Understanding frailty – a beginners’ guide

440x210_hands_hot_water_bottleGill Turner is Vice President, Clinical Quality for the British Geriatrics Society and Project Lead on the Fit for Frailty campaign. This blog, outlining the concept of frailty and highlighting the recent release of Fit for Frailty Part 2first appeared on the Age UK website.

It is hard to open a book, newspaper or listen to the news currently without hearing words like ‘the elderly’ , ‘dementia’ and ‘frail’. But what is meant by these words?

Frailty, for example. Many journalists use ‘frail’ to depict older people as victims of a failing NHS and underfunded social services. Doctors, nurses and relatives sometimes use ‘frail’ to describe people at the very end of their life, reinforcing its negative connotations.

And yet, work done by Age UK shows that older people see being ‘frail’ as akin to being weak, dependent and hopeless: they reject the idea of using it.

So, what if the word ‘frailty’ actually denoted a health condition which could be recognised, managed and even improved? What if the recognition of frailty opened the door to a range of health and social care services organised to address an older person’s wellbeing, independence and control over their own life? 

Frailty in scientific terms describes a situation where the body’s reserves are wearing out, meaning individuals are at risk of doing badly after a minor illness or stressful event. Decisions about health and social care for individuals with frailty need to be tailored to recognise their frailty, and in doing so address the problem.

The British Geriatrics Society, the Royal College of General Practitioners and Age UK have just published Fit For Frailty: a set of best practice guidance for managing frailty.
Part 1, published a few months ago, describes recognising  and managing frailty for individuals. Part 2, published last week, makes recommendations for the organisation of services for frailty. You can download both documents for free from the BGS website.

The guidance shows that there are several methods to recognise frailty; for example taking more than 5 seconds to walk 4 metres. Gold standard for treatment is a process called Comprehensive Geriatric Assessment(CGA): it’s an unattractive name, but research has demonstrated its effectiveness. We need to embrace its value, regardless of title.

CGA involves an holistic review to consider troublesome symptoms and problems which might not have been previously reported to the doctor, and a discussion with the patient about goals and aims for their life.

This could sometimes mean reducing medications. For example, research shows that  reducing blood pressure can reduce stroke risk: however, if an older person’s blood pressure medication makes them feel faint and fall over, that threatens their ability to shop and choose their own food, and thus their independence. Keeping a high level of medication might be the wrong treatment for that individual.

For another person who feels that being able to walk to church on Sunday  is an important priority, it could mean changing the focus of their treatment from careful diabetes control onto an exercise programme.

Of course, you could think of a million examples here: there will be as many different approaches as there are people. The point is that the treatment plans must be centred around what an individual older person needs for their life and wellbeing.

Sometimes, several different professionals will be involved: perhaps a geriatrician, a therapist or a nurse. Each of these will need to work in  a team around the patient, helping formulate their own well-being plan which will need to be revisited as things change and new priorities emerge. CGA covers this whole ongoing process.

Ensuring that older people with frailty have access to holistic medical review and CGA will require some reorganisation of services. Part 2 of the guidance gives advice about what is needed when it comes to the commissioning and design of health services.

Our expectation is that services will support the concept of frailty as a condition with which people live well and hence are keen to be associated with, not from which they suffer and die.

Find out more about the British Geriatrics Society Fit for Frailty campaign

Watch Age UK’s video of older people sharing their perspectives on frailty 

Making today’s healthcare services Fit for Frailty

BGS Logo CMYKAndy Clegg is a Clinical Senior Lecturer in the Academic Unit of Elderly Care and Rehabilitation, and Honorary Consultant Geriatrician, at Bradford Teaching Hospitals NHS Foundation Trust.

In this blog, he talks about Fit for Frailty Part 2, a new guidance document being launched by the BGS on Wednesday 14th January.

Fit for Frailty Part 2 has been written by the BGS and RCGP in association with Age UK, on developing, commissioning and managing services for people living with frailty. The guidance is aimed at those working with and commissioning services for older people with frailty, particularly GPs, geriatricians, health and social care managers and commissioners.

Continue reading

Vitamin D and bone health: A practical clinical guideline for patient management – National Osteoporosis Society Guideline

Dr Terence Ong is a Research Fellow at Nottingham University Hospitals NHS Trust.

Professor Opinder Sahota is Professor of Orthogeriatric Medicine and Consultant Physician at Nottingham University Hospitals NHS Trust

image by epSos.de

image by epSos.de

Vitamin D is not, in the truest sense, a vitamin because it is not exclusively obtained through diet alone. It is a secosteroid, mostly obtained intrinsically by the effect of ultraviolet radiation on previtamin D compounds and subsequent hydroxylation in the liver and kidneys.

Vitamin D plays an important role in calcium and phosphate homeostasis through its effect on gut and bone metabolism. Besides that, it also plays a key role in muscle function. In recent years, our understanding of vitamin D has expanded and we are starting to appreciate its much broader role in areas such as the immune system, cancer and cardiovascular disease. Continue reading

‘Pain in older people is under-recognised and under–treated’

Pain in older people is under-recognised and under-treated according to the authors of new guidance on the management of pain in older people published by the British PPainSuppCOverain Society and the British Geriatrics Society.

There have been very few studies dedicated to the management of pain in older people.  However, the bio-physiological changes that occur with ageing, the accumulation of co-morbidities and co-prescription of medication, frailty and psychosocial changes make older people rather different when considering treatment options for pain control. Continue reading

The Silver Book – guidelines for the emergency care of older people

The BGS is proud to announce the publication of the Silver Book, an essential guide to for all those involved in delivering emergency care to meet the needs of older patients and to promote continuous improvement in the standards of care.

The Silver Book recommends ways in which emergency admissions can be reduced and the experience of those admitted improved.  It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses. A core focus of the Silver Book is the skills and competencies needed by healthcare staff to ensure they are better able to assess and manage frail older people.  Continue reading

Failing the Frail: A chaotic approach to commissioning healthcare services for care homes

The BGS published its report, Failing the Frail, on the same day as the Care Quality Commission (CQC) published its Special Review of Care Home Residents Access to Healthcare Services.  The data collected by CQC as part of its review was analysed by the BGS under a data-sharing agreement and shows that primary care trusts (PCTs) do not accord sufficient priority to care home residents when planning and ensuring the delivery of local healthcare services.

Please see the BGS website for further details and a copy of the report.  

The BGS report was covered in the national press, including the Daily Telegraph, the Guardian and the BBC.

A Quest for Quality in Care Homes

An inquiry into the quality of healthcare support for older people in care homes: a call for leadership, partnership and improvement.

This BGS report marks the start of a process of partnership to develop impetus, resources and clinical guidance that will support the NHS to play part in improving the experience and the quality of life of residents in care homes.

Its recommendations were developed collaboratively with stakeholders drawn from care homes, social care, NHS (including primary care) and academia.

The report describes current NHS support for care homes. It tells a story of unmet need, unacceptable variation and often poor quality of care provided by the NHS to the estimated 400,000 older people resident in UK care homes. It describes what should and could be done and calls for national action by government and local action by NHS commissioners, planners and clinical services to improve the quality of NHS support to care homes.

It highlights the need to build joint professional leadership from the health, social, and care home sectors, statutory regulators and patient advocacy groups to find the solutions that none of these can achieve alone.

Download report in MSWord format
Download report in pdf format
Click here for a list of organisations who have endorsed the document