UKH

A while ago I noticed that my NHS records included a clinical frailty score.  When I checked what it meant I was mildly outraged to realise I was considered to be 'mildly frail', despite never having had any of the physical tests required to make the assessment.  I only just missed a 'fit' score, but still, given the level of physical exercise I can comfortably manage, I wondered how this score had been arrived at, and who by.

Then, the other day, I heard the first of the van Tullikan brothers' new series of "A thorough examination" on R4, which included a discussion about how easy it was to convince yourself that you are fitter than you really are.

In particular, they discussed a frailty test, involving getting into a standing position from sitting cross-legged on the floor, without using your hands to push on the floor or your knees...

https://www.bbc.co.uk/sounds/play/m001w171

20 seconds in.

Now, this seems to me a significantly higher bar than the usual tests, which include getting out of a chair without needing to use your hands, or how long it takes you to walk 10 metres! I can do it, after figuring out a technique that works for me, but it strikes me as a pretty stringent measure of frailty!

Just be grateful you're not dribbling down your bib. If you can still do the things that are meaningful to you then I can't see how some arbitrary number held in an obscure database is a problem. I know for sure that the last few years have seen a downturn in my physical health but I'll just continue to try and dodge the undertaker. I'm now a year older than my dad when he died so every day's a bonus!

It seems bizarre for your records to include an individual 'score' that isn't based on any kind of individual assessment.  I wonder where it comes from.

Well of course you would say that if you think you're fitter than you are.

Does time taken to get into the start position count?

Edit. Seems a bizarre test, as it's purely technique and balance rather than doing the most efficient movement to stand up.

That's a frailty test?  I can't do that because I'm a fat git, not because I'm what I would consider frail.  Frail to me means easily breakable and weak, and given that I went flying (landing quite hard) while walking down Devil's Kitchen on Saturday with no lasting effects bar embarrassment (fat backside probably helped a bit to soften the landing) and am just about strong enough to haul my 22 stone of lard up a climbing wall I don't think that indicates frailty.

That's an interesting point.  The last time I was flexible enough to sit "properly" cross legged I was about 5.  But I could probably get that back with a bit of regular stretching to improve hip flexibility, so that's not really frailty either?

Also seems more swayed towards females. My young and fit husband in his mid 30s struggles to sit cross legged, let along get up hands free. My mother in her late 60s can do it fine. Female hips tend to be more flexible due to basic body shape. I can do it no bother ☺️

Bizarrely I can (just about) "Asian squat" but I can't sit crosslegged.  It just varies I guess based on what flexibility you tend to use.  I guess it's because climbing involves repeating "squat and stand up" type movements but it doesn't involve moving the knee out in the way sitting crosslegged does.

But I don't see what flexibility has to do with frailty, the terms don't seem to fit together to me.

I think this needs to be thoroughly investigated, at about 2am on a well lubricated club meet.

"Mildly frail" means "more evident slowing...Typically mild fraility impairs shopping and walking outside alone, meal preparation and housework".  That doesn't sound like someone whose logbook shows them leading 6a only a few months ago.

https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2022/02/rockwoo...

I would query it with your GP. I suspect they may have got your records muddled with someone else's. What else might they have got wrong? It matters because it may influence what treatment a doctor (who may not be your regular GP) decides to give you. 

That’s very interesting. Where did you find it… was it via the NHS app? Prompted by your post I just had a good trawl around my records on the app but other than a long list of my Covid and flu jabs I couldn’t find anything related to a frailty record and being well on my way to my ninth decade I might have forgiven them for a random stab at it; notwithstanding that I am lucky enough to have no medical problems that I’m aware of.

I've never been able to sit cross-legged, and that includes the period (long ago) when I was running competitively in AAA's finals. For that matter just about all my competitors back then would have failed the same test for the same reason - not even able to do it.

Mind you, I also remember another little medical snippet; the ENTIRE English Rugby Union squad at a World Cup were officially obese, including the half-backs.

I'd love to know where some of these medical "assessments"  appear from.

It was a tough 6a too! I had to cheat on my first go, and I'm at least a decade less frail than Dave.

Dave's ego isn't even frail, or at least he deals with not being able to climb things he could in his younger years much better than I do!  

We're not doing naked oiled twister again, are we?

Any and all forms of lubrication would be appropriate, I feel.

I had a quick look for the NHS frailty test and it bears no resemblance to the somewhat nonsensical R4 one. I tend to mistrust anything I hear on the BCC these days, particularly of a technical nature. Why you have score never having been tested is a more serious matter that I'd pursue with my GP practice.

That's classic misuse of BMI, which was designed for population statistics, not individuals.

Meanwhile another patient is being told that they certainly can't have a disabled parking pass because they can climb 6a...

I think you might have missed the point on the BBC Sounds podcast. I understood that 'frailty' in this series is about how you can get up from the floor, because it has implications for whether you can get yourself up and out of a chair once you are elderly and your arms cannot support your body weight. This relates to your care requirements later in life. So it does also mean balance and technique and not just strength. 

You prompted me to google it - this sheds a little light perhaps, admittedly not much: https://www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/fra...

"The eFI is a risk stratification tool and not intended to be used as a diagnostic tool.
Confirmation of frailty in an individual should be undertaken using a validated tool such as:"
(Goes on to list the NHS tests you've probably already found.)

Obviously Radio 4 doesn't have an official frailty test BTW, and one of the Van Tulleken Brothers making a comment about something on the radio does not mean that thing is official BBC policy! 

Not surprised. Sadly, from real life experience I'd say one of the brothers is a decent guy and the other is an absolute c**k who thinks the sun shines out of his backside because he's been on the telly (and on occasion has interfered/derailed patient care in specialisms he knows nothing about, but is very charismatic so gets his way) and believes he's *the* expert in every medical specialism. So if he thinks frailty score is based on doing a breakdance head spin he probably wouldn't check the facts or listen to anyone on the contrary. Treat them as medical themed entertainers, at which they are very very good. But don't take any specifics as gospel.

For legal reasons I can't say which was which in that comment or whether I really meant the van Tullikan brothers at all. No, I must be thinking of some other doctors, sorry disregard my fantasy nonsense.

Edit: if someone can standing strict press a barbel from chest to straight arms above head that is approx. their own bodyweight - are they still "frail" if they have large hamstrings and quads from years of squats and deadlifts and can't stand up from cross legged without some help from hands as they struggle to get heels back towards bum enough to do that manoeuvre. This test makes me frail?  It's a weirdly very specific test to declare frailty

The NHS test I find very easy and straighforward, the BBC one impossible without some assistance from the hands (I’ve had a hip replacement, so to push my luck would be quite foolish I think). I walk strongly for long distances - walk everywhere, no car, plus some hillwalking, am fit, don’t regard myself as removely ‘frail’. 

I'd say I'm frail when a fall like on Saturday (just fell on my arse on a path as mentioned above) would have resulted in me being in hospital with a broken hip rather than just looking a bit stupid.

Indeed, it's probably the point where you go from "fell over" (annoying) to "had a fall" (medically consequential) for the same incident.

Very sorry to hear that. Do you generally use a stick for walking?

Really?  You weren't at all shy about specifying which brother you were talking about on the 'exercise doesn't necessarily burn calories Herman Pontzer' thread.  (Your comment on that thread very much came to mind when him pontificating on the radio was mentioned on this one.)

You’re looking at the wrong part of the documentation I think. If he can see his score was almost “fit” then it’s probably the eFI he’s looking at rather than an individualised assessment. The score is calculated somehow from your history of prescriptions and the issues that you’ve seen a GP for. I think it’s intended to be good enough for the GP to have an overall view of the state of the population they serve, but isn’t necessarily useful at an individual level. 

I suspect that, in the absence of any actual scores (PRISM etc), some algorithm based on age and whether any blood tests are in any way outside ´normal’ values just calculates a score.  If I ever actually manage to speak to a GP again I’ll ask.

For hillwalking yes (mainly on awkward descents) and have done for years, foot just slipped from under me, barely registered that it had happened until I was on my backside.  But it wasn't consequential, I got up and carried on without injury.  I'd have considered myself a bit frail if the same fairly minor fall had resulted in serious injury, certainly if it'd broken a bone.

This, I think.  My score was 0.14, with ‘fit’ being 0.00 to 0.12.  No significance other than the obvious existential crisis.

Should you not be doing laps of a table and other climbing high jinx?

Given everyone's advancing years it's probably quite prudent to do a 'frailty test' first.

Still a bit embarrassing that I haven’t done anything outside since then!

I think you are looking at the eFI, a system that uses your history of primary care contacts to calculate a score which is intended to help the GP identify groups who may be at risk of frailty and need assessing.

It is known to over-identify people with frailty, likely because it is better that way round than missing people who might need help. 

Basically, you are not considered to be mildly frail. You are considered to have a medical history that is similar to people who might be at risk of being mildly frail. Hopefully that feels a bit less offensive.

Edit: hadn’t seen your reply to my other post before I sent this. Didn’t mean to repeat myself. 

Basically everything in your medical record has a code attached to it. Illnesses, family history, tests, treatments, referrals, allergies, the lot. I think all of this is used to profile risk of frailty. 

hmmm....   I really didn't think I had. I better be more careful, if I had that was very foolish

To be fair: very good at his specialism - and a good TV entertainer

The NHS frailty score is useful for identifying patients who may be at risk of having health problems in later life, which generally means 65+.

It is not a diagnostic tool.

I suspect that if you were to see your GP, they would not consider you frail.

Sadly such risk tools are based on the usual pattern of inactivity for far too many of the UK population - we are generally unhealthy.

I have just retired from 39 years of working in the NHS (i am 63), the last few as a nurse in an Emergency Department.

All too often I saw people my age and younger who were basically knackered after decades of eating & drinking too much and being physically inactive.

The proportion of frail people in the UK continues to increase, with very significant consequences for health & social care systems.

Every so often senior politicians will say that we need to do more about prevention, but then fail to do anything about it. 

In the meantime, I suspect that most people on UKC are more physically active compared to the usual pattern for a corresponding age range.

As we get older, it is important to do something, rather than nothing.

It's just a bit disheartening at times, as we often relate our abilities to when we were in our 30s, rather than the reality of being in our 60s.

Ah, so it is a sort of 'future frailty' measure. A predictor.

Thanks very much for your replies, which pretty much confirm my suspicions.  I do understand that the older you are, the longer your medical history, even if a lot of it is tests or treatment intended to keep you healthy.  For instance, I have a poor family history of heart disease, consequently I have ensured that I had regular blood tests and had a very thorough set of scans, blood tests and ECGs (privately) to establish that my ‘heart age’ was more than 10 years less than my chronological age.  Nevertheless my cardiologist convinced me it was a ‘no brainer’ to take a statin, which halved my cholesterol, which was already pretty healthy.  Even so, I guess my family history, plus the statins, goes down as a small black mark.

Anyway, I’m fine about it now.  And I can do the standing from sitting cross-legged thing - about half of the people who tried it at the wall the other night couldn’t.

That’ll be me now then!

that does sound like an odd test

the crosslegged thing is something i've done since i was 18ish and just now tried again and yup still can,

i'm 63, but i've known how to do that for ages

and ... the GP said i had arthritis in both knees at 12

When I start seriously thinking about getting a Stenna Stair lift installed, that's when I'll start considering my mobility. 

After 50 years of heavy drinking and smoking,  my NHS record shows a dose of antibiotics 

For what it's worth, I think (as a non-lawyer) that you're much more concerned about that than you need to be.  It doesn't seem to me that you've said anything that could be construed as remotely libellous.

I doubt you’d register as even mildly frail. Check out the scale below 

Assuming cross legged just means each foot under the opposite hip (not the lotus / padmasana), it’s just a case of sufficient flexibility to sit cross legged in the first place, decent balance and being able to do a one legged sit up (at least that’s the easiest way I can do it). I suspect most climbers should be ok with the flexibility and balance but perhaps not the sit up…

I’m struggling with the ankle mobility to do it straight up, I can do it by standing up with my legs still crossed, which is kind of a bizarre scissor motion.

I actually noticed the ankle issue the other day when I went to do pistol squats and could no longer get my knee far enough forward to do them without something to stop me from falling over backwards. Should probably do something about that.

Alkis - 37 - frailty level depending on whether scissoring off the ground counts… 🤣

Edit: Worked out another way of doing it, which involves one leg straight, one foot planted under the crotch and a sort of rockover into a one legged squat. Definitely a club activity after a few beers.

That's an uncomfortable look into the future ☹️

I’d hope to qualify as ‘very fit’ on that classification based on running a couple of times a week and climbing at least twice a week.  I still ski pretty competently and aiming to get back to E3 this year if it ever stops raining.

I’ve no doubt that some level of frailty is inevitable eventually and I think I am probably a bit slower than I was once in some respects, although much of that is down to motivation as much as fitness.

That reminds me of those road signs that warn you of elderly people up ahead. 'Old guy with stick being groped by old woman'.

I vary between '1' and '4' (not including 2 or 3) depending on the day. I gave up running ultras a couple of years ago due to a disintegrating hip joint but now cycle lots (pretty much every day). Climb (as well as ever) at least once a week. So I'm a '1' most days unless I've have a bad night which means I might be a '4' the next day. I'm 65.

As to the cross legged stand up comedy, I think I've got a technique that would work if I gave it a few days' training: Roll forward into a crossed ankles kneeing position and then it's easy. Is that cheating?

I currently do some relief work for a care company as a responder. I go out to see people who have had falls or pressed their buttons for help. It's a real eye opener into possible futures, and a real incentive to do strength and flexibility training!!

We have various very cool toys for getting people off the floor when they fall, but it really is painful to see sometimes how frail these people are. 

Luckily, we also have examples around us of incredibly fit and capable older people, and I aspire to be like them. But we never know what will come our way due to sheer bad luck!

Just use 1 hand to push up , you will still have a very good score in comparison with most. 

Unless you do yoga I doubt most people on this site at mid 60s could do it clean. 

You would lose a couple of points for that, but there is no 'cheating'. 

The Van Tullekens are doing the same thing here, it seems to me, that Chris VT did on the radio programme that sparked the thread I mentioned above: taking something scientifically sound and quite reasonable and over-stating the case to the point that it becomes silly.

In that case, Chris VT said that according to Herman Pontzer no amount of daily exercise will increase the number of calories that you burn.  (Which is patently untrue, although that is indeed the case for a surprisingly large amount of exercise - much more than you might expect.)

In this case, Xand is saying that anything less than a perfect score of 10 points in this test means that you are 'frail'.  And again it's mostly bollocks with just the merest germ of truth in it.

Googling about a bit, here's a more informative link regarding this test and how to score it:
https://www.health.harvard.edu/blog/all-rise-now-just-how-fit-are-you-20200...

"Ideally, you want a score of eight or higher."  You get that if you can sit down without hands or knees and use both knees to get back up.  Or if you use one knee on the way down and again on the way back up.

Here's a link to a personal trainer/blogger type person, with a little video demonstrating a perfect '10' score, and suggesting some exercises and stretches to help improve performance in this test.

https://thefitcareerist.com/how-to-get-up-from-the-floor-without-using-hand...

Oh, that’s kind of what I meant by “scissoring”. It’s a very weird motion.

That's quite a big scale considering the average person is probably between 2 and 3.

Yep, but then the scale is designed for clinical assessment and if you’re scoring between 1 and 3 you’re unlikely to be troubling clinicians much. 
 

If you’re a 4 to 9, stringent assessment is entirely appropriate.

It's a scale focussed on people who are to some extent frail, not on the general population.

I agree.  Unfortunately, we're away skiing on March 16th, so it will have to wait until later in the year!

You could try doing the test on 16.3. with ski boots plus attached skis, to up the ante and the entertainment value?

Just got back from a trip to Costa Blanca with four people half my age and I certainly feel frail now 😀

Actually I think that would be easier, depending on how you crossed the skis!