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Frailty

WHAT IS FRAILTY?
  
Frailty is a condition recognised by the medical profession who now diagnose it in people who have at least three out of the five characteristics listed below
  • weakness for example, weakness of grip that makes them unable to take the top off a jam jar
  • slowness of walking
  • loss of weight
  • low levels of physical activity
  • exhaustion
People with one or two of these conditions are sometimes said to have pre-frailty.
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The medical profession, in particular the speciality of geriatric medicine, has developed this concept because they found out that when people were simply described as being frail as in “Mr Johnson is frail” then they were being written off whereas by reframing this and saying that “Mr Johnson has frailty” it was clear they were talking about  a distinct condition that was not an ephemeral part of ‘ageing’.  
Ageing is of course one of the factors that leads to frailty because ageing does lead to some loss of strength but the most important thing about ageing is that it reduces the persons ability to respond to challenges such as the challenge of immobility following severe illness.  When one, or more than one, serious health problems develop the person becomes immobile, loses fitness and therefore loses ability in addition to the ability they may lose by the direct impact of the disease.  For example someone who develops heart failure becomes less mobile and therefore in addition to having a weaker heart they lose fitness and therefore their ability declines and as their ability declines, they get weaker and  slower, and they may lose weight and  feel tired. 
Frailty is therefore due to ageing and disease and loss of fitness and, we should emphasise, to the negative beliefs and attitudes that many people hold so that if someone aged eighty-four develops a disease others start doing everything for them whereas if that person were thirty-four or forty-four other people  would all the time be thinking of how they can help that person to regain their ability themselves. 
 
Why is frailty important?
Frailty is important because it brings people very close to that line between relative independence and relative dependence.  No one is independent, even a multi-millionaire is dependent on electricity companies supplying his grand dwelling, as well as on a lot of other people doing different things.  However all of us are independent in looking after ourselves and our home but when frailty develops this level of independence may be lost for example the person may not be able to reach the toilet in time.

Frailty therefore is a reason why people become dependent on family and friends and indeed social care, and sometimes residential care.
 
Why is it important to understand frailty?
One of the benefits of the development of the term frailty  by the British Geriatric Society is that it makes people think about the prevention and treatment of frailty just as people think about the prevention and treatment of heart disease.  If, forty years ago, someone had been asked to describe old age and its effects, they would have listed weakness, slowness, weight loss, low levels of physical activity and tiredness.  However by distinguishing frailty from ageing it is possible to plan a course of action.  The development of the concept of frailty for example has helped change our culture to one that does not accept weakness and slowness as inevitable but recognise they are  something due in part to ageing but mostly to disease and loss of fitness and the negative beliefs and attitudes that accelerate what is called decompensation.
The decompensation syndrome is a name now given by doctors to the effects of admitting someone with prefrailty to hospital.  Even though the hospital is high quality a busy hospital ward is one which finds it difficult to give time to help the person who is recovering from an acute episode of illness encouragement and support to regain strength, stamina, suppleness and skill and this may therefore accelerate the onset of frailty.
 
Can progression be slowed, reduced or reversed?
The answer is clearly positive.  It is possible to slow the development of frailty and of course we should be looking at this as a process that takes place from forty on.  Doctors sometimes talk about sarcopenia which is Greek for wasting muscles but almost everybody from forty on is losing muscle mass partly because of ageing but more because of the car, the computer and the desk job.
It is also very important to remember and emphasise that the condition can be reversed.  It is true that ageing reduces resilience and the ability of the individual to bounce back when things happen, but we should always assume that 
  • frailty can be reversed to become pre-frailty
  • pre-frailty can be reversed so that the individual can no longer be diagnosed as having pre-frailty.
 
What can be done?
The most important thing to do is to increase physical activity.  Of course family members may be nervous of doing this but when someone with frailty is identified or when the frailty is revealed after a hospital admission the individual may be fortunate enough to be supported by a geriatric medicine team in which specialised physiotherapists play a vitally important role.
Occupational therapists too have a part to play by helping the individual overcome some of the environmental obstacles they face because this allows them to look after themselves longer and therefore not only delay loss of muscle strength but also actually increase it.
Families have a key part to play in not doing things too much, too early or too quickly for family members or friends who develop significant health problems.  Help is needed in the acute phase but as soon as that is over the individual must take action because healthcare is what you do for yourself.

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