Background

Frailty is a distinctive state related to the ageing process but it is not an inevitable consequence of ageing [1]. Not all older people are frail and not all people living with frailty are old; younger people with complex needs can also be classified as frail, although the majority of those living with frailty are old.  Frailty is related to but distinct from ageing, co-morbidity and disability. As multiple body systems gradually lose their in-built reserves (physical and psychological), people start to develop frailty, making them vulnerable to sudden changes in their health and social needs [2]. These changes are often triggered by seemingly small events such as a change in medication or a breakdown in carer support. A person with frailty therefore typically presents in crisis with a fall, confusion or the inability to walk. These presentations are examples of the ‘classic’ frailty syndromes [3].

NHS England has defined frailty as a progressive, long term health condition characterised by a loss of physical and/or cognitive resilience. Therefore, people living with frailty can deteriorate unexpectedly and do not recovery quickly after a simple illness or other stressful event [4].

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www.england.nhs.uk, reproduced with permission

In recent years, as the understanding of the impact of frailty on people, communities and services has grown, there has been a range of guidance and policies aiming to support health and care systems tackle the challenge of frailty. The following are provided as examples linked to the I-Care approach of the toolkit:

INVOLVE

  • The Care Act [2014]:  a preventative approach to the management of older people.

CONSIDER

  • Transforming Primary Care: safe, personalised and proactive care for those who need it most [Department of Health 2014]. Aims to drive up quality for older people through collaborative working and integrated provision of services.

ASSESS

  • NICE Guidelines: Multimorbidity: clinical assessment and management [2016]; Dementia, Disability and Frailty in Later Life: mid-life approaches to delay or prevent onset [2015].
  • General Practice General Medical Services [NHSE 2015]:  contractual requirements around the recognition and management of frailty.

RESPOND

  • Transforming Primary Care: safe, personalised and proactive care for those who need it most [Department of Health 2014]. Aims to drive up quality for older people through collaborative working and integrated provision of services.
  • NHS Five Year Forward View [NHSE 2015]:  more support for frail older people living in care homes; primary care of the future will build on the traditional strengths of expert generalists, proactively targeting services at registered patients with complex on-going needs.

EVALUATE

  • NHS Outcomes Toolkit [DH 2018]:  a set of indicators to monitor the health outcomes of adults and children in England.