Should I be worried my GP ’s labelled me ‘frail’? DR MARTIN SCURR answers your health questions
I was shocked to find that my wife and I have been subjected to ‘frailty indexing’ by our GP. This has been done without our knowledge or any explanation as to what it means. Could it also indicate hidden end-of-life planning? I am 78 and healthy.
Peter Bradley, Burgess Hill, W. Sussex.
Not long after the Covid-19 pandemic commenced, like several million other Britons, I received a letter from my GP saying that I was clinically extremely vulnerable and should shield.
This decision had been based on my medical history — as I have written about before,
I have sarcoidosis, an inflammatory disorder affecting my lungs. I welcomed the letter, as it was clearly sent in the best interests of my health.
The same intentions apply in the case of the Frailty Index, which is not, as you fear, a hidden end-of-life plan, but an automatic risk-assessment system for those aged 65 and over.
The electronic Frailty Index (eFI), to give it its proper name, uses information in electronic GP records to identify those at greater risk of adverse health outcomes and who need support (such as physiotherapy or occupational therapy). It also ensures they receive the most appropriate — and, in some cases, faster —attention if they are taken to A&E.
The same intentions apply in the case of the Frailty Index, which is not, as you fear, a hidden end-of-life plan, but an automatic risk-assessment system for those aged 65 and over
Frailty is measured using indicators such as weakness, fatigue, weight loss, low physical activity, poor balance and cognitive impairment.
The fact that you and your wife have been given a score — which is what ‘frailty indexing’ involves — means there are some ‘alerting’ factors in your medical history, but given your good state of health it cannot have been a high score.
Your age automatically puts you into an elevated risk category and may well have been part of this.
In your case, the problem seems to be the lack of communication from your GP about the rating and its meaning. Although there is no obligation for them to tell you the rating, they should explain it to you at your request.
Before this system was introduced, older adults regularly saw health visitors who could make judgments on their state of health. That service was abandoned and has evolved into this automated process.
As yet, not all GP practices are involved, which may explain the sudden addition of the eFI score to your record.
I sense your concern about the possibility of an unsolicited ‘do not resuscitate’ label on your records, but let me reassure you that this is not permitted without discussion in the case of anyone who is functioning, alert and lucid and coherent.
However, if you are still worried, you can pre-empt any error by creating a living will, also known as an advance care directive. You then lodge copies of this with your solicitor (alongside your will), at the bank and with your next of kin.
This document can be used to make your wishes known and protect yourself from any future unwanted intervention. The forms for this can be found online.
Two years ago, I had a polyp removed from one nostril to enable me to smell and taste. But I have not been able to smell or taste anything since — other than my wife’s sugary tea.
Philip Ball, Stoke-on-Trent.
You have what’s known as anosmia — the loss of the sense of smell which, in turn, affects taste. It is often caused by chronic rhinitis, or swelling in the nose.
This prevents the smell-carrying molecules of food reaching the smell receptors, which play a key role in our ability to taste.
Chronic rhinitis is usually associated with asthma and allergies. There’s also evidence that the bacterium S. aureus, which is found in the nasal lining of at least 30 per cent of people, can cause it.
Whatever the trigger, the mucus lining of the nose becomes inflamed, causing a runny or blocked nose, pain around the sinuses, and a reduced sense of smell.
You have what’s known as anosmia — the loss of the sense of smell which, in turn, affects taste. It is often caused by chronic rhinitis, or swelling in the nose
As a result of the inflammation, some people develop polyps, which are swollen areas in the nasal lining. Larger ones will be removed through surgery, which usually improves breathing. But there’s often ongoing inflammation, which means the molecules that help you smell and taste still cannot reach the necessary receptors.
Polyps can also re-form, and as your operation was two years ago it’s worth seeking a referral to your consultant.
This may lead to further surgery or treatment in the form of anti-inflammatory corticosteroid nasal drops, to be taken twice daily for a few weeks at least. Many patients regain their sense of smell on this regimen, but not all.
Write to Dr Scurr
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — include your contact details. Dr Scurr cannot enter into personal correspondence.
Replies should be taken in a general context and always consult your own GP with any health worries.
We deserve more detail from the Government about what the daily Covid infection rate actually means because, as with other infections, what you see is not what you get.
For example, the bacterial infection meningitis can result in death within hours if untreated.
When those who have come into contact with someone infected with this terrifying disease — say, in a classroom — are checked for bacteria with nasal swabs, several may prove to be carrying the bacteria but do not fall ill.
That’s because whether someone becomes mortally sick depends on some unknown factors in their immune system.
Here, the detected presence of the bacteria is similar to the situation with coronavirus: a positive test is not the same as having the infection — it means, rather, that you are carrying the virus.
Yet, day after day, we are told of the thousands of cases that have been identified in the past 24 hours.
But is that thousands of positive tests of those without symptoms, or is it thousands of ill people? We are not told.
This is worrying, as it is difficult to gauge the actual risk from current data.
My sense is that this is like all advertising — a way of manipulating our understanding of the facts. Withholding the exact truth bullies us into respecting the guidelines.
With real information about ‘positive’ tests — do they represent illness of asymptomatic carriers? — we would be in a better place to take our own risks and make our own decisions, as the Government now wants us to do after ‘Freedom Day’, with regards to mask-wearing and other preventative measures.
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