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People at the centre of health


People at the centre of health & care National Person-Centred Health & Care Programme Care Experience Breakout Sessions Trudi Marshall Nurse Consultant Older People – PowerPoint PPT presentation

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Title: People at the centre of health

People at the centre of health careNational
Person-Centred Health Care Programme
  • Care Experience Breakout Sessions
  • Trudi Marshall
  • Nurse Consultant Older People
  • NHS Lanarkshire
  • Older Persons Pathway

What is Frailty?
What is Frailty?
  • State of high vulnerability for adverse health
    outcomes, including disability, dependency,
    falls, need for long-term care, and mortality.
  • Commonly used to describe older persons at
    increased risk for morbidity and mortality.
  • Typically involves alteration in multiple, not
    individual, body systems.
  • Syndrome associated with reduced functional
    reserve, impairment in multiple physiological
    systems, and reduced ability to regain
    physiological homeostasis.
  • (Fried, Ferrucci, Darer, Williamson, Anderson,
    2004. Morley, Kim, Haren, Kevorkian, Banks,
    2005. Bartali et al., 2006) 

Why is Frailty Important ?
  • Caring for frail older adults is difficult and
    challenging because they have an increased burden
    of symptoms, are medically complex, and often
    have increased social needs. (Espinoza Walston,
  • Frailty is a strong predictor of several negative
    outcomes including disabilities,
    institutionalization, and mortality. (van Iersel
    Rikkert, 2006) Frailty has also been linked to
    acute illness, falls, and increased
    vulnerability. (Espinoza Walston, 2005)
  • The identification of frailty in its early stage
    is important because interventions may
    potentially prevent, or delay the clinical
    consequences of frailty. (Bartali et al., 2006)
  • Screening for frailty and assessing levels of
    frailty in older adults can identify those most
    vulnerable and assist in targeting nursing

Comprehensive Geriatric Assessment (CGA)
(No Transcript)
  • Well established MDT approach
  • In depth MDT assessment
  • Recognition of frailty
  • Discharge planning

  • ACE Nurse
  • Screening - signposting
  • CGA
  • AMT, functioning, social, urinalysis, LS BP,
    Falls history, Meds reconciliation
  • Supporting discharges

Getting the assessment of older people right in
the AMU has the potential to improve outcomes,
reduce inappropriate hospitalisation, and
potentially reduce the need for long-term care.
(RCP, 2012)
  • Over 85 of frail older people reaching
    speciality beds within 24 hours (prev 40-60)
  • All patients who require LS are now having this
    assessment undertaken (prev 5).
  • Over 90 of AMTs are now being completed (prev

  • Reducing the average length of stay of emergency
    or unplanned admissions
  • Reducing emergency inpatient bed days for people
    over the age of 65years
  • Improving the quality of the patient care
  • Supporting the increase in the level of older
    people with complex care needs receiving care at
  • Supporting Shifting the Balance of Care

Staff feedback
  • The nurse post in the emergency receiving unit
    makes a big difference to thorough assessment and
    early intervention for older people, we feel more
    informed and more in control of the acute care
    group. (Consultant Geriatrician).
  • The nurse often finds out from carers/ relatives
    which community pharmacy the patient uses and if
    they use a compliance aid. This is vital
    knowledge for discharge and allows the ward
    pharmacists to contact the community pharmacist
    on discharge and communicate changes made. They
    also identify patients who are having
    difficulties which allows me time to resolve
    these problems which were previously often only
    identified on discharge. (Pharmacist)