Frailty in older people

In common language, frailty means 'weak and vulnerable'. In older adults, frailty refers to the loss of physical, cognitive or social ability to recover from illnesses or stressful events. If you are frail, even a minor change, such as being prescribed a new medicine or a minor infection, can cause a dramatic change to your state of health. 

Frailty is not defined by old age. While frailty is more common in older adults, just because you are older doesn't mean you will be frail. Older people with frailty are often more resilient to health challenges than people who have frailty at a younger age. 

The diagnosis is important because if have frailty, you are at higher risk of other health problems if you have a stressful event or an illness. This may affect the decision made by your healthcare providers in regard to investigations or treatment of your condition. 

Older people with frailty are at higher risk of:

• falls
• immobility
• incontinence
• confusion
• being admitted to hospital and long hospital stays
• requiring nursing care
• side effects for new medicines
• major change in health state due to a minor problem such as a mild infection.

Frailty can be caused by a health problem and can cause more health problems. For example, a fall in an older adult can affect muscle strength and mobility, causing frailty. On the other hand, if an older adult is frail, he or she is more susceptible to falls. 

Common risk factors of frailty include:

• falls
• older age
• being female
• chronic health conditions such as COPD, multiple sclerosis, myalgic enchalomyelitis/chronic fatigue syndrome (ME/CFS), diabetes, stroke, heart disease or depression
• socioeconomic deprivation
• smoking
• obesity
• malnutrition
• being Māori or Pacific Peoples.

Because there is no one factor that makes a person frail, frailty is, in essence, a clinical diagnosis. This means there are no specific tests. Your doctor makes a diagnosis by taking into account the overall interaction of many factors, including health conditions, weight and physical function.

They will consider:

• your walking speed and physical activity status
• your grip strength
• whether you need help with daily activities such as household chores
• your weight and body mass index (BMI).

There are a number of different scores and questionnaires developed and used all over the world to help health professionals diagnose frailty, but there isn’t a standard one used in New Zealand. Examples of these include the Rockwood Clinical Frailty Score(external link) and the Edmonton Frail Scale(external link). 

The key to managing frailty is early recognition and careful planning. This can help avoid some of the impacts of frailty when your healthcare providers make decisions about your health.

Some of the things your healthcare providers may do include:

• reviewing your medicines regularly and remove unnecessary medicines to avoid potential harms of one or more medicines (polypharmacy)
• conducting regular checks of your health status, including your physical and mental health 
• assessing and providing specific needs for care and support 
• reviewing your home circumstances to reduce risk factors that can cause falls
• discussing with you about having an advanced care plan in the event of illness or falls
• supporting healthy lifestyle choices.

Unfortunately, frailty can't be reversed but there are measures to help prevent its progression. These include the following:

• Doing exercises that can improve muscle strength and balance. Find out about green prescriptions or exercise groups in your area(external link).
• Having a healthy balanced diet, especially with adequate protein intake, or taking nutritional supplements such as Ensure, Fortisip or vitamin D. Talk to your doctor about getting a referral to a dietitian if you need help with your diet. 
• Stopping smoking.
• Staying connected with family and friends. 
• Keeping your brain healthy. 

Apps reviewed by Healthify

You may find it useful to look at some falls prevention apps, healthy ageing and wellness apps, and joint and bone health apps.

Below are some support services and information designed to meet the needs of older people. 

• Age Concern NZ(external link) works to promote the rights, quality of life and wellbeing of older people around New Zealand. 
• Carers New Zealand(external link) is a national information centre for family carers who support frail older family members or friends.
• Eldernet New Zealand(external link) provides comprehensive, up-to-date information about services available for older people (eg, home help services, respite care, residential care, dementia care and community groups).
• Hub of Hope NZ(external link) is a non-profit organisation that equips and mobilises caring people to provide spiritual support for those at the end of their lives and their whanau.
• Live Stronger for Longer(external link) provides information for older people and their carers about preventing falls and fractures (funded by ACC, Health New Zealand | Te Whatu Ora and Health Quality & Safety Commission).
• New Zealand Home & Community Health Association(external link) provides information on available home health care services.
• Seniorline(external link) is a national service that aims to help older people who are considering rest home or long stay hospital care, or who are already in care.
• Sorted(external link) provides information on managing your money and moving into a rest home or retirement village. Its living in retirement(external link) section provides you with information in your semi-retired/retired years and how best to manage your nest egg.
• SuperGold Card(external link) is a discounts and concessions card issued free to all eligible seniors and veterans.

Read more about services for older people.