Why Better Training for Frail Elder Care is Necessary (Part 1)

April 1, 2021
April 1, 2021

This blog post excerpts an article in the Q4 2015 issue of PX Advisor, our quarterly magazine designed to bring you thought leadership and best practices for improving the patient experience. We interviewed Mitchel T. Heflin MD, MHS Associate Professor of Medicine, Duke University School of Medicine; Eleanor McConnell PhD, RN, GCNS-BC Associate Professor, Duke University School of Nursing; and Loretta Matters MSN, RN, Associate Director, Center of Excellence for Geriatric Nursing Excellence, Duke University School of Nursing about the Duke Inter-Professional Frail Elder Care certificate program that HealthStream is helping to develop as part of our Living Labs initiative.

How do you define Frail Elder and the need to improve care quality for the growing frail elder population across the continuum of care?

In general, older adults have a more difficult time recovering from illness or other health “stressors”—like surgery. This is, in part, related to higher rates of medical problems and medications. It is also due to less tangible factors like memory loss, weakness, and fatigue—a collage of problems we might refer to as “frailty.” Imagine an 85-year-old woman in the hospital for repair of a hip fracture. While we would hope that she would recover from surgery promptly and resume her prior routine, issues like confusion, poor nutrition, and immobility can threaten a successful recovery, prolong hospital stays, and increase the need for institutional care after discharge. Further, the complexity of the healthcare system and limited experience and training on the part of healthcare teams about care of frail older adults present additional risks.

Can you share some statistics about aging and the size of the frail population? 

The older adult population in the US is growing steadily—such that by 2030, there will be nearly 70 million adults over age 65. The fastest growing portion of that population will be those over 85, for whom frailty is a more common condition. This has important implications for all health professionals. While we imagine an active and contented late life for many of our older patients, we know that aging comes with a greater burden of illness and potential loss of ability and independence. This can result in a growing need for ongoing healthcare and significant challenges to recovery from acute illness. 

What is the importance of the quality of care and the care continuum for a frail population? 

Frail elders constitute a disproportionate percentage of those hospitalized. While older adults make up 12- 13% of the population, they constitute as much as 40% of those hospitalized. Recent data suggests that we have become better at caring for them in the hospital (at least as much as this is measured by length of stay). However as folks age, they are much less likely to return home after hospitalization to live independently and much more likely to need institutional care. The percentage requiring skilled care post-hospitalization grows by about 50% with each decade of age after 65, such that nearly 50% of those over 85 are routinely discharged to skilled care for rehab or long term care. 

What is the relationship between readmissions and the frail elder population? 

Frail elders comprise a significant proportion of hospital readmissions, which are expensive and now have an impact on Medicare/Medicaid reimbursements. Prevention of readmissions for older adults requires recognition of common problems and pitfalls in providing healthcare across settings. For example, greater awareness of the presence of acute confusion, also known as delirium, and the fact that it persists after discharge is important for understanding an older patient’s healthcare needs. Also, careful reconciliation of medications and recognition and removal of high risk drugs can help avoid unnecessary complications and can keep people from returning to the emergency department (ED) or hospital. Effective transitions also require careful communication between inter-professional team members across all settings, accounting for medical conditions, medications, monitoring, and follow-up visits. A structured approach to managing these transitions for older adults can improve care and the care experience for these patients and their families.