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The cost of frailty
While ageing is inevitable, the rate in which physical decline occurs is not. There are plenty of steps that you can take to live your best life throughout your later years.
Frailty and ageing positively
Too often, ageing is associated with frailty. While ageing is inevitable, the rate in which physical decline occurs is not. It starts however, by recognising and monitoring your risk of frailty to ensure it’s managed at all stages of your life. When recognised early – or better still, before it starts – it’s easier to limit the impact of frailty, introduce interventions to prevent physical decline, and ensure that you can stay healthier and independent for longer living a full life in the community.
The key ingredient to reducing risk and building strength is being able to recognise frailty and take steps to manage it as soon as possible.
What is frailty?
Claire Fletcher, Community Health and Care Regional Business Manager at Benetas, explains that frailty is not a disease, but a state of vulnerability. “It’s a condition where you are at increased risk of having adverse outcomes in response to a small event,” she says. “That might be a minor fall, for example, but if someone is frail, they are more likely to experience adverse events such as delirium, disability or reduced function as a result.”
A level of frailty will compound the recovery timeframe, or in some cases, result in an irreversible health decline. Imagine, for example, an 85-year-old man named Bert who has high blood pressure, high cholesterol and osteoarthritis. He is managing at home with minimal support from Mabel, his 83-year-old wife. Then Bert experiences a loss of appetite and starts having falls.
Next, Bert develops urinary incontinence. He continues to have falls. One day, he slips and hits his head on the bathroom sink. This leads to a bleed on the brain. Bert is admitted to hospital, but once back home he can no longer walk by himself and needs help for feeding, dressing and toileting. Mabel, who has her own health issues, is struggling to provide the full care her husband needs so Bert is looking into residential aged care.
Claire, a physiotherapist by profession, says she has seen “countless people present after a simple fall who expect to bounce back and be up on their feet, but continue to experience reduced walking tolerance, pain, loss of movement and loss of strength.”
Recognising frailty is important. The key ingredient to reducing risk and building strength is being able to recognise frailty and take steps to manage it as soon as possible. As Claire points out, unrecognised frailty can lead to a chain of events that impact your health, independence and ability to participate at home and in your community.
The value of getting in early
Once detected, a person found to be frail or pre-frail can receive the information, resources and support needed to help optimise healthy, active ageing, and potentially even reverse their degree of frailty.
“Once you identify the components that put an individual at greater risk, you can target interventions to improve that person’s situation,” Claire says. This could include diet modification, exercise and sleep hygiene, among other things.
In the case of falls, identifying early loss of leg strength or balance means you can commence a personalised strength and balance training programs to reduce your risk, Claire explains.
Returning to Bert’s example, early frailty screening could have flagged that Bert was losing weight and could no longer climb a flight of stairs. He could have been referred to a community physiotherapist and provided with a tailored leg strengthening program to reduce his risk of falls. A dietitian could have helped Bert with dietary advice to support maintenance of lean, healthy muscle. A community nurse could have supported him with continence aids.
These simple measures could potentially have prevented the adverse events that culminated in Bert’s admission to aged care, however it not always so simple.
Frailty too often goes unnoticed
As Claire points out, “we don't see ourselves growing older in the mirror every day, but you look back over time and think ‘hey, I've got a few more wrinkles.’
“In the same way, when you're seeing your family every day, you often don't notice the decline because it’s very slow. We need an objective test to identify the risk factors you don't usually see in day to day functioning.” (More about screening tests below).
Steeped ageism and cultural representations of older Australians being burden on the community further compound this issue. Let alone the growing mistrust and challenges faced in navigating aged care and preventative allied health services.
Frailty facts and figures
Frailty is common in older people, with a 2018 study of 8804 Australian adults aged 65 years or more finding 21 per cent of participants were frail and a further 48 per cent were “prefrail” (a precursor to frailty).
Frailty was shown to be highly prevalent in remote-living Aboriginal Australians and emerged at a younger age than expected.
A study published in the Medical Journal of Australia in 2020 looked at scores on a frailty index in 903,996 non‐Indigenous, community-dwelling Australians aged 65 years or more. It too found risk of death and entry into permanent residential aged care increased
Older adults with frailty were more likely to present to hospital emergency departments according to this 2017 Australian study.
The development of frailty is complex and involves sociodemographic, physical, biological, lifestyle, and psychological factors.
What causes frailty?
The cause of frailty isn’t fully understood. However, it is believed to be associated with damage to cells that can’t be repaired fast enough to maintain what scientists call ‘homeostasis’ (a healthy, stable state maintained through constant adjustment of biological processes).
Claire explains many factors are involved in the development of frailty, including genetics and lifestyle. She likens it to a loss of reserve. “Our tank is less full,” she says, “so when stressful things happen, our body is less able to cope. That triggers a higher load physiologically and then we experience significant health side effects.”
She adds that frailty isn’t a disease, nor is it the same as ageing. “The prevalence of frailty increases with chronological age,” she says, “but it's not directly linked to age alone and should not have to be accepted as a normal part of ageing.
“Things can be done about someone’s state of frailty to improve their reserve and therefore reduce their risk. It can be influenced by simple interventions in a person’s lifestyle and introducing healthy ageing choices.”
How is frailty assessed?
The first step in reducing frailty risk is knowing where to start. This is where frailty screening is vital. Claire says there are many different frailty screening tools. “Most are quite simple and have basic questions to identify risk factors for frailty,” she says.
Benetas’ Positive Ageing Tool (PAT), for example, contains five easy questions that you or a family member can complete. The PAT Health Check only takes a couple of minutes and has been verified as a reliable predictor of frailty risk (click here to read more about PAT <link to article 2>).
You can download the results along with a letter asking your GP to review your health plan. Most importantly, you’ll get a series of personalised recommendations to support healthy ageing choices.
What should I do if I recognise frailty in myself or a loved one?
If a tool like PAT indicates you or a loved one is frail, or at risk of frailty, it’s crucial to do something about it – the sooner the better! Taking simple steps to enhance your reserves can help to maintain your independence and quality of life for longer. And you don’t have to don lycra or start eating keto! Even small changes can make a big difference.
As Claire points out, “When people are connected to the right advice, education and services that can help them make positive choices about healthy ageing, then their risk factors can be reduced. Ideally, we want to stop people from becoming frail. Applying interventions at the pre-frailty stage will have the biggest chance of flattening the frailty curve in Australia and supporting older people to stay informed and in control of their ageing process.”
However, it's never too late to put healthy ageing strategies in place, Claire emphasises. For example, older people have the same capacity as younger people to build muscular strength.
“Getting older doesn't have to come along with reduced functional capacity. Many things can be improved with different health interventions. The individual has a big say.”
Go Deeper (8 minute read)
Screening for a better future
While frailty is linked with getting older, the two don’t have to go hand in hand. It’s about taking early interventions to help stay healthy and active for longer.
Prevention and management however, can only start when you realise that you – or someone you love – is becoming frail or at risk of frailty. Fortunately, easy and fast tools that assess your risk of frailty have been developed and validated by researchers. Read more...