Frazer Underwood Consultant Nurse for Older Peoples Services Associate Director of Nursing Royal Cornwall Hospitals NHS

1. Assessment Units for Older People Frazer Underwood Consultant Nurse for Older Peoples Services Associate Director of Nursing Royal Cornwall Hospitals NHS Trust

2.  • What older people are we looking for? • Care home admission deflections • Selected long-term conditions • Complex co-morbidity • ‘Step-up’…but not step over the front door • Day hospital assessment candidates • ‘Sub-acute’ cases • The Very Frail

3. What‘s frailty? “The debate has centred on whether frailty should be defined purely in terms of biomedical factors or whether psychosocial factors should be included” Lally, F and Crome, P (2007) Understanding Frailty. Post Graduate Medical Journal. 83 pp16-20

4. Three or more: Two or more • Unintentional weight loss • Self-reporting exhaustion • Weakness (reduced grip strength) • Slow walking speed • Low physical activity • Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group. J Gerontol A BiolSci Med Sci. 2001 Mar;56(3):M146-56. • Inability to perform one or more ADL in three days before admission • Stroke in prev. three months • Depression • Dementia • History of falls • One or more unplanned admission in prev. three months • Difficulty walking • Malnutrition • Prolonged bed rest • Incontinence • BGS 2010 (Best Practice Guide 3.5)

5. Finding the frail • Kings' A&E over 75 risk assessment • Waterlow (+ neurological deficit, mobility pre A&E, trauma and pre existing medical conditions inc. Clinical dehydration) • Davies-Gray M (2003) Nurse led fast track for vulnerable older people. Emergency Nurse 11(5). pp34-38

6. Assessing the frail • Comprehensive Geriatric Assessment • BGS (2005) Comprehensive Assessment of the Frail Older Person in Hospital .BGS Website Compendium 3.5 • BGS (2010) Comprehensive Assessment of the Frail Older Person. BGS website • Ellis, G and Langhorn, P. (2005) Comprehensive Geriatric Assessment for Older Hospital Patients. British Medical Bulletin. 71. pp 45-59

7. Wrapping the system around… Multi-factorial Inter- professional Assessment C O M M U N I T Y C A R E Frail Older Person A C U T E C A R E Transfer Triage Trajectory • Diagnostics • Treatment initiation • Liaison • Negotiation • Plan • Co-ordination • Communication

8. University Hospitals of Leicester Frailty Unit • Unit set-up and evaluation • Criteria • Over 70 years old plus one of the following: • Presence of delirium or dementia (AMTS) • Fracture as presenting problem but medically unstable (not NOF) • Care home resident • ED frailty score ≥ 25 (Waterlow+)

9. Royal Cornwall Hospitals OPAL Unit Frail Older Person’s Rescue Service • Unit set-up • Single front door = shrinking MAU bed base (OPAL Unit on MAU ward template) • Establishing bed base from ED and MAU frailty data – Frailty Tool (Waterlow+) (19 beds and ALOS = 72 hours) • One geriatrician on unit 7/7 (plus 0.5 for OPAL Team 5/7) • Specialist nursing and AHP team on unit

10. OPAL Unit Frail Older Person’s Rescue Service Frailty Unit Triage Trajectory Transfer