David Oliver: Frailty in acute care.

The National Institute for Health and Care Excellence recently published guidelines on assessing and managing patients with multimorbidity. 2 These placed distinct and welcome emphasis on frailty—adding momentum to several recent, professionally led good practice resources and guidelines explicitly highlighting the importance of frailty in community and acute care and showcasing services that work. Much nuanced research has been published on frailty as a clinical and physiological entity. It’s increasingly prevalent with older age but can affect people in their 50s. To oversimplify: two large schools of thought exist on how to characterise people with frailty. One is the “frailty phenotype” (with at least three of: slow walking speed, muscle weakness, unintentional weight loss, low physical activity, and self reported exhaustion). The other is an “accumulation of deficits” conception, where themore long term conditions or impairments someone lives with, the higher their frailty score or index. In either event, people with frailty tend to have poor functional or homeostatic reserve.When presenting to acute care, an illness episode, drug side effect, or metabolic disturbance, which might seem inconsequential in younger, non-frail patients, can present with steep and sudden functional or cognitive decline.