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Dr. Chris Leggett - Royal College of General Practitioners


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An Integrated Approach to Falls, Frailty and Physical Activity in an Ageing Population

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Dr. Chris Leggett - Royal College of General Practitioners

  1. 1. Dr Chris Leggett Chairman Down ICP
  2. 2. Minister for Health Department of Health, Social Services & Public Safety Health and Social Care Board (inc 5 Local Commissioning Groups) 6 Health & Social Care Trusts Primary Care: GP/ Dentists/ Opticians/ Pharmacist Private, Independent Sector Not for Profit, Charity and Voluntary Sector Health and Social Care NI Provider systems Public Health Agency Integrated Care Partnerships (as well as service users and carers and local councils )
  3. 3. Integrated Care Partnerships Networksof providers - Workingtogetherto deliverthe right care, in the right place at the right time. Population 100k
  4. 4. SE ICP Falls Multi-professional working group  Patient & Carer representative  Falls Co-ordinator  Physiotherapists  OTs  GPs  Pharmacists  NIAS  ICP Project Manager
  5. 5. What is frailty? WHO (2015): ‘frailty is a progressive age-related decline in physiological systems that results in decreased reserves of intrinsic capacity which confers extreme vulnerability to stressors and increases the risk of adverse health outcomes’ Strong predictor of relevant adverse outcomes Separate, but causally related to, multi-morbidity & disability Frequent: 1 person out of every 10 after 65+ years is frail Potentially reversible, particularly in the early stages
  6. 6. Frailty “syndromes”  Falls  Continence issues  Poly Pharmacy (more than 5 medications)  Mild Cognitive disorder  Social Isolation/Loneliness
  7. 7. Demographics NI
  8. 8. ICP Frailty Projects  NIAS Falls Pathway  Promoting Strength and Balance Programmes  Promoting Council Exercise / Activity Programmes  Enhanced Care At Home / Acute Home Care Schemes  Nursing Home In-Reach Programmes  Dementia Pathway Development  ECHO –Dementia  OOH Crisis Care Response  Social Prescribing
  9. 9. “PJ Paralysis” • Patients over 80 – 1 week in bed can lead to: • 10 years of muscle wasting • 1.5kg muscle loss • Increased Dependence • Demotivation • Increased Risk of Delirium
  10. 10. Acute Hospital • Toxic environment • Lack of exercise/movement • Intermittent light • Intermittent noise • Lack of control of environmental manipulation • Sensory deprivation • Poor sleep • Controlled fear • Disorientation
  11. 11. What’s the difference?
  12. 12. Healthy Ageing Collaborative: Electronic Frailty Index Academic Unit of Elderly Care & Rehabilitation, Bradford Teaching Hospitals Foundation Trust Yorkshire & the Humber Improvement Academy
  13. 13. Findings • AF • Postural Hypotension • Essential Hypertension • Falls • Continence Issues • Hearing Loss • Depression • Memory Loss • Social Isolation
  14. 14. Outcomes • New Diagnoses • Falls Prevention: Strength and Balance • Rationalisation of Medication • Referral to Audiology, Optician, Dentist.. • Care of Elderly • Dementia Clinic • Continence Services • Social Prescribing
  15. 15. Patient Experience • 73 year old lady referred to falls prevention following Frailty Assessment: No history of falls but significant fear of falls. Completed 12 week strength and balance program. • “My confidence has grown, my balance is so much better now and I don’t have the same fear of falling. Since starting the class I can get to the bathroom in time.”
  16. 16. Frailty Nurse Project 1 service user was referred back into GP surgery for further investigations. 6 service users referred to strength and balance programmes 8 medication changes 6 referrals for social prescribing 1 audiology referral 7 OT, physio referrals. 29 out of 50 patients seen had new identified need from a holistic assessment carried out. ? Role in mild frailty.
  17. 17. Preventing/Delaying Frailty Promote healthy lifestyle: Be physically active Follow Mediterranean diet Avoid being overweight Avoid tobacco Reduce alcohol consumption
  18. 18. Exercise and physical activity Physical activity is most promising intervention for preventing or improving frailty Frailty is not a reason not to prescribe activity Improves body composition, dietary intake, muscle function, upper and lower body flexibility, and reduces depression Multicomponent interventions x > 5 months x 5 times per week x 30–45 minutes per session
  19. 19. Social Prescribing 3 basic components 1. Referral from Healthcare Professional 2. Consultation with Social Prescriber 3. Use of community, voluntary or statutory sector services/programmes 23
  20. 20. GP Practice Advanced Nurse Practitioners Mental Health Worker Diagnostic Physio Pharmacists Enhanced District Nursing Teams Enhanced Multi-Disciplinary Teams Social Worker
  21. 21. NI Frailty Network  Virtual Network  Totally inclusive  Share Best Practice  Consult  Populate Task and Finish Groups  Updates on progress  Events
  22. 22. Dr Chris Leggett Chairman Down ICP