WELCOME

Wednesday 6 May 2015 Webinar

Prevention & Effective Interventions in Frailty

Prevention & Effective Interventions in Frailty

Wednesday 6 May 2015

12.30pm – 1.30pm

Helen LyndonNurse Consultant Older People, Clinical Lead Frailty, NHS England

&

Beverley MatthewsLTC 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.

Helen Lyndon

Nurse Consultant Older People, Clinical Lead Frailty

Currently on secondment to NHS England as Clinical Lead for Frailty. Leading on the development across organisations of an integrated pathway of care for frail older people. Clinically, Helen works with a Geriatrician Colleague offering falls and comprehensive assessment rapid access clinics.

Meet the Speakers

Beverley Matthews

LTC Programme LeadNHS Improving Quality

Beverley.matthews@nhsiq.nhs.uk

www.england.nhs.uk

LTC Year of Care Commissioning

Programme:

5

• 5 Early Implementer sites

• 35 Fast Followers

• Whole Population Datasets

• Implementation Guide

• Simulation Modelling

• Specialist Support Team

www.england.nhs.uk

LTC Framework Improvement

Programme:

6

Organisational &

Clinical

Processes

Informed and

engaged patients

and carers

Health & Care

Professionals

committed to

partnership

working

Commissioning

• Information and

technology

• Case finding & risk

stratification

• Care Planning

• Safety and

Experience

• Guidelines,

evidence and

national audits

• Care Delivery

• Self Management

• Information and

Technology

• Group and Peer

Support

• Care Planning

• Policies for carers

• Voluntary sector

patient & carer

support

• HSC Integration

• Multi Disciplinary

Teams

• Culture

• Workforce

• Technology

• Care Co-

ordination

• Care Planning

• Needs

Assessment and

Planning

• Joint

Commissioning

• Metrics and

Evaluation

• Service User and

Public Involvement

• Contracting and

Procurement

• Care Planning

• Tools and Levers

The table below sets out some of the key components needed to deliver the central

aim for LTC Framework - Person Centred Coordinated Care

Long Term Conditions Dashboardhttp://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html

Long Term Conditions House of Care Toolkithttp://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/long-term-conditions-improvement-programme/house-of-care-toolkit.aspx

Simulation Modelhttp://www.simul8.com/viewer/download.htm

#LTCyearofcare #LTCimprovement @NHSIQ

Tools and Resources:

LTC Lunch & Learn Series ….coming soon…

Date Webinar Hosted by Bev Matthews &

27 May 2015

12:30 – 13:30

Primary Care Workforce for the 21 Century

Webinar

Sharon Lee

Primary Care Workforce Facilitator

South Kent Coast CCG

4 June 2015

12.30 – 13.30

Home Checks/Prevention Peter O’Reilly & Geoff Harris

Manchester Fire & Rescue Service

9 June 2015

12 noon – 1pm

Health 1000 Rob Meaker

Barking, Havering & Redbridge

For registration details, email LTC@nhsiq.nhs.uk

Prevention & Effective Interventions in Frailty

• Understanding the preventable components of frailty.

• Understanding how clinicians can support people to prevent and delay the adverse effects of frailty

• Understand what interventions are effective across the frailty trajectory.

of Care foundation.

Today’s Learning Outcomes

www.england.nhs.uk

Prevention and

Effective Interventions

in Frailty

Helen Lyndon

Nurse Consultant

Clinical Lead for Frailty

NHS England

Lunch and Learn Webinar 6th May 2015

www.england.nhs.uk

• Understand the preventable components of frailty

• Discuss how clinicians can support people to prevent

and delay the adverse effects of frailty

• Understand what interventions are effective across

the frailty trajectory.

Prevention and Effective Interventions

in Frailty

www.england.nhs.uk

Where is frailty?

“ I know it when I see it but what I see may not be the same as what everyone else sees”

Community dwelling adults aged 65+ = 7% - 12%

Community dwelling adults aged 85+ = 25% - 50%

The Frailty ParadoxNot recognised

Not diagnosed

Not recorded

Chen, X, Genxiang, M, Sean X (2014) Frailty Syndrome: an overview. Clinical Interventions in Aging

2014:9 433–441

www.england.nhs.uk

Frailty – a complex syndrome of

increased vulnerability

13

Life course

determinants:

BiologicalGenetic

Psychological

Social

Environmental

Decline in

physiologic

reserves

+

Multiple

long term

conditions

Candidate markers:

Nutrition

Mobility

Activity

Strength

Endurance

Cognition

Mood

Adverse Outcomes:

Disability

Morbidity

Hospitalisation

Institutionalisation

Death

Prevent/delay frailty

Primary prevention

Health promotionDelay onset

FRAILTY

Delay/prevent adverse outcomes

Rodriguez-Mañas L, Fried LP. Frailty in the clinical scenario. Lancet. 2014 Nov 6

Reversibility

www.england.nhs.uk

‘Dementia, disability and frailty are not inevitable

consequences of ageing….there is sufficient evidence to

show the risk of developing them can be reduced

through changing common behavioural risk factors.’

• quitting smoking,

• increasing physical activity,

• reducing alcohol consumption

• having a healthy diet

• maintaining a healthy weight.

14

NICE Public Health Draft Guideline:

Dementia, disability and frailty in

later life – mid-life approaches to

prevention

www.england.nhs.uk

NICE Public Health Draft Guideline:

Dementia, disability and frailty in

later life – mid-life approaches to

prevention

15

• Beginnings of ill health can occur in midlife:

☼ start of a decline in cognitive functions (such as memory, reasoning and verbal fluency) by age 45

☼ age-related decline in walking speed has been observed after the age of 30

Mid-life is not too late for people to make meaningful changes. People often need more than one attempt to change, and mid-life can be the period in which change is finally sustained

‘However, key messages about risk reduction, particularly for dementia, are not well publicised or understood by health and other professionals or the public, unlike the link between smoking and cancer.’

www.england.nhs.uk

Proportion alive

Time

Primary care electronic Frailty Index (eFI): survival plots (n=227,648; >65y)

Fit

Mild frailty

Moderate frailty

Severe frailty

5 yrs

www.england.nhs.uk

Proactive interventions in frailty

Ten years ago

Two years ago

One month ago ‘He is a

fall

waiting to

happen

“Dad is

slowing

down”

“I’m not

as steady

on my

feet as I

was”

www.england.nhs.uk

Supported Self Management for

Frailty

What its not….

Provision of information;

leaflets, booklets, web links

etc

What it is…..

About acknowledging the person’s central role in the management their own care and empowering them and their family and carers to handle their condition as effectively as possible.

www.england.nhs.uk

What to focus on…..

Potentially modifiable risk factors associated with functional

decline in community dwelling older people.

• Alcohol excess

• Cognitive impairment

• Comorbidity

• Falls

• Functional impairment

• Hearing problems

• Mood problems

• Nutritional compromise

• Physical inactivity

• Polypharmacy

• Smoking

• Social isolation and loneliness

• Vision problems

MORE

THAN

MEDICINE

www.england.nhs.uk

Look after your feet

Look after your eyes

Make your home safe

Keep active

Medication review

Hearing tests

Preventing falls

Vaccinations

Keeping warm

Get ready for winter

Bladder problems

Mental wellbeing

www.england.nhs.uk

Supported Self Management for

Frailty: Key Messages

1. Language:

• “I am frail” v “slowing down”, “things taking longer” or “less energy.” This is reflected in the guide. Focus on “health and wellbeing” in later life.

2. Self-discovery and self-activation:

• Gait speed test, then menu of items – the person’s choice

3. Independence:

• focus on maintaining and promoting independence - this is an issue that is both important and well understood by older people.

4. Social Isolation and Loneliness

www.england.nhs.uk

Loneliness and Social Isolation

• 59% of older adults who report poor health say

they feel lonely some of the time or often

compared with 21% who report excellent health.

• Social isolation is one of the top five causes for

admissions to care homes.

• People who are socially isolated visit their GP

more often, use more medication and have more

falls.

• Lacking social connections is a comparable risk

factor for early death to smoking 15 cigarettes a

day and is worse for our health than obesity and

physical inactivity.

www.england.nhs.uk

Questions and

discussion

LTC Lunch & Learn Series ….coming soon…

Date Webinar Hosted by Bev Matthews &

27 May 201512:30 – 13:30

Primary Care Workforce for the 21 Century Webinar

Sharon LeePrimary Care Workforce Facilitator

South Kent Coast CCG

4 June 201512.30 – 13.30

Home Checks/Prevention Peter O’Reilly & Geoff HarrisManchester Fire & Rescue Service

9 June 201512 noon – 1pm

Health 1000 Rob MeakerBarking, Havering & Redbridge

For registration details, email LTC@nhsiq.nhs.uk