Professor John Young
National Clinical Director for Integration and Frail Elderly Care, NHS England.
Honorary Consultant Geriatrician at Bradford Foundation Trust.
Head of Academic Unit of Elderly Care and Rehabilitation at University of Leeds.
John Young trained at the Middlesex Hospital, London. He was appointed as a consultant geriatrician in Bradford in 1986 and has developed numerous new services including an elderly care assessment unit; a stroke unit; and an ortho-geriatric unit. In 2005 he was appointed as Head of the Academic Unit of Elderly Care & Rehabilitation, University of Leeds, now one of the largest elderly care health research units in the UK. Quality improvement work includes the national audits of intermediate care and of dementia care. Between 2001 and 2007 John was seconded to the DH to assist with the NSF for Older People. He is currently seconded to NHS England as National Clinical Director for Integration and Frail Elderly.
Professor Young is presenting as part of the morning Plenary on Day 2.
Professor Young will address
‘Living with frailty’
‘Vision of the empowered and self-managing patient’
Moderated by Marjory McLeod, Chair of the BDA Scottish Board and Senior Dietitian, NHS Lothian.
Visions of the empowered and self-managing patient
- What team do we need in place to achieve the goal of moving more patients from hospital to primary and social care?
- What do the service components look like?
- What are the best mechanisms for contact?
- Living with frailty: case studies of empowered frail and elderly patients
Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. This means the person is vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection or a change in medication. A person with frailty therefore typically presents in crisis with the “classic” frailty syndromes of delirium (acute confusion); sudden immobility (stuck in a chair or in bed); or a fall (and subsequent unsafe walking). There is a strong evidence base that rapid (within two hours) medical assessment, followed by specific treatment and a period of supportive and rehabilitation care, is associated with improved outcomes (lower mortality; greater independence; and reduced need for long-term care). Much of this urgent care response to frailty is currently done in hospitals by Geriatric Medicine departments. Increasingly, crisis assessment and management of older people with frailty is being done in the person’s home (“admission avoidance”). This requires the provision of dedicated, well led, multi-disciplinary community teams.
Frailty develops slowly over 5 to 10 years: so could more be done to help older people with frailty before a health crisis occurs? Older people with frailty can be readily identified and are usually well known to local health and social care professionals. They usually have weak muscles and also often have other conditions like arthritis, poor eyesight, deafness and memory problems. This means that frail older people typically walk slowly, get exhausted easily and struggle to get out of a chair or climb stairs. They are therefore more likely to become dependent on others for day-to-day cares and are at higher risk of future admission to a care home. At present, however, we do not formally “diagnose” frailty or identify it with a specific “code”. This means systematic case finding and proactive care is difficult. Slow walking speed is a simple test that could readily help identify people who are frail. Taking more than 5 seconds to walk 4 metres is highly indicative of frailty. The primary care electronic health record contains large amounts of health data from which selected existing items could be readily brought together to form a “Frailty Index” to identify the sub-group of older people who have frailty, and to grade the frailty state. This would allow a structured self-management plan for people with mild/moderate frailty and case management (multi-disciplinary assessment and individualised care planning) for people with moderate/severe frailty.