Laura Evans
Head of Occupational Therapy, Sheffield Teaching Hospitals
Professional Doctorate 2011 - 17
@Laura JaneEvans5
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‘Early’ literature based on bio-medical,
diagnostic set of parameters
Lack of agreement on ‘definition’ and
measuring tools
Gradual change to consider a more ‘holistic’
approach to diagnosis
A long term condition that is not curable,
persists but can be managed
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Frailty is a late life adverse health condition
that develops over many years
Frailty is characterised by high vulnerability to
minor stressors
Frailty shares many characteristics of LTC but
current management is dominated by urgent
and emergency responses
Older people with frailty can be readily
identified in the community with simple
evidence based tools
‘Frailty isn’t a label it’s a long term condition
which our patients live with every day’
(#NHSBNOP)
‘The Fail Elderly’
(i.e. a label)
‘an older person
presenting with frailty’
(i.e. a long term
condition)
Presentation acute &
in crisis
e.g. delirium, falls,
immobility
Timely identification for
preventative, proactive
care by personalised care
and support planning
Hospital based
episodic disrupted
and disjointed
Community bases
personal centred coordinated care and
support
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Exploring how our knowledge and skills
applies to the concept of frailty
Stakeholder views ‘set the scene’
3 Occupational Therapy Case Studies across
primary, intermediate and secondary care
Instrumental Case Study methodology
Framework and thematic analysis of 21
Interview transcripts
Cross Case Analysis – a ‘constructed’ model
with four themes.
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Frailty is a dynamic and changing picture
Transitions can be sudden or gradual from
stability to imbalance
Specific ‘weights’ can affect balance
Balance is aspirational but not always
possible
Balance requires effort and has a link to risk
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A ‘precarious’ balance
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The ‘tipping point’
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Restoring the balance
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Maintaining balance
• The frailty
trajectory
• Imbalance
• The spiral of
vulnerability
• Prevention
• Signposting
• Education
• Predicting the
tipping point
• Managing the
tipping point
• Resilience
A
precarious
balance
The tipping
point
Maintaining
the balance
Restoring
the balance
• Beyond the
crisis
• Embracing risk
• Achieving
occupational
balance
The Frailty trajectory
Imbalance
The spiral of vulnerability
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In what context can we identify older people
in the stage of “a precarious balance”?
What are the strategies for identification of
this stage?
What interventions would be useful to
consider for Occupational Therapists?
Knowledge of the different trajectories can
help identification
Awareness of the stressors/triggers in frailty
The link between frailty, risk and
independence
Predicting the tipping
point
Managing the tipping
point
Resilience
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In what contexts can we identify a tipping
point for an older person
An admission to acute care is a significant
tipping point with a potential high impact
Consideration of D2A/Home First models
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How can OT skills
have the most
impact at this point?
(PJ paralysis, last
1000 days)
What are
interventions are
useful to consider at
this point?
Understanding of
resilience ‘factors’
for an older person.
Moving beyond the
crisis
Embracing risk in
recovery
Achieving occupational
balance
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Where is the best context to restore the
balance for an older person?
Timing of intervention, time to recover
Chaos of transition from acute crisis to a
more steady state
Managing and embracing risk
Consider habituation
Occupational balance for an older person
Effort, risk and smoothness of activities
Continuity
Prevention
Education
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Proactive model of enquiry and collaboration
within a local population
GP/community team based.
Continuity and a value of the therapeutic
relationship, following the patient
Education of families and carers/support
agencies
Prevention, signposting and social Contact
Meaningful occupations to maintain balance
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Occupational Therapists can contribute to
the diagnosis/identification of an older
person who is becoming frail
The complexity of a frail condition aligns
with Occupational Therapy as a complex
intervention (Creek, 2010)
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The ‘balance’ analogy is useful to describe
our interventions across a range of contexts
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Transitional theory aligns with the instability
of a frail condition (Meleis, 2010)
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Occupational Therapists need to reflect and
be critical of how and where they can have
the most impact
• The frailty
trajectory
• Imbalance
• The spiral of
vulnerability
• Prevention
• Signposting
• Education
• Predicting the
tipping point
• Managing the
tipping point
• Resilience
A
precarious
balance
The tipping
point
Maintaining
the balance
Restoring
the balance
• Beyond the
crisis
• Embracing risk
• Achieving
occupational
balance
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Any feedback/comments to
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[email protected] or even better
@LauraJaneEvans5 !
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@AcuteFrailty
@frailsafe
@GeriSoc
@PJparalysis
#last1000days
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Acute hospitals and integrated care (2015) The Kings Fund
Creek, J (2010) The Core Concepts of Occupational Therapy : a
dynamic framework for practice
Fit for Frailty (2014) British Geriatrics Society, consensus best
practice.
Making our health and care systems fit for an ageing population
(2014) The Kings Fund
McIntyre, A and Atwal, A (2005) Occupational Therapy and Older
People
Meleis, A (2010) transitions theory, middle range and situational
specific themes in nursing research and practice
NHS England(2016) Quick Guide, Discharge to Assess
Young, J (2015) Living with Frailty : a guide for primary care
Stake, R (1995) The Art of Case Study Research
NHS Benchmarking for Older People 2017 Conference, #NHSBOP