People at the centre of health

1
People at the centre of health careNational
Person-Centred Health Care Programme

• Care Experience Breakout Sessions
• Trudi Marshall
• Nurse Consultant Older People
• NHS Lanarkshire
• Older Persons Pathway

2
What is Frailty?
3
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) 

4
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.

5
Comprehensive Geriatric Assessment (CGA)
6
(No Transcript)
7

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

8

• ACE Nurse
• Screening - signposting
• CGA
• AMT, functioning, social, urinalysis, LS 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)
9
Impact

• Over 85 of frail older people reaching
  speciality beds within 24 hours (prev 40-60)
• All patients who require LS are now having this
  assessment undertaken (prev 5).
• Over 90 of AMTs are now being completed (prev
  gt5)

10
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

11
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)