Uncomfortable with Everything
Since 2008, Our Mission has been to leverage frailty-driven solutions to improve clinical and financial outcomes. Our Vision has been to make frailty the global standard of care.
Best practices in geriatric medicine call for an understanding of the concept of frailty. As clinicians, we needed tools to assess frailty as easily and efficiently as possible. We want all disciplines caring for those who are frail to understand this and to embrace frailty assessments and frailty-drive solutions as a way to improve the quality of care provided and outcomes for patients.
Internationally, frailty is routinely considered in the care of chronically ill patients. Decades of research support using frailty to determine risk, to frame person-centered decisions, to support advance care planning, and identify patients in need of our attention to prevent adverse outcomes where possible.
It seems ethically appropriate to care for our patients using best practices and evidence-based medicine. As a company, these facts fed our innovation; but as is often the case with change in healthcare, buy-in takes time.
Then COVID-19 Happened
Within weeks of the arrival of this virulent infection, frailty was front and center of many papers and publications about COVID-19. People with chronic illnesses were getting sick and dying at higher rates than those who were younger and less likely to have multiple diagnoses. Since frailty occurs when chronic illnesses increase and impact function and cognition, it’s not surprising that research was identifying frailty as the highest risk for contracting the infection and dying.
During the same time frame, the NICE Rapid Guidelines for Urgent Care Assessments recommended screening people for frailty as part of a more comprehensive evaluation. This was considered as the best metric of risk for knowing who would be able to withstand the aggressive care associated with a respirator and others who may be harmed. There was pushback from many who were uncomfortable with any attempt to triage or limit care.
Nevertheless, screening for frailty remained a more frequent suggestion in literature and an explanation for why so many long-term care residents were dying from COVID-19.
Covid-19 brought crisis-fed change with alacrity rarely seen in healthcare. Goals and outcomes fueled change. Necessity drove decisions. Practices sought for years occurred. No one was comfortable with everything, and many disagreed with change. Still, we learned to accept change. Organizations that survived and remained strong during the pandemic were those that embraced flexibility and innovation.
As vaccinations against COVID-19 are underway, infection control practices are being revamped, and experts are considering how to provide better healthcare for older adults, we all need to remember the lessons of the pandemic and become more comfortable with change in healthcare. And this means ensuring that our practitioners and care teams understand the role frailty plays in treatments, outcomes, and care planning. They need to know how to assess frailty, consider how it may impact patient prognosis and the trajectory of illnesses and conditions, and how to have productive, open, and transparent conversations about this with patients and families. This may be unfamiliar territory for some, but this needs to be part of the post-pandemic change.
This opinion is well articulated in a recent article, and the author – a physician — calls for courage and decisiveness as we change healthcare in a post-pandemic world. At Patient Pattern, our mission and vision are as alive as ever and frailty continues to be recommended as a tool for informing clinical decisions and allocating scarce resources.