Frailty is a complex problem that usually requires multiple interventions. These interventions should target physical performance, nutritional status, mental health and cognition. There is emerging evidence that a person’s health assets - that is, the strength of their social supports, stability of their housing, their economic independence, level of education - could mitigate the effects of frailty.1
There has been little research into the effects of interventions on frailty in hospital; however, best practice suggests that healthcare professionals should consider the following actions.
Assess the patient
A comprehensive geriatric assessment can improve outcomes for frail older people in hospital, particularly when undertaken in geriatric evaluation and management units2. Most policy indicates that older people who are identified with frailty should receive one.
Ensure that reversible medical conditions are considered and addressed.
Explore their social circumstances to determine what existing supports can be harnessed to help them to manage their condition and identify where additional supports might be of use.
Know the risks and act
- Identify frailty in older people undergoing surgery, to manage the post-operative risk.
- Be alert to the development of delirium and the risks of incontinence, falls, pressure areas and malnutrition.
- Consider early transfer of patients with frailty to a subacute care setting.
Encourage regular mobilisation
Regular mobilisation can improve muscle strength, stamina and reduce the risk of older people experiencing adverse events such as pressure injuries.
- Encourage and where necessary assist patients to sit out of bed if possible.
- Encourage and support patients to mobilise, even short distances, around the ward on a regular basis.
- Refer patients for physiotherapy assessment and treatment and for exercise programs to maintain function.
Improve and maintain nutrition and hydration
Nutrition plays an important role in maintaining muscle mass and function.
- Encourage and assist patients to sit out of bed for meals.
- Monitor food wastage and encourage and assist patients to eat and drink regularly.
- Educate patients about adequate protein intake (leucine-enriched amino acids and possibly creatine) and vitamin D levels3.
- Refer any older person at risk of frailty to a dietitian
Encourage activities of daily living
- Encourage patients to get dressed each day if possible.
- Support and encourage patients to be as independent as possible in activities of daily living such as showering and dressing.
Educate patients, family and carers
- Educate patients and their family and carers about the factors associated with frailty.
- Tell patients, their family and carers how they can minimise the risk of increasing frailty while in hospital.
- Highlight the potentially modifiable risk factors – as outlined above.
- Engage patients in activities designed to reduce social isolation and involve carers and family in this process.
Refer to other professionals
If an older person in our care is frail or at risk of frailty, we should refer them to appropriate professionals as needed, for example:
- physiotherapist – for physical function assessment and intervention, including strength and walking
- dietitian – to assess nutritional status and treatment
- speech pathologist – for swallowing assessment and management
- occupational therapist – to assess activities of daily living and recommend treatment and home modifications
- social worker - for discharge planning and support and service coordination
- pharmacist – for a medication review
- Aged Care Assessment Service – for comprehensive geriatric assessment.
- Local councils, neighbourhood houses and libraries can link people to social activities that they might be interested in.
1. Gregorevic K.J., W.K. Lim, N.M. Peel, R.S. Martin, and R.E. Hubbard, Are health assets associated with improved outcomes for hospitalised older adults? A systematic review. Archives of Gerontology and Geriatrics, 2016. 67: pp. 14-20.
2. Ellis, G., M.A. Whitehead, D. Robinson, D. O'Neill, and P. Langhorne, Comprehensive geriatric assessment for older adults admitted to hospital: a meta-analysis of randomised controlled trials. BMJ, 2011. 343: p. d6553
3. Morley, J., W. Argiles, S. Evans, D. Bhasin, N.E.P. Cella, W. Deutz, K.C.H. Doehner, L. Fearon, M. Ferrucci, K. Hellerstein, H. Kalantar Zadeh, N. Lochs, K. MacDonald, M. Mulligan, P. Muscaritoli, M. Ponikowski, F. Posthauer, M. Fanelli, A.M.W.J. Schambelan, M. Schols, S. Schuster, and Anker, Nutritional Recommendations for the management of sarcopenia. Journal of the American Medical Directors Association, 2010. 11(6): pp. 391-396.