These resources are intended to help address the common ‘frailty syndromes’ of falls, immobility, delirium, incontinence and side effects of medication. There is also a range of case studies available at the future NHS Collaboration Platform on the topic of supporting older people living with frailty. Please contact us via email@example.com to gain access.
Frailty as a long term condition
To support health and care professionals and commissioners in the development of patient-centred services that enable people to age well there is a range of material available to improve understanding of frailty as a long term condition:
- NHS RightCare Frailty Toolkit, designed to support systems to understand the priorities in frailty identification and care, and key actions to take.
- Skills for Health, NHS England and Health Education England Frailty Framework of Core Capabilities
- National Voices narrative for coordinated support for older people
- Age UK and the British Geriatric Society research on the language and perceptions of frailty
- NHS England, Age UK and Public Health England patient information leaflet – Keeping your independence
- NHS England toolkit for general practice in supporting older people living with frailty
- NICE information relevant to frailty
- National Institute of Health Research on older patients living in hospital with frailty
- National Institute of Health Research summary of reliable evidence about the effects of important interventions for practitioners and decision makers
- British Geriatric Society Comprehensive Geriatric Assessment (CGA) toolkit for general practitioners and medical and healthcare professionals working in primary care settings
Every year more than one in three people over 65 suffer a fall, which can cause serious injury and even death. The costs to the NHS and social care from hip fractures alone are an estimated £6 million per day or £2.3 billion per year.
Falls are the main cause of a person losing their independence and going into long term care. After a fall, the fear of falling can lead to more inactivity, loss of strength, loss of confidence ,and a greater risk of further falls and a greater risk of death.
- NHS RightCare Falls and Fragility Fractures Pathway defines the core components of an optimal service for people who have suffered a fall or are at risk of falls and fragility fractures
Public Health England has developed:
- Consensus statement and technical pack on falls and fractures
- Falls prevention: cost-effective commissioning resource to help commissioners and communities provide cost-effective falls prevention activities
Older people who do not get enough opportunity to mobilise can have an increased risk of reduced bone mass and muscle strength, reduced mobility, increased dependence, confusion and demotivation.
- Public Health England’s Physical Activity Tool provides local data alongside national comparisons to support local health improvement
Older people (and people with cognitive impairment, dementia, severe illness or a hip fracture) are more at risk of delirium. About 20–30% of people on medical wards in hospital have delirium. Between 10% and 50% of people who have surgery go on to develop delirium, varying on different types of surgery and settings. In long term care settings, its prevalence is under 20%.
- British Geriatrics Society (BGS) and NICE Clinical guidelines on delirium and transient loss of consciousness
- Royal College of Physicians guidelines on Prevention, diagnosis, referral and management of delirium in older people
- Royal College of Psychiatrists Delirium advice leaflet for patients and carers
Delirium Assessment Tools:
In the UK, there are over 14 million people who have bladder control problems and 6.5 million with bowel control problems. People with continence needs are often too embarrassed or poorly informed about the possibility of improvement and even cure. Continence problems can be overlooked by providers in all settings and for this reason NICE recommends case finding in all at-risk groups, which includes people aged 65 and over.
- NICE clinical guidelines on managing urinary incontinence in women
- NICE clinical guidelines on managing faecal incontinence in adults
Medicines optimisation resources
The use of multiple medicines is increasing due to our ageing population, and nearly half of all medicines prescribed for long-term conditions are not being taken as intended.
Medicines optimisation looks at the value which medicines deliver, making sure they are clinically-effective and cost-effective. It is about ensuring people get the right choice of medicines at the right time and are engaged in the process by their clinical team. The following resources identify information relevant to older people and medicines optimisation.
NICE guidance relevant to the management of frailty:
- Medicines optimisation set out in NICE NG5
- NICE Quality Standard 6 – structured medication review
- NICE Guideline NG56: Multimorbidity Clinical Assessment and Management Tools and guidance
NHS Wales and NHS Scotland guidance on polypharmacy:
- NHS Wales: Polypharmacy Guidance for Prescribing in Frail Adults
- NHS Scotland: Polypharmacy Guidance
Yorkshire and Humber Academic Health and Science Network guidance on the management of frailty:
- Effectiveness Matters: Reducing harm from polypharmacy in older people
- Effectiveness Matters: Recognising and managing frailty in primary care
The STOPP START Tool is a medication review tool designed to identify medication where the risks outweigh the benefits in older people and vice versa:
- NHS Networks STOPP/START Toolkit: Supporting Medication Review
- NICE evidence search for STOPP/START checklist
- Journal of clinical pharmacy and therapeutics study on effectiveness of STOPP/START criteria
- Age and Ageing study on STOPP/START criteria for potentially inappropriate prescribing in older people
Both multimorbidity and frailty are associated with ageing. They have an adverse impact upon quality of life and are associated with higher mortality, adverse drug events and greater use of unplanned care. NICE Guideline NG56: Multimorbidity Clinical Assessment and Management is a tailored approach that should be undertaken with skilled clinical judgement and good communication to provide high quality care.
The GP contract requires clinicians to promote the benefits of activating an enriched Summary Care Record (SCR) to patients living with severe frailty. This provides the opportunity to:
- Increase patient safety by providing timely access to information like significant diagnoses
- Empower patients and increase satisfaction as patients can make their preferences known on topics such as end of life care
- Empower health professionals by providing consistent, accurate, accessible information
- Increase efficiency and effectiveness through more integrated care and reduced time/effort
Some areas may have a local version of shared health records but they must still use the SCR because it complements local integrated care records. It ensures that people accessing care outside their local area still benefit from the appropriate professionals having access to essential details about their healthcare.
Frailty remains a new area for much of the workforce and work is needed to position frailty as a long term condition and underpin it with the upskilling of the workforce. The Frailty Framework of Core Capabilities, published in September 2018 by Skills for Health aims to identify and describe the skills, knowledge and behaviours required to deliver high quality, holistic, compassionate care and support. It provides a single, consistent and comprehensive framework on which to base review and development of staff.