Frailty is a state of lowered bodily perform for seniors residing independently in the neighborhood. It could possibly have an effect on endurance, stability, cognition or social engagement. (Shutterstock)
Within the subsequent 10 years, the variety of Canadians residing with frailty will develop to greater than two million. Frailty issues as a result of it not solely impacts seniors’ skill to perform, but additionally places their well being in danger.
Frailty is a state of lowered bodily perform for seniors residing independently in the neighborhood. It seems to be totally different for various people and may have an effect on endurance, stability, cognition or social engagement. Usually frailty evaluation is proscribed to in-office assessments by physicians. If it could possibly be assessed in different settings, it could present alternatives to reply to seniors’ wants for companies quicker and with much less burden on the health-care system.
As nurse practitioners, we led a top quality enchancment mission to develop identification and response to frailty for seniors residing in the neighborhood. The mission additionally engaged social work employees and others working in seniors’ companies in Edmonton to evaluate older adults for frailty, performing these assessments at a seniors’ centre in the neighborhood.
Our purpose was to verify that frailty screening could possibly be efficient with out medical professionals’ involvement, and to check a brand new technique to establish and stop practical decline.
Enabling frailty evaluation
Sadly — or, trying again now, perhaps serendipitously — the mission started similtaneously the onset of the COVID-19 pandemic and the workforce needed to pivot rapidly to make sure continuation and success. The pandemic compelled the workforce to consider frailty evaluation in completely alternative ways and to develop an revolutionary strategy to evaluate and reply to frailty just about.
Digital evaluation used questions over the cellphone to evaluate frailty.
(Shutterstock)
We would have liked to discover a strategy to proceed this vital work regardless of restricted face-to-face interactions.
Initially, the plan was to have main care suppliers use a pre-existing instrument, the Medical Frailty Scale (CFS) developed at Dalhousie College, to evaluate frailty throughout in-person appointments at a community-based seniors’ group in downtown Edmonton. Since in-person visits had been restricted, our workforce recognized an alternate strategy that concerned interviewing seniors by phone and having them present a self-assessment of their frailty degree.
Permission was obtained from Dalhousie to adapt the Medical Frailty Scale to a Digital Frailty Screening instrument. Seniors responded nicely to the method and, after a couple of tweaks, we pivoted to a brand new and improved digital model of Constructing Resilience and Responding to Seniors Frailty, often called DRAGONFLY.
Offering help in the neighborhood
Digital Frailty Screening scores ranged from zero to 9 and had been divided into three classes: gentle frailty (scores of 1 to a few), average frailty (4 to 6) and extreme frailty (seven to 9). Apparently, it was the reasonably frail seniors who required essentially the most help. Those that had been experiencing gentle frailty didn’t require energetic intervention and people experiencing extreme frailty had been nicely supported. It was these seniors within the average class who required intensive intervention.
The DRAGONFLY workforce’s response targeted on offering each social and scientific helps for care in neighborhood. The commonest social helps included monetary help, housing help, transportation, dwelling companies, authorized referrals and completion of medical paperwork. Extra particularly, helping seniors with paperwork to entry funds or ample housing.
Different seniors required extra sensible sources, reminiscent of a connection to a driving service for medical appointments or help with grocery supply throughout the pandemic.
The commonest social helps included monetary help, housing help, transportation, dwelling companies, authorized referrals and completion of medical paperwork.
(Shutterstock)
Social connections had been crucial. Seniors had been referred to recreation programming to reinforce engagement with friends, connections with different seniors from particular newcomer communities, caregiver help, psychosocial help teams and digital communities. Effectively-being helps included use of multicultural navigators to assist newcomers acclimatize to their new properties, LGBTQ2S connections, medical translation and counselling for many who battle with hoarding behaviours.
The commonest scientific helps included connecting to a brand new main care supplier, assist discovering allied well being suppliers reminiscent of physiotherapists or pharmacists, main care community program registration, facilitating pharmacy opinions, connecting with drop-in psychological well being counselling and well being navigation.
Placing these in place and following up with seniors by way of cellphone regularly demonstrated enchancment of their resilience. We noticed a major lower of their help wants and gaps over a 12-month interval.
Frailty in the neighborhood
Assessing and responding to frailty in the neighborhood has by no means been so vital. The pandemic highlighted the inherent dangers of congregate residing and the significance of sustaining older adults residing of their communities so long as potential. Unbiased residing contributes to larger well being for seniors and in addition helps to maintain health-care prices decrease.
We already know that seniors who’re socially engaged will not be solely happier, however more healthy. Serious about and implementing new methods of figuring out frailty and together with social companies as a significant sector on this work represents a brand new strategy to combine our well being and social spheres, rooting wellness in our communities, not in our clinics.
Our program made an vital distinction to over 100 seniors throughout a really difficult time for them. Within the face of social distancing and restricted face-to-face companies, DRAGONFLY continued to evaluate frailty in seniors in the neighborhood and allowed us to reply to practical wants in a significant means.
This mission is coming to an finish, however we’re presently working with different organizations that serve seniors and hope to use the teachings of DRAGONFLY to construct capability to evaluate and reply to frailty, stopping its development.
Tammy O'Rourke receives funding from Healthcare Excellence Canada.
Anne Summach is affiliated with the Nurse Practitioner Affiliation of Alberta.
