Content area
Full Text
1. Introduction
Frail older people are vulnerable due to their loss of physiologic reserve across multiple organ systems, and can experience disproportionate loss of functional ability even when hospitalised for a relatively minor illness [1,2,3]. Delays to the clinical decision-making process have been found to prolong hospital stays exacerbating the problem further [4,5]. The literature suggests the best approach to prevent functional loss amongst older adults is to provide a comprehensive multidisciplinary integrated response [6]. For the majority of older persons in Ireland, the emergency department (ED) is the ‘front door’ of entry to acute care. A recent Department of Health special delivery unit report demonstrated that people aged over 65 year’s account for over one-third of ED attendances [7]. As older people often have complex requirements, the Irish healthcare system needs to adapt to meet these requirements, especially since the demand will increase as the population ages [8,9,10]. Recent attention has focused on identifying the best pathways for treating frail older patients. Previous studies illustrate the importance of continuing organizational support, clinical champions who communicate regularly with decision makers, dedicated staffing, and ongoing data collection [7,11].
One approach to improve pathways of care of frail older people is via the establishment of an acute frailty unit providing a multidisciplinary approach to care. Several units in the United Kingdom have assessed the benefits of acute frailty units (AFUs) demonstrated reduced admissions, shorter length of stay, avoidance of admission and increased percentages of admission <24 h [12]. Whilst the evidence that is emerging is positive very little information is available regarding the implementation of these strategies within the Irish context. We aimed to respond to this by undertaking a rapid realist review (RRR) of the literature as part of the Systematic Approach to Improving Care for Frail Older Patients (SAFE) study [13]. The aim of SAFE is to develop and explore the process of implementing a model of excellence in the delivery of patient-centred integrated care within the context of acute presentations of frail older people [13]. The project is funded by the Irish Health Research Board applied partnership award (APA). The grant specifications influenced the design of the study where the research must be applied by the knowledge user organizations [14]. The award supports projects...