Following my entry on the frailty project I was involved as a patient and public representative looking at the ways in which health professionals can try to integrate and work together to provide the best outcomes for frail patients, I have been thinking about how it relates to my role as an unpaid carer for my husband and mother.
I still believe that it is extremely hard to determine who is frail and who is not. Using geriatric guidelines for people who may only be in their 60s, like my husband, but whose degenerative condition (in his case, Parkinson’s) can lead to more falls and admission to hospital is not ideal. Staff, especially in hospital wards, quite rightly want training and definitive guidelines on how to deal with frail patients. But it cannot be a ‘one size fits all’ approach. I was amused during a long stay in hospital watching how the nurses and care assistants focused on people with grey or white hair, assuming that they would be the ones who were frail and needed the most support.
In the community, my mother continues to have repeated hospital admissions and calls an ambulance whenever she feels unwell. This is because she lives alone. Sometimes, she calls me, and although I live too far away to offer immediate assistance, just talking to her for a while stops her feeling frightened, takes her mind off her (almost always minor) symptoms, and avoids her calling an ambulance.
I understand that there is something called ‘social frailty’ which can often lead to physical frailty. Although my mother walks with a stick and rarely leaves the house without someone to assist her, I believe that her social frailty is often the trigger for hospital admissions, and not any physical illness. Since it has become impossible to see the same GP twice, I think this has exacerbated the problem. Some years ago she received a letter from the practice telling her she would be allocated a named GP and would be given priority for appointments as somebody they considered vulnerable. I don’t think that this ever happened!
Neither my husband nor my mother would describe themselves as frail. And so the term would have to be applied to them subjectively by professionals treating them. When I go out with either of them I have to be alert for falls and stumbles. This would seem to indicate that they are both frail to a certain extent, even though my husband is relatively young and my mother is 85. But my mother describes herself as ‘disabled’ and my husband says he is a ‘person with Parkinson’s’.
My husband has a friend from his Parkinson’s UK support group, who is a widower and lives alone. He has had several falls, with subsequent hospital admissions. Recently, he was told that he should look for residential care. He doesn’t suffer from ‘social frailty’ because there are lots of people, including my husband, who will pick him up and take him to concerts, theatres, and out for meals. It is when he is alone in his home that his physical frailty means he ends up with a hospital stay. And now, in his 60s, he will have to live with people 20 or more years older than him.
This is purely anecdotal, and doesn’t really help to guide researchers in what they need to do to put in place a strategy for frailty, I realise. I think that perhaps a wide range of studies (and the four I participated in covered very different issues) would help to develop an overall strategy. Maybe a national research project leading to national guidelines would help to some extent. But then it would be harder to tailor the care of people with frailty to their particular needs.
However, there is the issue of those people who slowly become frailer as they reach old age. This needs to be monitored by GP practices, where people are seen continually over the years. Just because a patient was fine in their 70s doesn’t mean that they won’t become frail as they reach their 80s. For people like my husband, whose illness is progressive, a better partnership between the GP practice and the consultant at the hospital would mean that the patient wasn’t being treated as frail too early, but frailty could be kept in mind as a possible outcome. And life changes –children moving away, changes in housing – should lead to an assessment to see if this had caused social frailty and thus a physical deterioration.
At the simplest level – as a carer I would urge those working in the field of frailty to look at how to work with people who are frail, rather than people who are elderly. The two are not exactly the same.
Message from Dr Melinda Taylor from the Data Science hub team
This is the final blog in our series on frailty. It is written by Vivienne Windle who was the patient and public (PPI) representative for the study that led to the blogs. Vivienne made an important contribution to our study and her reflections on frailty, presented in a previous blog and now this one, should be read by everyone working in the speciality. Many thanks Vivienne, from Melinda, Alex and Tom.
Download the final report HEEWessex-FrailtyStudy-FinalReport