Prevents adverse medication effects

Promote sleep

Helps prevent confusion and fatigue

Start discharge planning early

Helps patients safely return home