ER-WCPT: Physios must change their view of frailty, says US expert

Physiotherapists need to start thinking about frailty as a long-term condition, and should be collecting evidence to prove they can help.


Jennifer Bottomley: 'Frailty is a long-term condition'. Photo: Darren O’Brien/Guzelian

This was the message from Jennifer Bottomley, an associate professor at Simmons College in Boston, USA, and president of the International Association of Physical Therapists working with Older People (IPTOP).

Speaking during a panel discussion at the ER-WCPT conference she told delegates: ‘We need to change our perspective on frailty. We should be managing it as a long-term condition, in the same way that we think about managing diabetes or COPD or any other long-term condition.

‘It shares key features of other long-term conditions, but it’s not routinely identified as a diagnosis in primary or secondary care and as a result it is an invisible condition.

‘But if we can define the condition of frailty and start using that term [diagnostically] then we can start to address it in terms of a preventive health and social care response, and consider proactive intervention approaches.’

Professor Bottomley suggested that possible interventions could include

  • identifying the risk factors for frailty and tackling it before it becomes an issue
  • screening and intervening
  • maintaining high functional capabilities in older patients
  • increasing home support

Delegates also heard about research findings that indicate that physical therapy could have a positive effect on frailty, although Professor Bottomley stated that research in this field is currently lacking.

‘A systemic review of studies in the Cochrane database relating to geriatric assessments has shown that identifying risk factors and addressing them early on improves rates of independence at discharge, reduces institutionalisation and decreases mortality.

‘And this clearly shows that any sort of episode with rehab medicine – such as physiotherapy or occupational therapy– has a positive influence on the outcomes of older patients.’

She urged physiotherapists to start collecting their own data by using the Evaluative Frailty Index for Physical Activity [EFIP].

‘This is a reliable and valid instrument to measure changes in frailty, and we could use it clinically to show that what we do influences the outcomes for our frail patients.’

Author: Robert Millett

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