Opinion

New start for older people’s care URGENT CARE demand in England is rising faster than predicted. Of 18.3 million first attendees to emergency departments (EDs) in England in 2012/13, 3.6 million (20%) were aged over 65 years (Smith et al 2014). This population is at high risk of hospital admission following ED attendance, which can be regarded as a ‘sentinel event’ that heralds an intensive period of health and social care service use (Woodard et al 2013). Older people who access urgent care services tend to have multiple comorbidities, and many have cognitive and sensory impairments, all of which complicate their clinical assessments. Complex comorbidities drive polypharmacy, which is associated with interactions between drugs, and between drugs and diseases, that increase the likelihood of adverse events and hospitalisation. If urgent care services are to continue to operate effectively, they must adapt to the needs of older people. Model of care Evolution, standardisation of improved processes and the sharing of best practice are crucial to improving care for frail older people. For example, the standards and recommendations set out in the Silver Book, an intercollegiate document, can be adopted to improve urgent and emergency care services for older people (Banerjee et al 2012). One of the Silver Book’s recommendations is that the presence of one or more frailty marker should trigger a comprehensive geriatric assessment (CGA) process for the patient concerned. CGA is a multidisciplinary diagnostic evaluation that emphasises the patient’s quality of life, functional status and prognosis to produce better outcomes, including less long-term care, more patient satisfaction and lower costs (Ellis et al 2011). EMERGENCY NURSE

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Deborah Thompson and Simon Conroy discuss the work of the Acute Frailty Network in improving emergency care services

Frail, older people are at acute risk of hospital admission

Across the urgent care system there is a need for professionals to work together to ensure frail, older people receive the correct care when they need it and rely less on hospital admission (Banerjee et al 2012). To help local teams adopt best practice in a collaborative and co-ordinated way, NHS England has commissioned NHS Elect to implement a 12-month national improvement programme called the Acute Frailty Network (AFN). Launched last month, the AFN programme team will work initially with ten healthcare communities, namely: ■ Cambridge University Hospitals NHS Foundation Trust (FT). ■ Derbyshire Community Health Services NHS FT. ■ Gloucestershire Hospitals NHS Trust. ■ Imperial College Healthcare NHS Trust, London. ■ James Cook University Hospital, part of South Tees Hospitals NHS FT. ■ Kettering General Hospital NHS FT, Northamptonshire. ■ Poole Hospital NHS FT, Dorset. ■ Royal Berkshire NHS FT. ■ University Hospitals of North Midlands NHS Trust, Stoke-on-Trent. ■ York Teaching Hospital NHS FT. The programme team will work with these trusts to establish ways to help front line

staff improve acute frailty services and adopt or develop best practice. The cohort will focus on practice during the first 72 hours of care after an emergency, while being mindful of the whole frailty pathway. This process will inform the development of a set of principles for the adoption and improvement of acute frailty services across the NHS. It is also expected that over the coming year: ■ New models of urgent care for frail older will be tested and implemented in ten pilot sites, and the results will be disseminated across the wider NHS. ■ A repository of best practice and case studies that describes the lessons learnt at the pilot sites will be formed. ■ A bundle of tools and methodologies to support the implementation of acute frailty services at other sites will be devised. ■ A set of national guidelines on how to implement models of care that improve the experiences and outcomes of older people with frailty while reducing bed occupancy will be drawn up. Deborah Thompson is programme director of the Acute Frailty Network Simon Conroy is clinical lead at the Acute Frailty Network, consultant geriatrician at University Hospitals of Leicester NHS Trust and an honorary senior lecturer at the University of Leicester

References Banerjee J, Conroy S, O’Leary V et al (2012) Quality Care for Older People with Urgent and Emergency Care Needs: The Silver Book. tinyurl.com/cebaqz3 (Last accessed: January 16 2015.) Ellis G, Whitehead M, O’Neill D et al (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. British Medical Journal. doi.org/10.1136/bmj.d6553 Smith P, McKeon A, Blunt I et al (2014) NHS Hospitals under Pressure: Trends in Acute Activity up to 2022. tinyurl.com/llojy2e (Last accessed: January 16 2015.) Woodard J, Gladman J, Conroy S (2013) Interface Geriatrics: Acute Care for Older People in LLR. tinyurl.com/kruv8uk (Last accessed: January 16 2015.)

Find out more More information about acute frailty is available at www.acutefrailtynetwork.org.uk or by email to [email protected] February 2015 | Volume 22 | Number 9 13

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New start for older people's care.

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