Category Archives: wellbeing

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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How do we support each other with our mental health? Professor Anne Rogers

When people talk about managing mental health the most frequent thing to do is to recourse to self help or looking to services to help.  There is less recognition of the power of social networks for help and support based on connections and reciprocity around us.

Separating out the individual from their need for other people and ability to mobilise resources in order to manage effectively, has meant that the notion of a personal community of support (the array of personal ties with which people are located and embedded) has not tended to be included in understanding or responding to mental health need.

Now there’s a nascent social movement about networks.

Continue reading How do we support each other with our mental health? Professor Anne Rogers

Letting the cat out of the bag at the Mental Wealth Festival – Dr Sandy Walker

In September, Dr Helen Brooks and I popped over to London for the 2017 Mental Wealth Festival, we were talking about the work we had done looking at how pets can help people manage their long-term mental health problems.

It’s common for academics to be found popping up at conferences and even music festivals these days, telling people what they have been finding out in an effort to spread the word and get the message heard. This was just the activity we were engaged in and one of the benefits for us as academics is that we also get to hear about others work and this gives us ideas.

Perhaps you are wondering what the Mental Wealth Festival (MWF) is all about?

The MWF takes place over 3 days in London . The first day takes place in the Houses of Parliament where Baroness Hollins hosts panel discussions on aspects of mental well-being and the next two days take place predominantly in City Lit, a further education college that serves London. Throughout these two days there is a plethora of wonderful sessions that can be accessed, free of charge, by those registered for the event. Attendees include those with lived experience of mental distress, both themselves and as carers; interested members of the public; policy makers; commissioners and professionals from every group with a role in helping those in mental distress.

It really is the most eclectic, informative and creative space to find yourself in. A place where many, sometimes opposing, worlds collide.

Our talk was full, so we had a great audience of interested people who asked questions all the way along and shared their own experiences of being pet owners. What stood out particularly, and resonated with the findings from our study, was the way in which pets give unconditional love which is consistently there regardless of how we are feeling.

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Dr Sandy Walker (L) and Dr Helen Brooks (R)

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Pets are trusted more than people many said and seem to have an intuitive understanding of their owners, knowing just when to demand to go out or to curl up for a cuddle.

For me most important was the knowledge, which we gained from the study, that for our cohort none of the participants had their pets considered as important network members as part of their care and yet all that had pets stated that they were essential.

The room completely agreed with this and the professionals in the room were clear that pets will be considered more seriously in future, in fact two of the attendees stated that they were relieved to have some research evidence to back up something they had wanted to attend to for a while but had felt reluctant to do so in case they were laughed at.

Contact Dr Sandy Walker

Give me more: Why Insulin pumps aren’t just about what the doctor tells you – Claire Reidy

More and more of us are looking online for information to support our health (see Chris Allen’s work on support in Online Communities). In my research, I have found that the ability to get hold of that information and support, which is personal to you, can make a huge difference to how well you are.

I’m focusing on insulin pumps, which are an alternative means to deliver insulin to people with diabetes – compared to the more traditional multiple daily injections.

Insulin pumps have been developed to help people with Type 1 diabetes manage the condition better; both in terms of their quality of life and by more closely resembling a fully-functioning pancreas.

However, introducing a new health technology to an already difficult to manage condition is not necessarily simple, or easy.

Continue reading Give me more: Why Insulin pumps aren’t just about what the doctor tells you – Claire Reidy

Making the patient central: Mark Stafford-Watson Public Contributor and PPI Champion

Article by Martin Simpson-Scott, PPI Coordinator NIHR CLAHRC Wessex
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Mark Stafford-Watson

Mark Stafford-Watson is one of our NIHR CLAHRC Wessex public contributors. He’s also ‘PPI Champion’ for our Theme 1 research team (Integrated Respiratory Care) – of particular personal relevance to Mark, as he has a long-term respiratory condition.

Continue reading Making the patient central: Mark Stafford-Watson Public Contributor and PPI Champion

Who cares? Genie explores the lives of young carers

According to research by the Children’s Society there are estimated to be 700,000 young carers aged between 5 and 17 years old in the UK.

That figure surprise many people, and the charity goes on to explain how caring at a young age can impact a young persons’ education, health, development and quality of life.

Continue reading Who cares? Genie explores the lives of young carers

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

Where the NHS stops and online takes over – Chris Allen

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Chris Allen is a Research Fellow and a nurse in Southampton

There comes a point in everyone’s life when they get news that changes their life…of course it’s not always bad. Think “you’ve got the all clear” or “you’re going to have a baby”.

But what if that’s not so good. “You have diabetes” or “you have developed COPD”. In those cases firstly you might ask the doctor or nurse- “what can you do?” and “how is it going to affect me?”

Continue reading Where the NHS stops and online takes over – Chris Allen

The Recovery College Phenomena – Sandy Walker

I love being a researcher
Sandra Walker is a Senior Teaching Fellow in Mental Health at the University of Southampton

In 2015 I was fortunate enough to be awarded some funding from Solent NHS Trust to explore the networks of people with long term mental health issues. This project looked at how people manage their networks day-to-day and when they are in crisis, looking to see what the differences were between networks and how people negotiate the relationships within them. All the participants were recruited from community groups and many of the participants were students of a local Recovery College*.

Continue reading The Recovery College Phenomena – Sandy Walker