10/9/18 In place of fear of frailty Dr Shibley Rahman MA PhD MRCP(UK) LLM MBA NELFT Wednesday 10 October 2018 1
10/9/18 #WHA71 (2018) 2017 2
10/9/18 Identifying deficits can be important Rahman et al. (1999) Brain Frailty • “Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status.” (Clegg et al., 2013) 3
10/9/18 Frailty • There are a number of criteria for diagnosing frailty currently, but it is common for clinicians to claim that they “recognise frailty when they see it”. • This, however, can encourage stereotypes. • The frailty index score is calculated as the proportion of potential deficits that are present in a given individual (Rockwood and Mitnitski, 2007). • The frailty index recognises that frailty is multifactorial and dynamic. 2018 4
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10/9/18 Stigma • There is evidence that older people may not recognise themselves as being frail, or want to be considered as such, even if they are happy to accept that they are an older person. • Respondents to a recent survey by Age UK universally regarded “frail” as a negative label. • People with stigmatised conditions like this can be so ashamed of talking about them that they are unable to seek help. The repercussions are serious. Failure to seek care can worsen symptoms. 8
10/9/18 Rahman, Dening and Harrison-Dening (2018) 9
10/9/18 Assets • Rotegård and colleagues (Rotegård et al., 2010) have defined health assets as follows: “Health assets are the repertoire of potentials – internal and external strength qualities in the individual’s possession, both innate and acquired – that mobilize positive health behaviors and optimal health/wellness outcomes.” An assets-based approach to health policy, research and practice aims to support individuals, communities and organisations to secure the skills and competencies that can maximise opportunities for health and wellbeing (Morgan and Ziglio, 2017). 10
10/9/18 • An assets-based approach concerns itself with identifying those protective factors that keep us well so that they can help offset the risks that inevitably people will face in their lives. • Focusing on physical deficits, such as loss of muscle bulk or bone strength, means insufficient attention is being paid to the existence of “health assets”. Rahman, Dening and Harrison-Dening (2018) 11
10/9/18 MONTAGE – Rahman (2018) Rahman, 2018 12
10/9/18 Rahman, 2018 Potential advantages of an “assets based approach” (listed in Rahman (2018)) • helps people to think positively about their circumstances; • is realistic as it identifies what is already available; • • is inclusive and encourages equality and reciprocity needed for co- production; • facilitates both independence and interdependencies; • facilitates the valuing of others (what matters to people); 13
10/9/18 Potential advantages of an “assets based approach” (listed in Rahman (2018 )) • provides a mechanism for the mobilisation of the assets; • promotes the local population as a producer of health, rather than as a service user; • encourages people to realise their ability to contribute to the development of health and wellbeing; • facilitates the identification of a range of health promotion factors. Potential advantages of an “assets based approach” (listed in Rahman (2018)) • helps to develop more sustainable initiatives; • aims to empower people; • helps to identify methods in which individuals can use their talents. 14
10/9/18 Social health • Social resources, such as social capital, have been linked to the absence of loneliness among the general population (Islam et al., 2006; Kim et al., 2007) as well as among older people (Routasalo et al., 2009). The social networks within communities create ‘social capital’, resources such as support, reciprocity through volunteering networks and links which bridge divides of power, status, knowledge and access. Rahman, Dening and Harrison-Dening (2018) 15
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10/9/18 Kuchel GA. Frailty and Resilience as Outcome Measures in Clinical Trials and Geriatric Care: Are We Getting Any Closer? J Am Geriatr Soc. 2018 Aug;66(8):1451-1454. Kuchel GA. Frailty and Resilience as Outcome Measures in Clinical Trials and Geriatric Care: Are We Getting Any Closer? J Am Geriatr Soc. 2018 Aug;66(8):1451-1454. 17
10/9/18 Rahman and Swaffer (2018) Rahman and Swaffer (2018) “The life course approach is particularly useful, as it recognises that at any point in a person’s life things may go wrong. The asset approach then provides a process for understanding what is required to rebuild the confidence and self-esteem necessary for individuals to regain the motivation for doing well. The asset approach therefore must also rely on active disability support, and in the dementia-friendly communities, initiatives should therefore equate to communities being accessible and inclusive for people with cognitive disabilities, not only friendly.” 18
10/9/18 Rahman and Swaffer (2018) “Based on the original WHO definition, health in older age is described as a life course process of optimising opportunities for improving and preserving physical, social and mental wellness, independence, quality of life and enhancing successful transitions (Hornby-Turner, Peel, & Hubbard, 2017).” Rahman and Swaffer (2018) “The life course approach is particularly useful, as it recognises that at any point in a person’s life things may go wrong. The asset approach then provides a process for understanding what is required to rebuild the confidence and self-esteem necessary for individuals to regain the motivation for doing well. The asset approach therefore must also rely on active disability support, and in the dementia-friendly communities, initiatives should therefore equate tocommunities being accessible and inclusive for people with cognitive disabilities, not only friendly.” 19
10/9/18 Rahman, 2017 Rahman, 2017 20
10/9/18 Rahman and Howard (2018) Rahman and Howard, 2018 21
10/9/18 Rahman and Harrison-Dening (2016) 22
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10/9/18 The “hospital experience” • The “This is me” info above mum’s head had not been updated. Delirium-friendly ward? Different HCAs every day. Noisier @ night than Piccadilly Circus. Loss in confidence. “Bed rails” No help in eating meals. #EndPJParalysis (these adverse outcomes are not minor – e.g. loss of muscle bulk, pressure ulcers, DVTs, PEs.) #HelloMyNameIs. 24
10/9/18 @dr_delirious The rush to get people out of hospital 25
10/9/18 Matthiesen et al. (2014) 26
10/9/18 Matthiesen et al. (2014) • Methods An asset-based model of community engagement specific to end- of-life issues using a four-step process is described (getting started, coming together, action planning and implementation). The use of this approach, in two regional community engagement programmes, based across rural and urban communities in the northwest of England, is described. • Findings The assets identified in the facilitated community engagement process encompassed people's talents and skills, community groups and networks, government and non-government agencies, physical and economic assets and community values and stories. Five priority areas were addressed to ensure active community engagement work: information, outreach, education, leadership and sustainability. 27
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