“Frailty can be a distressing but not inevitable part of getting older. Although statistics show that people are living longer, they are not necessarily living healthier” says Helen Lyndon.
Helen is a Nurse Consultant for Older People at Cornwall Partnership NHS Foundation Trust and a Clinical Doctoral Academic Research Fellow. She has devised a major new study, supported and funded by the National Institute for Health Research (NIHR), which she hopes will change the way elderly people with frailty are cared for in the community.
To help older people live healthier lives, Helen’s new study, HAPPI (Holistic Assessment and care Planning in Partnership Intervention), will develop, implement and test a nurse-led intervention to improve healthy living in older people with frailty.
In 2050, one in three of the world’s population will be over 65 and one in 10 will be over 80. Recent published NHS figures from the establishment of electronic frailty index state that of the average 7,000 patients per GP practice, around 30 to 100 will be moderately frail. However, other studies have demonstrated prevalence figures of 25 to 50% of those aged 80 years and over.
People who are frail may feel more tired and weak than normal, have trouble getting around, lose weight and feel that they are slowing down. Frailty progresses over a period of five to 15 years and may lead to losing independence, hospital admissions and moving to a care home.
This does not mean that all hope is lost. Research has suggested that it may be possible to support older people to manage frailty like any other long term condition. “If recognised early, we can provide care and support that may delay or prevent negative effects of frailty so that older people can retain their independence and quality of life. To do this, people need effective support at home from health services such as their GP, community and practice nurses” added Helen.
The first part of the HAPPI study saw a nurse survey explore their views on care for frail older people in the community and to identify the training needs and skills that nurses need to deliver effective care. By doing this Helen was able to develop a care plan based on the individual needs of frail older people that can be used by their nurses and their carers.
The second part of the study which is currently ongoing, involves Helen undertaking a small 60 person trial to test the new care plan, including frailty assessment and evaluation, to see if it is practical and achievable. In this part of the study, there are a group of patients who will receive the new care plan by community matrons and a group who will receive care as usual. To be included in the trial patients must be 65 or over and moderately or severely frail.
The final part of the project will see care givers talk to frail patients, carers and nurses to explore their experiences of participating in the trial. The information gathered during the project will be used to inform a future clinical trial to ensure the methods used are fit for purpose.
“We know that once people are aged 80 years and over, between a quarter and a half will show some of the signs of frailty” commented Helen. “Therefore, it is important that we understand the causes and how best to manage the condition for the future.
“Frailty cannot be cured, so we need to understand how to empower people to live well with it. Our research aims to explore how people can be best supported at home and how community nurses need to work to provide individualised support. We want to explore if we can improve outcomes for patients enabling them to live at home, improve wellbeing, prevent falls and reduce the need for hospital care.”
Alongside the HAPPI study, Helen is currently undertaking a PhD at Plymouth University as part of a Clinical Academic Doctoral Research Fellowship.
This study is part of the Shaping our Future transformation programme that is bringing together the NHS, social care and public health across Cornwall and the Isles of Scilly to achieve positive and genuine improvement in health and social care delivery.