Using collaborative community care to deal with the emergency department frailty epidemic.

Abstract

Mr R.B. smiled at me, eyes dull in his shrunken face. ‘I just want to go home’ , he said. Exasperation radiated from his daughter. ‘But Dad, you’ll fall again. The carers are only there twice a day. Who’s going to help the rest of the time? Take the community hospital bed, Dad.’ A long pause. ‘I just want to go home’ , he said. One day after discharge, Mr R.B. had returned to A&E. Deconditioned after a long surgical admission he had waited hours for transport home, declining sandwiches — he didn’t like egg or cheese. Once home, too tired to eat, he nevertheless took his insulin. Worried about his new catheter bag overflowing, he slept poorly. The following morning, tired and weak with low sugar levels, he suffered an almost inevitable fall struggling to juggle sticks, catheter bag, and hearing aids. His pendant alarm signalled his return to hospital. Mr R.B, (although fictitious) captures perfectly the conundrum of the frail patient. Multiple comorbidities and reduced physiological reserve conspire against their independence. Until recently, hospital admission has been their default destination. However, with ever tighter budget constrictions, an ageing population, and the over-representation in resource utilisation among frail older patients, innovative relationships are needed to promote individual autonomy and minimise the toll on public services. The ‘frailty phenotype’ is a relatively recent concept. Despite the operational definition as an ‘age-related state of decreased physiological reserves characterized by a weakened response to stressors and an increased risk of poor …