Professor John Young, NHS England’s Director for Integration and Frail Elderly Care, supports a more proactive approach:
Frailty is an enigma. It surrounds us in health and social care and we recognise it when we see it – but it is also invisible because as healthcare professionals we do not regard it as a diagnosis or formally record it.
We tend to use the term as a description – “the frail elderly” – rather than considering it a long-term condition.
However, frailty behaves just like a long-term condition. It is progressive, it impacts adversely on life experience and – if unmanaged – it can cause the sufferer to become very sick, very quickly.
Catch them before they fall
Frailty is related to the ageing process, that is, simply getting older. It describes how our bodies gradually lose their in-built reserves, leaving us vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection or a change in medication or environment.
It’s because we do not pro-actively manage people with frailty, that they tend to become known to us in crisis. There is an over-reliance on secondary care responses, with over 650,000 people over the age of 65 attending hospital emergency departments each year after suffering a fall.
It is my belief that people living with frailty need improved support through the provision of preventative and individualised care. This should include everything from home adaptation and carer support to access to social networks, exercise promotion and nutritional guidance.
The Frailty Index
Frailty develops slowly over 5 to 10 years, so could more be done to help older people with frailty before a health crisis occurs?
Older people with frailty can be readily identified and are usually well known to local health and social care professionals. However, at present we do not formally diagnose frailty, making proactive care difficult.
The primary care electronic health record contains large amounts of health data which could be brought together with a simple slow walking test (an indicator of frailty) to form a “Frailty Index”. This would enable us to identify people with frailty and to grade their frailty state, allowing us to devise structured self-management plans for people with mild or moderate frailty and to move ahead with multi-disciplinary assessment and individualised care planning for people with moderate or severe frailty as quickly as possible.
A new model of care
Frailty is a late life adverse health state that develops over several years. Although frailty shares many characteristics of a long term condition, the current health service response is predominantly by urgent and emergency care rather than a preventative and proactive approach.
A new model of frailty care is needed and should be delivered through more robust primary care-based systems capable of routinely identifying people living with different severity grades of frailty and providing an appropriate response of supported self-management that is well integrated with community, mental, social and voluntary sectors.
Professor John Young is the National Clinical Director for Integration and Frail & Elderly Care for NHS England. Professor Young is a consultant geriatrician at Bradford Foundation Trust and leads a large research unit within the University of Leeds. He has held previous positions with the Department of Health and NICE. He has also worked on two national audit projects.