Recognising the signs of frailty in someone with dementia

By understanding and recognising frailty, you can help a person with dementia to access the right care, reduce the risk of ending up in hospital, and support them in getting the most out of life.

Understanding and recognising frailty

Frailty is a term that’s often misunderstood. It’s used a lot when talking about elderly people, and can bring to mind an image of an older person who’s perhaps a little weak or unsteady on their feet.

However the proper definition of frailty refers to a person’s mental and physical resilience – i.e how easily they can bounce back from health problems, injury or illness. A person living with frailty can take a lot longer to get better.

There are a number of signs to look out for which could suggest a loved one is living with frailty –

• losing weight without trying
• poor nutrition
• poor hydration
• fatigue and tiredness
• weakness / loss of muscle strength or grip strength
• reduced physical activity
• general slowing down – one example from the British Geriatrics Society is taking more than 5 seconds to walk 4 metres

The British Geriatrics Society also notes it’s important to remember that frailty varies in severity (we’ll look at this in more detail below) and that it’s not an inevitable part of ageing. Instead it’s a long term condition in the same sense that dementia is.

The association between frailty and dementia

Frailty is common among people with dementia. In fact, a study into the prevalence of frailty published by the Alzheimer’s Society found that the risk of dementia is around 3.5 times higher in older adults living with frailty, than those without frailty. Alongside this increased risk, dementia itself can lead to symptoms such as poor mobility, poor nutrition and poor appetite – which can accelerate frailty. This is why it’s especially important to understand the signs and when to seek medical support.

What are the three stages of frailty?

The level of frailty a person may be living with can be categorised into one of three stages –

Mild frailty – At this stage, you may notice a loved one with dementia slowing down. This may mean they need more help with everyday tasks, especially things like cooking or keeping their home clean and tidy. You may also notice them becoming a little more unsteady on their feet, and they may start relying on walking aids to keep their balance.

Moderate frailty – At this stage a loved one will need support getting out and about and will likely struggle with stairs in the home. They’ll need considerable help with household tasks and some level of personal care, such as help with getting washed and dressed.

Severe frailty – This is the stage where a loved one will need full-time care and be dependent on others.

The 5 frailty syndromes

As well as understanding signs of frailty, it can help to know it’s ‘syndromes’. These are conditions or situations that indicate a person may experience an adverse outcome or prolonged recovery should they fall ill or experience a health issue.

If a person experiences one or more of these 5 syndromes, it’s likely they are living with a level of frailty –

• Falls
• Immobility
• Delirium (a change in a person’s mental state that happens suddenly)
• Incontinence
• Susceptibility to side effects of medication

Getting a diagnosis and the frailty score

Because dementia can cause similar symptoms as frailty, the signs of frailty can be missed or overshadowed by the dementia itself. If you have concerns about frailty it’s really important to raise them with your loved one’s GP. They may do an initial assessment of frailty themselves, or refer your loved one to a specialist.

Healthcare professionals usually use a frailty score as an initial assessment – looking at a person’s level of ability and fitness. However, for a diagnosis of frailty, your loved one will likely complete a Comprehensive Geriatric Assessment (CGA) by an expert in frailty. This assessment will look at things like–

• their ability to perform everyday activities
• how at risk they are of falls
• cognitive decline and their stage of dementia
• mood and behaviour
• their medications and any side effects
• their current support network and the level of support they need
• their goals and preferences for their future

Your loved one should be fully involved and informed in the assessment process, and you or other family members can be involved too. Getting a CGA assessment can be really useful for the future, as the experts doing the assessment will be able to draw up a plan on what to do if your loved one becomes unwell – leading to a faster, specialist response to better support their recovery.

Living with frailty and dementia

The nature of frailty means it’s likely to get worse over time. However, there are things you can do to support your loved one to live as well and independently as possible.

• As we’ve already covered, speaking to their GP and getting a referral for an assessment is really important to prevent or prepare for health problems in the future.
• Be mindful of their mental health. Frailty can have a profound impact on a person’s sense of self and how they think others see and treat them.
• Step into their shoes. A loved one may acknowledge that daily life has become more difficult, but may not consider themselves as ‘frail’. Approach conversations carefully and give them ample opportunities to direct how and where you can help them.
• Make their home work for them. Look at ways to make their home more accessible and manageable. We have a guide to creating a safer, dementia friendly home here. You can also request a home assessment from your local social services, and may be given an improvement grant of £1000 to help pay for modifications and specialist equipment.
• Keep on top of their health. It’s really important to spot illnesses or health problems early, which means keeping up with regular health checks with their GP or any specialists they see, as well as hearing and sight tests.
• Help them to eat and drink well. This is essential to reduce the risk of constipation or urinary tract infections – the latter of which can be really difficult for a frail person to get over. You can help in many different ways, such as batch-cooking healthy meals they can store in their freezer, popping in at meal times to eat with them, or doing their weekly shop to ensure they’re eating a balanced diet. A meals on wheels delivery could be a good option to look into.
• Encourage them to stay active. Strength training such as taking a 5 minute walk, swimming, and chair based exercises, can help a person with frailty to stay mobile and build bone and muscle strength. Before starting any new exercises, be sure to consult your loved one’s GP.
• Make sure medications are taken correctly. If your loved one struggles with their memory, a timed dosette box or pill dispenser could help. If you’re worried about any side effects of a medication, be sure to ask their GP for a review.
• Make sure your loved one sees their GP if there are signs of illness, infection, pain or delirium.