Tilly Gardener is a member of the BGS Medical Students Subgroup and has recently been awarded runner-up in the annual Marjory Warren prize at the University of Bristol. The award is given to the best essay around a condition that affected older people and is adjudicated by Dr Emily Henderson, Consultant Geriatrician and Dr Grace Pearson, Specialty Doctor in geriatric medicine. Tilly also founded the Bristol University Geriatrics Society (BUGS) and is serving as the President for 2024-2025.
Below you can read Tilly’s essay into frailty. Congratulations, Tilly!
During my CMOP placement, I came to appreciate that recognising frailty’s nuances is crucial for providing safe, effective, and compassionate care to older adults, helping minimise risks, improve outcomes, and address both physical and emotional needs.
Before the placement, I viewed frailty as an inevitable consequence of ageing, defined by physical signs like muscle weakness, reduced mobility, and weight loss. I often equated frailty with multimorbidity and disability, using co-morbidities as a primary indicator of physiological vulnerability. However, encountering many independent and robust older adults challenged this perspective. I now recognise frailty as a dynamic, multifactorial condition that isn't always visible.
Frailty and communication
Another important lesson during CMOP was understanding how frail individuals and their families perceive frailty. In one encounter, a patient's relatives were offended by the label "frail," viewing it as derogatory. The doctor skilfully explained that frailty is a clinical diagnosis requiring a tailored management plan. This reinforced the importance of language in geriatrics. I learned that framing frailty as a deficit focused on decline could overlook opportunities for prevention or improvement. Shifting to person-first language and describing frailty as dynamic and modifiable reframed discussions around maintaining or improving independence. The BGS frailty e-learning course further emphasised that older adults respond better to conversations focused on promoting autonomy.
Considering autonomy, I observed physiotherapists and occupational therapists adeptly set personalised goals with patients, focusing on independence as a key motivator. This approach led to better patient engagement.
Risk stratification
A front-door approach to screening for and recognising frailty also allowed for better risk stratification, a cornerstone of geriatric care. Identifying frail individuals meant that a comprehensive geriatric assessment could be completed to address the unique needs of those living with frailty.
The role of patient-centred care
An encounter of a patient receiving palliative care emphasised the importance of integrating emotional, social, and spiritual needs into the care plans of frail patients. One patient, isolated in a side room, expressed distress about missing the outdoors and her garden. With staff stretched thin, no one could accompany the porters to take her off the ward. With time flexibility, I had the privilege of spending time with her out of hours, accompanying her to the spiritual care centre to reconnect with a comforting space. This experience reinforced my passion for geriatrics, which emphasises understanding and addressing what matters most to patients. Frail individuals often struggle to have their voices heard, especially in fast-paced clinical environments, dominated by problem lists. Many, accustomed to paternalistic care models, hesitate to express their preferences unless invited. This placement taught me the value of amplifying patients’ voices, either through direct conversations or by engaging with their families.
Conclusion
In conclusion, my time on the geriatric wards shifted my approach to older people’s healthcare. I now view frailty as a complex, multifactorial syndrome that requires early recognition and holistic management. This experience deepened my commitment to person-centred care, emphasising the importance of language, multidisciplinary teamwork, and individualised goal setting in optimising care for older adults.
Further information about the CMOP:
Complex Medicine in Older People (CMOP) is an 18-week clerkship (sometimes called a clinical attachment or placement) that medical students studying at the University of Bristol undertake in their fourth year of study, led by Dr Grace Pearson. CMOP encompasses a diverse range of teaching and experience that spans geriatric medicine, oncology, palliative care, and complex general internal medicine.
The clerkship is overseen in Bristol’s eight clinical ‘academies’ across the southwest, where students are embedded in multidisciplinary teams caring for older people. At the end of each 18-week clerkship, clinical educators from each academy have the opportunity to nominate any students they feel have excelled during CMOP.
Then, each year these nominees are invited to submit a reflective essay on any topic of their choice related to their experience during CMOP. These submissions are reviewed anonymously by the CMOP team at the University of Bristol, and the winner(s) awarded the Marjory Warren Prize in Ageing.
