BGS Spring Frailty: recent advances and next steps

Transcription

1 Frailty: recent advances and next steps Andy Clegg Senior Lecturer & Consultant Geriatrician University of Leeds & Bradford Teaching

2 Overview Review recent advances in frailty from a clinical and research perspective Discuss next steps for frailty research Describe how the Sarcopenia and Frailty Research SIG will help speed up the translational research pathway

3 Pushing the pace of frailty research It also takes almost 20 years, on average, for a treatment to progress through research to implementation* We need to speed up the translational research pathway... *with a few caveats!!!

4 Evidence base for communitybased frailty interventions Intervention Comprehensive geriatric assessment of older people Comprehensive geriatric assessment of frail older people Community-based post discharge care Group-based education (supported self-management) Falls prevention Exercise interventions Outcome 14% reduction in nursing home admission 10% reduction in hospital admissions 13% reduction in nursing home admission 10% reduction in hospital admission 40% more likely to be living at home 8% reduction in falls Improved function Beswick Lancet 2008

5 Inappropriate prescribing & adverse drug reactions in frailty If FI score >0.16: OR = 2.6 for Potentially Inappropriate Prescribing OR = 2.1 for Adverse Drug Reactions

6 Overcoming a key obstacle - routine frailty identification

7 Outcomes Outcome Mild frailty (HR, 95% CI) Moderate frailty (HR, 95% CI) Severe frailty (HR, 95% CI) 1 yr care home admission 2.00 (1.68 to 2.39) 2.70 (2.41 to 3.04) 5.94 (4.61 to 7.64) 3 yr care home admission 1.52 (1.37 to 1.69) 2.70 (2.41 to 3.04) 3.42 (2.84 to 4.12) 5 yr care home admission 1.56 (1.43 to 1.70) 2.34 (2.10 to 2.61) 3.00 (2.42 to 3.70) 1 yr hospitalisation 1.85 (1.81 to 1.88) 2.96 (2.90 to 3.02) 4.62 (4.50 to 4.74) 3 yr hospitalisation 1.71 (1.69 to 1.73) 2.54 (2.51 to 2.58) 3.64 (3.57 to 3.70) 5 yr hospitalisation 1.63 (1.61 to 1.64) 2.43 (2.40 to 2.46) 3.59 (3.54 to 3.65) 1 yr mortality 1.91 (1.78 to 2.04) 3.39 (3.15 to 3.65) 5.23 (4.73 to 5.79) 3 yr mortality 1.74 (1.68 to 1.81) 3.02 (2.90 to 3.14) 4.56 (4.29 to 4.84) 5 yr mortality 1.66 (1.62 to 1.71) 2.73 (2.64 to 2.81) 3.88 (3.68 to 4.09)

8 Implementation & dissemination 40% of UK general practices 50% of UK general practices 10% of UK general practices

9 A TRANSFORMATIVE advance (with special thanks to John Young and Martin Vernon)

10 Frailty research seize the day!!!!!!!

11 10 key frailty research topics (not an exhaustive list!!) 1. Organisation of care for older people with frailty 2. Holistic community assessment (e.g. CGA principles) 3. Stopping preventative medications/deprescribing 4. Interventions for pre-frailty 5. Pain interventions 6. Loneliness interventions 7. Co-existing frailty & dementia 8. Deconditioning in hospital 9. Advance care planning in very severe frailty 10.Analysis of real world data (big data)

12 Next steps Personalised care planning to improve quality of life for older people with frailty Clegg A, Young J, Bower P, Cundill B, Farrin A, Foster M, Foy R, Hartley S, Hawkins R, Holmes J, Hulme C, Humphrey S, Lawton R, Pendleton N, West R, Bates C, Nazroo J NIHR PGfAR 2.7M (October 2017 to February 2023)

13 Personalised Care Planning for Older People with Frailty Aim To establish whether PCP for older people with frailty improves quality of life (SF36) and reduces health and social care resource use at 12 months Work Package 1 Refining the target population by exploring QoL & health/social care resource use in frailty, using the efi (ResearchOne; CARE 75+; ELSA) Work Package 2 Optimising the Age UK integrated care service to deliver PCP for older people with frailty Work Package 3 Feasibility study (cluster RCT, 8 general practices, 400 participants) Work Package 4 Definitive cluster RCT, 40 general practices, 2,000 participants

14 Research Outputs Identification of the target population for PCP in frailty, using the efi as a well-validated and widely available tool A suitably optimised PCP intervention, including a common framework for routine NHS delivery Definitive evidence on the effectiveness and costeffectiveness of PCP for older people with frailty Information for policy-makers and commissioners on wider NHS implementation

15 Next steps RCT evaluation of a home-based exercise intervention as extended rehabilitation for older people with frailty after discharge from hospital or intermediate care Clegg A, Clarke D, Cundill B, Farrin A, Forster A, Goodwin V, Hartley S, Hulme C, Wright P, Young J NIHR HTA 2M (March 2017 to June 2021)

16 Implementation and QI

17 Sarcopenia & Frailty Research SIG a Translational Research Delivery Model

18 How should we push the pace? 1. Join up epidemiological and clinical trial research to better identify target populations for frailty interventions 2. Ensure future frailty research studies are designed to facilitate rapid implementation into clinical practice 3. Align with incentivisation mechanisms to help implement interventions with evidence of effectiveness 4. Build on UK and international collaborative frailty networks to share best practice, facilitate implementation and support QI methods 5. Join the BGS Sarcopenia and Frailty Research SIG to speed up the translational pathway

19 Be happy, happy, happy And seize the day of pleasure Robert Frost, Carpe Diem