Most nurses become familiar with hospital frailty protocols early on in their careers, especially when dealing with geriatric patients — but what happens to frail people outside that environment? How do they survive daily in the community, and how can nurses help with that? This article looks at the activities of specialist frailty nurses who visit patients at home and in community centers to help them manage or overcome frailty and reduce its risks.
Due to the shift in age demographics, this has become especially important when training nurses. Spring Arbor University, for example, offers an RN to MSN program for a family nurse practitioner specializing in gerontology. Nurses with a special interest in helping and supporting the elderly will learn how to keep them in everyday life and balance care with retaining the agency of the elderly patients.
Supporting daily activities
The strongest predictor of frailty is physical inactivity, and any increase in day-to-day movement helps to improve this. Even older adults can sometimes recover from light to moderate defects if they become more active. At the same time, in other cases, it effectively slows the decline rate. Exercise is great where patients can manage it, but often the most important thing is to help patients keep up with daily activities.
While most frail people struggle to do all their housework, the more time they can spend on their feet, the better, so persuading them to increase the amount they do themselves, even where help is available, is a good thing. Tasks like vacuuming, which involve walking about, are particularly helpful, as are those that involve stretching. Nurses can teach frail patients how to do these things more safely and encourage them to push to their limits within safe boundaries. They can recommend assistive devices, making tasks that may have become impossible and manageable again. They can also discourage family members from being too quick to step in and do everything.
Alongside housework, encouraging patients to spend time outside is positive because it helps to raise Vitamin D levels. At the same time, gentle activities like walking and gardening are good for building and maintaining muscle. Nurses listen to their patients to discover what appeals to them and help them find ways of carrying on their activities for as long as possible.
Often frail patients require multiple forms of medication throughout the day. This can be difficult to track, even for those not suffering from cognitive impairment. It is a challenge for older people, who are often resistant to using electronic aids like phone apps to help them stay organized. If you are nursing somebody like this, you can work with them to establish what approach works best for them, identify ways in which family members might be able to help or arrange phone calls at certain times of day to make sure that medication has been taken.
Nurses can also step in if patients are reluctant to take medication as prescribed. They notice if there are underlying physical issues, such as difficulty swallowing, a referral to a specialist could help. Alternatively, they may find that the patient has absorbed misinformation about what the medication does or has panicked over a list of side effects, not understanding how rare they are or how to assess them in balance with the risks of not taking medication. Often patients are far more willing to discuss their anxieties with nurses than with prescribing doctors, so nurses have a better chance of ensuring compliance.
In addition to these things, nurses are often responsible for collecting blood samples, urine samples, etc., for analysis, monitoring blood pressure, and keeping a record of patients’ symptoms to identify any deterioration as quickly as possible.
Supporting a healthy diet
Eating the right food becomes especially important when a patient is in fragile health. This is still more urgent if the patient is struggling to eat enough or is losing weight for other reasons, which is common in frail people. Furthermore, people may end up working on eating as well as they used to because they find it harder to shop and cook. Nurses can help them tackle these problems in various ways, as well as make sure that they understand the risks associated with poor nutrition and treat the matter with the appropriate seriousness.
The first stage of helping people in this situation is education. You might invite a patient to keep a food diary or go through their cupboards to determine what they eat daily. They may not realize that they are not getting enough of some kinds of food. Frailty nurses rarely advise against favorites that might be considered unhealthy because the primary aim is to get the patient to eat as much as possible. Suggesting simple, easy-cook recipes can help, as can helping the patient source ingredients. This might mean teaching them how to buy groceries online or encouraging them to use local stores they have not previously tried.
In some cases, patients will struggle to cook enough for themselves, though they may feel embarrassed about this and not admit it straight away. In this case, you may be able to arrange for family members to help or arrange a local meal on wheels program for them. You might also be able to suggest practical solutions to their struggles, such as electric can openers or pre-chopped vegetables.
Decreasing the risk of falls
One of the biggest dangers faced by frail people is falling. This is a particular risk in the early stages of the condition, when they may not realize how fragile they have become and may be trying to do things the way they always used to. Part of a visiting nurse’s job is to help them make the necessary mental adjustment to their new reality and to teach them lower-risk ways of undertaking their daily activities, from using a frame when walking to using a grabbing stick rather than overextending themselves when reaching for things.
If you are working with someone in this situation, you may be able to help them set up grab bars so they can move safely around a bathroom or set up an emergency alert system so that if they fall and cannot get back on their feet, they can still summon assistance. You may also teach them exercises to help build up their leg muscles or improve their balance. If a relative is looking after them, you can explain where the issues are likely and what practical help can be given.
Helping to prevent or manage cognitive decline
There is mounting evidence that, in many cases, cognitive decline can be slowed by increasing opportunities for conversation and other forms of social interaction. Not all frail people experience cognitive decline, but it is a common aspect of the condition; it can also occur because of isolation, in which weak people are particularly vulnerable, as they face barriers to many forms of social participation. When dealing with a patient like this, you can recommend local support groups or social groups that cater to people in this situation. You can also reassure family members that it is still worthwhile talking to them and teach them how to deal with problems in which conversation becomes difficult or upsetting for either party.
Where cognitive decline cannot be slowed or prevented, you can help people cope with it so that they can still enjoy life and retain some independence for as long as possible. You can talk to family members to ensure they have the right support network in place, and you can introduce mnemonic systems that help them cope. You can find ways to reduce the risk of them having accidents at home, and you can help them connect with older memories, which are often clearer and a source of pleasure, by making sure that things like family photo albums are easy to find.
Supporting the Family
In this kind of nursing work, you will often find that you are supporting the frail patient and the patient’s family. As a family nurse practitioner, your input will help to keep them on an even keel. You will be a source of advice on everything from how to lift a person safely to how often they should be checking in, which will change over time. You will be a source of information about social services and charities that may be able to help. You will liaise with other healthcare professionals to ensure that everybody who needs to be is up to date on the situation, recognizing that family members, even if they are devoted to the patient, is not always well placed to advocate on their behalf.
Most of us will enter a state of frailty at some point in our lives, but thanks to dedicated nurses, it does not have to be a dreadful experience, and we can still get a lot out of the time that remains for us. Knowing this is one of the factors that makes frailty nursing especially rewarding.