Management of frail older people with acute illness

Abstract

Frailty status is intrinsically related to every aspect of older patients’ hospital journeys: the way in which they present to hospital, their health status at admission, vulnerability to complications in hospital and rate of recovery after an acute insult. In younger people, hospitalisation is usually the result of a serious illness or injury, such as sepsis or major trauma. Management can be underpinned by evidence‐based algorithms relating to the precipitating insult and recovery usually follows a predictable trajectory. In older people who are frail, on the other hand, admission to hospital may be triggered by an illness that may seem minor, such as a viral infection, which causes a geriatric syndrome. A fall or delirium with no major precipitant should be considered an indicator of frailty. Promptly recognising the acute illness and the increased risk for hospital‐associated complications is essential for providing safe systems of care for frail older people. Early consideration of health assets and engagement of families and community services can have an important role in successful recovery during and beyond the hospital stay. Effective decision‐making about clinical interventions can benefit from explicit assessment of frailty status and consideration of patient priorities.

Delayed Intracranial Hemorrhage in Patients with Head Trauma and Antithrombotic Therapy

“…Clearly, the admission of patients must be indicated based on economic factors as well as on aspects of the patient’s will and ethical considerations for elderly patients, who might experience massive stress due to the changed environment in the hospital [34]. A relevant but unanswered question underlying this study is, how does the fear of legal consequences affect clinical management, although a potentially fatal DIH may not lead to an escalation of care due to advanced patient age?…”

Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study

“…There is compelling evidence that frailty is a significant predictor of hospitalisation and adverse outcomes after discharge in older people, such as readmission rates as well as increased risks of disability and mortality [1,14]. A prospective study implementing frailty screening and frailty pathway intervention among geriatric trauma and emergency general surgery patients in an acute hospital showed improvement of patients' outcomes including the reduction in length of stay, readmission rate, and loss of independence [15].Studies suggested frailty screening in hospital might benefit the patients by risk stratification and providing individualized and optimized care [16,17]. Hospitals have been increasingly stretched to cope with the influx of frail older patients and changes are needed to be made to address the shortage of beds in the acute hospitals.…”

A review of inpatient nursing workload measures

“…With an ageing population (Mudge & Hubbard, 2019), the healthcare system is faced with an increasing number of patients with chronic and complex health conditions. These adults have more frequent hospitalisations and re-admissions (Gallagher et al, 2015).…”