Fit
Clinical Frailty Score: 3 and less
Jackie said: 'I can live the life I want and do the things that are important to me as independently as possible'. So, we offered Jackie (and his family) personalised advice, information and support to help Jackie stay active, engaged and independent as possible
Across a person’s life course, offer Universal Personalised Care (including Personalised Care and Support Planning), enabling choice, shared decision making and support based on the person’s needs and 'what matters to them'
| Involve
Enhance the voice of older people, carers and families to tackle the frailty challenge together at a community and individual level.
Visit ‘involve’ on the Frailty ICARE website
| Consider
Risk factors for the development and progression of frailty should not be viewed in isolation as they are not mutually exclusive and many risk factors have a bi-directional relationship.
An awareness of the risk factors and complications of frailty can help with early appropriate support.
Social Class
The prevalence of frailty is significantly more common in those with low income compared to high income.
Education
The prevalence of frailty is significantly more common in people with low levels of education compared to high levels.
Alcohol Intake
People who have high consumption of alcohol in midlife have a 1.4 times likely risk of developing frailty more than people not drinking alcohol.
Diet
An increasing adherence to the Mediterranean Diet was associated with decreasing risk of frailty.
Smoking
Smoking is a predictor of worsening frailty status in community-dwelling populations.
Occupation
There is a significant relationship between frailty risk and life-course occupations in advanced age (e.g. manual or blue-collar employment).
Obesity
The prevalence of frailty is significantly higher is those who are obese.
Deprivation
There is a strong link between socioeconomic deprivation and multimorbidity.
Visit ‘consider’ on the Frailty ICARE website
| Assess
Older people should be assessed using an appropriate frailty diagnostic tool and have their frailty classified by the Clinical Frailty Scale.
Visit ‘assess’ on the Frailty ICARE website
| Respond
Personalised Care is relevant across the whole spectrum of frailty. However, it is crucial to understand a person's needs and 'what matter to them' to target support based on their level of frailty and associated needs.
For fit Jackie focus on healthy ageing approaches with signposting to keeping active, engaged and independent, including access to frailty-friendly living and homes.
What Works?
Look after your feet, mouth & teeth
Get moving - including aerobic, resistance, balance and flexibility training
Stop smoking
Eat well - consider nutritional supplements (vitamin D)
Drink alcohol sensibly
Get a hearing and eye test
Keep an active mind
Sleep well
Keep safe at home & keep warm
Get vaccinated
Visit ‘respond’ on the Frailty ICARE website for what works, useful links and developing evidence
| Evaluate
Frailty has a significant impact on people, populations and health and care systems. The following are examples of possible benefits, outcomes measures as well as impact estimates if we embrace healthy ageing approaches
Healthy Ageing possible benefits
A protective effect into retirement
Increased physical activity, reduced long-term exhaustion and improved energy intake
Frailty progression
Prevention of fractures (for vitamin D and calcium supplementation)
Reduced hospital admissions and mortality
Potential Impact
In the North East and North Cumbria region, an additional 2,400 people could progress to mild frailty as a result of obesity, a further 2,400 due to smoking and nearly 3,000 more mildly frail people as a result of excess alcohol consumption.
Potential measures (examples of frailtyicare metrics)
People aged 65 years or over who have had a frailty assessment
Dementia: 65+ years old estimated diagnosis rate
Flu immunisation rate in people aged 65 years and over
Visit ‘evaluate’ on the Frailty ICARE website for regional metrics
Making it happen
To make change, implement delivery and realise benefits, we must invest in our people, teams and technology through knowledge development, sharing and robust evaluation. Across the North East and North Cumbria we are running a bi-monthly Ageing Well Community of Practice of support this approach
Visit ‘making it happen’ on the frailty ICARE website
