Frailty as a long term condition

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

[email protected]

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

Case Studies

http://www.nhsiq.nhs.uk/10486.aspx

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

[email protected]

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