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Evaluating and improving care

Multimorbidity

Multimorbidity refers to individuals living and dying, most commonly in advanced age, with increasing frailty and chronic contributing conditions. Frailty is the most problematic component of population ageing[1]. Physiological decline is a natural component of ageing. In frailty this process accelerates determined by past individual and environmental stressors, and the resultant accumulative physiological damage, over an individual’s life time. Individuals experience vulnerability to poor resolution of minor stressors, notably infections. Individuals often present with fluctuating disability ‘good and bad days’, a history of falls, increasing fatigue, unexplained weight loss and frequent infections and delirium. This group are the most vulnerable members of our society, all of whom are nearing the end of their lives and could likely benefit from palliative care services and treatments.

Our work at the Cicely Saunders Institute concerns developing and evaluating palliative care services and treatments for older people living across care settings, including at home and care homes. Prominent evaluative work concerns the evaluation of dignity therapy to support older people’s psychological wellbeing in care homes and in hospital; and a joint study with Sussex Community NHS Trust to develop and evaluate short-term integrated palliative care for frail elders in community settings (OPTCare Elderly). We are undertaking international work with colleagues in North America and Ireland to better understand the needs of patients aged 65 years and over, receiving palliative care, to improve service provision to these patients and their families ( IARE - International, rights and empowerment study). 

Reference list

1. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013;381(9868):752-62 doi: 10.1016/S0140-6736(12)62167-9 [published Online First: Epub Date]|.

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