1. Frailty Project Dr Maliha Chowdhury GP Fellow in Urgent & Acute Care
South Warwickshire Foundation Trust
Ley Hill Surgery, Four Oaks

2. Outline What is frailty? The Geriatric Giants Who should we screen?
Frailty index
My Project
What did I find?
How can we take it forward?

3. Let’s face the numbers 10million >65yrs (1)
increasing by 5.5million in 20yrs
Mortality decreased from 48% to 14% (2)
Women live 21 yrs extra, men 19yrs extra
NHS cost
£5,200 for retired households cf £2,800
Increasing cost of long term conditions vs declining resources/tight budget (3)

4. What is frailty? The statistics: (4-7) 10% prevalence >65yrs
Avg age 82yrs
20% prevalence in IHD/MI patients
Late presentations & in crisis often to secondary care with falls
>650,000 falls/yr to ED
£275 million/yr cost to NHS

5. What is frailty?
Clinically recognised state of increased vulnerability
Results from ageing associated with a decline in body’s physical & psychological reserves
Varies in its severity
individuals should not be labelled as being frail or not frail but simply that they have frailty.
The degree of frailty of an individual is not static
it naturally varies over time
can be made better and worse.
Frailty is not an inevitable part of ageing
it is a long-term condition like diabetes or Alzheimer’s disease.

6. Fit for Frailty – British Geriatric Society.
The Geriatric Giants
Immobility
Instability/falls
Incontinence
Intellectual/cognitive impairment
Iatrogenic/polypharmacy
‘Invisibility’
Fit for Frailty – British Geriatric Society.
Accessed on 13/08/15. URL:

7. Screening BGS: Two part assessment:
No evidence of health improvement in general population screening
However, National Audit of Community Rehab 2012:
1 or more LTC 77% frailty
2 or more LTC 41% frailty
Two part assessment:
Gait Assessment
PRISMA 7

8. Screening Gait speed: ‘Timed up-and-go test’ (TUGT):
taking more than 5 seconds to cover 4 metres
‘Timed up-and-go test’ (TUGT):
a cut off score of 10 seconds to get up from a chair, walk 3 meters, turn round and sit down
(exclude obvious Knee OA)

9. Screening

10. (Score of >3 is positive for frailty)
PRISMA 7
1] Are you more than 85 years?
2] Male?
3] In general do you have any health problems that require you to limit your activities?
4] Do you need someone to help you on a regular basis?
5] In general do you have any health problems that require you to stay at home?
6] In case of need can you count on someone close to you?
7] Do you regularly use a stick/walker/wheelchair to get about?
(Score of >3 is positive for frailty)

11. Frailty Index Recognising & maintaining a frailty register
Computer softwares:
Prediction of individuals At Risk of Readmissions (PARR)
Advanced Clinical Groupings (ACG)
Based on:
individual’s previous service use/admission
number of meds prescribed
diagnosis of certain long term conditions
Recognising at risk groups that we can’t modify anything

12. Project Findings 43 patients aged 82 Invited via telephone
Went through the proform on attendance
Deemed frail based on PRISMA 7 & Gait Ax

13. Project Findings 10 recognised as frail Drugs:
5 with 3 co-morbidities/LTC
3 with 2 co-morbidities/LTC
1 with 4 & 1 with 6 co-morbidities/LTC
Drugs:
33 non-frail on >2 drugs = 24
Frail = 6/10 >6 drugs, 8/10 >2 drugs

14. Forward Plans

15. Forward Plans Physiotherapy interventions (8)
20% reduction in falls after group therapy
15% decrease in falls risk after individual exercise programmes

16. Forward Plans STOPP START BZD, NSAIDs, SSRIs, loop diuretics
BZD, NSAIDs, SSRIs, loop diuretics
2 studies based in Ireland & Spain (Cahir et al, 2014; Mera et al 2011):
>50% of >85yrs old patients on inappropriate prescriptions

17. What are your suggestions?
Forward Plans
What are your suggestions?

18. References
The ageing population: key issues for the 2010 parliament. Accessed on 06/08/15. URL:
Office for National Statistics 2011b and 2013c. Accessed on 20/08/15. URL:
NHS England Risk Stratification. Accessed on 13/08/15. URL:

19. References
4. Primary Care Supplement, an index of frailty. Accessed on 19/08/15. URL:
5. Chartered Society of Physiotherapy. Accessed on 20/08/15. URL:
6. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. Journal of American Geriatric Society 2012; 60:
7. McShane M, Young J. ‘The frailty paradox’, The Long Term Conditions Year of Care Data RCGP Annual Conference Oct Accessed on 20/08/15. URL:

20. References
8. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (9).