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How to spot frailty in older people and what emergency nurses can do to improve care

Older people living with frailty tend to present late and often in crisis at the emergency department
Frail older man lying on bed. Older people with frailty tend to present late and often in crisis at the emergency department

Older people living with frailty tend to present late and often in crisis at the emergency department

Picture: iStock

Emergency nurses can play a vital role in providing early interventions and improving care for older patients living with frailty.

Such patients tend to present late, often in crisis, which results in frequently unplanned, episodic, hospital-based care.

But it also means nurses in the emergency department will often encounter people living with frailty providing an opportunity to make every contact count.

What is frailty?

Frailty is best described as a clinical syndrome involving loss of reserves, energy and well-being . Although it is a

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Older people living with frailty tend to present late and often in crisis at the emergency department

Picture shows frail older man lying on bed. Older people with frailty tend to present late and often in crisis at the emergency department

Picture: iStock

Emergency nurses can play a vital role in providing early interventions and improving care for older patients living with frailty.

Such patients tend to present late, often in crisis, which results in frequently unplanned, episodic, hospital-based care.

But it also means nurses in the emergency department will often encounter people living with frailty – providing an opportunity to make every contact count.

What is frailty?

Frailty is best described as a clinical syndrome involving loss of reserves, energy and well-being. Although it is a relatively new term for the NHS workforce, there is a move for frailty to be considered as a long-term condition.

As it progresses, people become much more susceptible to rapid deterioration.

This means those living with frailty have an increased risk of mortality and readmission to hospital.

Frailty is common. Around 10% of people aged over 65 years have frailty, and this rises to between 25% and 50% of those aged over 85.

For patients, even a mild stressor, such as a minor infection, can cause a disproportionate and dramatic change in health.

How to spot a patient living with frailty

First, nurses should look out for the five ‘frailty syndromes’ that should raise suspicions the person may have frailty:

  1. Delirium – this is strongly associated with frailty and may include confusion, slowing of speech, apathy or withdrawn, sleepy/sedated patients.
  2. Recurrent falls – patients are more likely to fall and to have a significant injury, with postural hypotension a leading cause.
  3. Sudden deterioration in mobility – this is when patients are ‘off legs’, often attributed to an acute illness such as urine or chest infection, but many older, frail people present with atypical symptoms of infection.
  4. New or worsening incontinencetwice as common in older people living with frailty compared with those older people without it, but misguided beliefs that urinary incontinence is a normal part of ageing can mean incontinence is overlooked by patients and nurses alike.
  5. Medication side effects – patients can experience a higher incidence and severity of adverse drug events, are likely to be prescribed multiple medications and are often prescribed medications with anticholinergic or sedative effects, increasing falls risk .

Make every contact count

The NHS Long Term Plan is clear that improving care for older people living with frailty is a key priority.

As frail older people are so vulnerable to adverse healthcare outcomes, emergency nurses can play a pivotal part in recognising frailty syndromes and providing or advocating early interventions, such as prompt treatment of an infection, that can help improve patient outcomes.

Remember – make every contact count.

Seven simple assessment strategies for nurses

These simple assessment strategies will help emergency nurses to identify frailty, provide a patient-centred approach and reduce the risk of frailty to the patient in the emergency department:

  1. During assessment, consider using the ‘PINCH ME’ mnemonic (Pain, INfection, Constipation, deHydration, Medication, Environment) to help identify possible underlying causes and help promote appropriate care planning considerations
  2. Taking accurate blood pressure while the patients is lying and standing is often not included in an assessment, but emergency nurses are in an ideal position, if appropriate, to check lying and standing blood pressures
  3. Advocate further review if significant differences are recorded – a simple yet important and often overlooked assessment
  4. Be mindful to assess for signs of infection – vital signs should be measured and pyrexia, hypoxia, hypotension or increased respiratory rate may be red flags that should raise suspicion of infection and enable prompt and appropriate review by a suitably trained clinician
  5. Don’t overlook incontinence, which is an important marker for frailty and one which emergency nurses could consider during patient assessment
  6. Ask questions about whether the patient has full control or if they have been leaking or wetting, and consider starting continence assessments
  7. Consider medications that patients are prescribed and raise any concerns

Great Western Hospitals NHS Foundation Trust advanced clinical practitioner Neal AplinNeal Aplin is advanced clinical practitioner at Great Western Hospitals NHS Foundation Trust





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