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Frailty: A Primer for Rehabilitation Professionals

presented by Martha Acosta

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Disclosure Statement:

Financial: Martha Acosta receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Martha Acosta has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Accreditation Check:
This course introduces the healthcare professional to concepts related to the frail, older adult. Age-related changes are often referred to synonymously with ‘becoming frail’. However, this course examines the evidence that challenges that belief, although still acknowledges the effects of aging on the human body. The evolving definition of frailty also reflects changes in the body of knowledge as additional research helps to further refine concepts related to frailty. A common theme when defining frailty involves the deterioration of health and loss in reserves which then leads to vulnerability. This state is further characterized by two main phenotypes of frailty that have emerged: the physical phenotype and the multi-domain phenotype. Details of both phenotypes are described in this course. Once identified as frail, assessment considerations of the patient are addressed. In addition, the biological changes in multiple systems are reviewed as they contribute to a comprehensive understanding of this multi-system involvement. The role of interventions and exercise testing are then examined based on the current evidence in these areas. Also, related topics including the role of comorbidities and chronic diseases are discussed in terms of their impact on frailty. The overall conclusion with regards to working with the frail patient is that progress can be expected with the appropriate interventions.

Meet Your Instructor

Martha Acosta, PhD, PT, GCS

Dr. Acosta received her Bachelors degree in Physical Therapy from the University of Texas Medical Branch in Galveston, Texas after receiving a Bachelors degree in Pre-Medicine from the University of Southwestern Louisiana. After working several years as a clinician, she went on to pursue a Masters degree in Healthcare Administration from Southwest Texas State University.…

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Chapters & Learning Objectives

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1. Introduction

Become familiar with the multi-system involvement of frailty as reflected in evidence-based research. Identify the role of decreased reserve capacity in the area of adverse outcomes associated with frailty. Develop the skills to be able to distinguish between the multi-domain phenotype of frailty and the ICF model of functioning and disability in their relationship to frailty.

2. Building a Foundation for Assessment

Relate the role of sarcopenia in the frail, older adult to the modifiable factors of frailty. Identify recommendations for protein intake that help counter the loss of lean muscle mass in the older adult. Relate changes in the immune system to frailty, and recognize the three concepts most commonly identified in the recent definitions of frailty.

3. Therapeutic Interventions

Analyze the effects of compromised cardiac reserve in the frail patient. Compare a low-intensity to a high-intensity exercise intervention, and identify the impact of home-based intervention programs that focus on preventing functional decline in frail older persons. Recognize the major absolute contraindications to exercise testing in the older, frail adult.

4. Special Considerations

Develop an awareness of the expected outcomes from exercise programs among the most frail older adults, according to the findings of the Canadian study on aging. Compare the effects of a Tai Chi intervention on persons who are frail versus those who are transitioning into a frail condition. Identify the most appropriate tool used to assess the fear of falling. Lastly, recognize the nature of urinary incontinence and the frail condition.

5. Parkinson’s Disease; Chronic Diseases

Develop an understanding of the common theme associated with various definitions of “chronic diseases”. Identify the most common morbidities in persons over the age of 65 years. Analyze the role of homeostasis as it relates to chronic diseases in the frail patient, as well as the relationship between the severity of Parkinsons’ disease in the frail patient and the factor of walk time.

6. Discussion Panel

Martha Acosta sits down with local clinicians to discuss defining the frail patient, possible planning and treatment differences in the presence of a frail patient, and assigning functional skills to both the frail and non-frail individual.

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