This weeks #Otalk is on the topic of “Frailty, cancer and the role of OT” and will be hosted by Jeni Woods and Helen Bowker (@Jeni_Woods_OT and @Bowker_Helen).
Here is what they have to say…
The demographics of the UK are changing with more people living longer. There are over 11.8 million people aged 65 or over in the UK with this figure set to rise by approximately 40% over the next 17 years (Age UK 2017). One of the most significant shifts in the population is that more people are living beyond the age of 85 (ONS 2016, Age UK 2017).
An ageing population brings some major challenges for health and social care. The number of people living with longer term conditions and multi-comorbidities increases with age, all of which will impact on the individual’s engagement in occupational roles, ADLs and social participation (Macmillan 2012, Age UK 2017). Age UK (2017) state that by the time an individual reaches their late 80s, over one in three people have difficulty in manging five or more activities of daily living.
Macmillan (2012) reported that the UK had the worst survival rates in Europe for older people. Given that the UK is faced with an ageing population, who potentially are living with multiple comorbidities and long-term conditions, it is important to review how we support older patients through their cancer journey.
Handforth et al (2015) state that over half of older cancer patients have frailty or pre-frailty, which can have the following consequences: increased risk of mortality, post-operative complications and cancer treatment intolerances.
Frailty is commonly associated with ageing with the British Geriatric Society (2015) defining it as a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves.”
Frailty can have a significant impact on an individual’s ability to engage in activities of daily living. Frail older people often have more frequent unplanned admissions and readmissions, longer hospital stays, higher mortality rates and are more likely to require social care support on discharge (Age UK 2017, Torpy et al 2006, Oliver et al 2014)
This reinforces the need for health and social care professionals to evaluate the way that they support older patients through their cancer journey, through effective assessments and MDT working to improve outcomes and quality of care.
Frailty has the potential to impact many patients across their disease pathway journey, not just cancer. It is important for occupational therapists to share best practices in their field, so that we can promote the role of occupational therapy in supporting the nations ageing population to maintain their independence in undertaking ADLS, participating in occupational roles and social engagement.
Some questions to consider…
- How would you define frailty?
- What assessments do you use for identifying frailty?
- What outcomes do you use for older patients who are frail?
- Which occupational therapy models do you use to guide your practice with working with older patients?
- What can occupational therapists offer to supporting frail patients through their cancer journey?
- What examples are there of effective MDT working in your area that could support frailty?
- What training is available for occupational therapists for managing frailty?
- Age UK (2017) Briefing: Health and Care of Older People in England 2017. London: Age UK. Available at: http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/The_Health_and_Care_of_Older_People_in_England_2016.pdf?dtrk=true
- Age UK (2017) Later Life in United Kingdom. London: Age UK. Available at: https://www.ageuk.org.uk/Documents/EN-GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true
- Barnett K, Mercer SW, Norbury M, Watt G, Wyke S and Guthrie B (2012). Research paper. Epidemiology of multi-morbidity and implications for health care, research and medical education: across-sectional study The Lancet; 30(36): 37–43.
- British Geriatric Society (2015) Fit for Frailty. Part 2: Developing, commissioning and managing services for people living with frailty in community settings. London: BGS. Available at: http://www.bgs.org.uk/campaigns/fff/fff2_full.pdf
- Handforth C, Clegg A, Young C, Simpkins S, Seymour M, Selby P and Young J (2015) The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncology. 26(6): 1091-101
- Oliver D, Foot C and Humphries R (2014) Making our health and care systems for an ageing population. London: Kings Fund. Available at: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/making-health-care-systems-fit-ageing-population-oliver-foot-humphries-mar14.pdf
- Macmillan Cancer Support (2012) Age Old Excuse Report. London: Macmillan Cancer Support. Available at: https://www.macmillan.org.uk/documents/getinvolved/campaigns/ageoldexcuse/ageoldexcusereport-macmillancancersupport.pdf
- Office of National Statistics (2016) Overview of the UK Population: February 2016. London: ONS. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/february2016
- Torpy M, Cassio L and Glass M (2006) Frailty in Older Adults. JAMA 266(18): 2280