News

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Frailty declared a medical condition

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‘Frailty is a syndrome in itself.’
 
That is Professor Danny Liew, Chair of Clinical Outcomes Research at the School of Public Health and Preventive Medicine at Monash University, and senior author of a landmark new paper on this issue.
 
Published in the Journal of the American Medical Association (JAMA) Network Open, it is the first global study to estimate the likelihood of community-dwelling older patients developing frailty. It found that 4.3% of community-dwelling people aged over 60 will develop frailty per year, and with it a potentially lower quality of life and higher risk of death.
 
Professor Liew’s team analysed 46 studies of more than 120,000 people aged over 60 across 28 countries and found that, among nonfrail individuals who survived a median follow-up of three years, 13.6% became frail, with the pooled incidence rate being 43.4 cases per 1000 person-years.
 
They also discovered that women were more likely than men to develop frailty and that, in people aged over 60, 4.3% will develop frailty per year.
 
Professor Liew told newsGP he was taken aback by the results.
 
‘I honestly didn’t think it would be that high as an incidence measure for frailty among community- living people [aged 60 plus],’ he said.
 
‘Having said that, this is the first study that’s looked into it on a global scale so we didn’t have anything to reference against till now.’
 
He was also surprised by predictions of future frailty in the population.
 
‘These meta-analysis results suggest that, among those who are not presently frail, there is a fairly high probability that they will become so in the next year,’ he said, adding that this can have serious consequences.
 
‘Frailty is a bad prognostic factor for a lot of things.’
 
Adverse effects include an increased risk of hospitalisation and institutionalisation, poorer outcomes post-hospitalisation, and higher mortality rates.
 
There is no current ‘gold standard’ definition of frailty, but it tends to be regarded as a condition that meets three of five criteria, which is how it was measured in this new study.
 
These criteria are:

• Low physical activity
• Weak grip strength
• Low energy
• Slow walking speed
• Non-deliberate weight loss

 
While these results may seem surprising, Professor Liew said an important consideration when managing the condition is that natural remission of frailty is both possible, and common.

Professor Danny Liew believes that frailty can be defined as a medical condition rather than a natural consequence of ageing.
 
‘The saving grace is that it is a dynamic condition; people are not necessarily always going to be frail,’ he said.
 
‘In other words, people can move into and out of the condition.  
 
‘The second [saving grace] is that both in terms of recovery as well as preventive capacity, there are things people can do to avert progression towards frailty.’
 
Professor Liew says the two factors most supported by evidence to help avert frailty are strength training and protein supplementation.Other factors that have less evidence, but which may also help, include mild to moderate intensity exercise and cognitive training.
 
‘I think we can’t go wrong with clinicians prescribing good physical activity, within reason, to older people – as long as they stay safe with the activities they take up,’ Professor Liew said.
 
‘We all know that maintaining physical activity is good for function.’
 
Professor Dimity Pond, a GP with a special interest in aged care and dementia, told newsGP that over the past 12 months, her practice has implemented a ‘frailty scale’ which is used when performing health assessments for patients aged over 75.
 
The scale ranges from one – which is ‘very fit’, to nine – which refers to patients who are terminally ill.
 
A score of six represents being ‘moderately frail’ and refers to patients who need help with all outside activities and with keeping house. Such patients may also have trouble with stairs and need help with bathing, and might need minimal assistance (such as cueing) with dressing.
 
Professor Pond says patients that score six or more receive a home visit from their practice nurse, and a follow up care plan if needed, and that around one in ten patients aged over 75 are assessed according to this criteria as requiring ‘extra attention’.
 
Professor Pond says such attention can not only improve patient outcomes, but also help with reversible factors.
 
‘There are things you can do [to help reverse frailty] so we obviously need to take that opportunity and help people,’ she said.
 
Professor Liew believes the takeaway message of this new research for GPs is to acknowledge and recognise frailty as a syndrome in itself, and that it is not an inevitable consequence of ageing.
 
There is also a need to realise there are preventive components to the condition, along with a capacity for recovery.
 
‘Given the rapidly ageing population – and age being the main driver of frailty – the condition is going to be a lot more common as we move into the future,’ said Professor Liew.
 
‘That’s why we need to address it.’
 
The RACGP’s Medical care of older persons in residential aged care facilities, (The Silver Book), is due to be launched at GP19 and includes recommendations on how to measure frailty.

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Ageing population Frailty Geriatrics Old age

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