1. Rethinking Frailty
PHA & AgeNI
April 2018

2. ‘The most problematic expression of human ageing facing the NHS today’ (Clegg)

3. NI Issues No agreed definition for frailty
No ‘road map’ – do we know what good looks like?
Tend to operate from a medical model
We focus on conditions, rather than the ‘whole’ person
Service users views not captured until this year
Need to shift to public health, preventative model that is evidence based and has population health focus and measurable outcomes.

4. We all age, but not always in the same way..
FRAIL
FIT
Not all older people are frail, and not all people with frailty are old

5. Current Landscape

6. Paradigm shift THEN NOW ‘The frail Elderly’
‘An Older Person living with frailty’
A long-term condition
Late
Crisis presentation
Fall, delirium, immobility
Timely identification preventative, proactive care
supported self management & personalised care planning
Community based person centred & coordinated
Health + Social +Voluntary+ Mental Health
Hospital-based episodic care
Disruptive & disjointed

7. Frailty Fulcrum

8. Profile of Older Adults in Northern Ireland

9. Demographics- Changing NI population
2017
2027
2047
2064

10. Mortality- What do older people die from in NI
Mortality- What do older people die from in NI? (Registrar General Annual Report 2015)
Big cause of death
(65 to 84 years)
Cancer
Circulatory disease
Big cause of death
(85 and over years)
Circulatory disease
Alzheimer’s and dementia

11. Frailty prevention through active ageing
Lack of physical activity is costing the UK an estimated £7.4 billion/year
Including £0.9 billion to the NHS alone.
Long term conditions such as diabetes, cardiovascular and respiratory disease lead to greater dependency on home, residential and ultimately nursing care. This drain on resources is avoidable, as is the personal strain it puts on families and individuals.

12. Preventing frailty progression:
Potential Cost impact
Adjusting for age, gender and deprivation, in a 254K 65+ population:
If 10% of the severely frail had remained moderately frail the gross savings in Kent would be £1.6m over 10 months
If 10% of the mildly frail had remained fit, gross savings would be nearly £9m (owing to higher patient numbers)
NB: Gross estimates- these figures do not account for the costs of interventions to prevent frailty progression
Kent Integrated Dataset economic model NHS England

13. Bending the fitness curve
Also, consider inequalities carefully:
Lowest economic quartile frailty commences earlier in the life course and progresses more rapidly, contributing to reduced life expectancy

14. ‘As a population, we are living longer lives and many
In essence
Ageing population,
Cancer, circulatory disease,
Alzheimer’s & dementia,
Lifestyle & mental wellbeing focus,
Wider determinants,
In a digital world.
Implications for HSC
the working group
needs to put on
the agenda
Vision,
‘As a population, we are living longer lives and many
older adults enjoy good health and make significant contributions to their families, their friends, and to society.’
(The Public Health Agency, Corporate Plan )

15. Electronic Frailty Index (eFI)
Clegg et al: Age Ageing2016: 45:

16. Direct Clinical Verification

17. Suggested priority areas to think about
Frailty syndromes
Falls
Medicines
Cognitive disorder
Mental Health
Continence
Service approaches
Acute frailty care
Community frailty care
Specialist services
Frailty coordinators
Frailty networks
Key enablers
Data linkage with local IG agreements (system and individual)
Population risk stratification: understand demand/supply
Benchmarking to understand and manage outcome variation
‘Real time’ data pathways to drive quality improvement
Workforce core capabilities and skills

18. Ambition for frailty..
‘Everybody should know what to do next when presented with a person living with frailty and/or cognitive disorder’

19. Rethinking Frailty: What matters to older people

20. Rethinking Frailty: What really matters to older people

21. ExpertAge and Peer Facilitators
“I would like to feel like I was still a part of the world, not just waiting to die”
Model includes:
Bespoke recruitment, training and briefings
Multi-channel approach to reach older people across NI.

22. A snapshot of demographics
Sexuality
Heterosexual
89%
Bisexual
0.5%
Gay 1%
None
7.6%
Prefer not to say
1.9%
98%
White
23%
Carers
Gender
Male
21%
Female
78%
Other
1 %
51%
Report difficulty walking
62%
LT health condition

23. Characteristics of frailty

24. Perceptions of frailty
85% reported that they were not frail.
95% stated a professional had not described them as frail.
‘doesn’t look like me’.
77% of older people are not comfortable with the term frail.
56% believed that the possibility of being categorised as frail may deter people from seeking help.
40% related frailty with a loss of independence.

25. What makes a good life?
25% of people thought frailty was only physical.
25% believed frailty was irreversible.

26. What would help?

27. Conclusions
Co-design of services is key to shaping future health and social care services.
Peer facilitator model has been designed with older people and works to reach, engage and involve older people.
What really matters to older people is wellbeing and independence and approaches to frailty can reflect this
‘Personal health is basic to everything’
‘Independence gives you encouragement day by day’

28. Why is frailty so important right now?
Timely identification of people at risk with complex care needs
It permits sub-stratification by needs, not age
It provides opportunity to standardise care for people with similar needs
It crosses health & social care, so can drive integration
It’s predictive: finding those who benefit from active and healthy ageing
It will guide & track commissioning, design & service delivery
It directs towards key outcomes: maintained functional ability & wellbeing

29. Top priorities moving forward
We want to make NI the best place to age well
Use language that matters to people
Public conversation on frailty – focus on independence, maintaining good health
Develop a vision/guiding principles
Better identification
Know what works well and build on that
Agree what good looks like

30. Thank You