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Frailty as a Long Term Condition? Monday 10 November 2014 12noon – 12.45pm Professor John Young National Clinical Director for Integration & Frail Elderly, NHS England & Beverley Matthews LTC Programme Lead, NHS Improving Quality
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WELCOME
Today’s WebinarFrailty as a long term condition?
Frailty as a Long Term Condition?
Monday 10 November 201412noon – 12.45pm
Professor John YoungNational Clinical Director for Integration & Frail Elderly, NHS England
&Beverley Matthews
LTC Programme Lead, NHS Improving Quality
Bev MatthewsA nurse by background, Beverley has worked extensively throughout the NHS in a variety of clinical, managerial and strategic roles. Beverley’s current role as Programme Delivery Lead for Long Term Conditions Improvement Programmes: LTC Year of Care Commissioning Model and LTC Framework. Prior to joining NHS Improving Quality in April 2013, Beverley was Director of NHS Kidney Care and NHS Liver Care. Passionate about service transformation through developing networks and leading complex programmes. Providing strategic leadership to partners within health communities, managing stakeholders and working across agencies.
Professor John YoungTrained at the Middlesex Hospital, London; appointed as a consultant geriatrician in Bradford in 1986 . He has developed numerous new services including an elderly care assessment unit; a stroke unit; and an ortho-geriatric unit. Appointed as Head of the Academic Unit of Elderly Care & Rehabilitation, University of Leeds, 2005.
Quality improvement work includes the national audits of intermediate care and of dementia care. Between 2001 and 2007 John was seconded to the DH to assist with the NSF for Older People. He is currently seconded to NHS England as National Clinical Director for Integration and Frail Elderly.
Meet the Speakers
Frailty as a Long Term Condition?of Care foundation. Understanding of case finding tools for frailty
• Understanding a graduated long term condition response to people living with frailty based on supported self-management; care and support planning, case management; and anticipatory end of life care
Learning Outcomes
Beverley Matthews
LTC Programme LeadNHS Improving Quality
Bespoke Support
The approach:• Identify sites guided by intelligence from the LTC Dashboard and local
advice• Support local health economies to understand their baseline position
through the self assessment Diagnostic Tool• Provide coaching support to start identifying interventions that will
drive change and develop the local action plan.• Agree bespoke support package with memorandum of understanding• Developing a facilitators network of local champions• Use evidenced based improvement methodologies to facilitate
change• Embed measurement and evaluation expertise throughout the
delivery• Development of implementation guide in real time
Tools and Resources
LinksLong Term Conditions Dashboardhttp://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html
Long Term Conditions House of Care Toolkitwww.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care.aspx
SIMUL8: Simulation Modelhttp://www.simul8.com/viewer/download.htm
#LTCyearofcare #LTCimprovement @NHSIQ
LTC Learning Forum
“Lunch & Learn” Webinar Series&
Bite Size Master-classes
Virtual Learning Network “Lunch & Learn”
• 45 minute “real time” Webinar sessions
• Topics agreed and learning outcomes identified
• Faculty of Speakers identified
Open invitation
Bite Size Learning Master-Classes
• Pre-recorded 20 minute Master-classes
• Master-class either as stand alone sessions or pre-requisites for Wednesday “Lunch & Learn” Webinars
• Faculty of Speakers identified
Open invitation
Professor John Young
Geriatrician, Bradford Hospitals TrustNational Clinical Director for Integration & Frail
Elderly, NHS England
Frailty as a Long-Term Condition
Care and Support PlanningYou are, or would like to be, a health care professional.
Which of the following statements about care planning in respect of people with multiple LTCs are TRUE?
When I make a care plan:
1. I pass on lots of information to the patient True / False
2. I do most of the talking True / False
3. I follow a template very closely True / False
The Frailty ParadoxNational Audit of Community Rehab 2012
N = 3,150
Mean age 82y
One or more LTC 77%
Two or more LTC 41%
The frailty paradox:
We know it’s out there, but where exactly?
Mrs Greenaway was found on the floor (“FLOF”) with new confusion by the home care staff and taken to hospital where is was found to be poorly mobile.
Fall Delirium Immobility
Frailty is currently recognised ………………
The hyperacute frailty
syndromes
Frailty as a long-term condition ? A LTC is: “A condition that cannot, at present, be cured but is controlled by medication and/or other treatment/therapies” (DH 2012)
Frailty is:• Common (25-50% of people over 80 years)• Progressive (5 to 15 years)• Episodic deteriorations (delirium; falls; immobility)• Preventable components• Potential to impact on quality of life• Expensive
A view of Mrs Greenaway ………
85 yearsLives aloneRecently in hospital following a fallBroken hip 2011Chronic heart failureDiabetesChronic Kidney DiseaseTaking 10 medications
Review 1
Review 2
Review 3
Review 4
System designed to fragment care into packages
……. And the frailty??? ……
Mrs Greenaway was found on the floor (“FLOF”) with new confusion by the home care staff and taken to hospital where is was found to be poorly mobile.
Fall Delirium Immobility
“She was a fall waiting to happen.”
Home care staff
Frailty is ………………
Frailty as a LTC(Global loss of physiological reserve)
Clegg, Young, Iliffe, Olde-Rikkert, Rockwood. Frailty in elderly people. Lancet 2013; 381: 752-762
Frailty as a LTC(Global loss of physiological reserve)
Clegg, Young, Iliffe, Olde-Rikkert, Rockwood. Frailty in elderly people. Lancet 2013; 381: 752-762
Frailty as a LTC(Global loss of physiological reserve)
Clegg, Young, Iliffe, Olde-Rikkert, Rockwood. Frailty in elderly people. Lancet 2013; 381: 752-762
Resilience gap
Earlier (more timely) diagnosis of frailtyTwo approaches:
1. The simple way: empowering patients
2. The very simple way: empowering professionals
Which one shall we choose??
“Fit for Frailty” BGS/RCGP 2014http://www.bgs.org.uk/campaigns/fff/fff_full.pdf
The 4m walking speed test detects frailty
Van Kan et al JNHA 2009; 13:881Systematic Review of 21 cohorts
4M
Taking more than 5 seconds to walk 4m predicts future:
Disability Long-term care Falls Mortality
Development of an NHS Primary Care Electronic Frailty Index (eFI)
Existing EHR (“SystmOne”)
Read Codes (>80,000 8,000 2,200)
Read codes map onto 43 Candidate ‘DEFICIT’ Variables
Tested in ResearchOne (n=226,988 >65y)
Validation Process (n=227,063 >65y)
Deficits constructed for the eFI
Proportion alive
Time
Primary care electronic Frailty Index (eFI): survival plots (n=227,648; >65y)
Fit
Mild frailty
Moderate frailty
Severe frailty
5 yrs
Supported self-management
Care & Support Planning
Case Management/EoL care
Candidate Preventable Components for “Frailty”• Alcohol excess• Cognitive impairment• Falls• Functional impairment• Hearing problems• Mood problems• Nutritional compromise• Physical inactivity• Polypharmacy• Smoking• Social isolation and loneliness• Vision problems
Stuck et al. Soc Sci Med. 1999(Systematic review of 78 studies)
Additional topics:• Look after you feet• Make your home safe• Vaccinations• Keep warm• Get ready for winter• Continence………others…….??
Supported-Self Management Plan for Healthy Living in Later Life
“It’s Care Planning Jim, but not as we know it!”
Care & Support Planning:Evidenced-based medicine or Evidenced-informed practice?
Guideline medicine
Care & Support Planning
Single LTC Multiple LTCs/Frailty
Standardised care
Individualised care
Care and Support Planning(?2% ES 10% LES?)
Agreed & shared ‘care plan’
Information gathering
Professional Story
Information Sharing
Person’s Story
Goal Setting and Action Planning
Year of Care
Consultation 1
Consultation 2
Mrs Greenaway and Care & Support Planning……..
What are the most important things you’d like to discuss today?
1. The pain in my feet2. Difficulty sleeping3. Getting out for a chat4. I don’t like all these
tablets; do I really need them all?
Care and Support PlanningYou are, or would like to be, a health care professional.
Which of the following statements about care planning in respect of people with multiple LTCs are TRUE?
When I make a care plan:
1. I pass on lots of information to the patient True / False
2. I do most of the talking True / False
3. I follow a template very closely True / False
Understanding frailty as a LTC
Supported self-management for frailty
Care & support planning
Advanced care planning
Open Discussion
To register email [email protected]
LTC Lunch & Learn Series ….coming soon…
Date Webinar Hosted by Bev Matthews &
19 November 20141 – 2pm
Self Management for Life Renata DrinkwaterChief Executive & TrusteeSelf Management UK
3 December 20141 – 2pm
"Population level commissioning for the future"
Dr Abraham GeorgeKent County Council
7 January 20151 – 2pm
Self Management Support Return on Investment
Renata DrinkwaterChief Executive & Trustee Self Management UK
21 January 2015 Commissioning for Outcomes Bob Ricketts CBEDirector of Commissioning Support Services & Market Development, NHS England