Three Related Concepts

PROGRESSIVE INTERMITTENT FRAILTY. Frailty can be seen as a condition at a given point in time and as a process over time. It denotes a condition in which a person has difficulty with activities of daily living and is vulnerable to various assaults upon his or her person both from within, (e.g., organ failure) or without (e.g., falls). Frailty, especially in the elderly, often continues over time in a progressive fashion with periods of remission and exacerbation until the person becomes substantially dependent and dies.

Persons who are frail may have difficulties with activities of daily living either on a temporary or an ongoing basis. Frailty often accompanies chronic illness, though not all chronically ill persons are frail. Some frailty results from general system(s) failure that is associated with age and the gradual molecular deterioration accompanying it; other frailty can be associated with a transitory illness or trauma.

DEPENDENCY. Dependency is a state in which a person requires the assistance of others. It may be temporary or permanent, intermittent or continuous. It may or may not be associated with chronic illness. Chronic illness, depending on severity, may or may not create a dependent state.

NATURAL DEATH AND DYING. All will die. Dying occurs in different modes. It may be caused by sudden organ failure or by disease or infection. A relatively new phenomenon is the increasing number of persons with serious chronic illness at the end of life. Certain patients function quite well for a time, with substantial decline in the last few weeks before death, typical of cancer. Others experience a less predictable course, with periods of disease exacerbation interspersed with periods of higher functionality, as in organ system failure of the heart or lung. Some go through a drawn-out course with early loss of function and incremental decrements in function and vigor over many months or years before death, characteristic of frailty and dementia (Lunney, Lynn, and Hogan; and Lynn).

As the trajectory toward death becomes more apparent, even if still somewhat unpredictable as to its exact time, specific medical, psychological, and spiritual interventions become central, emphasizing physical and emotional comfort rather than seeking to cure the underlying cause.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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