Specialist Care Frailty Network – we need your help!

Dr Simon Conroy is a geriatrician at University Hospitals of Leicester, Honorary Senior Lecturer, University of Leicester and an Associate Editor for Age and Ageing journal. 

Dear fellow BGS members,

Some of you might have heard about the Acute Frailty Network, which has been in existence for a few years now. The focus of the Acute Frailty Network has been acute medical care and to some extent emergency care. The Specialist Care Frailty Network will focus upon the care of older people with frailty in six specialist services:

• Renal Dialysis
• Chemotherapy
• Emergency Cranial Neurosurgery
• Interventional Cardiology
• Complex Spinal Surgery
• Adult Critical Care

Why I’m Fine with “Frailty”

Professor David Oliver is a Past President of the BGS, clinical vice-president of the Royal College of Physicians, and a consultant in geriatrics and acute general medicine at the Royal Berkshire NHS Foundation Trust. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon? He tweets @mancunianmedic

Dr Steve Parry’s recent blog here, “The Frailty Industry. Too much too soon” certainly generated a great deal of hits and online responses. He is a well-respected geriatrician, has done sterling work for our speciality and we are friends in a speciality where solidarity and mutual respect are wonderfully the norm.

The more I reflect, the more I realise that none involved in the debate are a million miles apart in any case. We have all devoted our professional lives to the skilled multidisciplinary care of older people, especially those with the most complex needs; to the speciality of geriatric medicine; to the leadership of local services; to the education of the next generation of geriatricians and to developing the evidence base for practice. 

Identifying frailty in hospital

Professor Kenneth Rockwood has published more than 300 peer-reviewed scientific publications and seven books, including the seventh edition of the Brocklehurst’s Textbook of Geriatric Medicine & Gerontology. He is the Kathryn Allen Weldon Professor of Alzheimer research at Dalhousie University, and a staff internist and geriatrician at the Capital District Health Authority in Halifax in Canada. 

Last autumn, at a meeting of the Acute Frailty Network in London, I sat in on a discussion group about identifying frailty in acutely ill older people who come to hospital. Although some participants noted objections about such screening in some quarters, with this audience, there was no need to discuss why it makes sense to identify people at greater risk than their age peers of being harmed by usual hospital care.

Before moving on, let’s consider for a moment why anyone might object to screening for baseline frailty in patients who presented to A&E.  For those who see it as reasonable to screen for frailty it almost seems that those who don’t believe that it somehow encourages frail patients unnecessarily to seek hospital care. 

Collaboration and training: life as an ACF in Geriatric Medicine

Jenni Harrison is a Clinical Research Fellow and Junior Doctor, who has just started a PhD at the University of Edinburgh following completion of Academic Core Medical Training. She tweets @JenniKHarrison

I still remember opening the email from Dr Conroy, which simply said:

“Would you like to write an article about frailty with Professor Young and I?”

As you’d expect like many things during my time as an Academic Clinical Fellow (ACF) in Geriatric Medicine it was met with an enthusiastically prompt reply. Only a few weeks earlier I’d had the opportunity to participate in a Frailty Workshop in Leeds run by Dr Andy Clegg and Professor Young, discussing their Frailty Index using routinely-collected GP practice data. Professor Young had challenged us on that occasion to think about frailty not simply as a descriptive term, but as a long-term condition.

The Acute Frailty Network – solutions for urgent care for older people?

Dr Simon Conroy is Head of Geriatric Medicine, University Hospitals of Leicester, Honorary Senior Lecturer, University of Leicester and an Associate Editor for Age and Ageing journal.

Urgent care of frail older people is rapidly becoming the core business of acute hospitals; it is often described as a ‘wicked problem’. This year has been one of the most challenging periods for staff and patients in the NHS in many years. The debrief is on-going, but candidate theories include ‘too many old people’ (sic), lack of primary care, poor ED staffing, and reduced outflow relating to social care cuts. The truth is likely to be a combination of all of these factors, and many others. An important output from the post-mortem is to determine what we can do about it in the future?

Undoubtedly one of the drivers is the ageing demographic, which does mean that hospitals need to expect more older people coming though their doors, many of whom will be frail. Whilst there have been significant improvements over the last few years in the acute care response to older people, there is still a long way to go. There have also been some significant misunderstandings about what is required for older people accessing urgent care. It is not just geriatricians! Rather it is the technology to which geriatricians can usefully contribute to or even coordinate – Comprehensive Geriatric Assessment (CGA). But CGA is not an exclusive club. Every physician involved in managing frail older people should be able to play a useful part in CGA. It’s just that geriatricians are specifically trained to do it, although increasingly other physicians are developing their skills in this area which is key for future-proofing urgent care. Yet we see significant variation in the interpretation of what constitutes CGA. I have taken the liberty here of illustrating some of the key concepts.