Following Frailty - Long-Term Conditions Network2024-03-29T09:15:04Zhttp://selfmanagementnetwork.ning.com/forum/topics/following-frailty?commentId=3592047%3AComment%3A29532&x=1&feed=yes&xn_auth=noHi Phil
Julie Nitschke mentio…tag:selfmanagementnetwork.ning.com,2018-07-30:3592047:Comment:295322018-07-30T18:40:03.881ZJan Weststratehttp://selfmanagementnetwork.ning.com/profile/JanWeststrate
<p>Hi Phil</p>
<p>Julie Nitschke mentioned the Long-term Conditions network site to me. With great interest, I read your contribution and study the diagram that you posted. I like to add two more suggestions to consider for developing</p>
<p>1. Recently the Dutch Government approved to finance an experiment where elderly that still live at home and are "care dependent" on the presence of their partner or family member, can stay 2-3 night a week at what they call a " Care Hotel". This is a…</p>
<p>Hi Phil</p>
<p>Julie Nitschke mentioned the Long-term Conditions network site to me. With great interest, I read your contribution and study the diagram that you posted. I like to add two more suggestions to consider for developing</p>
<p>1. Recently the Dutch Government approved to finance an experiment where elderly that still live at home and are "care dependent" on the presence of their partner or family member, can stay 2-3 night a week at what they call a " Care Hotel". This is a section of an existing aged care facility that is specially designed for these weekly guest. The aim is to offer structural relief on a weekly basis to the partner and family of the 24 hourly care they usually provide to their family member. The two to three days the partner is in the Care Hotel they can use to re-energise by meeting again with friends or attend clubs they otherwise had difficulty to do so. It is suggested that it will reduce the isolation of the caring partner/family. This is different from respite care but could be seen as structural respite care.</p>
<p>2. In June the University Hospital Amsterdam has opened a special wing of a nearby aged care facility that admits frail elderly. They are not admitted via the ED department but go directly to this unit. You find more details on this innovative projects in our July <a href="https://mailchi.mp/88564c599475/quality-inspiration-1493441">newsletter</a>.</p>
<p>Jan Weststrate</p> ...especially given the cost…tag:selfmanagementnetwork.ning.com,2018-07-26:3592047:Comment:295252018-07-26T03:53:46.303ZDeborah Callahanhttp://selfmanagementnetwork.ning.com/profile/DeborahCallahan
<p>...especially given the cost of student housing in Auckland!</p>
<p>...especially given the cost of student housing in Auckland!</p> In respiratory we have a wide…tag:selfmanagementnetwork.ning.com,2018-07-26:3592047:Comment:296172018-07-26T03:52:32.943ZDeborah Callahanhttp://selfmanagementnetwork.ning.com/profile/DeborahCallahan
<p>In respiratory we have a wider perspective on what 'frailty' is, and who fits the definition. Often they're younger than who we typically label 'frail'. Easy to forget other factors in frailty in lieu of advanced age. </p>
<p>In respiratory we have a wider perspective on what 'frailty' is, and who fits the definition. Often they're younger than who we typically label 'frail'. Easy to forget other factors in frailty in lieu of advanced age. </p> Social connectedness is a ver…tag:selfmanagementnetwork.ning.com,2018-07-26:3592047:Comment:297202018-07-26T03:49:50.322ZDeborah Callahanhttp://selfmanagementnetwork.ning.com/profile/DeborahCallahan
<p>Social connectedness is a very important part of health and wellbeing and under-recognised in many of our medical models. We know in COPD that anxiety is both caused by and drives exacerbations, and that personal touch at the moment of calling for an ambulance is important in reducing unnecessary ED presentations. </p>
<p>Social connectedness is a very important part of health and wellbeing and under-recognised in many of our medical models. We know in COPD that anxiety is both caused by and drives exacerbations, and that personal touch at the moment of calling for an ambulance is important in reducing unnecessary ED presentations. </p> Last year I travelled back to…tag:selfmanagementnetwork.ning.com,2018-07-25:3592047:Comment:298132018-07-25T00:27:01.136ZPhil Woodhttp://selfmanagementnetwork.ning.com/profile/PhilWood
<p>Last year I travelled back to one of my old haunts in the UK. I worked in Leicester for about 5 years in various capacities last century. One role was at the Royal infirmary as a co-admitting acute admission consultant. I knew they had moved on a lot and become very influential in Frailty pathways in Acute care. It is a big hospital of around 1,000 beds, and they have a couple of unitis / wards supporting acutely unwell frail older people. below is an abstract about the service. It is…</p>
<p>Last year I travelled back to one of my old haunts in the UK. I worked in Leicester for about 5 years in various capacities last century. One role was at the Royal infirmary as a co-admitting acute admission consultant. I knew they had moved on a lot and become very influential in Frailty pathways in Acute care. It is a big hospital of around 1,000 beds, and they have a couple of unitis / wards supporting acutely unwell frail older people. below is an abstract about the service. It is planning to evolve again with a specially built part of the ED unit. While this example is beyond the needs of most NZ hospital (it's an economy of scale issue) the principles and processes are generic to making things more suited to the frail older patient. After 7 years of various alterations etc it is still very much an integral part of the Hospital and has a very stable staff.</p>
<p></p>
<p>Leicester, UK: In early 2011, a 12 bed “Emergency Frailty Unit” (EFU) was established within the ED of the Leicester Royal Infirmary, focusing on older patients who were likely to be discharged home within 24hrs, by embedding a comprehensive geriatric assessment pathway within the ED [4]. The business case for the EFU was predicated on reducing the proportion of elderly patients presenting to ED who go on to be admitted for on-going hospital care (the ED ‘conversion rate’). Geriatricians provided complete medical cover for the service from 8am-6pm, 7 days a week. Secondary/primary/community care pathways were developed and strengthened; for example, the EFU assessment was able to be used as the admission assessment and management plan in community rehabilitation facilities. <br/>A historical cohort evaluation of the impact of the EFU over its first 2 years, showed a significant reduction in the number of older people aged >85yrs requiring hospital admission (ED conversion rate falling from 69.6% to 61.2%). This was despite an 18% increase in the number of >85 yr old patients attending the ED during the intervention period (rising from 638 per month in 2010 to 753 per month in 2012). The 90 day readmission rate following discharge from the ED also fell from 26.0% to 19.9%. However, the mean length of inpatient stay was increased (from 8.9days to 11.1 days); possibly explained by only the sickest of elderly patients being admitted to hospital. ED conversion rates fell across all age groups and are thought to be related to the time freed up for emergency physicians to care more comprehensively for younger patients</p> I like to direct you to a "In…tag:selfmanagementnetwork.ning.com,2018-07-24:3592047:Comment:296162018-07-24T23:47:48.326ZPhil Woodhttp://selfmanagementnetwork.ning.com/profile/PhilWood
<p>I like to direct you to a "Interdisciplinary Approach to Frailty at the Front Door" an abstract to the Internal Medicine Society of Australia and New Zealand due in, March 2019. I'm not sure why it is visible this early as the program isn't published! It's worth the short read.</p>
<p>So what else is being explored in New Zealand by a similar process focusing at the hospital setting?…</p>
<p></p>
<p>I like to direct you to a "Interdisciplinary Approach to Frailty at the Front Door" an abstract to the Internal Medicine Society of Australia and New Zealand due in, March 2019. I'm not sure why it is visible this early as the program isn't published! It's worth the short read.</p>
<p>So what else is being explored in New Zealand by a similar process focusing at the hospital setting?</p>
<p><a href="http://www.imsanzconference.co.nz/emma-green--rosie-winters.html" target="_blank" rel="nofollow noopener">http://www.imsanzconference.co.nz/emma-green--rosie-winters.html</a></p>
<p>See also </p>
<p><a href="http://www.bgs.org.uk/june-2016/newsletter/news-jun16/jun16-identifying-frailty%C2%A0" target="_blank">http://www.bgs.org.uk/june-2016/newsletter/news-jun16/jun16-identifying-frailty </a>;</p>
<p></p> Yes, the diagram has been thr…tag:selfmanagementnetwork.ning.com,2018-07-24:3592047:Comment:295172018-07-24T22:10:53.214ZPhil Woodhttp://selfmanagementnetwork.ning.com/profile/PhilWood
<p>Yes, the diagram has been through various iterations, depending on audience. Ideally there would be a HUGH and dominant home but practical matters precludes this. I'll boost the home size when I get to use it again. </p>
<p>I can see where you're coming from with regards social services. The diagram was more to do with pathways of movement/activity rather than support mechanisms that underpin or promote such movement or stability.</p>
<p>Representations of such diagrams could reflect a…</p>
<p>Yes, the diagram has been through various iterations, depending on audience. Ideally there would be a HUGH and dominant home but practical matters precludes this. I'll boost the home size when I get to use it again. </p>
<p>I can see where you're coming from with regards social services. The diagram was more to do with pathways of movement/activity rather than support mechanisms that underpin or promote such movement or stability.</p>
<p>Representations of such diagrams could reflect a variety of perspectives, with Treasury particularly interested in the flow of $! Time in health versus time in ill-health would in general be in another representation.</p>
<p>The audience in the past has been largely clinical/funding and planning, hence speaking in that language.</p>
<p>We have to consider how to reflect the "Positive Ageing Strategy" under MSD, Office of Senior Citizens. It talks more to the social context of wellness/well-being. It would be interesting to see how this "diagram" would be remodelled in that context.</p>
<p></p> The concepts of mixed housing…tag:selfmanagementnetwork.ning.com,2018-07-24:3592047:Comment:297172018-07-24T22:01:03.316ZPhil Woodhttp://selfmanagementnetwork.ning.com/profile/PhilWood
<p>The concepts of mixed housing developments suitable for a true community as well as avoiding the ghettoising of older folk is a "work in progress".</p>
<p>There is nothing on paper, but it certainly is of interest especially where there is considerable housing shortfalls, e.g. Auckland.</p>
<p>Having students "living in" is a novel idea, and it probably could work in some circumstances. Proximity to transport to universities et cetera would be only one part of the need. In general there are…</p>
<p>The concepts of mixed housing developments suitable for a true community as well as avoiding the ghettoising of older folk is a "work in progress".</p>
<p>There is nothing on paper, but it certainly is of interest especially where there is considerable housing shortfalls, e.g. Auckland.</p>
<p>Having students "living in" is a novel idea, and it probably could work in some circumstances. Proximity to transport to universities et cetera would be only one part of the need. In general there are more examples of younger folk visiting, perhaps even performing some light duties, reducing social isolation and loneliness, and maybe receiving some compensation for this. There may be considerable implications for safety, security et cetera that would have to be put in place to support this.</p>
<p></p>
<p>Has anyone else seen or know of such examples in NZ or elsewhere?</p> Hi All, I'm not getting back…tag:selfmanagementnetwork.ning.com,2018-06-20:3592047:Comment:291032018-06-20T04:27:32.987ZPhil Woodhttp://selfmanagementnetwork.ning.com/profile/PhilWood
<p>Hi All, I'm not getting back to this site often enough,. Great comments and ideas out there. I'll get onto individual comments, but rest assured, other will be reading and can always feel free to respond. Getting like minds together is what this all about.</p>
<p>Hi All, I'm not getting back to this site often enough,. Great comments and ideas out there. I'll get onto individual comments, but rest assured, other will be reading and can always feel free to respond. Getting like minds together is what this all about.</p> Karen, Ruth Anna, service int…tag:selfmanagementnetwork.ning.com,2018-06-13:3592047:Comment:289072018-06-13T00:10:31.792ZPat Flanaganhttp://selfmanagementnetwork.ning.com/profile/PatFlanagan818
<p>Karen, Ruth Anna, service integration and social support themes coming through. Just providing a link to a section on the Health Navigator website about <a href="https://www.healthnavigator.org.nz/clinicians/s/self-management-support-project/working-differently/peer-and-social-support/#Caremaps&socialprescribing" rel="noopener" target="_blank">social support and social prescribing</a></p>
<p>As part of the self management support project we pulled together and developed a range of…</p>
<p>Karen, Ruth Anna, service integration and social support themes coming through. Just providing a link to a section on the Health Navigator website about <a href="https://www.healthnavigator.org.nz/clinicians/s/self-management-support-project/working-differently/peer-and-social-support/#Caremaps&socialprescribing" target="_blank" rel="noopener">social support and social prescribing</a></p>
<p>As part of the self management support project we pulled together and developed a range of resources and training. This work on developing a tool to map peoples social networks is interesting - Any thoughts</p>
<p>Pat</p>