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Frailty

 
Frailty is defined as the group of older people who are at higher risk of adverse outcomes such as falls, disability, admission to hospital, or the need for long-term care.
 
We are currently scoping the impact that improving detection of frailty could have on future service provision.
 
These issues cut across all of our workstreams, from Patient Activation to Polypharmacy, our work with Age UK, and End of Life Care.
 
For more information about our Frailty work, contact Ursula Clarke, Senior Programme Manager

Frailty research paper

The prevalence of multimorbidity is on the rise, with 44% of people over the age of 75 living with more than one long-term condition (RCOG 2016). Around 10% of people over 65 will also be living with frailty - a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves, putting them at greater risk of adverse outcomes after apparently minor events (BGS 2012). This long term condition can be diagnosed, is not curable but can be managed and persists. As resilience is lost, care and support planning assumes greater importance through to the end of life (Vernon 2017).
 
In short, frailty is seen as ‘the most problematic expression of human ageing facing the NHS today’ (Clegg 2013). Frailty is associated with an increased risk of poor outcomes with frail individuals at increased risk of hospitalisation, need for nursing home care and mortality compared with non-frail older adults. Improving the prevention, detection and treatment of frailty is essential given the projected rise in older people, the impact on future service provision and the need to help support and maintain frail and older people’s health and social independence (Carey et al 2017).
 
KSS AHSN’s Living Well For Longer (LWFL) programme is designed to support people to maintain their independence and vitality for longer.  Individual  LWFL projects, such as Hydration, Age UK, Polypharmacy, End of Life, Patient Activation and See What I See, each include frailty components, and the whole work links exponentially to the wider Frailty agenda.
 
A specific Frailty work stream is also in development. We recently commissioned a systematic review of Frailty interventions, looking at which intervention offers the best outcomes for people and best value for commissioners and providers (Carey et al 2017). We also have completed a search request on `Assistive technologies, innovation in frailty` (Surrey and Sussex Library and Knowledge Services 2017). The review findings are now been shared with our colleagues.
 
KSS AHSN is also looking at exploring the potential of Frailty practitioners with Health Education England and East Surrey Better Together. A national AHSN Network meeting in March 2017 provided an opportunity to be aware of on-going Frailty projects nationwide and introduced practice worth spreading from other AHSNs to share around KSS. Other nationwide projects are being scoped for value within individual regions and will be shared further, once defined. A collaborative event, hosted by KSS ASHSN, HEE KSS & ESBT in May 2017 `Exploring the potential of the frailty practitioner` proved to be very popular, with a wide range of specialist nurses, senior nursing leads, medical clinicians and commissioning partners attending.

References:

British Geriatrics Society,Fit for Frailty, June 2014. 3 Royal College of General Practitioners, Medical Generalism: why expertise in whole person medicine matters, June 2012.
 
Carey et al (2017) A systematic review of early interventions for people with frailty, Unpublished report commissioned by KSS AHSN
 
Clegg A et al (2013) Frailty in Elderly People, Lancet; 382: 752-62.
 
Evidence search: Frailty. Alison McLaren. (7th March, 2017). REDHILL, UK: Surrey and Sussex Library and Knowledge Services.
 
Royal College of General Practitioners, Responding to the needs of patients with multi morbidity: a vision for general practice, September 2016.
 
Vernon Martin (2017) Presentation at AHSN and NHS England Multi morbidity and Frailty Meeting; 20 March London