A Story of Frailty – Patsy & Rosie
This is the story of two lovely ladies and friends, Patsy and Rosie, who resided in the same nursing home and on the same unit for over a year. Both were 82 years old, with moderate dementia, diabetes, and occasionally, both were treated for episodes of congestive heart failure. Both loved to wear colorful clothes and fun jewelry. They also did their best to get a chocolate or a cookie from the nurses whenever possible.
Frailty Risk Assessments were first completed for Patsy and Rosie as part of the nursing facility’s admission process. Their respective Frailty Risk Scores indicated a significant difference in their degrees of Frailty – a difference that predictably impacted the state of their health and the quality outcomes each experienced.
Patsy’s score indicated she was Mildly Frail: Likely Able to Recover from a New Illness / Fall / Hospitalization. Rosie’s Frailty Risk Score indicated she was Moderately Frail: Less Likely to Recover from a New Illness / Fall / Hospitalization.
While Patsy and Rosie both looked to be doing well despite many chronic illnesses and disabilities in common, the outcomes associated with their different degrees of Frailty Risk became apparent when an outbreak of Influenza A hit the nursing facility and both became sick.
Mildly Frail Patsy spent several days in bed, tolerated the antiviral medication, and was able to drink enough liquids to avoid dehydration. While her blood sugars were impacted by the infection and she was clearly more fatigued, she managed to return to her favorite spot at the nurse’s station and ask for chocolates and cookies by the end of the second week.
Rosie, with a Moderate degree of Frailty and more associated risk for poor outcomes, did not do so well with the outbreak. She ran a higher temperature, became delirious from the antiviral medication and the fever, and was not able to maintain adequate oral hydration. She received the medical management indicated in her Advance Care Directive, including intravenous hydration, antibiotics for accompanying pneumonia, and aggressive nursing care to avoid skin breakdown.
Even though Rosie appeared to be doing as well as her friend Patsy prior to the flu outbreak, and despite the high level of quality care she received, Rosie did not recover. During week three of her illness, she died in the facility. The staff and her family were saddened but not surprised. They knew Rosie was frail and what the likely outcome would be if she became ill. Her family was by her side.
The clinically assessed baseline degrees of Frailty Risk for Patsy and Rosie put each of them at predictably different levels of risk for poor outcomes from the acute episode of Influenza A. Even though both had the same diagnoses and received the same level of clinical and nursing care, their outcomes were dramatically different based on their Frailty.
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