Frailty Units - British Geriatrics Society
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Transcript Frailty Units - British Geriatrics Society
Assessment Units for
Older People
Frazer Underwood
Consultant Nurse for Older Peoples Services
Associate Director of Nursing
Royal Cornwall Hospitals NHS Trust
What
older people are we looking for?
• Care home admission deflections
• Selected long-term conditions
• Complex co-morbidity
• ‘Step-up’…but not step over the front door
• Day hospital assessment candidates
• ‘Sub-acute’ cases
• The Very Frail
What‘s frailty?
“The debate has centred on whether frailty
should be defined purely in terms of
biomedical factors or whether
psychosocial factors should be included”
Lally, F and Crome, P (2007) Understanding Frailty. Post Graduate Medical Journal. 83 pp16-20
THREE OR MORE:
Unintentional weight
loss
Self-reporting
exhaustion
Weakness (reduced
grip strength)
Slow walking speed
Low physical activity
TWO OR MORE
Inability to perform one or
more ADL in three days
before admission
Stroke in prev. three months
Depression
Dementia
History of falls
One or more unplanned
admission in prev. three
months
Difficulty walking
Malnutrition
Prolonged bed rest
Incontinence
BGS 2010 (Best Practice Guide 3.5)
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch
C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke
G, McBurnie MA; Cardiovascular Health Study
Collaborative Research Group. J Gerontol A Biol
Sci Med Sci. 2001 Mar;56(3):M146-56.
Finding the frail
Kings' A&E over 75 risk assessment
• Waterlow (+ neurological deficit, mobility pre A&E,
trauma and pre existing medical conditions inc.
Clinical dehydration)
Davies-Gray M (2003) Nurse led fast track for vulnerable older people. Emergency Nurse 11(5). pp34-38
Assessing the frail
Comprehensive
Geriatric Assessment
BGS (2005) Comprehensive Assessment of the Frail Older Person in Hospital .BGS Website Compendium 3.5
BGS (2010) Comprehensive Assessment of the Frail Older Person. BGS website
Ellis, G and Langhorn, P. (2005) Comprehensive Geriatric Assessment for Older Hospital Patients. British
Medical Bulletin. 71. pp 45-59
Wrapping the system around…
Multi-factorial Interprofessional Assessment
Frail
Older
Person
A
C
U
T
E
Triage
Trajectory
Transfer
C
A
R
E
• Diagnostics
• Treatment
initiation
• Liaison
• Negotiation
• Plan
• Co-ordination
• Communication
C
O
M
M
U
N
I
T
Y
C
A
R
E
University Hospitals of Leicester
Frailty Unit
Unit
set-up and evaluation
Criteria
• Over 70 years old plus one of the following:
Presence of delirium or dementia (AMTS)
Fracture as presenting problem but medically
unstable (not NOF)
Care home resident
ED frailty score ≥ 25 (Waterlow+)
Royal Cornwall Hospitals
OPAL Unit
Unit
set-up
• Single front door = shrinking MAU bed base (OPAL
Unit on MAU ward template)
• Establishing bed base from ED and MAU frailty data –
Frailty Tool (Waterlow+) (19 beds and ALOS = 72
hours)
• One geriatrician on unit 7/7 (plus 0.5 for OPAL Team
5/7)
• Specialist nursing and AHP team on unit
OPAL Unit
Triage
Frailty
Unit
Trajectory
Transfer