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Clearing up the confusion over 'frailty'

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Frailty has become a focus for many clinicians and policy makers in recent years but the word is often poorly understood by both healthcare staff and people living with frailty, explains Dawne Garrett. 

dawn garrett

Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves both physical and psychological.

It is often described as not having the ability to “bounce back” from such things as infections or a physical trauma. It is important that frailty is not viewed as an inevitable or normal part of ageing but as a long-term condition.

The condition is complex and made up of a number of familiar syndromes including falls, sudden change in mobility, delirium, continence issues and susceptibility to side effects of medication

“Our role as nurses is to optimise the wellbeing of people who are living with frailty and to educate and support families so that they can plan for the future”

Whilst there is been a growing body of research internationally focusing on frailty, studies relating to the nursing contribution to the care of people living with the condition have been sparse.

In the nursing literature we have seen research investigating some of the frailty syndromes, notably continence and falls but many of these investigations have been outside the overarching diagnosis of frailty.

The lack of focus on nursing leadership and its contribution to the overall management of frailty is surprising particularly given the key role of advanced nurse practitioners in frailty assessment and the increasingly vital role of nurse leadership in the discharge from hospital of people living with frailty.

Our role as nurses is to optimise the wellbeing of people who are living with frailty and to educate and support the person and their families so that they can plan for the future.

It is welcome that The National Institute of Health Research (NIHR) Dissemination Centre has recently produced a themed review entitled Comprehensive Care - Older people living with frailty in hospitals (NIHR 2017).

“Engaging patients and their families in care planning reduces stress and more training is required to support use of the mental capacity act.”

This review features 53 studies funded by NIHR, which provides a roundup of the evidence around hospital based assessment, clinical interventions and discharge planning.

There are number of studies that have particular relevance to nursing and contribute to the body knowledge, for example a community appetite questionnaire now validated for the acute sector and a randomised controlled trial that is in the process of exploring whether high specification foam mattresses provide the same benefits as alternating pressure mattresses.

Other research affirms our tacit knowledge, for example engaging patients and their families in care planning reduces stress and more training is required to support use of the mental capacity act.

Hopefully this themed review will lead to discussion about the evidence base that informs our practice, and the way future studies could identify and articulate the unique role of the nurse in leading and delivering frailty intervention in all health and social care sectors.

The full review can be accessed at http://www.dc.nihr.ac.uk/themed-reviews/Comprehensive-Care-final.pdf

Dawne Garrett is the professional lead in the older people and dementia care nursing department at the Royal College of Nursing

 

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