What is Frailty?
Frailty is a common syndrome that occurs from a combination of de-conditioning and acute illness on a background of existing functional decline that is often under-recognised.
“Frailty is characterised by a decline in functioning across multiple physiological symptoms, accompanied by an increased vulnerability to stressors. It is associated with increased mortality, hospitalisation, falls and admission to long term care. There is also much individual burden for a person living with frailty, including impaired quality of life and loneliness”.It is important to note that frailty is not an inevitable result of ageing and can be treated and in some cases, even reversed.
Frailty: implications for clinical practice and public health Emiel O Hoogendijk, Jonathan Afilalo, Kristine E Ensrud, Paul Kowal, Graziano Onder, Linda P Fried Lancet 2019; 394: 1365–75
Frailty was succinctly described in plain English at the recent ACI Frailty Forum by Dr Tracy Brown, Geriatrician in Hunter New England LHD:
Dr Tracy Brown brilliant concept of understanding frailty as physical wealth, just like financial wealth. We want to have physical wealth; having a good quality of life, the ability to manage problems (like bills) as they come up and that there is often comprise #frailtyNSW pic.twitter.com/se1eKz6OML— Julia Thompson (@thompsonjuliak) February 7, 2020
Why is the Agency for Clinical Innovation focusing on frailty?
Not all older people are frail and not all people living with frailty are old. However, it is important to identify frailty early in order to combat the condition and it effects.Once frailty is established, other geriatric syndromes are more likely to emerge, e.g falls, incontinence, functional decline, pressure areas, mild cognitive impairment and delirium.
Sydney North Health Network
In 2018, the ACI embarked upon an investigation of overdiagnosis and overtreatment in older people living with frailty. The Overdiagnosis and overtreatment in the frail elderly report looked at a range of evidence and found that:
- people raised concerns about how frailty is defined, the choices they are given and decision making processes, their quality of life, and varying levels of health literacy;
- people with polypharmacy (≥5 drugs) and hyper-polypharmacy (≥10 drugs) have higher frailty scores, and
- over-diagnosed diseases included chronic kidney disease, hypothyroidism, prostate/breast cancer, hyperlipidaemia, hypertension and dementia.
- While research evidence is limited, positive effects ( arise from deprescribing efforts, other decision support tools and shared decision making and that culture and leadership is key within the healthcare setting.
Given the multifaceted interventions required to support improvements to care for people living with or at risk of frailty, ACI established a Frailty Taskforce in December 2019.