The Living and Dying Well with Frailty Collaborative and COVID-19

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Image credit: NIAID / CC BY-SA

by Dr Paul Baughan. GP, Dollar Health Centre. National Clinical Lead for Palliative Care with Living Well in Communities, Healthcare Improvement Scotland

Healthcare Improvement Scotland is temporarily refocusing improvement resource to support work aligned with COVID-19 resilience. The primary care team in the ihub and LWiC have been working together to pull together some resources to help respond to increased service demand. The topics will include developing Hospital at Home services, using NHS Near Me, and proactive Anticipatory Care Planning. More information will be available soon.

People living with frailty are among the most vulnerable to severe illness and death from the COVID-19 infection, and so the activities which teams have undertaken to identify this group, and then to develop anticipatory care plans will likely prove to be extremely helpful.

Some practices may be able to use the information within their frailty registers in a proactive way to target support for people with frailty.  The practice that I work in is planning the following activities:

  • Contacting people with severe frailty by phone to check that they understand what they need to do to minimise their risk of infection, and know how and where to seek advice if they have symptoms. We have produced a template for proactive COVID-19 – frailty work.
  • Asking people with severe frailty if they are happy to have a Key Information Summary (KIS), explaining that this will allow NHS24 to be aware of their medical conditions should they need to phone for help or advice.
  • Checking that any next of kin and power of attorney information is up to date on the KIS.
  • Adding a note on the KIS that this person has been identified through the electronic frailty index (eFI) as living with frailty.

Whilst the above activities fall short of a comprehensive ‘anticipatory care plan’, they will prove to be helpful should someone with frailty require to call NHS 24, or need help from a provider of unscheduled care.

These phone calls could be undertaken by several different members of the primary care team, and could even be undertaken by a well staff member with access to an NHS laptop who is self-isolating at home.

Please do not hesitate to contact a member of the team on hcis.livingwell@nhs.net if you have any questions about the frailty collaborative in the context of COVID-19.

Testing the eFI in Scotland: focus on Midlock GP practice

 

Some members of the Living Well in Communities and Midlock teams at the NHSScotland event

The Living Well in Communities team is working with Health and Social Care Partnerships in Glasgow City, West Dunbartonshire and Midlothian to test the electronic frailty index (eFI) to identify people over 65 who are living with frailty in the community. The Living Well in Communities team have developed an assets-based approach to support evidence-based interventions that are tailored to the individual. This article looks at the work to date with Midlock GP practice in Glasgow.

The testing in Midlock GP practice

The eFI uses GP read codes to calculate an individual’s degree of frailty and stratifies them into fit, mildly frail, moderately frail and severely frail. The tool has been validated in England. The purpose of testing at Midlock GP practice was to determine if the tool was accurate in a Scottish context. We have been working with a GP and other members of Glasgow City HSCP, including housing and the voluntary sector. The testing involved stratification of the GP population for frailty and reviewing case scenarios to determine if the eFI tool fits with a Scottish population. Continue reading “Testing the eFI in Scotland: focus on Midlock GP practice”

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”