The concept of frailty and its significance in the consequences of care or neglect for older people: an analysis

Older people, and particularly those of advanced age, become increasingly vulnerable to the consequences of abuse or neglect and, since the birth of specialist services for older people, researchers and clinicians have sought to understand the reasons for this.
Multi‐agency work across the UK is developing innovative strategies, protocols and tools to support investigation into situations of possible neglect in formal care settings. Emerging within this work has been a dilemma concerning which terminology should be used to most accurately describe care in specific situations, for example should care be described as ‘inadequate’ or ‘poor’, or as ‘neglect’. One key element in this decision is the consequence, or consequences, of the care for the vulnerable person, i.e. its impact on the individual. Because of the complex changes which accompany ageing, and particularly older age, this is not straightforward. Is a person’s health deteriorating as a consequence of ageing or disease? Are factors such as mental state or motivation impacting on their health? Is this the trajectory that their health would naturally follow? Or is the deterioration a direct consequence of the care that they have, or have not, been given? And, if so, to what degree? Identifying ways of addressing these questions could support the development of a lexicon of terms and definitions which could be used to accurately define specific categories of neglect in specific circumstances.
This paper describes the practice based dilemmas that prompted this work. It briefly sets a historical context for contemporary understandings of the mechanisms that render older people particularly vulnerable to the effects of neglect. Some perspectives on defining neglect are offered. The paper then outlines the findings of a literature review and concepts analysis of the term frailty. It offers a new definition of frailty and explains the theoretical approach within which this nests. The paper concludes with a discussion on the implications of frailty as a consequence of care or neglect for older people.