Frailty at the front door

Abstract

Significant numbers of older people attending hospital can be considered to be frail or living with frailty. This is a multicomponent syndrome with many manifestations that leads to poorer outcomes in terms of mortality, morbidity and institutionalisation. Recognition and management of frailty can be challenging, and requires a true multidisciplinary approach, but appropriate assessment and subsequent intervention have been proven to be beneficial. This article discusses the background to frailty, and a number of validated frailty scores which can be applied by non-specialists in the acute environment. It highlights other resources which are available to help with the management of this complex group of patients, and discusses potential local and national service developments in this area.

Barriers to the identification of frailty in hospital: a survey of UK clinicians

“…7,14 The best way to design these services remains an ongoing area of debate. 15 This survey found a clear deficiency in understanding of frailty in the surgical subspecialties, a concern given the high number of patients with frailty presenting to these service (eg hip fracture cohorts). 16 Hospitals integrating frailty pathways into standard workflows therefore need to be mindful of the need to remain inclusive across all areas of the hospital structure.…”

Is It Time to Begin a Public Campaign Concerning Frailty and Pre-frailty? A Review Article

“…Frailty also imposes a significant financial burden on health systems, particularly because frailty appears to have an incremental effect on ambulatory health expenditures (Sirven and Rapp, 2017 ). Awareness of these facts may afford us an opportunity to develop cost-effective care for this group of people, resulting in improvement in long-term care and its outcomes (Wyrko, 2015 ). However, despite numerous studies addressing this condition in recent years, frailty as an entity is not commonly recognized in the general population or even by some medical societies, and there are no consistent preventative and therapeutic strategies dedicated to this disorder.…”

Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: An observational study

“…It is increasingly recognized that a gold standard approach for measuring frailty is neither appropriate nor desirable, and that different validated instruments can be suited to different settings and/or purposes [10,11]. In the NHS, the assessment of frailty in the acute, inpatient setting could add value to the management of the growing -but heterogeneouspopulation of older people [12][13][14]. Therefore, the measurement of frailty in acute settings is being encouraged by national initiatives such as the Acute Frailty Network (http://www.acutefrailtynetwork.org.uk).…”