Frailty
Introduction
Frailty is related to the ageing process. It defines the group of older people who are at highest risk of negative outcomes such as falls, disability, admission to hospital, or the need for long-term care. Being frail can leave a person vulnerable to dramatic, sudden changes in their health and wellbeing triggered by seemingly small events, such as a minor infection or a change in medication or environment. It can be described as someone’s overall mental and physical resilience and how this relates to their chance to recover quickly following health problems, such as an illness or injury. Frailty varies in severity for each person, it can change over time and can be made better or worse.
Frailty is generally characterised by issues like reduced muscle strength and fatigue. Around 10% of people aged over 65 live with frailty. This figure rises to 25%-50% for those aged over 85. Frailty is not the same as living with multiple long-term health conditions. There is often overlap, but equally someone living with frailty may have no other diagnosed health conditions1.
Older people with moderate to severe frailty are often well known to local health and social care professionals. They usually have weak muscles and other conditions like arthritis, poor eyesight, deafness, and memory problems. This means older people with frailty will often walk slowly, get exhausted easily and struggle to get out of a chair or climb stairs. Frailty typically means a person is housebound, or only able to leave their home with help2. Having access to well-planned, joined-up care to prevent problems arising in the first place and rapid, specialist response should anything go wrong, is essential for those with frailty.
Why is it important to Population Health?
Frailty is an important factor in population health as it significantly influences the wellbeing of communities. It is associated with a range of health challenges, particularly among older adults, impacting their overall quality of life. Addressing frailty is essential for promoting healthier and more fulfilling lives within Derbyshire’s population. It can also reduce the overall burden on healthcare systems, improve outcomes, and enhance the quality of life for individuals.
High Prevalence and Impact: Although estimates of prevalence vary significantly3, 2020 estimates suggest the proportion of adults aged over 50 years living with frailty in England is 8.1%.
There is no universal measurement of frailty. However, the British Geriatrics Society (BGS) ‘Fit for Frailty’ guideline recommends that older people should be assessed for frailty at all healthcare encounters using:
- Gait speed
- The timed up and go test (TUGT)
- Or the PRISMA 7 questionnaire
Within the last decade, an electronic frailty index (eFI) has been validated for identifying those within a large population at risk of frailty. The eFI uses data in primary care electronic records on 36 conditions associated with frailty, such as fragility fracture, weight loss, mobility, and polypharmacy. The tool helps primary care professionals identify mild, moderate and severe frailty and was found to be a robust predictor of nursing home admission, hospitalisation and mortality4.
Population Health and Ageing: The UK’s ageing population is fueling the growth in the number of people living with frailty. In Derbyshire there are approximately 53,000 frail people, of which approximately 23,000 are moderately or severely frail5. The projected growth of those living with frailty is only predicted to increase. This requires further attention on prevention and a greater understanding of how population health efforts can support people to live healthier later lives.
Resource Implications: Frailty has substantial economic implications for individuals, families, and society as a whole. Older people living with frailty account for around £6 billion of annual NHS expenditure6. The moderately and severely frail population in Derbyshire had just over 100,000 non-elective bed days between May 2022 and April 20237. Older people living with frailty in Derbyshire are the highest users of services across health and social care and have the highest levels of emergency admissions to hospital8. Population health interventions aimed at supporting people to live healthier later lives can help reduce health and social care costs and alleviate the financial burden on individuals and society.
Quality of Life: People living with frailty may struggle to do everyday tasks, lack mobility and are often housebound. People living with frailty may also be more vulnerable to the diverse range of social, economic, and environmental factors which impact on people’s health9. For example, a person may become increasingly frail in poor quality housing. This can have a severe impact on their quality of life and requires joined-up care to ensure a better quality of life in later years.
Prevention and Promotion: By emphasising prevention and promoting ways to support people to age well, population health efforts can empower individuals, communities, and healthcare systems to take proactive measures to support people to live a healthier later life.
The Derbyshire Population Health Approach
The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.
When considering the topic of frailty within The Derbyshire Population Health Approach:
• Prevention
Preventing frailty is important to promote the health and wellbeing of older people and reduce their need to access health and social care services, especially as the population ages10. Poor health and frailty in later life is not inevitable. Promoting healthy ageing offers a chance to avoid or postpone the onset of frailty. The ‘Dementia, disability and frailty in later life - mid-life approaches to delay or prevent onset’ NICE guideline aims to increase the amount of time that people can be independent, healthy, and active in later life. The guideline includes recommendations on promoting a healthy lifestyle to reduce the risk of or delay the onset of disability, dementia and frailty by helping people to:
- Stop smoking
- Be more active
- Reduce their alcohol consumption
- Improve their diet
- Lose weight and maintain a healthy weight if necessary11
In addition to the NICE guideline, NHS England highlight that for people at risk of developing frailty there are potentially preventable or modifiable risk factors or conditions including:
- Cognitive impairment
- Falls
- Functional impairment
- Hearing problems
- Mood problems
- Polypharmacy
- Vision problems
- Social isolation and loneliness12
Interventions such as good foot care, preparing for winter and helping people keep warm can also be targeted for people most at risk of becoming increasingly frail.13
• Population
Taking a population-centred approach to frailty can help to identify high-risk groups and develop targeted interventions to address the specific needs of these populations. Frailty should be identified with a view to improving outcomes and avoiding unnecessary harm14.
• Evidence
Population health practitioners rely on evidence-informed practices when it comes to frailty prevention. They utilise research and data to identify effective interventions, evaluate their impact and implement evidence-informed guidelines for healthcare providers and community organisations.
• Causes
The strongest risk factor for frailty is age and prevalence clearly rises with age. Evidence suggests there are higher rates of frailty in people aged over 50 years in areas of higher deprivation15. The prevalence of frailty in community dwelling older people is also usually higher in women16. Understanding the wider causes of frailty, such as nutrition, physical inactivity, and social isolation, are also essential. Population health initiatives seek to address these root causes by promoting healthy behaviours, ensuring access to nutritious food, and fostering social connections.
• Collaboration
Collaboration is essential in the population health approach to frailty prevention. Population health professionals collaborate with healthcare providers, community organisations, local authorities, and other stakeholders to develop co-ordinated strategies, share resources and expertise, and ensure a comprehensive and multi-sectorial approach to frailty prevention. By incorporating frailty into the population health approach model, population health practitioners can implement targeted prevention strategies, address the underlying risks associated with frailty, and foster collaboration to reduce frailty prevalence and promote healthier communities.
Within Derbyshire, Team Up is creating one team across health and social care who see all the people in a neighbourhood who are currently unable to leave home without support17. This service is instrumental in ensuring people with frailty receive well-planned, joined-up care to prevent problems arising and receive a rapid, specialist response service when needed.
Latest Derbyshire Data
Trend Data
Derbyshire Quilt
Prevalence Maps of Derbyshire
The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.