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• Acute frailty in the community
  Firdaus Adenwalla
  Published on: 20 November 2023

• Published on: 20 November 2023

  Acute frailty in the community

  • Firdaus Adenwalla, consultant community Geriatrician Swansea Bay university Health board

  I work in a hospital at home (H@H) service and have found the AFN website a very useful learning resource and regularly recommend it to my Clinical practitioners and nurses. Read the paper with interest and tend to agree with the conclusion reached by the authors.
  Given that the flow of patients to hospital are from the community the way we deal with an acute frailty crisis in the community needs to be looked at. The atypical presentation of acute illness in the frail older person coupled with the move to virtual consultations ( due to work pressure on GPs) has led to a delay in the diagnosis and treatment of acute illness in this group of patients. We often come across the scenario of patients being prescribed multiple courses of antibiotics when the underlying diagnosis is not an infection. The consequence is that the patients become deconditioned even before they enter an Acute frailty unit (AFU) making them less responsive to all the interventions prescribed. I am sure a proportion of patients on an AFU do not need to be there if their acute illness was dealt with promptly in the community.
  A H@H service is well placed to deal with acute frailty crisis in the community but needs to be able to respond in a timely way to the high risk frail older population which are care home residents, the housebound older patient and the frail older person on the ambulance stack waiting a paramedic response. If this service is well resourced it will enable an AFU to...

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  I work in a hospital at home (H@H) service and have found the AFN website a very useful learning resource and regularly recommend it to my Clinical practitioners and nurses. Read the paper with interest and tend to agree with the conclusion reached by the authors.
  Given that the flow of patients to hospital are from the community the way we deal with an acute frailty crisis in the community needs to be looked at. The atypical presentation of acute illness in the frail older person coupled with the move to virtual consultations ( due to work pressure on GPs) has led to a delay in the diagnosis and treatment of acute illness in this group of patients. We often come across the scenario of patients being prescribed multiple courses of antibiotics when the underlying diagnosis is not an infection. The consequence is that the patients become deconditioned even before they enter an Acute frailty unit (AFU) making them less responsive to all the interventions prescribed. I am sure a proportion of patients on an AFU do not need to be there if their acute illness was dealt with promptly in the community.
  A H@H service is well placed to deal with acute frailty crisis in the community but needs to be able to respond in a timely way to the high risk frail older population which are care home residents, the housebound older patient and the frail older person on the ambulance stack waiting a paramedic response. If this service is well resourced it will enable an AFU to see the right patients at the right time. Both these services cannot work in isolation of each other.

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  Conflict of Interest:
  None declared.

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