Aging is a natural process that is generally determined by chronological age. A person who is 65 years or older is typically called elderly.
Nevertheless, when utilizing the generic terms elderly and older adults, there are no particular definitions that adequately represent this patient population.
Frailty is a broad term that refers to various disorders that affect elderly adults, including overall infirmity and cognitive deficits.
Frail Elderly Syndrome is a NANDA nursing diagnosis that can be used to describe elderly people who are at significant risk of negative consequences such as impairment, reduced quality of life, hospitalization, and death.
A few scrapes and bruises pose essentially no risk to a healthy young person, whereas colds and the flu are unpleasant but rarely serious.
However, when a frail person experiences physiological stress, poor medical results follow. Stress is frequently led to a long period of recuperation and then deterioration of function.
In general, Frail Elderly Syndrome can be quite fatal if left untreated.
Frail Elderly Syndrome: Criteria for Frailty Assessment
Various tools are used to diagnose and assess Frail Elderly Syndrome and its associated risks, but diagnosing frailty is considered generally simple as there are commonly visible symptoms.
Several independent studies have sought to detect frailty using recognized operational criteria or measured disability ratings.
The frail elderly syndrome is recognized and described as separate and independent of medical comorbidities and impairment in one of the researches assessing various widely observed markers of frailty.
At least three of the following five criteria are required to consider frail elderly syndrome:
- Weight loss. Considerable weight loss, as demonstrated by a reduction of at least 10 pounds or more than 5% of body weight in the previous year.
- Diminished Muscle Strength. Weakness of the muscles, as indicated by declining grip strength at 20% baseline, and modified according to gender and Body Mass Index (BMI).
- Decreased Speed. Physiologic slowness, as determined by the time it takes to walk 15 feet distance.
- Poor Endurance. Deficient stamina, as evidenced by self-reported tiredness.
- Low Energy. Minimal physical activity, as measured by a standard questionnaire.
Related Factors to Frail Elderly Syndrome
Frail Elderly Syndrome is a medical condition that has a multifactorial etiology and contributors, some of which are given below.
- Demographic Factors. Age is a major risk factor for Frail Elderly Syndrome as most frail adults are 80 years old or older. Frailty is also more prevalent in women and people with lower socioeconomic status, confirming demographic factors as a major contributor.
- Malnutrition. The key to healthy and active aging is maintaining a healthy nutritional status, but malnutrition is becoming more common in the elderly. Because of various comorbidities, frequent hospitalizations, and pharmaceutical treatment, among other factors, elderly patients are classified as having a high nutritional risk. Malnutrition is also linked to functional disorders, longer hospital stays, and a shorter life expectancy. As a result, clinical characteristics of the frail elderly syndrome are strongly connected to nutritional status in the elderly population.
- Polypharmacy. Polypharmacy refers to the use of four or more medicines. One in every two elderly people suffers from polypharmacy, which is associated with self-medication and the use of over-the-counter medications. Polypharmacy and multi-morbidity are components of the treatment cycle, in which an increasing number of comorbidities require treatment by multiple experts, which necessitates the use of more medications, which causes organ damage. Adverse effects are more common in the elderly, and the likelihood increases as the number of prescriptions used increases.
- Falls. The likelihood of falling increases with age as more than half of patients over the age of 80 fall once every year. Falls are the leading cause of death in elderly adults with traumatic brain injury and contribute to incapacity and hospitalization. The most significant risk factors for falling are previous falls, hospitalization due to falls, and visual impairment.
- Cognitive function deterioration. Short-term and long-term memory, language, visual and spatial skills, abstract thinking, and the perception of external stimuli are all examples of cognitive functions. Essentially, the full cognitive function allows for adequate biopsychosocial functioning in everyday life while aging processes include age-related memory deterioration and cognitive deterioration. Cognition has long been recognized as a component of frailty, and poor cognitive ability is linked to increased mortality by more than twice.
Treatment for Frail Elderly Syndrome
The next action is to treat the frail elderly syndrome once it has been diagnosed. Targeting the medical conditions associated with frailty and determining appropriate measures to address the concerns are essential in treating frailty.
- Management of common chronic comorbidities. As stated previously, medical diagnoses do not indicate frail elderly syndrome, although common chronic comorbidities have been found to be more prevalent in this population. Better outcomes, fewer exacerbations, and an overall improvement in physical function and quality of life are all positive implications of evidence-based pharmacological treatment of particular comorbidity. It also leads to better health, decreased hospitalizations, and a decline in the physical deterioration associated with frailty in the elderly.
- Regular medication review. A full medication review, including prescription and over-the-counter drugs, should be done during regular doctor’s visits, following the principles of geriatric medicine. Unexpected adverse effects from unrecognized prescription side effects and drug-to-drug interactions can predispose patients to frailty, mental and physical slowness, and increased incidence of falls. Medication reviews should be done regularly to discover the potential for medication adjustment and avoid polypharmacy.
- Detailed exercise program. The frail elderly syndrome has been proven to benefit from a comprehensive exercise regimen and increased physical activity. Physical therapy can help people with muscle weakness and neglect atrophy caused by a sedentary lifestyle or debilitating disease. Participating in a resistance-training-focused physical fitness program has been shown in studies to result in improved muscle strength and development. Tai chi has also been shown to reduce frailty and the risk of falling in the elderly.
Prevention of Frail Elderly Syndrome
Preventing falls and skin breakdown, reducing adverse drug events, maintaining dental health, and having adequate hydration can all contribute to decreasing frail elderly syndrome complications. Although aging is inevitable, the following tips can help people avoid becoming frail easily.
- Relative risk assessment. The first action in a patient’s prevention plan is to determine the risk level. Failure to recognize, diagnose, and treat underlying factors can have a negative impact on an older person’s quality of life. Preserving function, integrity, and self‐efficacy are important for overall health and longevity.
- Collaborative Health Management. A comprehensive geriatric nurse-centered interdisciplinary team strategy to care for older individuals is used in best practice illustrations of effective prevention initiatives. Interdisciplinary collaboration has been found to improve geriatric patient outcomes, and it has also been recognized as an important aspect of caring for the older population. Positive findings should be discussed with the patient, caregiver, doctors, other providers, and discharge planners by clinicians. The discharge plan should contain targeted interventions based on the evaluations, as well as additional needs assessments at transfers to homes, nursing home care, or other assisted living facilities.
Nursing Care of Patients with Frail Elderly Syndrome
Nurses will undoubtedly see an increase in the prevalence of the frail elderly syndrome as the population of the elderly increases and average life expectancy rises.
Although many of the predisposing variables arise as a result of aging, early detection and evaluation of the defined set criteria for the diagnosis of the frail elderly syndrome is an essential part of the process of guiding suitable therapeutic approaches and improving health outcomes.
Furthermore, all healthcare practitioners involved in the treatment or evaluation of elderly clients must comprehend the unique features of prevalent medical conditions in elderly individuals.
Nurses can focus on implementing several measures ahead of time, resulting in considerable improvement in quality of life.
The purpose of optimal geriatric care is to enable elderly people in achieving and sustaining their optimal level of function.
Nurses equipped with knowledge of age-related changes and appropriate assessment methods can significantly improve geriatric practice standards.
Frail Elderly Syndrome Nursing Diagnosis
Nursing Care Plan for Frail Elderly Syndrome 1
Nursing Diagnosis: Frail Elderly Syndrome related to multiple falls secondary to advanced age as evidenced by poor physical mobility, impaired balance, and disorientation.
Desired Outcome: The patient will be free of fall-related injuries and safety measures will be implemented.
| Frail Elderly Syndrome Nursing Interventions | Rationale |
| Identify factors that may increase a patient’s risk of falling, such as a history of falls, altered mental status, sensory impairments, coordination, drugs, and disease symptoms. | A thorough evaluation of the patient will aid in determining the necessary fall avoidance. |
| Examine the patient’s surroundings for anything that might put them at risk of falling. | A patient’s risk of falling is exacerbated by a new setting and inappropriate furniture and equipment arrangement. |
| Orient to and control the patient’s environment. | Reorienting elderly patients who have poor short-term memory will greatly help. |
| Maintain a safe environment by keeping the lights on at night, ensuring that the call bell is always operational, and maintaining an obstacle-free walkway. | Increases the patient’s safety and allows him or her to seek help. Elderly patients may have great difficulty moving around obstructions. |
| Put a wristband identification on the patient to remind healthcare personnel to use fall prevention measures. | Allows healthcare providers to recognize patients who are at a higher risk of falling. |
| Make sure the patient’s bed is low and close to the ground as feasible. | The older patient’s risk of falling is greatly reduced by positioning the bed in this manner. |
| Utilize side rails on the bed whenever necessary and eliminate the use of restraints. | Restraints do not lower the risk of falling; nevertheless, side rails do. |
| Educate the patient with an unsteady gait on how to operate adaptive equipment correctly. | It reduces the likelihood of injury. |
| Examine the patient’s prescriptions and how they may lead to falls. | Determine whether there are any drug interactions or adverse reactions that could jeopardize the patient’s safety. |
| Encourage the family members or significant others to remain at the patient’s side at all times. | The presence of family members can help patients with disorientation feel less confused. |
Nursing Care Plan for Frail Elderly Syndrome 2
Progressive Cognitive Impairment
Nursing Diagnosis: Frail Elderly Syndrome related to progressive cognitive impairment secondary to advanced age as evidenced by memory loss, easily distracted, short attention span, and confusion about person, place, and time.
Desired Outcomes: The patient will recognize alterations in behavior and exhibit methods to deal with health status changes.
| Frail Elderly Syndrome Nursing Interventions | Rationale |
| Examine the patient’s focus and concentration, decision-making abilities, and ability to send, receive, and think critically. | Helps determine the patient’s capacity to prepare and perform care and assists in determining the extent of deterioration. |
| Determine what factors, such as comorbidities, may be contributing to the condition. | Identifying significant factors can assist in the identification of possible causes. |
| Evaluate the patient’s neurologic status regularly. | The treatment regimen can be adjusted if cognitive impairment is detected early. |
| Orient the patient to reality by calling him or her by name and giving background information such as time, location, and date as appropriate. | Reality orientation promotes self-awareness and environmental consciousness. |
| Put the patient’s items and belongings in the same spot. | Provides a predictable and consistent atmosphere for the older patient, reducing frustration and confusion. |
| Allow for periodic rest times and shield the patient from information overload. | Information overload can cause confusion, while frequent rest breaks can help prevent exhaustion. |
| Ensure that the patient is always under constant supervision. | Elderly patients are kept under close supervision to avoid wandering or injuries. |
| Encourage the patient to express his or her feelings regarding memory problems. | Help the patient in decreasing anxiety and venting frustrations. |
| Allow plenty of time for the patient to answer by speaking slowly and clearly. | Reduces ambiguity and facilitates work completion. |
| Plan the patient’s schedule and stick to it as much as feasible. | Reduces frustration and confusion while assisting in job completion |
Nursing Care Plan for Frail Elderly Syndrome 3
Reduced Subcutaneous Fat
Nursing Diagnosis: Frail Elderly Syndrome related to reduced subcutaneous fat secondary to advanced age as evidenced by memory loss, easily distracted, short attention span, and confusion about person, place and time.
Desired Outcome: The patient’s skin will remain intact and free from erythema and damage.
| Frail Elderly Syndrome Nursing Interventions | Rationale |
| Assess for erythema on the patient’s skin above bony prominences. | Due to significant external pressures, skin that sits over certain bones, such as the sacrum, scapula, and ankles, is more prone to skin breakdown. |
| Inspect the patient’s skin for any regions of redness, textural changes, or cracks on the surface of the skin. | To avoid further breakdown and inflammation, redness or flaws in aging skin necessitate proactive skin care. |
| Use a lift sheet or roll the patient when repositioning the patient. | Shear damage can be caused by sliding, pulling, or dragging against linens. |
| Turn the elderly patient at least every two hours. | Turning shifts the location of pressure and promotes relaxation. |
| Cushion bony prominences using pillows or pads while the patient is up in a wheelchair or sits for extended periods of time. | This protects covering skin by maintaining alternate postures and padding bone prominences. When a patient is seated, the ischial tuberosities are more likely to break down. Gel cushions for chairs and wheelchairs help to diffuse pressure. |
| Apply lotion liberally, particularly on dry skin. | Lotions hydrate the skin and make it smooth and supple, particularly those containing lanolin. |
| Support the patient out of bed as often as practicable and make extensive use of mechanical lifting equipment to ease patient transfers. | These methods stimulate blood flow, which can help to avoid skin deterioration. |
| Bathe with tepid water and super-fatted, fragrance-free soaps. | While super-fatted soaps alleviate skin dryness, hot water can burn elderly persons who have decreased pain sensitivity and temperature sense. |
| Allow the significant other to provide foods that the patient enjoys and record the percentage of food consumed with meals. As needed, recommend nutritious snacks and consult with a nutritionist for nutritional assistance. | The skin is protected from breakdown by a diet rich in protein and ascorbic acid. |
Nursing Care Plan for Frail Elderly Syndrome 4
Chronic Disease
Nursing Diagnosis: Frail Elderly Syndrome related to impact of a chronic disease/s secondary to advanced age as evidenced by difficulty in doing self-care activities, weight loss, poor nutritional intake depression, and weakened immune function.
Desired Outcome: The patient will exhibit signs of improved functional abilities.
| Frail Elderly Syndrome Nursing Interventions | Rationale |
| Perform a thorough physical examination and determine the severity of any existing chronic diseases. | A comprehensive system evaluation establishes a baseline for further comparisons. |
| Review the patient’s laboratory results and any additional studies that the doctor has ordered. | A review of test data identifies dietary and electrolyte abnormalities that are critical for basic physical functioning as well as the presence or absence of infection. |
| Let the elderly patient express his or her worries, anger, sadness, disappointment, and doubts about his or her hospitalization and condition. | Understanding the patient and recognizing that these emotions are typical can assist to alleviate depression. |
| Enlighten the patient and family members about age-related changes. | It is critical to emphasize to the patient that as they age, their physiologic reserve falls, affecting many systems. |
| Collaborate with other health care providers on the patient’s care as necessary. | They can evaluate physical strengths and limitations, as well as the possibility for progress through a program or the use of assistive devices. They can also aid in determining support systems and preparedness for end-of-life scenarios. |
Nursing Care Plan for Frail Elderly Syndrome 5
Nursing Diagnosis: Frail Elderly Syndrome related to impaired sensory perception secondary to advanced age as evidenced by difficulty in doing self-care activities, weight loss, poor nutritional intake confusion, and weakened immune function.
Desired Outcome: The patient will not be injured or harmed as a result of his or her mental state.
| Frail Elderly Syndrome Nursing Interventions | Rationale |
| Check the patient’s level of consciousness and neurologic status from the caregiver or significant others during admission. Ask also the patient to complete a three-step task to assess his or her mental health. | This tool establishes a baseline for assessing a patient’s confusion in the future. Because it requires concentration and can also test for delirium, a three-step task is complex for a patient with confusion and serves as a broad indicator of brain function. |
| Identify the source of the elderly patient’s acute confusion. | Physical and psychosocial factors, not just age, play a role in acute confusion. For instance, arterial blood gas values may show poor oxygen levels, serum glucose may indicate high or low glucose levels, and electrolytes and complete blood count may reveal imbalances or the presence of infection. |
| Show the patient how to operate the call light, have them repeat the demonstration, and then wait at least 5 minutes before having them demonstrate it again. Make a behavioral record of the patient’s actions and explain the confused behavior. | Inadequate short-term memory is characterized by the inability to recall information for more than 5 minutes. |
| Monitor the patient’s apical pulse and notify the physician if an irregular pulse has been observed. | Poor brain oxygenation can develop from dysrhythmias and other cardiac irregularities, leading to disorientation. |
| Keep track of the patient’s pain by using a 0-to-10 rating scale. Assess for nonverbal signals such as frowning, grimacing, quick blinking, tightened hands, and restlessness if a pain scale is not obtainable. Seek support from a significant other or caregiver to assist in recognizing pain behaviors. | Acute disorientation could be an indicator of pain. |
| Maintain easy access to the patient’s urinal and other frequently used equipment. | A disoriented patient may put off seeking assistance with toileting until it is too late. |
| Make the patient wear his or her glasses and hearing aids or have them near the bedside and within easy reach. | Reduced sensory confusion is likely to be helped by glasses and hearing aids. |
| Advise the patient’s significant other to offer comfort items such as a comforter, bedding, and photos of family and friends. | Things that are familiar can help with orientation while also providing comfort. |
| Check on the patient every 30 minutes and whenever passing by. If at all possible, position the patient near the nurses’ station and provide a calm and safe environment. | Additional safety precautions are required for a confused patient. |
| Remind the patient of the date and day as needed and maintain a clock with large numerals and a large print calendar beside the bedside. | One of the most effective strategies to reduce the patient’s confusion is to reorient them. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
