The multi-dimensional model of frailty presented in this toolkit (frailty fulcrum) offers great potential to help individuals, carers and professionals to identify opportunities for supported self-care to improve quality of life for people with frailty. The model gives people the opportunity to understand the interactions between vulnerability and resilience in different areas of their lives, and to plan the ways in which they can achieve the best overall balance between them.
Opportunities Across the Domains of Frailty
This model could empower and motivate people by prompting them to consider opportunities and goals for self-care across all six domains of frailty:
- Social Environment
- Physical Environment
- Psychological Status
- Long-term Conditions
- Acute Health Events
- Systems of Care
It can also help them to understand why all of these domains make an important contribution to their Quality of Life. The concept of self-care can be explained in the context of this model as supporting and enabling people to control the positions of the domains along the balancing beam, helping and supporting them to move each domain towards resilience and away from vulnerability, thus helping them achieve the balance needed to reach the goals that are most important to their individual quality of life.
Managing Risk and Supporting Decisions
This model also helps to explain the importance of supporting people to make their own choices, which is one of the core principles of self-care, and, in particular, the importance of enabling individual choices regarding the management of risk. The quality of life benefits of supporting people to make their own decisions regarding the level of risk that is acceptable to them in order to achieve their desired goals is illustrated by the fact that optimising quality of life depends upon achieving the right balance between resilience and vulnerability. The model shows that trying to make somebody completely ‘invulnerable’, in other words trying to control their decisions to prevent them from taking any risks at all, can prevent them from achieving their best possible quality of life just as much as being too vulnerable.
Identifying Emerging Frailty
This model of frailty enables people to understand the relationship between ageing and frailty by explaining that frailty is a gradually emerging condition that is related to, but not the same as, getting old. It also shows that frailty can develop more quickly for some of us than for others, but should not be seen as a sudden or unexpected occurrence for any of us. The model helps to emphasise the positive value of recognising and acknowledging frailty as it emerges, at a stage when many opportunities exist to improve resilience through self-care. This model therefore has the potential to support self-care in frailty by helping to remove some of the stigma and negative perceptions often associated with the condition and thus increasing acceptance and motivation for patients, carers and professionals alike.
Marginal Gains to Improved Resilience
The model also helps to illustrate that, whilst the size and nature of the opportunities for self-care in frailty might vary for different individuals and at different times, some such opportunities can always be found in one or more of the domains of frailty. Furthermore, it helps to explain why small gradual changes as a result of self-care in one domain of frailty can help to offer resilience against sudden or unexpected changes in another. Importantly, it also helps to emphasise that the management of medical conditions and health events are only part of the overall balance, and thus highlights the value of looking for opportunities to support self-care across all domains of frailty, and at every stage of the condition.