Understanding Frailty: A CNA’s Guide
Frailty is a term commonly associated with elderly people. As a CNA you see frail older people every day. But what does it really mean? Is it having brittle bones? Being weak and having difficulty walking? Having a strong response to the environment? Frailty is these things and more. It is a clinical syndrome that is caused by a decline in multiple body systems from an increased vulnerability to stress, and an impaired immune response. However, the most important thing you need to understand about frailty is that it is both preventable and reversible.
Consequences of Frailty
Frailty can have many devastating outcomes. Frail older adults are more likely to fall and are more likely to require placement in a nursing home. If they experience illness, they are more likely to die. If your patient is frail, they may be fine day-to-day, but an acute illness such as pneumonia or a urinary tract infection may compromise their ability to function normally, and their frailty will make it difficult for their immune system to fight a disease, leading to sepsis and death.
Symptoms of Frailty
Frailty is a subtle condition that happens over time. Rarely it is a sudden change, but a series of small changes that significantly affect a person’s ability to function as they normally would.
The following symptoms are typical of frailty, and having at least three will put your patient at increased risk for the unfortunate consequences of frailty:
- Unintentional weight loss
- Muscle weakness
- Slow walking speed
- Low physical activity
The good thing about frailty is that small things affect the condition in a big way. Little things may tip the scale causing an increase in frailty, such as an infection, or tripping and falling on the floor. But likewise, small things can also prevent the scale from tipping, such as drinking plenty of fluids, and proper nutrition. Frailty is a subtle condition that can be avoided, and your knowledge of your patients and careful monitoring in any changes in status or behaviors can mean the difference between independence and dependence, or even life and death.
Many aspects of your patient’s daily life can lead to frailty, and there are many ways to prevent frailty from occurring.
As people age, there is a loss in their ability to sense thirst. As a result, they tend to drink less, causing a decrease in total body water. During a typical hospital stay your elderly patient’s total volume can decrease by 600 mL! Dehydration puts stress on your older patient’s body and puts them at increased risk for developing frailty and its associated consequences.
There are many strategies to encourage hydration. Always be sure your patients have water available to them and make sure to place it within reach and easily visible. Every time you enter your patient’s room make sure to provide them with a drink of water. If you patient is fasting for surgery or any other medical reasons, be sure to monitor them for signs of dehydration such as dry mucous membranes and concentrated urine.
As people age they lose their taste buds, affecting their ability to taste subtler flavors. Also, their saliva production decreases, make drier or crunchy foods more difficult to eat. This leads to poor nutrition, worsening chronic conditions and impeding recovery from illness or surgery. Proper nutrition can improve recovery times and prevent frailty from developing.
To ensure your patients get adequate nutrition, be sure to provide oral care before meals, and increase the frequency of oral care if they are on oxygen. Make mealtimes your top priority. Promote interaction with staff, family, and other patients when eating. If possible, encourage family and friends to visit during meal times. Be sure to ask about food preferences to ensure they receive the food they will be sure to enjoy.
When people age, they tend to lose muscle tone in their colon, as well as atrophy of colonic mucous glands. This causes an increase in constipation which can negatively affect your patient’s comfort and self-care abilities.
To prevent constipation, encourage lots of fluid intake, advocate for an increase in dietary fiber in their meals and promote regular exercise. If you notice your patient is having some fecal smearing note that this may indicate a fecal impaction. Keep a close eye on your patient’s elimination and document any changes.
Urinary tract infections are one of the most common causes of frailty and falls. Maintaining urinary tract health not only prevents infections and promotes better health, but it enhances their dignity and mental health. As people age their bladder muscles become weaker and less elastic. They also lose their sensation of the fullness of their bladder and have a decreased bladder capacity. Men often have an enlarged prostate which makes them more likely to experience urinary retention. These things can lead to infections or interventions such as urinary catheters which are a common cause of frailty.
To prevent this from happening, be sure to encourage your patients to void frequently, especially if they are receiving IV fluids. Encourage a trip to the bathroom even if they do not feel the urge to prevent incontinence or a panicked rush to the bathroom later. Always ambulate to the toilet whenever possible to also help increase their activity. Finally, monitor them for a possible urinary tract infection, like burning, foul smell, or increase in the urge to void to prevent an unnecessary development of frailty
Promoting and encouraging regular activity and exercise slows physical decline and improves your patient’s mental state. Regular activity strengthens bones and muscles, preventing debilitating falls or deconditioning.
To encourage activity in your patients encourage them to do as much for themselves as they can, including in bathing and ADLs. Encourage participation in range of motion exercises and ambulate your patients as much as possible and as tolerated.
Recent studies show that rest is essential in maintaining good health. As people age, they have a reduction in the amount of deep sleep they experience and have more frequent waking. They also tend to switch to an early to bed and early to rise pattern that further contributes to sleep deprivation.
The goals for care should be to increase the amount of good quality sleep and decrease the amount of sleep deprivation. Allow time for your elderly patients to nap and be sure to coordinate procedures and examinations with naps. Be sure to provide HS care and keep their room quiet with dim lighting. Encourage the use of sleep hygiene practices, such as a regular sleep/waking schedule, and decreasing energizing activities close to bedtimes.
Have you ever noticed that older people are cold in rooms that are unbearably hot to you? As people age they have less subcutaneous tissue and therefore produce less heat, causing them to always feel cold. They also are less able to adjust to changes in environmental temperatures as their younger counterparts. Frequent extremes in temperature can negatively impact your patient’s health and may cause frailty.
Maintaining a comfortable temperature for your patients is quite simple. Always be aware of your patient’s different needs for heat, apply warm blankets and encourage them to wear layers daily. If your patient is going to be transported by ambulance, be sure to protect them from the rapid changes in temperature by covering them with more blankets than you usually would. If a patient’s clothing or bedding is damp, be sure to change it promptly to prevent excess heat loss.
Maintaining skin integrity is essential to maintaining your elderly patient’s good health. A decrease in mobility due to injury or illness can cause bed sores or skin tears in an older patient and should be avoided whenever possible. Also, skin becomes drier and thinner with age, further increasing their risk of skin breakdown.
Be sure to apply moisturizer to your patient’s skin every day, especially to the arms and legs. If your patient is in bed or in a chair for long periods of time, be sure to change their position at minimum every 2 hours. When moving your patients in bed be sure to do so gently, avoiding any shearing forces to prevent chafing or shearing of the skin.
Frailty is a common and devastating condition for older adults and can lead to a decrease in independence and an increase in injuries, even leading to death. Luckily it is preventable and small changes in practices and in your patient’s environment can go a long way to preventing this unfortunate condition. Remember, it’s the little things that make a big difference. Providing a nice moisturizer, encouraging them to ambulate, and offering extra time to talk and give support can go a long way to maintaining your patient’s health. The special care and little comforts that you provide your patient’s every day can make a significant impact on their wellbeing.