Frailty

When the clinical state of Frailty is present a person has decreased physiological reserve across multiple systems, with an increased vulnerability to stressors such as illness or injury. Those living with Frailty are vulnerable to significant changes in their health and function, often suddenly, in response to stressors. For those living with Frailty there is an increased risk of falls, hospitalisation, and loss of independence. Those living with Frailty are at increased risk of adverse effects from medication.

Frailty is not the same as aging, and many older people are active and resilient. However, the risk of developing Frailty increases significantly with age, and with demographic shifts seeing a rising proportion of older adults, it is an increasingly important focus of Healthcare.

It is important to identify Frailty when it is present. Early identification of Frailty leads to improved outcomes. Identification of Frailty allows HCPs to undertake evidence-based interventions such as Polypharmacy reviews to help reduce and mitigate harm from medication, and to engage in Future Care Planning (FCP). Identification of Frailty allows clinicians to provide care that is patient centred, for example by contextualising Chronic Disease Management in a way that takes into account an individual’s Frailty.

Identifying Frailty

There are different approaches to identifying Frailty, some of which have been outlined in Local and National Enhanced Services.

Age based assessment

Ageing does not equal Frailty; however, the prevalence of Frailty significantly increases with longevity. It is however important to be aware that Deprivation has a significant effect on an individual’s likelihood of developing Frailty. Those who are in the most deprived SIMD categories are more likely to have an earlier onset of frailty and faster progression of Frailty.

Frailty Phenotype – Usually those living with Frailty have three or more of these five symptoms:
- Muscle weakness
- Fatigue
- Unintentional weight loss (10lbs or more in the past year)
- Low levels of physical activity
- Slow walking speed

Frailty Syndromes – the following presentations can be an indicator of Frailty:
- Falls
- Immobility (e.g. sudden change in mobility)
- Delirium
- Incontinence (e.g. change in continence)
- Susceptibility to side effects of medication

Associated Health Conditions and Social Indicators – Frailty is more common in those with pre-existing multimorbidity, with specific associations with the following:
- 2 or more long term conditions
- Visual impairment
- Cognitive impairment / diagnosis of Dementia

Other Indicators that Frailty should be assessed for:
- Polypharmacy of ten or more medications
- Increasing Care Needs including moving into a Care Home
- Information recorded on Secondary Care clinic or discharge letters
- Needing Home Visits for Primary Care
- Referral to MOE and/or Hospital at Home services

Frailty Assessment

In NHS Lothian the agreed tool for assessing and coding frailty is the Rockwood Clinical Frailty Scale.

This is a link to a training module on the CFS: CFS Training — Specialised Clinical Frailty Network When an assessment has been made, it is important that this is coded on the Primary Care Clinical System.