Frail Elderly: The Physiotherapist's Role in Preventing Hospital Admission

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Frailty

Costs

Length of stay and cost implications NHS

The latest published statistics which are being used in the literature relate to the years 2012 and 2013. Within this time frame 2,211,228 people over 60 were admitted to hospital in an emergency (DOH 2013b).

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70% of day beds are occupied by people over 65; this is more than 51,000 beds at any one time. 85 year olds on average stay in hospital eight days longer than their younger counterparts (RCP 2012).

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Most emergency admissions to hospital happen through accident and emergency (DOH 2013b). On average a person over 85 spends 11 days in hospital (RCP 2012). If they pass through accident and emergency the total spent is approximately £3241 per patient, per visit.
However, More than a 25% of over 85 year olds stay for 2 weeks and 10% stay longer than a month, when admitted as an emergency (Cornwall et al. 2012). This means that even more money is spent.

Table 2 insert

410,377 elderly persons were admitted to hospital due to a fall in 2013. Appropriate strategies could prevent this by up to 30% (Age UK, 2015).

Length of stay and cost implications worldwide

Across the world there are varying amounts of elderly people in hospitals, how much time they spend in hospital and how much it costs.

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In terms of falls 59,046 males and 113,632 females were admitted to hospital following a fall in Australia in 2013-2014 (AHIW 2015).

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92% of this care was paid for by insurance companies (Weiss and Elixhauser 2014).

Comparing this to the UK we can see that although most people stay in hospital for fewer days than in the USA, in the UK elderly people remain in hospital for longer. This may have negative health impacts. The UK is 16th in the world when it comes to average length of stay in hospital (health at a glance 2013).

Guidelines and Policies

Fit for Frailty

Part 1: Recognition and management of frailty in individuals in community and outpatient settings

This part of the fit for frailty guidelines by the British Geriatric Society (BGS) (2014) intend to support health and social care professionals working with frail older people in the community.

In order to recognise and identify frailty BGS (2014) recommends:

• During all encounters with health and social care professionals older people should be assessed for frailty
• There are 5 main syndromes of frailty; Falls, change in mobility, delirium, change in continence and susceptibility to side effects of medication. Encountering one of these should raise suspicion of frailty
• Gait speed, timed up and go test and the PRISMA questionnaire are recommended outcome measures to assess for frailty

For managing frailty in an individual BGS (2014) recommends:

• A Comprehensive Geriatric Assessment (CGA), which involves a holistic, multidimensional and multidisciplinary assessment of an individual
• The result of the CGA should be an individualised care and support plan (CSP).
• The CSP includes a named health or social care professional coordinating the person’s care. A plan for maintaining and optimising the person’s care as well as urgent, escalation and end of life care plans.
  

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