The model of frailty used in this toolkit helps to highlight the importance of looking for opportunities to support self-care across all domains of frailty, at every stage of the condition, and in all settings along the care pathways.
Approaches to self-care in other long-term conditions usually rely first and foremost upon a formal diagnosis of the condition in question. However, although frailty is increasingly understood and recognised as a long-term condition, the formal diagnosis of frailty is not yet being widely and consistently made in many areas of our health services.
So, in trying to encourage supported self-care for people with frailty, the first problem to overcome is that many older people with frailty, particularly those with early frailty, might not have been formally diagnosed as having the condition, and may be reluctant to be “diagnosed”. However, the model used in this toolkit helps us to explain that frailty is a gradually emerging condition. This can help us to understand why a practical and general approach to supported self-care in older age can help to build resilience and be of benefit in early frailty, whether or not a formal diagnosis has already been made.
NHS England and Age UK have produced a booklet called ‘A Practical Guide to Healthy Ageing’ which is a supported self-care guide suitable for all older people, but intended mainly for people with mild frailty (whether they know they have the condition or not!). The advice in this guide has been designed to address a number of evidence-based risk factors that have been demonstrated to be associated with functional decline in older people. The risk factors concerned are:
- Alcohol intake
- Cognitive impairment
- Functional impairment
- Hearing problems
- Mood problems
- Nutritional compromise
- Physical inactivity
- Multiple medications
- Social isolation and loneliness
All of these factors can exacerbate frailty and have an adverse effect upon quality of life.
The guide translates these risk factors into a series of areas of practical advice, covering many of the domains of frailty described in this toolkit. The areas of advice offered in the guide are:
- Look after your feet
- Look after your eyes
- Get your hearing tested
- Make you home safe
- Keep active
- Prevent falls
- Talk about your medicines
- Get your vaccinations
- Keep warm and well and get ready for winter
- Eat well and drink plenty
- Help with bladder problems
- Better mental wellbeing
- Caring and keeping well
The guide also encourages people to make a ten point personal action plan, with five actions recommended for all older people to which they are encouraged to add five things they have chosen to do for themselves.
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. It is designed to promote self-discovery and self-activation, by encouraging people living independently in their own homes to ‘self-diagnose’ the fact that they are ‘slowing down’, and to support empowerment and motivation by focusing upon steps people can take to help maintain their independence. Proactive self-care in early frailty is thought to slow the progression of the condition and encourage widespread acceptance of the condition. Active engagement of people with early or emerging frailty offers great potential to improve quality of life for many
What can health and care professionals do to support self-care?
- Read the guide;
- Promote and sign-post for the individuals they work with, adapt or focusing the communications based on the particular needs of the individual;
- Support development of action plans and subsequent follow-up.