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Chapter 8 - Frailty
- from Section II - Geriatric Syndromes
- Edited by Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Samuel C. Durso, The Johns Hopkins University, Maryland, Christine Arenson, Thomas Jefferson University, Philadelphia, Rebecca Elon, The Johns Hopkins University School of Medicine, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel
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- Book:
- Reichel's Care of the Elderly
- Published online:
- 30 June 2022
- Print publication:
- 21 July 2022, pp 81-90
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Summary
Frailty is an important geriatric syndrome that is common and commonly missed, and affects more than a third of people over age 85. Frailty is characterized by diminished physiologic reserves and function, leading to decreased capacity to withstand stressors. Frail adults are at a higher risk of dependency, institutionalization, and death. Multiple interventions have been attempted, including physical activity, improving nutrition, and hormonal therapy, but there are no curative interventions for frailty and it is not clear if frailty can be reversed. Several issues have limited the advancement of frailty research and translation into practice, including the lack of consensus regarding the definition of frailty, the proliferation of assessment tools, and the gaps in validated best practice guidance for frail patients. The recognition of frailty, especially in its early stages, offers the possibility of preventing or mitigating adverse clinical outcomes. Older adults who are frail may benefit most from a comprehensive geriatric evaluation to help elucidate a plan of care that is consistent with patient's goals, values, and preferences.
Chapter 7 - Frailty
- from Section II - Geriatric syndromes
- Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
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- Book:
- Reichel's Care of the Elderly
- Published online:
- 05 June 2016
- Print publication:
- 23 June 2016, pp 97-106
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Summary
Frailty is an important geriatric syndrome characterized by diminished physiologic reserves and function, and a decreased capacity to withstand stressors. More than a third of people over age 85 are estimated to be frail, and are at higher risk of adverse health outcomes, including dependency, institutionalization, and death. Although advanced age, multi-morbidity and disability are associated with frailty, there is strong evidence that frailty is a distinct entity. It is characterized by diminished strength and endurance, and impaired physiologic function in many organ systems (including musculoskeletal, neuroendocrine, and immune systems) and includes nutritional, cognitive, and psychosocial dimensions. The two main frailty constructs are a biological syndrome model and an accumulation of deficits model. Frailty is an important syndrome to guide clinical care, and several screening tools include combinations of nutritional status, physical activity, mobility, energy, strength, cognition, mood, and social relations and support.
Chapter 47 - Community-based long-term care for the elderly
- from Section IV - Principles of care for the elderly
- Edited by Jan Busby-Whitehead, Christine Arenson, Thomas Jefferson University, Philadelphia, Samuel C. Durso, The Johns Hopkins University School of Medicine, Daniel Swagerty, University of Kansas, Laura Mosqueda, University of Southern California, Maria Fiatarone Singh, University of Sydney, William Reichel, Georgetown University, Washington DC
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- Book:
- Reichel's Care of the Elderly
- Published online:
- 05 June 2016
- Print publication:
- 23 June 2016, pp 651-658
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Summary
Community-based long-term care encompasses a wide array of medic al and non-medical diagnostic, preventive, therapeutic, rehabilitative, personal, social, supportive, and palliative services in a variety of settings for individuals who have lost some capacity for self-care because of a chronic illness or physical, cognitive, or emotional impairment. Some support services allow the patient to remain at home, whereas other services require a change of residence. The goal of care is to build on interprofessional expertise and teamwork to promote the optimally independent level of physical, social, and psychological functioning in the least restrictive environment. Most older adults with chronic health problems prefer to remain at home or in a homelike setting. A minority of older adults live in nursing homes, and there has been a trend toward community-based services to provide support. Community-based long-term care services focus on the older adult's medic al and psychosocial needs and aim to maintain function, prevent acute exacerbations of chronic illness, and avoid unnecessary and costly emergency room visits and hospitalizations.
42 - Community-Based Long-Term Care
- Edited by Christine Arenson, Jan Busby-Whitehead, University of North Carolina, Chapel Hill, Kenneth Brummel-Smith, Florida State University, James G. O'Brien, University of Louisville, Kentucky, Mary H. Palmer, University of North Carolina, Chapel Hill, William Reichel, Georgetown University, Washington DC
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- Book:
- Reichel's Care of the Elderly
- Published online:
- 19 May 2010
- Print publication:
- 09 February 2009, pp 459-465
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Summary
Community-based long-term care encompasses a wide array of medical and nonmedical diagnostic, preventive, therapeutic, rehabilitative, personal, social, supportive, and palliative services in a variety of settings for individuals who have lost some capacity for self-care because of a chronic illness or physical, cognitive, or emotional impairment. Some of the support services allow the patient to remain at home (including adult daycare, home health services, home medical care, and telemedicine), whereas other services require a change of residence (such as assisted living, adult care homes, and continuing-care retirement communities). The goal of care is to build on interprofessional expertise and teamwork to promote the optimally independent level of physical, social, and psychological functioning in the least restrictive environment.
In 2003, approximately 7 million older adults (aged 65 years or older) needed some form of long-term care. During the past several years, there has been a trend toward community-based services, moving away from institutional care such as nursing homes. Most patients with chronic health problems prefer to remain at home or in a homelike setting, and only approximately 20% of older adults who require long-term care reside in nursing homes. This shift was formalized by the Olmstead Decision (July 1999) in which the U.S. Supreme Court upheld the right of individuals to receive care in the community instead of in an institution whenever possible.
Community-based long-term care services involve attending to the patient's medical and psychosocial needs, bringing together those services necessary to maintain or improve the patient's clinical status, preventing acute exacerbations of chronic illness, and avoiding unnecessary and costly emergency room visits and acute hospitalizations.