Page 147 - Hospital Authority Convention 2018

Symposiums

S6.1 Integrated Emergency Care for Older People 10:45 Convention Hall A

Identifying Frailty in Older Adults at the Front Door: Screening and Initial Assessment
Rockwood K
Department of Medicine, Division of Geriatrics, Dalhousie University, Canada
The initial evaluation of frailty proceeds in two related steps: screening, and assessment. Classically, screening happens HOSPITAL AUTHORITY CONVENTION 2018
when the condition being screened for is not rare, is serious, potentially can be ameliorated, and when intervention is less
costly when done earlier rather than later. Each of these criteria is met in frailty screening. Screening tests typically are safe,
simple, rapid and sensitive. Dozens of frailty screening tools exist, and often are interchangeable, when they meet these
criteria and are feasible for local use.
Assessment tools aim to classify whether frailty is present. Some also aim to detect the factors contributing to frailty, classify
the degree of frailty, and relate the presence of frailty to common frailty syndromes, such as delirium, immobility, falls,
functional decline, social abandonment, and incontinence. This presentation argues for assessment methods which achieve
each of these objectives. The reference criterion (“gold standard”) of frailty assessment is the Comprehensive Geriatric
Assessment. The goal of a CGA is a multidimensional care plan which, when enacted, has been shown in randomised
controlled trials to offer benefit in terms of rates of people alive and at home at one year.

Many healthcare systems have failed to invest in physicians trained to conduct comprehensive geriatric assessments
and formulate multidimensional care plans. In consequence, a central challenge now is how to use existing providers and
information systems in ways that allow the benefit of this approach to be realised. Experience with systems such as an
electronic frailty index, a frailty index based on common laboratory tests, and on having multiple providers collaborate to
gather the information needed for a geriatric assessment will be reviewed. The emphasis will be on having as much of this
information assembled as possible when patients first are seen for an adverse change in their health status.

S6.2 Integrated Emergency Care for Older People 10:45 Convention Hall A

The Silver Book – Quality Care for Older People with Urgent and Emergency Care Needs
Banerjee J
University Hospitals of Leicester NHS Trust, UK

The Silver Book represents a best practice guide for managing older people in medical crises in the first 24 hours of
presentation irrespective of care setting. It was developed by 14 national organisations in England between 2010 and 2012.
Since publication it has been downloaded over 200,000 times and cited in majority of national reports on care of frail older
people in the National Health Service. The principles have been applied in many initiatives across the NHS and also formed
the basis for a national quality collaborative to improve care in acute settings. Tuesday, 8 May 2018

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