Care of the frail older person in Vancouver, Canada, New York, United States of America and The United Kingdom: A report following an observational period and the implications this has on practice in the United Kingdom and recommendations
Background
The word ‘frail’ or ‘frailty’ is being used more commonly by medical staff to describe patients who are weak or unable to cope with day to day life, indeed it is a recognised syndrome used as a diagnosis. We hear it said in public regarding neighbours and friends, yet without an agreed definition, this concept is the ‘big thing’ in healthcare right now and one we need to address.
The evidence is strong that a boom of elderly frail people are expected by 2030 and we need to be able to manage the consequences of this. Frailty programs are in place in the UK, but what are other countries doing? And what could we learn from them?
Jules Cavalier is a Consultant Trainee Practitioner (Nurse) with Health Education Thames Valley. He is specialising in Living With Frailty whilst undertaking a PhD that is attempting to untangle the social construct of the word in order to understand it today and empower those classed as frail. During a search, the Home Vive Program in Vancouver was discovered, a frailty team that has been running for more than 15 years and is expanding its services by almost double. The leader, Dr John Sloan is a little maverick in his style and speech and seemed the perfect specialist to approach and spend time with his team. This would allow the UK to see what lessons could be learnt and hope to gain steering in our own frailty movement.
It is important to make a comparison to a private healthcare system, to offer an example of alternative ways of working and seek validity to this report. Through this international placement, New York academics and clinical experts in frailty ‘reached out’ and invited discussion and debate surrounding their frailty initiatives and widened the consideration of care and management for comparison between three countries with their own individual and unique issues.
Questions
Questions explored during the visit included:
What could a specialist team with over 15 years of experience in the field of frailty teach us in the UK how to improve and deliver a high standard of care within the next 15 years, when we reach a flash point of demand? A similar healthcare system that is free to residents allows direct comparison to the UK, but what are the important outlooks and beliefs of the team and the relationship between them and the patient? What is the overall picture of care in Vancouver and how has this program benefitted the healthcare system?
How has academia in New York City influenced frailty in a country where thousands of people do not have health insurance and what are the implications of that? What is the future of frailty care and what are the comparisons between the three countries.
This report seeks to identify what implications the findings have on the UK healthcare provision for the future of those living with frailty? It will offer recommendations for the development of services under the headings of clinical excellence, leadership, research and service improvement.
Conclusion
The frailty agenda in the UK is something to be proud of, we have several examples of excellent programs that address the frail and offer on-going care. We are the only country with a formal consultant training program in frailty. Through this study visit to Vancouver and New York many positive ideas have been brought back for example, understanding frailty as a speciality and creating dedicated frailty teams that are united and cross between hospital and community whist an American model of emergency departments for the over 65’s is an interesting prospect as were children’s accident and emergencies initially.
Ambulance services across Great Britain need to be included into the frailty agenda and potentially lead it as this is where frail people are often discovered and identified. It is a service where the very competent assessment and decision making skills of paramedics and technicians is under-utilised yet a core of clinicians who perform frailty assessments and manage the frail several times a day.
We have started making progress with frailty care, but we have a long way still to go.