Frailty

Frailty is a multidimensional geriatric syndrome characterised by a decline of physical and cognitive reserves that leads to increased vulnerability.

Frailty increases with age and is associated with falls, longer stays in hospital, difficulty recovering from illness and surgery, and mortality.

It is important to recognise frailty in older people in hospital so that we can develop and implement individualised care plans, reduce the risk of onset or deterioration and provide people with the opportunity to retain their independence and social connections on discharge.

Frailty and ageing

Frailty affects a person’s ability to recover from a clinical episode, their resilience, and function across multiple body systems. Frailty increases as we age.

Older people who are frail often experience poor health, falls and disability as well as longer stays in hospital and increased mortality.¹

Older people who are frail can have difficulty coping with minor illnesses and events, such as infections and constipation, and they can be more susceptible to side effects from certain medications. They are more likely to have difficulty recovering from surgery and periods of acute hospitalisation or rehabilitation.

We should identify and respond to a frail older person’s vulnerabilities during their admission to reduce their risk of functional decline so that people don't just survive hospital, but make a full recovery.

Signs of frailty can be obvious or subtle

While some signs of frailty and risk of frailty are obvious, others are not. Common presentations of frailty² include:

• non-specific signs - extreme fatigue, unexplained weight loss, frequent infections
• falls - frequent falls, fear of falling, restricted activity
• delirium - acute changes to their cognition
• fluctuating disability - day-to-day variation in ability to look after oneself, for example a loss of interest in food, difficulty getting dressed, experiencing good and bad days.

We can help patients make a smooth transition from the hospital to their home or residential aged care facility through comprehensive and clear discharge planning and communication.

Educate patients, family and carers

• Remind patients and their family and carers about strategies to optimise function and wellbeing at home.
• Emphasise the importance of maintaining a combination of interventions, which includes optimising opportunities for social connections.

Refer to health professionals and support services

• Include documentation about frailty and contributing factors in the discharge summary to the GP and other services.
• Inform the patient’s GP about ongoing treatment goals for the patient.
• Refer the patient to community or hospital based specialists to support functional independence in the longer term.
• Discuss services and opportunities for social participation based around the patient’s interests. This could include planned activity groups, or activities sourced through local councils, local newspapers, libraries, Neighbourhood Houses or Men’s Sheds that can keep the patient socially connected.

Practise person-centred care

• Encourage patients to ask questions or raise concerns about their recovery.
• Tailor plans to the individual patient, as discharge planning is not a one size fits all approach.

Responding to frailty

Frailty is a complex problem that usually requires multiple interventions. These interventions should target physical performance, nutritional status, mental health and cognition. There is emerging evidence that a person’s health assets - that is, the strength of their social supports, stability of their housing, their economic independence, level of education - could mitigate the effects of frailty.³

There has been little research into the effects of interventions on frailty in hospital; however, best practice suggests that healthcare professionals should consider the following actions.