Assessment Units for
Older People
Frazer Underwood
Consultant Nurse for Older Peoples Services
Associate Director of Nursing
Royal Cornwall Hospitals NHS Trust
 What
older people are we looking for?
• Care home admission deflections
• Selected long-term conditions
• Complex co-morbidity
• ‘Step-up’…but not step over the front door
• Day hospital assessment candidates
• ‘Sub-acute’ cases
• The Very Frail

What‘s frailty?
“The debate has centred on whether frailty
should be defined purely in terms of
biomedical factors or whether
psychosocial factors should be included”
Lally, F and Crome, P (2007) Understanding Frailty. Post Graduate Medical Journal. 83 pp16-20
THREE OR MORE:
Unintentional weight
loss
 Self-reporting
exhaustion
 Weakness (reduced
grip strength)
 Slow walking speed
 Low physical activity

TWO OR MORE

Inability to perform one or
more ADL in three days
before admission
Stroke in prev. three months
Depression
Dementia
History of falls
One or more unplanned
admission in prev. three
months
Difficulty walking
Malnutrition
Prolonged bed rest
Incontinence

BGS 2010 (Best Practice Guide 3.5)
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Fried LP, Tangen CM, Walston J, Newman AB, Hirsch
C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke
G, McBurnie MA; Cardiovascular Health Study
Collaborative Research Group. J Gerontol A Biol
Sci Med Sci. 2001 Mar;56(3):M146-56.

Finding the frail
 Kings' A&E over 75 risk assessment
• Waterlow (+ neurological deficit, mobility pre A&E,
trauma and pre existing medical conditions inc.
Clinical dehydration)

Davies-Gray M (2003) Nurse led fast track for vulnerable older people. Emergency Nurse 11(5). pp34-38
Assessing the frail
 Comprehensive
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Geriatric Assessment
BGS (2005) Comprehensive Assessment of the Frail Older Person in Hospital .BGS Website Compendium 3.5
BGS (2010) Comprehensive Assessment of the Frail Older Person. BGS website
Ellis, G and Langhorn, P. (2005) Comprehensive Geriatric Assessment for Older Hospital Patients. British
Medical Bulletin. 71. pp 45-59
Wrapping the system around…
Multi-factorial Interprofessional Assessment
Frail
Older
Person
A
C
U
T
E
Triage
Trajectory
Transfer
C
A
R
E
• Diagnostics
• Treatment
initiation
• Liaison
• Negotiation
• Plan
• Co-ordination
• Communication
C
O
M
M
U
N
I
T
Y
C
A
R
E
University Hospitals of Leicester
Frailty Unit
 Unit
set-up and evaluation
 Criteria
• Over 70 years old plus one of the following:
 Presence of delirium or dementia (AMTS)
 Fracture as presenting problem but medically
unstable (not NOF)
 Care home resident
 ED frailty score ≥ 25 (Waterlow+)
Royal Cornwall Hospitals
OPAL Unit
 Unit
set-up
• Single front door = shrinking MAU bed base (OPAL
Unit on MAU ward template)
• Establishing bed base from ED and MAU frailty data –
Frailty Tool (Waterlow+) (19 beds and ALOS = 72
hours)
• One geriatrician on unit 7/7 (plus 0.5 for OPAL Team
5/7)
• Specialist nursing and AHP team on unit
OPAL Unit
Triage
Frailty
Unit
Trajectory
Transfer