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Frailty and dementia

Over time, many people with dementia experience physical frailty. This is particularly true for older people, although it can also occur in people with young onset dementia (where symptoms develop under the age of 65). 

Understanding, recognising and managing frailty means the person with dementia can access the right care and support and have a better quality of life.  

The physical characteristics of frailty are: 

  • weight loss 
  • poor nutrition  
  • hydration issues
  • fatigue 
  • weakness 
  • reduced physical activity 
  • general slowing down 

As frailty increases, a person will steadily become more vulnerable and will find it harder to bounce back from illness, injury and changes in personal circumstances. 

There are three stages of frailty. 

  1. Mild frailty: the person will ‘slow down’ and need increasing help with everyday tasks such as meal preparation, housework and transport. They may be unsteady on their feet, especially outside, and need to walk with a frame.
  2. Moderate frailty: the person with moderate frailty will need help with all outside activities, all elements of housekeeping, and often bathing and dressing. They typically have significant difficulty with stairs.
  3. Severe frailty: a person who is severely frail will be dependent on others for full assistance with all aspects of care.

A person’s level of frailty can change over time and may improve or worsen depending on what intervention, care and support they receive. 

A syndrome is a group of characteristics, symptoms or conditions that typically go together. There are five frailty syndromes; if a person has one or more of these, it is likely that they are living with overall frailty. 

The syndromes are: 

  1. Falls 
  2. Immobility 
  3. Delirium 
  4. Incontinence 
  5. Susceptibility to side effects of medication 

It is important that healthcare professionals look out for signs of frailty and conduct a proper assessment so that it can be managed well. The signs of frailty may be missed if they are overshadowed by another long-term condition like dementia. 

If you have concerns about frailty, the first step is to make an appointment with the GP. They may carry out an initial assessment themselves or refer the person to another professional or service for assessment. 

Professionals usually assess frailty using Clinical Frailty Scores/Scales. These assess the person’s degree of fitness and frailty and classify it as mild, moderate or severe. 

If a person is identified as frail, they will typically receive a full assessment of their needs, known as a Comprehensive Geriatric Assessment (CGA). Despite its name, this assessment is also used for younger people with frailty. 

A CGA is a review of the person’s current symptoms and signs of frailty, taking into consideration any underlying medical conditions. It is carried out by a professional or team of professionals with expertise in frailty.  

The person with dementia and their family should be fully consulted and involved in the assessment process. 

The CGA is an assessment of the person’s signs, symptoms, and needs in a number of different categories: 

  • functional capacity: the ability to perform everyday activities 
  • falls risk 
  • cognition, including the person’s level of confusion, stage of dementia, and psychological symptoms 
  • mood 
  • polypharmacy: medications and their effects 
  • social support: who supports the person and whether the current level of support is sufficient 
  • financial concerns 
  • goals of care including the person and their family’s wishes around care and what is achievable 
  • advance care preferences: planning for the progression of the person’s condition and end-of-life care 

There may also be assessments of: 

Following a CGA, a care and support plan (CSP) should be formulated, focusing on: 

  • maintaining and optimising the health and functionality of the person living with frailty 
  • what to do if you or the person you support becomes unwell, including when you should seek help and who from 
  • making an ongoing care plan  

Sometimes, frailty syndromes such as delirium, reduced mobility and falls can mask other underlying illnesses. Knowing that a person has frailty – and ensuring that health professionals are also aware – can help to aid decision-making so they get the right treatment and support, particularly in emergency situations like an unplanned hospital admission.

Frailty is a long-term condition and typically worsens over time. However, some simple lifestyle changes may help a person with frailty function as well as possible.  

  • Look for ways to make the person’s home as safe and manageable as possible, eg removing trip hazards – you can ask social services for a needs assessment and home assessment to identify improvements or adaptations that may help
  • Make sure the person has regular health checks including blood pressure, hearing and sight tests to identify any problems that could lead to falls 
  • Support the person to eat a healthy, balanced diet and to stay well hydrated – this will help their overall health and reduce the risk of issues such as constipation and urinary tract infections (UTIs) that can affect continence 
  • Encourage the person to stay mobile and if possible, take exercise, as this builds bone and muscle strength. Seated exercises can be beneficial for people with frailty 
  • Ensure the person takes any medication as prescribed and attends regular medication reviews 
  • Make sure the person sees their GP if there are signs of illness, infection, pain or delirium 

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