Additional Teaching/Learning Resources

When planning the sessions coaching sessions for this project there were two ‘guests’ we were going to invite to discuss their work with you, Janis McDonald who is the Chief Officer of Deaf Scotland who was going to discuss frailty and hearing and sight loss and Alison Bunce, the Programme Lead for Compassionate Inverclyde who is a Queen’s Nursing Institute Nurse. See https://www.qnis.org.uk/queens-nurse/alison-bunce/ who was going to discuss Compassionate Inverclyde with you.

Since they were unable to speak to you in person online they decided to record what they were going to discuss for you to watch. Both videos are below.

The second video is below:

So far in the programme we have been using text and video resources but there are a number of resources that exist in podcast form that we have not utilised. Podcasts tend to be a bit longer than video resources but you can download and listen to them in your own time. So you can listed to them from your ‘phone, on a smart speaker, on a walk, in the car etc.. You can of course also listen to them and share them with your own team and as they tend to be published in series, then you and your team members can listen to those you/they want to hear or feel are most relevant at the time.

The first series we are going to point you to are a series of podcats from Eat Well Age Well is a national project tackling malnutrition in older people living at home in Scotland. Eat Well Age Well is brought to you by award winning Scottish Charity Food Train. The website for the project is at https://www.eatwellagewell.org.uk/

To access the first blog press play below

Their podcasts are all about sharing and discussing how we can support older people in Scotland to eat well, age well and live well. See https://anchor.fm/eatwellagewell#:~:text=Eat%20Well%20Age%20Well%20is,age%20well%20and%20live%20well.

The Royal National Institute for the Blind also have a series of Podcasts to aid in supporting people with sight loss. There are three different podcast series, focusing on:

Each podcast is less than 15 minutes long. They are designed for older people living with sight loss as well as those family members, friends and carers who support them, as well as anyone who supports and helps adults with complex needs – both in a home or care setting.

Another larger podcast resource which has a wider remit than just frailty is a resource called MDT Education on Ageing: which has been designed for anyone working with older adults. They are part of a podcast family of site called the Hearing Aid Podcasts. You can access all of their podcasts (there are 9 series) at http://thehearingaidpodcasts.org.uk/

A guide to all their podcasts can be found at http://thehearingaidpodcasts.org.uk/previous-series/

End of Life Care in Frailty

There is little need for us within this project to write about end of life care in frailty because an extensive, near comprehensive and free to access resource on this topic prepared by the British Geriatrics Society (BGS) already exits.

Rather than condense what this resource says we will just introduce it to you. The aim of the BGS guidance is to support clinicians and others in considering the needs of and providing high quality care for frail older people as they move towards the end of their lives.  It sets out to prompt and support timely discussions about preferences for care, ideally at a time which facilitates the input of the older person themselves. They hope their guidance will provide practical advice to help staff working with frail older patients so they can provide them with the best opportunity to live and die well. 

You can access this resource at: https://www.bgs.org.uk/resources/resource-series/end-of-life-care-in-frailty

It is worth noting that in the BGS End of Life Care in Frailty resource, where it discusses Advanced Care Planning refers you to the Advance Care Planning Resource for England and Wales at http://advancecareplan.org.uk/

Scotland has its own Anticipatory Care Planning Resource which has an earlier focus designed to give control to people with long term conditions control over their management plans at an earlier stage than end of life. You can find the Scottish Resource at https://www.nhsinform.scot/campaigns/anticipatory-care-planning

There is also an Anticipatory Care Planning Toolkit available at Healthcare Improvements iHub. See https://ihub.scot/project-toolkits/anticipatory-care-planning-toolkit/anticipatory-care-planning-toolkit/

They have also produced a number of videos about Anticipatory Care Planning of which this one, Anticipatory Care Plans (ACP’s) in a Care Home may have the most resonance when you consider ACP’s for the frail people that you encounter.

You can watch it here.

Mental Well-being in Later Life

Much of the literature on Frailty has focused on physical health, however mental health including cognition, sleep, social interactions and positive aspects like well-being are just as important.

In 2014 in the UK general population about 300 in every 1,000 people experienced mental health problems. Of those 300 people, 230 visited a GP and 102 were diagnosed as having a mental health problem. For people with frailty who are at higher risk of mental ill-health, these figures will to be higher. National Surveys of NHS patients indicate that approximately 91 per cent of people with a mental health problem are treated within the primary care system, meaning that very few are referred to specialist mental health services. Figures also suggest that at least 25% of individuals with symptoms of mental health conditions such as depression and anxiety do not report them to their GP. People living with frailty will behave similarly. There is also an assumption by some that mental health problems are a ‘normal’ aspect of ageing, but most older people don’t develop mental health problems, and they can be helped if they do.

Healthcare professionals in the community are ideally positioned to make a difference. Age UK has identified key steps that every healthcare professional can take:  

  • Remember that mental health is just as important as physical.
  • Try to get into the habit of asking about the emotional well-being of the people you see. 
  • Look out for signs that your patients are struggling with their mental health. 
  • Start the conversation. It can seem awkward bringing up mental health but older people do say that they want to be asked and find talking useful.    
  • Think about language. Older people can be put off by terms such as mental health and depression. Try to use more informal language. 
  • Remember mental health problems are not inevitable. With the right support older people can recover. 

We have looked at two of the biggest causes of mental illness in frail older people already. See the earlier post on Loneliness which is at http://frailtymatters.uws.ac.uk/2019/12/04/the-value-of-social-support/ and our post about Dementia which is at http://frailtymatters.uws.ac.uk/2020/02/27/dementia-some-guidance/

One of the main issues we have not examined relating to mental health is DEPRESSION. It has been estimated that 1 in 4 older people have symptoms of depression that require treatment, but fewer than 1 in 6 older people will seek help. Care home residents are also at an increased risk of depression. Depression in later life can be a major cause of ill-health and can have a severe effect on physical and mental well-being. Older people are particularly vulnerable to factors that lead to depression such as bereavement, physical disability, illness and loneliness. Depression in older people can be treated effectively through talking therapies and antidepressants. See the NICE Clinical Knowledge Summary on Depression mentioned below. Effective interventions to prevent depression in older people include reducing loneliness and isolation through encouraging learning, physical activity and any form social interaction including volunteering. Many of these are difficult at this time but a useful guide to ‘Keeping Well at Home’ which was devised for all older people whose interactions are restricted currently because of COVID-19 has been produced by the Healthy Ageing Research Group at Manchester University. You can download the booklet at http://documents.manchester.ac.uk/display.aspx?DocID=49104

There is limited guidance from the Royal Colleges for those in primary care on what to do to maintain older people’s mental well-being but there is NICE guidance that you can refer to. NICE Guideline 32 is all about mental well being and independence in older people and there is also a NICE Quality Standard 137 which is on the same topic. You can look at the NICE flowchart and download both documents at

NICE (2020) Mental wellbeing and independence in older people overview: Interactive Flow Chart

You might also find the following NICE Clinical Knowledge summary on Depression useful. https://cks.nice.org.uk/topics/depression/

England (2014), writing for the Royal College of GP’s has stated that community practitioners need to take responsibility for coordinating and signposting to services beyond health care, in particular social care, housing and benefits to effectively tackle mental well-being in older people. The more collaborative form of working integrated care heralds will move community staff from gatekeepers to that of navigators. Community healthcare workers need to take responsibility for co-ordination and signposting to services beyond health care and builds bridges with many community services, patients’ families and their communities, if improving the mental welfare of our older people is the goal.

If you want to know more about this topic an intersting report to read is by Lee, M. (2006) Promoting mental health and well-being in later life: A first report from the UK Inquiry into Mental Health and Well-Being in Later Life. London, Age Concern & Mental Health Foundation. 

The report highlights discrimination; participation in meaningful activity; relationships; physical health and poverty; as important parts of promoting mental health and well-being that also need to be considered

Dementia: Some Guidance

Caring for people with dementia in the community is one area which is currently expanding. Recently the Alzheimer Europe calculated that with an increasing, and increasingly ageing, UK population the overall numbers of people with dementia; estimated in 2018 to be 1,031,396 will by 2050 be 1,977,399. A rise from 1.56% of the overall population to 2 .67% in 2050. There is pressure therefore to get this right now ahead of this expansion.

There is no clear way to provide all the people and their carers who require support with what they will need, so new ways to provide effective care need to be considered. This blog will look at 3 existing resources that are already being used in Scotland.

The first resource we suggest that you consider using is the winner of the Scottish Digital Health and Care Award 2020; which was NHS Lanarkshire’s Online Post Diagnostic Support Website which you can access from HERE

Two things to be aware of before you go to the site. It might have been designed for people receiving post diagnostic support but the information and advice is far more extensive than this. It has been tailored to suit Lanarkshire, so some sections discuss services and processes available in Lanarkshire which may or may not be available within the NHS Ayshire and Arran area.

The advantage of using this resource is that the information that it provides is validated and conforms to NHS Scotland standards (the information sources and hwere to get more information are all ij the links given within the site). There is 24/7 access to information which you can return to easily. People living with dementia and their carers can all access it when desired. It can be used to enhance staff knowledge of dementia, post diagnostic support and the services which might be available to improve people’s support and experience.

Topics the resource covers include understanding the illness, Power of Attorney, Driving, Anticipatory Care Planning, support for carers and lots more. Please explore this resource and use as you see fit. Note that the easiest way to find the site is to type “Dementia NHS Lanarkshire” into Google.

The second resource you should consider using is the Social Care Institute for Excellence (SCIE) Dementia Gateway. The Dementia Gateway provides access to information, guidance, resources and training for anyone supporting people with dementia. It is a very extensive resource and worth taking a bit of time to explore. There is so much on it designed to be utilised by health and social care staff in the community both as a resource and as education that you will find something your team can utilise very quickly. A note of caution though. It has been designed for England and Wales which is particularly important when the information given refer to English legislation. You can access the Gateway HERE.

The third resource we suggest that you look at is work done by the “Focus on Dementia” Group who are part of Health Care Improvement Scotland. They are currently working on improving care co-ordination for people with dementia and their carers so that this becomes more integrated.

Their work can be found at https://ihub.scot/improvement-programmes/focus-on-dementia/integrated-care/ They have set about trying to identify the critical success factors for integrated care co-ordination of people with dementia in the community. The focus of their work has been Midlothian. Their overview of the Dementia Care Co-ordination Critical Success Factors is available on the site and is discussed in the video that you will find there. A more detailed report on the critical success factors is due to be published but the list of factors is something you might already be able to use. There is also other work done by Focus on Dementia that you can access from this site.