What is frailty – and how should it be measured?

Frail elderly lady

Judy Lowthian, Principal Research Fellow & Head of Research at Bolton Clarke, told HelloCare that in the United Kingdom frailty is considered a key factor in the care of older people.

“In the UK it is recommended that any interaction between an older person and a health and social care professional should include assessment, which helps identify if the individual has frailty,” she explained.

The type of assessment will differ, however, the planning of any intervention – including starting a new drug, transferring the person to the emergency department of a hospital, or elective surgery such as a joint replacement – will all be considered and determine the person’s degree of frailty, balancing the risks and benefits.

Exposing such procedures to a person with frailty may cause them harm, Lowthian added.

What is frailty?

Frailty is a “syndrome of decline” that occurs in later life, making older people vulnerable to adverse health outcomes and functional decline, says Lowthian.

There can be a number of causes of frailty, including physical, psychological or social factors, or a combination of these elements.

Individuals can be: 

  • robust (non-frail), 
  • pre-frail (susceptible to the impact of frailty), or 
  • frail.

Frailty is dynamic, in that it changes over time, and occurs across a spectrum.

What impact does frailty have on an older person?

Older people who are frail have far greater risk of adverse health outcomes.

The consequences of frailty are “far reaching” and include: 

  • reduced capacity to partake in the activities of daily living, 
  • reduced social engagement and access to social supports, 
  • reduced energy levels, 
  • cognitive impairment, 
  • depressed mood, 
  • poor health outcomes, and 
  • susceptibility to ill health or stressors that otherwise could be tolerated.

How is frailty measured?

Frailty should be identified and measured so that outcomes can be improved and harm avoided. 

Lowthian said there are two “broad” models of measuring frailty.

Firstly, there is the Phenotype model, in which a group of characteristics – unintentional weight loss, reduced muscle strength, reduced gait speed, self-reported exhaustion and low energy expenditure – predict poor outcomes. 

“Generally, individuals with three or more of the characteristics are said to have frailty,” Lowthian said.

The second model is the Cumulative Deficit model, which looks at an accumulation of deficits, including loss of hearing, low mood, tremor and diseases such as dementia. These symptoms can occur with ageing and, when combined, can be measured on a ‘frailty index’.

According to Lowthian, any measurement of frailty will ideally include:

  • evaluation of energy level, 
  • weight loss, 
  • nutrition, 
  • continence, 
  • medication use, 
  • general health status, and
  • functional independence (ability to transfer, mobility, activities of daily living, cognition, engagement).

Can frailty be fixed?

Frailty and pre-frailty are modifiable, says Lowthian.

“Physical exercise is effective in reducing or postponing frailty, particularly when conducted in groups,” she explained. 

“Favourable effects have also been found with nutritional supplements, physical exercise with nutritional supplements, cognitive training and combined treatments.”

Bolton Clarke is about to trial a “holistic” approach to improving frailty, focusing on the physical, nutritional, cognitive and social aspects of frailty, with recently hospitalised persons.

Bolton Clarke hopes to extend this research into the residential aged care sphere.

In this vein, Bolton Clarke is trialling the use of cognitive stimulation, music therapy and reminiscence therapy to maintain and improve cognitive capacity and reduce emotional disorders in people living with dementia. The results look promising so far, says Lowthian. 

“Watch this space.”

Leave a Reply

Your email address will not be published. Required fields are marked *

Banner Banner
Advertisement
Banner Banner
Advertisement

Government should be “fixing this waiting list” for home care

Everyone says a week is a long time in politics and I think this one has been an extra-long week for many Australians. Whilst everyone I talk to across the community has been dismayed by the events of the last few weeks in politics. The chaos and division of the Liberals leadership challenge isn’t just... Read More

Want to Have Your Say on the Royal Commission? Be Quick, submissions close Sep 25th

  What would you like to see examined by the recently announced Royal Commission into aged care? Is there a particular aspect of aged care that you believe needs attention? Or do you have a story to tell? If you would like to have some input into what the Royal Commission will investigate, the government... Read More

Chaos as Earle Haven evacuated, royal commission hears

Frail and vulnerable residents became distressed and frightened as they were evacuated from Earle Haven aged care facility, the royal commission has heard. When the paramedic, Cary Strong, arrived on the scene at 2.13pm on 11 July, he found a scene of chaos. Mr Strong quickly assessed there were not enough staff present to care... Read More
Banner Banner
Advertisement