Fitness not Age – The Determining Factor for Health and Social Care

02 April 2013

The assessment of older people’s fitness levels may become necessary in routine health and social care practice, argues an editorial published in Age and Ageing.

European populations are getting older in chronological, but not necessarily biological, terms. The association between chronological age and health status is extremely variable and decisions made in health and social care based solely on age do not reflect the complexity of older people.  The Equality Act came into force in October 2012 and gives older people the right to sue if they have been denied health and/or social care based on age alone.  The aim is to ensure that people are clinically assessed on the basis of their individual needs and fitness levels.

‘Fit’ individuals are resilient whereas ‘frail’ individuals are vulnerable and have an increased risk of adverse outcomes, including iatrogenesis, functional decline and death.  Frail individuals can benefit from specialist multidisciplinary care and interventions but require careful identification and management.  How do you determine where an individual sits along the fitness-frailty spectrum? ‘Fitness’ and ‘frailty’ are opposite ends of a challenging continuum and while experienced practitioners can (and often do) intuitively place their patients along that imaginary spectrum, this subjective ‘clinical impression’ of vulnerability may not be sufficient in the eyes of the Equality Act.

However, there is as yet no consensus on formal ‘frailty metrics’.  Being able to place a person along the fitness-frailty spectrum independently of their age will become crucially important in the years ahead, both to advocate for resource and to target specialist care appropriately.  Equality legislation should minimise instances of ageism and age discrimination but we need agreement on appropriate frailty metrics for health and social care to ensure that all individuals receive the most beneficial interventions.

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