Frailty and Risks

Angie SzumlinskiNews

It goes without saying that as elders become frailer, there is a higher risk that their care needs may not be met. Think about the 90-year-old who is transferred to the ER by ambulance with a “bad headache”. This transfer begins a journey of new faces, new care providers, new surroundings, and the delirium that often accompanies it. The patient is a poor historian, hard of hearing and has vision loss, the parade of practitioners starts immediately upon arrival to the ER and continues for hours on end. The patient is poked at, prodded, x-rayed, questioned and basically “yelled at” because he can’t hear so staff raise their voices. Whew, did I say he was on a journey? To add insult to injury, a recent study published in BMC Geriatrics identified gaps in care coordination contributing to preventable adverse events in frail and intermediate frail older adults.

Let’s face it, seniors receive care from multiple ambulatory providers. Just the process of seeing multiple providers may be clinically appropriate but creates challenges for communication. Does frailty in and of itself play a role and increase the risk of adverse events? According to this study, yes, frailty is associated with an increased prevalence for self-reported gaps in care coordination and preventable adverse events. So, what exactly is “frailty”? It is a syndrome characterized by a decline in the overall function of multiple body systems and decreased resistance to stressors. These patients often have multiple chronic conditions and complex healthcare needs requiring multiple healthcare providers, increasing the risk of communication breakdown.

Sure, EHRs have made a difference in managing patients with multiple healthcare providers, but do you remember the “good old days” when Marcus Welby was the one and only provider of care? He treated everything from a stuffy nose to an amputation (maybe an exaggeration). He was the end-all and remembered everything about everyone including the name of their family pet. Those days are long gone, maybe that is a good thing as physicians become more specialized and “expert” in their specific field of medicine with the goal of providing better care. Do you still long for the good old days? Me too! That said, listen, it is time to pay attention, are you sure your staff are managing discharges and admissions properly? Are your nurses capturing the important nuances of each newly admitted resident? Are they sharing the important SBAR type of communication with the ER upon transfer? Are you sure? Take a journey of your own, walk through the process of admission and discharge, witness a full admission beginning to end, complete the discharge paperwork (under stress while the EMTs are looking over your shoulder). Now, are you still sure, you are sure? Stay the course, stay well, and stay informed!