Liverpool Care Pathway - Going Stateside

Attention America, be on your guard...
They're hunting down your 1%.




It used to be just part of getting old. You slow down. You’re puffy going up the stairs, walking round the block. It doesn't mean you're checking out anytime soon. It's just the natural course of things.

Not anymore.

Doctors should screen all adults over age 70 for frailty, a medical syndrome that affects 5 percent to 10 percent of people in this age group, according to a new consensus statement from six international medical organizations.

Frail seniors are tired, weak, thin and listless, with a reduced ability to bounce back from physical challenges and a greater risk of becoming disabled, dependent and dying earlier than others of their age. This was first identified as a condition worthy of attention in the medical community in the 1990s by Dr. Linda Fried, now dean of the Columbia University Mailman School of Public Health.

This is Learning to Spot Frailty (Or, in other words, the US version of "Find Your 1%"... )

This is New York Times –

The Edmonton FRAIL Scale

This is Cleveland Clinic Journal of Medicine –

"As frailty advances, it is appropriate to shift the focus of care to palliation"

Frailty as a syndrome

Fried et al defined frailty as a syndrome arising from the “physiologic triad” of sarcopenia and immune and neuroendocrine dysregulation. Patients are considered frail if they have three or more of the following five criteria:

• Reduced activity
• Slowing of mobility
• Weight loss
• Diminished handgrip strength
• Exhaustion.

Someone who has only one or two of these items is said to be “pre-frail”; someone with none is said to be “robust.”

The FRAIL scale. The Geriatric Advisory Panel of the International Academy of Nutrition and Aging formulated a scale for measuring frailty as a “pre-disability state.” The FRAIL scale consists of five easily remembered items:

• Fatigue
• Resistance (inability to climb one flight of stairs)
• Ambulation (inability to walk one block)
• Illnesses (more than five)
• Loss of weight (> 5%).

"Because of the rapid rate of growth in the population aged 65 years and older, the number of frail elderly persons is increasing every year"

Trajectories of health and functioning -

Frailty: Are we able to identify the older adult who is frail? A discussion on methods and limitations’ 

Neil Pendleton - University of Manchester

A report in Mail Online says: Patients in their 50s are three times more likely to be offered emergency treatment for heart attacks than those in their 80s. 

This is not ageism; this is Communitarianism.

It was reported by the Mail Online on 13th March that our hospitals are dangerous and that the vulnerable and the elderly should not be treated there. No-one could reasonably disagree that hospitals have become very dangerous places. Isn't the sensible response to make our hospitals safe...?

This is all a tactical shift of emphasis. The frail and the fragile, the vulnerable and the elderly, are to be treated in the community for their own protection! What a clever ruse. What cunning... What a wheeze...!

Dave Cameron has installed Don Berwick as a guiding tsar to the NHS. 

What, that Don Berwick, running for governorship for Massachusetts, Medicare Director under the Obama administration, cohort of Ezekiel "Zeke" Emanuel, promoter of Communitarian Healthcare, delaying or denying access to medical innovations if your Communitarian profile doesn't fit? That Don Berwick.

Politico

This is not ageism. It is the Communitarian healthcare promoted by Zeke and Don.

And it's going Stateside.