Our team interviewed Deirdre Lang, Director of nursing at the Royal College of Physicians in Ireland, on the importance of frailty management and how education is crucial in frailty detection and how it can act as a catalyst for change in healthcare. Indeed, without the understanding of what frailty means, it would be difficult for the developed EU FrailSafe system to be efficient without the knowledge and support of the health professionals.

In Ireland the National Clinical Programme for Older People developed a National Frailty Education Programme in partnership the Irish Longitudinal Study on Ageing (TILDA); a partnership that allows research to inform practice in a unique way. The aim of the programme is to provide healthcare professionals with an enhanced understanding of frailty and frailty assessments, thereby ensuring earlier recognition of frailty, improved healthcare management, and better health outcomes for frail older adults”.

What does frailty mean to you? What are the key aspects one should know about frailty?
The literature suggests that frailty is best described as a state of increased vulnerability, associated with a decline in physical and psychological reserves, where an apparently small event may trigger a dramatic change in the persons physical or mental wellbeing. Personally I believe that rather than concentrating on a deficit model we need to educate healthcare professionals to look at the person’s abilities; if we want to proactively maximise their quality of life. Frailty, as a long term condition, needs to be managed as such with education programmes developed to inform people how to age well. A reablement approach to care will change the focus on ability rather than disability.

A National Frailty Education Programme as a driver of culture change in healthcare? What can you tell us about it?
In Ireland, the population 65 years and over is projected to increase by between 58 and 63 per cent from 2015 to 2030. The older old population (i.e. those aged 80 years of age and over) is set to rise even more dramatically, by between 85 per cent and 94 per cent in this time period (ESRI 2017). Much has been written about the need for healthcare systems to adapt to meet the growing demands associated with these demographic changes. For this to truly happen, we need a culture change. We need a paradigm shift in how we think, how we provide and where we deliver care to our ageing populations. To drive this change we need to unlock and share the “secret knowledge” of geriatric medicine – the care of older people with a long-term condition known as “Frailty”. We believe that the National Frailty Education Programme is the vehicle to drive this culture change. It promotes and encourages evidence based practice by ensuring knowledge is current. It promotes excellence, and encourages innovation and creativity in the management of the older person living with frailty. It complements the Guidance on Comprehensive Geriatric Assessment (CGA) produced by the National Clinical Programme in 2016 (NCPOP Guidance on CGA).

Is frailty included in Irish nursing education programmes? Why should this be important?
Frailty has been described as a relatively “new science” and research suggests it’s an area that is has been lacking in nursing education curricula to date. In light of this the National Clinical Programme for Older People (NCPOP) established an academic interest group with Higher Education Institutes (HEI) and Institutes of technology (IT). This provided a forum to discuss the outcomes of work undertaken on a “Strategic Vision & Educational Framework for Gerontological Nursing”. As a result, the academic partners agreed to map their undergraduate and post graduate programmes to the education framework developed as part of this initiative.

In recognising the importance of educating nurses on the concept of frailty a number of the academic partners attended The Irish Longitudinal Study on Aging (TILDA) health centre at Trinity College Dublin. They reported that this provided them with a greater understanding of frailty as a long term condition, which has enhanced their ability to teach on the subject at undergraduate and post graduate level. The NCPOP has since shared the “Fundamentals of Frailty” with a number of HEI and IT

Is frailty a health issue at national level? Were there public campaigns organised to inform, educate citizens about the syndrome?
The majority of older people are well, living independently in the community. With improved life expectancy, however, an increasing number of people suffer from multiple chronic illnesses, frailty, poly-pharmacy and other syndromes associated with ageing. Healthcare spending in Ireland is expected to rise from 5.8 to 6.7% of GDP by 2035 (European Commission, 2009). Almost 22% of all hospital emergency department attendees are aged 65 and over and this age group account for 40% of all acute emergency medical admissions and 47.3% of total hospital bed days. One of the greatest challenges posed by an ageing population is the ability of healthcare professionals to understand, recognise and manage frailty.

The National Clinical Programme for Older People was established in 2010 and is the health service response to the health needs of the ageing population. It is a joint initiative between the Health Service Executive (HSE) Clinical Strategy and Programmes Division and the Royal College of Physicians of Ireland. The overall aim of the programme is to improve and standardise the quality of care for older people in Ireland.

The Integrated Care Programme for Older People (ICPOP) is leading out on the development of cohesive primary and secondary care services for older people especially those with more complex needs. The current focus is on the development of a number of pioneer sites nationally. These sites are working to a 10-Step Framework that fundamentally adopts a population based approach with new ways of working, at the core of which is a case management approach to integrated care. The ICPOP proposes to implement, test and monitor integrated service developments for older people in pio¬neer sites and to evaluate this implementation so that lessons learned may be ex-tended nationally.

The Irish Longitudinal Study on Ageing (TILDA) is a major multidisciplinary study designed to provide an evidence base for addressing current and emerging concerns associated with population ageing. TILDA is one of the most comprehensive research studies of its kind both in Europe and internationally. TILDA collects data from a representative sample of the Irish community dwelling population aged ≥50 years. To date, TILDA has carried out almost 12,000 health assessments. These measures provide insight into the key cardiovascular, physical and cognitive functions that characterise frailty. These reports have informed policy at national level in health and social care.

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