Frailty score

Looking at the link to the Frailty Score, the icons do indeed appear to be all male!

I don’t have anything about fraility test on my app

Thanks Whiff, I mentioned it to the receptionist and was told to fill in the online form which I will do. I’m glad you got yours removed.

Clara talk to your practice and get it removed . Mine was nice about it and it was taken off as I talked to her . I checked straight afterwards and it had been removed.

I always check what has been written about me . This is the first time since I moved here in 2019 I have disagreed with what was written.

That's really interesting as I noticed last week that on 22nd January an entry had been posted on my NHS app by a doctor that I've never seen, it said Moderate Frailty. I've just reached 67 and can walk for miles, I do have a couple of health issues but they don't stop me from doing anything, I think I am fit. I am going to object to this as I think this entry has been put on in error.

Talked to the practice manager who had talked to the drs and the severe fragility and fraility index score has been taken off my medical records.

Which shows my practice does listen to their patients and acts on it . Can't fault the health care I get from them . Plus the hospital phoned yesterday and got an appointment at the stroke assessment and rehab clinic on Thursday. Spoke to my neurologist as well yesterday and upped my tablets to help with my stiffness in my limbs .
Brilliant result all round .

More likely to be institutionally helpless.

I did raise my eyebrows when I saw the first two questions on the Prisma test:

1. Are you 85 or over?
2. Are you male?

The rest of the questions were about mobility, needing help etc. But what has being male got to do with anything?

nurse shrugged.

I had an over the phone medication review with a clinician (no idea how qualified she was). When I checked the NHS app a bit later it said my pulse was regular! She must be psychic if she could check my pulse down the phone line! I asked how she could put that when I went for a blood test and the just shrugged. I’ve also been mixed up twice with other patients. Fortunately I found out in good time.

On 2 occasions I visited a consultant nurse and the entry on my NHS app began 'Patient speaking in sentences.' I thought it might be part of a Mental Capacity score?

Today none of these entries are available to me on the app!!!

The thing I discovered that I hadn't known before was a note diagnosing me as having "white coat syndrome" (ie, don't expect to get an accurate reading from this patient because she works herself up into a state of utter panic when she catches sight of a doctor). I'd always thought of myself as calm and co-operative, but there you go....
I think medics are having to tick too many "yes I've tested for this" boxes these days in order to satisfy desk-bound NHS advisers. Still, if your score is 0.361 and the lowest "pre-frail" score is 1, I wouldn't worry about it. Just take care of yourself, try to improve your strength & stamina and leave it at that.

Your figure is below frail.

I was described as an elderly prima gravida at 28 when I had my first child. It was the early 1970s and the average age of a new mother was 23. In the new town we lived in, it was even younger.

The midwife used the term and my comment was that I thought I would grow up before I had a child. The midwife looked towards the closed door to the waiting room, and said,' I wish more women would do the same.

Baggs

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 was classified as elderly prima gravida, think that's the spelling but basically elderly first time pregnant woman. I was 39 and it was my 3 rd baby. I was a bit gob smacked but apparently I was treated as a first timer due to a gap of 15 years. I wondered if you could be a born again virgin if you were celibate for long enough. Some time medical terms can be a bit mystifying.

I have no problem with being described as geriatric. That is an expression of a fact. Chronology is all.

Frailty indices seem to be based entirely on opinions or based on information that is incomlete and that is their weakness.

petra

Baggs

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.

Baggs
I think your second paragraph sums up the thinking of people who feel insulted by the truth.

I think geriatric is often associated with the word ward ie geriatric ward. Or geriatric doctor.

So it conjures up illness and frailty.

Its not about being insulted by the truth, it is about not being consulted or having a proper test done, just a category allocated that may well be incorrect.

I have no problems with having a frailty score, providing it accurately calculated and I am part of the process.

The other problem is that there are two different frailty indices being discussed on this thread.

One is the Rockwood index, which is defined in terms of physical condition and needs and does not discuss the causes.

The other is the eFI, which seems to be based entirely on what medical conditions you have, which is misleading because take something like diabetes, at one end of the scale someone may just be teetering on the edge and not need medication and at the other end may have severe uncontrollable diabetes that makes them very ill. It is patently clear that the level of frailty attached to those two extremes of diabetes would be very different. The same will apply to almost any other medical condition an older person will have.

But I still hold to my belief that, certainly at the start of the scale any score that has been made with out seeing and talking to the person being scored is not worth the compute screen it is shown on.

The other aspect is the accuracy of the medical records somene's frailty index is based on. My medical records show I have had two TIAs. In fact since that diagnosis the first one has been shown, quite unequivocally, to have been a misdiagnosis. The condition I actually had was quite minor and has since been treated so I no longer have it. Severe doubts have also been expressed as to the accuracy of the diagnosis of the second one, for very valid reasons I will not bore your with here.

Presumably any frailty index for me will include the misdiagnosed strokes in the calculation.

Baggs

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.

Baggs
I think your second paragraph sums up the thinking of people who feel insulted by the truth.

Although I find the NHS app extremely useful, there are some dangers in having access to some medical records without the underpinning knowledge to interpret them properly. I noticed something on a blood test result, did a bit of google research and discovered that I had reduced kidney function. As I take quite a few drugs that can affect my kidneys I was a little concerned. My daughter (NHS doctor) was visiting so I mentioned it to her, she looked at the result in question and laughed. Absolutely what she would expect to see in a reasonably healthy woman of my age. Rockwood 3, yup, can't be any higher as I have an issue with my heart, if I didn't I'd be a 1.
However, she did say something of interest to those of us who are no longer young. Doctors in A&E, ITU doctors etc look at how we present ourselves, our general demeanor and positivity or not. How well do we take care of ourselves etc It can be a guide to how well we cope with illness and surgery and can influence the way we are treated.

Yes, well said BlueBelle.

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.

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.

Bluebelle, what a sensible post.

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.