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 now passionate about bridging the health and social care divide by providing high quality education for domiciliary care agencies. I have seen the effects of long hospital stays in patients living with frailty and it is my mission to help carers help their clients avoid hospital by:
Recognising illness sooner so it is reversed quicker
Providing proactive personalised care to help people slow the progression of frailty.
In this article I will walk you through common causes of illness and delirium in older adults living with frailty.
Using a highly memorable PINCH ME mnemonic your carers will remember!
It includes a typical case study at the end. Feel free to share with your team.
#2: What is frailty?
#3: Can your team recognise illness in frailty?
#1: Why recognising illness in frailty is important
In the world of both informal and formal caregiving, recognising when a client is unwell is crucial. A key concept caregivers must be familiar with is frailty.
Frailty is a common condition among older adults and those with multiple chronic conditions, and it often presents in ways that can be subtle and easy to overlook.
Understanding the signs and common presenting conditions associated with frailty can empower caregivers to provide timely and appropriate care.
#2: What is the definition of frailty?
Frailty is now being used more as a diagnosis, rather than just a descriptive tool.
Frailty is a health state that describes the gradual loss of the body's reserves as people age. It's characterised by a number of factors, including: Reduced muscle strength, Fatigue, Slow walking speed, Low energy, and Vulnerability to adverse health outcomes.
Frailty can make people more likely to experience sudden increase in dependency in response to small events, such as a change in medication or environment. It can also increase the risk of falls, disability, hospital admission, and long-term care.
Frailty is more common in older people, with around 10% of people over 65 affected, and up to 50% of people over 85.
The Clinical Frailty Scale (also known as the Rockwood) is a tool that can help caregivers assess the degree of frailty in their clients.
This tool considers various factors, such as the degree of assistance a person over the age of 65 requires in carrying out their activities of daily living.
Why score "Frailty"?
The reason to score frailty is that it enables you to provide more personalised care based on the degree of frailty. For example people living with severe frailty have poorer outcomes if admitted to hospital, hence for this group it is important to have advance care plans that can help them avoid hospital if possible.
#3: Can your team recognise illness in frailty?
Clients living with frailty often present with conditions that may not be immediately recognisable as signs of illness. Here are some common presenting conditions to be aware of:
Falls and Mobility Issues
Falls are a significant concern for clients living with frailty. A history of falls or a fear of falling can indicate underlying frailty.
Factors contributing to falls include muscle weakness, poor balance, vision problems, and medications that affect coordination. Observing a client’s gait and balance, and noting any recent falls, can provide important clues about their health status.
Unintentional Weight Loss
Fatigue and Low Energy
Cognitive Decline and Delirium
Chronic Pain
PolyPharmacy
Frequent Infections
Taking action
Recognising these common presenting conditions in clients living with frailty is the first step in ensuring that they receive the appropriate care and support they need.
Caregivers should:
Conduct regular assessments to monitor for signs of increasing frailty and associated conditions.
Maintain open communication with clients, their families, and healthcare providers to share observations and concerns.
Create and follow personalised care plans that address the specific needs of clients living with frailty.
Encourage and support activities and lifestyle choices, such as balanced nutrition, regular physical activity, and social engagement, to improve overall well-being. In conclusion, understanding frailty and its common presenting conditions can significantly enhance the quality of care provided to clients.
By adopting a proactive approach and confidently escalating concerns and findings to healthcare providers, caregivers can help manage the complexities of frailty, ensuring that their clients live healthier lives and safely avoid hospital admissions.
#4: PINCH ME a helpful mnemonic to identify causes of delirium and illness in frailty#
Mrs. Smith, an 82-year-old woman receiving domiciliary care, was usually alert and oriented. However, her caregiver noticed a sudden change in her behaviour—Mrs. Smith became disoriented and agitated.
This is termed “hyperactive” delirium as there is increased agitation. The other type of delirium is “hypoactive,” where a person becomes more sleepy than usual (e.g., they may not want to get out of bed).
Using the PINCH ME mnemonic, the caregiver assessed the potential causes of delirium:
P (Pain):
Mrs. Smith had been experiencing chronic back pain, which might have worsened recently. She had been taking codeine regularly to treat this.
I (Infection):
N (Nutrition):
Mrs. Smith had not been eating well or drinking enough fluid over the past few days.
C (Constipation):
H (Hydration):
M (Medications):
E (Environment):
Based on this assessment, the caregiver contacted Mrs. Smith’s healthcare provider, provided the background of the situation and the urine sample, and a urinary tract infection was confirmed and treated. Codeine also caused constipation which in turn can increase the risk of a urinary infection.
Her pain medication was adjusted, and Mrs. Smith’s "hyperactive delirium" resolved, allowing her to return to her usual state of health and baseline. The effect of the codeine was documented in her care plan, and alternatives should be considered in the future.
#5 Transform Your Frailty Care Through Expert Training
The invaluable PINCH ME mnemonic for recognising causes of delirium is just one example of the accessible tools I use to teach frailty.
80% of successful care improvements come from investing in staff expertise, and it’s no surprise when empowered carers make better decisions for clients every day.
Is it time to rethink your approach to frailty training?
If you're ready to transform frailty care in your organisation, I’d love for you to explore my Upskill for Frailty Webinar Programme, designed specifically for domiciliary care agencies.
Special Offer: 1 month free, no obligation.
4 webinars per month, over 3 months we will cover the frailty core capabilities framework
CPD certificates for each participant after each webinar
Monthly agency-specific reports
Useful resources and digital downloads
Core Topics Include:
Understanding Frailty and recognising causes of illness early
Comprehensive Geriatric Assessment
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 highly experienced GP specialising in frailty, Chair of the Community Hospital Association, and passionate about bridging the gap between health and social care.
Here’s what participants say:
Loved being able to take part via chat. All the information provided on screen and of cause the host who was very Informative and did and excellent job
Direct & punchy
Good, clear advice given throughout
Informative and engaging – Dr. Kirsten explains topics clearly without rushing
#6 Register Your Agency here:
Once registered your agency will receive a registration code for your carers to join webinars at no cost.
Let me know if you’d like more information—I’d be happy to chat!
Warm regards,
Dr. Kirsten Protherough
💡 Unsure where to go from here? contact me to learn more:
Learn more about my frailty training and empower your carers to deliver exceptional care.
Or call: 07400808480
Call to learn more
Comments