ECFs and ANPs – The Future of Frailty?

Rachel Viggars is an Advanced Nurse Practitioner at Ashley Surgery (North Staffordshire CCG). Brigitte Knowles is a Elderly Care Facilitator at Madeley Surgery (North Staffordshire CCG). Both are undertaking the MSc Frailty and Integrated Care at Keele University.

We’ve always loved working with older people. Our roles in general practice certainly facilitate this!  When we were offered the opportunity to study at Masters Level in Medical Science: Frailty and Integrated Care, we jumped at the chance.  Finally, there was a focus on older people and an opportunity to improve standards and care.  But aside from this, it was a fantastic opportunity for us to complete a MSc in an area that we are passionate about, and the multi-professional learning that took place, really valued us as individual Health Care Professionals.  We were able to share and learn from the other professionals on the course and we really started to believe that we could do this and make a difference to our patient groups. 

The right intervention, at the right time, in the right place…

Stephanie Robinson is an occupational therapist at Harrogate hospital working as the  frailty team leader across the medical elderly wards and previously seconded into the Supported Discharge Service. She has had a key role in cross boundary working, outreaching from frail elderly inpatient based wards to the community.

The right intervention, at the right time, in the right place… How Harrogate District Foundation Trust therapists from the community and in-patient wards are tackling the national bed crisis: piloting a Supported Discharge Service.

The pressure is on in Harrogate – the population of over 60s is 26.5% compared to 22.4% nationally.  By 2030 the district’s over 65 population is predicted to increase by 15,000 people.  One of the Trust’s strategic aims for the next five years is to integrate acute, community and social care to allow patients to be treated closer to home, or at home and reduce reliance on acute beds.  It is understood that therapy assessments completed in a patient’s own home are a more accurate reflection of their capabilities than those completed in the hospital environment.  Based on the Discharge to Assess model, the concept that the hospital is often not the most appropriate place for patients of any age to remain is not a new one.

Other than exercising? Another way for fear of falling…

Mr. Tai-Wa LIU is a Senior Lecturer at the Open University of Hong Kong.  In this blog, he shares a recent Age and Ageing publication looking at the effectiveness of cognitive behavioral therapy in reducing fear of falling and improving balance among older people.

Whenever you are afraid of losing balance in doing something, it means you might have fear of falling.  For example, a baby first tries to stand on its own, or a kid learns cycling.  We all have had this fear of falling, especially in situations where we might get hurt or be embarrassed in public. This fear is normal and self-protective in nature, but the reality is that older people with excessive levels of this fear could lead to restricted activity of daily living, limited social participation and physical deconditioning.  Eventually, it could lead to increased fall risks and form the vicious cycle of “fear of falling and actual falls”.

For some reasons, such as deteriorated physical ability or previous fall experiences, fear of falling is common among older people.  The origin of this excessive level of fear is believed to be psychological and stems from the impaired balance confidence and over-pessimistic view regarding the consequences of falls. 

Swallowing Awareness Day #swallowaware2018

Esther Clift is a Consultant Practitioner in Frailty and Chair of Wessex BGS, as well as the Vice Chair of the BGS Nurses and AHP Council. She tweets as @EstherClift

The Royal College of Speech and Language (RCSLT) held a Symposium on dysphagia to work collaboratively at a system wide level in order to improve patient care, safety and outcomes for adults with dysphagia. The current prevalence data was presented in conjunction with NHS Improvement and the Academy of Medical Royal Colleges. Kamini Gadhok, MBE, the CEO for the RCSLT opened the symposium.

Dysphagia is a significant issue for patient safety. The reality of choking and asphyxia is firmly on the agenda since some high stake cases in February 2015, over ‘a risk of death from asphyxiation by accidental ingestion of fluid/food thickening powder.’

Creating a ‘Frail Friendly’ Acute Medical Unit… ‘not rocket science’

Teresa Dowsing trained as a physician associate at the University of Birmingham Medical School. She has worked in geriatric medicine for around 7 years and is the Frailty Lead for the George Eliot Hospital NHS Trust. To read more about physician associates and the British Geriatrics Society click here.

Creating a ‘Frail Friendly’ Acute Medical Unit (AMU) at George Eliot Hospital NHS Trust ….or what some specialities in my Trust used to call ‘not rocket science’…

Thinking about the latter part of this title, most of us that try to ‘practice’ geriatrics understand that it does sometimes feel like some form of mysterious dark art. A pinch of medicine, followed by a smidgeon of rehabilitation, mixed together with a drop of social care, a big dollop of communication and a dash of common sense. Simple? Not always…..

Fostering attachment in dementia care

Matthew Berrisford is a Charge Nurse at The Meadows Community Hospital, Pennine Care NHS Foundation Trust. He tweets @berrisfjord

One of the most useful pieces of advice I can share with a colleague working in dementia care is this: whenever confronted with what you perceive to be attention­-seeking behaviour, reframe it to yourself as attachment-seeking behaviour.

Attachment is a hard-wired evolutionary mechanism in all mammals. Simply put, in order to survive, infants must imprint upon a main carer (typically one or both parents) to ensure that their essential needs are met.

These needs are not purely physical (food, drink, protection); the relationship itself is essential. This fact is aptly demonstrated by animal experiments (Harlow’s monkeys and Skinner’s rats, for example) which consistently show that infant mammals raised in isolation – with no access to a main carer to imprint upon – age quickly and die younger.

Blue Ribbon Patient: Do Not Transfer

Rick Strang RN is Emergency Care Improvement Lead at Isle of Wight NHS Trust in England. When not involved in all types of emergency care Rick is usually finding innovative ways to avoid household chores.

Most of us across acute care have been involved in late night bed pressures that call for that dreaded decision to need to move some patients around between wards. Typically we see the only beds available to be surgical ones whilst the demand is for acute medical beds. Moving acute medical patients directly to these outlying beds from the emergency department (ED) may present too much of a risk. Lower acuity patients from acute wards are therefore often sought out to be transferred into these surgical beds thus making way for the more acute ED demand. End of Life (EoL) patients seem particularly at risk of being moved, which can be very distressing for families, friends, the patient and the care teams.

Taking control of our homes as we get older

Dr Rachael Docking is Ageing Better’s Senior Evidence Manager. Rachael’s remit is to work on their evidence work stream and manage one of their programmes of work, as well as providing cross-cutting evidence support to other work-streams. Rachael leads on their homes and neighbourhoods programme and has also been managing a commissioned review on inequalities in later life.

Jill is 68 years old. She’s still working and cares for her husband. With reduced mobility due to osteoarthritis, Jill has been in a lot of pain, living in a house that wasn’t suited to her changing needs and didn’t know where to turn to for help. She began to develop coping strategies like shuffling upstairs on her bottom, and couldn’t bathe or shower properly.

After a needs assessment from a local occupational therapist, Jill had a number of adaptations installed at home, including a wet room and extra stair rail. As a result she can now shower herself and though still in pain, the adaptations have helped her remain in her own home.

Advanced Professionals supporting our frail patients, but how?

Beverley Marriott is an Advanced Nurse Practitioner working in the Birmingham community healthcare foundation trust. She is also a King’s College Older Person Fellow. She tweets @bevbighair

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.

Quality Dementia Care in Hospital Settings – It can be done!

Lynn Flannigan is an Allied Health Professional who is working as an Improvement Advisor for Focus on Dementia. She tweets @lynnflannigan1 Dr Graeme Hoyle is a Consultant Physician in the Department of Medicine for the Elderly in NHS Grampian. He tweets @AbdnGeriatrics.

Focus on Dementia, in partnership with Aberdeen Royal Infirmary, have produced a publication which explores the critical success factors which lead to improved outcomes for people with dementia, their carers and staff in acute care, which we would like to share with BGS members.

Focus on Dementia is a national improvement portfolio based within the ihub of Healthcare Improvement Scotland. We work in partnership with national organisations, health and social care practitioners, people with dementia and carers to reduce variation and improve quality of care.