Flow Navigation Centre (FNC) and Emergency Department (ED) Frailty Pathway

1. Age:

• Aged 65 years or older

2. Clinical Frailty Scale (CFS)

• CFS 6 or above (moderate to severe frailty)
  
  • Must not meet any exclusion criteria (see below)
• CFS 5
  • Admission must be primarily due to frailty
  • Must present with at least one frailty syndrome, such as:
    • Falls
    • Reduced function
    • Delirium or Cognitive impairment (excluding delirium tremens)
    • Carer strain
    • Must not meet any exclusion criteria (see below)

3. High NEWS

• A high NEWS score (NEWS >5) does not automatically exclude admission
• Patients must have:
  • Documented escalation plan
  • Decision not for ITU/HDU
  • Not met any of the exclusion criteria (see below)
  • Please discuss with senior FAU nurse/ACE team if patients condition is of high concern prior to transfer

Exclusion Criteria:

• New or suspected acute stroke
• Cardiac presentations requiring acute intervention or urgent cardiologist review
• Potential surgical or orthopaedic intervention/operation
• Need for procedures such as; lumbar puncture, pleural tab and chest drains
• Patients requiring or potentially requiring ITU or HDU
• Clear priority clinical need for a speciality other than frailty

If there are any concerns or questions regarding a patient’s suitability for transfer, please contact the FAU/ACE team for discussion and guidance.

What is the CFS?

The Clinical Frailty Scale scores functional baseline from 1-9, based on a person’s independence with daily activities.

In older adults, increasing dependence on others for Activities of Daily Living (ADLs) is usually a sign of increasing frailty.

Why Use the CFS in Hospital?

Frailty scores can be used to guide medical decisions regarding risk vs benefit from interventions – including hospital admission itself.

Selected patients with higher frailty scores benefit from frailty-specialised wards (Frailty Assessment Units in NHS Lanarkshire) for Comprehensive Geriatric Assessment.

How to Use the CFS

• Score based on baseline (not current) function – normally 2 weeks prior to presenting acute illness
• Scoring requires accurate information – obtain collateral, clarify specifics – who helps, with what tasks?
• Do not use CFS for patients younger than 65
• Assess carefully if disability existed prior to age 65 – CFS should reflect deteriorating function with age. (Do not assume all patients with carers are frail once they turn 65)

The CFS Scores Summarised

More detailed descriptions for each point on the scale are provided on the Medicine for Older Adult Frailty Scale screening tool (available on FirstPort).

Scoring Frailty in People with Dementia

The degree of frailty generally corresponds to the degree of dementia:

• Patients with mild dementia require minimal assistance from others for ADLs.
• In moderate dementia, recent memory is impaired but they can do personal care without prompting.
• In severe dementia, patients cannot do personal care without help.
• In very severe dementia, patients are often bedbound. Many are virtually mute.