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<p>Getting It Right First Time (GIRFT), in conjunction with the British Geriatrics
Society, published <em>Six Steps to Better Care for Older People in Acute Hospitals</em>,
which accompanies the GIRFT hospital acute care frailty pathway. A copy of the document
is attached.</p><p>The acute care pathway recommends that all older patients admitted
to hospital as an emergency are assessed for their degree of frailty using a standardised
assessment, namely the Clinical Frailty Scale. For patients identified as living with
moderate or severe frailty, the pathway recommends a multidomain assessment, namely
the Comprehensive Geriatric Assessment, and links this to functional optimisation,
which would commonly include physiotherapy assessment supporting recovery or maintenance
of mobility.</p><p>Ongoing support to patients to prevent hospital-acquired deconditioning
should be supported by the whole ward team after physiotherapists have recommended
appropriate intervention.</p><p>The Six Steps to Better Care guidance makes similar
recommendations for older patients admitted to hospital for planned care. As part
of GIRFT's ongoing review and support, implementation of these recommendations is
reviewed at individual hospital trusts, including the staffing levels of older person
multidisciplinary teams, which include physiotherapists.</p><p>In addition, GIRFT
recommends the development of Advanced Care Practitioners (ACPs) specialising in frailty.
Some trusts have development programmes to support training of ACPs, although there
is variation in provision.</p>
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