We are all very familiar with the term ‘frail’ as a generalised description associated with age and poor health. Increasingly however, health professionals apply the term more precisely, to mean a specific condition which should be measured, diagnosed then carefully managed (just like a diagnosis of diabetes, arthritis or other condition).
Frailty is characterised by the following symptoms: weight loss, exhaustion, low activity levels, very slow walking speed, muscle weakness and poor ability to grip (this is known medically as the Frailty Phenotype).
The British Geriatric Society (BGS), the professional body for doctors, nurses and other professionals working with older people, is a leading advocate for better awareness and management of frailty. In their publication, Fit for Frailty, the society emphasises although the risk of frailty increases with age, not all elderly people are frail and some younger people, particularly those with long term health problems, can be frail.
Why is it important to have this better understanding and more precise meaning of frailty? There are two main reasons: the condition of being frail means a person is at risk of a relatively minor event having very serious and sometimes life-threatening consequences.
To take falls as one example of this: falls are an extremely common problem, with one in three people aged over 65 falling each year, rising to one in two aged over 80. What would be a very minor event for a younger or non-frail person, often has very serious consequences for the frail elderly: 10 to 25 per cent will sustain a major injury such as a hip fracture and for those aged over 75, falls are the leading cause of mortality (Chartered Society of Physiotherapists). There is a widely recognised spiralling of events: one fall results in increased frailty and loss of confidence, making further falls more likely. However, in a publication produced by Age UK (Falls Prevention Exercise – following the evidence) considering research from a number of different studies, suggests a tailored exercise programme for elderly people can reduce falls by as much as 54 per cent.
Similarly, the British Geriatrics Society (doctors, nurses and other health professionals working with the elderly) argues we should not see frailty as a fixed state but as a condition which can both worsen and improve (Fit for Frailty). Their report urges: “Older people should be assessed for the possible presence of frailty during all encounters with health and social care professionals.”
What does all this mean for families who are struggling to support an elderly relative still living in their own home? The advice from the British Geriatrics Society report emphasises frailty can escalate to a crisis point, when functions the individual was previously able to manage are no longer possible. The best place for the elderly person to be at this time is in a community setting, rather than an acute hospital, providing the necessary support is rapidly put in place. The society’s report states:
“If a patient is not severely unwell but is unable to maintain their usual status quo in the community due to a temporary change in their care needs, it is good practice and better for an older person with frailty to transfer care to a responsive community service rather than admission to hospital. This could be either a rapid response type ‘hospital at home’, or a community based intermediate care service such as a ‘step up bed’. There will be some variation in local schemes.”
In other words – elderly people who are losing their capacity to do things have the best chance of recovering that capacity to some extent if they are in their own home, or a community based setting. In the busy and unfamiliar environment of an acute hospital, it is much harder to regain lost capacity. But the frail, elderly individual must be safe above all and therefore community based support is vital.