People at the centre of health and care

People at the centre of health & careNational Person-Centred Health & Care Programme

Care Experience Breakout SessionsTrudi Marshall

Nurse Consultant Older PeopleNHS Lanarkshire

Older Person’s Pathway

People at the centre of health and care

What is Frailty?

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What is Frailty?• State of high vulnerability for adverse health outcomes, including

disability, dependency, falls, need for long-term care, and mortality.

• Commonly used to describe older persons at increased risk for morbidity and mortality.

• Typically involves alteration in multiple, not individual, body systems.

• Syndrome associated with reduced functional reserve, impairment in multiple physiological systems, and reduced ability to regain physiological homeostasis.

(Fried, Ferrucci, Darer, Williamson, & Anderson, 2004. Morley, Kim, Haren, Kevorkian, & Banks, 2005. Bartali et al., 2006) 

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Why is Frailty Important ?• Caring for frail older adults is difficult and challenging because they

have an increased burden of symptoms, are medically complex, and often have increased social needs. (Espinoza & Walston, 2005)

• Frailty is a strong predictor of several negative outcomes including disabilities, institutionalization, and mortality. (van Iersel & Rikkert, 2006) Frailty has also been linked to acute illness, falls, and increased vulnerability. (Espinoza & Walston, 2005)

• The identification of frailty in its early stage is important because interventions may potentially prevent, or delay the clinical consequences of frailty. (Bartali et al., 2006)

Screening for frailty and assessing levels of frailty in older adults can identify those most vulnerable and assist in targeting nursing interventions.

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Comprehensive Geriatric Assessment (CGA)

People at the centre of health and care

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•Well established MDT approach•In depth MDT assessment•Recognition of frailty•Discharge planning

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•ACE Nurse•Screening - signposting•CGA•AMT, functioning, social, urinalysis, L+S BP, Falls history, Meds reconciliation•Supporting discharges

Getting the assessment of older people right in the AMU has the potential to improve outcomes, reduce inappropriate hospitalisation, and potentially reduce the need for long-term care. (RCP, 2012)

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Impact

• Over 85% of frail older people reaching speciality beds within 24 hours (prev 40-60%)

• All patients who require L&S are now having this assessment undertaken (prev 5%).

• Over 90% of AMT’s are now being completed (prev >5%)

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Impact

• Reducing the average length of stay of emergency or unplanned admissions

• Reducing emergency inpatient bed days for people over the age of 65years

• Improving the quality of the patient care experience • Supporting the increase in the level of older people

with complex care needs receiving care at home • Supporting “Shifting the Balance of Care”

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Staff feedback• “The nurse post in the emergency receiving unit makes a big

difference to thorough assessment and early intervention for older people, we feel more informed and more in control of the acute care group.” (Consultant Geriatrician).

• “The nurse often finds out from carers/ relatives which community pharmacy the patient uses and if they use a compliance aid. This is vital knowledge for discharge and allows the ward pharmacists to contact the community pharmacist on discharge and communicate changes made. They also identify patients who are having difficulties which allows me time to resolve these problems which were previously often only identified on discharge.” (Pharmacist)