Chris Netherton, M.D.

Delivering integrated care for our frail, older citizens

The new initiatives being taken by the NHS to identify and manage frailty in older people represent a vital step forward for our healthcare system.

The success of modern healthcare is demonstrated by the fact that life expectancy in developed countries has been increasing steadily over the past century. However, with people living longer there is an increased likelihood that they will suffer from long-term health conditions that make it difficult for them to maintain active, independent lives. In fact, our medical professionals spend more time treating people aged over 75 than they do any other age group.


Medical professionals spend more time treating people aged over 75 than they do any other age group.

Over recent years, the NHS has taken steps to define frailty in older people and to put better care pathways in place for these patients. Frailty develops when there is age-related decline in multiple body systems, so it can be quite complex to assess and document.

Frailty makes people vulnerable to sudden changes in their health, which can be triggered by events such as an infection or a fall at home. People need graded care plans depending on their level of frailty. By doing this, we can help them to maintain their health and lead independent lives for as long as possible.

Frailty doesn’t happen overnight. It will typically develop very gradually over a 5 or 10 year period. The exciting aspect of this new initiative is that if we assess frailty properly and deliver a structured plan of integrated care, then we can treat the underlying causes of their deterioration and make patients much less likely to need hospital care.

As in many other aspects of modern healthcare, electronic medical records have a pivotal role to play in helping to put these new methods of care into action. As the NHS have highlighted, the electronic health record already contains much useful information that can be used to help compile a ‘Frailty Index’ to identify older people who are in a frail state and to grade their level of frailty. This can then provide a foundation for deciding what level and type of care is required.

At Microtest, we will be providing a tool to do exactly that, which will be made available during the summer. This Electronic Frailty Index (eFI) tool will allow GP practices to meet their contractual requirement to identify patients aged 65 and over who are living with moderate to severe frailty.

This is a great example of using the technology that we have to target those patients who need specific help and then intervening at a much earlier stage in the development of their condition. It also means that we will now be gathering significant amounts of data across the country on this condition, which can form the basis for evaluating the scale of the problem and the most effective strategies for dealing with it. If you can measure it, you have a much better chance of managing it.

It will be fascinating to see how this new approach develops over the coming years. The benefits for our older citizens could be huge.