Frailty Driven by Clinical, Social, and Environmental Barriers in an OxygenDependent Older Woman: A Case Report

Daniel Lopez-Hernandez, Andrea Vazquez-Perez, Leticia Brito-Aranda, Alberto Vazquez Sanchez, Miriam Azucena Gonzalez Sandoval, Maria Clara Hernandez-Almazan and Edgar Esteban Torres-García.

Abstract

Background: Frailty is a multidimensional geriatric syndrome characterised by increased vulnerability to adverse outcomes. Beyond biological ageing, clinical conditions, psychosocial factors, and environmental barriers play a critical role in its develop-ment and progression. Oxygen dependence may further compromise physiological reserve and functional capacity.

Case Presentation: We report the case of a 69-year-old community-dwelling woman with a history of pulmonary thromboembo-lism, peripheral vascular disease, and Sjögren’s syndrome requiring chronic oxygen therapy. A comprehensive geriatric assess-ment (CGA) revealed moderate dependence in basic activities of daily living (Barthel Index: 85/100) and functional impairment (Katz Index: 4/6), with preserved instrumental function (Lawton Scale: 8/8). Frailty was identified (FRAIL score: 3/5). Physical performance was reduced (Short Physical Performance Battery: 7/12), with markedly decreased gait speed (0.16 m/s) and in-creased risk of falls (Timed Up and Go: 20.66 seconds). Cognitive function was preserved (Mini-Mental State Examination: 29/30; Mini-Cog: 5/5). Emotional assessment revealed clinically significant depressive symptoms (CESD-7: 12/21), despite a non-pathological Geriatric Depression Scale score (4/15). Nutritional status was adequate (Mini Nutritional Assessment: 13/14; BMI: 24.9 kg/m²). Additional findings included urinary incontinence, sleep disturbances, visual impairment, family dysfunction, social isolation, and environmental barriers.

Conclusion: This case illustrates how frailty may emerge from the interaction of clinical, social, and environmental barriers rather than disease burden alone. Comprehensive geriatric assessment enables identification of these multidimensional factors and supports targeted, multidisciplinary interventions.