Frailty

With an aging population, the number of people living with frailty is on the rise. Around 10% of people aged over 65 years have frailty, rising to between a quarter and a half of those aged over 85 years. People living with frailty have reduced resilience and an increased vulnerability, which impede their ability to recover from illness, injury or stresses.

Anyone working in Adult Health or Social Care will come into contact with people living with frailty at some point in their role and it is important to understand how this may affect the individual. As well as the local pathways, the below learning objectives have been based on the National Core Capabilities set out by Skills for Care.

Relevant Legislation

Mental Capacity Act

Resources

NHS Frailty Resources

Improving Care and Support for People Living with Frailty NICE Resources

Pre and Post Knowledge Assessment

HCPA have developed word documents which can be used as a guide for Training Needs Analysis of the different levels outlined in this framework. The questions in this document can be copied into other formats such as Microsoft Forms or Excel and are a guide to the type of information you need your staff to know.

Frailty Awareness Pre & Post Assessment (43kB docx)

Frailty Intermediate Pre & Post Assessment (42kB docx)

Falls Advanced Pre & Post Assessment (41kB docx)

Learning Objectives

Identifying and Assessing:

Identifying Frailty can be anyone’s responsibility. While a diagnosis is usually sought by a clinician, it is important for anyone regularly working with people living with frailty to be able to identify early stages and suggest referrals as needed. With this in mind, anyone in regular contact with people living with frailty will need to be trained up to Awareness level. 

Awareness

For all staff in regular contact with people living with frailty

  • Staff should be able to recognise the physical characteristics of frailty, e.g. general ‘slowing down’, loss of resilience, weight loss, poor nutrition and hydration, fatigue, weakness, reduced physical activity
  • Staff understand that frailty is a result of multiple health problems and that the affect it has on daily tasks is more important than the severity of each individual problem
  • Staff are aware that health and care professionals have ways of assessing frailty, which can help in planning appropriate care and support
  • People living with frailty are identified in a timely manner and receive appropriate interventions for their level of Frailty

Intermediate

For staff responsible in planning care and assessing frailty of people living with frailty.      

  • Staff take into account a person’s frailty level in planning healthcare or support interventions
  • Staff understand the importance of both proactive and reactive approaches to frailty identification
  • Staff are able to explain the need for an assessment of frailty with sensitivity and in ways that are acceptable to the person and appropriate to their communication needs. Staff can take into account that people may not like to recognise themselves as living with frailty and may be unwilling to acknowledge or disclose problems
  • Staff understand the importance of equal access to frailty assessment, e.g. for people from diverse communities or with specific needs (such as sensory or cognitive impairment) or learning disabilities
  • Staff understand reasons for caution about assessing frailty in a person who is acutely unwell
  • Staff understand the concept of a ‘frailty index’ as a means of measuring frailty
  • Staff understand that a person’s degree of frailty can change (up or down) over time
  • Staff are able to use relevant frailty screening and assessment tools in accordance with local policy such as Gait (Walking) Speed Test; Time Up and Go (TUG) Test; “
  • Staff are able to document assessment decisions and know what to do next
  • Staff understand one’s own role in initiating, contributing to, or referring on for a multi-disciplinary comprehensive and holistic assessment of frailty, often known as Comprehensive Geriatric Assessment (CGA)”
  • Staff have the skills to educate patients and their families living with frailty about their condition

Advanced

For staff acting as decision-makers in people’s care and acting as a final point of escalation within their organisation.

  • Staff are able to use relevant frailty screening and assessment tools in accordance with local policy such as PRISMA-7 Questionnaire; Clinical Frailty Scale also known as the Rockwood Score”
  • Staff are able to carry out a comprehensive and holistic assessment of frailty (e.g. CGA) in partnership with people living with frailty and as part of a multi-professional team 
  • Staff are able to act on the findings of a comprehensive and holistic assessment of frailty in partnership with people who have frailty, their family and carers and the multi-professional team
  • Staff understand factors contributing to frailty and can provide insight to the underlying causes and offer potential solutions to guide interventions
  • Staff are aware of the experience of a person with frailty and their family and carers and be able to communicate with sensitivity about the assessment of frailty and related implications 
  • Staff know how to enrol the person with frailty in post-assessment care and support planning and associated interventions
  • Staff are able to promote and evaluate approaches to frailty identification and assessment
  • Staff understand polypharmacy and how this can affect someone’s frailty level and increase risk of falls

Managing Frailty

These objectives are designed for staff working regularly with the same person/s living with frailty to support them in the ongoing management of their frailty. If staff do not regularly interact with the same people but do come into regular contact with people living with frailty, we would recommend them being trained to Awareness level so they can offer advice and guidance as needed.

Awareness

For all staff in regular contact with people living with frailty

  • Staff know that if recognised early, there are interventions to improve independence and quality of life for people living with frailty
  • Staff understand the importance of exercise, physical activity, diet and hydration for preventing and reducing the risk of frailty and know that factors such as smoking, obesity and inactivity can increase risk of frailty
  • Staff understand the risks associated with social isolation and the importance of social networks and communities for people living with frailty and their carers
  • Staff understand the positive and/or negative impact the home environment may have on people living with frailty
  • Staff are aware of and be able to access services such as health checks, free eye and hearing tests and home safety checks
  • Staff understand how physical and mental wellbeing relates to frailty
  • Patients living with frailty have their frailty taken into account in all interactions with health and social care professionals
  • People living with frailty have targeted intervention to increase their level of function, reduce or reverse their deterioration and prevent adverse outcomes connected to their frailty

Intermediate

For staff that will have regular contact with the same people living with frailty and who can support in day-to-day management of frailty

  • Staff are able to act on day-to-day interactions with people to encourage changes in behaviour that will have a positive impact on the health and wellbeing of individuals, communities and populations, i.e. ‘Making Every Contact Count’ 
  • Staff know how to effectively communicate messages about healthy living according to the abilities and needs of individuals
  • Staff are able to facilitate access to sources of health promotion information and support
  • Staff understand the importance of early recognition and timely management of frailty syndromes and understand approaches to prevent or reduce the risk of these and can give an examples of preventative measures to reduce risk of frailty
  • Staff are able to educate patients to manage their own frailty

Advanced

For staff acting as decision makers regarding people living with frailty’s ongoing care.

  • Staff understand the impact that a range of social, economic, and environmental factors can have on outcomes for people with frailty, their carers and their circles of support
  • Staff are able to facilitate environmental change such as thermal comfort, adaptations, or moving to new accommodation
  • Staff understand factors that may impact on the ability to make changes such as patient activation and health literacy
  • Staff are able to facilitate behaviour changes using evidence-based approaches such as motivational interviewing, health coaching and supporting self-management
  • Staff are able to promote population and community health and wellbeing, addressing the wider determinants of health and health inequalities and can collaboratively across agencies and boundaries to improve health outcomes. Staff understand health inequalities and how this may affect a patient’s level of care
  • Staff understand how to manage medication of those with frailty and assist patients to better understand their medication
  • Staff understand how to write a care plan for frailty in combination with the individual living with frailty

Legal

All staff that may come into contact with people living with frailty should understand the below learning objectives.

Awareness:

  • Staff know the laws surrounding frailty
  • Staff understand ethical issues that may arise with frailty
  • Staff know when and how to raise safeguarding
  • Research and evidence-based practice

Education Resources and Case Studies

British Geriatrics Society and NHS England developed e-learning packages relating to Frailty. If organisations choose to use these packages for training, they are responsible for ensuring that staff are compliant with the relevant learning objectives set out in this document.

e-LfH Frailty Programme Package

British Geriatric Society Training

HCPA have developed PowerPoint presentations and lesson plans in line with learning objectives cited in this document. If organisations choose to use these packages for training, they are responsible for editing content to be in line with organisation policies and local strategies.

HCPA Frailty Packages – Awareness. Click here (Coming soon)

HCPA Frailty Packages – Intermediate. Click here (Coming soon)

HCPA Frailty Packages – Advanced . Click here (Coming soon)

Supporting Case Studies – Coming soon

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