Caring for the Frail Older Adult

Although long-term care settings house a variety of patients with chronic illnesses or disabilities that interfere with their ability to care for themselves for extended periods of time, not all of these patients are frail. For a person to be classified as frail, he or she will exhibit three or more of the following characteristics: low physical activity, muscle weakness, slowed performance, fatigue or poor endurance, and unintentional weight loss.¹ Patients who meet these criteria are among the most complex patients to care for, particularly because they are especially vulnerable to illnesses and injuries, yet have a low threshold for tolerating these stresses, which also places them at higher risk of poor outcomes. In this issue of Annals of Long-Term Care: Clinical Care and Aging^”  (ALTC), we include several articles that shed light on how the care of frail older adults can be improved, including at the end of life.

In the first article, “Using Evidence-Based Organizational Strategies to Prevent Weight Loss in Frail Elders,”which is the first article in our nutrition series, the authors examine how making changes at the organizational level can have a more significant impact on preventing unintentional weight loss in frail older adults than treating individual residents who are experiencing involuntarily weight loss on a case-by-case basis. The authors examine a variety of evidence-based organizational strategies that have been reported in the literature, including staffing strategies, such as hiring more higher level nurses and increasing the amount of direct care time residents receive; care planning strategies, such as developing standardized protocols for daily care routines and holding regular care conferences; leadership/supervisory strategies, such as performing meal rounds; educational strategies, such as educating nurses on common nutritional issues encountered in frail elders; and environmental strategies, such as improving the ambiance of the dining environment and improving food quality and choice.

The second article, “Aquatic Therapy and Alzheimer’s Disease”, describes how aquatic therapy enabled physical activity in a patient with advanced Alzheimer’s disease. The patient was confined to a wheelchair, and in addition to giving the patient the ability to ambulate in the water, the aquatic therapy sessions improved the patient’s cognition, expression, and communication skills. Although aquatic therapy has not specifically been evaluated for Alzheimer’s disease, the authors outline some of the benefits that have been observed with this exercise modality in other clinical areas, such as in improving balance, facilitating recovery in patients after a stroke, improving gait in patients with Parkinson’s disease, and reducing pain in patients with lower extremity arthritis. Based on the authors’ experience with their patient and the findings of their literature review, the authors call for studies to specifically evaluate aquatic therapy to improve the quality of life of patients with dementia.

In the third article, “Care Demands by Families and Family Healthcare Proxies: A Dilemma for Palliative Care and Hospice Care Staff”, the author outlines two cases that exemplify the types of conflict that may arise in hospice care settings when family healthcare proxies have unrealistic expectations regarding the care of their loved ones at the end of life. These unrealistic expectations can lead to demands that compromise patient care, resulting in treatments and other interventions that patients may not have wanted. To avoid such issues, the author emphasizes the importance of explaining treatment plans to the patient’s family and maintaining open communication throughout the process to avoid potential conflicts and ensure a comfortable death for the patient. 

We welcome your thoughts on the articles in this issue of ALTC. Responses can be sent to our associate editor, Allison Musante, at amusante@hmpcommunications.com and may be published in an upcoming issue of the journal.

Thank you for reading!

Reference

1.     Torpy JM, Lynm C, Glass RM. Frailty in older adults. JAMA. 2006;296(18):2280.