What are the criteria for acute frailty unit?

Across acute care settings, frailty is a common condition affecting a significant portion of older adults. Understanding the specific criteria for an acute frailty unit is crucial for healthcare professionals and families to ensure timely and appropriate care for these vulnerable individuals.

Quick Summary

Acute frailty units admit patients based on factors like a specific Clinical Frailty Score, the presence of frailty syndromes, and suitability for a rapid discharge plan.

Key Points

• Assessment Tools: Eligibility for an acute frailty unit (AFU) is primarily determined by a formal assessment, often using the Clinical Frailty Score (CFS) alongside a Comprehensive Geriatric Assessment (CGA).

• Frailty Syndrome Presentation: Patients are admitted due to a frailty-related health crisis, such as a fall, delirium, or acute mobility issue, rather than a single organ-specific condition.

• Exclusion Criteria: Patients with severe acute illness (e.g., high NEWS2 score), stroke, major trauma, or other conditions requiring specific non-geriatric specialties are typically not admitted.

• Focus on Rapid Discharge: AFUs are designed for short stays (often under 72 hours), prioritizing a fast and safe discharge back to the community or home environment.

• Multidisciplinary Team Care: A team including geriatricians, specialist nurses, therapists, and social workers works collaboratively to create a holistic and patient-centered treatment plan.

• Positive Outcomes: Effective AFU care leads to shorter hospital stays, reduced costs, lower readmission rates, and better functional recovery for frail older patients.

What Is an Acute Frailty Unit?

An acute frailty unit (AFU) is a specialized hospital ward designed for the rapid assessment and treatment of frail older adults experiencing a health crisis. AFUs prioritize holistic, patient-centered care and aim for a shorter hospital stay, often within 72 hours, to facilitate a safe return home. The main goal is to prevent functional decline and reduce disability risk for frail individuals during hospitalization.

The Core Criteria for AFU Admission

Admission to an AFU is determined by a multidisciplinary team based on a combination of clinical assessments, not just age. Key criteria include:

Clinical Frailty Score (CFS)

The Clinical Frailty Score (CFS) is a tool used to assess an individual's baseline health before acute illness. A higher score indicates greater frailty. Most AFUs require a CFS of 5 or higher for consideration, with some requiring a CFS of 6 or higher for direct admission.

Presentation of Frailty Syndromes

Patients must be experiencing a health crisis precipitated by their frailty, such as falls, delirium, sudden mobility problems, or acute incontinence.

Suitability for Rapid Discharge

A key criterion is the potential for a rapid return to the community, as AFUs are designed for short-term stays, typically within 72 hours. Early discharge planning is essential.

Exclusion Criteria

Certain conditions or severity levels may exclude a patient from AFU admission, including high-acuity illness requiring immediate high-level care, specific conditions like stroke or fractured neck of femur, or complex mental health needs outside the unit's scope.

The Multidisciplinary Assessment Process

Eligible patients undergo a comprehensive geriatric assessment (CGA), which evaluates their functional, cognitive, and psychosocial state. The multidisciplinary team (MDT) typically includes geriatricians, nurses, physiotherapists, occupational therapists, social workers, and pharmacists.

Frailty Assessment Tools Comparison

Various methods exist to identify and quantify frailty. The table below compares some common approaches:

Feature	Clinical Frailty Scale (CFS)	Frailty Phenotype (Fried's)	Frailty Index (FI)
Focus	Clinical judgment based on overall function before illness	Physical markers (e.g., grip strength, weight loss)	Cumulative count of deficits (e.g., diseases, symptoms)
Measurements	Score from 1 (very fit) to 9 (terminally ill)	Five criteria based on physical measurements and self-report	Ratio of health deficits to total considered deficits (score 0–1)
Domain	Holistic (physical, cognitive, functional)	Primarily physical	Multidomain (physical, mental, cognitive, social)
Sensitivity	Recognizes changes over time based on clinical experience	Less sensitive to early changes in health status	Highly sensitive to change, reflecting overall health deficits
Use Case	Rapid screening in acute settings like the ED	Epidemiological research, standardized physical assessment	Comprehensive geriatric assessment, long-term health tracking

Outcomes and Benefits of AFUs

AFUs offer significant advantages for suitable patients:

• Shorter Length of Stay: A focused MDT approach leads to faster treatment and discharge.
• Reduced Readmissions: Addressing underlying frailty helps lower readmission rates.
• Lower Costs: Shorter stays and reduced readmissions result in cost savings.
• Improved Functional Outcomes: Patients often experience better functional recovery.

Conclusion

AFUs provide tailored care for frail older adults experiencing acute health events. Eligibility involves assessing frailty using tools like the Clinical Frailty Score, identifying specific frailty syndromes, and confirming the potential for a safe, rapid discharge. Through a holistic, multidisciplinary approach, AFUs help restore independence and facilitate a quick return to the community. For more details on acute frailty care best practices, visit authoritative sources such as the NHS in England.

The Future of Frailty Care

With an aging population, the need for specialized geriatric services like AFUs will increase. These units are vital for improving patient outcomes and resource efficiency. Future developments will focus on assessment innovations and better integration with community services.

Frequently Asked Questions

What is the Clinical Frailty Score (CFS) and how does it relate to AFU admission?

The CFS is a nine-point scale based on a patient's pre-illness state to assess their overall resilience. Many AFUs require a score of 5 or higher, indicating moderate to severe frailty, for a patient to be considered for admission.

Can a person with dementia be admitted to an acute frailty unit?

Yes, dementia is a common frailty syndrome and is often managed within an AFU, especially when accompanied by an acute episode of delirium or a fall. The unit's environment is designed to be more appropriate for patients with cognitive impairment.

What does 'rapid discharge' mean in the context of an AFU?

Rapid discharge in an AFU refers to the goal of transitioning a patient out of the hospital as quickly and safely as possible, often aiming for within 72 hours. This is achieved through proactive discharge planning from the point of admission.

Who is on the team in an acute frailty unit?

An AFU team is multidisciplinary and typically includes geriatric consultants, specialist nurses, physiotherapists, occupational therapists, social workers, and pharmacists, all working together on the patient's comprehensive care plan.

Are AFUs only for falls?

While falls are a common reason for admission, AFUs also treat other frailty syndromes like delirium, unexplained mobility issues, incontinence, and infections that have significantly impacted a frail older person's health.

How does an AFU prevent functional decline?

AFUs prevent functional decline by providing specialized, holistic care, promoting early mobilization, and maintaining cognitive function in a safe, prepared environment. The MDT ensures all aspects of health are addressed.

What happens if a patient doesn't meet the criteria for an AFU?

If a patient is deemed too severely ill or requires a specific non-geriatric specialty, they will be directed to the appropriate department, such as a general medical ward, stroke unit, or surgical ward.