Optimising the management of heart failure improves patient survival and reduces hospital admissions. However, standards of care continue to vary, and many HF patients are still not receiving recommended therapy with diseasemodifying drugs or specialist input to their care. Outcomes will only improve for all HF patients if evidence-based clinical guidelines are implemented throughout the NHS.
Diabetes clinics form a major part of the workload for practice nurses, but 95% of routine diabetes care is delivered by patients themselves or by family members and carers. It is imperative that we offer people with diabetes concise, up-to-date education for effective foot care and to prevent complications.
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.