Acute health events often present non-specifically as one of the frailty syndromes. Collateral history is often needed to ensure effective diagnosis and treatment.
This domain considers the acute health events that we will all experience at one time or another. These can range from the relatively minor to the very serious (for example, a minor infection compared to a serious heart problem) and can include both physical and mental health problems.
Some acute health events occur totally unexpectedly (for example, if a person suffers a sudden stroke).
Other acute health events might be sudden but less unexpected, or even relatively predictable in their general nature, if not their exact timing (for example, a person with chronic obstructive pulmonary disease might experience recurrent infective exacerbations of their condition, or somebody who is known to have experienced recurrent urinary tract infections might suffer a further similar episode).
Some significant and important acute health events can even take place on a planned basis (such as, elective joint replacement or cataract surgery).
The most common acute events that result in older people attending emergency departments, or being admitted to hospital, are falls and infections, and many more such episodes are also treated in the community without the person concerned ever being sent to hospital. One of the complexities of frailty is that the acute event may present “non-specifically” as a frailty syndrome.
The 5 frailty syndromes were previously known as the ‘geriatric giants’ and are:
All acute health events risk a sudden increase in vulnerability for the individual concerned, the impact of which is often proportionately much greater in older people compared to younger people.
Very often the scale of this impact can be helped by direct treatment of the acute health event (for example, treating an infection with antibiotics or undertaking surgery to fix a broken bone). Furthermore, sometimes the impact can be counter-balanced by other factors that create resilience (for example, a person with good preoperative fitness is likely to recover more quickly from surgery than somebody less fit, whilst somebody on bone protection medication might be less likely to suffer a fracture as a consequence of a fall).
The acute health events domain of frailty has close interactions and interrelationships with the other domains of frailty, particularly the multimorbidity (long-term conditions), systems of care and environment domains; for example:
- Some long-term conditions can increase the risk of acute health events; for example people with chronic respiratory conditions have an increased risk of acute respiratory infections;
- Some acute health events may lead to the development of new long-term conditions, such as when somebody suffers an acute stroke or an acute myocardial infarction;
- Good systems of care can reduce the vulnerability associated with acute health events with good coordination between primary and secondary care, and poor systems of care can increase the risk of acute health events;
- Environmental factors, such as a poorly maintained or cluttered home, might increase the risk of acute health events (such as falls), whilst the provision of appropriate aids and equipment might reduce this vulnerability;
- Other environmental factors, including poor housing conditions, might increase the risk of acute respiratory infections.
Further information is available in Managing Frailty in Acute Settings.