Frailty Hub: Frailty in specific settings

Cardiac disease

• Singh M, Stewart R, White H. Importance of frailty in patients with cardiovascular disease. European Heart Journal (2014) 35, 1726–1731 doi:10.1093/eurheartj/ehu197
  Overview of the relevance of frailty in assessing and managing patients with cardiovascular disease.
   
• Heart failure Association/European Society of Cardiology position paper on frailty in patients with heart failure. European Journal of Heart Failure (2019) 21, 1299–1305. doi:10.1002/ejhf.1611
  Overview of the impact of frailty in heart failure patients.
   
• European Society of Cardiology Practice guidelines: Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section
  Explores the relevance of frailty in the context of care of older cardiac patients, including cardiac rehabilitation.

Community

• Fit for frailty Part 1: Consensus best practice guidance for the care of older people living in community and outpatient setting - BGS
  Guidance intended to support all levels of health and social care professionals who may encounter older people living with frailty in the community, in outpatient clinics, in community hospitals and other intermediate care settings and in older people’s own homes.
   
• Fit for Frailty Fit for Frailty Part 2: Developing, commissioning and managing services for people living with frailty in community settings
  Guidance intended to support the development, commissioning and management of services for people living with frailty in community settings. It is aimed at GPs, geriatricians, Health Service managers, Social Service managers and Commissioners of Services
   
• Integrated care for older people living with frailty: Innovative approaches in practice - RCGP & BGS
  A case study-based report that aims to support GPs and geriatricians in delivering integrated care within their locality, through sharing effective initiatives that have developed nationwide.
   
• Toolkit for General Practice in Supporting Older People Living With Frailty - NHS England
  Guidance intended to provide GPs, practice nurses and the wider primary care workforce with tools to support the case finding, assessment and case management of older people living with frailty.
   
• Toolkit for comprehensive geriatric assessment (CGA) in primary care settings - BGS
  Toolkit providing an overview of comprehensive geriatric assessment and how it may be effectively implemented specifically in the primary care setting.
   
• Multimorbidity: clinical assessment and management - NICE
  Guidance on identifying and assessing frailty in the context of those with multimorbidity.
   
• Nicholson C et al. The experience of living at home with frailty in old age: a psychosocial qualitative study. Int J Nurs Stud 2012. doi:10.1016/j.ijnurstu.2012.01.006
  A qualitative psychosocial narrative study providing insight into the experience of older people living with frailty in their own homes and the common strategies that they employ to retain their quality of life.

Care homes

• EHCH: The framework for enhanced health in care homes - NHS England
  Shares successful initiatives which have been shown to be effective and deliverable and within a care home in a co-ordinated way.
   
• Quick Guide: Clinical Input into Care Homes - NHS England
  This 'Quick Guide' by NHS England complements the EHCH framework for enhancing health in care homes.
   
• How new care models are (likely to be) making a difference to residents in care homes
  Access to presentation from 2017 National Frailty Conference which provides an overview of new models of working within care homes

COVID-19

• COVID-19 in older people: Resource series - BGS
  If you are looking for information on the impact of frailty on outcomes in COVID 19, please see our resource series dedicated to Coronavirus.

Diabetes

• TREND end of life care guidance - diabetes nursing guideline (in association with Diabetes UK and others)
   
• Older adults and diabetes recommendations - NHS England
  A statement with plan for future care in England in this area.
   
• An international position statement on the management of frailty in Diabetes Mellitus: Summary of recommendations (2017)
   
• Inpatient Care of the Frail Older Adult with Diabetes - Joint British Diabetes Societies for Inpatient Care (JBDS-IP)
  This UK Consensus guideline outlines the key recommendations to support clinicians in managing diabetes in older hospital patients living with frailty. 

Emergency department and acute hospital care

• Front door frailty:  Advice on setting up services - BGS
  In this document, the BGS sets out five principles that should underpin front door frailty services. It provides tips on establishing services from those who have been through the process. 
• Wyrko Z. Frailty at the Front Door. Clinical Medicine 2015 Vol 15, No 4: 377–81
  Provides a useful introduction to frailty within the acute hospital setting.
   
• Silver Book II - BGS
  Intercollegiate updated clinical best practice guideline for quality care of older people living with frailty during the first 72hours of an urgent care episode.  Further to the 2012 guideline this provides not only an overview of key presentations in older people, but the role of interdisciplinary holistic care, quality improvement  and service development.
   
• Acute care toolkit 3: Acute medical care for frail older people - RCP
  Toolkit recommending procedures for both initial assessment on admission and later comprehensive geriatric assessment for older patients living with frailty attending hospital.
   
• Conroy SP. Stevens T. Parker SG. Gladman JR. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: 'interface geriatrics'. Age & Ageing 2011;40(4):436-43.
  Summarises the evidence for the management of frail older patients who have been discharged from an emergency department or acute medical unit setting within 72 hours of their initial hospital attendance.
   
• Improving the flow of older people: Sheffield Teaching Hospital NHS Trust’s experience of the Flow Cost Quality improvement programm
  Case study of the work undertaken by Sheffield Teaching Hospitals NHS Trust as part of the Health Foundation’s Flow Cost Quality programme which focused on the trust’s geriatric medicine service as part of the emergency care pathway.
   
• Acute Frailty Network: Case Studies
  The Acute Frailty Network aims to optimise acute care of frail older people in England. These case studies explore different methods acute hospital trusts have improved the care of older persons living with frailty.
   
• Themed Review: Comprehensive Care – Older people with frailty in hospital - NIHR
  Aimed at supporting the assessment, identification, management and discharge planning for staff involved in the care of older people living with frailty within a hospital setting.
   
• Conroy SP, Bardsley M, Smith P, Neuburger J, Keeble E, Arora S, et al. Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed-methods study. Health Serv Deliv Res 2019;7(15).
  Aimed to provide evidence on delivering hospital-wide comprehensive geriatric assessment.
   
• Hospital-Wide (HoW) CGA Service level toolkit - BGS
  Hospital level toolkit aimed at improving the care of older persons living with frailty within different services.
   
• Sit up, get dressed, keep moving - University Hospital of North Midlands (UHNM) and BGS
  The Sit Up, Get Dressed and Keep Moving campaign aims to help healthcare professionals recognise the long term effects of deconditioning, implement simple measures to prevent it, and educate patients and carers about the importance of remaining active during hospital admission and following discharge.
   
• Older people’s contribution to understanding and preventing avoidable hospital admissions - Birmingham School of Social Policy
  Qualitative work undertaken by Birmingham School of Social Policy, that seeks to identify greater scope for preventing potentially avoidable admissions by more fully understanding the experiences of older people and their families, and of front-line staff. Includes videos and publications.
   
• What matters most in acute care: an interview study with older people living with frailty - BMC Geriatrics (2022) 
  This qualitative work seeks to understand the important patient centred outcomes for acute care in older people living with frailty.

Lung disease

• Frailty and lung disease: Best practice - BGS
  A practical summary of the assessment and management (including intermediate respiratory care services) of patients living with frailty who present with acute respiratory issues.
   
• Marengoni A, Vetrano DL, Manes-Gravina E, Bernabei R, Onder G, Palmer K. The Relationship Between COPD and Frailty: A Systematic Review and Meta-Analysis of Observational Studies. Chest. 2018 Jul;154(1):21-40. doi: 10.1016/j.chest.2018.02.014.
  A systematic review and meta-analysis that evaluates the association of COPD with frailty and pre-frailty.
   
• Maddocks M, Kon SSC, Canavan JL, et al. Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study Thorax 2016;71:988–995.
  A single centre prospective cohort study that aims to characterise the frailty phenotype in stable COPD and evaluate the role of pulmonary rehabilitation in this cohort of patients.

Oncology

• Handforth C, Clegg A, Young C et al The prevalence and outcomes of frailty in older cancer patients: a systematic review. Annals of Oncology 26:1091–1101, 2015 doi:10.1093/annonc/mdu540.
  A review of the prevalence and outcomes of frailty and pre-frailty in older cancer patients.
   
• Huisingh-Scheetz M, Walston J. How should older adults with cancer be evaluated for frailty? Journal of Geriatric Oncology 2017;8(1):8-15. 
  An introduction into the assessment, impact and management of frailty in older patients with cancer.
   
• Frailty assessment in the care of older people with haematological malignancies - Lancet Healthy Longevity (2021)
  A review of the impact frailty has on assessment, decision making and treatment of older persons with haematological malignancies, including practical advice in the care of this vulnerable subset.

Palliative

• End of Life Care in Frailty - BGS
  The aim of this guidance is to support clinicians and others in considering the needs of and providing high quality care for frail older people as they move towards the end of their lives.
   
• Pal LM, Manning L. Palliative care for frail older people. Clinical Medicine 2014;14(3):292–5.https://doi.org/10.7861/clinmedicine.14-3-292
  An introduction to the role of palliative care in frail older people.
   
• The GSF Prognostic Indicator Guidance: The National GSF Centre’s guidance for clinicians to support earlier recognition of patients nearing the end of life
  Summary guidance aimed to clarify the triggers that help to identify patients who might be eligible for inclusion on palliative care registers.
   
• Stow D, Spiers G, Matthews FE, Hanratty B. What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis. Palliative Medicine 2019;33(4):399 –414 . https://doi.org/10.1177/026921631982865
  Synthesizes evidence on the end of life care needs of people living with frailty.
   
• Living and dying well with frailty: Quality end of life care for older people - BGS
  Access to presentations from this BGS 2018 Conference aimed at improving end of life care for older persons living with frailty (BGS members only).

Renal disease

• European Renal Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3Bb or higher
  Evidence based guidance to enhance the quality of patient care and experience in frail and older patients.
   
• Ryan L, Brown E. Supporting and maintaining the frail patient on long-term renal replacement therapy. Clinical Medicine 2020;20(2):139–41. DOI: 10.7861/clinmed.2019-0416
  Introduction to managing frail older patients undergoing renal replacement therapy.
   
• Nixon AC, Bampouras TM, Pendleton N et al. Frailty and chronic kidney disease: current evidence and continuing uncertainties. Clinical Kidney Journal 2018;11(2):236–245. doi: 10.1093/ckj/sfx134
  A review of frailty within the renal population.
   
• Nixon AC, Bampouras TM, Pendleton N et al. Frailty is independently associated with worse health-related quality of life in chronic kidney disease: a secondary analysis of the Frailty Assessment in Chronic Kidney Disease study. Clin Kidney J 2019;30;13(1):85-94. doi: 10.1093/ckj/sfz038.
  Explores relationship between frailty and health related quality of life in end stage renal failure.
   
• Lancashire Teaching Hospital Case Study: Renal Frailty Service
  This case study outlines the quality improvement work the renal service at Lancashire Teaching Hospital undertook through The Specialised Clinical Frailty Network to develop a renal frailty team to support holistic management in patients living with CKD and frailty.

Trauma and Perioperative Care

• Partridge SL, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age and Ageing 2019;41(2):142–147, https://doi.org/10.1093/ageing/afr182
  An introduction into the impact of frailty within the surgical population, and an overview of current evidence for its assessment and management within this patient group.
   
• Dhesi JK, Lees NP, Partridge JSL. Frailty in the perioperative setting. Clinical Medicine 2019;19(6):485–9. https://doi.org/10.7861/clinmed.2019-0283
  A clinical overview of the assessment and management of frailty in the perioperative setting.
   
• BOAST: The care of the older or frail orthopaedic trauma patient 
  An overview of the standards of practice for the care of orthopaedic trauma in older frail patients, developed by the British Orthopaedic Association and British Geriatrics Society.
   
• BGS Peri-operative care of Older People undergoing Surgery (POPS) Special Interest Group (SIG)
  Provides access to further resources specifically focused on the care of the older person undergoing surgery.
   
• Major trauma in older people - The Trauma Audit and Research Network (TARN)
  An older person suffering a fall from standing height is now the commonest type of major trauma in the national database. This report from the Trauma Audit and Research Network is the first comprehensive review to provide a description of major trauma in older people in England & Wales. It shows that our understanding of the demographics of the disease of major trauma is rapidly changing.
   
• Centre for Perioperative Care (CPOC) Guidelines: Perioperative Care of People Living with Frailty - Centre for Perioperative Care (CPOC)
  This interdisciplinary best practice guideline sets out standards of care for patients living with frailty through all components on the perioperative pathway. It also outlines ideas for outcome measures, quality improvement work and research for service providers.