Exercise and Frailty

Something you might want to try: Assessing strength and balance.

We know that physical activity can help people to maintain their functionality, independence, and quality of life, preventing and delaying some of the diseases which affect people as they age. The illnesses affected range from osteoporosis to cardiovascular disease and cognitive decline, as well as the syndromes which together can be described as frailty. Kidd, Mold, Jones et al, (2019) go further stating that physical activity interventions are the key to maintaining independence in pre-frail and frail older adults.

Older people tend to become less active – with 47% of people aged 75-84 being inactive, and 70% of those over 85 years. Over half of all inactive people across the UK are aged 55 and over.

Increasing physical activity has the potential to improve strength, decrease the risk of reduced bone mass, improve balance and overall fitness. Activity can also be an important way of reducing isolation and increasing well-being for older people. Improving strength and balance is particularly important to reduce falls, which are a common injury for older people and may lead to people no longer living independently at home. For advice about Falls Prevention from NHS Education for Scotland (NES) CLICK HERE

Evidence from NIHR suggests that a range of approaches may be effective in promoting exercise in older people, including both supervised exercise, from walking groups to dance classes, and behavioural approaches such as motivational counselling and tailored activity plans. They suggest that older people are more likely to keep exercising with group classes in a centre than through home-based activity. NIHR also suggest that there is a need for interventions that combine supervised exercise opportunities with an understanding of behavioural change principles as these are the most effective in increasing activity over time.

Increasing inactivity is also more likely in certain groups including women, smokers and those with a longstanding illness, depressive symptoms, arthritis, those who were obese, those with lower starting fitness or have weaker social networks. This suggests a need for more tailored approaches to get those people active. More effort also needs to be directed at these groups as they are the most likely to benefit and least likely to take part.

What Can You do to Promote Increased Activity

Firstly, you have to an awareness of what is available so the first issue to consider is “Are physically active social and group-based opportunities available for older people in your locality? If they are where are they and how do you refer people to go?

Secondly, this is a link to the Age Concern site “Being active as you get older” On the site is a lot of advice and links to other Age Concern resources that are designed to encourage older people to find the best way to keep their bodies moving. You will also find a resource designed for older people with one or more long term conditions called “We are Undefeatable” which is a good place to start. Note that if you follow that link you will also find Age Concern’s Falls Prevention advice.

Finally make use of the following acronym when promoting activity and reducing inactivity. F.I.T.T. This stands for start gently and build up your Frequency (the number of times per week you exercise) or Intensity (how hard you exercise) or Time (go for longer) or Type of exercise (e.g. build up from slow walking to brisk walking). Remember that the target is to get the person to be more active so any increase in activity no matter how it is achieved will be beneficial.

To help, here is something to try. It might not be useful for many people that you would identify as frail but anyone in a Pre-frail group may benefit from using this App. Its called iPrescribe and it creates a 12-week exercise plan based on health information entered by the user. It then sets the duration and intensity of the exercise based on this information. See https://www.nhs.uk/apps-library/iprescribe-exercise/

Some additional reading:

Academy of the Royal Medical Colleges (2015) Exercise: The miracle cure and the role of the doctor in promoting it. Available at: http://www.aomrc.org.uk/wp-content/uploads/2016/05/Exercise_the_Miracle_Cure_0215.pdf

Kidd, T., Mold, F., Jones, C. et al. (2019) What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials. BMC Geriatrics, 19, 184 doi:10.1186/s12877-019-1196-x

The Value of Social Support

In class yesterday we looked at the value of social support and the damaging effect of loneliness even without the addition of frailty. Social support is the perception and actuality that one is cared for and has assistance available from other people. It requires you to be part of a social network. These supportive resources include

Appraisal support: Information that is useful for self-evaluation; like what should I wear? Should I buy this?

Informational support:  Advice, suggestions, and information

Instrumental support: Tangible aid, for example lending or giving you money, help if you broke your leg, or a service like babysitting for you.

Emotional support: Expressions of empathy, love, trust and caring

Social support can be measured as the perception that one has assistance available, the actual received assistance, or the degree to which a person is integrated into a social network and/or their local community. Support can come from many sources, such as family, friends, pets, neighbours, co-workers or via external organisations.

Below is the Sway that we discussed in class which focuses on tackling loneliness

The BBC Scotland Documentary that was mentioned during the day was called the “Age of Loneliness” and was made in 2016. Its not currently available on the BBC iPlayer but there are many clips from it scattered across the internet. This is the director Sue Bourne discussing making it.

Living Well with Frailty

On the first day of teaching we looked at defining frailty and how you would recognise and screen people for it. What we didn’t discuss was why this is important. To make the effort worthwhile we need to know if frailty is amenable to prevention and treatment. The answer is YES.

Reducing the Likelihood of Frailty

So what can we do to reduce people’s chances of becoming frail? We know that “healthy ageing” reduces the risk of developing frailty. Healthy ageing involves ensuring

  • Good nutrition
  • That you don’t take too much alcohol
  • That you stay physically active
  • That you prevent obesity
  • That you remain engaged in your local community/ avoiding loneliness.
  • That Influenza and pneumococcal pneumonia vaccination is taken up by those identified “at risk”.

NHS England, in partnership with Age UK, Public Health England, and the Chief Fire Officer’s Association and older people themselves, have published “A Practical Guide to Healthy Ageing“. The guide is designed to help people to stay physically and mentally well by providing hints and tips on how to keep fit and independent. It recognises that there is always something that can be done to improve our own health and wellbeing. You can access the guide by clicking HERE

On the same page you will also find “Practical Guide to Healthy Caring“. This guide provides information and advice to carers about staying healthy and identifies the support available to help carers maintain their health and well-being.

What About People With Established Frailty?

The adverse effects of frailty can be mitigated by for example by:

  • Vision and hearing assessment and referral
  • Reducing people’s falls risk
  • Timely medication review can reduce risk of adverse drug reactions, drug interactions and non-compliance.
  • Strength and balance training
  • Assessment of home hazards and then interventions to reduce these
  • Using assistive technology as part of a menu of options in place to help people to effectively self-manage their long-term condition

(NICE, 2019)

A more detailed list of interventions that can be used by both commissioning groups and providers can be found in the NHS England Document “Compassionate care for frail older people using an integrated care pathway” which you can download from

https://www.england.nhs.uk/wp-content/uploads/2014/02/safe-comp-care.pdf

The interventions list starts on page 17 of the booklet and finishes on page 21.

You could also look at the information available from NICE onImproving Care and Support for People with Frailty” Click on THIS LINK to view.

Frailty Focus is a test campaign commissioned by NHS North Hampshire Clinical Commissioning Group which has a website for tackling frailty in their local area. There are areas of the website for healthcare professionals, the general public and carers/volunteers all aimed at enabling more of the local population to age well while planning ahead, discussing what matters most and ensuring they get the right care and support now, and into the future.

The Frailty Focus introductory video is below

This is the link to the projects main web page which you should explore and use with your own team

http://www.frailtyfocus.nhs.uk/