Research into frailty enables personalised care for older people
15 December 2020
Professor Andy Clegg explains how his research is helping slow down frailty, enabling people to live healthier for longer and bring greater efficiencies for health and care services.
We know more people are living longer, but not necessarily healthier lives. As people age, they are often likely to develop more than one long term health condition and become increasingly frail.
Frailty is a condition that is affecting more and more people. Nationally, frailty affects 10 per cent of people aged over 65, rising to 25 to 50 per cent of people aged over 85. In West Yorkshire, rates of frailty are higher than the national average.
The total additional UK NHS primary and secondary care costs for older people with frailty is an estimated £6 billion per year and this is likely to grow due to our ageing population.
Leeds is the third largest city in the UK. We have an ageing population of which the 65+ age group is projected to grow by over 15,000 (+13%) between 2016 and 2026. In Leeds, older people with frailty are estimated to account for over £100 million of health and social care expenditure. So, we need to better understand how our health and social care can help support people with frailty and reverse this trend.
I’m interested in research into ageing that studies important conditions in later life, for example frailty, delirium and dementia. My research looks at how to improve and personalise care for older people with these conditions. It includes researching what type of support people with these conditions need to help them retain their independence for as long as possible.
I am proud to have led the development, testing and national implementation of the award-winning and NICE-recommended electronic frailty index (eFI). Using data from the health records of around one million people in the UK, we developed a tool to identify patients who may be living with mild, moderate or severe frailty. The tool uses information on 36 clinical signs, symptoms, diseases, disabilities and impairments recorded in GP electronic health records to calculate a frailty score.
As part of my work with the Leeds Centre for Personalised Medicine and Health, we are now refining the eFI by adding additional information including those that describe mental health conditions.
So how does this help improve people’s health and support our health and care services?
The electronic frailty index helps us better understand people’s personal level of frailty and to know how to help them live well for longer. That includes finding ways to help them avoid having to go into hospital.
The most common reasons for people who are frail being admitted to hospital are because they fall or the medication they’re taking has a bad effect on their health. It’s also crucial that we understand what support they need when they leave hospital, appropriately tailored to meet their individual needs and preferences.
By exploring these issues through careful research, we can start to discover the answers and find ways to help people enjoy the best possible quality of life, whatever stage of frailty they may be facing.
A related part of my work for The Leeds Centre for Personalised Medicine and Health with a range of other partners involves studying the potentially harmful side effects of medications that are commonly prescribed to older people. These medications are used to help treat many conditions including chronic obstructive pulmonary disease (COPD), bladder conditions, digestive disorders, and symptoms of Parkinson’s disease. But they can also adversely affect people’s memory, walking, and bladder function, leading to side effects such as delirium (rapid onset confusion), falls and urine retention. Our research will show how that prescribing could be improved and personalised.
Our health and care partners are already doing excellent work in Leeds to better understand, prevent and treat frailty. They are working in specific local areas in Leeds to trial and test different interventions.
For example, even taking relatively simple, preventative actions, such as providing the right kind of help to prevent falls, to have an advance care plan, or to have health and wellbeing coaching, can help people stay well for longer.
As our research progresses we will be exploring ways to use it to support this preventative work by testing and evaluating it with our health and care partners in the community.
Ultimately, this will mean better, more personalised care for Leeds’ people, less strain and worry for their families or carers, and more targeted, efficient use of our precious health and care resources, here in Leeds and beyond.
Andy Clegg is Professor of Geriatric Medicine at the University of Leeds.
 University of Leeds, University of Liverpool, Bradford Teaching Hospitals NHS Foundation Trust (BTHFT), Leeds Teaching Hospitals Trust (LTHT) and the University of Bradford, comprising the Better Care North Partnership* (HDR UK North) initiative .
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