Identifying frailty can be challenging. Not all older people have frailty and not all people living with frailty are old. Individuals with severe frailty are easily identifiable whereas those living with less advanced frailty can be much harder to distinguish. As well as working to identify those over the age of 65 with frailty it is just as important to try and identify it at an earlier stage in life and severity so measures can be taken to prevent it getting worse.
Across North and Mid Hampshire, the following steps are encouraged for identifying Frailty:
Additional resources for identifying frailty
So once a patient is identified as living with frailty, what next?
Across England we want everybody in the work force to begin to think F.R.A.I.L (Forward thinking, Resilient, Active and Informed in Later life). We can all be more ‘Forward thinking’ by contributing to the identification of frailty as early as possible.
Forward thinking can also be applied in the health care setting. Prevention and mitigation are at the centre of this. Being forward thinking can prevent hospitalisation and can help individuals to lead independent lives for as long as possible.
Regardless of whether they have been identified as living with frailty or not, empower your patient; involve them, their family and carers in decision making and to talk to them about what to expect and what they can do going forward.
These individuals may have a Rockwood score of 1-4. It is important to signpost these patients to information and advice on preventing frailty; the public facing pages of this website host an abundance of information on this.
If your patient is identified as living with frailty after initial assessment (Rockwood score 5-8) it is worth thinking over a few things:
If more specialist input or diagnostics are required patients can be referred for urgent or rapid assessment at hospital.
In North and Mid Hampshire:
There are an abundance of studies that highlight the negative effects of hospitalisation for the older patient. Some well-known statistics include:
There are many ways to mitigate this:
The Forward thinking section of our website for the public hosts advice and information that patients can use to reduce their risk of hospital admission.
Sometimes hospital admission is required and the only appropriate action to take. When someone living with, or at risk of, frailty needs treatment in hospital it is important to keep their stay as short as possible. All over the UK hospital teams are developing new ways of working to reach this goal. Take a look at this video from Hampshire Hospitals NHS Foundation Trust to see how they are helping patients get home as soon as they are well enough.
Clark D, Armstrong M, Allan A, Graham F, Carnon A, Isles C. Imminence of death among hospital inpatients: Prevalent cohort study. Palliative Medicine. 2014;28(6):474-479. doi:10.1177/0269216314526443.
Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, O'Neill D, Robinson D, Shepperd S. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD006211. DOI: 10.1002/14651858.CD006211.pub3.
Fortney S.M, Schneider V.S, Greenleaf J.E, The Physiology of Bed Rest. Compr Physiol 2011, Supplement 14: Handbook of Physiology, Environmental Physiology: 889-939. First published in print 1996. doi: 10.1002/cphy.cp040239
Kortebein P, Symons TB, Ferrando A, Paddon-Jones D, Ronsen O, Protas E, Conger S, Lombeida J, Wolfe R, Evans WJ. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci. 2008; 63: 1076–1081.
Empowering our population to be more resilient, both in mind and body, can help to reduce the impact and effects of frailty. This resilience is also important for those that care for a family member or friend living with frailty.
Our public facing page on resilience can provide information for your patients on the following:
Being a carer of a friend or family member living with frailty can have a profound effect on their physical, social and emotional wellbeing. Therefore, it is crucial to build their resilience as well as the frail individual. There is an abundance of information for carers and family members on where they can seek support and advice in our Carers and Volunteers section.
Remember don’t be afraid to ask the unaskable, sometimes a simple question can encourage a patient to open up more about their situation, making frailty easier to identify and tackle.
As mentioned in our ‘Resilience’ section, staying physically and mentally active is important for your patients’ mind and body. There are a range of studies that suggest that exercise and remaining active can have a positive impact on individuals living with Frailty (Theou et al, 2011; Clegg et al, 2012). It was also highlighted that there were no adverse events in most of the studies reviewed (Theou et al, 2011).
There are many programmes and groups across Hampshire where you can refer your patient, to help increase their daily activity. Not only will this combat social isolation in these individuals but also decrease the risk of having a fall. Group exercise has been shown to decrease the rate of falls by 29% and the risk of falling by 15%.
Some examples of programmes include:
However, some individuals may prefer not to attend group exercise programmes. If clinically appropriate there are many simple exercises that your patient can complete at home with similar benefits. Home-based exercise has been shown to reduce the rate of falls by 32% and the risk of falling by 22%.
This video from the Chartered Society of Physiotherapy demonstrates six simple exercises that can be performed at home. This can also be downloaded as a leaflet, containing further falls prevention information here.
You can also direct your patient to the Active section of our website for more ideas on staying engaged with everyday life.
As health care professionals it is important to keep up-to-date on frailty including understanding the syndromes, triggers and mitigating its impact.
By working collaboratively with our partners and other organisations we can share skills, resources and expertise which are available in the wider health and care system.
There are a variety of subjects covered on the NHS England website:
The Hampshire Connect to Support website is a resource that can be used to navigate the clubs, hubs and support available across Hampshire.
Helping your patients to stay informed is another great way to prevent and mitigate the effects of frailty.