Is frailty becoming less fatal?

Professor Fiona Matthews is Professor of Epidemiology at Newcastle University, Newcastle-upon-Tyne, UK. In this blog, she shares a recent Age and Ageing publication looking at data collected since the 1990s on how much frailty exists in the population and whether it is more or less related to dying now than 30 years ago.

Most doctors involved in the care of older people would claim to know a frail patient when they see one. Being able to detect this frailty is crucial to ensure that treatment is appropriate, proportionate and likely to produce positive outcomes wherever possible. The measurement of frailty has become important recently with the inclusion of frailty within the requirements of an assessment in general practice, and tools to assist doctors in emergency departments evaluate frailty quickly. The most popular method for these investigations has been the frailty index, where diseases and impairments are added all together to give a score. The relationship between this frailty index and mortality has been seen across the world, giving rise to suggestions that it is one measure that is consistent across time and place. Continue reading

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.  Continue reading

When low blood pressure is too low in old age

Sven Streit is a general practitioner at the Institute of Primary Health Care (BIHAM) in Bern (CH) and PhD Candidate at Leiden University Medical Center (NL). In this blog, he introduces the results of his PhD in a recent Age & Ageing paper on blood pressure, mortality risk and cognitive decline in a population-based cohort of oldest-old (all 85 years) in Leiden. He tweets @Sven_Streit

With increasing age, blood pressure rises as a consequence of arterial stiffness. It has been debated whether or not to it is beneficial to treat hypertension in old age, especially in >75-year-olds when they have multimorbidity, polypharmacy or frailty. Large hypertension trials showed that lowering blood pressure in over 60-year-olds is beneficial and lowers the risk for myocardial infarction, stroke and all-cause mortality, even in >80-year-olds. However, these trials lack generalizability and typically excluded patients with multimorbidity and frailty. At the same time, observational studies raise concerns about lowering blood pressure too much, since there are several cohort studies showing a reverse association between low blood pressure and increased mortality and accelerated cognitive decline starting from age >75-year-olds. Continue reading

Identifying older patients with frailty from routinely collected hospital data

Dr Thomas Gilbert is a consultant geriatrician (Hospices Civils de Lyon, FRANCE), with interests in Health Services Research. He worked with Dr Jenny Neuburger and colleagues from the Nuffield Trust in London on the development of the Hospital Frailty Risk Score whilst he was a clinical research fellow under the mentorship of Prof. Simon Conroy in Leicester (Department of Health Sciences).  He will be speaking at the Urgent care for frail older people event on 25 May at Horizon in Leeds. 

Advances in health care have helped people in developed countries live longer than ever before. This is good news for all of us, but it also presents a challenge to our health systems and a need to rethink the way that we provide healthcare. Out of nearly 20 million people admitted to an NHS hospital in the UK in 2015, a quarter were aged 75 years or older, and this proportion is set to increase.

For some older people, hospitalisation is associated with increased harms over and above their presenting clinical condition. Recognising that age alone is insufficient to identify and respond to such vulnerability, the term ‘frailty’ is increasingly being employed to highlight patients exposed to an increased risk of poor outcomes and likely to require higher resource use. Continue reading

Where and how would you want to spend your last 1000 days?

Premila Fade is a Geriatrician with an interest in medical ethics and end of life care. Here she discusses BGS’s Living and Dying Well with Frailty event which was held on 6 March in London. She tweets @premzf 

If you were an older person living with frailty where and how would you want to spend your last 1000 days?  It is often difficult to accurately predict prognosis for older adults living with frailty and they have different needs at the end of life to younger people.  Traditional models of specialist palliative care do not always meet these needs or those of the carers and family supporting them.

What makes frailty different from other conditions at the end of life is that there can be prolonged periods of relative stability and then a potentially mild illness/insult causes a significant or catastrophic deterioration. This acute deterioration often triggers the conventional response to crisis – 999, ambulance to ED, investigations and the commencement of invasive medical treatment. Continue reading

Uncontroversial truths; Discussing urgent care for older people

Stuart Parker is Professor of Geriatric Medicine at Newcastle University and a consultant physician at Newcastle upon Tyne Hospitals NHS Trust where he is helping to develop an acute inpatient service for frail older people. Here he discusses the Urgent care for frail older people – Hospital Wide Comprehensive Geriatric Assessment Meeting on 25 May in Leeds.

Frailty is now widely recognised as a key component of declining health and function in old age.  Older people with urgent care needs are particularly likely to experience frailty.  New acute illness can trigger the onset of frailty in an older person who, in whom the limits of their functional capacity may be urgently revealed. Older people are increasingly the main users of urgent care services. Accordingly, urgent care services for older people need to be able to recognise, evaluate and manage frailty. Continue reading

The Wild Wild Southwest: BGS Regional Meeting, Bath

Alasdair Miller is a ST6 Specialist Registrar in Geriatric Medicine at Royal United Hospital, Bath.

In the warm spell between the two flurries of snow and ice which have buffeted the UK in recent weeks, Bath’s Kingswood School Sports Pavilion played host to the Southwest Regional Meeting of the BGS. The event attracted a wide variety of attendees from different walks of Geriatric Medicine across the southwest- a multidisciplinary crowd ranging from junior trainees to eminent seniors, and with strong representation from both community and hospital teams. The day’s remit: to share learning and innovation from across the patch, update ourselves on topical and important areas within Geriatric Medicine, and foster links, cooperation and friendship with colleagues. Continue reading

How (I try!) to avoid a hospital admission for someone with frailty

Dr Amy Heskett is a Speciality Doctor working in a Community Geriatrics team within West Kent called the Home Treatment Service. This team works alongside paramedics, GPs and district nurses to prevent unnecessary hospital admissions for people with frailty, multiple comorbidities, caring responsibilities or as part of end of life care.  The home visits use bedside testing and a multi-disciplinary approach to provide management of many acute medical presentations in a home-setting.  The development of these holistic plans requires a creative approach and the experiences often generate tweets @mrsapea and blogs at communitydoctoramy.wordpress.com

The bag I take on every home visit has numerous pockets with endless equipment and forms required at my fingertips. I clip the same badges and emergency kit to myself at the start of every shift and I take this order and strict routine with me into environments over which I have little control.  It is within this mix of structure and chaos that the creativity to manage conditions and sometimes crises within a community setting arises.

Publications and conferences have explained the importance of avoiding unnecessary hospital admissions (especially for those with frailty) and commissioners require data on the number we have achieved. Continue reading

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….. Continue reading

Using population sub-segmentation to promote tailored end of life care in later life

Professor Martin Vernon is National Clinical Director for Older People and Person Centred Integrated Care at NHS England. He tweets @runnermandoc. Dr Dawn Moody is Associate National Clinical Director for Older People and Integrated Person-Centred Care for NHS England. She tweets @Moody_D_K. They will be speaking at the BGS Living and Dying Well with Frailty event today. Follow the conference via #bgsconf

Frailty is an especially problematic long term condition characterised by declining intrinsic capacity to deal with stressor events such as acute illness or physical accidents. When severe it significantly increases personal annual risk of reaching end of life. While occurring alongside human ageing, not everyone develops frailty and it is not solely confined to older people. NHS England estimates 20% of the population aged 90 and over remains fit and are therefore likely to be fortunate in ageing well. Conversely we estimate that up to 25% of people aged 65 to 69 are living with mild frailty in England which compared to their fit peer group places them at twice the annual risk of reaching end of life.  A further 5% of this age group is estimated to be living with moderate or severe frailty. Continue reading