The frailty fulcrum model helps us to understand that, as well as being full of complexity; frailty is also a dynamic and changing condition. The dynamic nature of frailty gives rise to several important characteristics of the condition, which are important in helping to offer the best possible support to individuals throughout their journeys of frailty:
- Critical Tipping Points: The first of these characteristics are what can be described as ‘critical tipping points’. This means that at certain points in time, or as a result of certain combinations of circumstances, frailty can reach a point at which a small additional change can result in disproportionately large adverse impact upon the individual’s wellbeing and quality of life. Again, this is easily understood by considering the frailty fulcrum model, which demonstrates how relatively small changes in the positioning of domains at the extremes of either increasing vulnerability or reducing resilience can create an imbalance that has significant adverse impact upon quality of life (see frailty fulcrum);
- Points of Maximum Leverage: The second of these characteristics is what can be described as ‘points of maximum leverage’. This means that at certain points in time or as a result of a certain combination of circumstances, frailty can be at a point where specific interventions can be particularly beneficial and have an enhanced positive impact upon either improving or protecting the wellbeing and quality of life of a person with frailty. In other words, ‘points of maximum leverage’ are effectively the mirror image of ‘critical tipping points’. Using the frailty fulcrum model, this can be explained in terms of talking actions, or offering interventions, at a point at which they will have the maximum impact in either preventing the movement of domains towards positions of creating vulnerability and away from those creating resilience, or in helping to reposition domains directly to improve this balance and therefore the person’s quality of life (see frailty fulcrum);
- Emergent Outcomes: A further characteristic of frailty is what can be described as ‘emergent outcomes’. This means that a person’s priorities for their goals and outcomes of care can change during their journey of frailty. In other words, the things that are most important to a person at one stage of their journey of frailty might be less important at a different stage. For example, evidence shows that people with early frailty tend to prioritise health related domains most highly in relation to their quality of life, whilst at more advanced stages of frailty other domains, in particular those concerning social contact, become more important to people. This is part of the process of adapting to frailty and is often a very important part of somebody’s journey of frailty. It is important for individuals and their families / carers to acknowledge and understand these emergent outcomes, and to adapt to, respect and support these changing priorities. For example, sometimes a person might have been quite fixed in declining offers of care in their own home, but a change in circumstances, such as a change in their own health status or experiencing bereavement, might result in a change of heart and a new acceptance of the benefits of such support. The report “Frailty:Language and Perceptions” outlines various trigger points as individuals’ levels of independence change. Recognising the existence of ‘emergent outcomes’ helps to explain the need for a continuous cycle of follow up and review in order to effectively support people living with frailty.