What is Frailty?
Frailty is a geriatric syndrome that is a state of increased vulnerability and functional impairment caused by cumulative declines across multiple body systems. Frailty can have multiple causes and represent co-morbidities in physical, psychological, or cognitive disease processes, as well as social vulnerabilities. [source:1-2]
Frailty, and specifically a person’s level of frailty, is a stronger predictor of negative health outcomes than chronological age alone. [source:1-2]
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For instance, consider three people who are all 82 years old:
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Connie lives in a nursing home and is dependent for all personal care;
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Fred lives at home with his wife, has mild dementia, and needs help with groceries, meals, and medications;
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Amanda lives fully independently at home and swims twice a week.
If facing an illness or acute medical event, all three could simply be described as “an 82-year-old frail person,” which overlooks their very different baseline levels of function and vulnerability and can lead to inappropriate assumptions and care decisions. This tendency to treat age as a proxy for frailty is problematic for many reasons and is explored in greater depth during workshops and education sessions.
Living With Frailty
Older adults living with frailty are more likely than their peers of the same age living without frailty to experience falls and injuries, hospitalizations, longer hospital stays, medical complications, and functional or cognitive decline. They also face a higher risk of earlier death. [source:1-2]
Although risk of developing frailty increases with age, frailty can be avoided and the risk of becoming "frail" can be lowered. Frailty is not an inevitable part of ageing. (AVOID Frailty - Canadian Frailty Network)
Ageing itself isn’t the issue—developing frailty, especially at higher levels, and not understanding how to manage its complexities effectively, is what drives poor outcomes for patients and healthcare systems.
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“Understanding the risk of frailty among seniors and the impact that frailty can have on health needs and outcomes can help health planners develop and improve plans to support seniors with complex medical needs.”
-Canadian Institute for Health Information.
A profile of hospitalized seniors at risk of frailty in Canada | CIHI
How is Frailty Measured?
An older adult’s level of frailty can be assessed or measured by looking at key domains such as mobility, everyday function, and cognition. One widely used and validated tool to measure frailty is the Clinical Frailty Scale (CFS), which summarizes an older adult's baseline functioning into an easily understood frailty score. [source: 2-3]
Here are a few ways that assessing frailty can support better care:
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Anticipates functional risks and informs care planning, including caregiver education and coaching.
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Highlights an older adult’s remaining strengths and abilities, while identifying areas where support may be needed. For example, consider the differences between an older adult living with mild dementia, (CFS 5), and an older adult living with moderate frailty (CFS 6) due to physical frailty only.
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Reduces ageist or overly protective attitudes by clarifying distinctions between levels of frailty, ensuring we don’t treat all older adults in the same way.
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Learn to Measure Frailty
Presentations and workshops begin with an overview and understanding of Frailty, Clinical Frailty Scale, and how to anticipate care planning based on CFS score. Knowledge level of these topics can be assessed/discussed upon initial consultation.