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What is frailty?

11 May, 2018

Author: Tracy O’Regan, Professional Officer for Clinical Imaging


Skills for Health recently invited the CoR to attend a stakeholder workshop for frailty. The invite brought the question of the meaning of frailty to the fore. It is a commonly used term therefore few people stop to consider its definition.

Radiographers are acquainted with the word because it is provided in the clinical history section of request cards. Occasionally, referrers use the word frailty interchangeably with the word fragility, which is confusing, because fragility may be related to an insufficiency fracture. 

While frailty is a term generally taken to refer to elderly patients, especially the population living in their eighties and nineties, frailty is not an inevitable result of the aging process. Elderly people are not necessarily frail and frail patients are not all elderly. You may be surprised to know that frailty is about to be positioned as a longterm condition alongside diabetes and COPD.

There are over 26 million people with at least one long-term condition in the UK. There are various definitions and stages of frailty used in literature. There is consensus that certain indicators point to a state of pre-frailty (referred to as 'vulnerability' in some papers). Pre-frailty commonly progresses but progression is not inevitable. It would appear that there is more to frailty than meets the eye.

There are interventions that can be undertaken in a bid to prevent or revert prefrailty including exercise to reverse sarcopenia (loss of muscle mass) and modifying the diet to increase consumption of protein-rich food and vitamin D. Some members may be pleased to hear that literature also refers to moderate consumption of alcohol as a preventative factor - carefully exercised though, because excessive alcohol consumption is a risk factor for frailty.

Frail patients may experience exacerbation of symptoms that are referred to as a syndrome of frailty. The key signs associated with frailty syndrome are:

  1. exhaustion or fatigue and weakness;
  2. anorexia/weight loss;
  3. reduced walking speed and/or physical activity;
  4. cognitive impairment;
  5. feeling sad or depressed;
  6. incontinence;
  7. use of five or more prescription medicines (poly-pharmacy); and
  8. need for physical or social support.

Exacerbation of these factors can result in a downward spiral of frailty, likened to a domino effect, which often results in hospital admission or. more long-term, the loss of independence.

Factors that can lead to this spiral include underlying delirium, infections, falls and loss of mobility; indications that radiographers see written in the clinical histories on request cards. The exacerbation of symptoms can also be a direct result of acute illnesses, infections, falls and other events that are traumatic for the frail person such as bereavement.

Obviously this is important information for clinicians who will speak with patients about preventative interventions. However, a huge number of people are already living with the symptoms. Evidence suggests that there is a specific point at which progression of frailty symptoms indicates that the frail person will have approximately five years of life expectancy.

A recent paper reports that when given the choice, two-thirds of frail elderly adults wanted to discuss a five-year prognosis with their clinician; primarily so they can prepare personally, spiritually, and financially for their end of life.

Health Education England and Skills for Health are asking how AHPs, including radiographers, student radiographers and assistant practitioners, can develop and improve awareness of the condition of frailty so that we can help patients. An example of how we are being encouraged to help is the involvement of stakeholders in the development of mechanisms to alert the healthcare team.

Sharing information will allow clinicians to either initiate targeted interventions to reverse frailty, or at the other end of the spectrum to enable sensitive forward planning for end of life. There are areas where our members can be involved in spotting and highlighting patient symptoms to clinicians.

The frailty work stream is intended to explore how a wide range of professionals can contribute to the care of people living with frailty. The skills for health workshop enabled stakeholders, including the CoR, to liaise. Invitations were extended to a wide range of professionals including nurses, AHPs, GPs, local councils, CCGs, and emergency services. Notably the fire
service are already carrying out excellent work: for example, during home safety checks officers assess social isolation and frailty, even running follow-up frailty strength training sessions in local fire station gyms.

The workshop was inspirational and also predictable. Issues of time and workload were pressures cited by all participants and across all professions. A result is that Skills for Health are preparing a frailty capability framework for multi-professionals. When the framework document is complete, the CoR plans to produce guidance that will translate how our diagnostic and radiotherapy members can be involved.

If you are interested in further literature and conversation about frailty or links to frailty work, please contact Tracy O'Regan.

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