TIME OUT ON LABELLING OLDER ADULTS AS FRAIL?

A PROPOSITION:

Labels and terms change over time, especially those used within the health and social care fields of professional practice and especially assessment. 

Here's a list:

• Catastrophic schizophrenia
• Feeble-minded
• "Homexulatity" as a disease
• Male/Female/Other Hysteria
• Identity disorder
• Idiot
• Imbecile
• Lunatic
• Vapours

It is interesting that many social workers and care workers in the past banded these terms about, particularly at meetings and in their case notes. This reminds me, of when I started my social work career back in the late sixties and well into the eighties we talked about those with whom we were working, as a Case!

The time has come to consider that the term Frail or Frailty be added to the list of obsolete terms and labels.

Frailty is classified as the medical condition of reduced function and health in older adults and hence patients are classified as Frail. Inactivity, poor nutrition, social isolation ( and God help me Loneliness) and multiple medications are among the predisposing factors and the symptoms that are deemed to warrant the term are:

• Falls
• Immobility
• Delirium
• Incontinence
• Side effects of medication 

 10 REASONS TO BE DOUBTFUL?

1. Frailty is associated with and feeds stereotypical images (mindsets) of clinicians and their teams who tailor their care to enable to help the individual to manage their "frailty"
2. It 'others' older adults and increases the stereotyping of them (me!)
3. Frailty is not binary. It is seen as a heterogeneous identity
4. The term does not capture the multifaceted concept of the so-called five Frailty syndromes
5. The degree of Frailty Indexes do not do justice to the variety  and complexities of the syndromes and thus the interaction between them
6.  There is a lack of clarity about the socio-economic determinants of functioning
7. There exist a (mis)balance between assets and deficits as determined by the Frailty Indexes
8. Coping with physical /psychological deterioration depends on resilience/ environmental and numerous other factors
9. Chronological age is too restrictive a factor to predict health status
10. The notion of frailty is in the eye of the professional beholder, not necessarily the individual labelled as such.

CHANGING THE NARRATIVE 

Not disputing the existence of the "conditions" that lead to the concept and labelling of Frail or Frailty applied to individuals or a whole section of an older demographic but the very term(s) exclude:

• Precarious conditions and the political context of Care
• The lifestyles of an older adult and their life course experiences and their perception of them/it 
• The issue of unmet need and the impact of reduced services ( eg Covid) and lack of access
• The terms are not attuned to the experiences of vulnerability and existential vulnerability

SO WHAT AM I SAYING?

To me, the term Frail and Frailty need to reflect and be underpinned by the notion of preciousness - the determinants of those conditions that constitute the label and thus the social conditions/environment and political systems which increase vulnerability.

The following quote says it all:

" The lens of precarity renders visible the extent to which frailty operates as a taken-for-granted practice based on an acceptance of individual and biomedical/functional interpretations.

It confronts how assessments are of frailty are constructed with the sole purpose of discriminating between needs and targeting service responses" *

 The label "Frailty" - like the term senility should become obsolete, it fails to acknowledge the moral imperative and ethical position with regard to care and later life. It fails to respond to and confront social justice. It is absolutely time to call it out! 

* See Liesbeth De Donder et al. Critical Reflections on the Blindsides of frailty in Later Life ( Journal of Ageing Studies. June 2019. pp 66-73

Ananda Grenier, Chris Phillipson & Richard A Settersten. Precarity and Ageing: Understanding Security and Risk in Later Life Policy Press ( 2020)