Set against a backdrop of strained health and care services with tightening budgets, shifting the focus to preventing ill and worsening health has become critical.
Leeds’ outstanding track record in developing new and effective approaches to such prevention repeatedly attracts national and international acclaim, and it continues to raise the bar.
Here, we explore how Leeds’ research is further refining and advancing care to manage and mitigate the risks associated with one of the most widespread health challenges – frailty.
As the saying goes, prevention is better than cure.
And when a cure isn’t available, prevention becomes even more critical.
That’s usually the case with frailty.
Mostly associated with ageing, frailty commonly brings with it risks of falling, admission to hospital or the need for long term care.
In 2017, data showed that around one million people in England were living with moderate or severe frailty, costing the NHS approximately £6 billion a year. More than half of those were people aged over 85, and the number in that age group is set to double by 2041.
Until recently, there was no accurate, standardised way of identifying levels of frailty and their associated risks. In turn, no way of accurately tailoring care to reduce those risks and preventing further, often catastrophic, consequences for people’s lives.
Since then, thanks to pioneering and detailed work by University of Leeds’ Professor of Geriatric Medicine Professor Andy Clegg and his team, clinicians in the UK and around the world are now using a tool which helps do just that.
Through research funded by the National Institute for Health and Care Research (NIHR), the Electronic Frailty Index (eFI) is a Leeds-made innovation successfully established and adopted worldwide as the standard frailty assessment tool.
It arises from Andy’s landmark research (2016) which analysed UK data sets of around one million patients to understand trends and patterns of what was happening for frail people.
Today, having worked with the National Health Service (NHS) to make the tool readily available, the multi-award-winning [1] eFI is freely available to all general practitioners in England and 95 per cent of those across the UK.
The eFI is transforming healthcare for thousands of people, while also saving precious health system resource in both clinician time and service costs.
In the 12 months following its implementation, more than 2.5 million older people were assessed for frailty. Of those people, more than 25,000 with frailty were referred to a falls service, preventing an estimated 2,300 falls and saving the NHS around £6.9 million.
And eFI initiated medication reviews for a further 200,000+ people to minimise potential side effects which would worsen their frailty.
The impact of this outstanding example of pioneering data science is far-reaching. It has had direct influence on national and international policy [2] and practice by influencing eFI development and implementation in the US, Canada, Spain and Australia.
Andy’s newly published research shows he and his team have now taken the eFI to another level.
The original eFI considered 36 different variables or factors of a person’s health, such as dementia, falls and fractures, weight loss and the number of regular medicines people take.
By measuring those variables, it enabled a clinician to gauge a person’s frailty level as fit, mild, moderate or severe.
Having used the eFI to gauge those frailty levels, GPs can then identify the care best suited to each person, which may include exercise regimes, medicine reviews or referrals to falls prevention services.
But more recent insights revealed that those variables could better reflect what was happening in real life.
“We’ve now refined the tool as part of eFI 2, so that we ‘weight’ health variables according to how strongly they predict the risk of an older person experiencing outcomes such as needing home care services or experiencing a serious fall.
“We’ve also changed the scoring system so that some health problems with potential to improve and that are older than five years, such as anaemia, drops out of the frailty score, making the assessment more accurate,” explained Andy.
“And we’ve had further insights from GPs – the ones who are actually using the tool. They were finding that a category of ‘mild frailty’ was a very big and diverse group of people, making it more difficult to accurately personalise their care.
“So we’ve further refined the scoring for these people and, having observed and compared our predictions with real life outcomes, we’re confident this will bring further significant improvements.”
The investment from Andy and his team doesn’t stop at publishing research and designing and refining the eFI. They also demonstrate to practitioners how it works.
“Translating something from research to real life impact is hard. It takes a lot of investment to support people in a new way of working and we get calls about this from all over the country.
“But once we achieve that impact, it means those clinicians’ assessments that were previously labour intensive, are more efficient and can almost be done at the press of a button,” said Andy. “So it’s important for everyone that we do that extra work.”
Having established this outstanding advancement in managing frailty, eFI opens up possibilities for a range of other related health challenges.
For example, frailty is a primary cause of falls. The implications for people who fall can be devastating, causing severe injury, a fear of future falls, lack of independence and therefore isolation and loneliness. This globally leading cause of hospitalisation is expected to rise as populations age. [3]
So, alongside eFI 2, using routinely collected health care data, Andy is developing a prediction model to identify people at risk of serious falls.
The local health and care system in Leeds is already considering adopting and testing this new tool in a couple of areas of the city. This, alongside other local measures, aims to help more people know how to avoid falling and reduce unplanned hospital admissions.
Sue Wilkinson, Leeds Health and Care Partnership senior programme manager, focuses on long term health conditions, frailty and end-of-life care.
“In Leeds, we face the same challenges as other cities and communities around the world in relation to our growing and ageing population,” said Sue.
“With an estimated 83,000 people with frailty in our communities, we are increasingly focusing our resources on helping people live well at home for as long as possible.“We are seeing success in various new ways of working, such as Leeds’ nationally acclaimed HomeFirst programme. And we anticipate this emerging falls prediction tool being invaluable in helping us have an even greater impact for those in our care.”
Cover image credit: pocketlight
[1] 2016 EHI Healthcare IT Product of the Year Award, 2017 RCP Excellence in Patient Care Award.
[2] 2023 Advancing Health report highlighting the impact of UK Medical Schools’ research(13) and the 2023 CMO Report on Health in an Ageing Society(14), 2017 NIHR Report on World Class Research Making a Difference, 2019 Health Foundation report.
[3] Falls in Older People: Assessing Risk and Prevention. National Institute for Health and Care Excellence (NICE) Clinical Guideline 161. London, UK: NICE, 2013.