Are We Failing our Frail: Lessons from International Evidence.

Background

The impact of the ageing population on health and social care services was forewarned by government policy some decades ago. It appears, however, that it is only recently that frailty has become a focus of attention in terms of improving outcomes at individual level and is directly related to the increasing threat to the sustainability of our organisations. It is suggested that appropriate management of care of the frail older adult at presentation to hospital and during in patient admission improves outcomes at individual level and as a direct result improves performance at organisational level specifically in terms of reduced average length of stay, improved patient flow and a reduction in need for ongoing domiciliary nursing and social care need. Much of the available literature relating to the assessment and management of the clinically frail in hospital heralds from North America.

Study

This report outlines an observational study of the assessment and management of the clinically frail in Nova Scotia, Canada. The study encompasses care practices relating to frail adults in the community, in the emergency department and during admission. The latter particularly focuses on discharge planning and reducing length of stay while minimising patient harm.

Results and Discussion

This study demonstrated that an evidence based care pathway was embedded into clinical practice relating to the frail older adult particularly in relation to the Emergency Department and throughout the inpatient stay. This pathway embraced the evidence based and provided care centred around person centred goals which were set by a multi disciplinary team recognising the heterogeneic needs of the frail older adult. Moreover, the study demonstrated that recognition of the sick older adult was imperative in order to effectively manage their care and reduce length of stay. While it is acknowledged that nurses are in a key position to recognise and assess for frailty and begin interventions to help prevent decline and improve or maintain independence they cannot do this independently of the multi disciplinary team.