About this Webinar
An expert panel discusses frailty in the geriatric ED and why it is an important concept in the care of older ED patients.
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Webinar Details
Expert Panel
Kenneth Rockwood, MD, MPA, FRCPC, FRCP
Professor of Medicine (Geriatric Medicine & Neurology)
Dalhousie University, Halifax, Canada
Simon Conroy, MB ChB, FRCP, PhD
Professor of Geriatric Medicine
University College London
Lead, Acute Frailty Network, England
Aaron Malsch, RN, MS, GCNS-BC
Senior Service Program Manager
Advocate Aurora Health
Wisconsin
Moderated By
Goals
- To review the concept of frailty and various definitions and tools
- To explore why it is an important concept in the care of older ED patients
- To highlight some strategies for integrating frailty screening into ED processes of care
Supporting Materials
PODCAST | September 17, 2021
Failure to Thrive and Frailty
Dr. Christina Shenvi sits down with Dr. Katie Selman to discuss complex, frail older adults in the ED, and the problematic diagnosis of “failure to thrive” in older adults.
JGEM |Volume 3 | Issue 1 | Article 2 – Collective Wisdom: Editorial | March 17, 2022
What’s in a Name? Understanding Failure to Thrive and Frailty in the Emergency Department
Read this JGEM article by Dr. Christina Shenvi and Dr. Katie Selman to learn more about the terms “failure to thrive” and “frailty”.
Dr. Rockwood, a geriatrician at Dalhousie University, reviewed the concept of frailty and how it is intrinsically linked to aging. Then he described how the Clinical Frailty Scale broadly stratifies the degrees of frailty and can be used as a tool to screen for frailty.
Key points
The challenge of frailty arises from the complexity of managing multiple interacting medical and social problems that begin to grow exponentially in older adults. In order to care for these patients, recognize the degrees of frailty rather than simply distinguishing between frail and not frail. When assessing frailty, consider what functions does the patient need help with? What degree of help do they require? And how high order are these functions? Also, understand how a patient was presenting two weeks before they became ill or injured, and based on this, discuss plausible goals of care. All of this information is crucial for informed decision-making and creating a care plan that includes a consideration of frailty.
British Geriatrics Society | October 12, 2017
How older people move in bed when they are ill
Age and Ageing | January 19, 2017
Frailty affects the initial treatment response and time to recovery of mobility in acutely ill older adults admitted to hospital
Intensive Care Medicine| February 4, 2022
Impact of frailty on persistent critical illness: a population-based cohort study
Canadian Geriatrics Journal| August 24, 2020
Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources
Age and Ageing | November 2021
The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine
Dr. Conroy, a geriatrician in London, England, outlined how the Acute Frailty Network has been working to improve outcomes for older people and standardize frailty screening across the National Health Service in the UK. He emphasized the need for a cultural change in the way the care of older adults is approached.
Key points
The protocolized approach to care that is often applied to the older adult population does not work. His main concern is that healthcare professionals are adapting their treatment, attitude, and care to the needs of older patients based on where they are in their life trajectories. And frailty is fundamental to understanding where someone is on their life trajectory. Frailty scoring can be quick, simple, and easy to implement even at a large scale. He highlighted the different levels of impact that need to interact to standardize frailty screening from individual clinicians to service structures to national policy. It provides a common currency in the care of older people. When creating a care plan, differentiate between multifactorial frailty, an accumulation of deficits, and unifactorial frailty.
British Geriatrics Society | February 22, 2021
Silver Book II | Quality care for older people with urgent care needs
Aaron Malsch, a frontline nurse clinician, discussed a different approach to the topic of frailty within Advocate Aurora. Their Geri ED program chose the Identification of Seniors At Risk (ISAR) tool to screen for frailty, which is performed on all older adults over the age of 65.
Key points
The first two questions of the ISAR are adequate proxies to engage with frailty: Before the injury or illness did you need help on a regular basis? Since the illness or injury have you needed more help? He stressed the importance of critical thinking, not just asking questions but also considering how this information and the concept of frailty can be built into protocols. Frailty should be integrated into the workflow of physicians, nurse practitioners, and case managers who can identify post-ED services, as well as other professionals that can address frailty both in the ED and after the ED.
Journal of the American Geriatrics Society | December 01, 2022