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.  Continue reading

Translating Isaacs

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. 

chinaIn May 2016 I was honoured to speak about frailty at the Chinese National Geriatrics Conference in Beijing. The audience, not just geriatricians, was people who care for frail older adults. They recognized in geriatric medicine the tools and concepts needed to improve the care of those patients.

For that reason I found myself discussing how best to translate the great Bernard Isaacs’ nicely alliterative phrase “Geriatric Giants. In The Challenge of Geriatric Medicine (Oxford: OUP, 1980) Isaacs elaborates them, also alliteratively, as “instability, immobility, incontinence, intellectual impairment/memory and impaired independence”. These were key ways in which patients and their families understood that “something was wrong”. Continue reading