Ruth E. Hubbard is an Associate Professor in Geriatric Medicine at the University of Queensland, Consultant Geriatrician at the Princess Alexandra Hospital and Head of School for PA-Southside Clinical Unit. As a clinical academic, she has always combined hospital practice with research and teaching. While training as a physician and geriatrician in Cardiff, Wales, she completed an MSc in Medical Education and an MD on pathophysiological changes in frail older people. She then undertook a 2 year post-doctoral fellowship in Dalhousie University, Halifax, Nova Scotia with Professor Ken Rockwood. Here, she was able to test hypotheses regarding the determinants and manifestations of frailty through the interrogation of large datasets. She has published widely on the inflammatory aetiology of frailty, the difficulties of measuring frailty in clinical practice and the relationships between frailty and obesity, smoking, socioeconomic status and exercise and is currently ranked number 3 in a list of the world’s leading experts in frail elderly research (http://expertscape.com/ex/frail+elderly).
Along with colleagues at CRGM, she is promoting academic geriatrics among Advanced Trainees, students and Allied Health colleagues. She is currently supervising 3 PhDs, 4 MPhils and numerous medical student projects. She has also generated more than $4.6 million in grant income in the last 4 years, including an NHMRC Project Grant to derive a measure of frailty from the interRAI assessment instrument.
Measurement of Frailty in the Acute Care Setting
Older inpatients often have complex care needs and multiple co-morbidities. These patients are vulnerable to poor outcomes (including falls, institutionalisation and death) – a vulnerability often linked with the term “frail‟ or “frailty‟. In this presentation, the measurement and management frailty in older inpatients are explored.
Different approaches to the measurement of frailty are reviewed, with particular emphasis on their potential clinical utility. Phenotypic measures of frailty may have limited feasibility in patients due to their dependence on performance-based tests. Subjective scales have high face validity but lack precision and may be better suited to screening. The frailty index approach has been criticised as too complex and mathematical but if the information required is collected as part of Comprehensive Geriatric Assessment, frailty quantification could be integrated into existing systems, which serve other clinical and administrative purposes. This could optimise clinical utility and minimise costs, without losing fidelity.
A frail older person is comparable to a complex system on the threshold of failure and the management of frail inpatients requires a multi-disciplinary, holistic approach. One important aspect of management is pharmacotherapy and, since medication can cause significant harm, appropriate prescribing according to frailty status will be considered.
In conclusion, understanding frailty has the potential to improve the clinical care of vulnerable older people in the hospital setting. Yet this is only the first step in more precise risk stratification. Quantification of the severity of insult plus individual resilience will be essential to obtain a more accurate picture of each patient’s likely trajectory.
Call for Abstracts open: 25th October 2016
Registration Opens: 18th November 2016
Call for Abstracts Closes: 24th February 2017
Notification of Abstracts: 20th March 2017
Close of Early Registration: 31st March 2017
Conference: 10th May 2017
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