The ‘F’ word: Why we should break the stigma and talk about ‘Frailty'
By AAG members Dr Arti Appannah, Research Fellow at Bolton Clarke; Dr Ahsan Saleem, Research Fellow at Bolton Clarke; Dr Claudia Meyer, Senior Research Fellow at Bolton Clarke (and AAG President); and Dr Judy Lowthian, Head of Research and Principal Research Fellow at Bolton Clarke.
Too often, being ‘frail’ is misconstrued as being ‘weak’ or ‘dependent’. There is also evidence that self-identifying as ‘frail’ can also contribute to a ‘frailty identity’, which could lead to a loss of interest in taking part in social and community activities, poor health and increased stigmatisation surrounding ageing.1
Little wonder, then, that we often shy away from using the term ‘frailty’ with health consumers, in both research and healthcare settings.
Approximately 2.1 million Australians aged over 65 years are living with frailty.2 We know that frailty can result in increased vulnerability to illnesses, higher healthcare needs, repeated hospitalisations and a loss of independence.
Less well known is that frailty is preventable and can even be reversed, with the right interventions. These interventions are general principles of healthy ageing and can be easily done at home or with family and friends and in community-based group settings. They are:
- Physical activity;
- Eating well;
- Staying socially connected; and
- Keeping an active mind.
These simple messages could make a world of difference to individuals and their families. Despite its stigma, frailty does not have to be a normal part of ageing.
With this in mind, a research team embedded within a home care provider has developed a Healthy Ageing Fact Sheet covering these four key areas, with detailed information and examples of what can be done for ‘eating well’, ‘connecting well’, ‘moving well’ and ‘thinking well’.
The team advocated for this factsheet to be distributed to clients by frontline staff when conducting frailty screening. The team then administered a survey to the staff in order to capture the process and workflow of frailty screening and included some questions on whether the factsheet was useful. However, it was found that despite knowledge that the factsheet existed, the factsheet was not being distributed to clients at home visits. This may have been because of high workloads and challenges with access as the factsheet had to be downloaded from the intranet and printed at the staff’s own accord.
This brings about the question of how to best raise community awareness about frailty, its signs, assessment and healthy ageing strategies. Health professionals are well placed to do this, by talking about frailty and breaking the stigma. However, high workloads and the actual use of the word ‘frail’ may make it difficult to start the conversation. Furthermore, a potential limited awareness about frailty by healthcare professionals may contribute to the lack of dialogue about this condition.
An educational approach that targets both health practitioners and consumers is needed, but whether this should be through formal frailty training and/or through a community awareness campaign with media coverage are important questions to consider. A good example comes from Barcelona, where the Catalan Society of Geriatrics of Gerontology organised an outreach activity called ‘Move on against frailty,’3 which successfully raised awareness in older adults, the community and the media.
In policy and practice, frailty is an important topic that warrants attention. However, as individuals, we all play a role in breaking the stigma and talking about frailty, without the negative connotations.
1. Green, M.M., Meyer, C.M., Hutchinson, A.M., Sutherland, F., & Lowthian, J.A. (2022). Co-designing Being Your Best program – A holistic approach to frailty in older community dwelling Australians. Health & Social Care in the Community, 30(5). 2. Australian Institute of Health and Welfare. Older Australians 2021 [Available from: https://www.aihw.gov.au/reports/older-people/older-australians/contents/demographic-profile. 3. Inzitari, M., Ruiz, D., Martos, J., & Santaeugenia, S. (2016). “Move on Against Frailty”: Time to raise awareness about Frailty and prevention of disability in the community. (2016). The Journal of Frailty & Aging, 5(4), 201-203.
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