Nationally there is increasing recognition of the needs of frail older people in health systems, and the UK’s rapidly ageing population will only increase in the years to come.
Dr Ram Byravan (Consultant and Clinical Director Heart of England Elderly Care) states that the prevalence of multimorbidity is on the rise, with 44% of people over 75 now living with more than one long-term condition – geriatricians and GPs are uniquely suited to lead the response to the challenges of caring for this group.
Despite Geriatric Medicine being one of the largest medical specialties in the UK, a majority of frail older people in hospital or community care are not under the direct care of a geriatrician. There simply isn’t enough of them to go around. Could the role of the Advanced Clinical or Nurse Practitioner support our growing number of frail patients?
RCN (2012) define advanced practitioners as Autonomous decision makers, managing patients with undiagnosed conditions, undertaking diagnosis, initiating investigations, making decisions regarding on-going care, admission or discharge care plans.
Liz Hamilton (Good Hope Elderly Care and Community Services Manager) stated that ACPs and ANPs can be from a range of health-care backgrounds. They bring a whole set of expert skills and experience which our frail patients require from their professionals. Coupled with their knowledge, skills, empathy and emotional reserve, ACPs and ANPs can enhance the capacity of the multidisciplinary team.
The gold standard for patients with frailty is to receive CGA, comprehensive geriatric assessment. There is compelling evidence that CGA improves patient outcomes. CGA is by definition multidisciplinary and we see in daily practice professionals who are highly skilled at recognising frailty, initiating relevant parts of the comprehensive assessment and developing individually tailored care plans. Paulette Hutchinson (Trainee Advanced Clinical Practitioner Elderly Medicine – Frailty Good Hope Hospital) feels that the conceptual model of CGA fits in well with existing ANP or ACP assessment processes and care planning, but the additional skills needed to provide best care for older people are not always recognised or encouraged nationally.
Robbie Jane Curtis (Trainee Advanced Clinical Practitioner Elderly Medicine – Frailty Good Hope Hospital) feels there are other essential skills that are critical to the role include advanced skills in dementia and delirium, palliative care, continence, polypharmacy, rehabilitation and falls
Liza Walsh (Divisional Birmingham Community Healthcare Foundation Trust Director – Adult Community Services) highlights that specialist or extended practice can contribute to meeting the needs of our frail patients. However it is important that we are able to embed these advanced roles within both community and acute services so they can contribute to being a very valuable resource.
Advanced clinical roles, if perceived as enhancing both the quality of the care and provide the ‘reach’ of the other services forming part of their inpatient stay and discharge planning. The scope of knowledge and skills required of ACPs for frail older people is potentially vast and it will take many years for them to be fully trained.
Advanced clinical roles can play an integrated and vital role in ‘caring for our frail patients’ both in enhancing quality of care and providing the ‘joined up, multi-disciplinary holistic approach’ to support with the CGA and comprehensive discharge planning with in acute care and supporting to prevent avoidable hospital admission within primary and community services.