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anarrativeforcoordinatedsupportforolderpeople2Wealllikecategories.
Theyhelpusmakesenseoftheworldandfeelmorecomfortable.
Andsowehave'youngpeople';'middleagedpeople'and'olderpeople'.
Thesefamiliarcategoriesautomaticallyentreatustoconsiderdifferences.
Yetanextramoment'sthoughtmightredirectustoaviewthatanydifferencesareactuallysmallerthanthesimilaritiesofsharedhumanitybetweenthegroups.
Anolderpersonisnotanalienspecies–simplyour(former)selvesgrownolder.
Olderpeoplevaluetodaywhattheyvaluedyesterday–thatis:independence;liferoles;connectionswithfamily,friendsandcommunities;fun;challenges;etc.
,etc.
Whatneedstoberecognisedisnotthe'oldness'ofaperson,buttheirindividuality.
Itisthisindividualitythatcansoeasilybecomesubmergedandhiddenfromviewinthepressurecaldronthatcharacterisesourcontemporaryhealthandsocialcaresystem.
ThisOlderPeople'sNarrativeservestoremindusofvitalcorevaluestowhichweallmightlayclaim–butrestatedthroughtheeyesofanolderperson.
Inasense,itisashamethatthereisaneedtorestatethesevalues.
Butwearewhereweare.
Professionalsandserviceprovidersneedexplicitlytoreconnectwiththesecorestatements.
Thenarrativeisdesignedtolifttheindividualwithintheolderpersonlabelintoclearerfocus–notanalienbeing,butsimplyahumanbeingwhohaslivedlonger.
JohnYoungNationalClinicalDirectorforIntegration&FrailElderly,NHSEngland;HonoraryConsultantGeriatrician,BradfordTeachingHospitalsNHSFoundationTrust;Head,AcademicUnitofElderlyCareandRehabilitation,UniversityofLeedsPreface.
.
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anarrativeforcoordinatedsupportforolderpeople3Acknowledgements:ThisdocumenthasbeenjointlypublishedbyNationalVoices,AgeUKandUCLPartners,developedinpartnershipwithNHSEnglandthroughitsvoluntarysectorStrategicPartnersProgramme.
UCLPartnersprovidedsignificantresearchsupportandworkshoporganisation,whileAgeUKLondonconductedtheinitialliteraturereview,andhelpedarrangetheparticipationofmanyoftheinterviewees.
Acoregroupwascreatedtosteertheproject,includingUCLPartners,NationalVoices,AgeUKLondon,AgeUK(England),theBritishGeriatricsSociety,theAlzheimer'sSociety,ThinkLocalActPersonal,andolderpeople'srepresentatives.
Thankyoutoallwhoparticipatedinthesurveyandworkshops,toallofthedaycentres,hospitalsandcommunityhealthserviceswhoassistedwiththerecruitmentofparticipants,tothosethatvolunteeredtimetohelpwithinterviewing,andtotheolderpeoplethemselvesforsharingtheirexperiencesandstorieswithus.
Thisreportwaswrittenby:DonReddingPolicyDirector,NationalVoicesTomGentryPolicyAdvisor,AgeUKJennyShandDirector,IntegratedCo-morbiditiesProgramme,UCLPartnersLauraStuartFrailtyProgrammeManager,UCLPartners.
Published:December2014Preface2Contentsandacknowledgements3Introduction4TheIstatements6Researchmethods7Whatmattersmosttoolderpeople:keythemes8UsingTheIstatements12The'frailty'challenge14Contents:4Thesetofnarrativestatementspublishedinthisdocumentdescribesthewayolderpeoplewanthighqualitycoordinatedcaretosupportthem.
ThisdocumentisintendedtobeusedasanextensiontotheNarrativeforpersoncentredcoordinatedcare1publishedbyNationalVoicesandThinkLocalActPersonal,inMay2013.
Togethertheywillhelpcommissionersandproviderstoworktogetherwitholderpeople,todesigncareandsupportthatwillbesuccessfulinachievingtheoutcomesthatmattermosttothem.
WhyolderpeopleWhynowOurpopulationisageingbyfivehoursaday2.
ThenumberofpeopleintheUKovertheageof85issettodoubleinthenext20yearsandtrebleinthenext303.
Asaconsequenceolderpopulationswillformagrowingproportionofoursociety.
75%of75yearoldshavemorethanonelong-termcondition,risingto82%of85yearolds4.
Themajorityofolderpeoplemaythereforehavemultiplephysicalandmentalhealthneedswhichrequireinputfromacrossprimarycare,secondarycaresettingsandsocialcare.
Forolderpeoplelivingwithfrailtyorcomplexneeds,healthandqualityoflifeisvulnerabletosuddenchanges.
A'triggerevent'suchasafall,orachangeincircumstanceslikethelossofacarer,canresultinarapiddeteriorationinhealthandsignificantlossofindependence.
Itmayalsoleadtosharpincreasesinthecostsofcare.
Withbettercareplanningandmoretailoredsupport,manysuchepisodescouldbeavoided,ortheneedcouldatleastbeanticipatedandbettermanaged.
Therefore,itisbecomingapriorityforhealthandsocialcaresystemstolookathowtheyrespondtotheneedsofolderpeople.
Inparticular,howtheyidentifypeoplewhoareatriskofsuchcrisesandhowtheythenensurethatproactivestrategiesareinplace.
Thisenablesservicestointerveneearlyandsupportpeopletoavoiddistressingemergencies,whichtypicallycarrywiththemasubstantialhumanandfinancialcost.
WhyadditionalstatementswereneededTheNarrativeforpersoncentredcoordinatedcarehasprovidedasingle,commoncross-systemdefinitionofthegoalsforcareintegration.
Itwasconsciouslydesignedtobe'generic'andequallyrelevanttoallgroupsofpeoplewhoneedtousemultiplehealthandcareservicesovertime.
Thisgenericapproach,however,mightexcludesomefactorsinthecareofolderpeoplethatareverysignificanttothem,butdonotalwaysapplytoothergroups.
NationalVoices,UCLPartnersandAgeUK,workingwithotherpartnersandwitholderpeoplethemselves,setouttoexaminewhetherthiswastrue.
Welookedparticularlyatolderpeoplewhomightbevulnerabletosuddendeteriorationintheirhealth,possiblyincludingcrisisorhospitaladmission.
Theymightbedescribedbyprofessionalsas'frail'–but,aswediscusslater,thisisatermthatolderpeoplethemselvesreject.
Similarpiecesofworkwithothergroupsofserviceusers–suchaspeopleusingmentalhealthservices–resultedinquiteextensivenewsetsofIstatementsgivingtheirparticularperspectivesontheircareandsupport.
5Witholderpeople,therewasadifferentneed.
AlthoughwefoundthatthedomainsandstatementsintheexistingNarrativewererelevanttothem,theolderpeoplewespoketowerelessconcernedaboutthespecificshapeortypeofserviceprovision,andmoreconcernedabouttheoutcomesthatmatterinrelationtolivingtheirlives.
ThisnewNarrativeseekstoarticulatetheseoutcomes,andweurgecommissionersandproviderstoconsideradoptingthesestatementsalongsidethegenericNarrativeasthegoalsofcareforolderpeople,particularlythosewithcomplexneeds.
Introduction51NationalVoices&ThinkLocalActPersonal(2013)ANarrativeforPerson-CentredCoordinatedCare.
http://www.
england.
nhs.
uk/wp-content/uploads/2013/05/nv-narrative-cc.
pdf2Kirkwood(2006)TooFastByMistake.
Nature444:1015-10163OfficeofNationalStatistics(2013)NationalPopulation2012-basedStatisticalBulletin.
London:ONS.
http://www.
ons.
gov.
uk/ons/dcp171778_334975.
pdf4Mercer(2011)TheScottishSchoolofPrimaryCare'sMultimorbidityResearchProgramme.
http://www.
slideserve.
com/ryann/multimorbidity-in-scotland5NationalVoices&ThinkLocalActPersonal(2014)NoAssumptions:ANarrativeforPersonalised,coordinatedcareandsupportinMentalHealth.
http://www.
england.
nhs.
uk/wp-content/uploads/2014/08/no-assumps-mh.
pdfINDEPENDENCE"IcangotobedwhenIwant,getupwhenIwant.
Icanthinkformyself.
Idon'trelyonotherpeople,aslongasI'vegotmymobility.
"56TheIstatements.
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anarrativeforcoordinatedsupportforolderpeople6.
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anarrativeforcoordinatedsupportforolderpeopleIamrecognisedforwhatIcandoratherthanassumptionsbeingmadeaboutwhatIcannotIamsupportedtobeindependentIcandoactivitiesthatareimportanttomeWhereappropriate,myfamilyarerecognisedasbeingkeytomyindependenceandqualityoflifeIndependenceIcanmakemyowndecisions,withadviceandsupportfromfamily,friendsorprofessionalsifIwantitDecisionmakingIcanmaintainsocialcontactasmuchasIwantCommunityinteractionsIcanbuildrelationshipswithpeoplewhosupportmeIcanplanmycarewithpeoplewhoworktogethertounderstandmeandmycarer(s),allowmecontrol,andbringtogetherservicestoachievetheoutcomesimportanttomeTakentogether,mycareandsupporthelpmelivethelifeIwanttothebestofmyabilityCareandsupport7Inordertodevelopaspecificnarrativeforolderpeople,reflectingthedifferentperspectivesandpreferencesofthatpopulationgroup,weneededtoinvesttimelisteningtothem,askingthem'Whatmattersmosttoyou'andreflectingonthekeythemesthatemerged.
Theresearch,carriedoutbetweenMay2013andMarch2014,included:Aliteraturereviewofexistingresearchandmaterialstounderstandcorethemesandprovideafoundationforinterviewstobuildon.
Publishedandgreyliteraturewasincludedthatcontainedthesearchterms:olderpeople,frailty,frail,vulnerable,[and]person-centred,outcomes,careneeds.
Anonlinesurveyandtwofocusgroupstogathertheperspectivesofhealthprofessionals,systemleaders,carersandolderindividuals,bothreflectingontheexistingNarrativeforcoordinatedcareandsuggestingadditionalthemesandstatementsthatarerelevantforolderpeople.
43peopleparticipatedinthefocusgroupsand28respondedtotheonlinesurvey.
EthnographicresearchconductedbyIPSOSMorionbehalfofAgeUKtoexploretheexperienceoflivingwithfrailty6.
Theresearchersspentaround30hourswithfivehouseholds,seeingtheimpactoflivingwithfrailtyandsomeofthewaysolderpeopleadaptedtolivewithchangingneeds.
1:1interviewswitholderpeopleexploringthethingsthataremostimportantintheirlives;theirexperiencesofaccessingservicesandsupport;andattitudestoterminologysuchas'frail','old','elderly','older'.
74semi-structuredinterviewswereconductedwithparticipantsagedover75years,eachlastingonaverage25minutes.
IntervieweeswererecruitedfromAgeUKdaycentres(51%),hospitalwards(42%),house-boundGPpatients(4%)andAgeUKbefriendingservices(3%).
Purposivesamplingwasusedtoensurethatthecohortwasvariedintermsof:functionalability,levelofsupportreceived,cognitiveability,age,culturalandethnicgroups,socialclasses,urbanandruralsettingsandlivingarrangements.
6IPSOS/MORI(2014)Understandingthelivesofolderpeoplelivingwithfrailty:Aqualitativeinvestigation.
IPSOS/MORIforAgeUKhttp://www.
ageuk.
org.
uk/frailtyResearchmethods1234Interviewresearchcohort:Averageageof84Ethnicityofparticipantsfellmid-waybetweenfiguresforLondonandEnglandasawhole(WhiteBritish:80%,Indian:7%,Black:6%,Other:7%)63%livedalone(includinginshelteredhousing),18%livedwithfamily,8%livedwithapartnerand4%hadotherarrangements(7%unknown)42%ownedtheiraccommodation,31%rented,3%other(24%unknown)28%wereindependentlymobile,68%wereindependentwithawalkingaid,and4%werenotmobile.
47%hadformalsupportpackagesinplace.
23%hadnoformofsupport(formalorinformal)(30%unknown).
8Independence:Independencewasdescribedbythemajorityoftheolderpeoplewespoketoasoneofthemostimportantthingstothem.
Formostthismeantbeingableto'dowhatIwant,whenIwant'and'gettingoutandabout'.
Supportfromeitherfamilyandfriendsorformalcarerstomaintainalevelofindependence,particularlywhenmobilitywaslimited,wasnotseentoimpactperceivedindependence.
Inboththeinterviewsandethnographicwork,peoplewhoweresupportedandabletoadapttochanginghealthneedswereabletoenjoyabetterqualityoflife.
Theirperceptionsoftheirownhealthandperceptionsoftheirindependencedidnotnecessarilycorrelate,suggestingthatolderpeopledonotwanttobedefinedorlimitedbytheirdiagnoses.
Therecanbeatensionbetweenindependenceandsafety.
Whilstseveralstudiesintheliteraturereviewspokeaboutindependenceandsafety,theydidnotdelveintothemeaningoftheseandmanystudiesappearedtobevery'problemfocused'ratherthanlookingatthepeoplewithfrailtythemselvesasindividuals.
Beingabletodoactivitiesthatwereimportanttothem,alsohelpedtomaintainasenseofachievementandidentity.
Forexample,manyintervieweesdescribedgreatprideindoingthewashing-uporhouseworkanddisappointmentwhenthesehabitualtasksweretakenoverbycarers.
Theworkshopparticipantssuggestedthatindependencewasaboutmorethanattendingtothebasicactivitiesofdailyliving–butaboutbeingabletodoactivitieswhichweremeaningfultothemandevenhavingtheopportunitytotrynewactivities.
Communityinteractions:Manyoftheolderpeoplewespoketosaidthattheydidfeelpartoftheircommunity.
Buttherewasalsoasenseofpeoplewantingtohavecontrolovertheamountofsocialcontacttheyhad–somewantedmuchmoresocialcontactbutothersvaluedtimealone.
Manydescribedfeelingsofloneliness.
Manysaidthattheymissedfriendswhohaddiedandinsomeinstances,therewasresignationthattheycouldnolongerexpecttohavepeerrelationships.
Thiswasoftenassociatedwithlosingapartner.
Surprisingly,intheinterviewcohorttherewasahighercorrelationofself-reportedlonelinessinthosethatlivedwithfamilythanthosewholivedaloneandthereforefelttheyneededtomaketheeffortforsocialinteraction.
Thishighlightsthathavingfrequentsocialcontactisnotenoughtopreventfeelingsofloneliness.
Decisionmaking:Individualswantedtoretainchoiceandcontrolofdecisionmaking.
Howevermanyalsodescribedthedesireforclearguidanceandsupportfromprofessionalsandfamily.
Inmanyinstancesfamilywerethefirstportofcallforbothaccessingsupportandfordiscussingdecisions.
Whatmattersmosttoolderpeople:keythemes9COMMUNITYINTERACTIONS"IfeellonelywhenIgetupinthemorning.
Ihatemornings…youwanttotalktosomebodyaboutsomething,oryouthoughtofsomethinginthenight,orsometimessomethinghappened,whenyouwalkintothehouseandyouwanttotellsomebodyandthere'snobodyheretotell.
"CAREANDSUPPORT"IlikethecompanyofthemcomingintomyhomeandIfeelshe'spartofitnow…Iwishshehadmoretime.
"10.
.
.
anarrativeforcoordinatedsupportforolderpeopleDECISIONMAKINGCOMMUNITYINTERACTIONS"Ijusthavethetelevisionforcompany.
"CAREANDSUPPORT"Iliketobeknownbymynameandnotthatoldwoman.
"10"Wellyou'renotincontrolofyourhealthbecausethingshappentoyou.
…Ithinkit'simportantthatyoudomakeyourowndecisionsbutatthesametimeyouhavetolistentoaprofessional,that'swhatthey'retherefor.
"11Careandsupport:Boththeworkshopandtheinterviewparticipantsemphasisedthesocialaspectsofcareinadditiontothepracticalcomponents.
Peopleoftendescribedtheirsatisfactionordissatisfactionwiththeircareintermsofpersonalrelationshipsratherthantheactualcarethatwasbeingdelivered.
Itisimportanttonotethattheolderpeoplewespoketodidnotgenerallydrawadistinctionbetweenhealthandsocialcaresupport;theysawtheirsupportasoneentity.
Thereappearedtobelimitedawarenessordiscussionofformalcareplansandalthoughsomeintervieweessaidthattheyhadthoughtaboutthefuture,thiswasseldomwithregardstoadvancecareplanningorendoflifecare.
Mostparticipantsreferencedthefuturewithregardstoplansinplaceforsupportingfamilyintheirabsence,funeralarrangements,ormoregenerallyasaninevitabilityoverwhichtheyhadnocontrol,andthereforeadesireto'takeonedayatatime'.
Tosummarisewhatwasimportantintermsofcareandsupport,thesurveyandworkshopparticipantsfoundthecompositestatementsfromtheexistingnarrativeveryuseful,hencethesewerecarriedintothecareandsupportsectionofthisnarrative.
Terminology:Thereweremixedviewsontheterms'old'and'elderly',but'frailty'wasalmostuniversallyrejected.
Thoughtherewassomesensethatitcouldberecognisedinothers,peopledidnotseeitasawaytodescribethemselves.
COMMUNITYINTERACTIONS"Imisssocialinteractions.
Idon'tmeangoingoutwhatever,Imeanhavingagoodconversation.
"DevelopmentoftheIstatementsTheIstatementswereinitiallydraftedbythesteeringgrouparoundtheabovekeythemesthatemergedfromtheliteraturereview,thesurveyandtheworkshops–butwithparticularreferencetowhattheolderpeopleweintervieweddescribedasbeingmostimportanttothem.
Thenarrativewasthenreviewed,revisedandverifiedthroughfurtherdiscussionswitholderpeople.
Thegroupfeltitwasessentialtoensurethatthenarrativereflectedtheviewsofolderpeopleandthatthestatementsresonatedwiththem.
12Theresearchweconductedforthisnarrativeilluminatesthechallengesoflong-termconditionsandfrailtyfromtheperspectiveofolderpeoplewithcareandsupportneeds.
Thisposessomekeychallengesforhealthandcareservices.
Perceptionofhealth:Aneffectiveapproachtosupportingolderpeoplelivingwithfrailtyisnotsimplyabout'managinglong-termconditions'.
Whileolderpeoplerecognisetheconstraintsthattheirhealthconditionssometimesplaceontheirlives,theyhavetoldusthattheydonotidentifythemselvesbytheseconditionsandthattheyarefocusedonlivingtheirlives–notonapreoccupationwiththeirhealth.
Thisimpliesthattherewillbelimitstothesuccessofstrategiesthatseektoengagepeopleonlythroughtheirmanagementoftheirhealth.
Useofcareservices:Peopledonotpicturetheirlivesinrelationtotheiruseofcareservices.
Indeed,whenaskedaboutwhowouldbetheirfirstpointofcontactforahealthproblem,veryoftenpeopleciteafamilymember(e.
g.
theirspouseorchild)astheirprincipaladviserandthepersonwhowouldmake,orsuggestmaking,contactwithservices.
Thisimpliesbothaneedformainstreamservicestoestablishproactiveoutreach;andaneedtoworkcloselywithfamilymembersandinformalcarersinsupportoftheperson.
Independence:Althougholderpeoplewanttobeabletogetsupportwhentheyneedit,theyalsowanttoremainasindependentaspossible.
Thevalueofcareandsupportisthat,astheIstatementsays,it'help(s)melivethelifeIwanttothebestofmyability'.
Thiscanpresentachallengeinthatrehabilitationservicesareoftenstretchedandtherecanbeaperceptionthatitisquickerforstaffto'dosomethingto'apersonratherthanencourageindependence.
Therecanalsobea'riskaverse'attitudeamongbothhealthandsocialcarestaffandolderpeople'sfamilies,whichresultsinpeoplebeingdiscouragedfromparticipatinginactivitiesofdailylivingwhereitisfeltthattheremaybeaperceivedrisktotheirsafety.
Socialsupport:Theresearchhasalsohighlightedtheimportanceofsocialsupport–bothaspartoftheircommunitybutalsoinrelationtofeelingthattheyhaveapersonalandsocialrelationshipwiththehealthandcareprofessionalswithwhomtheycomeintocontact.
Thispresentsachallengeintermsofthetimethathealthandsocialcarestaffhaveavailable.
UsingtheIstatementsINDEPENDENCE"I'mindependentbecauseI'mlivingmyownlifeinmyownhomeandIloveit.
I'mninetytwoandIcanstilldothat.
Icallthatindependence.
"13ItisintendedthattheseIstatementswillbeusedtoencouragehealthandsocialcareservicestoworktogethertofocusontheoutcomesthatareimportanttoolderpeopleintheirpopulation.
WewouldencouragepeopleworkingwithinhealthandsocialcareservicestoreflectontheissuesidentifiedintheIstatements.
Forexample:ArewehelpingpeopletomaintainindependenceAreweenablingolderpeopletobuildandmaintainrelationshipswiththeirprofessionalsandpractitionersHowtoreachouttopeopleinwayswhicharenotsolelydominatedby'healthmanagement'considerationsHowtoworkwithfamilyandinformalcarersandsupportersHealthandsocialcareservicesshouldalsoreflectonwhethertheyaremeasuringwhatisimportanttoolderpeople.
Forexample,maintainingindependenceandsocialinteractionarerecognisedinsocialcarebutarelesslikelytobeseenasoutcomesbywhichmainstreamhealthservicesandpractitionersjudgetheirsuccess.
Thiswillhavetochange.
DECISIONMAKING"Italkitoverwithmydaughter…she'soneofthosethataslongasyouwanttobeindependent,she'llletyoube.
Ifshethoughtsomethingwasradicallywrong,shewoulddosomething.
"COMMUNITYINTERACTIONS"I'mextremelylonely.
Imissmywife.
"14Asdiscussedintheintroductionwehaveanageingpopulation,andacrossEnglandlocalareasareprioritisingcareandsupportforolderpeople.
Tohelpidentifyolderpeopleatriskofpoorhealthoutcomes,considerableeffortisnowputintobetterdefining'frailty',inthehopeofmanagingitasalong-termhealthcondition.
TheBritishGeriatricsSociety(BGS),inassociationwithAgeUKandtheRoyalCollegeofGPs(RCGP),hasproducedguidanceonrecognisingandmanagingfrailtyoutsideofhospital.
7Akeyfeatureoffrailtyisthatitdescribesapersonatahigherriskofasuddendeteriorationintheirphysicalandmentalhealth.
Thiswillincludepeoplewhocouldotherwisebeverystableandlowusersofhealthservices.
Itwillalsoincludepeoplewhorequirehighlevelsofsupportandmaybeattheendoftheirlives.
Recognisingaspectrumofneedthatoverlaps,ratherthanduplicateslong-termconditionsmanagementisanimportantmessage.
Asasystem,thismeansthathavingfrailtyinmindwhenidentifying,assessingandplanningcareneedswillbevitaltoachievingbetteroutcomesforolderpeopleandpreventingtheneedforcrisisoremergencycare.
Afoundationofgoodpracticewillmeancoordinatingolderpeople'ssupportneedsacrossalloftheagenciesandpeopleinvolvedintheircare,includinginformalcareandsupportaswellasthatprovidedbyvoluntaryandcommunitysectorgroups.
Callforanationaldialogueonfrailty:Thisresearchhasfocusedonaskingolderpeoplewhatmattersmosttothemandithasremindedusthattheolderperson'sperceptionofwhatconstitutesgoodhealthorfrailtyisoftenverydifferenttotheclinician'sperspective.
Evenpatientswithanumberofhealthconditions,whowemaydescribeasbeingfrail,didnotassociatethemselvesassuch,andwantedtobesupportedtobeasindependentaspossible.
Significantly,olderpeoplehavetoldusthattheydonotliketheterm'frail'or'frailty'andveryfewwishedtodescribethemselvesusingtheseterms.
Infact,thisnarrativewasoriginallyabout'frail'olderpeople,butwesoondroppedthatwordinthefaceofitsrejectionbytheverypeoplewewereworkingwith.
Thispresentsuswithadilemma:HowdoweensurethatweidentifyfrailtyasatriggersothatpeoplearereferredappropriatelywithinthehealthandsocialcaresystemAndhowdowedothisinawaythatisacceptableforolderpeopleandenablesthemtoworkinpartnershipwiththeirprofessionalsHealthcommissioners,practitionersandservicesmaybeinvestinginfrailtystrategiesthatriskbeingrejectedbythepeoplewithwhomtheyareseekingtoworkinpartnership.
Wearethereforeissuingacallforanewnationalconversation.
Weneedtounderstandbetterhowolderpeoplewithhealthconditionsandthosewhosejobitistocommissionandprovidetheircareservices,canfindacommonlanguageandprinciplesforworkingwitheachother.
Itisvitalthatthisconversationcontinuestobeledbytheviewsofolderpeople.
7BritishGeriatricsSociety(2014)FitforFrailty.
http://www.
bgs.
org.
uk/campaigns/fff/fff_full.
pdfThe'frailty'challenge"Iidentifywithgettingolder.
I'mnotfrail.
"CasestudyThechallengeofdefiningfrailtyThisisKen.
Kenmayhavebeendescribedasfrailbyclinicians.
Whenwemethim,hewas100yearsold,hadanumberofco-morbiditiesandwasclosetotheendofhislife,passingawayjustafewweekslater.
.
.
However,hedidnotidentifyhimselfasbeingfrail.
Helivedalonewithonlydomesticassistance.
HeusedaniPadandwenttoPilatesclassestwiceaweek.
Hedescribedhishealthas'prettygood'andsaidthatindependencetohimmeant'doingthingsforothers'PicturecourtesyoftheHemelHempsteadGazette.
ManythankstoKen'sdaughterforherkindpermissiontosharehisstory.
"nobodycallsmefrail.
"15UCLPartnersisaleadingacademichealthsciencepartnershipthatsupportsthehealthcaresystemservingoversixmillionpeopleinpartsofLondon,Hertfordshire,BedfordshireandEssex.
MemberorganisationsfromhighereducationandtheNHShavecometogetherthroughUCLPartnerstoimprovehealthoutcomesandcreatewealthforthelocalpopulationatscaleandpace.
Website:www.
uclpartners.
comE-mail:contact@uclpartners.
comTwitter:@UCLPartnersNationalVoicesisthenationalcoalitionofhealthandsocialcarecharitiesinEngland.
Weworktogethertostrengthenthevoiceofpatients,serviceusers,carers,theirfamiliesandthevoluntaryorganisationsthatworkforthem.
Website:www.
nationalvoices.
org.
ukE-mail:info@nationalvoices.
org.
ukTwitter:@NVTweetingAgeUKisthecountry'slargestcharitydedicatedtohelpingeveryonemakethemostoflaterlife.
Theover-60sisthefastest-growinggroupinsocietyandtherearemoreofusthaneverbefore.
AtAgeUKweprovideservicesandsupportatanationalandlocalleveltoinspire,enableandsupportolderpeople.
Westandupandspeakforallthosewhohavereachedlaterlife,andalsoprotectthelong-terminterestsoffuturegenerations.
Website:www.
ageuk.
org.
ukE-mail:contact@ageuk.
org.
ukAdviceLine:08001696565Twitter:@age_uk