2. Frailty Conference Unity Works 18 th March 2016 WIFI Cowork@unityworks Password UWcw123!

3. Causes of Frailty A combination of genetic and environmental factors combine to cause cumulative damage. Nutritional factors and reduced activity then combine to cause frailty. Frailty increases susceptibility to stressor events (such as infections, drugs etc.) which can then cause adverse events such as falls, delirium and fluctuating disability leading to increased care needs and hospital admissions Lancet2013;381;752. quoted in North Tyneside Clinical Commissioning Group North Tyneside New Models of Care Clinical Design Model (v4.1)

4. Frailty is Common (25-50% of people over 80 years) Progressive (5 to 15 years) Episodic deteriorations: frailty syndromes (delirium; falls; immobility) Preventable components: 13 modifiable risk factors; Stuck et al (1999) Potential to impact on quality of life Expensive Sarah De Biase - Academic Unit of Elderly Care & Rehabilitation, BTHFT | Y&H Improvement Academy

5. Frailty Explained Courtesy of Dr Dawn Moody, a GP with a special interest in the care of older people and holds an MSc in Geriatric Medicine https://vimeo.com/weareingenious/review/140588708/19f348eec7

6. Stages of Frailty Fit People who have no or few long-term conditions that are usually well controlled. This group would mainly be independent in day to day living activities Mild frailty People who are slowing up in older age and may need help with personal activities of daily living such as finances, shopping, transportation Moderate Frailty People who have difficulties with outdoor activities and may have mobility problems or require help with activities such as washing and dressing Severe Frailty People who are often dependent for personal cares and have a range of long-term conditions/multimorbidity. Some of this group may be medically stable but others can be unstable and at risk of dying within 6 - 12 months

7. Current Tools Those spoken about most favourably – eFI through SystmOne and EMIS – Rockwood Scale – Gait Speed Test – PRISMA 7 A formal diagnosis of Frailty requires a doctor but these can help to indicate likely issues

8. SystmOne Electronic Frailty Index Report Path

9. Electronic Frailty Index - 36 Rockwood-derived Deficits

10. SystmOne Frailty Scoring Fit (eFI score 0 - 0.12) Mild frailty (eFI score 0.13 – 0.24) Moderate Frailty (eFI score 0.25 – 0.36) Severe Frailty (eFI score > 0.36)

11. Rockwood Defines various stages of Frailty using descriptions with images Requires training to use with skill In use already in MidYorks by geriatricians

12. Gait Speed Test Guide to Healthy Ageing version Find safe, flat, well-lit and unobstructed area with over 4 metres clear Mark start and finish lines 4 metres apart Position the person with feet behind and just touching the 0-meter start line Ask the person to “Walk at your comfortable pace” until a few steps past the 5-meter mark Advise them not to slow down as they reach 4-meter mark Repeat three times, allowing sufficient time for recuperation Begin each trial on the word “Go.” Start the timer with the first footfall after the 0-meter line. Stop the timer with the first footfall after the 4-meter line. Record the times in seconds If more than 5 seconds, and no known condition affecting this, refer for assessment as agreed with your service

13. Prisma 7 Questions 1.Are you more than 85 years? 2.Male? 3.In general do you have any health problems that require you to limit your activities? 4.Do you need someone to help you on a regular basis? 5.In general do you have any health problems that require you to stay at home? 6.In case of need can you count on someone close to you? 7.Do you regularly use a stick, walker or wheelchair to get about? 3 or more positive answers could indicate frailty

14. Next Steps Start thinking about Frailty Distribute the ‘Guide to Healthy Ageing’ to your patients and service users Discuss tools you might use as part of your routine assessments Consider referrals at all levels of need Listen for news about Frailty