Using a population screening tool to identify people with frailty in the community: the e-frailty index

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by Laura Dobie, Knowledge and Information Skills Specialist

The Challenge

A person with frailty can experience serious adverse outcomes following even a relatively minor illness. Timely identification of frailty can help to reduce the likelihood of a poor outcome following an intervention (or eliminate the need for an intervention entirely) and support the long-term management of people’s health needs.

If we can identify people with frailty in the community, we can offer preventative support that could improve their quality of life and reduce the risk of unscheduled admissions.

There are a number of tools which professionals can use to screen people for frailty (see the British Geriatric Society’s Fit for Frailty guidance). However, many of these tools are based on questionnaires that require practitioners to have direct contact with individuals and can only be used to assess people who are actively engaged with services.  It would be resource-intensive and challenging for services to screen large population groups for frailty using these individual assessments.

The risk stratification tool, Scottish Patients at Risk of Re-admissions or Admissions (SPARRA) identifies individuals within the whole population at risk of hospital admission based on nationally-collected data on acute admissions and community prescribing.  However, it does not discriminate frailty from other high-risk population groups and can only identify individuals who are known to services, as they have had recent acute admissions or have been prescribed high-risk medications.  Alternative population screening tools are needed to identify people with frailty living in the community. Continue reading “Using a population screening tool to identify people with frailty in the community: the e-frailty index”

How care homes in Argyll and Bute are working to reduce falls

By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland

On 5th December I went along to the Argyll and Bute Care Homes Quality Improvement for Falls Prevention event. It was a really interesting day, and it was great to hear about the work that care home staff are doing to reduce falls and improve quality of life for their residents.

PDSAs and data

Dr Christine McArthur, Project Lead, introduced the day and Sheila Morris, Occupational Therapy Care Home Lead, gave an overview of Plan Do Study Act cycles and the role of data in improvement. She emphasised the importance of carrying out small tests of change and having a clear plan.

The project participants then had the opportunity to discuss a case study of a 72-year-old lady who had had a number of falls, considering risk factors such as polypharmacy and multiple complex conditions, and reviewing the data in the falls diary to identify whether there was a pattern to her falls.

The care home staff observed that people are increasingly coming in to care homes with more mobility problems and multiple conditions and co-morbidities. Sheila commented that everyone in the care home sector is at risk of falling and should have a multifactorial falls assessmentContinue reading “How care homes in Argyll and Bute are working to reduce falls”

Scottish Ambulance Service Falls and Frailty Pathways Action Group first meeting

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On 25th November 2016 the Living Well in Communities team from Healthcare Improvement Scotland’s Improvement Hub (ihub) supported the first meeting of the Active and Independent Living Improvement Programme (AILIP) and Scottish Ambulance Service Falls and Frailty Action Group. This Storify summarises the discussions from the day. Presentations and other resources can be accessed on the Falls and Bone Health Community site.

 

Risk Prediction: Using the Electronic Frailty Index in Scotland

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We’re all aware of how important an issue frailty is, particularly the effect it has on a person’s quality of life.

Supporting people in the early stages of frailty could help them maintain independence and live healthier lives in their communities, time that would otherwise have been spent in hospital.

One of the ways Living Well in Communities are doing this is by looking at risk prediction tools to identify people at risk of frailty in the community. We can use these tools to help explore the types of support that would most benefit people.

Electronic Frailty Index

Our workshop in December 2015, involving experts across health, social care and data analytics, looked at the available risk prediction tools. We had great dialogue around what’s important for predictive tools and decided to test the electronic Frailty Index (eFI) in Scotland.

Unlike other prediction tools, it uses information outside of acute care to evaluate someone’s condition. It’s based on the cumulative deficit model of frailty, and uses GP read codes to analyse the number of ‘deficits’ an individual has, to score whether a person is Fit, Mildly Frail, Moderately Frail, or Severely Frail. Continue reading “Risk Prediction: Using the Electronic Frailty Index in Scotland”

Preventing falls in Argyll and Bute: Cowal Befrienders’ exercise classes

Strength and Balance

In this article we look at a service which is aiming to prevent falls by supporting older people who have difficulty attending classes to take part in exercise.

Background

Exercise has an important role to play in reducing the risk of falls among older people in the community. A recent BMJ review has indicated that exercise-based and tailored interventions are the most effective way to reduce falls and associated healthcare costs among older people in the community, while a recently updated Care Inspectorate good practice resource, Managing Falls and Fractures in Care Homes for Older People has stressed the importance of keeping mobile, doing regular exercise and being physically active.

The Cowal Befrienders’ falls prevention exercise classes are working towards the overall aim that “Older people have a reduced risk of falls that may affect their ability to live independently in the community”.

The classes

Cowal Befrienders host two strength and balance exercise classes per week for older people who require some help to get to the Befrienders’ drop-in centre where the classes are held and support to participate in exercise classes.

Classes are co-ordinated and delivered by Otago-qualified staff employed by Cowal Befrienders (the Otago  exercise programme is designed to prevent falls). Referrals and assessments are managed by the NHS Highland physiotherapy team.

Clients are entitled to six free classes, and can continue to attend for a modest fee of £2.50 per session. There is a small charge for clients requesting transport to their classes to help offset the additional costs incurred to provide this service (£3 return for individuals living within Dunoon, and £5 return for those living outside of the town).

In addition to health and wellbeing benefits, such as increased strength, balance and mobility, and helping participants to feel more confident and independent, the classes also have a social aim: to help older people to expand their social networks and foster peer support, and to increase access to health-promoting information that meets their needs.

The social aspect of the classes has been particularly valued by participants, with 97% citing this as one of the things that they enjoyed most about the classes. Clients also particularly appreciated the encouragement that they were given by staff and volunteers, and the pace of the classes. Continue reading “Preventing falls in Argyll and Bute: Cowal Befrienders’ exercise classes”

There’s No Place Like Home: Living Well in Communities at the NHSScotland Event

The Living Well in Communities team held two workshops at the NHSScotland Event, which took place at the SECC on 14th-15th June 2016. These sessions explored initiatives from Health and Social Care Partnerships across Scotland that are helping people to spend more time at home or a homely setting that would otherwise have been spent in hospital.

We’ve put together a Storify of the tweets from the sessions.

The sessions were chaired by Susanne Miller, Chief Officer for Strategy, Planning and Commissioning and Chief Social Work Officer for Glasgow City Health and Social Care Partnership. June Wylie, Head of Implementation and Improvement at Healthcare Improvement Scotland, introduced the Living Well in Communities portfolio and frontline speakers from across the different Living Well workstreams and related areas of work:

  • High Resource Individuals – Anne Palmer, Programme Manager, Connected Care, NHS Borders
  • Frailty and Falls – Rebekah Wilson, Ayrshire and Arran Falls Lead and Falls Community Connector.
  • Anticipatory Care Planning – Janette Barrie, Nationa Clinical Lead (Nursing) Anticipatory Care Planning, Healthcare Improvement Scotland
  • Housing – Maureen Cameron, Manager, Lochaber Care & Repair
  • Intermediate Care and Reablement – Lorna Dunipace (Day 1), Interim Head of Transformational Change (Older People), and Christine Ashcroft (Day 2), Service Manager, Glasgow City Health and Social Care Partnership
  • Palliative Care – Caroline Sime, Research Fellow University of the West of Scotland and Ardgowan Hospice

Here are some of the themes from the workshops: Continue reading “There’s No Place Like Home: Living Well in Communities at the NHSScotland Event”

Working with care homes to reduce falls: Argyll and Bute Health and Social Care Partnership

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By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland

Argyll and Bute Health and Social Care partnership has been holding a series of quality improvement workshops for care home staff, in collaboration with Scottish Care. I went along to one of their workshops with care home staff in Dunoon on 10th May to find out more about the work that the partnership is doing with care homes.

Background

All 20 care homes in Argyll and Bute are signed up to a quality improvement project to reduce falls. Funded by the Integrated Care Fund, and supported by health professionals in each locality, the project aims to support care home staff to address falls risks in their care home. A particular emphasis is on improving physical activity for health and wellbeing.

The quality improvement workshops

Dr Christine McArthur, NHS Highland Coordinator Prevention and Management of Falls, Jane Howe, Quality Improvement Manager, and Kirsty Brown, Assistant Practitioner (Physiotherapy), facilitated the workshops. The team worked collaboratively with Scottish Care to develop events which met the needs of care home staff. The care homes requested a series of smaller local workshops, rather than one big event, as some staff do not drive and it was easier them to attend local events.

The team held workshops in Bute, Oban, Campbeltown, Dunoon and Helensburgh. Having dedicated events for care home staff and small group sizes ensured that all participants were able to contribute to discussions and ask the team for advice. Continue reading “Working with care homes to reduce falls: Argyll and Bute Health and Social Care Partnership”

Managing Frailty The Fife Way: Summary and Resources

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Managing Frailty the Fife Way took place on 17th March 2016 at the Carnegie Conference Centre. The event was an interesting and informative day which explored good practice in managing frailty from Fife, highlighting innovative ways of working and successful examples of integration. There was a lot of sharing and learning on Twitter throughout the day, and you can view a selection of tweets from the day on the event Storify. You can also view the agenda for the day.

Dr Graham Ellis, National Clinical Lead for Older People and Frailty, gave a lively introduction to the day and declared an ambition for Scotland to be the best place to grow old.

Professor Scott McLean, Chief Operating Officer (Acute Services) NHS Fife, gave an overview of acute care redesign in Fife. He argued that it is a myth that hospitals are places of safety and explained their decision not to open surge wards, commenting that they are not good for older people or staff.

Dr Seònaid McCallum discussed health and social redesign in Fife. She emphasised the importance of relationships and building bridges, and the continuous nature of the work.

Karen Goudie, Joy Reid and Louise Kellichan presented on Frailty at the Front Door, highlighting NHS Fife’s frailty screening tool, their frailty huddles and the Integrated Assessment Team’s journey to a 7-day service at the front door.

Avenue Care’s Francis Davidson discussed their work on the Short Term Supported Discharge project, which aimed to help people to recover in their own homes, eliminating the need for a stay in hospital or readmission to hospital. She highlighted the success of joint working on the project and argued that the project has demonstrated that integration really works.

Continue reading “Managing Frailty The Fife Way: Summary and Resources”