Renal frailty clinic

What is frailty?

Frailty is a long-term condition which refers to a person’s physical and mental resilience, where they lack the ability to recover from things like illness or injury. The frailer someone is, the less likely they are to ‘bounce back’ from relatively minor health problems. Frailty can also lead to poorer health outcomes.

Getting older does not mean you will become frail; however, it becomes more common with older ages. It is important to be aware of frailty so that you can help prevent your health and wellbeing from worsening. Common symptoms include:

• weakness 
• unintentional weight loss 
• low physical activity 
• slowness 
• falls 
• fatigue.

There are many things you can do to reduce your risk of becoming frailer. Factors that contribute to frailty include:

• alcohol
• memory decline
• falls
• hearing and vision problems
• poor nutrition
• sedentary lifestyle (not moving around)
• taking lots of medications
• smoking
• loneliness and isolation.

These are things can often be prevented or improved with the correct information and support. Early identification of frailty symptoms means early action and support to keep people living well.

What is the renal frailty clinic?

The renal frailty clinic aims to provide care and support to patients living with kidney disease who may be experiencing symptoms of frailty.

The clinic is a small team consisting of a physiotherapist, an occupational therapist and a physician. You may be seen by one or all of us depending on your needs. We also work closely with the specialist nurses, dieticians and consultants as part of the larger kidney care team.

Frailty can look different in each person. It’s important to us that we understand your life, what you’re doing well, what you’re struggling with, and what matters to you. Together, we can create an individual plan for your health and wellbeing.

Who is referred to the renal frailty clinic?

Patients who attend the low clearance clinic for regular kidney function monitoring can be referred to the renal frailty clinic who are:

• frail
• high risk of becoming frail.

If you have any of the following issues, we may be able to offer you help or refer you on to specialist services:

• having falls
• difficulty with your mobility
• need more help with daily activities
• difficulty taking your medications
• fatigue
• feel your memory is not as good as it used to be
• feeling unsure or overwhelmed with a decision around dialysis.

We hope that by speaking to you and understanding what matters to you, we can work together to meet your needs and support you as best as possible.

Before your appointment

Once referred to the clinic, you will be booked in for an appointment to see either the therapists, the physician, or both the therapists and the physician.

If you are being seen by the therapy team, you will also be booked in for a telephone call to complete our pre-clinic therapy assessment. We will ask you questions about your daily life, physical, mental and emotional health, and your environment. This is to give us a general idea of how you are managing and what you might be needing support with.

At your appointment

Your appointment in the clinic will be 45 minutes if only seeing one of us, or 90 minutes if seeing both the physician and therapy team. You should receive a letter in the post with this appointment information.

Please try to arrive 15 minutes before your appointment time. You are more than welcome to bring someone with you to your appointment.

When you get here, we will ask you to fill out a few questions while you wait. These are standardised measures which are used across the UK and Europe for health equality data and will help us to build a better picture of kidney disease and care.

In our clinic, we aim to explore any issues you are currently having. We may complete some practical tests where we can observe your movement and walking. We may also complete some other routine assessments. The physician may explore different areas around your health and wellbeing and address any questions or concerns.

We will then look at what matters to you and create a personal plan going forward, which may include follow-up sessions in our clinic/via telephone or onward referrals to other services.

What do our physicians help with?

The physician in our team can support with a variety of issues surrounding your health and wellbeing. You may or may not see the physician depending on your needs.

They will look at all areas of your health - not just your kidney disease - to try and optimise your care. This may include reviewing your medications, looking at recent scans/tests or requesting new ones, making onwards referrals to other specialist services, and/or liaising with your GP and other professionals.

If you have any questions or concerns about your current health, care, treatments or general wellbeing, feel free to write them down in the back of this pamphlet to bring with you to your clinic.

We hope the renal frailty clinic provides you with the space and time to explore your health and wellbeing and look at the whole picture to ensure the best possible care.

What do our occupational therapists help with?

Occupational therapists provide practical support to help you do the activities (occupations) you need and want to do to give your life meaning. They consider all your needs - physical, psychological, social and environmental - and how best to meet these.

They can help you with:

• daily activities (eg. Managing anything you do in your day-to-day life)
• moving around your house (eg. Getting on or off your toilet, bath, bed, chairs, stairs, etc.)
• fatigue
• sleep
• memory
• community connections.

Please let us know in your clinic session if you are struggling with any of these factors.

We may be able to support you through things such as rehabilitation, therapy equipment, fatigue management programmes, education and/or onward referrals to community teams and services.

What do our physiotherapists help with?

Physiotherapists can help maintain and build muscle, as well as improve overall fitness. This is particularly important for kidney patients who struggle to meet recommended exercise levels.

With exercise, it can become easier to do the things you need to do, as well as the activities you find enjoyable. Keeping as strong and well as you can while living with kidney disease can help maintain independence and improve energy levels, blood pressure and sleep.

Please let us know in your clinic session if you are struggling with any of the following:

• reduced mobility
• falls
• balance
• strength
• dizziness
• breathlessness.

We may be able to support you through things such as a prescribed exercise programme, education/advice and/or onward referrals to various services in the community.

Other useful contacts

Kidney Beam 

Specialist platform for people living with kidney disease, focusing on movement, education and wellbeing. Developed by therapists, it offers online programmes, classes and community support.

Website: www.beamfeelgood.com.

Universal Care Plan

A Universal Care Plan (UCP) is a digital care plan based on what matters to you. Care planning enables your wishes and individual care/support needs to be communicated digitally with your healthcare professionals. If you do not have a UCP or would like to update your current one, please let us know at your next appointment. Patients who have a UCP can view their plan through the NHS App.

Website: ucp.onelondon.online.