Proactive Nurse Driven Frailty Screening for Early Palliative Care Intervention

Our older population is growing, our estimated population of older adults, 65 years of age and older is projected to be 83.7 million by the year 2050 (Ortman, J., Velkoff, V.A., 2014, p. 25).  This increase in our older adult population creates an increase in the number of older adult trauma patients admitted to the hospital.  Many different variables must be considered when caring for our geriatric population, including their end of life wishes.  Palliative care is often a misunderstood term by not only families and patients, but also physicians and nurses.  The goal of palliative care is to improve the patient’s quality of life during a time of serious illness.  Many studies have assessed the cognitive function of patients predicting functional decline such as (Zahodne ,  Manly, MacKay-Brandt, & Stern, 2013) which discovered that cognitive scores could predict subsequent functional abilities of patient with eventual incident dementia.  However, there were not any studies showing pre-injury frailty as an indicator for functional outcomes in trauma patients.  In a study accepted by the Journal of Trauma Acute Care Surgery by Maxwell et. al., (2016) it was discovered that pre-injury physical frailty was the determining factor for functional decline and mortality at 1 year post hospitalization.   Maxwell discovered that 25% of the patients rated as frail died within the first year post hospitalization.  From this work, a nurse driven frailty screening tool was developed.  The screening tool was used as a guide to assess the level of physical frailty and cognitive function prior to hospitalization.  The scores from this tool were used to determine if an early palliative care consultation would be initiated.  The screening tool was piloted from March 2015 – May 2015 and data were collected.  The results showed that 136 patients were admitted to service, with 70 patients receiving a nurse driven screening, and 66 patients did not.  The mean age was 76.2 and the number one mechanism of injury was falls.  The patients were placed into 3 categories based on their scores from the screening tool; non-frail, pre-frail and frail.  Out of the 70 patients screened, 29% were non-frail, 34% were pre-frail and 36% were assessed as frail and we were able to increase our palliative care consultation rates from 13% to 32%.  Our goal was not to change the level of care, but to provide patients and their families with a realistic clinical trajectory and to help them be more prepared to make end of life decisions outside of a crisis situation.