Published: December 2024

Frailty describes someone’s overall resilience. When we lack resilience, we become vulnerable to frailty.

It is often small, unrelated events that kick starts a domino effect into frailty… It could be the one best friend falling ill that leads to less social activities, then a reduction in physical activity. Or it could be a fall in the garden that leads to temporary reduced mobility and reduced confidence, strength and resilience to other conditions.

Preventing frailty requires improving resilience. This can be achieved by successful condition management, reliable support networks and with a healthy approach to ageing.

Headlines

There are more than 16,000 Wakefield residents with a frailty diagnosis.
This equates to 2.1% (mild), 2.0% (moderate) and 0.4% (severe) of the population with frailty.
20.2% of those aged 65+ have frailty (9.0% have mild, 9.2% have moderate and 2.0% have severe frailty).
Mild and moderate frailty are more prevalent in the most deprived areas.
People with Asian or Asian British ethnicity are significantly more likely to have mild or moderate frailty compared to the district average.
Females are significantly more likely to have moderate or severe frailty compared to males.

What is frailty?

Identifying frailty

Changes to the core GP contract in 2017/18 introduced routine frailty identification for patients who are 65 and over.

They are required to do so by using the Electronic Frailty Index (eFI) or another appropriate assessment tool. 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:

The Gait Speed Test and the Timed Up and Go Test focus on the mobility of the patient, whereby the PRISMA-7 Test looks at the wider picture.

Frailty deficits

Deficits are diagnoses, symptoms, sensory impairments and disabilities that have been linked, through research, to the development of frailty. The below set of 36 deficits underpins the Electronic Frailty Index (eFI), a risk stratification tool used in Primary Care medical systems to identify patients who may be at risk.

Disease states	Symptoms / signs	Abnormal test results	Disabilities
Arthritis Asthma / COPD Atrial fibrillation Cerebrovascular disease Chronic kidney disease Diabetes Foot problems Fragility fracture Heart failure Hypertension Hypotension / syncope Ischaemic heart disease Osteoporosis Parkinsonism and tremor Peptic ulcer Peripheral vascular disease Respiratory disease Skin ulcer Thyroid disease Urinary system disease	Dizziness Dyspnoea (difficulty breathing) Falls Memory and cognitive problems Polypharmacy (on several medications) Sleep disturbance Urinary incontinence Weight loss or anorexia	Anaemia and haematinic deficiency	Activity limitations Hearing impairment Housebound Mobility and transfer problems Requirement for care Social vulnerability Visual impairment

The eFI calculates a frailty score based on the number of deficits present divided by the total possible. For example, if a patient has 9 out of 36 deficits, the eFI score is 0.25.

Frailty is classified as fit, mild, moderate and severe with the following criteria:

Fit is a score of 0-1.2 (i.e. between 0 and 4 out of 36 deficits)
Mild is a score >0.13 and <=0.24 (i.e. between 5 and 8 out of 36 deficits)
Moderate is a score >0.25 and <=0.36 (i.e. between 9 and 12 out of 36 deficits)
Severe is a score >0.36 (i.e. more than 13 out of 36 deficits)

Frailty and ageing

The frailty fulcrum is an animated model that has been designed by Fusion 48 that creatively demonstrates the relationship and difference between frailty and ageing. It explains how our psychological status, social environment, long term conditions, acute health problems, physical environment and systems of care all play a part in our quality of life, particularly as we age.

How does Wakefield district compare nationally?

This section contains nationally published data from NHS Digital: GP Contract Services.

Wakefield is in line with the England average for moderate frailty, ranking 51st out of 106 sub-ICBs for prevalence of moderate frailty among patients aged 65+.
Wakefield ranks 104th out of 106 sub-ICBs for prevalence of severe frailty among patients aged 65+. Given the deficits used in the eFI and their prevalence within Wakefield, Wakefield ranks much lower than is to be expected. The Public Health Intelligence team are currently working with colleagues in the ICB to investigate any potential reasons for this.

What are the differences within Wakefield district?

This section contains data from the ICB’s Linked Data Model which is derived from primary care.

As is to be expected, frailty is more prevalent in the older age bands.
Mild and moderate frailty are more prevalent in the most deprived deciles.
People with Asian or Asian British ethnicity are significantly more likely to have mild or moderate frailty compared to the district average.
People with White Other ethnicity are significantly less likely to have moderate or severe frailty compared to the district average.
Females are significantly more likely to have moderate or severe frailty compared to males.

Care home locations have been included on the ‘Neighbourhood’ tab of the dashboard as they should be considered when looking at the geography breakdown of frailty. The size of the circle indicates the capacity of the care home. Those living in care homes are more likely to be moderate or severely frail, and will therefore increase the prevalence in wards with a higher number of care homes.

The interactive dashboard below can be used to explore the demographics of frailty in Wakefield. Click on the buttons at the top to navigate between the different demographic breakdowns.

Further information

What support is available?