Frailty Services

Older people living with frailty tend to have one or more of the following:

• Multifactorial accidental falls
• Impaired mobility, being reliant on walking aids or equipment
• Developing problems with cognition such as dementia or with mood such as depression or anxiety
• Care dependence: being reliant on others to help them with daily tasks such as washing and dressing, or living in a care home
• Multiple long term health conditions
• Being on multiple medications (polypharmacy)

There are five frailty syndromes to look out for in urgent and emergency care settings. Experiencing one or more of these may indicate a person has underlying frailty in response to a stressor event:

• Falls e.g. collapse, legs gave way, ‘found lying on floor’.
• Immobility e.g. sudden change in mobility, ‘gone off legs’ ‘stuck in toilet’.
• Delirium e.g. acute confusion, ’muddledness’, sudden worsening of confusion in someone with previous dementia or known memory loss.
• Incontinence e.g. change in continence – new onset or worsening of urine or faecal incontinence.
• Susceptibility to side effects of medication e.g. confusion with codeine, hypotension with antidepressants.

However, there are often one or multiple underlying and potentially reversible conditions causing these sudden changes. This requires a comprehensive assessment of health and care needs to determine these.

 Frailty is not an inevitable consequence of ageing. If found early it can often be reversible and the person return to their previous level of health and lifestyle.

It is important that people with frailty keep active. Look out for campaigns such as #endPJParalysis and Get, sit up, keep moving from the British Geriatric Society.

There are exercises people can do even when in bed or in a chair. Keeping active prevents loss of muscle and general deconditioning. This is of particular importance in the Hospital setting in order to help prevent Hospital acquired functional decline.

To support the person who has frailty, you may have to change the way you communicate with them. As much of 90% of communication can be something other than talking (verbal). This is particularly relevant for people with a dementia or cognitive impairment.

Non-verbal communication can include things like:

• facial expression
• eye contact
• body language
• gestures
• touch
• tone of voice

When talking to people, it is helpful to do so in an area which is quiet, without noisy and distracting backgrounds that can make it difficult to listen and talk.

It is important the person is comfortable so they can focus on the communication, for example sitting in a comfortable chair.

Think about how the person can overcome any sensory difficulties. Do they need their glasses, hearing aids and is their first language English. By supporting the person it helps them communicate with you.

Health staff use a range of tools and assessments to identity if a person is frail. These may include:

• Questionnaires
• Functional Assessments eg. a timed ‘up and go’ test, walking and/or grip strength test
• Clinical Screening tools eg. a clinical frailty scale such as the Rockwood Clinical Frailty Scale

When attending a hospital of GP appointment, you may be asked questions or asked to do some activity to help the health care staff to identify if you are living with frailty.

To support health and social care staff to develop their skill and knowledge of frailty, we have a Frailty Academy. A training programme is in place for staff (including volunteers) to increase their capabilities in accordance with the national NHS Frailties Core Capabilities Framework. By increasing the opportunities for staff learning, the Royal Surrey will be best placed to deliver compassionate, safe care everyday for patients with frailty.