Tag Archives: patient

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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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

Maths without equations: Dr Tom Monks insights into patient flow from queuing theory

Previously I have written about using a detailed computer model to ask ‘what-if’ an emergency department could be run differently.   Hidden away in complex models like these are important rules of thumb that tell us how to efficiently manage patient flow.

Continue reading Maths without equations: Dr Tom Monks insights into patient flow from queuing theory

I want to go home: Can modelling the whole health care system reduce the number of patients waiting to leave hospital?

Dr Tom Monks puzzles the opportunities and pitfalls of modelling large parts of the health care system and how this might help patients waiting to leave hospital.

I work as a modeller for CLAHRC Wessex. In part that means I spend a lot of time speaking to health care professionals and commissioners about their priorities and teasing out if modelling could help.  More and more often I am asked “can we model the whole health care system?”.

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I want to be alone… single rooms and fundamental care – Professor Peter Griffiths, University of Southampton

Last month saw the publication by the NIHR of the final report on our study evaluating England’s first 100% single room hospital at Pembury, part of the Maidstone and Tunbridge wells trust, which opened in 2011 (1).

Continue reading I want to be alone… single rooms and fundamental care – Professor Peter Griffiths, University of Southampton

Are you 1 of the MISSING 200? – Tackling the Hepatitis C virus by Bicycle

I’m Ryan Buchanan, a specialist registrar doctor in liver disease and a PhD student carrying out research for NIHR CLAHRC Wessex. My project is centred on Hepatitis C in the Isle of Wight community.

Hepatitis C is a virus, which unlike other viruses such as ‘flu’ or the common cold directly affects your liver. It is usually passed from person to person via blood and develops into a long lasting infection. The virus actually causes very few symptoms allowing it to hide within the body making people unaware they carry it.

Continue reading Are you 1 of the MISSING 200? – Tackling the Hepatitis C virus by Bicycle

Why staying well is hard work. Professor Carl May – Healthcare Innovation

Living with a serious long-term condition is often hard and complex work. My team and I are interested in finding ways to reduce complexity and lift the burden for people with these conditions, and their families, at end of life.

To help us think about the kind of research questions we should be asking we held a research forum at Freemantle Community Centre in Southampton. We invited people with a range of conditions to join us and to inform our work.

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Tackling operational problems in health care using modelling and simulation – Dr Tom Monks

NHS clinical commissioning groups across the UK are all focused on improving patient care while facing the pressures of an aging population, increasing volumes of patients with multiple complex health problems and the stark political reality of the need to cut costs. 

The complexity of these decisions and how to improve care is often enormously underestimated in the popular media. Take for example, the waiting time performance of accident and emergency (A&E) departments in the UK. 

Continue reading Tackling operational problems in health care using modelling and simulation – Dr Tom Monks