Assessment Units for
Download
1 / 10

Frailty Units - PowerPoint PPT Presentation


  • 419 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Frailty Units' - Jims


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

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

    • ‘Step-up’…but not step over the front door

    • Day hospital assessment candidates

    • ‘Sub-acute’ cases

    • The Very Frail


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


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)


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


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


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

E

Transfer

Triage

Trajectory

  • Diagnostics

  • Treatment

    initiation

  • Liaison

  • Negotiation

  • Plan

  • Co-ordination

  • Communication


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+)


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


OPAL Unit

Frail Older Person’s Rescue Service

Frailty

Unit

Triage

Trajectory

Transfer


ad