The time is right for an Irish Frailty Network for Education, Improvement and Research

Introduction from Dr. Diarmuid O'Shea, President of the Irish Gerontological Society

The World Health Organisation Global strategy and action plan on ageing and health (2016 - 2020) advocates for major reform to healthcare systems to empower healthy ageing across the life course.  Public health initiatives, policy and data are of vital importance to this work. 

The Irish Gerontological Society working collaboratively with many organizations has the capacity to become a powerful advocacy voice for change and progress and in making Ireland a country we can all be proud to grow up and grow old in.

The work of the National Clinical Programme for Older People, in association with the Royal College of Physicians of Ireland and the HSE, is very much in line with these aspirations.  Many Irish health care professionals have given their valuable time to work with the NCPOP and integrated care programme to make a difference and arm all of us with increased knowledge and information around chronic long term conditions, including frailty, to empower all of us to provide and improve the process of care and support for all of us as we age. 

Among the areas the National Clinical Programme for Older People has led in is the delivery of a National Frailty Education ProgrammeThe featured blog published today is an update on that.  At the Autumn IGS 2018 meeting there were many presentations from hospitals and community groups around the country highlighting the dedicated work being done to improve management frameworks and care pathways for older people, including those living with chronic long-term conditions like frailty and dementia.  Harnessing this good work to support the needs emerging from the SlainteCare report will be another challenge.

The focus on our own continuous professional development, arming us with increased knowledge and information, will empower us all to be better advocates for older people in our work place and communities, in order to make them age-attuned.  In an environment of ever increasing demands and expectations, this knowledge and information will also enable us to work to continuously improve the services delivered as we age.  The following blog on frailty is one such example of what is achievable when we work together.

We look forward to your comments and observations as to how we will proceed with initiatives like this. Your views on if and how the IGS should become a more influential advocate for Older People in the Ireland of today are important to us.  You are invited to add your voice by adding any comments or feedback on the following blog. (Please scroll to end of page)

Diarmuid O’Shea

12 February 2019

The time is right for an Irish Frailty Network for Education, Improvement and Research

The Framing Frailty: A Step Towards Positive Aging summit took place at the Hibernia Conference Centre, Dublin Castle on Thursday 6th of December 2018 and celebrated the achievements of the National Frailty Education Programme (NFEP), which is developing a cadre of interprofessional Frailty Facilitators from across acute, community and residential care settings. The partnership between the National Clinical Programme for Older People and The Irish Longitudinal Study on Ageing has been central, and unique in its kind, in developing and delivering the NFEP. In order to achieve the implementation objectives of Sláintecare 2018 we need to continue to deepen and widen those interconnections. In Ireland, we already have the fundamental ingredients for a network for education, improvement and research. At the next 67th Annual Meeting of the Irish Gerontological Society we will call for an Irish Frailty Network (IFN) interest group to facilitate further collaborative work at the boundaries between interdisciplinary education, quality improvement in older people’s services, and generation of policy-relevant knowledge through research.

The National Clinical Programme for Older People (NCPOP) designed the National Frailty Education Programme (NFEP) in 2016, in partnership with The Irish Longitudinal Study on Ageing (TILDA). The NFEP evolved under the clinical guidance and expertise of the NCPOP clinical advisory groups, with the initial pilot “for proof of concept” commencing in February 2017. The aim of the NFEP is to develop a cadre of Frailty Facilitators to provide healthcare professionals with an enhanced understanding of frailty and frailty assessments, thereby ensuring earlier recognition of frailty, improved healthcare management, and better health outcomes for frail older adults. The NFEP complements the Guidance on Comprehensive Geriatric Assessment (CGA) produced by the NCPOP in 2016.

TILDA identified an opportunity to promote outreach and translation of its population-based research, and subsequently developed a one-day frailty education programme for healthcare professionals to include an overview of the theoretical models underpinning frailty, and the standardised TILDA health assessment methodologies and research outputs. In tandem, the NCPOP developed the National Frailty Education Programme “Fundamentals of Frailty”. Both elements of the NFEP have been awarded Category 1 approval from the Nursing & Midwifery Board of Ireland and provide 6.5 CEU points for Health & Social Care Professionals. The Facilitator development programme includes participation in the TILDA programme followed by a one-day workshop with the NCPOP, where they co-design the local roll-out of the NFEP to other frontline healthcare professionals and staff in their Community Health Organisations and Hospital Groups. The ethos of the facilitators’ development programme is to promote the concept that they are more than facilitators of an education programme; indeed, they are champions of change and new ways of working within and across their organisations.

In a recent systematic review, the NFEP was identified as the first such national frailty education programme, and recognised as a pioneer among educational strategies to provide knowledge to health care professionals across the education continuum on the process of frailty prevention and frailty management.

The partnership between the NCPOP and TILDA has been central, and unique in its kind, in developing and delivering the NFEP. The initial pilot “for proof of concept” commenced in February 2017 with SAOLTA/CHO 1 & 2, Ireland East Hospital Group/CHO 5, 6, 8 & 9 and South/South West Hospital Group/CHO 5. The first local programme was delivered by the Donegal facilitator network in September 2017. By December 2018, 271 healthcare professionals have attended the one-day TILDA course, of which 140 have become Frailty Facilitators, who in turn have delivered the education programme to around 1,800 healthcare professionals in their local areas. This is work in progress with more facilitators from the remaining CHOs and Hospital Groups completing this pathway in 2019.

One of the aims of the NFEP is to act as a catalyst for frailty education and to encourage participation by everyone delivering care to older people. This is promoting system-wide education processes in order to spread the adoption of the principles of geriatric assessment across all specialties and levels of care. The aim is to create a gerontologically-attuned system where everyone will feel equipped with the appropriate language and knowledge and naturally inclined to the care of the older person, ultimately providing the right care, right place, right time in line with national policy (Sláintecare Implementation strategy, 2018).

To celebrate the success and roll-out of the NFEP, the Framing Frailty: A Step Towards Positive Aging summit took place at the Hibernia Conference Centre, Dublin Castle on Thursday 6th of December 2018. The meeting was organised by the Office of the Nursing and Midwifery Services Director, the NCPOP, TILDA and the Health and Social Care Professions Office. This event attracted over 350 delegates from across the spectrum of healthcare and many professions were represented including medicine, nursing, physiotherapy, dietetics, occupational therapy, social work, speech & language therapy and pharmacy. Older people and their carers were also well represented. At the end of the event, Dr Colm Henry, Chief Clinical Officer, HSE, Deirdre Lang, Director of Nursing/Older Persons Lead and Dr Diarmuid O’Shea, Clinical Lead of the NCPOP, presented a certificate of excellence to the Frailty Facilitators who have delivered the NFEP in their local areas.

                     

                     

Certificates of excellence to the Frailty Facilitators who are delivering the National Frailty Education Programme in their local areas were presented at the end of the Framing Frailty summit, which took place at the Hibernia Conference Centre Dublin Castle on Thursday 6th of December 2018.

The speech by Professor Rose Anne Kenny (Founder and Principal investigator of TILDA) at Framing Frailty highlighted the intimate connections between education and research within a positive narrative of frailty and a continuous drive towards quality improvement in services. The positive narrative of frailty was emphasised by scientific evidence as to the crucial roles of physical activity, nutrition and social engagement in the prevention and reversal of frailty in populations. The unique partnership with the NCPOP and the NFEP is an example of TILDA’s ongoing commitment to finding innovative ways of translating cutting edge longitudinal research into informing clinical practice and improving patient care. TILDA has already informed over 60 national policy documents and its policy relevance will be increasing in the future through ongoing generation of policy-relevant knowledge.

                     

Prof. Rose Anne Kenny’s speech at the Framing Frailty summit highlighted the crucial interconnections between education, quality improvement and policy-relevant research within a positive narrative of frailty.

The concept of frailty as a long-term condition is now gaining speed as a key lever for change in attitude, focus and approach for the next ten years in delivering improved care and outcomes for older people in Ireland. The collaboration between a national ageing research platform such as TILDA and a National Clinical Programme has now emerged as an important driver of the delivery of quality, improved care for older people; and events like Framing Frailty are providing a platform for practitioners around the country to meet, share good practice, and learn from each other. The time is now right to capitalise on this momentum and continue to build working relationships between Education, Research and Improvement within this positive ageing narrative of frailty.

In the UK, the Acute Frailty Network was set up to optimise acute care of frail older people using the collaborative improvement model; this approach involves health and social care systems working to improve services locally, supported by national clinical and improvement experts sharing their experiences through national networking events. The network team delivers various national events every year and a set of masterclasses and webinars that support participating teams in delivering improvements to local acute frailty services and enable teams to share experiences with one another. This initiative is hosted by NHS Elect, which is part of the NHS. We share the vision of a collaborative improvement model; however, we believe that the focus for a network of improvement and innovation should be system-wide and not only restricted to urgent care. This network should support and enable the embedding of collective leadership that will enable cross-community interdisciplinary advocacy, and care and support for older people, a vision shared with the Older People’s Programme.

In Canada, the Canadian Frailty Network (CFN) is funded by the Government of Canada’s Networks of Centres of Excellence (NCE) Program, which is an initiative of Canada’s research granting agencies. In that way, the CFN is strongly focused on research and knowledge translation, and as such it has already funded more than a hundred research and knowledge translation projects. We believe that research is an essential component of the collaborative improvement model. Yet, for effective translation, research needs to address the real needs of knowledge users (including policy makers and frontline staff) and be able to engage patients and the public through effective education and dissemination strategies.

In Ireland, we already have the building blocks for the best of each model: a thriving National Clinical Programme for Older People, the NFEP, many active research networks including a national research and knowledge translation platform embodied in TILDA, and a number of networking events hosted throughout the year by a number of groups and organisations including the Irish Gerontological Society and the Older People’s Programme. We believe that these are some of the fundamental ingredients that can facilitate the development of all-inclusive Irish Frailty Network (IFN) for Education, Improvement and Research.

We feel that over the past years, there has been enormous innovation in older people’s services across Ireland with limited opportunity to facilitate awareness and cross-site learning from these innovations at national level, in a language that everyone can understand. Between the work done around the country by people involved in the Frailty Programme Sites and the integrated care sites (highlighted at the meeting in the RCPI on December 13th, 2018) we have the potential to harness this momentum into a cohesive movement with improved care of older people being its core aim. The momentum is scheduled to continue with the inclusion of a focus on frailty in many of the suite of meetings being run in 2019. Frailty will feature in the 5th “Transforming Care of Older People” meeting in Ireland on May 28th in the RCPI and we look forward to seeing you there.

At the next 67th Annual Meeting of the Irish Gerontological Society (IGS) in Cork, we will propose the constitution of an Irish Frailty Network (IFN) interest group. It is intended that the interest group will work towards the formal launch of the IFN in late 2019/early 2020, in the form of a national conference that will help compile an Irish roadmap of innovation and best practice in health services for older people, with case studies from as many sites as possible, describing their work and lessons learnt. This will help establish linkages between organisations, and support the spread and sharing of good clinical practice. Inter-related developments will also be pursued in the areas of education and policy-relevant research. Harnessing all this good work to support the needs emerging from the Sláintecare report will be a challenge, but together we can be ready for it. We feel that the time is right.

If you would like to register your interest in the activities of the IFN interest group, please contact Helen Whitty (Programme Manager, National Clinical Programme for Older People) on HelenWhitty@rcpi.ie.

Signed:

Prof Román Romero-Ortuño, Associate Professor in Medical Gerontology, Trinity College Dublin and Consultant Physician, St James’s Hospital, Dublin
Dr Rónán Ó Caoimh, Consultant Geriatrician/Specialty Lead in Geriatrics, University Hospital Galway/National University of Ireland, Galway
Dr Diarmuid O’Shea, National Clinical Lead for the Older Persons’ Programme
Deirdre Lang, Director of Nursing/National Lead Older Persons Services, Clinical & Integrated Programmes, Office Nursing & Midwifery Services Director
Prof Rose Anne Kenny, Founder and Principal Investigator of The Irish Longitudinal Study on Ageing (TILDA); Chair of Medical Gerontology, Trinity College Dublin; Director of the Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin
Prof Sean Kennelly, Consultant Physician in Geriatric and Stroke Medicine, Department of Age-related healthcare, Tallaght University Hospital. Clinical Associate Professor in Medical Gerontology, Trinity College Dublin
Dr Marie Therese Cooney, Consultant Geriatrician, St Vincent’s University Hospital, Dublin
Dr John Cooke, Consultant Physician (Medicine for the Elderly), Lead for Waterford Integrated Care for Older People (W.I.C.O.P.) project, Department of Medicine for the Elderly, University Hospital Waterford
Dr Emer Ahern, Consultant Geriatrician, St Luke’s General Hospital, Kilkenny
Helen Whitty, Programme Manager, National Clinical Programme for Older People
Mary O’Shea, Research Nurse, The Irish Longitudinal Study on Ageing (TILDA)
Paul Maloney, Occupational Therapy Manager, Beaumont Hospital, RCSI Hospital Group, Dublin