Improving outcomes for older people with frailty

The ihub is working with HSCPs and NHS boards to improve care and support for people with frailty, both in the community and on presentation at hospital emergency departments.

The ihub’s work has focused on identifying people with frailty to ensure they receive the right support to improve their quality of life. This has included:

  • Development of an evidence based frailty screening and assessment tools selection guide to help practitioners in health and social care to select an appropriate method to identify people with frailty.
  • Testing of the electronic frailty index (eFI) with GP practices to enable them to identify people with frailty in their population.
  • Development of a Frailty and Falls Assessment and Intervention Tool to guide multidisciplinary team (MDT) meetings for people with frailty.
  • The production of Living Well in Communities with Frailty - a review of the evidence on community-based interventions for people with frailty to support decisions locally about the design of new models of care.
  • Establishing a Frailty at the Front Door Collaborative to improve processes for identifying frailty and coordinating care in acute hospitals.
  • Developing and testing the Think Frailty screening tool to identify people with frailty in hospital.

Timely identification of a person with frailty can reduce the likelihood of an adverse outcome and support the long-term management of people’s health and wellbeing. An array of published tools exist to identify people with frailty which, can make it difficult for health and social care professionals to select the most effective tool for their local context. The ihub developed the frailty screening and assessment tools selection guide to summarise the existing evidence base in an easily accessible format to support local decision making.

Qualitative feedback from health and social care professionals has confirmed that the guide is easy to use and 52% of practitioners involved in testing the guide changed their choice of frailty identification tool as a result of the guide. Tools from the guide have been selected by at least 15 HSCPs to identify people with frailty enabling better targeting of community-based interventions to people most at risk of adverse outcomes and unplanned admissions.

Community-based frailty interventions can reduce the demand on unscheduled care. However, for people who require admission to hospital the evidence demonstrates that improvements in care should focus on early identification, assessment and coordination of care.

The ihub has been supporting five hospitals to improve frailty at the front door. While this work is in its early stages, early indications are showing improvements in the quality of care and on the outcomes for people with frailty.

Initial prototyping work with the Queen Elizabeth University Hospital (QEUH) in Glasgow demonstrated a sustained reduction of 28% in average length of stay within the Department of Medicine for the Elderly (17.5 to 12.5 days). This followed the introduction of a frailty unit and the implementation of a frailty pathway.

Forth Valley Royal Hospital has reported an increase in the number of people who can be successfully discharged within 24 hours as a direct result of introducing frailty screening and comprehensive geriatric assessment at the front door. Feedback from people with frailty who were discharged from Forth Valley Royal Hospital confirms that being at home is what matters to them.

Staff in local sites have reported a positive experience of being part of the ihub improvement programme. Sarah Henderson, Geriatrician at Forth Valley Royal Hospital said, “The collaborative has allowed clinical, management and HSCP colleagues to come together and focus on what needs to be done using a clear structure and timeline for delivery.”