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What is frailty?

Frailty is described as a person's overall resilience and how this relates to their chance to recover quickly following health problems. It is a long term condition that affects your health in the same way that other chronic health conditions might. Frailty is not an inevitable part of aging and not all older adults live with frailty, but it is more common as we age.

Frailty is characterised by the loss of inbuilt body reserves. These reserves help us to recover from adverse events. As we start to lose these reserves, it can be harder to recover from a relatively ‘minor’ health problem, such as an infection or a fall, making it possible to have a severe long term impact on someone’s health and wellbeing.

Frailty can range from mild to severe. Older adults with frailty might notice:

• Feeling slower
• Weakness and muscle loss
• Feeling tired
• Needing more help with daily tasks like getting dressed
• Weight loss without trying
• Taking a long time to recover from illness

What are the risks of hospital admission for older adults living with frailty?

For some patients, being in hospital is the right place as they need to receive treatments that can only be given in hospital. However, we also recognise that hospital admissions can cause harm for older adults living with frailty and therefore we aim to avoid unnecessary hospital admission and discharge patients as soon as it is safe to do so.

So that we have all the information to get you home safely, we start these discussions regarding discharge early and usually at the point of admission to hospital.

Some of the risks to older adults with frailty in hospital include:

• Hospital acquired infection
• Risk of falls
• Risk of deconditioning and step wise deterioration– see below for more details
• Risk of worsened confusion (delirium) 
• Risk of pressure ulcers

Deconditioning in older adults with Frailty

A common myth is that patients need to have bed rest when they become unwell or are admitted to hospital. Whilst bed rest may be the right thing for a few patients, we know that for many patients bed rest can cause harm and that these patients may find themselves less able to walk and look after themselves after a hospital stay. This is called deconditioning.

Research shows that just 10 days bed rest in a person over the age of 80 years can lead to 10 years’ muscle aging.

For an older patient, this could be the difference between a patient remaining independent in their own home or being admitted into a care home. This is why we are very keen to keep our patients as mobile and independent as possible.

We support the #EndPJParalysis Campaign to try and prevent hospital deconditioning.

Find out more about #EndPJParalysis

As we know, frailty can make it harder to recover from an apparently minor event.

We sometimes find that when an older person with frailty is admitted to hospital, despite the best care, their ability to look after themselves, walk, memory etc. on a day-to-day basis deteriorates and they often do not recover back to how they were before.

If this does happen, the frailty team will discuss how we can help to support you or your loved one.

Your wellbeing: things you can do to keep yourself healthy and mobile

• Eat well: have a colourful plate of food with food from each food group like rice, potatoes, pasta etc from the carbohydrate group; steak, chicken, fish, beans and pulses etc from the protein group; broccoli, green beans, carrots, apples, bananas etc from the fruit and veg group.
• Stay active: If you belong to any exercise groups keep up with your attendance.  Remember, you can also do things within your own home that can help to keep you fit like gardening, vacuuming the house, walking up and down your stairs a few times (if safe to do so), chair based exercises, basic standing exercises.  If you prefer being outdoors then you can go for brisk walks as an exercise.  The Chartered Society of Physiotherapy (CSP) have more examples of things that you can do to stay active.  Find out more by visiting the website.
• Stay connected: Keep up with your friends and family members in every way that you can.  This may be weekly phone calls, a video call, a physical visit etc. Some people have community groups that they belong to such as church groups, daycentres etc. This is another good way to see your friends, an opportunity to make new friends and to see the people that are important to you helping you to stay connected within your own groups and communities. 

Be prepared: coming into hospital

Being admitted in to hospital can happen via many different routes such as a referral from your GP, being brought in by ambulance, being admitted via a RACE clinic appointment etc.  Some people will come in to hospital many times particularly in their later years and for others it may only be a few times or as a one-off incident.  In any case, having to come in to hospital can be a worrying time especially if it is an unplanned admittance.  One way to help alleviate this worry is to be prepared (as much as you are able).

It is a good idea to have a pre-packed overnight bag ready for use for whenever such a time may arise. Have a special place within your home that is easily accessible where your bag can be stored. Have the conversation with your family/friends/carers about your bag so that they also know exactly where it is if they have to locate it in an emergency.

While you're in hospital

The Frailty Team understand that your time is important and our hospital is not where you want to be. We follow the principles of the 'End PJ Paralysis' campaign which means we wholeheartedly encourage you to wear your own clothes whilst you are on the ward with us and we encourage you to get up, get dressed and get moving every single day as it will help you to retain your muscle mass and strength, maintain your mobility and will help you to maintain your independence leading to a better outcome of being able to live independently once you are home.

Leaving hospital - Safe supported discharge

Knowing all that we do about older adults with frailty, we embrace the idea of ‘Home First’ – this means that as soon as our patients are safe to be discharged we will do everything we can to get them home.

You are much more likely to recover better and more quickly in your own home. So that we have all of the information to get you home safely, we start these discussions regarding discharge early and usually at the point of admission to hospital.

Comments or concerns

If you have any comments or concerns which you wish to raise you may do so through our Patient Advice and Liaison Service (PALS) on 01895 279973 or email thh-tr.pals@nhs.net. 

You can also complete the short Friends & Family Test to tell us about your experience of our services. All completed questionnaires are completely anonymous and your participation is voluntary.