Frailty Resources

According to the old saying, age is just a number, although exactly what that number is and how much time we have left is open to interpretation. Many of us might be satisfied to see three score and ten, while others hold onto their youth like the proverbial Peter Pan. Some among the so-called billionaire elite even imagine they can cheat old age through cryonics, freezing their bodies after death in the hope that technology might one day be advanced enough to revive them.

Whatever method we choose to keep age at bay, none of us are immune from the inexorable march of time and while UK government figures show that life expectancy is increasing (27% of the UK’s population is expected to be over 65 by 2072), longer lives come with their own issues (‘Preparing for an ageing society inquiry launched’ – committees.parliament.uk).

Here, Dr Anne Holdoway, malnutrition pathway clinical director and consultant dietitian, looks at a recently launched online resource, ‘A Guide to Managing Frailty, Sarcopenia and Malnutrition’, to help healthcare professionals in managing the overlapping syndromes of frailty, sarcopenia and malnutrition, which are often wrongly considered to be an inevitable part of ageing. This new resource outlines considerations for protein consumption while also highlighting the importance of exercise to enhance muscle synthesis and strength. In addition, other areas of consideration include vitamin D supplementation, hydration, medicines management, social support, cognitive function, comorbidity optimisation, and falls and fragility fracture prevention.

Healthy ageing has become a global priority to add quality to our later years and reduce the morbidity associated with ageing. Entering older adulthood, however, increases the risk of frailty and sarcopenia — key factors driving age-related morbidity. Frailty is a multi-system impairment associated with increased vulnerability to stressors. Sarcopenia is the loss of muscle mass and function and is a major component of frailty. Skeletal muscle has a reduced response to stimuli such as protein intake and exercise with advancing age, driving the gradual loss in muscle mass seen in older adults. High protein diets, especially when paired with resistance exercise, can help to overcome this anabolic resistance and restore or maintain physical robustness. The commonly cited protein requirements for adults published by the Department of Health (DH) underestimate the needs of older adults. Other nutritional factors, such as weight loss and vitamin D status, also play important modulating roles in frailty and sarcopenia.

The impact of ageing on the body and its association with skin harm and frailty in relation to multimorbidity, comorbidity and polypharmacy is clearly described in the literature. The ageing population globally brings with it the challenge for healthcare professionals of managing individuals with increasingly complex and inter-related needs. This article considers ageing skin and skin tears within the context of frailty as a syndrome. It discusses what frailty is understood to be, how to recognise and assess for it, and how to consider risk and prevention of harm to the skin of the ageing person with frailty.

The risk of developing type 2 diabetes increases with age and can lead to poorer outcomes for individuals and create greater demands on healthcare services. The NHS Long Term Plan (2019a) highlighted the need for more complex care to be provided in patients’ homes and, with recognition of a decreasing community workforce, new ways of working and upskilling the workforce are required to provide integrated, person-centred care. Blended roles programmes focus on a commitment to develop education and competencies to build effective relationships and collaboration between independent care workers to provide individualised person-centred care.

The population is ageing and so we are seeing an increase in the prevalence and incidence of age-related conditions, such as frailty and dementia. These two conditions can often go ‘hand in hand’, making it important to ensure appropriate recognition, assessment and then management of each when experienced together. This paper uses a case study approach to illustrate and discuss the issues as relating to community nurse practice.

The UK has a population of approximately 11 million adults, 18.6% aged 65 and over (Centre for Ageing Better, 2022). Indeed, the demographic profile of the population of England and Wales and primary care records indicate that one in five people are over the age
of 65 in England (Office for National Statistics [ONS], 2018; Robards, 2020). The condition of frailty is more prevalent in the older person, and estimates provided by various studies suggest that 3% of people over the age of 65 in England have the condition (Clegg et al, 2016; Sinclair et al, 2021). Community nurse caseloads are representative of the ageing population of the UK and frailty has been recognised as a clinical condition of the older person (Leary and Bushe, 2022). Early detection of frailty by experienced nurse practitioners can assist in developing a management strategy for the patient in order to inhibit progression of the condition (Ruiz et al, 2020).

Projections suggest that in 50 years’ time there will be an additional 8.6 million people over 65 years old in the UK. As a consequence, England will see an increase in older people who have higher levels of dependency, dementia, and comorbidity. People living with dementia are likely to have on average, an additional 4.6 chronic conditions. However, the true extent of comorbidities experienced by people with dementia may be unreported and underdiagnosed as a result of their difficulties in communicating their symptoms or in others failing to observe them. There is evidence to suggest that people with dementia are less likely to access effective treatment and monitoring of their comorbid conditions compared to people without dementia who have the same comorbid conditions. This impacts negatively on their health and wellbeing. This second paper of the series relating to dementia considers some of the complications that may arise when trying to support people with dementia and comorbid conditions, and how this impacts upon the two families introduced in the first paper.

Lower limb haematomas caused by trauma are debilitating wounds for the elderly who are most at risk. Prompt action needs to be taken to stop the bleeding and reduce the extent of tissue damage and skin loss. Literature on the management of lower leg haematoma is sparse compared to the management of skin tears, and there may be debate regarding surgical versus conservative approach. Many patients are not suitable for surgery due to underlying comorbidities, frailty and anaesthetic risk. Conservative management should support early evacuation of the haematoma and application of compression bandaging, avoiding lengthy hospital stays and enabling patients to be managed in the community setting.