Category Archives: elder care

Let’s learn about Frailty: a blog series on training for healthcare staff in this complex field. By Alex Recio-Saucedo and Melinda Taylor

This is the first of a series of blogs drawing on a study of training for those working in frailty care, with additional reflections from other work.

What is frailty?

Before looking at training in frailty care, it would be helpful to understand something about what frailty is. Descriptions of frailty will almost always refer to the complexity of the condition. But what makes frailty different to other conditions that could be described as complex? We might think perhaps of multiple sclerosis, in which the patient may experience a range of clinical conditions and in which physical, psychological and social factors need to be taken into account. The same can be said for patients diagnosed as frail. Well, in a recent study, our participants considered that the complexity of frailty; how two patients could have such a wide disparity of signs, symptoms and needs; its evolving nature; its acute susceptibility to interventions or to the lack of them, and the high number of professions, sectors and organisations necessary to carrying out effective frailty care, were sufficient reasons for it to stand apart.

This series of blogs draws largely upon an evaluation of the training elements of four very different initiatives to develop frailty care pathways. Two significant themes stood out in this study. Firstly, the high level of staff commitment to looking for ways of enhancing the care provided to patients diagnosed as frail. Secondly, their agreement on the extremely broad and nebulous nature of the concept of frailty. While the various tools and checklists available were helpful in identifying frail patients, all agreed that it was difficult to find a comprehensive definition of frailty that conveyed its real meaning; one patient diagnosed as frail could present quite differently to another. The term could concern age, a single clinical condition or comorbidities, and a range of individual circumstances. As one of the study participants commented:

Not everybody who is elderly is diagnosed with frailty and not everybody who is living with frailty is elderly. The problem is that frailty is not a fixed population and it’s not synonymous with age, so it’s a very variable thing, so people can move from one (level of) frailty to another.’

Others noted the wide range of clinical conditions that could be encountered under the umbrella of frailty, with one sometimes feeling ‘overwhelmed’ with all that was to be learned and taken into account when caring for these patients.

In a further discussion, participants commented that the level of complexity was only revealed when actually working with frail patients; regardless of any formal training or self-directed study carried out beforehand, appreciating the complexities could only be appreciated by active involvement in providing care:‘…you’ve got to live it a little bit to understand it.’ The health care professionals felt that they each interpreted frailty in their own individual ways and that it was necessary to understand how others viewed it and the skills and services each profession contributed in order to develop a more meaningful understanding and to enhance the care they provided.

To add to the complexity, there is the issue of the stigma associated with the term frailty. Health care professionals, of course, need a name, a diagnosis, to know what is being dealt with and to develop a care plan. But patients and others, including healthcare professionals themselves, can associate ‘frailty’ with age, infirmity and loss of mental acuity, and patients can find it difficult to come to terms with being classified as such.

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One patient fought hard against being labelled ‘disabled’, even though he was wheelchair dependent, used a Disability Parking Permit and needed assistance with all personal care and daily living. He preferred to be referred to by his name or as a person with Parkinson’s disease. When later hearing himself referred to as frail, he immediately retorted ‘I’m not frail I’m disabled.’

These are just a handful of the frailty issues that participants discussed and it is interesting to note that they rarely mentioned any particular clinical conditions involved in frailty or offered a definition. Their concerns were focused on addressing complexity rather than specific clinical conditions. Yes, the clinical conditions were important, but they were clearly being viewed within the bigger picture of a system or process of frailty, rather than a discrete event in a patient’s clinical life.

Looking back to our initial question, ‘What is frailty?’, these blogs do not aim to provide the answer but present some of the components of frailty, its complexity and multi-faceted nature, defying comprehensive definition, that were important to those taking part in our study. These elements had a significant impact on how they perceived the training they received for their roles within the new initiatives and their future training requirements.

This was the central focus of our evaluation and, having set the scene for the context of the study, our next blog will provide a brief overview of the initiatives and reflect upon our findings relating to the various approaches to training, preferred methods and why they were thought to be appropriate for training within the speciality of frailty.

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Why might nurses miss people’s ‘danger signs’ at night? – Dr Jo Hope

We know that nurses miss or delay taking patients’ vital signs (such as pulse, temperature and blood pressure) at night. Until now, no one knew why.

The NHS expects hospitals to use ‘Early Warning Scores’ to measure how ill someone is. These are based on the observation of ‘vital signs’ – measurements of things like pulse, temperature, blood pressure and breathing speed. The higher the score, the more often someone’s vital signs should be checked. This is so staff can spot the early danger signs of someone becoming very unwell, in time to help them.

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Your local hospital will probably have an ‘early warning protocol’ that says how often people should be checked according to their early warning score. At higher levels observations will need to be done in the middle of the night. Despite this, we know that nurses are much less likely to do the observations that are expected to be done at night.

Continue reading Why might nurses miss people’s ‘danger signs’ at night? – Dr Jo Hope

What are we missing here? (Are at risk older people spotted early enough in hospital?) – Dr Kinda Ibrahim, Research Fellow at Academic Geriatric Medicine

Nearly two thirds (65%) of people admitted to hospital in the UK are aged over 65 years old. Many of them are frail and at high risk of poor healthcare outcomes – like staying longer in hospital, reduced physical abilities, becoming dependant, going to a care home, and even death.

National recommendations suggest that these high-risk older individuals should be routinely identified when they are admitted to hospital to allow healthcare teams to provide appropriate individual care that meets patient’s needs (1).  It is unclear whether and how those people are identified in hospital. Therefore our study looked at the current practice in one hospital with regard to identification of patients at high-risk of poor healthcare outcomes. To do that, we reviewed a random sample of patient’s clinical notes and interviewed staff members who worked at five acute medicine for older people wards (2).

Continue reading What are we missing here? (Are at risk older people spotted early enough in hospital?) – Dr Kinda Ibrahim, Research Fellow at Academic Geriatric Medicine

Should Wessex implement ReSPECT process? – The NIHR CLAHRC Wessex hosted event May 11, 2017

The event in Southampton attracted organisations* from across the Wessex region and beyond and a wide range of people including the public, paramedics, nursing staff, clinicians, managers and researchers.

Many stakeholders were represented bringing together 44 delegates, all there to examine and reflect on whether the ReSPECT approach to decision making for emergency care should be adopted.

Continue reading Should Wessex implement ReSPECT process? – The NIHR CLAHRC Wessex hosted event May 11, 2017

Prioritising the fundamentals of care with patients, professionals, carers and the public – Anya de Iongh

As PPI Champion for the Fundamentals of Care theme within NIHR CLAHRC Wessex, I’ve a great experience and opportunity to be an equal member of a team developing the research priorities for this area of work. Crucially, these weren’t priorities that we developed together in a closed room, but rather they were co-produced at several stages.

Continue reading Prioritising the fundamentals of care with patients, professionals, carers and the public – Anya de Iongh

Breathe in the knowledge -by Lindsay Welch

lindsay-welchLindsay Welch is the Integrated COPD Team Lead; Solent NHS Trust and UHS NHS Foundation Trust

COPD or Chronic Obstructive Pulmonary Disease is a preventable disease and is one of the world’s biggest killers – it causes a narrowing of the breathing tubes and air sacs in our chest and lungs, reducing the amount of oxygen we can get into our bodies. There are several causes, air pollution and exposure to dust, but the main culprit is smoking. It is estimated that over three million people with COPD in the UK but only a quarter of those are diagnosed

Continue reading Breathe in the knowledge -by Lindsay Welch

Are some social networks better for self-management than others? Dr Ivaylo Vassilev, Senior Research Fellow

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The everyday management of a long-term condition is almost never done by individuals in isolation from others. The networks of relationships around people may include family members, friends, neighbours, colleagues, health professionals and even pets all of who play an important role in the management of long-term conditions. This is through, for example, their knowledge, support, help with accessing services, resources and valued activities.

Continue reading Are some social networks better for self-management than others? Dr Ivaylo Vassilev, Senior Research Fellow

Dementia care at meal times in acute hospitals – Naomi Gallant

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Almost a year on from my last post here and I’ve done a lot of work on my developing my research proposal – reading, learning, literature reviewing – but sadly not a lot has changed for people with dementia in acute hospitals. My desire to improve the quality of care, especially at meal times has certainly grown.

Continue reading Dementia care at meal times in acute hospitals – Naomi Gallant

NATIONAL CONSULTATION ON EMERGENCY CARE AND TREATMENT PLAN: IMPLICATIONS FOR THE TREATMENT ESCALATION PLAN (TEP) PROJECT? Professor Alison Richardson

Having conversations about the best course of action in the event a person’s condition deteriorates is difficult for everyone involved, whether it is the patient themselves, their family or carer and the clinician.

After an initial study on Advance Care Planning (A. Richardson, S. Lund1), research into the current application of treatment escalation plans across the country, and early engagement with some of the acute trusts in the Wessex region, it was apparent there was a desire to improve this process.

Continue reading NATIONAL CONSULTATION ON EMERGENCY CARE AND TREATMENT PLAN: IMPLICATIONS FOR THE TREATMENT ESCALATION PLAN (TEP) PROJECT? Professor Alison Richardson

Getting a grip on high risk older inpatients with low grip strength -Dr Kinda Ibrahim and Dr Helen Roberts, Associate Professor in Geriatric Medicine

Our muscles play an important role in our health and grip strength is a good way of measuring how well our muscles are doing. Our grip strength builds through young adulthood to reach its peak in our 30s after which it gradually tails away. It is a reliable and valid way of evaluating someone’s hand strength, which in turns provides an objective measure of the skeletal muscle strength and function in their whole body.

Continue reading Getting a grip on high risk older inpatients with low grip strength -Dr Kinda Ibrahim and Dr Helen Roberts, Associate Professor in Geriatric Medicine