Gerontological Nursing Foundations

Ageing is not a disease, and frailty is not an inevitable result of getting older. The useful clinical distinction is reserve: how well a person tolerates a stressor and returns to baseline afterwards. An older adult with good reserve may recover from pneumonia, a medication change, or a short period of bed rest. A frail adult may not. A relatively minor stressor can trigger falls, delirium, functional dependence, hospitalization, or institutionalization. Frailty is a multidimensional syndrome marked by unintentional weight loss, self-reported exhaustion, weakness, slow gait speed, and low physical activity. These findings reflect reduced physiologic reserve across several systems rather than one isolated disease. Comorbidities can contribute to frailty, but frailty is not simply a count of diagnoses. Functional decline is often the first meaningful signal. An experienced nurse notices that a patient who usually transfers independently now pushes hard on the armrests, pauses halfway to standing, or needs to rest after washing. That change may appear before a dramatic abnormality in vital signs because the patient’s reserve is being spent on ordinary activity. Frailty, disability, sarcopenia, malnutrition, depression,...