Development of a frail older peoples’ advice and liaison service

Principal Investigator: Dr Simon Conroy

Other Key Staff: Dr Kay Phelps, Dr Emma Regan, Professor Richard Baker, Dr Liz Anderson, Nicola Clague-Baker, Janette Camosso-Stefinovic, Lorraine Pollard, Aidan Dunphy, Dr Paul Sinfield, Dr Gemma Viggars, Dr Nainal Shah & Ms Mei Yee Tang

Partners Involved: University Hospitals of Leicester NHS Trust, University of Leicester

Summary:
Frail older people comprise approximately 3% of all Emergency Department attendees at any one time, 10% of all patients on the Acute Medical Unit and a much higher proportion of patients on base wards within our hospital (University Hospitals of Leicester). Frail older people tend to have the longest length of stay and the highest rate of in-patient complications. This is in part related to the nature of the population – who tend to have multiple comorbidities, polypharmacy and cognitive impairment. But in part the high admission rate reflects diagnostic uncertainty in this patient group, who frequently present non-specifically.

This project concerns the development of a frail older peoples’ advice and liaison (FOPAL) service. The purpose of this service will be to deliver Comprehensive Geriatric Assessment (CGA) to frail older people attending the acute medical unit at Leicester Royal Infirmary. This developmental phase will identify important issues that may play a significant role in determining the success or failure of the intervention, as well as informing future trial design.

The project consists of four stages:

1. Review the literature on liaison services aiming to deliver CGA.
2. Define, describe and refine the FOPAL team using an action research framework including interviews, audit and case reports.
3. Assessing fidelity of the intervention
4. Assessing team impact

Aims:

• To develop a multidisciplinary team to support the needs of frail older people attending the acute medical unit at the Leicester Royal infirmary.
• To carefully describe the roles, facilitating and inhibitory factors involved in developing an interdisciplinary team
• To prepare the ground for a controlled evaluation of the service

Further Information:
Age UK and care home representatives will provide patient and public insight to this study. For more information about this project please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Start Date: March 2011                                                                                       Expected End Date: September 2011

Project Outcomes:
Development of a Frail Older People’s’ Advice and Liaison Service - This developmental phase will identify important issues that may play a significant role in determining the success or failure of the intervention, as well as informing trial design

This work will inform the evaluation of the liaison service using an RCT design, which is justified in view of the clinical pressures, the balance in research evidence (for or against), and the lack of robust information of cost-effectiveness. An additional outcome of this phase will be a clear description of ‘usual care’.