Frailty – A major cause of disability in the elderly and something that can be prevented

The recent royal commission into the aged care sector has found very clear findings that falls due to frailty is the highest cause of preventable death in the aged care sector. This is both sad news, that both this is a known factor that can be addressed and hasn’t, but from a positive perspective, is something that both Physiotherapists and Exercise Physiologists can play and implement a key role in preventing and reversing frailty in the elderly to help with both a long and high quality life. In fact, implementing a strengthening and balance program, such as the Sunbeam program for 6 months can prevent falls in the elderly by 55%.

At present, there is no direct funding instrument in the aged care sector that helps improve resident’s strength and balance, just funding for massage, electrotherapy, technical equipment of pain management, none of which improve strength and reduce the risk of falls (APA 2020).   The COVID-19 allied health package will provide limited funding to selected aged care facilities to run a falls prevention program for a limited amount of time, however this funding is temporary only, with no long term plans to continue such programs into the future, despite the clear and obvious benefits.

What is frailty?

Frailty is directly characterized as being weak and delicate, not being able to cope with adverse health events. In particular, it makes you susceptible to illness, hospitalization, disability and mortality. One big aspect, is sarcopenia, a loss of muscle mass as you get older (especially after 65), however and most importantly, frailty is NOT an inevitable result of getting older and can be reversed!!!!!! (Gill et al 2006).

The key to management of frailty is early identification (British Geriatrics Society 2017), with the following 5 factors the major indicators:

• Falls
• Reduced mobility
• Delirium
• Incontinence
• Susceptibility to medication side-effects

As a physiotherapist or exercise physiologist, we can use simple, standard functional tests to test for falls and mobility risks, such as:

• Gait speed – Measure of Mobility
• Four metre walk test – Measure of mobility
• 10 minute walk test – Measure of mobility and endurance
• Timed up and go – Measure of both mobility and falls risk
• Grip strength - Proxy test for overall strength, however, specific testing for strength can be added for the individual
• Balance assessment – Test for balance and falls risk

Management of the other 3 factors, delirium, continence and medication side-effects needs to be discussed and managed with your GP or specialists.

What can be done about frailty?

The first and most important start, is a structured and specific exercise and strengthening plan focusing on improving strength, muscle function, functional ability and cardio fitness. Physical activity and a structured exercise program are BOTH safe AND effective in managing and preventing frailty.

A great program should incorporate the following (Theou et all 2011):

• A combination of weight and resistance training – for building muscle mass and improving bone density
• Balance exercises
• Exercise programs should be conducted 2-3 times a week and should be difficult enough to be challenging, to encourage adaptation and growth, but be safe enough to minimize the risk of injury. This is where the professional knowledge of a physiotherapist or exercise physiologist is of great value. These guidelines are also consistent with American College of Sports Medicine’s recommendation for exercise for Older Adults (2009).

Other management strategies that should be implemented with the help of other professional disciplines include:

• Home environment modification – With the assistance of an occupational therapist
• Lifestyle changes and protein supplementation – With the assistance of a clinical nutritionist or dietitian
• Medication Review – With the assistance of the GP or specialist

Jovetic, M (2021) As Aged Care reform Quest Continues, Data Back Physiotherapy in Falls Prevention. Physiotherapy In Motion. P 37-42