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Fit for Frailty - a new BGS campaign to help healthcare workers in the community

Given the current emphasis on emergency admissions and older people, it is perhaps not surprising that the words “frail” and “frailty” are used almost interchangeably with “older people”. Yet more than 50 per cent of people over the age of 85 will not have frailty.

The new BGS consensus best practice guidance for care of older people living with frailty in the community and outpatient settings was launched in June at the King’s Fund Event, ‘Innovations in the delivery of care for older people.’  

Writing for the BMJ blog, Dr Gill Turner, BGS Vice President for Clinical Quality and project lead on the campaign said, “For those living with frailty, it is a long term condition, just like diabetes or heart disease. It can vary in its severity, and people’s individual problems can move up and down the scale. It needs active management to attenuate its effects, and to reduce the potential adverse outcomes of other illnesses or interventions. Frailty can occur on its own or alongside other long term conditions. While some people with frailty have disability to a greater or lesser degree, many do not.”

One of the other problems is that frailty can often go unnoticed until the adverse effects are already happening. People with frailty are not necessarily known to their GPs as significant users of the health service, and may not have big care packages. Consequently, in the current NHS culture, which is very disease focused, many older people might also be having their other long term conditions actively managed in primary care, without it being recognised that they have frailty.

Indeed, these patients may only come to notice when they become immobile or bed bound after a bout of flu, or are admitted to hospital with acute confusion (delirium) because of a chest infection, or fail to recover according to plan after an elective joint replacement.

The ‘F’ Word

Within the BGS and among health professionals specialising in older people’s care, frailty probably scores as the most talked about condition over the past year. It is hard to go to any scientific event around geriatrics, participate in any discussion about health service development, or even read a newspaper without encountering the ‘F’ word. Writing for the BGS blog, David Oliver, our President Elect, said: “Our perennial discussions about frailty have been far too solipsistic and abstract. Endless academic debates about the condition as a construct, cellular determinants of frailty, complex tools and scales to define it have done little to ‘sell’ the concept to those outside geriatric medicine’s inner circle.”

With the growing trend to move health services away from hospitals, which tend to address single diseases and illnesses, towards a more community based, personalised and holistically orientated service focusing on individuals with long term conditions in order to reduce the need for hospital care, frailty is the most frequently encountered long term condition in community health and social care settings where one encounters a wide range of professionals representing many different services who have expertise in recognising, assessing and managing frailty ranging from excellent to very poor. It is these people at whom the new guidance is targeted.

Produced by a multi-disciplinary team and in collaboration with the Royal College of General Practitioners and Age UK, the BGS guidance answers the questions: What is frailty? Is it entirely related to age? What does it imply? Why does it matter if we know if someone has frailty? Is frailty reversible?.

It is available in two versions. The long version is more medically focused while the short version - a kind of executive summary - is accessible to all professions including social care.

The project team was particularly privileged to have Age UK contributing to its work. Tom Gentry, writing for the Age UK blog provided an important older person’s perspective on living with frailty when he said: “Frailty is not a term that people like [applied to themselves]. It is almost universally rejected. There is a sense that it could be recognised in others but people do not see it as a way to describe themselves. This has important implications for how those that care for older people roll out initiatives such as Fit for Frailty as it may risk alienating people by rooting their needs in terms of their vulnerability and frailty rather than their capabilities.”

Speaking in the context of the Government’s attempts to transform primary care, Tom goes on to say that, people who are supported and able to adapt to changing health needs are on the whole better off. It is understood that older people are more likely to live with multiple long-term conditions and disability, but it can often be the inability to respond to this that creates challenges, rather than simply the conditions themselves. Identifying people living with frailty; planning their care in a coordinated way; and creating responsive services for urgent needs (all features of the improving primary care plan) must become a minimum, and not just for 2% of the [general] practice list.

“Planning for what’s important for the person receiving care rather than simply a clinical outcome must become a central feature of how we support older people living with frailty.”

Readers are also invited to read a series of excellent blogs written on the on the BGS blog to coincide with the launch in June. These include: Keeping or increasing function in frail older people after a hospital admission (Hugh Senior, Epidemiologist, University of Queensland); The Science of Frailty (Roman Romero-Ortuno, Addenbrooke’s Hospital); Understanding the lives of people living with frailty (Tom Gentry) and more.

Gill Turner

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