Rapid evidence review to understand effective frailty care pathways and their components in primary and community care

Abstract

PurposeDifferent pathways of frailty care to prevent or delay progression of frailty and enable people to live well with frailty are emerging in primary and community care in the UK. The purpose of the study is to understand effective frailty care pathways and their components to inform future service development and pathway evaluation in primary- and community-care services.Design/methodology/approachA rapid evidence review was conducted: 11 research publications met the inclusion criteria and were analysed using narrative thematic synthesis.FindingsThere is strong evidence that resistance-based exercise, self-management support, community geriatric services and hospital at home (HAH) improve patient health and function. In general, evaluation and comparison of frailty care pathways, components and pathway operations is challenging due to weaknesses, inconsistencies and differences in evaluation, but it is essential to include consideration of process, determinant and implementation of pathways in evaluations.Originality/valueTo achieve meaningful evaluations and facilitate comparisons of frailty pathways, a standardised evaluation toolkit that incorporates evaluation of how pathways are operated is required for evaluating the impact of frailty pathways of care.

Virtual wards: A rapid evidence synthesis and implications for the care of older people

“…Following full-text screening of 52 records, 39 publications relating to 31 unique reviews were included. (1, 10-39) This included four Cochrane reviews. (1, 10-12) Although most included reviews did not use age or frailty as inclusion criteria, most participants included in the reviews were older and/or had one or more chronic conditions, and the identified Cochrane reviews were included in a rapid review of hospital at home as a component of the frailty pathway.…”

“…(1, 10-12) Although most included reviews did not use age or frailty as inclusion criteria, most participants included in the reviews were older and/or had one or more chronic conditions, and the identified Cochrane reviews were included in a rapid review of hospital at home as a component of the frailty pathway. (39) We therefore consider the results of the RES as a whole to be relevant to the use of virtual wards for older people.…”

“…(1) However many of the participants across the reviews would be likely to be classed as frail although they were not specifically included on that basis As we noted, a review which considered hospital at home as a component of the frailty pathway used the Cochrane reviews we identified (1, 10) as their main evidence source. (39)…”

IJHG review 27.1

“…Jagric et al (2022) expand on the issues of hospital finance from a European perspective and examine the effect of healthcare spending on national budgets. Thompson et al (2022) highlight the growing problem of the frail elderly population in the UK and examine evidence for frailty care pathways. They conclude that there is a paucity of current research and make the case for further high quality investigations to create a robust evidence base to use to inform frailty care pathways.…”

“…For this reason, the National institute of Healthcare Excellence (NICE) in the UK recommends systematic assessment of all people over 65, together with early appropriate interventions using specific frailty-care pathways. Thompson et al (2022) report on their scoping exercise to identify the robustness of differing components and outcomes of these pathways in primary and community care services. Findings indicate that many studies are low quality and focus only on single care pathways.…”