Definitions:
NHS England[Frailty] 'describes how our bodies gradually lose their in-built reserves, leaving us vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection or a change in medication or environment.'
Professor John Young, NHS England’s Director for Integration and Frail Elderly Care Journal of Gerontology[Frailty is] 'a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity.'
Linda P Fried et al, 2001. Linda Fried is the Dean of Columbia University's Mailman School of Public Health |
Clinics in Geriatric Medicine'Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes including falls, incident disability, hospitalization, and mortality.'
Qian-Li Xue, Associate Professor at Johns Hopkins Bloomberg School of Public Health wikipedia.orgFrailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults. Frailty is a condition associated with ageing.'
Qian-Li Xue, Associate Professor at Johns Hopkins Bloomberg School of Public Health |
uptodate.com - medical resource websiteFrailty is most often defined as a syndrome of physiological decline in late life, characterized by marked vulnerability to adverse health outcomes. Frail older adults are less able to adapt to stressors such as acute illness or trauma than younger or non-frail older adults.
Jeremy D Walston MD British Geriatrics Society'a state of increased vulnerability to poor resolution of homoeostasis after a stressor event.'
www.bgs.org.uk |
Our working definition
"Frailty is an age-related condition which may result in the loss of strength, speed, energy, activity, muscle mass, resilience to minor health strains and, subsequently, the loss of independence and personal freedom."
How do I know if I am frail?
Frailty is unlike other medical conditions, in that it is not one singular problem, instead it is known as a 'syndrome'. That means it is made up a lots of factors which combine together to produce what we call frailty. This means there is no single determining factor which would indicate whether you are frail or not.
Technically speaking, frailty can be measured or screened for using a number of different tools but the two methods or instruments which seem to be most widely regarded are: 1. The Fried Frailty Phenotype 2. The Frailty Index |
The Fried Frailty Phenotype.
This approach to assessing frailty involves the observation of five elements of health and performance. It was developed by Linda Fried (see link below) and her colleagues. One of the reasons this approach is so useful, especially for early screening, is that one can observe many of the five elements without extensive medical tests (though proper screening for elements such as strength should be done using the proper equipment) i.e. it can be used when a person first comes into contact with a medical practitioner. With this system, it is hypothesised that each of the five elements reflect underlying biological systems (or physiologic systems) which may in some way be dysfunctional or operating in a sub-optimal way, sometimes described as dysregulation.
These five elements are:
If you were to present with one or two of the above, you would be classed as pre-frail.
If you were to present with three or more of the above you would be classed as frail.
Each one of the categories has certain thresholds or cut-off points which would determine whether you would be classed as having, for example, slow walking speed.
There are limitations with this particular type of screening as it does not account for complications such as disability or cognitive impairment. This is where the Frailty Index (see below) can be very useful.
If you are concerned about your own health and wellbeing in relation to any of the above, please feel free to join us at one of our free events in 2019, or speak to your doctor.
These five elements are:
- Reduced muscle strength
- Slow walking speed
- Low levels of activity
- Unintentional weight loss
- Exhaustion / low energy levels
If you were to present with one or two of the above, you would be classed as pre-frail.
If you were to present with three or more of the above you would be classed as frail.
Each one of the categories has certain thresholds or cut-off points which would determine whether you would be classed as having, for example, slow walking speed.
There are limitations with this particular type of screening as it does not account for complications such as disability or cognitive impairment. This is where the Frailty Index (see below) can be very useful.
If you are concerned about your own health and wellbeing in relation to any of the above, please feel free to join us at one of our free events in 2019, or speak to your doctor.
"the challenge of the 21st Century"
"The challenges of turning into an ageing society, in a way that was good, was going to be the challenge of the 21st Century"
Click the image to see an interview with Linda P Fried, geriatrician and Dean of the Mailman School of Public Health at Columbia University, on how to prevent frailty and transition as an ageing society - as a mature economy, the USA is facing similar challenges to the UK.
Click the image to see an interview with Linda P Fried, geriatrician and Dean of the Mailman School of Public Health at Columbia University, on how to prevent frailty and transition as an ageing society - as a mature economy, the USA is facing similar challenges to the UK.
The Frailty Index.
The Frailty index is a more detailed and comprehensive approach for assessing the health of an elderly person. This system was developed by Kenneth Rockwood and his colleagues for the Canadian Study of Health and Aging. When using this tool to assess frailty, a person's doctor or medical team uses a checklist of medical conditions and diseases. The number of items on the list can be up to 70, though it is rare to use that many. The idea behind this screening system is to assess the accumulation of health deficits in proportion to the total number of items being checked.
When measuring a person's Frailty Index score, the following formula would be calculated:
Frailty Index (FI) = (number of health deficits present) ÷ (number of health deficits measured)
So, if a person is being screened for a total of 40 different items on the checklist and it is discovered that he/she has 20 deficits, then they would receive an FI score of 0.5 (20 divided by 40). Someone with 10 deficits would receive an FI score of 0.25 (10 divided by 40). One of the interesting things about the Frailty index is that it has been shown that a person usually scores a similar FI score when the items from the list of 70 are interchanged with each other. So, it doesn't really matter which of the 70 items are picked when using, say 40 items. The scores normally come out the same.
In 2005, Rockwood and his team conducted a study with 2305 participants over a period of 5 years to determine how accurate the Frailty Index was for predicting the health outcomes for the elderly person compared to other frailty tools. The strength of this system is that is encompasses a large number of health issues and uses them to determine the overall wellbeing of a person. This cannot be used at point of first contact with a medical practitioner though, and it takes time to test for the various health items being assessed .
After testing the system through much study and research, it was determined that the scores reveal the following:
Score (SD) - Characteristic
0.09 (0.05) - Very fit
0.12 (0.05) - Well
0.16 (0.07) - Well, with treated comorbid disease
0.22 (0.08) - Apparently vulnerable
0.27 (0.09) - Mildly frail
0.36 (0.09) - Moderately frail
0.43 (0.08) - Severely frail
(SD = standard deviation)
Below is the the comprehensive list of 70 Frailty Index health variables:
• Changes in everyday activities
• Head and neck problems
• Poor muscle tone in neck
• Bradykinesia, facial
• Problems getting dressed
• Problems with bathing
• Problems carrying out personal grooming
• Urinary incontinence
• Toileting problems
• Bulk difficulties
• Rectal problems
• Gastrointestinal problems
• Problems cooking
• Sucking problems
• Problems going out alone
• Impaired mobility
• Musculoskeletal problems
• Bradykinesia of the limbs
• Poor muscle tone in limbs
• Poor limb coordination
• Poor coordination, trunk
• Poor standing posture
• Irregular gait pattern
• Falls
• Mood problems
• Feeling sad, blue, depressed
• History of depressed mood
• Tiredness all the time
• Depression (clinical impression)
• Sleep changes
• Restlessness
• Memory changes
• Short-term memory impairment
• Long-term memory impairment
• Changes in general mental functioning
• Onset of cognitive symptoms
• Clouding or delirium
• Paranoid features
• History relevant to cognitive impairment or loss
• Family history relevant to cognitive
impairment or loss
• Impaired vibration
• Tremor at rest
• Postural tremor
• Intention tremor
• History of Parkinson’s disease
• Family history of degenerative disease
• Seizures, partial complex
• Seizures, generalized
• Syncope or blackouts
• Headache
• Cerebrovascular problems
• History of stroke
• History of diabetes mellitus
• Arterial hypertension
• Peripheral pulses
• Cardiac problems
• Myocardial infarction
• Arrhythmia
• Congestive heart failure
• Lung problems
• Respiratory problems
• History of thyroid disease
• Thyroid problems
• Skin problems
• Malignant disease
• Breast problems
• Abdominal problems
• Presence of snout reflex
• Presence of the palmomental reflex
• Other medical history
If you are concerned about your own health and wellbeing in relation to any of the above, please feel free to join us at one of our free events or speak to your doctor.
When measuring a person's Frailty Index score, the following formula would be calculated:
Frailty Index (FI) = (number of health deficits present) ÷ (number of health deficits measured)
So, if a person is being screened for a total of 40 different items on the checklist and it is discovered that he/she has 20 deficits, then they would receive an FI score of 0.5 (20 divided by 40). Someone with 10 deficits would receive an FI score of 0.25 (10 divided by 40). One of the interesting things about the Frailty index is that it has been shown that a person usually scores a similar FI score when the items from the list of 70 are interchanged with each other. So, it doesn't really matter which of the 70 items are picked when using, say 40 items. The scores normally come out the same.
In 2005, Rockwood and his team conducted a study with 2305 participants over a period of 5 years to determine how accurate the Frailty Index was for predicting the health outcomes for the elderly person compared to other frailty tools. The strength of this system is that is encompasses a large number of health issues and uses them to determine the overall wellbeing of a person. This cannot be used at point of first contact with a medical practitioner though, and it takes time to test for the various health items being assessed .
After testing the system through much study and research, it was determined that the scores reveal the following:
Score (SD) - Characteristic
0.09 (0.05) - Very fit
0.12 (0.05) - Well
0.16 (0.07) - Well, with treated comorbid disease
0.22 (0.08) - Apparently vulnerable
0.27 (0.09) - Mildly frail
0.36 (0.09) - Moderately frail
0.43 (0.08) - Severely frail
(SD = standard deviation)
Below is the the comprehensive list of 70 Frailty Index health variables:
• Changes in everyday activities
• Head and neck problems
• Poor muscle tone in neck
• Bradykinesia, facial
• Problems getting dressed
• Problems with bathing
• Problems carrying out personal grooming
• Urinary incontinence
• Toileting problems
• Bulk difficulties
• Rectal problems
• Gastrointestinal problems
• Problems cooking
• Sucking problems
• Problems going out alone
• Impaired mobility
• Musculoskeletal problems
• Bradykinesia of the limbs
• Poor muscle tone in limbs
• Poor limb coordination
• Poor coordination, trunk
• Poor standing posture
• Irregular gait pattern
• Falls
• Mood problems
• Feeling sad, blue, depressed
• History of depressed mood
• Tiredness all the time
• Depression (clinical impression)
• Sleep changes
• Restlessness
• Memory changes
• Short-term memory impairment
• Long-term memory impairment
• Changes in general mental functioning
• Onset of cognitive symptoms
• Clouding or delirium
• Paranoid features
• History relevant to cognitive impairment or loss
• Family history relevant to cognitive
impairment or loss
• Impaired vibration
• Tremor at rest
• Postural tremor
• Intention tremor
• History of Parkinson’s disease
• Family history of degenerative disease
• Seizures, partial complex
• Seizures, generalized
• Syncope or blackouts
• Headache
• Cerebrovascular problems
• History of stroke
• History of diabetes mellitus
• Arterial hypertension
• Peripheral pulses
• Cardiac problems
• Myocardial infarction
• Arrhythmia
• Congestive heart failure
• Lung problems
• Respiratory problems
• History of thyroid disease
• Thyroid problems
• Skin problems
• Malignant disease
• Breast problems
• Abdominal problems
• Presence of snout reflex
• Presence of the palmomental reflex
• Other medical history
If you are concerned about your own health and wellbeing in relation to any of the above, please feel free to join us at one of our free events or speak to your doctor.