Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. This means the person is vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection or a change in medication.
A commonly heard clinical expression is "He/she is very frail". It provides a summary statement of an older person that implies concerns over vulnerability and prognosis. This is how we have conventionally considered frailty—as a descriptive label: 'the frail elderly'. In this article, we will re-frame frailty in a potentially more helpful way. We will examine frailty from the perspective of an abnormal health state that behaves just like a long-term condition. This conceptualisation of frailty opens up new approaches to helping people who are frail.
The first section of this supplement made the case to consider frailty from the perspective of a long-term condition. This and the next section explore what this means in terms of applying some of the well-developed models for the care of long-term conditions to people who are living with frailty. First, we examine how the highly evidence-based model of supported self-management might be applied to frailty.
Supported self-management is feasible and desirable for people with mild frailty, but care and support planning is more appropriate for individuals with moderate frailty. This section considers how the primary healthcare team can apply a whole person and personalised approach to care and support planning.
Most nurses are involved in the care of the 1% of the population currently nearing the end of their lives: that is, people considered to be in their final year, months, weeks or days of life. The Gold Standards Framework (GSF) programmes can help provide a structured framework in this challenging area, leading to more proactive and consistent standards of care, and enabling more people to live well and die well where they choose.
The World Health Organization has recommended that everyone should be eating more foods that contain potassium, and we routinely measure this electrolyte as part of the standard U&Es blood test. But why is potassium important for our health, and why do we need to worry if a patient's levels are too high or too low?
Atrial fibrillation (AF) is the commonest cardiac arrhythmia seen in primary care and, if left untreated, is a significant risk factor for stroke. New guidelines from the National Institute for Health and Care Excellence (NICE) include some practice-changing recommendations on diagnosing AF, the role of aspirin and the novel oral anticoagulants (NOACs), and shared decision-making to ensure patient-centred care.
Chronic heart failure (CHF) continues to be a leading cause of death and readmission to hospital in the UK. Since the availability of specialist CHF services is variable, many patients rely on practice nurses to review their care. The National Institute for Health and Care Excellence (NICE) guidelines have proved very helpful, but are now a cause for confusion as new evidence changes the management of heart failure.