In session one we introduced the electronic Frailty Index (eFI) indicating that it could be more widely used as a means of alerting community staff to people who are already frail or maybe at risk of becoming frail. Not a lot of detail was given about the method used ‘behind the scene’ that make it valuable, this short blog aims to explain more about what it does.
The electronic frailty index (eFI) itself is a clinically validated tool that can identify people with frailty on a population basis using routinely collected primary care data. The eFI, which uses a cumulative deficit model for frailty. The Cumulative Deficit model assumes that an accumulation of deficits (ranging from symptoms e.g. loss of hearing or low mood, through clinical signs of illness as tremor, through to various diseases such as dementia) which primarily occur as you age combine to increase the likelihood of you becoming frail. Becoming frail increases the risk of an adverse outcome.
The team who proposed this model, led by Rockwood at Dalhousie University in Canada used it to develop a Clinical Frailty Scale which was used in a very large Canadian Study of Health and Aging (CSHA) as a way to summarise the overall level of fitness or frailty of an older adult after they had been evaluated by an experienced clinician.
Rockwood et al (2005) proposed that their clinical frailty scale (CFS) should be used after a comprehensive assessment of an older person had been carried out. They suggested this to validate that the scores given using the scale matched what was seen in clinical clinical practice.
Although introduced as a means of summarising a multidimensional assessment the CFS quickly evolved for clinical use, and has been widely taken up as a judgement-based tool to screen for frailty and to broadly stratify degrees of fitness and frailty. It is not a questionnaire, but a way to summarise information from a clinical encounter with an older person, in a context in which it is useful to screen for. It roughly quantifies the person’s overall health status. To find out more about the tool CLICK HERE
The electronic frailty index (eFI) uses a similar method to the CFS to segment the population into 4 categories; fit, mild, moderate and severe frailty. You can find a table that shows the on pages 2 and 3 of this document https://ihub.scot/media/6106/frailty-and-the-electronic-frailty-index.pdf
Being able to access the eFI and the data it creates for a GP’s population though is not something many of you can do currently so please remember that the simple screens for frailty introduced on the first day, that is the PRISMA 7 questionnaire and TUG. Remember using both prevents many false positives for frailty arising. They are both simple and quick to do.
What might alert you to Frailty? This list from Southern Health NHS Foundation Trust in England might help. They recommend screening in the event of
- Sudden change in mobility
- Delirium (acute confusion or suddenly worsening confusion)
- Sudden change in continence
- Reported side effects from medication
The day started with introductions and establishing the ground rules for each session. Working in groups is like one to one clinical work, establishing good relationships and trust are the fundamentals of working well and moving learning and action, so focus is placed on “checking in” and setting the ways of working together.
A short film from Age UK on frailty was shown and then a discussion took place about what the film had brought up, what was recognisable and what was new. The group then split into pairs to do an exercise exploring our own experience of frailty. This had a two fold purpose, one to help us to understand our own experience and how these relate to learning and the second aspect of the exercise was to continually listen and not speak whist the other person was telling their story. Listening is an essential skill in coaching development. Although we spend our lives listening, how much do we truly listen; do we listen to hear or listen to respond? The focus here was on really listening and not talking in response, just encouraging. Each person took 10 minutes doing this. The group then discussed how this exercise made them feel and why it was important to listen. What people shared was that it was harder than they imagined to just listen and not interject with their own story or give advice. They also noticed how good it was to be really listened to questioning how often does that happen? Audrey suggested that if all they took away was how to really listen this will have made a difference to everyone.
We then went on to do an exercise in pairs discussing what matters to you rather than asking what’s wrong with you. Audrey shared the video on Don Berwick discussing where the campaign came from and the important shift in care and support that happens when we approach a therapeutic relationship with “what matters to you”. The exercise helped people experience that for themselves and start to look at how that will be different for each individual.
At the end of lunch the group participated in a mindfulness session. Audrey explained that offering mindfulness was about helping people develop tools for resilience which help everyone involved in the care relationship. Also mindfulness is not a relaxation technique but rather an awareness skill which the group will build on over the sessions but the sessions will be entirely voluntary to take part in.
In the afternoon the Frailty Matters Blog was introduced and since you are on it to read this you should know its at: http://frailtymatters.uws.uk
All the information on frailty covered in the programme will posted on this Blog. A new post will be made every fortnight for the duration of this phase of this project. You are encouraged to revisit the Blog and comment on any aspect of it. Suggestions for improvements, more information etc. are welcome this resource is designed to help you with all aspects of the programme.
Each participant was given a notebook for reflection to be used in whatever way is comfortable to them. This is each participants reflective book and participants won’t be asked to share it.
Each person was given a have a postcard that you have completed about what you would like to get out of these sessions. People in the main want to learn about frailty and how to work with it. Participants gave feedback at the end of the session and were asked to reflect on what they would like covered in these sessions. Prevention was mentioned as important and the group was asked to bring further suggestions to the next session.