Frailty has been identified as a complex issue for the health system and the community. In response, the ACI has established a Frailty Taskforce to improve care for older people living with, or at risk of, frailty. Drawing on the strengths of our clinical networks, the taskforce brings together a range of expertise from consumers and health professionals across diverse clinical areas.
In late 2019, the ACI called for expressions of interest from those interested in contributing to the Frailty Taskforce. More than 100 nominations were received from across the health system to join the Taskforce.
In early 2020, a 26-member Frailty Taskforce was established, involving expertise from geriatrics, intensive care, aged care, surgery and perioperative care, dental care, dietetics, pharmacy, palliative care, general practice and primary health networks, physiotherapy, social work, ambulance; and most importantly, those who have a caring role.
A four-member executive team provides leadership for the Taskforce:
- Helen Tuxworth, Carer
- Professor Sue Kurrle, Geriatrician
- Professor Ken Hillman, Intensivist
- Sandeep Gupta, Physiotherapist
From the ACI, Kate Lloyd, Stream Manager Chronic and Long Term Care, leads a cross-organisational team working with key stakeholders across the frailty care continuum.
Partnering across the ACI and the health system
The Frailty Taskforce brings together expertise from across the frailty spectrum of care. In the core team, the following ACI clinical networks are involved:
- Chronic Care Network
- Aged Health Network
- Palliative Care Network
- Nutrition Network
- Primary Healthcare Institute
- Rehabilitation Network
- Clinical Excellence Commission’s Older Persons Patient Safety Team
Other NSW Health stakeholders involved, include:
- Ministry of Health
- NSW Ambulance
Primary health networks, the residential aged care, university and non-government sectors are also represented.
Over the last year, the Taskforce has also built a community of practice of more than 500 members who meet every second month to share knowledge and expertise.
Improving care for older people living with frailty
The goal of the Taskforce is to improve care for older people living with, or at risk of, frailty through:
- building capability in shared decision making
- ensuring older people living with frailty and their families/carers have understandable information to make informed choices
- reducing unnecessary and/or non-beneficial treatments
- reducing unwarranted variation in clinical practice.
How will the Taskforce achieve its goal?
“In order to create a roadmap for the realistic care of frail older people, we have established working reference groups in four key areas,” explain Kate Lloyd. These include:
- shared decision making
- resistance training
- optimising medication management
“We are focused on completing an evidence review: ‘What recent evidence has been published on models of care for older people living with frailty?’. From there, we aim to bring together the work of each reference group to inform the development of an organisational model and a suite of supporting resources.
“We are partnering with surgical colleagues to provide advice on making the best surgical and non-surgical choices for frail older people, and we are also bringing experts together to develop solutions for living and dying with frailty.”
What does this all mean for clinicians and the community?
“The Taskforce is creating awareness of the importance of identifying people living with frailty and advising what the system can do to support people to live the best possible life,” explains Dr Tracey Tay, Clinical Executive Director, CATALYST at the ACI.
“There is good evidence that frailty can be addressed and managed successfully in many older people with interventions, such as targeted exercise, improving nutrition and reducing polypharmacy.
“There is also increasing evidence that frail older people near the end of their life may experience non-beneficial interventions," adds Dr Tay. "This initiative is encouraging more honest and empathetic discussion between the person and their healthcare professional about prognosis and personal goals to ensure the most appropriate care and support for that individual.
“There is agreement that the medicalisation of care for frail older people is not always the most appropriate option. Increased literacy among the community and healthcare workers is essential, with regard to end-of-life support for people living with frailty.”
How does the Taskforce stay connected?
The Frailty team at the ACI has a collaborative meeting every fortnight to set the work plan, and they meet fortnightly with the Executive for strategic guidance. Every second month the Frailty Taskforce meets to provide strategic and subject matter expert advice, explains Ms Lloyd.
“Our community of practice meets on alternate months and we distribute regular newsletters to the group. We have also established a SharePoint site as an online collaborative space for the collection and collation of resources.
“The broad range of people involved means that we don’t always agree, but giving people time and space to express their views, and have an opportunity to collaborate has been a key part of our success.”
What has the Taskforce achieved so far?
“We have brought together a fabulous team and supported an amazing group of clinicians and carers to provide advice and guidance on areas that matter to them,” says Dr Tay.
The Taskforce held a Frailty Forum in February 2020 with more than 200 attendees and hosted a series of three webinars with almost 500 attendees across the year.
The Taskforce is creating awareness of the importance of identifying people living with frailty and advising what the system can do to support people to live the best possible life.
A new web-based resource has been developed, Frailty screening and assessment tools, which focuses on five of the most referenced screening and assessment tools. The Taskforce has also partnered with the Health Education and Training Institute to develop a podcast, Frailty education for the multidisciplinary team, which NSW Health staff can access My Health Learning. The Taskforce is exploring access for other audiences as well.
Through a partnership with Deakin University, the Taskforce is also hosting a shared decision-making series, including a webinar for 250 people on 4 March and in-depth communication coaching for clinical experts on 20 April.
What advice do you have for others working with diverse stakeholders?
“At a team level, while it takes a bit longer, it is worth getting to know each other – finding out how to work best with each other,” advises Ms Lloyd. “We’ve applied skills from our Aboriginal colleagues about the importance of non-linear learning, yarning and sharing our strengths.
“We’ve made time to understand each other and collaborate to capitalise on each team member’s key strengths, and then give them the space to lead and shine from their area of strength.
“At a Taskforce level, reach out to others – create opportunities for connection and collaboration among clinicians that might not otherwise be made. Connect those who are like-minded to make sure they have support if they might present a dissenting view. And remember that complex challenges take time to define (let alone solve), so be patient and persistent!”