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New Portiuncula service enhances care for older persons

 Five women and one man standing indoors, four of the women wear green medical scrubs.

“The Frailty at the Front Door (FFD) Service provides great expertise in the assessment and management of older patients presenting to the Emergency Department (ED),” according to Dr Laura Bandut, Emergency Medical Consultant at Portiuncula University Hospital.

“They ensure that a multidisciplinary approach within the ED environment is developed, avoiding unnecessary admissions. The FFD team is a great addition to our ED team and has significantly enhanced the quality of patient care by putting in place appropriate follow-up and continuity of care for these patients in the community.”

Introduced in Portiuncula University Hospital to provide a holistic assessment and intervention to patients aged over-75 presenting with frailty to the ED, the FFD service identifies and assesses patients and provides individualised interventions. Many people present to the service following a fall or with changes in their ability to complete everyday tasks. Early comprehensive assessment can improve their healthcare outcomes and experience, and can support their further recovery at home.

The team consists of a Clinical Nurse Specialist, Senior Occupational Therapist, Senior Physiotherapist, Geriatric Medical Registrar, Therapy Assistant and Assistant Staff Officer.

The service commenced in September 2021 as part of the Enhanced Community Care programme (ECC) to improve and expand community health services and reduce pressure on hospital services. This year the FFD team has supported discharge directly home in 55% of older people assessed, by referring them to community services.

According to Lisa O’Looney, Senior Physiotherapist, studies have shown that “older adults are those most likely to visit a GP and to require inpatient hospital beds. For many frail older adults, a hospital stay may result in a loss of independence and a need for extra assistance on discharge. This team focuses on what matters to the patient. Most people identify a preference for recovery at home. By completing an early assessment we aim to support this wish by referring our patients to local community supports as needed. This year, so far, 25% of the patients using the service presented to the ED after a fall. Following an assessment by the team, factors contributing to falls and frailty were identified and measures were put in place to promote a safe recovery.

“Frailty is often recognised as decreased mobility, weight loss, muscle weakness and reduced energy levels. Frailty is not an inevitable part of ageing, and can be prevented, reversed or slowed down. The team supports older adults to live and age well by identifying drivers of frailty and by promoting physical and mental health in those at risk of becoming frail. The 2022 census reports that people are living longer and those aged over-85 are the fastest growing age group, so it is important to recognise and address the challenges faced by older people and to continue to support them to remain healthy at home.”

According to James Keane, Hospital Manager, the introduction of the service is part of their “on-going commitment to ensure that quality-of-care for the older person is a top priority. The team ensures that early multidisciplinary involvement is available at the front door and can provide an alternative pathway to hospital admission for many.”