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Older peopleMar 8, 2023

Physios Kate Bennett and Esther Clift contribute to BGS blueprint on preventing and managing frailty

Physiotherapists Kate Bennett and Esther Clift contributed to a blueprint on preventing and managing frailty in older people, which was launched this week (6 March) by the British Geriatric Society (BGS).

They appear to be the only allied health professionals (AHPs) to have been members of a 22-strong ‘expert members group’, a list of which appears at the end of the 24-page blueprint.

This document’s lead author is Anne Hendry, the BGS’s honorary secretary and an honorary professor at the University of the West of Scotland. The blueprint sets out seven system ‘touchpoints and outcomes’ that should be considered by planners and commissioners in health and social care for older people. It also lists 12 actions points will help to create the conditions for high-quality integrated care. 

Ms Bennett, who formerly held a professional adviser’s post at the Chartered Society of Physiotherapy, is a clinical lead physiotherapist with Solent NHS Trust. Esther Clift chairs the BGS’s nurse and AHP council. Dr Clift is also a professional adviser with NHS England and Improvement and a consultant practitioner in frailty with Southern Health NHS Foundation Trust.

Photo Credit: Shutterstock
If delayed transfers of care are unavoidable, rehabilitation should start in hospital

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The blueprint points out that a nationwide shortage in AHPs and other practitioners is currently blighting attempts to improve older people’s services at a time of ‘rising demand’, noting: ‘The need for innovative and effective workforce solutions has never been greater nor more urgent.

‘Older people and their carers require timely access to a wide range of generalist and specialist care and support delivered by primary care, community services, acute care, social care, housing, community and voluntary partners as well as specialist palliative care services.

‘There is an urgent need to train more specialists in older people’s healthcare to provide direct clinical care and to build the capability of generalists to prevent and manage frailty across the system.’

Rehabilitation must be available to older people leaving hospital, regardless of whether they are discharged to their own home, a care home or other setting

Enabling independence and promoting wellbeing

The blueprint states that ‘wellbeing’ is a concept that includes physical, mental, emotional and spiritual health. ‘Loneliness and social isolation are associated with higher mortality, increased risk of coronary heart disease, stroke, high blood pressure, depression and suicidal thoughts, and contribute to frailty and dementia risk as much as physical inactivity.’

It refers to ‘strong evidence’ showing that regular exercise – particularly strength and balance training – reduces falls and ‘partially reverses or slows progression of frailty’.

‘Age-friendly communities enable people of all ages to live healthy and active later lives, live at home for longer, participate in the activities that they value, and contribute to their communities. Targeted approaches and support are needed to fully involve people with communication, cognitive, sensory or physical impairments.'

Reablement, rehabilitation and intermediate care

Many older people who experience an acute illness or decompensation of a frailty syndrome prefer to receive healthcare at home or closer to home, the blueprint states. 'All localities should offer a high-quality multi-professional integrated urgent community response that provides both intensive short-term hospital-level care at home through Virtual Wards and Hospital at Home, and goal-oriented home-based and bed-based reablement and intermediate care services that optimise recovery through rehabilitation.

'Together, these services reduce risk of deconditioning, delirium and hospital-acquired infection, improve hospital flow, support older people to regain independence and reduce demand for readmission and long-term support.’

Older people with frailty need early mobilisation in hospital, a rapid establishment of rehabilitation goals, and continued therapy input until their condition has stabilised, according to the blueprint. ‘Older people leaving hospital often do not have access to the rehabilitation services they need to support their recovery. Rehabilitation must be available to older people leaving hospital, regardless of whether they are discharged to their own home, a care home or other setting.'

Delayed transfers

Where delayed transfers of care to community rehabilitation services are unavoidable, rehabilitation should start in hospital. Older people with rehabilitation goals should not be transferred to a care home or community bed without an assurance that appropriate rehabilitation will be available, the blueprint adds.

'Without rehabilitation, older people being discharged from hospital experience further deterioration of their health. Already on average 15 per cent of older people being discharged from hospital are readmitted within 28 days. With each admission their level of frailty and care needs increase, generating even more demand for health and social care at home or in a care home.’

To access the full version of the document, which is titled Joining the dots: A blueprint for preventing and managing frailty in older people, click

Esther Clift is scheduled to speak at the annual conference of AGILE, the CSP professional network for therapists working with older people. Her talk is titled Move Forwards: Focus on Advanced and Consultant Practice for Older People.

The conference, titled Connect, Reflect, and Move Forwards, will be held at Engineers House in Bristol from 28-29 April.

For more details, see: https://agile.csp.org.uk

Author: Ian A McMillan
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