Frailty

The nurse practitioner manages Frailty through comprehensive geriatric assessment and application of age-specific evidence to clinical decision-making. The clinician evaluates older adults across multiple domains: functional status (ADLs, IADLs using validated scales), cognitive function (Montreal Cognitive Assessment, Mini-Cog), mood (Geriatric Depression Scale), fall risk assessment (Timed Up and Go, gait and balance evaluation), nutritional status (MNA, albumin, BMI), polypharmacy review (Beers Criteria for potentially inappropriate medications, STOPP/START criteria, deprescribing using evidence-based algorithms), and social determinants (living situation, caregiver support, social isolation, financial resources). The clinician differentiates normal age-related changes from pathological processes, manages geriatric syndromes (falls, delirium, incontinence, frailty, polypharmacy, malnutrition, functional decline), and adjusts pharmacotherapy for age-related pharmacokinetic and pharmacodynamic changes (reduced renal clearance, decreased hepatic metabolism, increased drug sensitivity). The clinician applies principles of geriatric prescribing: start low and go slow, consider time-to-benefit versus life expectancy when initiating preventive therapies, prioritize treatments aligned with patient goals and values, and implement structured deprescribing when medications are no longer beneficial. The clinician coordinates comprehensive care planning, advance care planning, and community resource navigation.