Frailty score

Is it such a bad thing to have on your medical records?
I’m thinking about medical/holiday insurance etc. Are we going to be expected to know what our score is and let the insurers know in the future? Could work both ways.

I wouldn’t be worried about a higher frailty score on my medical records, they might take better care of me!

growstuff frailty is a measurement of condition, not medical history. I do not have any symptoms of osteoporosis, it was found out because I am part of the UK Biobank sample and I was invited in for a baseline resurvey.

Frailty Group 1 (see the previous page of this thread) says ^ Very Fit – People who are robust, active, energetic and motivated. These people commonly exercise
regularly. They are among the fittest for their age^

Frailty Group 4 says ^Vulnerable – While not dependent on others for daily help, often symptoms limit activities. A common complaint is being “slowed up”, and/or being tired
during the day.^

I am far closer to group 1 than group4 and age does not come into it. None of my activities are limited. I have already told you that I can still dig over a potato patch and prune trees, standing on ladders wielding a pruning saw. I have no symptoms that limit my activities, nor do I feel tired during the day.

On the other hand I walk a lot, do heavy gardening, Tai Chi and other exercises on most days.

MOnica Whatever your definition of frailty is, I'm using the same one as the NHS. No way are you Category 1.

For me having frail on my medical records is an insult. I was born disabled I was not born frail. I have enhanced PIP for mobility and living indefinitely because I am disabled . Not because I am frail .
Hospice UK
Definites frail as falls,sudden reduced mobility,new or accelerated state of confusion ( delirium ), acute change in continence and sensitivity to a new medication..

Would you call a person who has had a limb removed or born without a limb or limbs frail, person in a wheelchair,a disabled athlete frail no of course not and yet they are all entitled to PIP.

You do not get PIP for being frail . Disabled doesn't mean incapable. Disabled people are not frail we have to find ways to do the things we what but our way. Frail doesn't mean you would get cheaper travel insurance infact it would make you uninsurable. Plus having frail on your medical records if you drive could mean the DVLA could take your licence away.

A couple of people on GN have meet me in person and they wouldn't call me frail nor me them. And you can have things taken off your medical records you disagree with it's called patients rights.

I can never be Category 1 because I have T2 diabetes and will have for the rest of my life. I manage the condition well and my activities aren't limited. Nevertheless, I have neuropathy and things are going on in my body I'm not aware of. Whenever I go into a hospital (and I've been quite a bit over the last couple of years) the staff make a note of my diabetes (and past heart attack) and monitor me a bit more closely. I really don't have a problem with that.

There is no way that you are as fit as a 20 year old with no medical conditions.

No Whiff it's not an insult. It's a realistic description of your condition. That's why you receive PIP.

As I wrote before, it's not a mark out of 10 for effort or some kind of contest.

You are disabled - therefore, you are frail and need a bit of extra care.

No, having frail on your medical records does not mean that you would have your driving licence taken away - unless you have one of the conditions on the DVLA site.

A person born without a limb would score 1 point for mobility problems. It's not judging you as a person, but assessing you for the medical help you need.

Our surgery is holding wellbeing appointments for older patients. One of the questions DH was asked was whether he felt there was nothing to look forward to.

growstuff

No Whiff it's not an insult. It's a realistic description of your condition. That's why you receive PIP.

Why on earth is it an insult? Is is a realistic assessment of your capabilities.
I hate being deemed extremely clinical vulnerable, and frail, but I am not insulted.

I think the problem here may be semantics. If I think of someone, who is frail, it does conjure up an image of a tiny old lady, hardly able to walk. Whiff, your fight to remain independent is admirable, but if you are receiving enhanced PIP, you must be deemed to need assistance to some degree.
It is not awarded lightly.
To fulfil the criteria for receiving enhanced PIP, you need to score twelve points or more. It is not easy to score twelve points. If you do, it indicates that you need assistance of some sort or other,
I speak from experience, I don't qualify for enhanced PIP, (although I have a Blue Badge), despite having multiple comorbidities, a DNR on my medical records and dexterity and mobility issues.

Initially, being deemed geriatric by a clinician at the age of sixty three, after my first hearted attack, felt insulting. It is in fact a medical definition, just like frail.

Fuming about it would be a waste of time and energy.

Whiff. You are over-reacting.

I posted the Rockwood scale back on page one. It is from the NHS England website. It says, it is the first health system in the world to systematically identify people, aged 65 and over, who are living with moderate and severe frailty.

As Marydoll says, it is question of semantics. However we may think about ourselves, at 65 we are considered old even though that adjective can be used to describe anyone from 65 to over 100.

It’s called the Frailty Scale but clearly someone classed as category 1 “Very fit” is not frail. Nor is someone in category 2 “Well” frail. Nor is someone in Category 3 “Managing Well” frail.

Then we get to category 4 “Vulnerable” - while not dependent on others for daily help, often symptoms limit activity - a common complaint being slowed up and or being tired during the day.

You have been classed as between 3 and 4. That sounds reasonable to me and would probably be the category that many people of pension age without any active serious illness but slowing up a bit with aching back and joints after just a few hours in the garden would fall into.

In a paper from the BMJ, they say The Rockwood Clinical Frailty Scale (first described in 2005) is a semiquantitative tool used to estimate an individual’s degree of frailty on a scale of 1 (very fit) to 9 (terminally ill). Patients who score a 5 or higher are considered frail.

If you look at the scale, 5 is “Mildly Frail”. These people have more evident slowing and need help in high order IADLs (Instrumental activities of daily living - finances, transportation, heavy housework, medication). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation and housework.

The instrumental ADLs are those that require more complex thinking skills, including organizational skills.

•Transportation and shopping: Ability to procure groceries, attend events, and manage transportation, either via driving or by organizing other means of transport.

•Managing finances: This includes the ability to pay bills and manage financial assets.

•Shopping and meal preparation, ie, everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.

• House cleaning and home maintenance. Cleaning kitchens after eating, maintaining living areas reasonably clean and tidy, and keeping up with home maintenance.

• Managing communication with others: The ability to manage telephone and mail.

• Managing medications: Ability to obtain medications and take them as directed.

The NHS makes it clear that the index is a risk stratification tool and not intended to be used as a diagnostic tool. I doubt a GP practice is going to be overly concerned about the risk to anyone classed 1-4.

Look again at the scale. Which of the categories from 1 to 9 do you think you fall into?

Thank you for your informed post, Silverbrook.

I was considered called a Vintage Mum(m) – 🥂– by a GP friend after producing DD3 shortly before my 45th birthday. Did I mind. I did not. I was still teaching Scottish dancing in my 39th week and still, according to the same chap, "the best dancer in Oxfordshire".

I think people who mind being 'geriatric' in medical terminology (I'm in that category) must actually feel older than they like to admit because if they felt pretty good for their age, as I do, why would they mind?

I really don't get why people are so hyper-sensitive, so quick to take offence when none is meant. The frailty scale is to help medics assess a person's needs. It's a tool they use. That's all. Take it or leave it.

I've been given a 3 on the Rockwood scale because I'm in my 70s with a well managed heart condition. In the year that I was assessed I was riding a fit dressage horse 4 x weekly, walking a dog on hilly terrain daily, doing two pilates classes weekly and was generally fitter than most people 20 years younger. I was initially a bit non plussed until I looked at how the scale was constructed. Tbh it's nothing to be concerned or annoyed about.

Whiff , the word 'frail' is an example of medical terminology. Medical terms are used in medical situations, when the same word would have different connotations in everyday situations.

For instance, if you get a new dog and it wees indoors you probably would not say it's incontinent, however in medical terms incontinent is what it is and if the dog can't learn to wee outside you take it to the vet to rule out a medical condition.

I think the worry with scales like these are that they influence medical staff when treating you and affects decisions they make.

When my father was first admitted to hospital at 92, the doctors and nurses were so gobsmacked at his really good physical appearance, fitness and mental acuity that they actually said we need to get you up and running as fast as possible so that you can get back home as soon as possible (because very old people in hospital can deteriorate very fast)

Later when the naure of his illness was realised, he was put forward for a pioneering new operation because of his actual fitness etc.

But throughout his stay in hospital, until he died. nursing and medical staff had a very positive attitude to his prognosis, which, I think, undoubtedly affected his care, not that other people were less well looked after, but nursing expectations of his capacity were higher so,he was nursed up to an expectation of recovery rather than cared for gently on an assumption of gradual decline.

With 'fraility' indexes, these have an assumption of 'failing health' running through them. They need a less value loaded word. They need also to be discussed with the patient and perhaps scored with the patient answering questions

I have come across the same problem with DH who suffers from heart failure. Here it was the nurse in the team caring for him who ws complaining about the term, because, as she said, with modern medecine and care, people diagnosed with this problem can live for a decade or more. She did not suggest an alternative, but I am sure one could be found

Whiff I can understand your annoyance at being called frail when for all your life you ve fought to be strong and independent and prove you aren’t held back by anything handed out to you at birth or beyond as you have obviously achieved so much against the odds and it feels like a real insult
But and there is a but
First of all remove your anger at the nurse she had nothing to do with your score she was just in post when you found out

Second let your anger go I like to think of myself as fit and strong and capable for my age I haven’t seen any score but I expect mine will say frail too as I m in the ancient bracket and have osteoperosis although I don’t see that as a problem I ve had cateracts done and a brush with cancer so all older persons problems
Lastly do be careful in your quest to get ‘frail’ removed from your notes it could be the very reason you get some of your extra benefits is it worth it to prove a point

Forget it, let it go, get on with being the strong woman you are

M0nica wrote: They need a less value loaded word.

Spot on because as I said upthread, the first four categories of Rockwood are not describing someone who is frail. Perhaps it would be better called the Rockwood Index, just as we have temperature (Fahrenehit, Celsius, Kelvin) and wind (Beaufort) scales names after the scientists who did the work.

(The Frailty Index (FI) was devised about 10 years ago by Doctors Kenneth Rockwood and Dr. Arnold Mitnitski working at at Dalhousie University in Canada.)

FI serves as a “proxy measure” i.e. is not in itself directly relevant, but it serves in place of an unobservable or immeasurable variable.

Proxy variables in other fields are, for example, Gross Domestic Product (GDP) to measure standards of living and years in education to meaure intelligence. Taking those examples, we know that GDP is applied to a country but standards of living within that country will vary from household to household. Similarly, intelligence doesn’t necessarily equate to how much compulsory and post-compulsory education someone has had. I am sure we can all think of intelligent, high-achievers who struggled with school and did not attend university.

One of the scientific papers published on FI says: This framework also allows a practical means of addressing a fundamental fact of old age, which is, as pointed out in a recent Nature commentary that its problems come as a package.

And they tend to, don’t they? Tiredness can lead to sedentariness which can lead to weight gain etc which all impact on general health.

But there isn’t a one size fits all e.g. the example of M0nica’s father, but as a general risk stratification I think FI serves reasonably well as a tool to assess a pensioner population of around 13 million people so long as it is not used negatively to influence treatment.

Bluebelle, what a sensible post.

Well said Bluebelle! Perfectly put.
Please don't get stressed over it Whiff - there's probably countless codes in our records that we never see, know nothing about but it helps medical staff to navigate our details all the more efficiently.

If you read the NHS guidelines for using the score, it's not intended as a diagnostic tool, but as a way of flagging up patients who could be at risk, especially in primary care.

GPs each have hundreds of people on their list. They can't possibly know all of them, so a computer algorithm uses information which is already available from codes generated when we visit a GP to calculate the score. As part of their contract, they should then do a sweep of all the patients who have reached certain milestones on the score - or changed quite quickly from one category to another. They should then look at their records and decide whether any further action is needed.

A few months ago, my practice did a sweep of all the patients with polypharmacy (ie more than ten items on a repeat prescription). It's a risk factor for some patients because they don't always know why they're taking particular meds and they can unwittingly cause side effects. I was invited to an appointment with the practice pharmacist, who went through everything and referred me to the GP because she was concerned that something was causing a side effect and could be treated differently. That wouldn't have happened if my score hadn't been flagged up.

We all know that GPs are stretched to the limit. Scores such as this one are a way of using information already available to highlight patients who might need further investigation to prevent further deterioration of existing conditions. GPs just don't have the time to go through all patients' records individually, so they use scores such as this one to help them prioritise.

Yes, well said BlueBelle.