Frail Elderly Syndrome is a complex clinical condition characterized by increased vulnerability to stressors, leading to decreased physiological reserve and functional decline in older adults. This nursing diagnosis focuses on identifying risk factors, implementing preventive measures, and managing complications associated with frailty in the elderly population.
Causes (Related to)
Frail Elderly Syndrome can develop due to various factors that contribute to its progression:
- Advanced age (typically over 65 years)
- Physiological factors including:
- Sarcopenia (loss of muscle mass)
- Osteoporosis
- Chronic inflammation
- Hormonal changes
- Nutritional deficiencies
- Medical conditions such as:
- Social and environmental factors including:
- Social isolation
- Limited access to healthcare
- Poor living conditions
- Inadequate support system
- Financial constraints
Signs and Symptoms (As evidenced by)
Frail Elderly Syndrome presents with multiple indicators that nurses must recognize for proper assessment and intervention.
Subjective: (Patient reports)
- Increased fatigue
- Decreased appetite
- Unintentional weight loss
- Weakness
- Poor endurance
- Sleep disturbances
- Fear of falling
- Depression symptoms
Objective: (Nurse assesses)
- Slow walking speed
- Decreased grip strength
- Unintentional weight loss (>5% in 6 months)
- Low physical activity level
- Impaired balance
- Multiple falls
- Cognitive decline
- Poor nutritional status
Expected Outcomes
The following outcomes indicate successful management of Frail Elderly Syndrome:
- The patient will maintain or improve functional independence
- The patient will demonstrate improved strength and endurance
- The patient will maintain adequate nutritional status
- The patient will avoid falls and injuries
- The patient will engage in regular physical activity
- The patient will report an improved quality of life
- The patient will demonstrate effective coping strategies
Nursing Assessment
Physical Assessment
- Evaluate muscle strength and mass
- Assess gait and balance
- Monitor vital signs
- Check nutritional status
- Evaluate skin integrity
- Assess cardiopulmonary function
Functional Assessment
- Evaluate activities of daily living (ADLs)
- Assess instrumental activities of daily living (IADLs)
- Monitor mobility status
- Evaluate transfer abilities
- Assess fall risk
Cognitive Assessment
- Check mental status
- Evaluate memory function
- Assess decision-making capacity
- Monitor mood and behavior
- Screen for depression
Social Assessment
- Evaluate support system
- Assess living situation
- Check financial resources
- Monitor caregiver stress
- Evaluate access to healthcare
Environmental Assessment
- Check home safety
- Evaluate the need for assistive devices
- Assess lighting and accessibility
- Monitor temperature control
- Evaluate bathroom safety
Nursing Care Plans
Nursing Care Plan 1: Risk for Falls
Nursing Diagnosis Statement:
Risk for Falls related to decreased muscle strength, impaired balance, and altered mobility as evidenced by slow gait speed and history of falls.
Related Factors:
- Muscle weakness
- Impaired balance
- Poor vision
- Environmental hazards
- Medications affecting balance
Nursing Interventions and Rationales:
- Implement fall prevention protocol
Rationale: Reduces risk of injury and maintains safety - Assess the environment for hazards
Rationale: Identifies and eliminates potential fall risks - Provide appropriate assistive devices
Rationale: Supports safe mobility and independence
Desired Outcomes:
- The patient will remain free from falls
- The patient will demonstrate proper use of assistive devices
- Patient will identify and avoid fall hazards
Nursing Care Plan 2: Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to decreased muscle strength and endurance as evidenced by difficulty with transfers and decreased activity tolerance.
Related Factors:
- Muscle weakness
- Joint stiffness
- Pain
- Fear of falling
- Decreased endurance
Nursing Interventions and Rationales:
- Implement a progressive mobility program
Rationale: Improves strength and endurance gradually - Teach energy conservation techniques
Rationale: Maximizes available energy for essential activities - Provide physical therapy referral
Rationale: Develop a specialized exercise program
Desired Outcomes:
- The patient will demonstrate improved mobility
- The patient will participate in a daily exercise program
- The patient will report decreased fatigue with activities
Nursing Care Plan 3: Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less Than Body Requirements related to decreased appetite and difficulty preparing meals, as evidenced by unintentional weight loss and poor nutritional intake.
Related Factors:
- Poor appetite
- Difficulty shopping/cooking
- Dental problems
- Depression
- Limited financial resources
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Identifies deficiencies and tracks progress - Implement a supplemental nutrition plan
Rationale: Ensures adequate nutrient intake - Arrange for meal delivery services
Rationale: Provides access to balanced meals
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will demonstrate an improved appetite
- The patient will meet daily nutritional requirements
Nursing Care Plan 4: Risk for Caregiver Role Strain
Nursing Diagnosis Statement:
Risk for Caregiver Role Strain related to complexity of care requirements and limited support system as evidenced by caregiver reports of stress and fatigue.
Related Factors:
- Complex care needs
- Limited resources
- Lack of respite care
- Multiple responsibilities
- Emotional strain
Nursing Interventions and Rationales:
- Assess caregiver stress levels
Rationale: Identifies the need for additional support - Provide respite care resources
Rationale: Prevents caregiver burnout - Connect with support services
Rationale: Expands available assistance
Desired Outcomes:
- The caregiver will demonstrate effective coping strategies.
- Caregiver will utilize available support services
- The caregiver will report decreased stress levels
Nursing Care Plan 5: Self-Care Deficit
Nursing Diagnosis Statement:
Self-care deficit related to physical limitations and decreased strength as evidenced by difficulty completing ADLs independently.
Related Factors:
- Physical limitations
- Fatigue
- Pain
- Cognitive decline
- Environmental barriers
Nursing Interventions and Rationales:
- Assess self-care abilities
Rationale: Identifies specific areas needing assistance - Implement assistive devices
Rationale: Promotes independence in ADLs - Teach adaptive techniques
Rationale: Enables safe completion of self-care activities
Desired Outcomes:
- The patient will demonstrate improved independence in ADLs
- The patient will utilize adaptive equipment properly
- The patient will maintain an optimal level of self-care
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Dent, E., Hanlon, P., Sim, M., Jylhävä, J., Liu, Z., Vetrano, D. L., Stolz, E., Pérez-Zepeda, M. U., Crabtree, D. R., Nicholson, C., Job, J., Ambagtsheer, R. C., Ward, P. R., Shi, S. M., Huynh, Q., & Hoogendijk, E. O. (2023). Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology. Ageing Research Reviews, 91, 102082. https://doi.org/10.1016/j.arr.2023.102082
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Lee H, Lee E, Jang IY. Frailty and Comprehensive Geriatric Assessment. J Korean Med Sci. 2020 Jan 20;35(3):e16. doi: 10.3346/jkms.2020.35.e16. PMID: 31950775; PMCID: PMC6970074.
- Overcash J, Cope DG, Van Cleave JH. Frailty in Older Adults: Assessment, Support, and Treatment Implications in Patients With Cancer. Clin J Oncol Nurs. 2018 Dec 1;22(6):8-18. doi: 10.1188/18.CJON.S2.8-18. PMID: 30452021.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
