The importance of recognising frailty in primary care

By Dr Kristen Riley

‘Frailty’ is a word that is used a lot when referring to the care of older people.

To improve the response to frailty and support the use of a common language when identifying frailty across the sector, Metro North Hospital and Health Service is utilising the Clinical Frailty Scale (known as CFS) and will be encouraging referrers to apply the CFS to their patient prior to referral.

Studies have shown that 48 per cent of people over 85 die within one year of a hospital admission, and 10 days in a hospital bed leads to the equivalent of 10 years ageing in the muscles of people over 80.

Frailty is defined as a medical syndrome, which develops as consequence of age-related decline in many physiological systems and collectively results in vulnerability to sudden health status changes triggered by minor stressor events.

Once an older person has lost their physiological reserves, even minor isolated events, such as cystitis, can lead to geriatric syndromes such as falls, delirium, fluctuating disability, which can mean the difference between a person surviving, or continuing to function independently.

The frail older person, who is not recognised as such, often presents in a non-specific way, late and in crisis with a geriatric syndrome. Their care is often hospital-based, episodic, disruptive, disjointed and associated with poor health outcomes, such as higher mortality, risk of requiring residential care, hospitalisation and increased length of hospital stays.

Identifying frailty and responding in ways that are proactive, preventative and coordinated can modify frailty severity, reduce stressors and improve outcomes. There is proven benefit in performing a Comprehensive Geriatric Assessment and 75+ health assessment with interventions such as exercise, nutrition support, vaccination, managing polypharmacy and falls risk.

By recognising frailty and using a standardised tool, we can coordinate care and provide timely interventions in the community that result in long term benefits for older people. Our patients can live well with frailty.

Dr Kristen Riley is a local GP and is working as a General Practice Liaison Officer supporting the Health Alliance’s Ageing Well Initiative. A focus of the Ageing Well Initiative is supporting general practice to recognise frailty and to improve how the health system better responds to older people.

Clinical Frailty Scale by K. Rockwood available here. For more information visit www.healthalliance.org.au.