Frailty in older people and an introduction to an important initiative to help
I was fortunate to attend a fascinating meeting at the Royal Society of Medicine, on the impact of frailty in the treatment of older people. The meeting was presented by the British Geriatric Society; chaired by Dr Mashkur Khan, President Geriatric and Gerontology section of the Royal Society of Medicine and presentations were given by Professor Finbarr Martin from Guy’s and St Thomas’ NHS Foundation Trust, Professor Simon Conroy of Leicester NHS Trust and Dr Anna White from Dartford and Gravesham NHS Trust. Nick Triggle, from the BBC, rounded off the evening with an incredibly insightful update into NHS funding, the state of the NHS and the need for more funding for social care.
Frailty is defined as a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built biological and functional reserves. Frailty is a condition where people lose their ability to compensate when they are medically challenged, and frailty makes an older person more prone to falls and more susceptible to being floored by a minor infection or injury, thereby increasing the likelihood of admission to hospital. Something such as a minor urinary tract infection can cause confusion and rapid deterioration, quickly knocking a frail individual off their perch!
Around 10% of people aged over 65 years are thought to be frail, rising to between a quarter and a half of those aged over 85 years.
Many people with multiple long-term conditions (multi-morbidity or co-morbidity) will also have frailty which may be masked or missed when the focus is on other disease-based, long term conditions. Likewise, some people who have frailty alone, may not have been diagnosed as such and can be lost in the system until they experience a minor injury or infection which causes a swift and dramatic deterioration in their physical or mental well-being.
How many times have we heard people say, “my mother was coping just fine on her own until that fall, or until that urinary tract infection.”
On a personal level, my mother-in-law is now 83 and living what appears to be a full and active life. However, she never fully recovered from her hip replacement 3 years ago and over the last few months has been struggling to walk, with increasing breathlessness, loss of balance and loss of confidence. She has definitely lost her physical reserve and we are still struggling to find someone to take a holistic approach to her care and stop referring her to different system specific specialists. The danger is that she becomes increasingly frail, loses her independence, loses her ability to socialise and a minor injury or infection precipitates a lengthy admission to hospital.
My experience is that the system remains clunky for patients and sadly it is not as easy as it should be to obtain a thorough, comprehensive geriatric assessment and appropriate intervention to treat the older patient as a whole and identify potential frailty.
Key indicators of frailty are factors such as gait, speed, grip strength and these along with several other physical and mental markers are evaluated using various assessment tools.
Nutritional advice and exercise are two fundamental approaches to treating frailty. Interestingly, although frail individuals were traditionally thought of as having experienced recent weight loss and being of slimmer stature, obesity induces a pro-inflammatory state and so a weight loss diet may form part of the treatment too. Specific muscle strengthening exercises are important in preventing falls, however there is also increasing research showing that the individual’s self-motivation to undertake the exercise is even more important in the treatment of frailty.
These findings are entirely in keeping with the work we are trying to do with this website and everything we are trying to achieve with stay safe.
For more information about participating in the Stay Safe initiative, please email firstname.lastname@example.org
First Aid for Life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information. It is strongly advised that you attend a first aid course or do one online to understand what to do in a medical emergency.
Introducing a comprehensive guide to accident prevention and treatment in the older generation; Slips, Trips and Fractured Hips by Emma Hammett RGN. This book has been written for people caring for older friends and relatives; children caring for elderly parents, for spouses, for older people wanting to keep themselves that bit safer and for anyone working with or caring for older people. It is designed to help you take measures to prevent life-threatening injuries and help you plan, prepare and avoid mishap, as well as equip you with the necessary skills should an accident occur.