Since 2017, the NHS has been applying a frailty rating to the medical records of the over-65s, but the outbreak of the pandemic has meant face-to-face assessments have not been possible. This has led to the ratings being based solely on automatic scanning by a computer program.
The Electronic Frailty Index takes a number of factors into account, including the age of the patient, their weight, any health conditions they have and regular medications they’re on. It then assigns them a rating of fit, mildly frail, moderately frail or severely frail and it’s included in their medical records.
Many over-65s have not been aware of the system until they have noticed the assessment within their records when accessing them online. While the conclusions drawn by the Electronic Frailty Index program would usually be mitigated by face-to-face observations from a GP, coronavirus restrictions have prevented many in-person appointments.
This has led to some fit and healthy over-65s feeling that they have been misclassified as frail when they continue to live active lives. In the NHS’ definition of being moderately frail, it states that an individual with this classification is likely to “have difficulties doing outdoor activities, problems with mobility and need help with tasks like washing and dressing”.
Helen Knock, who is 71, was assigned a mild frailty rating under the system. She told the Daily Mail: “'I can walk further than a younger person and I look after and run around after two grandchildren, aged nine and 12. I am perfectly capable of cleaning, cooking and doing all the laundry and ironing.”
The NHS in England is the first health authority anywhere in the world to adopt a process of systematically assessing all over-65s for frailty. It is designed to identify people who may require intervention, which can range from falls assessments, medication reviews and additional information put into their summary care record right through to care home admission.
Usually, three further in-person assessments would be used alongside the Electronic Frailty Index before a classification was given. These are the Gait Speed Test, the PRISMA-7 set of questions and the Timed Up and Go Test, which take ability to walk and fall risk into consideration.
Professor Martin Vernon, former national clinical director for older people at NHS England, helped to set up the system for identifying frailty. He said: “It's absolutely crucial to get this right because wrong diagnosis of frailty could lead to wrong decisions being made.”
Frailty-related issues, which range from fractures to dementia, are a considerable challenge for the NHS as the UK’s population continues to age. At present, £6 billion is spent by the authority every year treating conditions associated with frailty and identifying those at risk is designed to help manage the situation.