Dr Diarmuid O’Shea is a Consultant Geriatrician at St Vincent’s University Hospital in Dublin, Ireland
Deirdre Lang is the Director of Nursing, National Clinical Programme for Older People, Royal College of Physicians of Ireland and Health Services Executive
This article was also published in the British Geriatrics Society Blog (5 Feb 2018)
We all know that population ageing is occurring rapidly. Between 2015 and 2030 the number of people in the world aged 60 years or over is projected to grow by an extraordinary 56%. By 2050, the global population of older people is projected to more than double its size (United Nations, 2015). In Ireland, the population 65 years and over is projected to increase by between 58 and 63 per cent from 2015 to 2030. The older old population (i.e. those aged 80 years of age and over) is set to rise even more dramatically, by between 85 per cent and 94 per cent in this time period (ESRI 2017).
Much has been written about the need for healthcare systems to adapt to meet the growing demands associated with these demographic changes. For this to truly happen, we need a culture change. To drive the culture change we need a paradigm shift in how we think, how we provide and where we deliver care to our ageing populations. To drive this change we need to unlock and share the “secret knowledge” of geriatric medicine – the care of older people with a long-term condition known as “Frailty”.
In Ireland, we feel that ‘Frailty’ is the new health care currency and our National Frailty Education Programme, “The Fundamentals of Frailty” is the vehicle to drive this culture change. The programme has evolved out of collaborative working between the Older Persons, Acute Medicine and Emergency Medicine Clinical Programmes in Ireland (Specialist Geriatric Services Model of Care, 2012).
Frailty, an emerging syndrome in the field of Geriatrics is a concept not understood well outside of the realm of gerontology. With this knowledge our national education programme was developed to provide healthcare professionals with an understanding of frailty coupled with the knowledge and skills required to provide effective care to older people living with frailty as a long-term condition, wherever they access health services.
As older people have different healthcare requirements, the Irish healthcare system is now beginning to adapt to meet the demands associated with these demographic changes. Empowering health care professionals with up-to-date knowledge and skills will ensure that when an older person needs health or social care, the care they receive will be better planned, better coordinated, easier to access and truly person centred (integrated care).
Of course none of this can happen without the buy in of all health care professionals and without the support of key group leaders. In Ireland we see this leadership from the Office of Nursing and Midwifery, the Clinical Strategy and Programmes Division of the Health Service Executive and the Royal College of Physicians of Ireland (RCPI). However, none of this support and leadership is of any value without the extraordinary dedication and talent of those who provide this compassionate and expert care on the front line.
The ‘National Frailty Education Programme’ philosophy is based on the belief that education increases knowledge and enhances healthcare professionals’ skills in clinical areas. It complements the Guidance on Comprehensive Geriatric Assessment (CGA) produced by the National Clinical Programme in 2016 (NCPOP Guidance on CGA). Our national frailty education programme promotes and encourages evidence based practice through ensuring knowledge is current. The philosophy underpinning this education programme is to promote excellence, encourage innovation and creativity in the management of the older person living with frailty.
Our approach in Ireland has been to develop a cadre of skilled “Facilitators” from across the multi-disciplinary team. This begins with a one day 'Insights on Frailty' education day delivered by 'The Irish Longitudinal Study in Ageing' (TILDA), based at Trinity College University, Dublin. This partnership between the National Clinical Programme for Older People (NCPOP) and the university based “TILDA” allows research inform practice, in a unique manner.
Each cohort, subsequently attends a workshop with the NCPOP to support them to develop a local methodology for the roll out the “Fundamentals of Frailty” Programme across their hospital/community healthcare organisation. The key to the success of this programme is that it is multidisciplinary and integrated, with facilitators representing services from across the continuum of care. It is also dependent on clear leadership and governance structures being established in each region.
Creating a critical mass of people with a common language, shared knowledge and skills empowers them to be 'the change'. The facilitators have embraced ownership of their codesigned methodology to champion the education programme in their region. Funding for individual illness and patient groups is often driven by those who shout the loudest, rather than true need and advocacy.
Funding for health and social care service provision for older people has always lagged behind and there is a danger that lip service might be paid to this clearly growing need. Innovative ways of meeting this growing need, new ways of working together, across the care continuum and life spectrum, more integrated care and a new language is needed. We feel that FRAILTY can serve as the language in this health care currency debate.
Empowering people, through knowledge and education - both society at large and health care professionals specifically - has the power to address and harness the collective innovative skills, dedication and compassionate care that health care workers strive to provide.
The question is – is now the time for everyone to jump on the 'Frailty Train', and use it to be the one of the real key levers for change in attitude, focus and approach for the next ten years in delivering improved care and outcomes for older people? Is this the “change moment” - we believe so.