LTC Lunch and Learn: Prevention & Effective Interventions in Frailty, 6 May 2015
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Transcript of LTC Lunch and Learn: Prevention & Effective Interventions in Frailty, 6 May 2015
Prevention & Effective Interventions in Frailty
Wednesday 6 May 2015
12.30pm – 1.30pm
Helen LyndonNurse Consultant Older People, Clinical Lead Frailty, NHS England
&
Beverley MatthewsLTC Programme Lead, NHS Improving Quality
Bev MatthewsA nurse by background, Beverley has worked extensively throughout the NHS in a variety of clinical, managerial and strategic roles. Beverley’s current role as Programme Delivery Lead for Long Term Conditions Improvement Programmes: LTC Year of Care Commissioning Model and LTC Framework. Prior to joining NHS Improving Quality in April 2013, Beverley was Director of NHS Kidney Care and NHS Liver Care.
Passionate about service transformation through developing networks and leading complex programmes. Providing strategic leadership to partners within health communities, managing stakeholders and working across agencies.
Helen Lyndon
Nurse Consultant Older People, Clinical Lead Frailty
Currently on secondment to NHS England as Clinical Lead for Frailty. Leading on the development across organisations of an integrated pathway of care for frail older people. Clinically, Helen works with a Geriatrician Colleague offering falls and comprehensive assessment rapid access clinics.
Meet the Speakers
Beverley Matthews
LTC Programme LeadNHS Improving Quality
www.england.nhs.uk
LTC Year of Care Commissioning
Programme:
5
• 5 Early Implementer sites
• 35 Fast Followers
• Whole Population Datasets
• Implementation Guide
• Simulation Modelling
• Specialist Support Team
www.england.nhs.uk
LTC Framework Improvement
Programme:
6
Organisational &
Clinical
Processes
Informed and
engaged patients
and carers
Health & Care
Professionals
committed to
partnership
working
Commissioning
• Information and
technology
• Case finding & risk
stratification
• Care Planning
• Safety and
Experience
• Guidelines,
evidence and
national audits
• Care Delivery
• Self Management
• Information and
Technology
• Group and Peer
Support
• Care Planning
• Policies for carers
• Voluntary sector
patient & carer
support
• HSC Integration
• Multi Disciplinary
Teams
• Culture
• Workforce
• Technology
• Care Co-
ordination
• Care Planning
• Needs
Assessment and
Planning
• Joint
Commissioning
• Metrics and
Evaluation
• Service User and
Public Involvement
• Contracting and
Procurement
• Care Planning
• Tools and Levers
The table below sets out some of the key components needed to deliver the central
aim for LTC Framework - Person Centred Coordinated Care
Long Term Conditions Dashboardhttp://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html
Long Term Conditions House of Care Toolkithttp://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/long-term-conditions-improvement-programme/house-of-care-toolkit.aspx
Simulation Modelhttp://www.simul8.com/viewer/download.htm
#LTCyearofcare #LTCimprovement @NHSIQ
Tools and Resources:
LTC Lunch & Learn Series ….coming soon…
Date Webinar Hosted by Bev Matthews &
27 May 2015
12:30 – 13:30
Primary Care Workforce for the 21 Century
Webinar
Sharon Lee
Primary Care Workforce Facilitator
South Kent Coast CCG
4 June 2015
12.30 – 13.30
Home Checks/Prevention Peter O’Reilly & Geoff Harris
Manchester Fire & Rescue Service
9 June 2015
12 noon – 1pm
Health 1000 Rob Meaker
Barking, Havering & Redbridge
For registration details, email [email protected]
Prevention & Effective Interventions in Frailty
• Understanding the preventable components of frailty.
• Understanding how clinicians can support people to prevent and delay the adverse effects of frailty
• Understand what interventions are effective across the frailty trajectory.
of Care foundation.
Today’s Learning Outcomes
www.england.nhs.uk
Prevention and
Effective Interventions
in Frailty
Helen Lyndon
Nurse Consultant
Clinical Lead for Frailty
NHS England
Lunch and Learn Webinar 6th May 2015
www.england.nhs.uk
• Understand the preventable components of frailty
• Discuss how clinicians can support people to prevent
and delay the adverse effects of frailty
• Understand what interventions are effective across
the frailty trajectory.
Prevention and Effective Interventions
in Frailty
www.england.nhs.uk
Where is frailty?
“ I know it when I see it but what I see may not be the same as what everyone else sees”
Community dwelling adults aged 65+ = 7% - 12%
Community dwelling adults aged 85+ = 25% - 50%
The Frailty ParadoxNot recognised
Not diagnosed
Not recorded
Chen, X, Genxiang, M, Sean X (2014) Frailty Syndrome: an overview. Clinical Interventions in Aging
2014:9 433–441
www.england.nhs.uk
Frailty – a complex syndrome of
increased vulnerability
13
Life course
determinants:
BiologicalGenetic
Psychological
Social
Environmental
Decline in
physiologic
reserves
+
Multiple
long term
conditions
Candidate markers:
Nutrition
Mobility
Activity
Strength
Endurance
Cognition
Mood
Adverse Outcomes:
Disability
Morbidity
Hospitalisation
Institutionalisation
Death
Prevent/delay frailty
Primary prevention
Health promotionDelay onset
FRAILTY
Delay/prevent adverse outcomes
Rodriguez-Mañas L, Fried LP. Frailty in the clinical scenario. Lancet. 2014 Nov 6
Reversibility
www.england.nhs.uk
‘Dementia, disability and frailty are not inevitable
consequences of ageing….there is sufficient evidence to
show the risk of developing them can be reduced
through changing common behavioural risk factors.’
• quitting smoking,
• increasing physical activity,
• reducing alcohol consumption
• having a healthy diet
• maintaining a healthy weight.
14
NICE Public Health Draft Guideline:
Dementia, disability and frailty in
later life – mid-life approaches to
prevention
www.england.nhs.uk
NICE Public Health Draft Guideline:
Dementia, disability and frailty in
later life – mid-life approaches to
prevention
15
• Beginnings of ill health can occur in midlife:
☼ start of a decline in cognitive functions (such as memory, reasoning and verbal fluency) by age 45
☼ age-related decline in walking speed has been observed after the age of 30
Mid-life is not too late for people to make meaningful changes. People often need more than one attempt to change, and mid-life can be the period in which change is finally sustained
‘However, key messages about risk reduction, particularly for dementia, are not well publicised or understood by health and other professionals or the public, unlike the link between smoking and cancer.’
www.england.nhs.uk
Proportion alive
Time
Primary care electronic Frailty Index (eFI): survival plots (n=227,648; >65y)
Fit
Mild frailty
Moderate frailty
Severe frailty
5 yrs
www.england.nhs.uk
Proactive interventions in frailty
Ten years ago
Two years ago
One month ago ‘He is a
fall
waiting to
happen
“Dad is
slowing
down”
“I’m not
as steady
on my
feet as I
was”
www.england.nhs.uk
Supported Self Management for
Frailty
What its not….
Provision of information;
leaflets, booklets, web links
etc
What it is…..
About acknowledging the person’s central role in the management their own care and empowering them and their family and carers to handle their condition as effectively as possible.
www.england.nhs.uk
What to focus on…..
Potentially modifiable risk factors associated with functional
decline in community dwelling older people.
• Alcohol excess
• Cognitive impairment
• Comorbidity
• Falls
• Functional impairment
• Hearing problems
• Mood problems
• Nutritional compromise
• Physical inactivity
• Polypharmacy
• Smoking
• Social isolation and loneliness
• Vision problems
MORE
THAN
MEDICINE
www.england.nhs.uk
Look after your feet
Look after your eyes
Make your home safe
Keep active
Medication review
Hearing tests
Preventing falls
Vaccinations
Keeping warm
Get ready for winter
Bladder problems
Mental wellbeing
www.england.nhs.uk
Supported Self Management for
Frailty: Key Messages
1. Language:
• “I am frail” v “slowing down”, “things taking longer” or “less energy.” This is reflected in the guide. Focus on “health and wellbeing” in later life.
2. Self-discovery and self-activation:
• Gait speed test, then menu of items – the person’s choice
3. Independence:
• focus on maintaining and promoting independence - this is an issue that is both important and well understood by older people.
4. Social Isolation and Loneliness
www.england.nhs.uk
Loneliness and Social Isolation
• 59% of older adults who report poor health say
they feel lonely some of the time or often
compared with 21% who report excellent health.
• Social isolation is one of the top five causes for
admissions to care homes.
• People who are socially isolated visit their GP
more often, use more medication and have more
falls.
• Lacking social connections is a comparable risk
factor for early death to smoking 15 cigarettes a
day and is worse for our health than obesity and
physical inactivity.
LTC Lunch & Learn Series ….coming soon…
Date Webinar Hosted by Bev Matthews &
27 May 201512:30 – 13:30
Primary Care Workforce for the 21 Century Webinar
Sharon LeePrimary Care Workforce Facilitator
South Kent Coast CCG
4 June 201512.30 – 13.30
Home Checks/Prevention Peter O’Reilly & Geoff HarrisManchester Fire & Rescue Service
9 June 201512 noon – 1pm
Health 1000 Rob MeakerBarking, Havering & Redbridge
For registration details, email [email protected]