presented by Martha Acosta
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.
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. She was awarded a PhD from the University of Texas Medical Branch in Preventive Medicine and Community Health (Rehabilitation Sciences). Dr. Acosta has worked in a variety of settings including acute care, rehabilitation, out-patient, long-term care, skilled nursing facilities, psychiatric hospital, and home health. With approximately 35 years of clinical practice, she brings an abundance of expertise and clinical application to the academic setting to enhance student learning of clinical concepts. She has taught previously at the University of Texas at El Paso where the focus of her teaching responsibilities included management of the adult patient with neurological impairments. She also taught management of health care systems for Physical Therapists as well as geriatric elective courses and hippotherapy. Dr. Acosta also has been awarded clinical specialist certification by the American Physical Therapy Association (APTA) as a Geriatric Clinical Specialist (GCS). She also is an item writer for the board certification exam and is a member of the APTA Specialization Academy of Content Experts. Her current teaching responsibilities include topics of clinical foundation skills for first-year physical therapy students and aging across the lifespan for third-year physical therapy students.
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.
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.
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.
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.
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.
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.