This domain considers the systems of care that exist to support us in our times of need. They have a direct impact upon our wellbeing, not just through the care they provide but also through the way in which they deliver that care.
Systems of care must consider all elements of care that people might need to support them throughout their journey with frailty including:
- Public Health Services
- Primary and Secondary Medical Services
- Community Services
- Social Care Services
- Voluntary Organisations
- Supported Self-care
Each element of the system must be:
- Of Sufficient Capacity
However, the availability of high quality and accessible elements of care on their own are not enough to offer resilience in this domain, which crucially considers how these elements link together to provide a whole system of care. Other themes that must be considered between, and across, all the elements making up the care system include:
- Continuity of Care
There is widespread acknowledgement that many of our current systems of care, particularly those providing acute and urgent care, are not well suited to delivering holistic care to older people with frailty. Prolonged hospital stays and the delayed transfers of care that are experienced by older people with frailty are a frequent problem, with well described consequences of increasing dependency and vulnerability. It is recognised that older people with frailty often suffer adverse outcomes due to poor systems of care and one recent commentary has proposed that ‘system abuse’ is a form of elder abuse (BMJ 2015:350:h2697). As outlined in the NICE guidance on multimorbidity, the level of co-ordination and integration of care affects the treatment burden for an individual and that this should be considered in planning care.
The system of care domain of frailty has close interactions and interrelationships with the other domains of frailty; for example:
- Systems of care with good communication and coordination between primary and secondary care can reduce the vulnerability associated with acute health events;
- Systems of care that do not consider and coordinate public health, housing and social care services alongside medical services are likely to increase vulnerability in the long-term conditions domain;
- Systems of care for people with frailty have a major impact upon the social and psychological domains of frailty, for example, unnecessary hospitalisation isolates people from their family and friends and increases their anxiety.
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