Background It is now widely recognised that the palliative care needs of older people with frailty are poorly met compared to those of others at the end-of life (Hamaker, van den Bos, Rostoft, 2020). More people die of frailty and age related comorbidities than of cancer or heart disease and yet they are not the focus of end-of-life care. The COVID-19 pandemic has emphasised the difficulties in providing the right care at the right time for this particular disadvantaged group (Lebrasseur, Fortin-Bédard, Lettre, Raymond, et al., 2021).
Aim To improve confidence and capability in (a) hospice and (b) community sectors in understanding and delivering age-attuned palliative care.
Method We implemented the approach described in Age-attuned Hospice Care (Nicholson & Richardson, 2018). Three phases: (1) Focus groups with key stakeholders, July- Nov 2019; (2) Establish special interest groups to develop resources, July 2020 onwards; (3) Disseminate information locally and nationally, May 2021 onwards.
Results The focus groups identified three core capabilities: (1) Assessment of frailty and palliative care needs, (2) Recognition of deterioration and symptom management, (3) Communication around advance care planning (ACP). We established six special interest groups related to frailty: recognition; resource mapping; partnerships; rehabilitation in care homes; dementia; and ACP.
Activities to date include: implementing frailty identification as routine practice across the hospice including adaption of electronic systems to plan and audit care, creating proformas for multidisciplinary meetings with GPs and DNs focusing on frailty; devising crib cards for ACP conversations using CLaD intervention methodology and management of frailty related symptoms e.g. delirium and building capability with local partners in rehabilitation and recognition of palliative care need. Early evaluation suggests wide spread adoption and increased confidence and understanding of frailty.
Conclusion We have shown that the palliative care needs of older people with frailty can be enhanced by highlighting information and resources. We plan to cascade further through local and national conferences.
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