Frailty – an enormous problem

An apology

This blog is one week late – very sorry and it won’t happen again.

Frailty – again

For this blog I return to the subject of frailty – for which I don’t apologise. Frailty is the most important, expensive and destructive problem facing the NHS and society – and it is preventable.

What is frailty?

A verbose definition of frailty is: “A clinically recognisable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with every day or acute stressors is compromised”

This means that the frail individual is living on the edge with little reserve for dealing with anything that goes wrong – falls, illnesses and change in circumstances can all result in inability to cope and the need for help, support or hospital admission.

The less verbose definition is “Old and feeble”. Some of the features include weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss.

The diagnosis of frailty

There are a number of scales for the diagnosis of frailty, the most commonly used in the UK being the Clinical Frailty Scale (CFS) which gives a grade of degree of frailty. However there is no clear cut-off point to divide the frail from the non-frail.  In most cases if the doctor or nurse says you are frail then you are frail!

The rising age of our population guarantees an increase in the numbers of the frail elderly. However the rather imprecise definition makes it difficult to decide the exact prevalence of frailty. Using the definition above, the prevalence of frailty in the UK rises from about 3% in the 60-69 age group to 5% in the 75-80 group to 12% in the 85-89 group and nearly 20% in the over 90s.  There is a lot of it about.

Why is frailty important?

Frailty matters to the individual because it limits activity and the enjoyment of life. If you are frail you cannot get about much , you need help with daily activities, you probably feel tired and unwell for much of the time and you may feel a burden on your loved ones. Worst of all you may lose your independence – you may need to rely on others to get you through the day.

Frailty matters to those close to the frail individual because someone has to provide help and care for the sufferer – which can be an exhausting role. Most of this care is given by close relatives, usually women – traditionally the role of the unmarried daughter! The number of people caring for a family member has reached 7.6 million, a sharp increase of one million compared with a decade ago. Although there may be funding from local authorities, most give their time for free. Informal carers lose out in a number of ways – work, financial and health related.

As one economist has said: “More women with professional and managerial jobs are trying to combine work with family care. We know that carers are often driven to reduce their hours or leave work altogether, and without proper support for these carers, there is a risk that women are increasingly driven out of professional careers, reversing recent progress towards equality in the workforce”.

Costs to society

Frailty matters to society, the NHS and to the national economy. Mean annual social care costs for people who are frail are nine times greater than for the non-frail – £2,895 for individuals with frailty compared with £321 for the non-frail. Healthcare costs are roughly doubled by the change from non-frail to frail status. Around 47% of hospital inpatients aged over 65 are affected by frailty and this costs the wider UK healthcare systems around £5.8 billion per year.  Almost half of all people arriving in A&E by ambulance in 2021/22 were over 65, with a third over 75.  Last year nearly 100,000 elderly patients waited more than 12 hours on trolleys in A&E departments  – a 25 fold increase since 2019. About one in seven NHS hospital beds are occupied by patients who have no ongoing medical reason for being in-patients but who are too frail to send home.

Is this necessary?

Emphatically NO! 

Frailty is not inevitable. Watch this space and I will tell you why in two weeks time.