It is estimated that up to half of people over the age of 65 may be living with some level of frailty, and about 1 in 7 are living with Moderate to Severe Frailty.  In order to effectively support people with frailty, and to offer services to meet their needs, frailty must be recognised and acknowledged in a timely and appropriate way.

The recognition of an individual’s frailty can occur informally through the process of self-awareness and self-discovery, or through more formal diagnostic routes.  In what is thought to be a global first for frailty care, GP practices across England have been contractually required to undertake routine frailty identification and frailty care for patients who are 65 and over from 1 October 2017.  The GP contract requirements are the first steps towards a shift of focus and resources from reacting to the consequences of unmanaged frailty to a more proactive, holistic and person-centred approach to frailty care.

NHS England and Age UK have produced a booklet called A Practical Guide to Healthy Ageing. This guide is designed to promote self-discovery and self-activation, by encouraging people living relatively independently in their own homes to ‘self-diagnose’ the fact that they are ‘slowing down’, and to support empowerment and motivation by focusing upon the steps people can take to help maintain their independence. The content in the guide was created with input from focus groups to make sure that it is meaningful and acceptable for the intended audience of older people. For this reason it does not actually use the terms ‘frail’ or ‘frailty’, but instead refers to the fact that a person might be ‘slowing down’ see here for more on the language of frailty.

With the recognition of Frailty as a long-term condition, and the changes to the GP contract, the formal diagnosis of frailty is being made more often and more consistently, although analysis of the data indicates that considerable variation remains.  The British Geriatrics Society, Fit for Frailty, guidance advocates that older people should be assessed for frailty during all health and social care encounters.

A systematic review of the diagnostic test’s accuracy of simple instruments for identifying frailty in older people living in the community found the gait speed test to be the most useful and simple test for identifying frailty in this group of people. The gait speed test measures how long it takes a person to walk four metres, and if it takes the person more than five seconds then it is very likely that they have frailty. This gait speed test is one of a number of diagnostic tools recommended in the NICE guidance on multi morbidity (NG56) and further details can be found in Identifying and Assessing Frailty  and Tools for Identifying and Assessing Frailty.

It would also be extremely helpful if it were possible to predict which older people were most likely to develop frailty.  The electronic Frailty Index is another recent development that has the potential to enable a step-change in the early identification of people at greatest risk of living with frailty.  It uses routine primary care data to provide frailty risk score for all patients aged 65 and over.  Clinical verification is required to confirm the level of frailty, but the eFI provides a prioritised list of individuals for further assessment and support.

In order to offer effective care to help achieve the best possible quality of life for people with frailty, it is also important that once frailty has been recognised and diagnosed, that individuals, carers and professionals alike are supported to acknowledge the condition and to consider its implications for the planning of future care and support see here for more information.

 

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