By Heather Smith, Consultant Pharmacist: Older People, West Yorkshire Integrated Care Board, Ðula Alićehajić-Bečić, Consultant Pharmacist Frailty and Co-chair British Geriatrics Society Pharmacy Group Wrightington, Wigan and Leigh NHS Teaching Trust and Jayne Agnew, Consultant Pharmacist for Older People, Southern Health and Social Care Trust
Frailty and what pharmacy teams can do
Frailty affects millions of older adults, shaping the way they interact with healthcare services - including pharmacy teams. Have you considered how frailty influences your approach to providing care? What steps can you take to improve that care? The RPS Briefing on Joining the Dots: a blueprint for preventing and managing frailty in older people summarises our profession’s approach to improving care for this vulnerable group.
Person-centred care
When reviewing a patient’s medicines, consider their overall goals. Ask, “what matters to you?”, as most people say they wish to stay independent and mobile for as long as possible. Then work on agreeing a treatment plan aligned with these aims to ensure a patient-centred approach.
Do you incorporate frailty assessments into your practice? Tools such as the Clinical Frailty Score help identify levels of frailty and guide decisions about medicines appropriateness, goal setting and health targets such as blood pressure management.
Proactive care and health advice
Integrating proactive care into treatment pathways allows pharmacy teams to identify older people at risk of deterioration and offers personalised interventions to keep them well. Medicines optimisation is an important element of proactive care.
Do you have frailty or proactive care teams in your locality that you can link with to provide medicines optimisation? Pharmacy teams play crucial role in signposting people to health advice, intervention activities and prevention strategies to delay frailty progression. Every interaction is an opportunity to make a difference.
Improving coordination across services
Many services for older people living with frailty are fragmented. How can pharmacy teams improve integrated working across organisations to help bridge these gaps? Examples include:
- Community pharmacists referring people to GP practice teams for in-depth medication reviews
- Hospital pharmacists ensuring a smooth transition by sign-posting people to community pharmacy services upon discharge
- Primary care and community services teams working together to support patients in care homes.
Leadership and system working
We need leadership across the profession working with older people to provide services which meet their needs and deliver outcomes that are important to them. What does this look like in your area? Do you use data to identify at risk patients or monitor outcomes at a larger scale?
For example, in Greater Manchester, the Frailty Care Reference Group includes multiple stakeholders who evaluate the effectiveness of regional and national interventions – such as falls across the region and measuring the impact of falls interventions.
Education and Training
Historically, frailty wasn’t taught in pharmacy undergraduate and postgraduate education, meaning many pharmacy professionals learned about it “on the job”. However, understanding how frailty impacts medicines optimisation, shared decision-making and medicines risks is crucial.
To support learning, a free e-learning module is available from the British Geriatrics Society website. Embedding education on frailty at all levels of pharmacy professional development will ensure they are equipped to deliver high-quality care.
Frailty is our business
Most of us will be working with people living with frailty, so frailty is our business. Providing multidimensional, personalised care means looking beyond prescriptions to understand the person behind the medicines. Consider the issues raised here and ask yourself: “What will I do to improve the care of older people living with frailty?”
Explore the RPS Briefing on Joining the Dots: a blueprint for preventing and managing frailty in older people.
Read more RPS blogs.