Frail elderly are at high risk of decline in well-being, hospitalisation, care dependency and death, especially with hospitalisation. Early stage assessment and geriatric intervention show positive outcomes. Chapter 2 compares physical frailty based on physical aspects of functioning with comprehensive frailty based on all aspects of functioning. Comprehensive frailty occurred in almost two-thirds of the hospitalised elderly and disability, comorbidity and/or disease burden was also seen in most of them.
There is an association between decline in physical functioning with care dependency and a medical diagnosis, so frailty could occur to a greater or lesser extent in patients with different diseases. Chapter 3 examined the prevalence and implication of frailty (vulnerability) in elderly people admitted to five different nursing wards. Frailty was seen in half to more than three quarters of patients aged 75 years and over, and the psychosocial aspects of frailty were found to be independent of health problems and problems with mobility.
Chapter 4 examines the usefulness of information from the proxy regarding the identification of frailty of the patient at the time of hospital admission. The patient's proxy considered the patient to be more frail than the patient himself. The difference between patient and spouse was smaller than the difference between patient and child, and there was more agreement in responses for the more observable aspects of frailty like mobility, than for the more subjective aspects like feelings of loneliness.
To examine the added value of the geriatric nurse, nursing diagnoses of frail patients were studied in Chapter 5. A total of 4 nursing diagnoses were recorded on average, with 'reduced physical mobility', 'nutritional deficiency' and 'high risk of injury (falls)' being the most common. More than half of the diagnoses were added by the consulting geriatric nurse. The ward nurses mostly recorded diagnoses that were physical in nature and required immediate care. The geriatric nurse also added possible nursing problems and problems whose aetiology was related to hospitalisation and/or problems that required attention after hospitalisation.
Chapter 6 examined the effect of a newly created intervention programme with a central role for the geriatric nurse providing advice to frail older people admitted to a non-geriatric nursing unit in a general hospital. The final sample was smaller than needed to establish a significant difference. When monitoring respondents, the intervention group was found to do slightly better than the control group and, as in the study in Chapter 5, more individual care needs were identified in the intervention group.
Chapter 7 described the usefulness of the RE-AIM model for evaluating the intervention study described in chapter 6. The model consists of five dimensions and focuses on different aspects of an intervention that affect an everyday practice situation and then the translation of research into practice; Reach, Effectiveness, Adaptation, Implementation, Maintenance. It became clear that with this quasi-experimental research design, the intervention study focused mainly on reach and effectiveness and thus on the individual short-term effect of the intervention.
With the ageing of the population, longer life expectancy, the prevalence of frailty and thus the risk of poor health outcomes, frail older people in general hospitals are a group of patients who need targeted attention. Early recognition and targeted deployment of appropriate care is needed to prevent or delay deterioration. Because the issues surrounding frailty usually lie within the domain of nursing care, a central role for the geriatric nurse in these high-risk patients is recommended.