Abstract
We present an Executive Summary of a guideline produced by a Joint British Diabetes Societies for Inpatient Care Writing Group for managing frail older inpatients with diabetes. This represents a multidisciplinary stakeholder consensus document providing more than 100 recommendations in eight areas: functional assessment and detection of frailty; preventative care: assessing risk factors and avoiding hospital admissions; general inpatient management principles; managing therapy choices for the frail older inpatient with diabetes; managing associated comorbidities and concerns; pre-operative assessment and care; discharge planning and principles of follow-up; and end of life care. The document is intended to guide effective clinical decision-making in an inpatient setting and is supported by four appendices: Appendix 1, STOPPFRAIL criteria; Appendix 2, Acute care toolkit 3-Royal College of Physicians; Appendix 3, a description of physical performance and frailty measures for routine NHS application; and Appendix 4, Inpatient Frailty Care Pathway-template. This document is expected to enhance clinical outcomes and overall health status for this vulnerable inpatient population of older people with diabetes. The full version of the guideline, including the appendices, can be found at https://abcd.care/sites/abcd.care/files/resources/Inpatient_Care_of_the_Frail_Older_Adult.pdf.
Highlights
The recommendations provide an individualized multidimensional integrated approach to the comprehensive management of diabetes in older inpatients with diabetes and frailty
A further aim is to convince commissioners of healthcare and policy-makers to use the guideline plan to coordinate inpatient care pathways with the overall objective of delivering high-quality diabetes care to this vulnerable group of inpatients. [H2]Definition and detection of frailty We have chosen to characterize frailty as a summary concept based on:
A vulnerability state that leads to a range of measurable adverse outcomes, such as falls or a decline in physical performance;
Summary
The recommendations provide an individualized multidimensional integrated approach to the comprehensive management of diabetes in older inpatients with diabetes and frailty. We have placed emphasis on the importance of a focused assessment of both physical and cognitive domains during the course of admission, and recognize that clinicians will need to adopt a new set of outcome measures in the management of frailty in diabetes both in hospital settings and in community and primary care.
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