What Is "Severe Frailty"?

[MikeyBikey]

I was recently looking at my medical notes on line and saw the comment "Sever frailty"! My initial reaction was "What the 'eff'?". Thinking about it I did wonder how the person defined it? Was it because I am a Type 1 diabetic who has had an amputation and have other health issues? It cannot be physical strength as in the physiotherapy gym I have lifted 37kg (didn't go heavier as already over limit for wheelchair) have done 100 reps with 23kg, hold the one legged exercise bike record in a rehab centre, etc., Irritatingly I have had to take three cognitive tests as they seem to like testing older people - passed with flying colours. In fact it means nothing if for instance if a retired person or hospital patient gets the day of the week wrong as every day may be the same! So what do they mean by "Severe frailty"? In fact it feels like a NHS insult!

 

[Lucyr]

The frailty index is just an electronic scoring system that uses your health record to decide whether your frailty score is mild, moderate or severe. They haven’t been watching how much you can lift.

 

[CliffH]

I was recently looking at my medical notes on line and saw the comment "Sever frailty"! My initial reaction was "What the 'eff'?". Thinking about it I did wonder how the person defined it? Was it because I am a Type 1 diabetic who has had an amputation and have other health issues? It cannot be physical strength as in the physiotherapy gym I have lifted 37kg (didn't go heavier as already over limit for wheelchair) have done 100 reps with 23kg, hold the one legged exercise bike record in a rehab centre, etc., Irritatingly I have had to take three cognitive tests as they seem to like testing older people - passed with flying colours. In fact it means nothing if for instance if a retired person or hospital patient gets the day of the week wrong as every day may be the same! So what do they mean by "Severe frailty"? In fact it feels like a NHS insult!

I guess it's an example of the archaic language that the NHS still tends to use, unfortunately: "geriatric mother" is another. I worked in the NHS for many years and I hate the way in which language is still used by some clinicians as part of an 'us and them' narrative. For example, why do we have to use the word 'bolus', rather than simply saying, "before meals"?. I'd encourage you (and any patient) to challenge anything written about you that you're not happy with, or at least ask for an explanation in plain English.

In your case, clearly the clinician is using a standard measure and isn't trying to insult you. Nevertheless, it's important for the clinician involved (and the wider system) to understand that use of such language without explaining it first can be disconcerting for the patient.

 

[Satan’s little helper]

I was recently looking at my medical notes on line and saw the comment "Sever frailty"! My initial reaction was "What the 'eff'?". Thinking about it I did wonder how the person defined it? Was it because I am a Type 1 diabetic who has had an amputation and have other health issues? It cannot be physical strength as in the physiotherapy gym I have lifted 37kg (didn't go heavier as already over limit for wheelchair) have done 100 reps with 23kg, hold the one legged exercise bike record in a rehab centre, etc., Irritatingly I have had to take three cognitive tests as they seem to like testing older people - passed with flying colours. In fact it means nothing if for instance if a retired person or hospital patient gets the day of the week wrong as every day may be the same! So what do they mean by "Severe frailty"? In fact it feels like a NHS insult!

You’re as solid as a rock as far as I’m concerned, Mkey. My name was bandied about at the back of the chemist whilst I was picking up a prescription for my wife yesterday evening. Chemist came out & asked me if he could do a BP check? OK said I but I’ve already had the all clear on a check a couple of months back. My BP was fine. As were all the panels. Then he asked me do I work. I looked at the guy then gazed myself down wearing trade clothing & a hi viz coat. No said I, all the kids are wearing this fashion during office hours.

 

[helli]

why do we have to use the word 'bolus', rather than simply saying, "before meals"?

Bolus is given at other times as a correction dose.
If only food was the only thing that raised BG.

However, I agree that “bolus” and “basal” are unnecessarily complex terms.

 

[Proud to be erratic]

@MikeyBikey, my late brother was categorised with "severe frailty" after he lost his first leg (the 2nd went a year later). We chatted about this over a cup of coffee.

At first he was irritated. I pointed out that while I personally knew he was far from "in the best of health" others might not appreciate just how poorly he could be sometimes, needing to go to bed and sleep because he was so tired - his body was fighting with several ailments. I think he steadily came to realise that the frailty tag was actually beneficial, providing him with prompt care when needed and an element of priority at his GP's Practice as well as Hospital appointments.

It may be archaic language, but certainly not an intended insult; just a way of making sure you don't get ignored during a triage either from a referral for a Consultant or an unexpected trip to A&E or Minor Injuries Unit.

 

[AndBreathe]

To be honest, @MikeyBikey , I feel certain there would be several folks on this forum who would be boxed similarly. It's a somewhat hammer-style tick box exercise that generates a label at the end of it.

My steer to you would be to ignore it and keep on doing as you are - doing your best to keep yourself in decent shape, despite a somewhat cruel hand of cards.

 

[Tdm]

I guess it's an example of the archaic language that the NHS still tends to use, unfortunately: "geriatric mother" is another. I worked in the NHS for many years and I hate the way in which language is still used by some clinicians as part of an 'us and them' narrative. For example, why do we have to use the word 'bolus', rather than simply saying, "before meals"?. I'd encourage you (and any patient) to challenge anything written about you that you're not happy with, or at least ask for an explanation in plain English.

In your case, clearly the clinician is using a standard measure and isn't trying to insult you. Nevertheless, it's important for the clinician involved (and the wider system) to understand that use of such language without explaining it first can be disconcerting for the patient.

Tagging on re nhs language...

I got a letter recording a recent interaction re kidney stones a year ago, in which it said...
'Patient claims to have had no further pain since'

Perhaps i'm being overly sensitive, but you use that sort of language to express scepticism/a degree of doubt...eg 'he claimed to have seen a ufo and a blue alien', 'the prisoner claims they are innocent'
'Says' would have been fine. Ditto 'reports'

 

[CliffH]

Bolus is given at other times as a correction dose.
If only food was the only thing that raised BG.

However, I agree that “bolus” and “basal” are unnecessarily complex terms.

Well I have several 'A' Levels and Degrees and worked in the NHS for many years, so if I can get such things wrong, perhaps other people can too. Jargon is always excluding and sometimes dangerous.

 

[CliffH]

Tagging on re nhs language...

I got a letter recording a recent interaction re kidney stones a year ago, in which it said...
'Patient claims to have had no further pain since'

Perhaps i'm being overly sensitive, but you use that sort of language to express scepticism/a degree of doubt...eg 'he claimed to have seen a ufo and a blue alien', 'the prisoner claims they are innocent'
'Says' would have been fine. Ditto 'reports'

Great point! Us clinicians almost all have at least one 'science' Degree and so we hate to make mis-statements. However, there are ways of being precise in our language without alienating people.

In a situation such as you're describing, I'd write, "[The person's name rather than "patient"] told me that he's had no further pain since". Even better would be to have asked you to indicate on a five-point scale how much pain you'd had and then reported that.

A trivial example is that I had to ask a few days ago what "HS" means when it's used in this Forum. Its meaning ("House Special", apparently, referring to a specific blood glucose level) couldn't possibly be guessed by anyone not 'in the club' and so that itself sets up an 'us and them' dynamic. I'm confident enough to not mind showing a lack of knowledge about things - but what about people who may be less confident to ask?

 

[martindt1606]

Bolus is given at other times as a correction dose.
If only food was the only thing that raised BG.

However, I agree that “bolus” and “basal” are unnecessarily complex terms.

What’s wrong with BOLUS and BASAL? After my Total pancreatectomy I was thrust into the alien world that is diabetes having had no previous exposure to anyone living with diabetes. One thing I am thankful for is that bolus and basal are words that have a very clear meaning which meant that I could ask clear questions to both medical professionals and the good people on this forum and know that they would understand my concerns before giving a thoughtful answer.

 

[Satan’s little helper]

What’s wrong with BOLUS and BASAL? After my Total pancreatectomy I was thrust into the alien world that is diabetes having had no previous exposure to anyone living with diabetes. One thing I am thankful for is that bolus and basal are words that have a very clear meaning which meant that I could ask clear questions to both medical professionals and the good people on this forum and know that they would understand my concerns before giving a thoughtful answer.

I see no issue with the terms either. Unless there is a plan to call them “Fred & Ginger?”

 

[Robin]

What’s wrong with BOLUS and BASAL

Nothing….except when I was diagnosed, I had to work out what they meant from reading around on the internet, because the DSN who introduced me to insulin at the hospital called them Mealtime and Background. Consistency would help!

 

[helli]

I was introduced to the terms basal and bolus plus glargine and aspart as well as Lantus and NovoRapid at the same time.
I was given three different names to each of two things and didn’t know whether NovoRapid was glargine or aspart and whether to take my bolus once a day or with every meal.
It took me some time to come up with the memory trick that basal sounds like base so it was the base/background dose.
But, for months, I struggled whether I should order glargine or Aspart from my prescription when I ran out of Lantus. I got it wrong more than once.

Then out of the blue, the diabetes nurse (who I later learnt was a “DSN”), came out with “MDI”.

It could have been much easier for someone already dealing with the mental overload of being diagnosed with a chronic condition.

 

[Robin]

I was introduced to the terms basal and bolus plus glargine and aspart as well as Lantus and NovoRapid at the same time.
I was given three different names to each of two things and didn’t know whether NovoRapid was glargine or aspart and whether to take my bolus once a day or with every meal.
It took me some time to come up with the memory trick that basal sounds like base so it was the base/background dose.
But, for months, I struggled whether I should order glargine or Aspart from my prescription when I ran out of Lantus. I got it wrong more than once.

Then out of the blue, the diabetes nurse (who I later learnt was a “DSN”), came out with “MDI”.

It could have been much easier for someone already dealing with the mental overload of being diagnosed with a chronic condition.

I’ve seen plenty of newbies on here using the name of the pen, which is presumably how the nurse referred to it, ie,‘I’m taking Solostar and Penfill' or whatever.

 

[Docb]

I'm tempted to throw in my normal observation about labels and that they have their upsides and downsides. They can be very good shorthand when everybody involved has a common understanding of what can be inferred from the label. They can be a bit of a problem when they escape into the wild and gain wider meanings depending on who is using the label.

Things like "severe frailty" are particularly bad labels to me in that it no doubt has a clear meaning to anybody in the know but is open to wildly different interpretations by those who are not. Basal and bolus are not so bad because you either know or don't know what they mean and if you come across them you will not be tempted into assigning your own interpretation.

 

[Satan’s little helper]

But, for months, I struggled whether I should order glargine or Aspart from my prescription when I ran out of Lantus. I got it wrong more than once.

.

Was the brand of insulin not named on your prescription that you knew you were running short of? I normally order well before I have none.

 

[helli]

Was the brand of insulin not named on your prescription that you knew you were running short of? I normally order well before I have none.

No, it was not!

It was just “Aspart” and ”Glargine” on the prescription.
I may have been mentally stressed by the diagnosis of a chronic disease but I wasn’t so stressed that I could not read my prescription. I eventually found “Glargine” somewhere in the Lantus box but it was not obvious. Otherwise, I would not have made the mistake multiple times.

And I too always order before I run out. Even when I ordered the wrong insulin I had time to order the other one before I ran out.

You are missing the point of this thread: Terminology.
You are focusing on my mistakes.

 

[Satan’s little helper]

No, it was not!

It was just “Aspart” and ”Glargine” on the prescription.
I may have been mentally stressed by the diagnosis of a chronic disease but I wasn’t so stressed that I could not read my prescription. I eventually found “Glargine” somewhere in the Lantus box but it was not obvious. Otherwise, I would not have made the mistake multiple times.

And I too always order before I run out. Even when I ordered the wrong insulin I had time to order the other one before I ran out.

You are missing the point of this thread: Terminology.
You are focusing on my mistakes.

Oh, OK? You always appear confident & know what you are doing. Just confused by your earlier post.

 

[everydayupsanddowns]

For example, why do we have to use the word 'bolus', rather than simply saying, "before meals"

However, I agree that “bolus” and “basal” are unnecessarily complex terms.

I agree about the complexity / unfamiliarity of the terms, but bolus just means “lump” doesn’t it? When you chew food, and your mouth forms it into a manageable blob that you can swallow, that blob is called a bolus as it passes down into your stomach (thanks pre-O-level biology!)

So for me the B and B terms are more trying to describe quick acting and long acting.

As to language generally, I couldn’t agree more. How many times have we shared experiences of the terrifying wording used in retinal screening letters? Or the blame and stigma that can be experienced by poorly chosen phrases.

The Language Matters work was great at highlighting how important this is, and how much impact it can have

https://www.diabetes.org.uk/resources-s3/2018-09/language-matters_language%20and%20diabetes.pdf