Date of Award
Summer 7-31-2026
Document Type
Dissertation
Degree Name
Doctor of Nursing (ND)
Abstract
Background: Frailty frequently goes unrecognized in primary care, particularly among older adult women living with chronic obstructive pulmonary disease (COPD) who also experience social isolation and/or loneliness. These overlapping vulnerabilities reduce self-care capacity and increase the risk of adverse outcomes. This study evaluated primary care workflows to justify integration of the FRAIL Scale, into the electronic health record (EHR), ensuring proactive identification of at-risk older adults.
Methods: A quantitative, retrospective, observational chart review was conducted on 183 patients with COPD and once the final sample population was identified, the FRAIL Scale was retrospectively applied. Data was entered into SPSS for planned analyses. This included descriptive statistics, Cohen’s kappa to evaluate measurement agreement between frailty classifications and SDoH indicators, and Pearson’s chi-square test of independence alongside binary logistic regression to examine associations between frailty, SDoH variables, and 30-day adverse outcomes.
Findings: Of the records screened (N = 111), nearly half experienced an adverse event within 30 days of a primary care visit. Those who met the criteria for frailty had a higher adverse event rate when compared to current evaluation with SDoH indicators, which demonstrated limited predictive value.
Implications: Findings pinpoint the benefit in developing an evidence-based toolkit for primary care to support identification of signs of frailty using the FRAIL Scale while also improving documentation, coding, and initiation of referrals to supportive services. This project highlights the ability for early detection of frailty in this population and promote coordinated, patient-centered care, while decreasing adverse outcomes.
Recommended Citation
Gunter, Susan, "A Retrospective Review of Older Adult Females with COPD, Loneliness, and Isolation: Frailty Level and Its Impact on the Progression of Disease and Quality of Life" (2026). Dissertations. 14.
https://roar.una.edu/dissertations/14
