Abstract
BackgroundFrail individuals are at risk of significant clinical deterioration if their frailty is not identified and managed appropriately. Research suggests that any interaction between an older person and a health or social care professional should include an assessment for frailty. Many older care home residents are frail when admitted, but we have little knowledge of whether or how this is assessed. The aim of this paper is to understand and establish the characteristics of the reported ‘assessments for frailty’ used in care homes with nursing (nursing homes) across North-West London. This will help understand what an ‘assessment for frailty’ of care home residents mean in practice in North-West London.MethodsTelephone contact was made with every Care Quality Commission (CQC) (independent regulator of health and adult social care in England) regulated nursing home across North-West London [n = 87]. An online survey was sent to all that expressed interest [n = 73]. The survey was developed through conversations with healthcare professionals, based on literature and tested with academics and clinicians. Survey responses were analysed using descriptive statistics. The Mann-Whitney U test was used for statistical analyses.Results24/73 nursing homes completed the survey (33%). Differences in the characteristics of reported ‘assessments for frailty’ across nursing homes were evident. Variation in high level domains assessed (physical, social, mental and environmental) was observed. Nurses were the most common professional group completing assessments for frailty, with documentation and storage being predominantly paper based. A statistically significant difference between the number of assessments used in corporate chain owned nursing homes (3.9) versus independently owned nursing homes (2.1) was observed (U = 21, p = .005).ConclusionsGreat variation existed in the characteristics of reported ‘assessments for frailty’ in nursing homes. Our study suggests that not all physical, social, mental and environmental domains of frailty are routinely assessed: it appears that frailty is still primarily viewed only in terms of physical health. The consequences of this could be severe for patients, staff and healthcare settings. Research illustrates that frailty is a broad, multifactorial health state and, as such, an overall ‘assessment for frailty’ should reflect this.
Highlights
Frail individuals are at risk of significant clinical deterioration if their frailty is not identified and managed appropriately
The British Geriatrics Society (BGS) recommends that, ‘Any interaction between an older person and a health or social care professional should include an assessment which helps to identify if the individual has frailty’ [9]
Our study indicated a statistically significant difference in the number of assessments used in corporate chain owned nursing homes versus independently owned nursing homes, suggesting different levels of comprehensiveness in assessing for frailty between the two
Summary
Frail individuals are at risk of significant clinical deterioration if their frailty is not identified and managed appropriately. Research suggests that any interaction between an older person and a health or social care professional should include an assessment for frailty. Since a significant proportion of individuals 65 years or older will be frail, there will be additional implications for patients, healthcare professionals and health and care settings. Frailty in individuals will need to be recognised and managed appropriately to avoid significant deterioration in their wellbeing [2]. At present, health and social care systems are often fragmented, complicating accurate recognition, assessment and management of patients with frailty [3]. To better manage patients with frailty, there is a need to identify frailty early. A variety of assessments examine different aspects of frailty, in practice, few consider frailty across these four domains [11]
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