We’re only as old as we feel
Caring Times, March 2013
The assessment of older people’s fitness levels may become necessary in routine health and social care practice, argues an editorial published today in Age and Ageing, the scientific journal of the British Geriatrics Society.
European populations are getting older in chronological, but not necessarily biological, terms. Dr Roman Romero-Ortuno and Dr Diarmuid O’Shea, authors of the editorial, observe that the association between chronological age and health status is extremely variable and that decisions in health and social care based solely on age do not reflect the complexity of older people.
The Equality Act, which came into force in October 2012, gives older people the right to sue if they have been denied health and/or social care based on age alone. Instead, people should be clinically assessed on the basis of their individual needs and fitness levels. ‘Fit’ individuals are resilient whereas ‘frail’ individuals are vulnerable and have an increased risk of adverse outcomes, including iatrogenesis, functional decline and death. Frail individuals can benefit from specialist multidisciplinary care and interventions but require careful identification and management.
The authors highlight the challenge of determining where an individual sits along the fitness-frailty spectrum. They acknowledge that ‘fitness’ and ‘frailty’ are opposite ends of a challenging continuum and whilst experienced practitioners can (and often do) intuitively place their patients along that imaginary spectrum, this subjective ‘clinical impression’ of vulnerability may not be sufficient in the eyes of the Equality Act.
However, there is as yet no consensus, nor any official guidance, on formal ‘frailty metrics’ and the objective measurement of frailty has limitations (for example, some physical performance measures are unfeasible in the very frail). Dr Romero-Ortuno said: “The intuitive concepts of ‘fitness’ and ‘resilience’ often underpin decisions on escalation of medical therapy, as they safeguard against iatrogenesis.
“However, despite ongoing research efforts, the development and validation of frailty metrics is currently underdeveloped, compared to the clarity of concept and implementation speed of the equality legislation.
“Health and social care practitioners are in urgent need of easy and valid instruments for frailty assessment and now is the time for professional consensus on this complex matter.”
Dr O’Shea said: “Being able to place a person along the fitness-frailty spectrum independently of their age will become crucially important in the years ahead, both to advocate for resource and to target specialist care appropriately. Equality legislation should minimise instances of ageism and age discrimination but we need agreement on appropriate frailty metrics for health and social care to ensure that all individuals receive the most beneficial interventions.”