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Frazer Underwood Consultant Nurse for Older Peoples Services Associate Director of Nursing Royal Cornwall Hospitals NHS Trust

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Assessment Units for Older People. Frazer Underwood Consultant Nurse for Older Peoples Services Associate Director of Nursing Royal Cornwall Hospitals NHS Trust. . What older people are we looking for? Care home admission deflections Selected long-term conditions Complex co-morbidity

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slide1

Assessment Units for

Older People

Frazer Underwood

Consultant Nurse for Older Peoples Services

Associate Director of Nursing

Royal Cornwall Hospitals NHS Trust

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  • What older people are we looking for?
    • Care home admission deflections
    • Selected long-term conditions
    • Complex co-morbidity
    • ‘Step-up’…but not step over the front door
    • Day hospital assessment candidates
    • ‘Sub-acute’ cases
    • The Very Frail
slide3

What‘s frailty?

“The debate has centred on whether frailty should be defined purely in terms of biomedical factors or whether psychosocial factors should be included”

Lally, F and Crome, P (2007) Understanding Frailty. Post Graduate Medical Journal. 83 pp16-20

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Three or more:

Two or more

  • Unintentional weight loss
  • Self-reporting exhaustion
  • Weakness (reduced grip strength)
  • Slow walking speed
  • Low physical activity
  • Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group. J Gerontol A BiolSci Med Sci. 2001 Mar;56(3):M146-56.
  • Inability to perform one or more ADL in three days before admission
  • Stroke in prev. three months
  • Depression
  • Dementia
  • History of falls
  • One or more unplanned admission in prev. three months
  • Difficulty walking
  • Malnutrition
  • Prolonged bed rest
  • Incontinence
  • BGS 2010 (Best Practice Guide 3.5)
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Finding the frail

  • Kings\' A&E over 75 risk assessment
    • Waterlow (+ neurological deficit, mobility pre A&E, trauma and pre existing medical conditions inc. Clinical dehydration)
  • Davies-Gray M (2003) Nurse led fast track for vulnerable older people. Emergency Nurse 11(5). pp34-38
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Assessing the frail

  • Comprehensive Geriatric Assessment
  • BGS (2005) Comprehensive Assessment of the Frail Older Person in Hospital .BGS Website Compendium 3.5
  • BGS (2010) Comprehensive Assessment of the Frail Older Person. BGS website
  • Ellis, G and Langhorn, P. (2005) Comprehensive Geriatric Assessment for Older Hospital Patients. British Medical Bulletin. 71. pp 45-59
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Wrapping the system around…

Multi-factorial Inter- professional Assessment

C

O

M

M

U

N

I

T

Y

C

A

R

E

Frail Older Person

A

C

U

T

E

C

A

R

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Transfer

Triage

Trajectory

  • Diagnostics
  • Treatment

initiation

  • Liaison
  • Negotiation
  • Plan
  • Co-ordination
  • Communication
slide8

University Hospitals of Leicester Frailty Unit

  • Unit set-up and evaluation
  • Criteria
    • Over 70 years old plus one of the following:
      • Presence of delirium or dementia (AMTS)
      • Fracture as presenting problem but medically unstable (not NOF)
      • Care home resident
      • ED frailty score ≥ 25 (Waterlow+)
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Royal Cornwall Hospitals

OPAL Unit

Frail Older Person’s Rescue Service

  • Unit set-up
    • Single front door = shrinking MAU bed base (OPAL Unit on MAU ward template)
    • Establishing bed base from ED and MAU frailty data – Frailty Tool (Waterlow+) (19 beds and ALOS = 72 hours)
    • One geriatrician on unit 7/7 (plus 0.5 for OPAL Team 5/7)
    • Specialist nursing and AHP team on unit
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OPAL Unit

Frail Older Person’s Rescue Service

Frailty

Unit

Triage

Trajectory

Transfer

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