Frailty
What is frailty?
Frailty is a common syndrome that occurs from a combination of de-conditioning and acute illness on a background of existing functional decline that is often under recognised. Many of the causes of frailty can be managed and, in some cases reversed to create better health outcomes and quality of life. It is therefore important to identify older people who are living with frailty.
How to identify frailty
Current health guidelines suggest that people over the age of 70 should be screened routinely. In Northern Sydney we recommend the use of the The Frail Scale to identify a level of frailty. A score of 1 to 2 indicates pre-frailty and a score of 3 or more indicates frailty. Frailty is more common in females, and the risk of frailty increases with age.
Identification and Management Quality Improvement Program
Then Sydney North Health Network (SNHN) invites practices to participate in the Frailty Identification and Management Quality Improvement Program (FIMQIP). The aim of the FIMQIP is to encourage and support general practices within SNHN’s catchment area to improve practice processes, resulting in better health outcomes for patients and provide sustainable quality improvement for General Practice. This will be achieved by identifying measurable and achievable key indicators within your practice setting.
View the “Frailty Management in Primary Care” Quality Improvement Toolkit.
How to manage frailty
Correctly managing frailty can significantly improve a person’s function and quality of life. It can also provide a better chance of recovery from acute illness as it reduces susceptibility to negative health outcomes.
Once you have assessed a person’s level of frailty (pre-frail or frail,) it is important to develop a management plan that addresses the corresponding sections of the frail scale.
This targeted approach can include:
- Referral to appropriate allied health professional such as a physiotherapist or dietitian
- Exercise classes
- Reviewing medications
- Managing weight loss
The decision support tool below provides more detail and some guidance for best course of action.
Frailty Management and Decision Support
Things to consider when implementing the Frail scale
Clinical Resources
The Best Practice and Medical Director templates
The Best Practice and Medical Director templates (.rtf files) can be imported to your software. These templates should not be opened and viewed before importing them. You will need to right click, copy and save or drag the .rtf file onto your desktop. Refer to the instructions below.
Frail Scale Templates for Medical Director
- Directions on how to upload templates
- Frail Scale for Medical Director (MD). To download, please Right Click and save link (clicking directly on this link will load the BP file into your web browser instead).
- 75+ assessment that includes Frail scale (MD). To download, please Right Click and save link (clicking directly on this link will load the BP file into your web browser instead).
Frail Scale Templates for Best Practice
- Directions on how to upload templates
- Frail Scale for Best Practice (BP). To download, please Right Click and save link (clicking directly on this link will load the BP file into your web browser instead).
- 75+ assessment that includes Frail scale (BP). To download, please Right Click and save link (clicking directly on this link will load the BP file into your web browser instead).
Other Resources
- Online Positive Aging Tool
- Suggested Management tool to accompany Frail Scale
- HealthPathways – Frailty Pathway
- Northern Sydney Frailty Initiative – Healthy Ageing and Frailty clinician brochure
- When Seniors Say No brochure
- Basic Steps (falls prevention program) resources order form
- Stepping On referral form
- Medication review for people living with frailty | Agency for Clinical Innovation (nsw.gov.au)
Evidence to Support Frail Scale:
- Asia Pacific Clinical Practice Guidelines for the Management of frailty
- Nutritional Interventions in Sarcopenia
- Effects of physical exercise interventions in frail older adults
- The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review
- Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
- Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting
- The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review
Referrals
HealthPathways – For detailed clinical referral , assessment and management information related to the Northern Sydney region visit Sydney North HealthPathways site.
(Log in details are required and if you do not already have these please email healthpathways@snhn.org.au and they will be sent directly to you.)
Geriatrician – To refer to a Geriatrician for a comprehensive geriatric assessment please use the following:
- Search for a Geriatrician via postcode on Healthshare Open Search
- NSLHD Geriatrician referral
- Hornsby Ku-Ring-Gai Hospital – Ph: (02) 9477 9514 / Fax: (02) 9477 5684
- Royal North Shore Hospital Campus – Ph: (02) 9462 9333 / Fax: (02) 9906 4301
- Brookvale Community Centre – Ph: (02) 9998 6120 / Fax: (02) 9979 7876
- Mona Vale Community Centre – Ph (02) 9998 6120 / Fax: (02) 9979 7876
Geriatrician Outreach to Primary Care – aims to increase Geriatrician input into GP-led patient planning and care in the community while building relationships and facilitating two-way learning opportunities. It works with GPs to manage complex patients and prevent conditions that may be at potential risk of deterioration.
Search for Allied Health Professionals in Sydney North
Please use this search tool for Allied Health providers in Northern Sydney listed with an interest in frailty as registered in the Primary Health Network, this includes pharmacists that can assist with polypharmacy review.
Exercise
Active and Healthy Frailty prevention exercise program options in NSW
ViviFrail – for professionals responsible for the prescription of a program of physical exercise
Progressive resistance training for frailty
For patients requiring individual exercise prescription, a physiotherapist or exercise physiologist:
Australian Physiotherapy Association: Find a physiotherapist
Exercise & Sports Science Australia: Find an exercise physiologist
NSLHD outpatient Physiotherapy referral information
Dietary advice
Home safety assessment and occupation therapy
- NSLHD outpatients
- Hornsby Ku-ring-gai Hospital Outpatients – Ph: (02) 9477 9493
- Northern Beaches Health Service – Ph: (02) 9998 6100
- Royal North Shore Hospital – Ph: (02) 9462 9666
- Ryde Hospital – Ph: (02) 9858 7888
Sydney Home Nursing Safe and Steady Program
Regal Home Health Ph: (02) 9264 4555 – Care coordination links to assist in conducting 75+ health assessments with patients
PalliAGED Frailty – Improving Care
https://www.palliaged.com.au/Improving-Care/Complex-Needs/Frailty