Acertainty of life is that we get older, and our health changes as our bodies go through the ageing process. Yet, frailty is not an inevitable part of this process. A person living with mild frailty has double the risk of dying than an older, fit person does (NHS England, 2019). Each day, over 4000 people are admitted to hospital with varying degrees of frailty, which increases the likelihood of poorer health outcomes and dying in hospital (Imam et el, 2021). For people living with frailty, the ability to bounce back from minor illness is greatly reduced, and they are likely to suffer adverse outcomes. It is estimated that over 10% of people aged 65 years and over are living with moderate frailty and are three times more likely to require hospital admissions and care home admissions than older, fit people (NHS England, 2019). Early recognition of frailty will not only improve health outcomes, but also ensure that older people have access to the right care and support to prevent significant deterioration and reduce the likelihood of admission to secondary care or need for a care home (NHS England, 2021).
While working as the lead nurse for complex care in a primary care network, I have set up a service identifying varying degrees of frailty in people aged 65 years and over. The service is proactive in identifying very early an older person's likelihood of frailty, using evidence-based tools for support, such as the PRISMA-7 Questionnaire and Electronic Frailty Index risk stratification (Hoffmann et al, 2020). Complex care nurses complete a Comprehensive Geriatric Assessment (CGA) with people who have been indicated as having frailty, and once a full holistic assessment has taken place, a Clinical Frailty Scale (CFS) score is identified. Research has shown that those who have had a CGA completed are 12 times likely to be alive and living in their own homes at 6 months after the assessment (Ellis and Langhorne, 2005). The service aims to identify those with moderate frailty and proactively support them to prevent further deterioration (NHS England, 2019). The appropriate care plan can be put into place, identifying falls risk, which can reduce injury and hospital admission, as well as including a structured medication review, which can can reduce polypharmacy (Cudby and Syan, 2019). Older people with worsening frailty have access to well-planned advance care planning with all the appropriate services involved, reducing the likelihood of crisis and the need for residential care home admissions. Care coordinators work closely with the older person and the multidisciplinary team (MDT) to bring together all the services and actively ensure the most appropriate service is involved and care is supported.
Although adopting a proactive approach to frailty and ageing well in older people will improve health outcomes, more needs to be done to ensure a full system-wide proactive approach to recognising frailty and the associated syndromes. Education across both primary and secondary care is essential to identify frailty early and prevent hospital admission. Further consideration is needed regarding length of stay in hospital for older people with frailty, with proactive identification of the earliest opportunity to facilitate safe discharge being a priority. The COVID-19 pandemic has impacted older people, many of whom have experienced deconditioning, and our vision for frailty must be refocused to proactive care; the time to act is now.