Frail Adult Case Study Assignment Discussion

Frail Adult Case Study Assignment Discussion

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Frailty is a multidimensional syndrome characterized by decreased physiologic reserve and increased vulnerability to stressors. Frail individuals are at higher risk for adverse outcomes, such as disability, hospitalization, and mortality (Kojima et al., 2019). This case study focuses on the frailty of Mr. Mills, a 94-year-old retired army colonel, businessman, and college teacher. Mr. Mills suffers from chronic conditions, including cerebrovascular disease, hyperlipidemia, prostate cancer, glaucoma, and recurring deep venous thrombophlebitis. His diffuse degenerative lumbar arthritis with spinal stenosis has progressed, leading to chronic backaches, leg weakness, gait instability, and bladder atony. In recent months, his mild chronic memory deficit has become more evident; he has lost 5 lbs in 60 days and has become less enthusiastic about exercise. Despite the treatments he is receiving from an oncologist, his overall frailty has been increasing Frail Adult Case Study Assignment Discussion.

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Frail Considerations

Based on the information provided, it is reasonable to consider Mr. Mills as frail. Mr. Mills exhibits several signs and symptoms of frailty, including unintentional weight loss, reduced physical activity, chronic pain, gait instability, functional decline, and cognitive impairment. His medical history is complex, and he requires daily support from the nursing staff, suggesting a high degree of dependence. Therefore, Mr. Mills meets the criteria for frailty, and his health status requires careful monitoring and management to prevent further deterioration.

High-Risk Factors and Comorbidities

Mr. Mills has multiple risk factors and comorbidities that contribute to his functional and physiologic decline. His cerebrovascular disease, hyperlipidemia, prostate cancer, glaucoma, and spinal stenosis are chronic conditions that require ongoing management and increase the risk of adverse outcomes. Additionally, his age, male gender, and history of falls increase the risk factors for frailty and disability. Mr. Mills also has a history of DVT, which can cause long-term complications, such as post-thrombotic syndrome, chronic venous insufficiency, and pulmonary embolism (Bushman, 2019)Frail Adult Case Study Assignment Discussion. He takes medications, including bicalutamide, leuprolide, warfarin, and atorvastatin, with potential adverse effects and interactions that need careful monitoring and adjustment. Therefore, Mr. Mills’ risk factors and comorbidities require a comprehensive approach to ensure optimal management and prevent further complications.

Significant Possible Contributors to Mr. Mill’s Functional and Physiologic Decline

Several factors are possible contributors to Mr. Mills’ functional and physiologic decline. His chronic pain, gait instability, and leg weakness are likely due to spinal stenosis and arthritis, which limit his mobility and physical activity. Glaucoma and declining vision can affect his balance and increase the risk of falls. Mr. Mills also has cognitive impairment and memory deficit, which can impair his ability to perform activities of daily living and manage his medications and appointments. His reduced appetite and decreased enthusiasm for exercise may be due to depression, social isolation, or other psychosocial factors affecting his overall well-being. Therefore, a comprehensive assessment of Mr. Mills’ physical, functional, cognitive, and psychosocial status is necessary to identify the underlying contributors to his decline and tailor a plan accordingly Frail Adult Case Study Assignment Discussion.

Components of Multilevel Plan of Action to Address the Decline

A multilevel plan of action should be implemented to address this decline. The components should include a comprehensive geriatric assessment, including a review of Mr. Mill’s medical history, medication reconciliation, physical examination, functional assessment, cognitive screening, and psychosocial evaluation. Optimizing his medical management, including medication adjustments, monitoring his chronic conditions, and collaborating with his oncologist, ophthalmologist, and other specialists will also help improve his decline. The plan will also address his pain and mobility issues through physical therapy, occupational therapy, assistive devices, and pain management strategies, such as nonsteroidal anti-inflammatory drugs, acetaminophen, or opioids, as appropriate. Nutrition counseling and support should address his reduced appetite and promote adequate intake of protein, vitamins, and minerals (Hartford Institute for Geriatric and Nursing, 2020)Frail Adult Case Study Assignment Discussion. Addressing his psychosocial needs should involve depression screening, social engagement, and caregiver support. I will also develop a fall prevention plan, including environmental modifications and balance and gait training.

Need for Referral

Referrals may be necessary to address specific aspects of Mr. Mills’ care. For example, he may benefit from a referral to a physical therapist or occupational therapist to address his mobility issues and optimize his functional status. Nutrition education from a nutritionist will ensure that he receives a balanced diet that meets his nutritional needs. To address his functional decline, he should be referred to an occupational therapist to assess his ability to perform activities of daily living and provide appropriate interventions and adaptations (Hagelskjær et al., 2021)Frail Adult Case Study Assignment Discussion. A referral to a neurologist will facilitate further assessment and referral for proper cognitive rehabilitation services. Finally, his psychological needs can be addressed through a referral to a mental health provider to evaluate and treat any depression or anxiety symptoms and for social work services to ensure he has the necessary support and resources.

References

Bushman, B. A. (2019). Deep vein thrombosis. ACSMʼs Health & Fitness Journal, 23(1), 4–7. https://doi.org/10.1249/fit.0000000000000442

Hagelskjær, V., Nielsen, K. T., von Bülow, C., Graff, M., & Wæhrens, E. E. (2021). Occupational therapy addressing the ability to perform activities of daily living among persons living with chronic conditions: A randomized controlled pilot study of ABLE 2.0. Pilot and Feasibility Studies, 7, 122. https://doi.org/10.1186/s40814-021-00861-9

Hartford Institute for Geriatric and Nursing. (2020). Assessing nutrition in older adults | NYU Hartford institute of geriatric nursing. Hign.org. https://hign.org/consultgeri/try-this-series/assessing-nutrition-older-adults

Kojima, G., Liljas, A., & Iliffe, S. (2019). Frailty syndrome: Implications and challenges for health care policy. Risk Management and Healthcare Policy, Volume 12, 23–30. https://doi.org/10.2147/rmhp.s168750 Frail Adult Case Study Assignment Discussion

The Case of Frank Mills

Frank Mills is a 94-year-old widower who has been in your practice for many years. He is a retired army colonel, businessman, and college teacher with many awards and mementos on his walls in his continuing care retirement home. He requires daily support from the aides and nursing staff. He has cerebrovascular disease (CVD), hyperlipidemia, prostate cancer, glaucoma, and recurring deep venous thrombophlebitis (DVT). His diffuse degenerative lumbar arthritis with spinal stenosis has progressed and contributed to chronic back ache, leg weakness, gait instability with several recent falls, and bladder atony requiring an indwelling bladder catheter. His CVD is diffuse, with a history of transient ischemic attacks, scattered small deep lacunar infarcts, and white matter disease on magnetic resonance imaging. The CVD contributes to his gait slowness and instability. He receives bicalutamide (Casodex) and leuprolide (Lupron) treatments from an oncologist, and his prostate-specific antigen (PSA) has been low. He has not had a recurrence of his DVT or new transient ischemic attacks in the last couple years while on warfarin. His international normalized ratio is kept at around 2.0 and he has not suffered significant bleeds. For years his hyperlipidemia has been controlled with atorvastatin. His sight is declining significantly in spite of frequent ophthalmology consultations and adjustments of his glaucoma management. His mild chronic memory deficit has been more evident in recent months.

The nursing director notifies you that Mr. Mills is not eating as well as usual, and he has lost about 5 lbs in 60 days. The fitness center director reports that he is not the usual enthusiastic exercise participant he had previously been.

Read the case of Frank Mills.

After reading the case, answer the following questions:

1. Would you consider Mr. Mills to be frail, and if so, why?
2. What are his risk factors and comorbidities?
3. List significant possible contributors to Mr. Mills’ functional and physiologic decline.
4. List key components of your multilevel plan of action to address this decline.
5. Would you see a need for referrals? Why, and who would you refer Mr. Mills to see? Frail Adult Case Study Assignment Discussion

Be complete in your responses and include scholarly citations. Include references per APA 7^th edition. Use full sentences and paragraphs in your responses.

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Week 3: Learning Materials

Readings

Required

Read the following in your Kennedy-Malone textbook:

• Chapter 4: Nutritional Support in the Older Adult, pp. 38–41 (malnutrition)

Read the following articles: Frail Adult Case Study Assignment Discussion

• American Association of Nurse Practitioners. (2019). Standards of practice for nurse practitioners.
• Hartford Institute for Geriatric and Nursing. (2020). ConsultGeri: Assessing nutrition in older adults.
• Kumeliauskas, L., Fruetel, K., & Holroyd-Leduc, J. M. (2013). Evaluation of older adults hospitalized with a diagnosis of failure to thrive. Canadian Geriatrics Journal, 16(2), 49–53.
• Richards, K., Demartini, J., & Xiong, G. (2018). Understanding sleep disorders in older adults. Psychiatric Times.
• Robertson, R. G., & Montagnini, M. (2004). Geriatric failure to thrive. American Family Physician.
• Suzuki, K., Miyamoto, M., & Hirata, K. (2017, March 30). Sleep disorders in the elderly: Diagnosis and management. Journal of General and Family Medicine, 18(2), 61–71 Frail Adult Case Study Assignment Discussion