In order to provide effective services to meet the needs of older people throughout their journeys of frailty, we need to understand both the underlying condition of frailty and the associated individual trajectory of a person’s needs. This is because the trajectory of need for a person with frailty is determined by two key components:

  • A baseline level of need that is a result of the degree of the person’s frailty, dependency and disability;
  • The transient and variable needs that are associated with changes in acute or long-term medical conditions.

The level of need that a person with frailty experiences at any point in time is the result of the combination of these two factors.

The underlying extent of a person’s frailty can be understood using both the frailty fulcrum model and the three classic illness trajectories that have been described to explain functional decline for people with long-term conditions BMJ: Illness Trajectories and Palliative Care:

  1. A short period of rapid decline (typical in people with cancer);
  2. Episodic periods of decline with some improvement in between (typical in heart failure and chronic obstructive pulmonary disease, which show periods of exacerbation interspersed with periods of greater stability);
  3. Prolonged periods of gradual decline (typical in people with dementia).

Although frailty is most usually considered to follow the third of these trajectories (a prolonged period of gradual functional decline), in some cases it can follow a more rapid course similar to the first trajectory, and in others there can be episodic periods of decline as in the second trajectory.

Understanding which trajectory a person’s frailty is most likely to be following is important in helping to plan the care required to best meet their needs at each stage in their journey. The advantage of using the frailty fulcrum model is that it can help us to understand much more fully the factors contributing to an individual’s frailty at any point in time, and over time. It can therefore help to understand and predict a person’s areas of greatest vulnerability and sources of resilience, thus help to provide care and support services which maximise the opportunities for interventions that will have a positive influence upon the overall frailty trajectory.

The services and support required in order to meet the transient and variable needs that are associated with changes in other acute or long-term medical conditions in people with frailty may be the same as those needed to meet similar needs in people who do not have frailty, or may need to be modified in order to take account of the person’s frailty.

Understanding these two components of need in people with frailty will help to better support the delivery of care to support these needs. This applies to supported self-care as well as to all other aspects of the care and support offered.

 

Journeys of Frailty Presentation