HDFT Plans to Achieve Excellence for Older People with Frailty

Home Instead recently attended a seminar at Harrogate Hospital to learn how the Harrogate & District NHS Foundation Trust plans to achieve excellence for older people with frailty.

Home Instead Harrogate, Ripon and Thirsk is a member of the trust and took the opportunity to attend this event as frailty is an issue and a concern that affects many older people in the local community including many of the Home Instead clients.

Home Instead attends regular seminars at Harrogate Hospital relating to older people’s issues and is always keen to learn how the Trust plans to improve the experience of older people when receiving treatment at the hospital

Elderly Care Consultant Rebecca Leigh spoke of the complex needs of frailty with people today living longer with multiple illness, therefore longevity in life but with complexity of illnesses. She explained that in the 1950’s when geriatric wards were introduced, they were big long wards with 50 people or more. Modern geriatrics is very different, taking into consideration quality of life and careful care planning. Rebecca Leigh also spoke of the challenge facing modern geriatrics with staffing and finance problems including budget cuts.

50% of patients in Harrogate Hospital are aged over 80 years old. Nursing recruitment is a challenge to support these people on the frailty wards. Cuts to the social care budget mean it takes longer to get people home. In line with these cuts the Clinical Commissioning Group (CCG) are now asking smokers and those who are overweight to embark on a 6-month programme prior to surgery to help reduce the strain on the NHS.

Rebeca Leigh believes solutions to these problems include leadership and new committees, training, new care models such as the Vanguard Programme- a service improvement linking together social and health care, keeping people at home and looking at care in the home.

Rebecca explained that as we age we naturally become more frail through changes in molecular, cellular and hormonal structure plus our immune system and reflexes slow down.

She stated that ‘Age is just a number’ as age is an insensitive and non-specific measure for use in individual decision making. Frailty is emerging as a better measure and finding out what illness that person has had in the past, looking at their state of vulnerability and seeing if that person is less able to respond to challenges of illness.

The questions need to be asked; Are they at risk of falls? Have they reduced mobility? Have they delirium? Are they incontinent? Are there any possible side effects of medication?

On closing the seminar, Rebecca feels there needs to be a more holistic view of the patient such as looking at side effects of medication and organ specific diagnosis needs to be more holistic for quality of life, for example, could there be falls from a specific medication?

It is also important for social support in the community. GP’s are soon to start using a Frailty Index Admission Avoidance Plan with increased links with the community geriatrician. A medication review assesses the risk of falls, adverse side effects of medication and some common-sense about prescribing.   Falls prevention in the community is also beneficial through good nutrition and exercise enabling older people to live the life they want.

Sheena Van Parys co-owner of Home Instead Harrogate, Ripon and Thirsk added; ‘Here at Home Instead our aim is to ensure that older people can live a good quality of life in their own homes and local community. We work with other organisations in the community to make sure people have access to exercise classes to improve strength and stamina plus we run our own workshops on how to be falls free. We also offer home cooked nutritious meals to our clients and offer continuous support and encouragement to enable them to continue living their life safely and in good health, which includes an awareness on any medication being taken and how it may affect them.’