FRAILTY PART 2

Frailty and Physical Fitness

Several surveys have highlighted the low level of fitness in the general population and all confirm the progressive reduction which occurs with increasing age.

However physical capacity becomes increasingly important as age increases. For 50-year-olds, not being as fit as they should be for that age will not make a substantial difference to their daily living (unless they are extremely unfit). But for an 80 or 90 year old, poor fitness levels (relative to that age group) may mean that the individual is unable to maintain an independent life. The difference between being fit or unfit at this age means the difference between being able to get out of bed and dress unaided or relying on carers. Or the difference between able to get up from a chair and put the kettle on or being dependent on others to do it for them.

The level of physical fitness, as measured by VO_2max,  which predicts loss of independence has been calculated at about 18ml/min/kg for men and 15ml/kg/min for women. Personally I believe that these figures are a deal higher than reflected by reality but the point is well made that the lower your VO_2max the less able you are to look after yourself.

Comorbidities

Frailty is usually the result of the accumulation of all the diseases discussed earlier – obesity, diabetes, heart disease, osteoporosis, osteoarthritis, and general unfitness.

The condition is hugely aggravated by fall related injury to which old people are at particular risk. 50% of people aged over 80 fall at least once a year and about 5% of these falls result in a fracture, most seriously of the neck of the femur (the “hip”). Falls are a major threat to older adults’ quality of life, often causing a decline in self-care ability and in participation in physical and social activities. Fear of falling can lead to further limiting of activity, independent of injury.

All this is largely avoidable!

Social and Financial Implications

The social and financial consequences of frailty are enormous and growing. When frail people become ill they have poorer outcomes for mortality, morbidity or institutionalisation than the non-frail. If they need hospital treatment they have a high rate of readmission – as much as 40% over six months. Our hospitals are full of “bed blockers” who only needed admission because they were frail and who are unable to go home because of lack of carers and lack of money to pay for them. The frail elderly occupy increasing numbers of beds in residential homes and nursing homes for dependent people. If able to stay at home they require regular visits from informal or formal carers to allow them to keep a semblance of normal life. Frail elderly people are major users of emergency medical services presenting with such problems as immobility, incontinence and confusion. The current estimate is that falls cost the NHS more than £2.3 billion per year.

The future

We have a growing army of dependent elderly people, with increasing social care costs, increasing difficulty in finding enough younger carers and an inability to afford them. The trajectory of this problem is inexorably upwards with the proportion of the population aged over 80 set to double over the next forty years while the number of over 85s requiring 24 hour care is also expected to double to 446,000, a staggering number. The media frequently publicise the crisis in social care funding, predicted to rise to £2.6 billion annually by 2020. The Institute for Fiscal Studies has predicted that, unless they are bailed out by the Government, local councils will have to spend up to 60% of their revenues on social care by 2034.

Between 2012 and 2017 the number of care homes in England fell by 8% but the increase in capacity of each home meant that the total number of places rose by 4% – during a period when the number of citizens aged over 85 increased by 16%. The problems of caring for our ageing population will be compounded by cuts in funding and by the restriction of immigration on which staffing depends.

Covid – again

The plight of old people herded together in care homes throws more light on the awful consequence of premature dependence – and it is mostly premature and preventable. Add Covid to the equation and you have the modern tragedy of lockdowns and isolation of elderly relatives who can only see their much loved relatives through a closed window. We all need to learn the lesson, keep physically fit and protect ourselves from such a future when the next deadly virus strikes.

PS

Gyms are safe!
Good news for all you gym bunnies. A study carried out by Sheffield Hallam University has looked at the rates of Covid-19 infections among attenders of gym exercise sessions in 14 European countries, including the UK. They found that the risk of becoming infected at a gym session was just 0.78 per 100,000 visits. A lead researcher said that gyms were ‘safe places to exercise’, and that while preventing Covid-19 spreading was a primary objective, being ‘physically fit can help reduce the severity of Covid-19 infection and, moreover, being active can help us cope psychologically’, Amen to that