Frailty – what it means and how to keep well over the winter ...

Frailty is related to the ageing process, that is, simply getting older. It describes how our bodies gradually lose their in-built reserves, ... Skiptomaincontent CookiesontheNHSEnglandandNHSImprovementwebsite We’veputsomesmallfilescalledcookiesonyourdevicetomakeoursitework. We’dalsoliketouseanalyticscookies.ThesesendinformationabouthowoursiteisusedtoaservicecalledGoogleAnalytics.Weusethisinformationtoimproveoursite. LetusknowifthisisOK.We’lluseacookietosaveyourchoice.Youcan readmoreaboutourcookiesbeforeyouchoose.   Changemypreferences I'mOKwithanalyticscookies Home News Publications Statistics Blogs Events Contactus SincethepublicationofthisblogJohnYounghasleftNHSEngland. ByProfessorJohnYoung,NationalClinicalDirectorfortheFrailElderlyandIntegration,NHSEngland Frailtyisrelatedtotheageingprocess,thatis,simplygettingolder. Itdescribeshowourbodiesgraduallylosetheirin-builtreserves,leavingusvulnerabletodramatic,suddenchangesinhealthtriggeredbyseeminglysmalleventssuchasaminorinfectionorachangeinmedicationorenvironment.Inmedicine,frailtydefinesthegroupofolderpeoplewhoareathighestriskofadverseoutcomessuchasfalls,disability,admissiontohospital,ortheneedforlong-termcare. Olderpeoplewithmoderatetoseverefrailtyareoftenwellknowntolocalhealthandsocialcareprofessionals.Theyusuallyhaveweakmusclesandalsousuallyhaveotherconditionslikearthritis,pooreyesight,deafnessandmemoryproblems.Thismeansolderpeoplewithfrailtywillwalkslowly,getexhaustedeasilyandstruggletogetoutofachairorclimbstairs.Typicallythereforetheyarehousebound,oronlyabletoleavetheirhomewithhelp.Thiscanbeasimplepracticalwaytoidentifypeoplewhoarefrail. Olderpeoplewithfrailtyareparticularlyvulnerableoverthewintermonthssoherearefivesimpletipsthatcanhelpthosewithfrailtycopeandkeepwell. “Restisrust” Frailtymakesustired.Evensmallamountsofactivitycanbeexhaustingsoit’seasytoretreatintothecomfortofanarmchair,particularlyduringthecoldermonthswhenotherpartsofthehomemaybechillyandunwelcoming. Butthiscanacceleratethefrailtyprocessandresultinmoremuscleloss,especiallytheleg,chestandheartmuscles. Formostpeoplewithfrailty,simpleadvicetokeepactiveinthehomeisallthatisrequired.Promotingtheuseofstairs,it’sagoodsourceofexercise,butmakesurethatitissafe–isanadditionalhandrailneeded? Ifthepersoncannoteasilygetupoutoftheirchair,ormovefromroomtoroom,alarmbellsshouldring.Thesepeopleneedamobilityassessmenttodeveloppersonalisedmobilityplansthatmightincludeanexerciseprogramme(forstrengthandbalance),mobilityaids,supportivefootwearandhomeadaptations. YourlocalGPshouldbeabletohelporganisethis. Innerfuel Weightlossisacharacteristicfeatureoffrailtyasmusclesbecomethinnerandweaker,whichinmedicinewecallthesarcopeniaaspectoffrailty. Manyolderpeoplewithfrailtyreportadiminishedappetiteandalthoughresearchinthisarearemainsinconclusive,itseemssensibletocheckthatatleastonesubstantialhotmealisavailableeachday,alongwithsnacksandhotdrinks. AsliceofChristmascakeandaglassofmilk,whichcanbesupplementedwithaspoonfulofpowderedmilk,isroughlyequivalenttothecaloriecontentofabottleofEnsure,andtastesalotbetter! Bebrave!Stopthosedrugs! Olderpeoplewithfrailtyareverysensitivetomedicinesbecausethebodyhastroublegettingridofthem. Thiscanmeananormaldoseofmedicinecanbuild-upinthebodycancauseanadversereaction. AdverseDrugReactions(ADRs)accountfor6.5percentofhospitaladmissionsforolderpeopleanditisestimatedthatabout70percentofthesemightbeavoidable. Therearecommonculpritdrugsforfalls(nitrates;calciumchannelblockers;ACE-inhibitors;angiotensinreceptorantagonists;diuretics),andfordelirium(opiateanalgesia;benzodiazepines). Benzodiazepinesareparticularlynastydrugsinolderpeople(NumberNeededtoHarm=6people)withincreasedriskforfallsanddelirium,andtheycontributethefatiguestateoffrailty. NHSCumbriahasusedtheSTOP-STARTcriteriatoproduceanevidencedbasedguidetomedicationsmanagementinolderpeople.YourGPorNursePractitionercanhelpreviewyourdrugswithyou. Butoneextradrug! SupplementationwithVitaminD,commonlyasacombinationtabletwithcalcium,isassociatedwithareducedrateoffallingforhouseboundolderpeople. Askthelonelinessquestion What’sthis? Thesingleandmostobviousquestionis“doyoufeellonely?” Thisremindsusthatbeinghouseboundisariskfactorforloneliness,andthatlonelinessisitselfariskfactorfordepression,poorsleep,impairedthinkingskills,higheruseofhealthcarewithmoreGPvisits,higheruseofmedication,andhigherincidenceoffalls. Italsoremindsusofthelimitationsof“standard”healthandsocialcareresponsesforolderpeoplelivingwithfrailtyandthespecialplaceforthevoluntarysectorintacklingthesemiserymakingsituations.Therearesomeexcellentbefriendingservicesupanddownthecountry,suchastheCockermouthCentrefortheThirdAge,LeedsOlderPeople’sForum,ortheNHSWinterFriendscampaign,supportedbytheRoyalVoluntaryService. Thesefivesimplethings,whichifdoneroutinely,canhelpkeeppeoplewithfrailtywell,especiallyoverthewintermonths. JohnYoung ProfessorJohnYoungwaspreviouslyNationalClinicalDirectorforIntegrationandFrail&ElderlyCare,sincethepublicationoftheseblogshehasleftNHSEngland. Topics Olderpeople Latestposts COVID-19vaccinationcentresarethrivinganddeliveringamidstadiverseworkforce Theroleofbusinessesinreducinghealthinequalities Innovationandcollaborationsuper-chargedeliveryofanetzeroNHS ReducinghealthinequalitiesinClacton-on-Sea ThetransformationofNHShumanresourceswillputusinastrongerpositionthaneverbefore