Emergency care for frail older people—urgent AND important—but what works?

Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway

“… Three grey literature articles/reports: Including the Beaumont hospitals FITT program operational model [ 21 ], a UK report on older people’s contribution and understanding and preventing avoidable hospital admissions [ 24 ], and the UK report on hospital care of frail older people [ 25 ]. Two editorials/summary pieces: An overview of new horizons of urgent care of frail older people [ 2 ] and on what works within emergency care for frail older people [ 26 ]. Six studies/interventions within one acute site: UK study on older patient’s flow through hospital to improve efficiency and reduce mortality [ 27 ]; an evaluation of an ED frailty unit in the UK [ 28 ], geriatric ED intervention in Australia [ 29 ], outcome study of frailty indicators in Sweden [ 30 ], US study on the impact of an eat walk engage program [ 31 ] and on embedding a comprehensive geriatric assessment unit [ 32 ].…”

“…Two editorials/summary pieces: An overview of new horizons of urgent care of frail older people [ 2 ] and on what works within emergency care for frail older people [ 26 ].…”

“…Frail patients are vulnerable to adverse effects of hospitalisation including deconditioning, immobility, and loss of independence [ 22 ]. There is an overall agreement that acute hospitals should identify frailty at the earliest possible opportunity considered to be at the ‘front door’ emergency department [ 4 , 6 , 7 , 21 , 22 , 23 , 24 , 25 , 26 , 33 ]. However, there is a lack of good recent quality evidence to guide the care of frail older people attending the emergency department [ 4 ].…”

“…Significantly the literature recognised that the scale and complexity of implementing and sustaining an integrated approach can easily overwhelm with even strong leadership. Key to the success is adapting the activities to the local context whilst recognising that changes to practice will take longer to achieve than anticipated [ 23 , 26 ]. When rolling out a pathway consideration and support should be provided to staff who may not be familiar with working the ED.…”

Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: An observational study

“…It is increasingly recognized that a gold standard approach for measuring frailty is neither appropriate nor desirable, and that different validated instruments can be suited to different settings and/or purposes [10,11]. In the NHS, the assessment of frailty in the acute, inpatient setting could add value to the management of the growing -but heterogeneouspopulation of older people [12][13][14]. Therefore, the measurement of frailty in acute settings is being encouraged by national initiatives such as the Acute Frailty Network (http://www.acutefrailtynetwork.org.uk).…”