Jan 22, 2020

Program to reverse frailty being trialled in Australia


Frailty affects half of all Australians over the age of 65, making them vulnerable and at increased risk of poor health outcomes, and even death, in the event of illness or injury. 

But research tells us the progression of frailty can be slowed and even reversed. 

The key problem has been encouraging frail people to take part in interventions, and to keep those interventions going.

To address this issue, Bolton Clarke Research Institute is adapting a successful program from Singapore to help older people coming home from hospital in Australia. The aim is to get people returning from hospital to embark on interventions and then to maintain their program. 

The program is called ‘Be Your Best” and is being co-designed with three hospitals – Cabrini Health, Alfred Health and Monash Health – and also with Bolton Clarke’s own home care clients, and older people admitted to hospital emergency departments.

What is frailty?

Bolton Clarke Research Institute Principal Research Fellow, Dr Judy Lowthian, spoke to HelloCare about the program, and she began by explaining how frailty affects older people.

“Ageing is associated with changes in biological, physiological, phycological, behavioural and social processes,” she said. 

“Some of these age-related changes are quite benign, such as your hair going grey, but others result in decline in function and senses, such as (delines in) your hearing and your sight, (declines in) activities of daily living, and also an increase in your susceptibility or vulnerability to disease, frailty or disability,” she explained.

“Someone who’s frail could experience reduced energy levels, reduced ability to partake in activities of self care, activities of daily living, grooming, bathing and toileting, reduced social engagement, cognitive impairment, depressed mood, and poor health outcomes.” 

Older people who become frail are more susceptible to poor health and stresses that they could otherwise tolerate, Dr Lowthian said. 

Going to hospital can make frailty worse

A trip to hospital can make frailty worse, Dr Lowthian said.

“Interestingly, frailty increases the risk of hospitalisation, but, importantly, admission to hospital worsens frailty,” she said.

“An older person who is frail or susceptible to frailty can go into hospital frail and come out worse than when they went in. Sometimes it can take a lot longer to get back to where they were before they went into hospital, or they don’t get quite back to that level,” Dr Lowthian explained. 

“That’s why we have to pick (frailty) up routinely, and do something about it,” she said.

“The person might have had a knock to their system, and we’re looking after that particular issue, such a pneumonia or a broken hip, and we’re not mobilising them quickly enough, and then they go home.”

Frailty is not only bad for the person, it’s a burden on our health system

“Frailty is not just a burden for the person and their family, Dr Lowthian said, “it’s also a burden on the community in terms of lost productivity, (for example) paid work, informal caregiving and volunteering. 

“It also increases health costs because we know it’s associated with increased use of health services and increased hospitalisation.” 

Aim: To reverse frailty

The Bolton Clarke program is looking at people who are aged 65 and older who’ve had a recent hospitalisation.

“We’re going to do an assessment of them, and we’re considering the person as a whole, not just the physical side of things. We’re looking at their cognition, their general health, what social supports they’re got, what their nutritional status is like, what their mood is like. 

“The evidence tells us that we can reduce frailty, reverse it or postpone it by using physical activity, strength and balance, cognitive training and, importantly, social support,” Dr Lowthian said.

Each person will be analysed for their physical mobility and access to nutritional support, cognitive stimulation and emotional support.

Community interventions tailored to each person’s needs

The program will use interventions that are already available in each person’s community, and each person will have interventions tailored to meet their needs. 

Bolton Clarke has been working with health consumers – patients, family members, friends, carers – over the last year co-designing the program. 

They have found people say that frailty is not just a “physical thing”, it’s cognitive took, which feeds into social aspects of their lives.

During their consultations they also discovered older people have an aversion to the word ‘frailty’.

“We’ve been asking them about what they think of the word ‘frailty’ and… they hate that word,” she said.

The term ‘difficulties with function’ can be used instead of ‘frailty’, she suggested.

Asking the consumer ‘what do you want?’

Dr Lowthian is optimistic about the Bolton Clarke program.

“I think it’s going to work”, she said, because of the involvement of health consumers, and their ability to have a program that suits their needs and wants.” 

“We’re telling them this is what research is showing us works, what would this look like for you? 

“Some people will say ‘I don’t want to go out to a program, what can I do at home?’ So we’ve shown them pictures of exercises they can do. 

“And we might ask ‘how can we motivate you to keep doing these things?’. We’ve come up with the idea of a diary so they can tick a box to motivate themselves. We’ll phone them and see how they’re going,” Dr Lowthian said. 

“And we know that early intervention is always the best. It’s about trying to get in early.”

“I think we’re going to get good results”

The program is still in the process of being co-designed with each of the different communities:  the three hospitals, Cabrini Health, Alfred Health/Monash University and Monash Health/Deakin University, and with Bolton Clare’s home nursing clients.

“Each of these communities have their own subtle differences,” Dr Lowthian said. 

“We’re going to look at people who’ve had a hospitalisation and work with them over a six-month period. 

“After six months we’ll go back and see how their programs have been sustained,” Dr Lowthian said.

“Because we’re using existing programs and we’re co-designing it and involving the person in their care, we think it will be much more sustainable,” she predicted.

Results will be available in around 12 months.

“We know that once someone starts physically declining they start socially withdrawing, and we know the impact of that on their cognition, their thinking and their socialisation. 

“If we can engage people back into the community, I really think we’re going to get good results,” Dr Lowthian said.

Image: Stock image. Model is posed. Source iStock.

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