Frailty and delirium – the Scottish approach

Christine McAlpine is a consultant geriatrician at Glasgow Royal Infirmary. She served on the Working Group which developed the BGS’ Fit for Frailty guidance and was Chairman for some years, of the BGS Clinical Effectiveness and Quality Committee.

10% of patients admitted to hospital as an emergency stay more than two weeks, using 55% of all hospital bed days, and 80% of that group are aged over 65 years.

The average age of a hospital inpatient is over 80. Good care for older people in acute care is a key priority for health services.

In 2012 Healthcare Improvement Scotland (HIS) was asked by the Scottish Government to “improve acute care for older people by March 2014”. A review of the published evidence plus the themes coming from the inspections of acute care services for older people suggested there were opportunities for improvement in the care of frail older people coming in to hospital, and that in particular delirium was often undetected with resulting poor outcomes for patients (including higher risks of death or institutionalisation).

The Older People in Acute Care (OPAC) improvement programme was therefore set up.

Fit for Frailty

Dr Gill Turner is Vice President – Clinical Quality for the BGS and project lead for Fit for Frailty –  guidance published today on the recognition and management of older patients with frailty in community and outpatient settings. 

Frailty, or the ‘F’ word, must score as the most talked about condition over this last year. It is hard to go to any scientific meeting, participate in any discussion about health service development or even read a newspaper without encountering the  ‘ F ‘ word.

But what does it mean?  It is likely that frailty means different things to each audience ranging from a scientific phenotype with specific outcomes in the Framingham heart study to a social description of someone in the last months of their life.

However, the real meaning of frailty for the NHS and social care is the possibility of identifying a group of older people, for whom services need to be specifically focused to improve quality and safety. The expectation is that through increasing effectiveness in proactive care, increasing efficiency and value for money will follow.

The British Geriatrics Society which represents more than 2700 UK specialists in health care for older people (doctors, nurses and allied health professionals) has produced  Best Practice Guidance for Frailty in community and outpatient settings. Under the title ‘Fit for Frailty’, it is published in 2 parts. Part 1, launched today describes the recognition and management of individuals with frailty in community and outpatient settings. Part 2 to be launched later in the summer, will describe the development, management and commissioning of services for people with frailty.

The F word

Dr Gill Turner is Vice President – Clinical Quality for the BGS and project lead for Fit for Frailty –  guidance published today on the recognition and management of older patients with frailty in community and outpatient settings. 

Frailty, or the ‘F’ word, must score as the most talked about condition over this last year. It is hard to go to any scientific meeting, participate in any discussion about health service development or even read a newspaper without encountering the  ‘ F ‘ word.

But what does it mean?  It is likely that frailty means different things to each audience ranging from a scientific phenotype with specific outcomes in the Framingham heart study to a social description of someone in the last months of their life.

However, the real meaning of frailty for the NHS and social care is the possibility of identifying a group of older people, for whom services need to be specifically focused to improve quality and safety. The expectation is that through increasing effectiveness in proactive care, increasing efficiency and value for money will follow.

The British Geriatrics Society which represents more than 2700 UK specialists in health care for older people (doctors, nurses and allied health professionals) has produced  Best Practice Guidance for Frailty in community and outpatient settings. Under the title ‘Fit for Frailty’, it is published in 2 parts. Part 1, launched today describes the recognition and management of individuals with frailty in community and outpatient settings. Part 2 to be launched later in the summer, will describe the development, management and commissioning of services for people with frailty.

Quality Mark for Elder Friendly Hospital Wards

Ensuring that we are delivering a high quality service is, or should be, the preoccupation of geriatricians and specialists in health care for older people. But how do we know if we are? As we consider the ongoing implications of the Francis Report, the BGS will be seeking to develop tools and services which help in this quest. There is much more to do but the BGS has assisted with the development of a Quality Mark for Elder Friendly hospital wards in collaboration with the Royal College of Psychiatrists and others. Dr Chris Dyer, the BGS representative on this project (with Peter Crome) shares more details.

At a single ward level, the Quality Mark for Elder Friendly Hospital Wards is a method that hospitals can use to raise standards of care for its most vulnerable group of patients. Indeed, as part of its response to the Francis Report the Royal College of Physicians has recommended use of the Quality Mark.

Digital inclusion and older people

Emma Solomon OBE is Managing Director of Digital Unite, an independent organisation that helps people, particularly older people, to understand and use computers, the internet and other digital technology.

image by southerntabitha

Having the skills to use digital technology is a must-have in today’s modern society. It can save us time and money, make us feel better connected, less lonely and better informed.

For the citizen as a patient, having digital skills means being able to book and cancel doctors’ appointments more easily, order repeat prescriptions, improve the access to information and services to support their own care and that of others.

By 2015, the NHS Commissioning Board aims to guarantee every patient the opportunity of online access to their own medical records. This is an ambitious target made even more challenging because today in 2013, many older people still either aren’t online or don’t have good enough digital skills to use such a service.

Quality Matters

Dr Gill Turner is the recently appointed BGS Vice President for Clinical Quality and is a clinical consultant at  University Hospital Southampton

The BGS exists to promote quality health care for frail older people. So, why do we need a Vice President for Clinical Quality in the BGS?

I asked this very question when I applied for the post last summer – and although not yet fully answered, I now believe I understand some of what might be needed of this leadership role. I have spent the 4 months since my appointment considering how we need to develop our ‘quality’ agenda. This has, so far, involved much thought, hours of reading and many visits and conversations with experts from throughout the UK.

New recruits needed to help build services for frail older people undergoing operations

Dr Jugdeep Dhesi is Chair of the BGS Peri-operative Care of Older People Ungergoing Surgery SIG (POPS) and is consultant physician and clinical lead for the POPS service at Guy’s and St Thomas’ Hospitals.

The number of frail older people undergoing elective surgical procedures is rapidly increasing. In fact the number of older people undergoing operations, as a proportion of all those having surgery, is increasing more rapidly than is the proportion of frail older people across the population as a whole.

There are a number of reasons for this. Advances in surgical technique and improvements in anaesthetic management have made it possible to operate safely on patients who would have been considered too frail for surgery in the past. At the same time patients and doctors now expect that they will be able to receive operations much later in life.  

The Silver Book – guidelines for the emergency care of older people

The BGS is proud to announce the publication of the Silver Book, an essential guide to for all those involved in delivering emergency care to meet the needs of older patients and to promote continuous improvement in the standards of care.

The Silver Book recommends ways in which emergency admissions can be reduced and the experience of those admitted improved.  It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses. A core focus of the Silver Book is the skills and competencies needed by healthcare staff to ensure they are better able to assess and manage frail older people.