Healthy Ageing and Frailty

What is frailty?

Frailty is a common syndrome which occurs due to a combination of de-conditioning and acute illness on a background of existing functional decline that is often under recognised. Frailty is more common in females and the risk of frailty increases with age.

People with frailty have 2-3 times the health care utilisation of non-frail people and experience higher morbidity and lower quality of life.

Frailty can affect up to 25 per cent of patients aged 70 and over. It can increase their risk of falls, prolong hospital stays, and cause decline in function. It also increases the likelihood of institutionalisation and death.

However, while frailty is linked with getting older, the two do not have to go hand-in-hand. Effective early intervention can help people stay healthy and active for longer.

Many causes of frailty can be managed and - in some cases - reversed, to create better health outcomes and quality of life. By supporting general practices to identify older people who are living with pre-frailty or frailty, the PHN hopes to better support ageing well and enable people to remain at home longer.

See “Frailty Fundamentals” for more information, including diagnosis, referral and recommendation options for patients.

Identifying frailty

Not all older people are frail, and not all people living with frailty are old. However, it is important to identify frailty early, in order to combat the condition and it effects. Current health guidelines suggest that people over the age of 70 should be screened routinely.

Use of a validated screening tool will help ensure that identification of frailty is accurate, reliable and consistent. The PHN recommends use of the “FRAIL Scale”.

A score of 1 to 2 indicates pre-frailty and a score of 3+ indicates that the patient is living with frailty.

Download the Frailty Flowchart incorporating the FRAIL scale and referral options.

Managing frailty

Early intervention can allow people to stay active and healthy longer, keeping them out of hospital and in their homes.

Correctly managing frailty can significantly improve a person’s function and quality of life. It can also provide a better chance of recovery from acute illness.

In addition to assessment via the FRAIL Scale, clinicians can consider using the 4m walk (gait speed) test, testing grip strength and measuring the number of sit to stands in a set period (see Hunter New England HealthPathways and Central Coast HealthPathways for more information).

Once a person has been assessed as pre-frail or frail, a management plan should be developed. See “Frailty Fundamentals” for referral and recommendation options in the patient’s location.

The decision support tool also provides guidance about the best course of action for pre-frail and frail patients.

Implementing Frailty Screening

When implementing frailty screening, be careful to:

• Think outside the disease and injury box (e.g. if a patient with a cold mentions that they have lost quite a bit of weight, don’t assume they will improve when the cold is gone, but think about whether they may be pre-frail or frail, and consider the options available).
• Be proactive in thinking and talking about frailty:
  • Ask patients aged 75+ years about healthy ageing and staying active, and
  • Provide advice and support (e.g. referrals, contact numbers or brochures) so they can learn more and take action.
• Observe patients with frailty in mind - pay attention to how patients walk to the consultation room or move during your consultation. This can tell you a lot about how unsteady patients are on their feet.
• Utilise Practice Nurses, who have an important role in frailty screening and management:
  • Identify, recruit and send out recall letters to people at risk of frailty.
  • Talk about falls prevention with at-risk patients (e.g. during immunisation, wound care, 75+ health assessment, GP management plan, etc.).
  • Go through some of the frailty prevention resources with patients.
  • Help GPs assess for risk factors and follow-up with the patient’s progress.
• Schedule a follow up appointment to discuss risk factors and make a fall management plan with the patient if you cannot complete all frailty management activities in one appointment.
• Consider affordability and provide options suitable for the patient:
  • If the patient has private health insurance, some prevention activities will be subsidised. This helps them get good use out of their insurance.
  • Some patients might prefer to pay to attend group classes which have a social element.
  • Others might prefer or require one-on-one consultation (e.g. with a physiotherapist or exercise physiologist).
  • Some patients might prefer to do their own exercises at home (e.g. following exercises in information leaflets) to save service and transport costs.

Referral options

See “Frailty Fundamentals” for referral and recommendation options in the patient’s location.

Articles by Dr Chris Bollen

Article 1 - Frailty: A reversible decline

Article 2 - Doing What Matters : Keeping Older People Well at Home

Article 3 - Frailty and polypharmacy are linked!

Article 4 - Improving diet and nutrition in older people to change the trajectory of frailty

Article 5 - Grief - a big issue for older people and the trajectory of healthy ageing

Frail Scale Templates

Templates (.rtf files) can be imported to Best Practice and Medical Director software. See Appendix 1 of “Frailty Fundamentals” for FRAIL scale templates for Medical Director, Best Practice and ZedMed.

Referral options

See “Frailty Fundamentals” for referral and recommendation options in the patient’s location.