Assessment of frailty in Alzheimer's: a literature review
As the UK's older population continues to rise, the more likely it is for practice nurses to encounter patients living with Alzheimer's and frailty. Kirsty Smith and Sophie Wallington explore the definitions and models of frailty available in medical literature
As a consequence of an ageing global population, it is likely that encounters between health professionals and frail patients will rise. Patients with both suspected frailty and Alzheimer's disease are frequently encountered in primary care. There are links and overlaps between these disease states; however, the key theories and models of frailty propose some contradictions. This review of the definition, theories and models of frailty, and relevance to patients with Alzheimer's disease will add a quality, evidence-based approach to the assessment of frailty in patients in primary care living with Alzheimer's disease.
There are multiple definitions of frailty across medical literature, and despite more focus on this condition in academia, no consensus on frailty's definition or criteria has been agreed (Panza et al, 2011). The principal features of physical frailty include a decline in reserve capacity, characterised by an increase of adverse health outcomes such as falls, vulnerability to functional decline and disability, institutionalisation, hospitalisation, morbidity and mortality (Fried et al, 2001; Gobbens et al, 2010; Aarts et al, 2015). It is now accepted that these features can extend beyond the confines of age, with frailty no longer being limited to a ‘geriatric syndrome’ (Bonner and Lone, 2016; NHS England, 2017).
The UK's population is ageing and the Office for National Statistics (ONS) (2019) predicted that by 2066 there will be an additional 8.6 million people in the UK aged 65 years and over. While frailty and old age are not inevitably linked, it is widely acknowledged that one of the consequences of an increased life expectancy is an increased prevalence of older people living with frailty (Fried et al, 2004; Rockwood et al, 2006; Szanton et al, 2009; Royal College of Nursing, 2018). Indeed, NHS England (2017) argued that frailty is projected to be the most challenging aspect of ageing in modern healthcare.
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