Frailty resources

These resources are intended to help address the common ‘frailty syndromes’ of falls, immobility, delirium, incontinence and side effects of medication. There is also a range of case studies available at the future NHS Collaboration Platform on the topic of supporting older people living with frailty. Please contact us via england.clinicalpolicy@nhs.net to gain access.

Frailty as a long term condition

To support health and care professionals and commissioners in the development of patient-centred services that enable people to age well there is a range of material available to improve understanding of frailty as a long term condition:

Falls resources

Every year more than one in three people over 65 suffer a fall, which can cause serious injury and even death. The costs to the NHS and social care  from hip fractures alone are an estimated £6 million per day or £2.3 billion per year.

Falls are the main cause of a person losing their independence and going into long term care. After a fall, the fear of falling can lead to more inactivity, loss of strength, loss of confidence ,and  a greater risk of further falls and a greater risk of death.

  • NHS RightCare Falls and Fragility Fractures Pathway defines the core components of an optimal service for people who have suffered a fall or are at risk of falls and fragility fractures

Public Health England has developed:

Immobility resources

Older people who do not get enough opportunity to mobilise can have an increased risk of reduced bone mass and muscle strength, reduced mobility, increased dependence, confusion and demotivation.

  • Public Health England’s Physical Activity Tool provides local data alongside national comparisons to support local health improvement

Delirium resources

Older people (and people with cognitive impairment, dementia, severe illness or a hip fracture) are more at risk of delirium. About 20–30% of people on medical wards in hospital have delirium. Between 10% and 50% of people who have surgery go on to develop delirium, varying on different types of surgery and settings. In long term care settings, its prevalence is under 20%.

Delirium Assessment Tools:

Incontinence resources

In the UK, there are over 14 million people who have bladder control problems and 6.5 million with bowel control problems. People with continence needs are often too embarrassed or poorly informed about the possibility of improvement and even cure. Continence problems can be overlooked by providers in all settings and for this reason NICE recommends case finding in all at-risk groups, which includes people aged 65 and over.

Medicines optimisation resources

The use of multiple medicines is increasing due to our ageing population, and nearly half of all medicines prescribed for long-term conditions are not being taken as intended.

Medicines optimisation looks at the value which medicines deliver, making sure they are clinically-effective and cost-effective. It is about ensuring people get the right choice of medicines at the right time and are engaged in the process by their clinical team. The following resources identify information relevant to older people and medicines optimisation.

NICE guidance relevant to the management of frailty:

NHS Wales and NHS Scotland guidance on polypharmacy:

Yorkshire and Humber Academic Health and Science Network guidance on the management of frailty:

The STOPP START Tool is a medication review tool designed to identify medication where the risks outweigh the benefits in older people and vice versa:

Multimorbidity

Both multimorbidity and frailty are associated with ageing. They have an adverse impact upon quality of life and are associated with higher mortality, adverse drug events and greater use of unplanned care. NICE Guideline NG56: Multimorbidity Clinical Assessment and Management is a tailored approach that should be undertaken with skilled clinical judgement and good communication to provide high quality care.

Sharing information

The GP contract requires clinicians to promote the benefits of activating an enriched Summary Care Record (SCR) to patients living with severe frailty. This provides the opportunity to:

  • Increase patient safety by providing timely access to information like significant diagnoses
  • Empower patients and increase satisfaction as patients can make their preferences known on topics such as end of life care
  • Empower health professionals by providing consistent, accurate, accessible information
  • Increase efficiency and effectiveness through more integrated care and reduced time/effort

Some areas may have a local version of shared health records but they must still use the SCR  because it complements local integrated care records. It ensures that people accessing care outside their local area still benefit from the appropriate professionals having access to essential details about their healthcare.

Workforce development

Frailty remains a new area for much of the workforce and work is needed to position frailty as a long term condition and underpin it with the upskilling of the workforce. The Frailty Framework of Core Capabilities, published in September 2018 by Skills for Health aims to identify and describe the skills, knowledge and behaviours required to deliver high quality, holistic, compassionate care and support. It provides a single, consistent and comprehensive framework on which to base review and development of staff.