Clinical guide

This document aims to support prescribing decisions for older people with moderate to severe frailty. This information can be incorporated into shared decision-making conversations. It provides more lenient therapeutic targets than standard guidelines that better balance potential benefits and harms of medicines in this population.

These guidelines were developed by the World Falls Task Force, which assembled 96 multidisciplinary experts from 39 countries across 5 continents, with representation from 36 scientific and academic societies, including the BGS. 

Introduction from Dr Eileen Burns, Consultant Physician and Past President of British Geriatrics Society, and foreword by Dr Sarah Russell, family carer.

This section of the BGS guidance on end of life care in older people looks at the religious, spiritual and cultural aspects that may influence appropriate end of life care.

This section of the BGS guidance on end of life care in older people looks at the emotional and psychological needs that may be present as an older person approaches the end of life.

This section of the BGS guidance on end of life care in older people examines the issue of polypharmacy at the end of life.

This section of the BGS guidance on end of life care in older people looks at swallowing difficulties in the final phase of life.

This section of the BGS guidance on end of life care in older people addresses nutritional needs at the end of life. 

This section of the BGS guidance on end of life care in older people covers the identification and management of delirium in older people at the end of life.

This section of the BGS guidance on end of life care in older people looks at the investigation and management of falls in the last phase of life.

This section of the BGS guidance on end of life care in older people examines the management of continence-related issues in frail older people at the end of life. 

This section of the BGS guidance on end of life care in older people examines the management of pain in older people living with frailty at the end of life.

This section of the BGS guidance on end of life care in older people examines the management of acute deterioration in the context of frailty at the end of life. 

This section of the BGS guidance on end of life care in older people looks at the role of advance care planning (ACP) in helping to make decisions about a persons wishes for the future.

This section of the BGS guidance on end of life care in older people examines how to identify when a person with frailty is entering the last year of life.

The National Institute for Health and Care Excellence (NICE) has published an updated Quality Standard on dementia describing high-quality care in priority areas for improvement.

This guideline provides recommendations based on current evidence for best practice in the detection, assessment, treatment and follow up of adults with delirium.

The overarching message about successful improvement shows how social relationships in organisations are key for embedding the technical features of change. A lot of time and energy in leading organisational change will require you to uncover and mitigate barriers. 

Designing solutions and delivering change is more effective when delivered by a core team of people who invest in engaging with a network of stakeholders. You may wish to start thinking about the advocates of improving care for frail older people in your service early.

You may already have a good idea about the service outcomes you wish to improve. Evidence suggests that integrating assessment and management of frail older patients into your service is more effective than having a consultation geriatric service at arm’s length.