Frailty is the term used to describe our bodies gradual loss of its inbuilt ability to recover quickly from an illness or injury. This leaves us more vulnerable to sudden, severe changes in health triggered by what would usually be a minor problem for most people. An infection, change in your medication or environment could have a much greater, long-term impact on your health and wellbeing if you’re frail.
Frailty is a term that’s used a lot, but is often misunderstood. It refers to a decline in our mental and physical resilience related to the ageing process. This impacts our ability to bounce back and recover from illness or injury. As we age, our body gradually loses its inbuilt reserves. This leaves us more at risk of sudden, severe changes to our health in response to an otherwise relatively minor health problem, such as a urinary tract infection (UTI).
Frailty isn’t limited to older people, but it does become more common the older we get. Around 1 in 10 people aged over 65 years have frailty. This rises to between 1 in 4 and 1 in 2 of those aged over 85. But frailty is not an inevitable consequence of getting older.
There's a range of factors which may contribute to whether you become frail or not. These include:
Frailty is different from living with a long-term condition or disability. Many people living with frailty don’t have any other health conditions. But many people with a long-term condition will also be frail. Frailty may be the cause of disability in some people and the consequence in others. Often people don’t see themselves as ‘frail’. Instead, they might feel that they’re ‘slowing down’ or change how they do activities as their physical abilities decline.
There are five ‘frailty syndromes’ – a syndrome is a group of characteristics, symptoms or conditions that typically go together. The following are considered ‘red flags’ for frailty.
Frailty is associated with reduced muscle strength – which can affect your ability to stand, your balance and grip strength. Fatigue can also be an issue; frailty makes you tired or feel like you have no energy. Even small amounts of activity can be exhausting.
Unintentional weight loss can also be a physical sign of frailty. This could be due to poor nutrition or as a result of the muscles becoming thinner or weaker due to being less physically active. Reduced muscle strength can also result in weakness.
Dehydration may also be a problem. This is for a variety of reasons – such as limiting your fluid intake to try and manage urinary incontinence, or if you don’t recognise that you’re thirsty or forgetting to drink if you have issues with your memory or experience confusion.
Other conditions can mask frailty. You’ll recognise that many of its symptoms overlap with those of MS. This means that frailty isn’t always picked up by health professionals as their focus will be on your MS.
There are three stages of frailty.
1. Mild frailty – this is when you recognise that you’re ‘slowing down’. You might need some help with everyday tasks such as preparing meals and doing the cleaning or laundry. You may feel unsteady on your feet, especially when you’re outside, and need support such as a stick or frame when walking.
2. Moderate frailty – this is where you find you need more help with more daily tasks, possibly including washing and dressing. It’s not unusual to have difficulty with going up and down stairs at this stage.
3. Severe frailty – this is where you become entirely dependent on others for help with all aspects of your care.
As frailty increases, you become more vulnerable. If you live with severe frailty you’re nearly six times more likely to be admitted to hospital than those who aren’t frail.
Your level of frailty can change over time. It may worsen, but it can also improve with the right care and support in place.
Frailty is not one single problem. Lots of factors combine together to cause frailty. There isn’t one key sign that would determine if you were considered frail or not.
It’s important that healthcare professionals look out for signs of frailty and conduct a proper assessment if they are concerned so that it can be managed well. The signs of frailty may be missed if they are overshadowed by another long-term condition like MS.
If you have concerns about frailty, the first step is to make an appointment with your GP. GP practices are required to identify and manage patients living with frailty as part of routine consultations. They may carry out an initial assessment themselves or refer you to another professional or service for assessment.
Health professionals usually assess frailty using clinical frailty scores or scales. This initial screening doesn’t usually involve extensive medical tests. The assessment establishes whether you’re experiencing any of the following:
There are limitations with this assessment as it may not fully take into consideration any coexisting conditions such as MS. Following your assessment, you will be identified as one of the following.
If you are identified as frail, it should be classified as mild, moderate or severe. You should also have a further, full assessment of your needs. This is known as a Comprehensive Geriatric Assessment (CGA). Despite its name, the CGA is also used in younger people with frailty.
The CGA should be carried out by someone with expertise in frailty. In some areas there are specialist frailty teams. It will look at your current symptoms and signs of frailty, along with your needs. It should also consider any other underlying medical conditions. The following areas will be assessed:
The following may also be assessed:
Following a CGA, you should be given a care and support plan (CSP). This should contain information on maintaining your health and function as much as possible and an ongoing care plan. It should also include what to do if you become unwell, and who you should seek support from and when.
Assessments for frailty should not be a one-off event. Routine screening is recommended, ideally this should be annually but may be less frequent if you’re at low risk of frailty or living with mild frailty.
A healthy, active lifestyle is one of the most important ways in which you can both prevent and manage frailty. Whilst ageing is inevitable, your lifestyle and wellbeing choices have a huge influence on how you age. Keeping your body and mind as healthy as possible not only reduces your risk of frailty, or becoming increasingly frail, but also lessens the impact of ageing on your MS. It is never too late to make some lifestyle choices that will influence how you age.
When you’re frail, if one symptom deteriorates, it often has a knock-on effect on other symptoms and can lead to a downward spiral. For example, if you’re struggling to eat a balanced diet, this can lead to weight loss and having less energy. If you’ve less energy you become less physically active. This can impact on your strength and walking speed. If you’re less mobile, your balance may worsen and put you at increased risk of falls.
If you’re living with frailty, it’s important to be proactive to maximise your health and wellbeing. Being aware of how deterioration in one area can have a knock-on effect on others is vital. Focusing on your diet, staying active, and maintaining balance, muscle strength and bone health are especially important.
There is evidence that suggests that both physical activity and diet can delay the onset of frailty, and reduce its severity. A 2020 review highlighted the potential benefits of physical activity including resistance training, aerobic exercise and balance-based exercises (such as Tai Chi). The same review also suggested dietary changes including increased protein intake and a Mediterranean diet rich in vegetables, fruits, cereals, olive oil and fish were also beneficial. The SPRINTT trial – a large, randomised study which reported in 2022 – found that regular physical activity combined with dietary advice, improved the mobility of people with frailty.
Although your physical health is important, don’t forget to look after your mental health too. Depression and anxiety are common in later life, especially in those who are frail. There are lots of self-management strategies to help manage your mental wellbeing. But if you find they’re not working, speak to your GP for support to manage stress, anxiety or low mood.
If you’re living with more severe frailty you may need to adapt how you live your life, and find new ways to manage day to day tasks. There are professionals who can support you and your family if you’re living with frailty. Ask your GP to refer you for support if you need it. For example, an occupational therapist can help with a care and support plan to meet your individual needs, based on your goals and preferences. This might include recommending aids or equipment such as supportive footwear, mobility aids or home adaptations. A dietitian can help you if you’re finding eating well a struggle. A physiotherapist can recommend exercises to keep you as active as possible. This might be simple strategies to keep you moving in the home, such as being able to get up and out of a chair or using the stairs safely, or an exercise programme that focuses on building your strength and balance.
Manage your MS, and any other health conditions, well by taking any medication as prescribed. But it’s also important to have a regular medication review as some can contribute to an increased risk of falls including diuretics, calcium channel blockers and ACE-inhibitors. Others can make you more susceptible to delirium, for example opiate painkillers and benzodiazepines.
Living with frailty or a long-term condition like MS can put you more risk of loneliness and social isolation. Both can have a negative impact on your mental health and leave you feeling anxious, stressed, low or depressed. Which in turn can have a negative effect on both MS and frailty. Try and keep in touch and maintain social relationships as far as possible to reduce your risk of loneliness and social isolation.
It's vital to ensure that any health professionals involved in your care are aware that you’re living with frailty. This can help them make sure you get the right treatment and support, especially in an emergency situation, for example an unplanned hospital admission.
How ageing can affect your MS (and what you can do about it) – blog exploring why ageing may affect your MS
Talking advance care planning – podcast discussing the process of thinking and having conversations about the care you would like if your health were to change in the future
Understanding frailty – information from Age UK
Frailty and ageing well – information from Cornwall Partnership NHS Foundation Trust
Frailty prevention: what is frailty? – information from Frailty Prevention: Ageing with Confidence
Frailty: identification and assessment – information from Hospice UK
