Journal scan

Care home nurses’ role in identifying frailty in older people

Ways in which healthcare professionals may be able to help and intervene

Ways in which healthcare professionals may be able to help and intervene

Exercise programmes can help physical function. Picture: iStock

Frailty is a condition in which an individual experiences losses in one or more domains of human functioning – physical, psychological or social. It affects up to 50% of people aged over 85 years. A combination of age, genetic and environmental factors contribute to a decline in multiple body systems leading to vulnerability to sudden health status changes, often triggered by minor stress or illness.

Identification of frailty is important because it may be reversible by identifying contributing factors.

Indicators of frailty are:

  • Falls.
  • Immobility.
  • Delirium.
  • Worsening incontinence.
  • Susceptibility to side effects of medications, for example, confusion with codeine or hypotension with antidepressants.

There are assessment tools, such as the PRISMA-7 where a score of 3 in a 7-item questionnaire indicates frailty and other tools, which include the time needed to stand up, walk three metres, turn and return to the chair.

Possible interventions

Three areas in which the care home nurse may be able to intervene are:

  • Nutrition.
  • Polypharmacy.
  • Exercise.

Malnutrition is common for many reasons including hormonal changes resulting in reduced appetite. Nurses should introduce individualised interventions that might include supplements, reducing polypharmacy, ensuring a comfortable eating position and environment, and presenting food attractively in manageable portion sizes.

Polypharmacy is common, with up to 50% of older patients taking more than four medications. This can lead to damaging side effects, which may themselves be treated by using further medication. Nurses should encourage medical reviews to help reduce inappropriate prescribing.

Nurses can also provide exercise programmes that can help physical function and reduce agitation in people with dementia.


Ruth Sander is an independent consultant in the care of older people

This article is for subscribers only