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Aging in Place and Frailty

Aging in place, or an individual’s desire to live in a location of choice for as long as possible, is currently a popular concept among older Americans.  This location of choice is often a person’s private home.  Although the desire to remain at home is strong, as they age, Americans have a tendency to avoid planning to meet this goal.

Aging in place is often complicated by the development of frailty.  An individual’s inability to see himself/herself potentially becoming frail and an attitude of “it won’t happen to me” are major stumbling blocks in the path of planning to remain at home.

What is frailty?  An image of a person who exhibits muscle weakness, moves slowly, and is dependent on others may come to mind.  Cognitive frailty is a developing term which infers vulnerability due to impairments in thought processes.

Among researchers and health professionals, no clear and consistent definition of frailty exists. Frailty is generally viewed as a condition in which an individual experiences changes in wellness which impair physical, cognitive, and/or social functioning.  This decline reduces the person’s ability to adapt to physical and psychological stressors such as illness, injury, loss of loved ones, and environmental changes.

Frailty has significant personal and societal implications for aging in place. Studies have linked the presence of frailty with negative health outcomes including mortality, falls, fractures, urinary incontinence, increased medication use, hospitalization, and institutionalization.

Although advanced age may increase the risk of developing frailty, growing older does not guarantee that one will become frail. The presence of one or more disease processes are significant risk factors, but other elements also contribute to frailty including personal attitudes and behaviors related to aging and health, levels of social support, the availability and accessibility of community resources, poor nutritional status, challenging economic conditions, and medication use. 

It is important to note that the development and consequences of frailty differ widely among individuals, which complicates efforts to develop standardized screening tools and interventions to prevent or minimize its symptoms. 

Individuals living in the general community usually have less frequent interactions with health  professionals than those who reside in care facilities, and thereby must accept greater personal responsibility for recognizing and taking action to combat frailty if they wish to age in place.

 A recognition that some of the factors which may contribute to frailty are within personal control is one step which should impact an individual’s planning for his/her later years. If some limitations due to frailty should evolve; a willingness to admit that limitations exist and the development/implementation of a plan to address those limitations early on may reduce the experience of additional changes which could threaten aging in place.

Karen Kaslow, RN, BSN