Is My Client Unwell?: your ultimate guide to recognising frailty and common presenting conditions in clients living with frailty

# Understanding Frailty in Older Adults: A Guide for Caregivers

Dr. Kirsten Protherough | Clinical Director & Lead GP, Upskill for Frailty

For years, I have worked with older adults living with frailty in community hospitals. I am passionate about bridging the health and social care divide. My goal is to provide high-quality education for domiciliary care agencies. I have seen the negative effects of long hospital stays for patients living with frailty. Therefore, I am on a mission to help carers assist their clients in avoiding hospital visits. Here’s how:

Recognizing illness sooner so it can be addressed quickly.
Providing proactive, personalized care to slow the progression of frailty.

In this article, I will guide you through common causes of illness and delirium in older adults living with frailty. We will use a memorable PINCH ME mnemonic that your carers will easily remember. Additionally, I will share a typical case study at the end. Please feel free to share this with your team.

1: Why Recognizing Illness in Frailty is Important

In both informal and formal caregiving, it's essential to identify when a client is unwell. Understanding frailty is key. Frailty is a frequent condition among older adults, particularly those with multiple chronic conditions. It often presents in subtle ways that can be easily overlooked.

Recognizing the signs and common presenting conditions associated with frailty can empower caregivers to offer timely and effective care.

2: What is Frailty?

Frailty is increasingly recognized as a diagnosis rather than a descriptive term.

Frailty is a health state describing the gradual loss of the body's reserves as people age.

It's characterized by various factors: reduced muscle strength, fatigue, slow walking speed, low energy, and increased vulnerability to adverse health outcomes. Individuals with frailty are more likely to experience a sudden increase in dependency due to minor events, such as medication or environmental changes. This can heighten the risk of falls, disabilities, hospital admissions, and long-term care requirements.

Frailty is particularly common among older adults, affecting about 10% of people over 65 and up to 50% of those over 85.

The Clinical Frailty Scale (Rockwood Scale) can help assess the degree of frailty in clients.

The Clinical Frailty Scale (aka the Rockwood scale)

This tool evaluates various factors, such as the level of assistance a person over 65 requires in daily living activities.

Why Score "Frailty"?

Scoring frailty allows for more personalized care. For instance, individuals with severe frailty experience poorer outcomes if admitted to the hospital. Hence, it's vital for this group to have advance care plans to avoid hospitalization when possible.

3: Can Your Team Recognize Illness in Frailty?

Clients living with frailty often exhibit conditions that aren't immediately recognizable as signs of illness. Some common presenting conditions to monitor include:

Falls and Mobility Issues

Falls are a major concern for frail clients. A history of falls or a fear of falling may indicate underlying frailty. Contributing factors include muscle weakness, poor balance, vision problems, and medications affecting coordination. Careful observation of a client’s gait and balance, along with tracking any recent falls, can provide essential insights into their health status.

Unintentional Weight Loss

Unintentional weight loss is a significant indicator of frailty. It may stem from poor appetite, swallowing difficulties, malabsorption, or increased metabolic demands due to chronic illnesses. Caregivers should regularly monitor clients' weight and remain vigilant for signs of reduced food intake.

Fatigue and Low Energy

Chronic fatigue is common in frailty and can arise from various factors, including anemia and heart failure. Caregivers should note any changes in a client’s usual activity levels, such as increased napping or reluctance to engage in activities.

Cognitive Decline and Delirium

Clients with frailty are more prone to cognitive decline and delirium. Delirium often arises from infections, medications, and dehydration. Unlike dementia, it has a sudden onset. Caregivers must be alert to confusion, disorientation, and changes in mental status and should seek medical evaluation promptly.

Chronic Pain

Chronic pain in joints and muscles is prevalent among frail individuals. Conditions like arthritis and osteoporosis can lead to persistent pain that affects both mobility and quality of life. Regular assessments for pain and its impact on daily activities are crucial.

Polypharmacy

Many frail clients take multiple medications, leading to potential interactions and adverse effects like dizziness and confusion. Caregivers should maintain an updated list of medications and collaborate with healthcare providers to optimize the regimen.

Frequent Infections

Frailty often leads to weakened immune systems, making clients susceptible to infections, especially respiratory and urinary tract infections. Recognizing atypical symptoms like fatigue or confusion is vital for prompt treatment.

Taking Action

Recognizing these presenting conditions in frail clients is the first step to ensuring they receive appropriate care. Caregivers should:

Regularly assess for signs of increasing frailty.
Maintain open communication with clients and healthcare providers.
Create and follow personalized care plans addressing the specific needs of their clients.

Encouraging balanced nutrition, regular activity, and social engagement can enhance overall well-being. Understanding frailty significantly improves care quality. A proactive approach allows caregivers to manage complex issues effectively, ensuring that clients live healthier lives while avoiding hospital admissions.

4: PINCH ME – A Helpful Mnemonic to Identify Causes of Delirium and Illness in Frailty

Mrs. Smith was disorientated and agitated

Consider Mrs. Smith, an 82-year-old woman who usually had a sound mind. Suddenly, her caregiver noticed a shift—she became disoriented and agitated. This scenario illustrates "hyperactive" delirium, characterized by increased agitation. In contrast, "hypoactive" delirium results in excessive sleepiness.

To address potential causes of delirium, the caregiver used the PINCH ME mnemonic:

P (Pain):

Mrs. Smith had been experiencing chronic back pain, potentially exacerbated by her recent medication regimen.

I (Infection):

The caregiver noted signs of a urinary tract infection, collecting a urine sample for lab analysis. Signs included a slight fever and frequent urination.

N (Nutrition):

Mrs. Smith had not been eating well or drinking enough fluids.

C (Constipation):

Inquiry revealed that she hadn’t had a bowel movement in three days.

H (Hydration):

A reduction in fluid intake had led to dehydration.

M (Medications):

Reviewing her medications, the caregiver noted that the recent introduction of codeine could have contributed to her symptoms.

E (Environment):

Mrs. Smith had also recently changed rooms, which might have unsettled her.

Based on this assessment, the caregiver contacted Mrs. Smith’s healthcare provider. The urinary tract infection was confirmed and treated, while adjustments were made to her pain medication regimen.

With the changes implemented, Mrs. Smith's "hyperactive delirium" resolved. She returned to her usual state of health, and the new medication's effects will be noted in her care plan.

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5: Transform Your Frailty Care Through Expert Training

The PINCH ME mnemonic is just one of the accessible tools I employ to enhance frailty education. Research shows that 80% of successful care improvements stem from investing in staff expertise. Empowered caregivers consistently make informed decisions for their clients.

Is It Time to Rethink Your Approach to Frailty Training?

If you want to revamp frailty care within your organization, consider my new 2 day Upskill for Frailty Train The Trainer Programme, tailored for domiciliary care agency Care Managers.

Special Offer: £375 for 2 day online course which includes a follow up 1 hour teaching observation and 30 minute feedback with yourself taking a session with your team.

Core Topics Include:

Understanding frailty and recognizing early signs of illness.
Comprehensive geriatric assessments.
Addressing health inequalities.
Dementia, delirium, and frailty.
Hydration and malnutrition strategies.
Managing infections: UTIs, chest infections, cellulitis, and more.
Advanced care planning.

I am a dedicated GP specializing in frailty and the Chair of the Community Hospital Association. My goal is to bridge the health and social care gap.

Participant Feedback:

"Loved participating via chat. The information provided was insightful, and the host did an excellent job!"

"Clear, direct advice was given throughout."

"Informative and engaging – Dr. Kirsten explains topics clearly without rushing."

Register Your Interest In the 2 Day Course by contacting Dr Kirsten Protherough at:

kirsten@upskillforfrailty.com

💡 Unsure Where to Go from Here? Contact Me to Learn More:

Learn about my frailty training programs and empower your caregivers to deliver exceptional care.

Or call: 07400808480

Happy to zoom, email, or speak on the phone