1. Frailty Programme
Fran Rose-Smith
June 2018

2. What is Frailty?
Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. Around 10% of people aged over 65 years have frailty, rising to between a quarter and a half of those aged over 85 years. Older people living with frailty are at risk of adverse outcomes such as dramatic changes in their physical and mental wellbeing after an apparently minor event which challenges their health, such as an infection or new medication. (British Geriatric Society 2014) Frailty is not an inevitable part of ageing; it is a long term condition in the same sense that diabetes or Alzheimer’s disease is.

3. Local context
Of the West Norfolk population 17% are 70 years or older compared to 12% for England overall. The West Norfolk population is growing at around 0.6% a year, with the population aged 85 or older growing by 3 - 4%. Added to which Attendances to the Emergency Department at the Queen Elizabeth Hospital Kings Lynn have increased by 14% since 2015/16 to 17/18 and for > 65y we have seen a 23% increase.
John has given you an insight to the local issues for our health system and challenges we face.

4. Hospital admission for the older person
Older people can lose mobility very quickly if they do not keep active. For healthy older adults, 10 days of bed rest can lead to a 14% reduction in leg and hip muscle strength and a 12% reduction in aerobic capacity: the equivalent of 10 years of life.
Older people’s ability to perform everyday activities can reduce while in hospital. One study found that 12% of patients aged 70 and over saw a decline in their ability to undertake key daily activities (bathing, dressing, eating, moving around and toileting) between admission and discharge.
Older people are more likely to acquire hospital infections. Between 2008 and 2012, the Methicillin‑resistant Staphylococcus aureus (MRSA) infection rate for men aged 85 years and over was 574 times greater than the rate for those aged under 45 years. A similar pattern was observed for women.

5. Frailty admission avoidance initiatives
Frailty Single Point of Access Service
Led by Consultant Geriatrician at the Queen Elizabeth Hospital
To ensure early detection of clinical deterioration to enable changes in clinical management in order to avoid inappropriate admission to hospital and promote recovery
To reduce unnecessary hospital attendances, admissions and re-admissions
To manage patients more effectively in the community
Accessed by GP’s, Community Matrons, Community Therapists and Specialist Paramedics to provide;
Advice and guidance over the phone
Rapid Frailty Clinic appointment
Review at Multi Disciplinary Team meeting
Story so far;
132 health professionals have contacted the consultant for advice and guidance
83 seen in the rapid access clinic
92 (70%) have not been admitted to hospital within 30 days

6. Specialist Paramedics 2 Car trial for West Norfolk

7. Enhanced training Wound closure
Urine testing for potential urinary tract infection
Prescribing abilities for antibiotics, analgesia etc
Assessing gait
Issuing of basic equipment such as walking aids (not yet in place)
Understanding and access to multiple services to call in health and social support
Story so far;
57% of all types of calls discharged at home
73% of category 3 (likely to be the frail patient cohort) not conveyed to A&E
Main focus is to keep frail elderly people at home when safe to do so

8. A&E audit
The Frailty programme identified that nearly 80% of frailty admissions for the 65y and over have no procedures coded; suggesting they are more observational and nursing in nature and may be amenable to non-acute healthcare. This pressure can lead to less than optimum outcomes for patients and cost pressures for commissioners and the system as a whole.
As part of the Frailty programme and admission avoidance a GP led audit of patients attending A&E has been undertaken
45% (18) were considered necessary attendance
55% (22) considered suitable for management in primary care / GP
22.5% (9) did not have any pre attendance contact
10% (4) contacted 111
77.5% (31) had answered yes to an alternative service prior to attendance of which
38% (12) had contacted their GP by phone or appointment within last few days
19% (6) attempted to see GP but appointment not soon enough or advised by receptionist to go to ED
Meeting to review findings with providers and to develop an action plan is in place

9. Thank you and any questions