Dawne Garrett, Professional Lead - Older People and Dementia Care, Royal College of Nursing.
Voltaire tells us we are all formed of frailty and error. Certainly we all have a picture of frailty, perhaps an old thin, small, stooped and wrinkled lady, slow of step, quiet of voice and without strength.
In terms of the clinical label of frailty this is untrue. Frailty is phenotype; not a normal part of ageing, but a long term condition. If frailty was about age then all older people would be frail and clearly they are not.
Frailty is frequently described as a distinctive health state related to ageing in which multiple body systems gradually lose their in-built reserves. Frailty can be a difficult term, complex to describe and difficult to live with. The difficulty is in the name because no-one wants to be labelled frail and everyone has their own understanding of frailty. It is as if “You live as if you were destined to live forever, no thought of your frailty ever enters your head” (Seneca).
We know frailty is more common in increasing age. Around 10% of people aged over 65 years have frailty, rising to between a quarter and a half of those aged over 85 years.
However, frailty has increasing clinical prominence and a body of research. We know infections and trauma can result in disproportionate illness and can be associated with an inability to return to the previous level of activity or life style. We can all think of people who have had an illness, even a serious one and then bounced back. A forty year old male with a severe chest infection (or even sepsis) who has recovered and is carrying on in life as if nothing has happened. For those living with frailty the bounce is limited; like the slightly deflated football, this must be highly frustrating and worrying. Perhaps it results directly in maintaining independence or a realisation that life and activity might be limited.
So what can we do? Recognition is the start and there are a wide range of tools to screen whether someone has frailty. The Rockwood Frailty Scale widely used in hospitals, the Electronic Frailty Index in primary care and other tests such as the gait speed test are frequently used. Everyone who is identified as living with frailty should have an holistic clinical review based on comprehensive old age assessment. As a result of this review, a personalised care plan should be created and co- produced with the person, thus ensuring that there is a focus on the individual’s needs and goals.
The care plan documents a plan to optimise and maintain health and function. It also explains the person’s choices and plans regarding the level of treatment they would like and, when necessary, an end of life plan. The care plan should contain decisions about what to do if the person becomes unwell, and recommending when the patient/carer might need to seek further advice.