Frailty and what it means for older people

Frailty is a word in common use but this article aims to shine a light on it and ask the question 'What can we do about it?'

What is frailty?

Frailty is about lack of resilience. NHS England define it as ‘…a distinctive state, related to the ageing process, as multiple body systems gradually loose their in-built reserves. This means the person is vulnerable to sudden changes in health, triggered by seemingly small changes in health such as a minor infection or change of medication’. These sudden changes can include for example rapid changes in the ability to cope independently, moving from a stable mobility to falling, from being lucid to delirious and from being mobile to immobile. This means of course that frailty can be hidden until ‘sudden changes in health’ manifest themselves. We can therefore be unaware of underlying vulnerability.

The cause of frailty is a cumulative decline in multiple physiological systems over a lifetime. Around 9% of people over 75 are estimated to have frailty and between 25% and 50% of those over 85 years old. Taking demographic data from Cherwell District Council ( this means that across the district, including the towns of Banbury and Bicester, between 1000 and 2000 people over 85 have symptoms of frailty. Extrapolating the same data for West Northamptonshire, which includes the towns of Brackley and Towcester, There are between 2305-4612 people living with frailty.

There is also a close corelation between frailty and other physical and mental health conditions such as COPD, heart disease and diabetes, emotional distress, depression, anxiety and poor cognition. In the case of dementia there is also a relationship in both directions in that dementia contributes to frailty and vice versa.

How do we know if someone is becoming frail?

Given that the onset of frailty makes an individual more vulnerable to big changes in their health, reliable assessment of frailty may give a significant benefit in the care and  wellbeing of older people.  There are varying indicators of frailty which include unintentional weight loss, muscle weakness, self-reported exhaustion, low energy expenditure (i.e. the amount of energy a person uses), reduced gait speed. If a person has one or more of these a person is said to have frailty. In terms of objective tests that can be done there are many which involve self-reports form the individual concerned, assessment by clinicians and physical observation of mobility. A clinical frailty scale has also been put forward see below.

Can frailty be managed an outcomes improved?

There are a number of factors in all our lives that make a contribution to our wellbeing at any age. These include things like our social environment, our physical environment, our psychological status (diagnosed conditions or more general loss of confidence or lack of motivation), any chronic or acute health conditions as well as our support and care needs and how they are met. Quality of life, depends on the balance of these factors. Shortcomings in these areas can be improved / adjusted, or compensated for by enhancing other areas of our lives. This offers the opportunity of improving wellbeing and offseting frailty. In other words by staying socially and physically active active, eating well and managing health conditions properly the likelihood of experiencing frailty can be reduced and an individual’s vulnerability improved. See also video here.

As an organisation trying to improve the quality of people’s lives being on top of these issues is a key part of what we try to do.  This involves recognising changes that happen in our clients, liaising with families as needed to keep them informed, and working with other health care professionals (e.g. GPs, Nurses, Occupational Therapists, Speech and Language Therapists). Overall our service can therefore help improve outcomes for people. This includes falls prevention, management of mobility and medical issues (e.g. diagnoses, prescribing of medication), improvement in nutrition and hydration, management of continence, provision of social contact and helping people stay active and feeling productive all of which can improve the quality of someone’s life and help prevent frailty. To find our more about what we do click here or contact us here.

This blog has been created from a series of work done by others including that of the British Geriatric Society, and in particular their ‘fit for frailty’ document here, and the University of Worcester.