The rail against frailty

BY JANE DUNBAR

Feeling a bit low? A little bit frail? If so, it might be time for action.

We're used to the idea of the elderly being frail, even accept it as inevitable.

But frailty is something we can help prevent, or at least delay. And it's in all our interests that we do. It's in the interests of the young and middle-aged to build up reserves now to help fend off frailty in older age and it's in the interests of the elderly to fight off frailty as long as possible.

If we can hold frailty at bay, we can hold off steep declines in our ability to function. And it's that aim that is the focus of a pilot study being done through University of Otago, Christchurch research and Princess Margaret Hospital (PMH).

Claire Heppenstall is leading the study which will track 50 people for six months each. The study's focus is on people who are at risk of becoming so frail that moving to a rest home is a likely outcome. Once identified, the study's participants will receive intensive attention, aimed at keeping them in their own homes as long as possible.

"We know that older people prefer to stay in their own homes," Heppenstall says. "There was a recent study done out of Auckland that showed about 70 per cent of people who move into rest homes regret the decision and there are high levels of problems such as depression for rest home residents. So our aim is to try to support people to stay in their own homes and community."

Frailty is a key focus of the study because it's an indicator of the likelihood of rest home admission.

Heppenstall describes frailty as "a collection of conditions, but the effect is that people are left with limited reserve capacity to cope with problems or difficulties so that even a minor injury or change in social circumstances can lead to a catastrophic deterioration and collapse".

"There's a domino effect - one little tap and everything goes cascading down."

Five key features of frailty are weight loss, loss of muscle mass, feeling slowed down, feeling fatigued and decreased strength. Added into that are mental issues such as depression and dementia, and social circumstances, such as whether people are able to access help when they need it.

For the PMH study, participants are chosen from among people who have recently been treated at the hospital, and live relatively close.

On their return home from hospital, Heppenstall gives them a phone call to see how they are feeling. If they think their health is deteriorating, a multi-disciplinary team kicks into action.

"The idea is we pick up problems early and go in there with extra support," she says.

"In our work so far we've shown that people who feel their health is deteriorating after they go home from hospital have got a 50 per cent chance of moving into residential care within the next year. So what we're trying to do is for one of us to visit and do a comprehensive geriatric assessment - a general review of their physical health, their mental health and their social reserves."

After the assessment is done, a team - including a physiotherapist, occupational therapist and those who provide domestic assistance and personal care – get together to work out a care plan.

"There are several things that have been shown to help," Heppenstall says. "Exercise is key - anything from trying to take short walks to longer. We set goals of maybe just walking outside to start with; then going out on the street and increasing by one lamppost each week. We set achievable targets and do that in conjunction with a physiotherapist to make sure people are as safe as they can be. Tai chi is also very popular - that's been shown to improve balance and muscle strength. Water- based exercises are also very good.

"Then we look at nutrition. A lot of older people maybe aren't getting all the nutrients they need as they get frailer. We encourage a diet with a good range of protein and carbohydrates and some fats and plenty of vitamins. We also try to involve people in community activities; that's important, too."

Frailty is common among the elderly, particularly the over 80s. The likelihood increases with age, though some suffer from it earlier than others. There are people in their 60s and 70s who are frail; people in their 90s who do marathons. Generally though, as you get older you're more likely to develop conditions that lead to frailty.

The best way of delaying frailty is to concentrate on physical activity and diet, Heppenstall says.

"If you're physically active through middle age then you build up greater reserves, greater muscle mass, greater cardiovascular fitness so you start your older age at a higher base line to decline from."

Heppenstall's project, entitled Maintaining Independence, is funded by the Health Research Council.

If the study reveals that early home intervention can reduce the number of rest home admissions, the project could be rolled out across the city, she says.

"We could even do it in multiple cities and do it on a large scale and do a proper cost analysis for funding agencies."

Such work is critical for the future, she says.

"We are living longer so there is going to be a big growth in people aged over 80. There will also be a relative decrease in the number of people who are in fulltime work, so proportionately there's going to be quite a change in the balance between middle-aged and older-aged people. It's very important then that we look at ways of supporting older people."

As for recent controversy over Canterbury District Health Board funding of home help for the elderly, she says the changes are about trying to get more home help hours for the frail.

"The health board is reallocating home help hours to help people who need them to become more independent.

"The effect of that has been that some of the less frail older people have experienced a reduction in services.

"It's all done to fund this model of care of increased support for the frail."

- © Fairfax NZ News