Date: 09 February 2018
As the winter crisis in the NHS continues, the increase in the numbers of people living into older age is again coming under the spotlight. Whilst many continue to live full lives, a small but significant group experience frailty. Frailty means that they are unable to cope with challenges that other people can easily overcome. For these people, straightforward ailments can trigger profound and sometimes life threatening responses.
The NIHR Dissemination Centre recently published a review of evidence on how hospitals might manage these people, who often present with atypical symptoms and who can deteriorate dramatically in hospital if their needs are not carefully considered and met. The publication was marked by a launch event, where academics, managers, public representatives and clinical professionals came together to discuss the implications of the findings.
Research showing the importance of a comprehensive, multidisciplinary assessment to identify the particular care people with frailty need resonated with all the participants. The question now is how do we to bridge the knowledge-practice gap? The review showed that there are many different interpretations of Comprehensive Geriatric Assessment and this may explain the variation in outcomes. Or it may be that we are completing the assessment but don’t yet know the best in hospital interventions to support identified needs. The participants at the launch felt that all hospital staff, not just specialist older people’s care practitioners, need a good understanding of frailty and how to manage it. The emergence of Acute Frailty Practitioners in some parts of the country was seen as a way of doing this and also of bridging the communication divide between primary care, social care and secondary care.
Participants were surprised how little research there has been on managing the frailty syndromes in hospital. Participants noted that medicines management remains a challenge despite the NICE guidance. We also do not know enough about what people with frailty value and what living well means to them. Research suggests that for many, this is about the nature of relationships and having time, something which is clearly difficult within the current service models in acute hospitals. It was noted that patients not making a fuss is not the same as being content with the degree of involvement in decision making.
Workforce was described as the elephant in the room, both in terms of numbers and type of staff to care properly. More research is needed on the optimum shape of the workforce. We also need to consider the most effective models of care delivery in hospitals as well as out of hospital, do we need speciality frailty wards in the way we have stroke units?
A recent tweetchat hosted by @WeNurses that centered on the themed review bought up similar issues to those raised at the launch event, amongst other discussions.
By bringing some of the existing research into a narrative about the whole hospital journey, the gaps in evidence and the areas for immediate improvement in implementation are brought into sharp focus, setting an agenda for both researchers and practitioners to improve care for people with frailty.
Academics, NHS managers, public representatives and clinical professionals discussed the implications of research featured in Comprehensive Care.
Clinical Advisor - NIHR Dissemination Centre