Frailty & Comprehensive Geriatric Assessment:
Frailty is defined as “a condition characterised by loss of biological reserves, failure of physiological mechanisms and consequent increased risk of experiencing a range of adverse outcomes, including hospitalisation, longer length of inpatient stay, and delirium”1.
The word ‘frailty’ can conjure up images of a small, wizened person who may appear ‘skinny’ or ‘weak’. In fact, frailty can come in all shapes and sizes and it can have a huge impact on people as they age. It can manifest itself as a decline in mobility or function, generalised weakness, deterioration in our memory, a requirement for more support and weight loss, among others.
Frailty can be categorised in a number of ways but the scale most commonly used in Ireland is the Rockwood Clinical Frailty Scale2. It categorises frailty on a scale of 1 (Very Fit) to 9 (Terminally Ill) and is valid for people over 65 and should be measured on how the person was 2 weeks ago.
If you have concerns that you or your loved one is becoming frail, or at risk of frailty, you should make an appointment to speak with your GP. They may make some recommendations in relation to delaying or reversing this process, as well as a possible onward referral to see a geriatrician with a view to having a comprehensive geriatric assessment (CGA). A CGA is an ‘organised approach to assessment designed to determine an older person’s medical conditions, mental health, functional capacity and social circumstances’2. As well as seeing a geriatrician you may also see other members of the multi-disciplinary team such as an occupational therapist, a nurse, a social worker, a speech and language therapist, a pharmacist, a dietician or a physiotherapist. The four main elements in a CGA are physical assessment, functional assessment, psychological assessment and social assessment. The breakdown of these assessments can be found here3.
We at PW Physiotherapy have huge experience in assessing and treating frailty in the older person, with many aspects of our assessment aimed at identifying causes of frailty before making recommendations as how to possibly reverse or delay this process. Our treatments will consist of advice and education in relation to exercise and lifestyle, as well as an assessment of your living environment. We can provide information and advice on how to reduce your risk of falls and allow people to maintain their independence for longer. We can also make referrals and liaise with other healthcare professionals whose input you might benefit from.
Further information in relation to frailty and its assessment can be found below:
British Geriatric Society Silver Book 2
Rockwood Clinical Frailty Scale
References:
1. British Geriatric Society. Silver Book 2: Frailty – A Good Practice Guide. Clegg a, Rockwood K, Romero-Ortuno R, Cunningham C, February 2021.
2. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95. doi: 10.1503/cmaj.050051. PMID: 16129869; PMCID: PMC1188185.
3. HSE Comprehensive Geriatric Assessment – A Summary. National Clinical Programme for Older People (2016).