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Hospital nurses urged to carry out more frailty assessments

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Hospital nurses could do more to identity the needs of the most vulnerable patients when they are admitted, suggests a new report on frailty in acute care.

The report, published by the National Institute for Health Research, draws together findings from more than 50 recent and ongoing studies, with the aim of raising awareness of the specific needs of frail and elderly patients.

“It is important hospital staff are able to quickly identify these people and provide additional support”

Elaine Maxwell

Key messages in the report include the importance of carrying out a Comprehensive Geriatric Assessment (CGA), which is “widely accepted as the gold standard for assessing older people living with frailty”.

One study featured in the report – titled Comprehensive Care: Older people living with frailty in hospitals – found that for every 20 such assessments carried out, one admission to a care home could be avoided.

A separate evidence review found older people who came to hospital as an emergency, had a CGA and received specialist care were more likely to be living in their own home a year later, compared to those who got routine care on a general ward.

However, a National Audit Office report, published in 2016 and also featured in the NIHR report, found just 42% of hospitals were undertaking CGAs.

“Not every old person coming into hospital is frail but those who are need special care,” said the report’s co-author Elaine Maxwell, clinical advisor at the NIHR Dissemination Centre.

“It is important hospital staff are able to quickly identify these people and provide additional support,” she said.

“Our themed review shows strong evidence for the CGA process and also demonstrates the importance of caring for these people in appropriate environments,” she added.

Elaine Maxwell

Elaine Maxwell

Elaine Maxwell

The NIHR said it hoped the review would be particularly useful to hospital nurses and other staff who have not received specific training in the care of older people.

Other key findings include the need to ensure older people get the correct medication and that hospital staff have the right support and training to assess the mental capacity of older people with dementia before discharge.

It also highlighted the importance of developing relationships between staff and frail patients when they are in hospital.

One study published this year found only a third of trusts provided training to healthcare assistants on building positive relationships.

Researchers went on to develop a short training package called Older People’s Shoes, developed with nurses, HCAs, managers and older people, which was “well received” after being trialed with more than 110 HCAs.

Dawne Garrett, the Royal College of Nursing’s professional lead for the care of older people and dementia, said: “These helpful reviews of research on frailty by the NIHR will be useful and accessible for all nurses caring for older people.

“We will now circulate the findings to our members,” she said. “It’s extremely welcome that more attention is now being devoted to how best to care for older people living with frailty.”

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Readers' comments (1)

  • Nurses are drowning under the load of paperwork as it is. I wonder how long ago it was when Elaine Maxwell and her team worked on a busy ward.

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