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Six steps to better care for older people in hospital are outlined in new guidance

Guidance supporting clinical teams to improve care of older people living with frailty is now available, in a collaboration between Getting It Right First Time (GIRFT) and the British Geriatrics Society (BGS), supported by the Royal College of Physicians.

Six Steps to Better Care for Older People in Acute Hospitals is to accompany the new GIRFT Hospital Acute Care Frailty Pathway (co-badged by RCP) and offers detailed measures teams should take to improve care and reduce hospital-acquired dependency for those living with frailty, as well as stressing that interventions should be monitored and linked more widely to community-based services.

The new guidance is the result of several months of clinical collaboration to agree a standardised pathway for frailty care. The six steps outlined in the guidance are:

  • Assess for frailty: Systematically identifying frailty in all settings using the Clinical Frailty Scale.
  • Prevent complications: Measures to prevent, identify and effectively manage delirium and reduce hospital-acquired deconditioning.
  • Home First: Starting discharge planning for older people with frailty and/or dementia as soon as possible after admission, using a Home First principle.
  • Surgical liaison: Offering evidence-based surgical specialty liaison that improves individual and service-level outcomes for older people.
  • Rehabilitation: Taking steps to ensure there is effective recuperative rehabilitation for older people on all wards in hospital and in linked community services.
  • Primary and community care: Developing effective primary and community care services that support older people to remain in, or return to, their usual residence.

The guide also advocates for the development of a local comprehensive strategy for supporting care for people living with frailty (using frameworks such as the NHS Rightcare Frailty Toolkit) and for careful and creative use of the available workforce and development of a larger specialist workforce to ensure that staff with the required expertise are deployed where they can add most value.


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