Research News

Nurse scientists from Cleveland Clinic have updated their comprehensive frailty care model, aimed at supporting aging patients. The team, led by researcher Lee Anne Siegmund, PhD, RN, published results from years of gathering literature and feedback from patient encounters to winnow in on the most important factors behind aging well and maintaining independence. 

Published in Geriatric Nursing, the study’s findings highlight the importance of addressing mobility issues, nutrition, and depression for older adults at risk for frailty. Nurses face multiple competing demands during every patient encounter, Dr. Siegmund explains. A consideration of frailty may not be foremost in the nurse’s mind in the face of whatever problem brought an older adult to the clinic in the first place. 

“Ongoing research on the Frailty Care Model allows the research team to identify the most important predictors of and interventions for frailty, ensuring nurses and practitioners have the most comprehensive framework available to care for older adults,” she says. “Updating these models allow us to consistently improve the way we care for our patients, which in turn allows them to live happier and healthier lives as they get older.” 

What is the definition of frailty? 

The term “frailty” refers to a decline in physiologic reserve and an individual’s inability to respond to physical stressors. Characteristic traits of frailty include weakness, poor endurance, weight loss and fatigue.  Frailty can often be prevented, stabilized, and to some extent, reversed. Frailty needs to be identified and addressed as early as possible to avoid complications, but it can often go undiagnosed until it is too late, Dr. Siegmund says. 

Developing our knowledge of aging well 

Dr. Siegmund developed the initial frailty care model as a way for nurses and nurse practitioners to integrate frailty tests into every patient encounter. A care model is a visual framework that identifies the main factors influencing a specific clinical outcome and describes how to incorporate those factors into clinical practice.  

The first version of the framework, published in the Journal of the American Association of Nurse Practitioners, used “middle-range” or consensus nursing theory to create guidelines and frameworks for patient care, including what nurses should assess to identify frailty. After adoption into patient encounters, the research team partnered with statisticians from Quantitative Health Sciences to refine their recommendations. 

"We are aging as a population, and there will be more and more older adults and likely not enough clinical caregivers to keep up with the demand. We need to be laser-focused on the best interventions to help older adults age well and maintain their independence,” Dr. Siegmund says. “For example, we know physical activity is important, but we don’t know which type of physical activity is the most effective one to prescribe as an exercise regimen.” 

Through administering surveys focused on modifiable factors that may lead to frailty, the team analyzed the care model in action. They could prioritize factors within the existing care model based on data.  For example, survey analyses showed that an older adult’s odds of frailty increased by over 400% if they were at risk for malnutrition. Odds were 20% higher in individuals with depression.

The second version of the model reflects these findings by emphasizing the need for early identification and intervention for patients at risk of malnutrition. Only one factor in the survey predicted lower odds of frailty: physical activity. There was a 7% decrease in odds of frailty for every 10 unit increase in physical activity scores. This shows the importance of supporting mobility through physical therapy and other interventions. 

“With early detection, intervention, and management, our framework can help nurses prevent and even reverse frailty in older adults, letting them live fulfilling and independent lives,” Dr. Siegmund says. “As we gather more data, we move closer to testing interventions to see what works best."