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NIHR report highlights research on patients with frailty in hospital

Date: 05 December 2017

A new report highlights the importance of carrying out a Comprehensive Geriatric Assessment (or CGA) in older people living with frailty who are admitted to hospital, amongst other findings.

An NIHR-funded study featured in the report found that for every 20 patients receiving this assessment, one admission to a care home could be avoided. CGA involves carrying out a multi-disciplinary assessment of medical, functional, psychological and social capacity to ensure issues are identified and managed appropriately.

The research features in Comprehensive Care: Older people living with frailty in hospitals, a new themed review from the NIHR Dissemination Centre. The themed review contains details of over 33 published and 20 ongoing studies about caring for older people living with frailty in hospital.

Frailty is a state of increased vulnerability to poor health outcomes. It becomes more prevalent as people age; whereas only 5% of people aged 60-69 live with frailty, this figure rises to 65% in those over 90.

The review aims to raise awareness amongst hospital staff about what can be done to identify and support the needs of these people and avoid known problems, ensuring patients return to living well at the end of their hospital stay.

Comprehensive Geriatric Assessment is one area where there is strong evidence to underpin its use. A Cochrane review, also featured in the report, concluded that older people coming into hospital as an emergency who received the assessment and were admitted to a specialist ward were more likely to be living in their own home a year later than those who received routine inpatient care on a general ward. Despite this, the National Audit Office reported in 2016 that just 42% of hospitals were undertaking early geriatric assessments.

 “Not every old person coming into hospital is frail but those who are need special care,” says Dr Elaine Maxwell, Clinical Advisor at the NIHR Dissemination Centre, who authored the report.

“It is important hospital staff are able to quickly identify these people and provide additional support. Our themed review shows strong evidence for the CGA process and also demonstrates the importance of caring for these people in appropriate environments.”

Other findings featured in the themed review include:

  • On approaching hospital: NIHR research has developed and validated a tool to help GPs identify people with moderate to severe frailty. The efrailty index is now used in over a third of GP practices.
  • On medication: Being prescribed new drugs whilst in hospital can lead to drug interactions that can reduce a person’s ability to recover and live independently. Research shows pharmacist-led review of medication can ensure older people receive the correct medicines.
  • On caring environments: Research shows the importance of building relationships between staff and these patients. However, only a third of NHS Trusts provide training to healthcare assistants on building positive relationships with patients.
  • On discharge planning: Researchers found hospital staff need more support and training to assess the mental capacity of older people with cognitive impairment before discharge.

Comprehensive Care: Older people living with frailty in hospitals is available to download now from http://www.dc.nihr.ac.uk/themed-reviews/comprehensive-care.htm.

  • Summary:
    Comprehensive Care, a new themed review, brings together important NIHR research on caring for older people living with frailty in hospitals.
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