The Frailty Fulcrum

Frailty as a long-term condition

The concept of frailty as a long-term condition brings with it the opportunity to adopt a much more proactive, person-centred, community-based approach to care. Achieving this requires a new approach to care, particularly through supporting self-care. This new approach will be enabled through a wider awareness of frailty and a greater shared understanding of the condition.

The ‘frailty fulcrum’ is an animated model for frailty that has been developed with these opportunities in mind.

A common language for frailty

This model aims to provide a ‘common language’ for frailty that can be shared between individuals, carers and professionals.  It offers an interpretation of frailty that is meaningful, relevant and sustainable for people living with the condition, throughout their journeys of care.

The domains of frailty

The frailty fulcrum highlights the multi-dimensional nature of frailty.  It considers the many different aspects of our lives that contribute to our overall wellbeing through a series of domains. The domains identified in the model are:

  • Social environment, including our families, our friends, our communities, any of the people or places that are important to us.
  • Physical environment, which is our homes in particular but also the many places that we visit as we live our lives.
  • Systems of care, which have a direct impact upon wellbeing, not just through the care that they provide, but also through the way in which they deliver that care.
  • Psychological status, which includes both specific conditions, such as anxiety, or more general feelings like a loss of confidence or a lack of motivation.
  • Long-term conditions, such as diabetes, heart disease or respiratory conditions.
  • Acute health problems, including for example, infections or injuries.

Keeping the balance and improving quality of life

The frailty fulcrum explains how keeping a good balance between all the different things going on in our lives becomes more difficult over time and that as we get older the likelihood of relatively small things causing bigger problems increases.  The model also highlights that these changes can occur more quickly for some people than for others and therefore explains both the association and difference between frailty and ageing.

The frailty fulcrum demonstrates that even though challenges in some areas of our lives might in themselves be difficult to overcome, a person’s quality of life can still be improved by promoting resilience in other areas, whatever the individual’s age or degree of frailty. It also highlights the important contribution that supporting individual decisions and choices, and supporting self-care, can make to improving quality of life for people living with frailty.

The frailty fulcrum, therefore, offers a shared language for frailty to enable a consistent approach to holistic assessment and action planning. It helps to identify and understand the multi-dimensional opportunities that exist to optimise quality of life for people living with frailty and is intended to empower these individuals to exercise choice and control over the care they receive and the ways in which they live their lives.

Using the Frailty Fulcrum

A simple and memorable concept that will stick in one’s mind. Very useful for teaching and conveying the issues.

This is one of the comments left on the NHS England website after the Frailty Fulcrum was featured as guest blog.  You can access the blog here.

The Frailty Fulcrum animation is also available to watch online and can be accessed on vimeo or YouTube.  There is also an overview of the Frailty Fulcrum available on our YouTube channel. It is part of a series of short videos based on the NHS England Webinar on "Frailty: building understanding, empathy and skills to support self-care." presented by Dr Dawn Moody on 31st March 2016.

The Frailty Fulcrum forms an integral part of our Frailty Training events and you can see some examples of how it has been used to explore a case studies here. 

To discuss how you can access Frailty Fulcrum training resources please email us:

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