Increasing number of deaths attributed to frailty of old age over the last 7 years

Introduction 
 

In many older adults, frailty is due to underlying co-morbidities rather than just due ageing. Frailty was rarely mentioned in the death certificates until the Royal College of Pathologists revised the causes of death list in 2020 which suggests two terms: Frailty syndrome which should be quantified with comorbidities and Frailty of old age if the deceased was above 80. The aim of this study was to identify the trend in deaths coded as Frailty of old age in England and Wales over the last 7 years. 

Methods 
 

We extracted data from the Office for National Statistics. Since ICD (International Classification of Diseases) -10 do not have a code for Frailty of old age, they are coded under R68.8 (other specified general symptoms and signs). For deaths recorded as frailty syndrome due to comorbidities, they are coded under those conditions. Deaths recorded as old age are coded under R54 (senility). These two codes are also used for few other non-specific conditions associated with old age. Due to the lack of an ICD-10 code for frailty, we used R68.8 as a surrogate marker.

Results 
 

Deaths coded under R68.8 rose from 2376 in 2016 to 11715 in 2023, almost a fivefold increase with a steep increase from 2020. However, deaths coded under R54 remained stable.  

Conclusion
 

Deaths attributed to frailty of old age has rapidly increased over the last 7 years. The reasons are multifactorial: improved documentation of frailty in case notes, new causes of death list mentioning frailty, implementation of medical examiner services with emphasis on frailty of old age, and inappropriate use of the term frailty of old age for adults above 80. There should be a code for frailty and doctors should specify the underlying causes for frailty rather than using the term frailty of old age.