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Nurses called on not to badge older patients as ‘frail’

  • 11 Comments

Using the clinical term “frailty” can provoke a strongly negative reaction from older patients, because of its associations with loss of independence and end of life, a report has warned. 

It found older people preferred to describe their needs in more straightforward terms, such as starting to struggle with things or being worried about their health.

The priority for those interviewed for the report was staying independent and they saw “frailty” as an irreversible state, entered into at the end of life and linked with severe lifestyle limitations.

“Health and care services need to re-evaluate their use of the word ‘frailty’”

Caroline Abrahams

The view contrasts starkly with the clinical concept of frailty as a condition that needs to be identified and diagnosed so it may be managed with appropriate support.

Older people were felt to be so put off by the words “frail” and “frailty” that their use might deter them from seeking appropriate support should they actually experience the symptoms of frailty. 

In many cases, those interviewed described the moment they needed to ask for help as “a major turning point” in their sense of wellbeing, and a real threat to their independence.

The research, commissioned by Age UK and the British Geriatrics Society, recommended avoiding the term “frailty” or “frail” when in dialogue with older people.

Instead, it suggested using language that promoted what can be achieved through a person’s healthcare, rather than assuming nothing can be done.

“The take home message here, though, has to be that no patient, no matter how old or dependent, is beyond help”

Adam Gordon

However, the report – titled Frailty: Language and Perceptions (see PDF top-right) – highlighted the vital importance of health professionals working with older people to signpost them to appropriate services.

Dr Adam Gordon from the British Geriatrics Society noted that frailty had been “embraced as a concept” by parts of the NHS to signpost multi-disciplinary services known to deliver better health for older people in later life. 

“If the patients we are seeking to help are put off by the very use of the word frail, then perhaps we’ll need to reconsider how we refer to such initiatives,” he said.

“The take home message here, though, has to be that no patient, no matter how old or dependent, is beyond help,” he said. “We have to find the right words to help our patients recognise this.”

Caroline Abrahams, charity director at Age UK, also suggested that healthcare services might need to “re-evaluate” their use of the word frailty.

“Frailty is all at once a medical term, an adjective, and a noun, but as the research shows for many older people it feels like a judgement,” she said.

“It would be better to focus on the factors that may be underlying someone’s frailty and find solutions that help,” she said. “This should also be reflected in how all professionals communicate.”

  • 11 Comments

Readers' comments (11)

  • A personal view: I found it profoundly disturbing and a 'major turning point' when I had to admit to my GP that I felt that my muscles were not going to be able to 'save me' from falling should I trip...the spectre of loss of independece danced in front of me! (Am in my 80th year, by the way - and still following what is going on in the world of nursing...)

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  • Pedro Stephano

    For me the term can strongly imply "worthy of extra care, observation, and intelligent assessment of risks eg falls"
    What's a good alternative word or phrase that doesn't conjur up negative feelings for the patient, but still identifies them as deserving of extra attention by the carers?

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  • Well said, PedroStephano.

    Thank you

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  • michael stone

    This is 'problematic' - I've read at least one paper, which uses 'extreme frailty' as an indicator of impending death (in the 'final year of life' sense of 'impending').

    But medics do know that patients often object to being described as 'frail', and/or dispute that they are frail.

    We could - very easily - get into another one of those situations where clinicians are 'using an obfuscatory label' and that serves to seriously complicate lay-clinical conversations.

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  • They ARE frail! It's not an insult it's a fact. Ridiculous.

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  • Like everything else in life, you can't 'tar everyone with the same brush'. there are a lot of terms that are derogatory, for example 'bed blockers, etc...). Shouldn't we be asking the public, instead of putting our own opinions on them. Many older people become frail, short term, due to whatever admitted them to hospital. But their aim will hopefully to return to their independent life they enjoyed before. I think many remain 'frail' with the lack of support and encouragement after discharge. Before I get criticised for that comment, I realise the resource difficulties in the community. let me give you a recent example. A lady, who is very mentally astute, with some limited mobility, has recently fractured her shoulder. This wasn't due to a fall, but a computer chair she was sat on that flew into a door jarm when she tried to get up. With only one arm she struggled at home, so was sent into respite. With no encouragement to get up and keep some independence, she languished resting on the bed, without realising the possible of the consequences. She now has a raging UTI, hospitalised and hardly rousable. This should have been avoided. If older people are not managing at home, in the short term, then strategies should be employed to maintain their independence, and not lead them into the life of dependence or even death

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  • Frail may be interpreted as fragile. Frail may be interpreted as being unable to cope. Frail may be interpreted as being a burden. Frail may be interpreted as not being trusted with control of their life. Frail may be interpreted as loss of autonomy. Frail may be interpreted as a sign of dementia. Frail may be interpreted as a sign that they should give up or others have given up on them.

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  • michael stone

    Anonymous | 25-Jul-2015 1:48 am

    I agree with you.

    But there is something, that seems to me to be problematic in connection with some elderly people. I have come across quite a few instances, when (to use my phrase) 'Granny was quite fit, she had a fall at home, was taken into hospital, and we expected her to be back home in a week: but she was dead inside a week'.

    I think it is true, that elderly people can often be much more 'fragile' when struck by injury or illness than younger people: I'm not convinced, that all family and friends understand this. So unless hospital staff, etc, explain that to relatives (explain that the elderly can sometimes go from 'seeming to be quite healthy' to 'irreversibly dying' quite quickly, and that sometimes nobody can do anything to prevent that), some of those bereaved relatives end up believing that 'granny died, because the hospital didn't care for her properly, and they were not bothered'. I think a few of the bereaved, conclude that 'they set out to kill granny' when that happens, and it isn't being properly explained to the family, while granny is deteriorating (it is no good, trying to explain it after granny has died: if the staff do that, then some relatives 'see that as part of a cover up').

    That isn't at all good, when it happens - it really makes the bereaved family 'distrust/blame the NHS'.

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  • Some areas are killing off granny and categorising people as frail may aid and abet these erroneous people.

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  • So is this saying that an older person seeking help/admitted to hospital is being told "You are frail?" Where do they get the idea from that they are being labelled as frail? I would be very insulted if somebody said that to me. Even if I WERE frail.
    When I need to point out to my patients that they are becoming less robust, I usually say something like "With respect, you're not 21 any more...we just don't bounce back from things the same as we did when we were younger". As I'm 61 myself I can use the word 'we' without sounding patronising.
    It's like the difference between 'old' and 'elderly'. My mother taught me that 'old' was rude, 'elderly' was polite, just as 'woman' was considered rude but 'lady' acceptable. The way words are used changes. If I live long enough I will become old. Heaven forbid that I should ever be 'elderly'. And if I do become 'frail', I don't want somebody rubbing my nose in it.
    It's fine for us to use the word amongst ourselves, professionally and descriptively. But I wouldn't dream of using it to a patient.

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