CARE OF THE OLDER PERSON

Developing a postal screening

tool for frailty in primary care:
a secondary data analysis
Lauren Kydd
Lecturer, Robert Gordon University, Aberdeen
l.a.kydd@rgu.ac.uk

T he population of Scotland is ageing and it is pro-

jected that the number of people aged over 75
will increase by 85% by 2039 (National Records
of Scotland, 2015). Health policy suggests that a shift from
a traditional reactive model of care to a more proactive one
Overview and results of the Elderly
Care Community Nurses project
A GP surgery, with its aligned consultant geriatrician based
in the local hospital, was interested in developing a postal
screening tool (PST) to identify potential frailty and inter-
would enable health professionals to assess patients at risk vene before a crisis occurred.
of frailty or pre-frailty and avert a potential crisis (Scottish The NHS board applied for funding from the Reshaping
Government, 2007; 2010a; 2010b; 2013; NHS Education Care for Older People programme in 2012 to employ
for Scotland, 2016). The Scottish Government (2010c) in two nurses (2-year, fixed-term posts), with the intention
its Reshaping Care for Older People Programme 20112021 that they would become elderly care community nurses
stated that emergency admissions of older people cost (ECCNs) and work as advanced practitioners (one of the
1.4 billion each year. Reducing the number of bed days ECCNs is the researcher). Depending on the results of
as a result of emergency admissions by older people (a the PST the ECCNs would carry out a thorough exami-
proportion of which can be avoided) has been suggested nation of potentially at-risk patients in their own home,
as key to cost saving (Scottish Government, 2010c; NHS using a multitude of supporting assessment tools
Scotland, 2015). (including falls assessment, depression screening and mem-
Scottish Patients at Risk of Readmission and Admission ory testing).
(SPARRA) is a risk-prediction tool that was developed
by Information Services Division (ISD) Scotland to pre-
dict an individuals risk of being readmitted or admit-
ted to hospital as an emergency inpatient within the next
year (ISD Scotland, 2010). SPARRA data is a combina-
ABSTRACT
tion of information on patient demographics, inpatient
The purpose of this secondary data analysis (SDA) was to review a subset
admissions, community dispensed prescriptions, new
of quantitative and qualitative paired data sets from a returned postal
outpatient attendances, accident and emergency admis-
screening tool (PST) completed by patients and compare them to the clinical
sions and psychiatric inpatient admissions. ISD Scotland
letters composed by elderly care community nurses (ECCN) following
(2010) suggests that patients with a SPARRA score of
patient assessment to ascertain the tools reliability and validity. The aim
50% or more have a one in two chance of hospital admis-
was to understand to what extent the problems identified by patients in
sion within the following year. Patients scores can be
PSTs aligned with actual or potential problems identified by the ECCNs. The
reviewed at a primary care level and community staff can
researcher examined this connection to establish whether the PST was a
intervene and prioritise those with complex care needs
valid, reliable approach to proactive care.
who are likely to benefit from anticipatory healthcare (ISD
The findings of this SDA indicated that patients did understand the PST.
Scotland, 2010).
Many appropriate referrals were made as a result of the ECCN visit that
Funding from the Reshaping Care for Older People
would not have occurred if the PST had not been sent. This article focuses
programme (Scottish Government, 2010c) was used to
specifically upon the physiotherapy section as this was the area where the
2016 MA Healthcare Ltd

support a project based around the idea of implementing

most red flags were identified.
a more proactive approach in preventing the deterioration
of individuals conditions to the point where an emer-
KEY WORDS
gency admission could be avoided altogether, by using
w postal screening tools w primary care w frailty
community nurses with advanced practice skills to assess
w prevention w reliability w validity
patients at home.

British Journal of Community Nursing July 2016 Vol 21, No 7 335

CARE OF THE OLDER PERSON
The questions for the PST were devised with the input
of the multidisciplinary team (MDT)pharmacy, occupa-
tional therapy, physiotherapy, medicine for the elderly, mental
health, social work, the patient focus public involvement
group and the equality and diversity manager.
PSTs designed to identify red flags were then sent out to
all over people aged over 75 years registered at the surgery
to detect unrecognised potential problems (Figure1). The
PSTs were sent with a covering letter from the GP sur-
gery, which included how to get help with completing the
questionnaire, and a stamped addressed envelope (SAE).The
ECCNs proposed assessment via face-to-face contact in the
patients home if they selected certain red flag responses and
consented to the home visit.
Measuring frailty
Before the project was started, a literature review was under-
taken to examine existing screening tools.The results yielded
a wealth of literature. However, upon closer inspection, many
articles were not relevant; this was because a lot of the litera-
ture was very singular in its approach in that many articles
focused on only one aspect of health and ECCNs wanted
to explore the use of generic screening tools for assessing
frailty to determine future care needs. Numerous articles and
potential screening tools were therefore excluded.
Meyer et al (2007) recognised that a question can be
open to interpretation and misunderstood, so may produce
misleading responses. The layout, font, Flesch readability,
response format and the intention of the questionnaire/
screening tool may affect its content and validity (Meyer
et al, 2007). Meyer et al (2007) also recognised that patients
can experience problems when completing a screening tool
and may respond with incomplete answering. Common
problems that the public face when completing question-
naires or screening tools include double-barrelled questions,
ambiguous questions, bias and/or leading questions and an
inappropriate level of wording (Polgar and Thomas, 2008).
None of the studies in this literature review involved
developing a screening tool independently.The studies used
or adapted tools that already existed in their clinical areas.
According to Bell (2010), when developing a tool or using
an existing one, it is worthwhile considering how valid or
reliable the tool is.The reviewed literature found that a range
of very similar screening tools focusing on global frailty
detection exist and have been trialled across western socie-
ties without conclusion (van Hout et al, 2005; Wagner et al,
2006; Drennan et al, 2007; Rache et al, 2007; Rubenstein
et al, 2007; Metzethlin et al, 2010a; 2010b; Barreto, 2012).
Method
Aims and objectives of
secondary data analysis
The ECCN project was deemed successful in terms of
identifying patients and offering further services through a
ECCN home visit. The researcher conducted a secondary
data analysis (SDA) to investigate the accuracy and applica-
bility of the PST. This examined:
336
ww
Whether the PST appeared to be understood by patients
ww
Whether the PST was valid and reliable
wwTo what extent problems identified by patients in the PST
aligned with actual or potential problems identified by the
visiting ECCN
wwWhether the PST could be replicated in its current format.
Questionnaire design
The PST had to appeal to as many members of the public
as possible as it would not be completed by a health profes-
sional. The 26 closed questions were intended to highlight
issues that led to a domiciliary visit by an ECCN to address
these problems.
The categories of physiotherapy, occupational therapy,
continence, mental health, medication and social work were
chosen as they are well recognised as being of particular con-
cern in the elderly, as identified in the literature review (van
Hout et al, 2005; Wagner et al, 2006; Drennan et al, 2007;
Rache et al, 2007; Rubenstein et al, 2007; Metzethlin et al,
2010a; 2010b; Barreto, 2012).
Pilot study
In a small pilot study, 50 PSTs were sent initially to determine
if there were any major problems. After a 100% response rate
to the letters, the ECCNs continued to send out PSTs at a
rate of about 50100 every two weeks.
Eight hundred and fifteen PSTs were sent out; 742 people
returned the PST and 299 patients were visited at home by
the ECCN as a result of their responses.
The reliability and validity of the PST had not been tested
in depth during its development and, as will be discussed,
there were some issues that the pilot did not detect.
Ethical considerations
The project did not require ethical approval as it was classed
as service development and was a means of exploring options
for addressing the ageing population and its unmet needs.
Caldicott guardian clearance was required and obtained by
the researcher.
Data collection
For the SDA, the researcher had a copy of both the returned
PSTs of the patients randomly selected from the database
and the corresponding clinical letters that were sent from
the ECCNs to the GP after the home visit.
The only data known to the researcher was the sex of the
patient; of the 50 people selected the researcher requested
25men and 25 women.When examining the received paired
sample data sets in greater detail, there were discrepancies
between the data requested and that provided and the final
number was 26 women and 19 men (n=45). It is acknowl-
edged that there is a greater representation of females to
2016 MA Healthcare Ltd
males within this SDA.
Data analysis
The quantitative and qualitative data extracted from the
PSTs was transferred to an Excel spreadsheet and the words
from the free text options were rendered into meaningful
British Journal of Community Nursing July 2016 Vol 21, No 7
 CARE OF THE OLDER PERSON

Patient address 10 Do you use any of the following?

- Walking stick(s) YES / NO
Practice logo and address
- Zimmer frame YES / NO
Dear_____________________, - 3 wheeler YES / NO
- Trolley YES / NO
In order to improve the services that we offer to adults aged over - Crutches YES / NO
75 registered with this practice we ask that you take the time to 11 Do you have difficulty with washing and YES / NO
complete this short questionnaire and return it back to nnnnn dressing yourself?
nnnnnnnnnn in the envelope provided by __________________
12 Are you able to make hot drinks and meals YES / NO
yourself?
If you have any difficulty in completing the questionnaire please
13 Do you have any problems with any of the
seek assistance from a friend or relative or alternatively contact
following? YES / NO
nnnnnnnnn or nnnnnnnnn Elderly Care Community Nurses
- Getting in or out of bed YES / NO
on nnnnnnnn or nnnnnnnn for further assistance Monday -
- Getting in or out of a chair YES / NO
Friday between 09:00 - 16:00.
- Getting on or off of the toilet
Please leave a message if there is no-one available to take your
call. 14 Do you ever find yourself wet because you
cant get to the toilet in time? YES / NO

The information obtained from this questionnaire will be held in 15 Do you have problems with your bowels? YES / NO
the strictest of confidence. 16 Do you think you have a problem with your YES / NO
memory?
This questionnaire is also available in other formats and 17 Has anyone in your family suggested that your
languages, upon request. These can be obtained by contacting memory is less good than it used to be? YES / NO
nnnnnnnnn or nnnnnnnnn on the above number.
18 Do you worried about your mood? YES / NO

Thank you for your co-operation. 19 How many different types of tablest do you take? YES / NO
None 1 to 4 5 to 9 10 or more
Yours sincerely,
20 Do you think your tablets are giving you YES / NO / N/A
Name the GPs... side effects?

21 Do you have difficulty remembering to take YES / NO / N/A

1 Have you had any dizziness in the last 12 YES / NO all of your tablets?
months?
22 Do you have a blister pack/dosette box? YES / NO / N/A
2 Have you had any falls in the last 12 YES / NO 23 Do you live alone? YES / NO
months?
24 Do you have a community alarm? YES / NO
3 If yes, how many falls have you had?
25 Do you have support from carers? This can YES / NO
1 to 2 3 to 4 5 or more N/A be from family, social work, private or others.

4 Were you able to get up without any help? YES / NO / N/A 26 For how many hours a week do your carers visit?

5 Are you worried about falling? YES / NO N/A 1 to 3 4 to 6 7 or more

6 Do you have steps to get in to your home? YES / NO Is there anything that you are worried about? For example finance,
health, benefits, housing etc.
7 Do you have stairs inside your home? YES / NO _____________________________________________________
_____________________________________________________
8 Do you have difficulty getting up or down YES / NO / N/A
steps or stairs? Are you happy for a nurse to contact you with any of your concerns?
By telephone? YES / NO Home visit? YES / NO
9 Do you still manage to get outdoors? YES / NO Please can you supply an up to date telephone number.
2016 MA Healthcare Ltd

- on your own? YES / NO ________________________________________________

- with help? YES / NO Thank you for your time.

Figure 1. The screening tool consisted of 3 sheets of A4 paper. It was sent to over 75s registered at a local GP surgery with a covering
letter and a stamped addressed return envelope.

British Journal of Community Nursing July 2016 Vol 21, No 7 337

CARE OF THE OLDER PERSON

researcher must try to establish if the screening tool would

50 produce the same results when replicated in similar circum-
45 stances and conditions (Holloway and Wheeler, 2010). This
40 43 can be checked with test-retest, inter-rater and internal con-
42
sistency (Gerrish and Lacey, 2010). According to Blaxter et al
35
(2010), to test the reliability of a screening tool, it is essential
30 to perform a test-retest to see if the screening tool would
25 27 produce the same results in the same situation when admin-
26 26
20
istered twice over a short period of time. Ross (2012) states
21 that the reliability of a tool is more important that its validity.
15 Reviewing the returned PST responses against the clinical
10 letters and proposed interventions meant that the reliability
5 and validity of the PST in identifying frailty and potential
frailty could be assessed. While the ECCNs were reviewing
0
the returned PSTs, they found many questions had been
py

apy

n
th

ork
enc

atio

left unanswered. This can be problematic in determining

eal
era

lW
her

ntin

dic
lH
oth

whether the question was understood, and whether a patient

cia
al T

nta

Me
Co
ysi

had a real need and required a home visit. All the patients
So
ion

Me
Ph

reviewed in this SDA did receive a home visit; not all of the
cupat

PSTs were returned with accurate or correct answers, as was

Oc

n Red Flag Categories evident upon the ECCN visits.

The researcher required access to the Excel spreadsheet
Figure 2. A representation of the red flags found in the PST grouped in that was used during the ECCN project to populate patient
to the subheadings of physiotherapy, occupational therapy, continence, data. The clinical effectiveness team, in collaboration with
mental health, medication and social work the ECCNs, created the spreadsheet.
By reviewing the PST responses against the ECCN
clinical letters, it was possible to begin to establish if there
Refused N/A Attending Referred Waiting List was an association between the PST and its outcomes. For
11 8 4 2 1 example, if a patient reported they had had 34 falls in the
past 12months, was a referral made to the falls and dizzi-
Figure 3. ECCN remedial action dizziness ness pathway after the home visit. If not, why not? Was the
patient was already known to services? Were they already
on a waiting list? Had the question been misunderstood and
25 the wrong option selected? Or did the patient refuse? This
information was entered into another spreadsheet.
20
Findings
15
Response rates, postal interview
10 comparison and evidence of health need
For the purpose of this article, only the physiotherapy sec-
5 tion will be discussed and reviewed in depth.This is because
falls and dizziness are common problems for older people
0 and are often a result of heart disease, postural hypotension,
1 to 2 3 to 4 poor vision and loss of consciousness (NHS Choices, 2015).
n Number of Falls Also, in relation to Figure 1, the ECCNs decided, along with
the MDT, that anyone responding with falls and dizziness
Figure 4. Number of falls experienced by patients in the last 12 months as would warrant a home visit for further investigation. As
identified by the PST Figure 2 shows, responses to the PST showed that 43 out of
45 respondents experienced physiotherapy problems.
phrases.The results were both numerical in terms of review- Out of the 45 reviewed data sets, 26 patients had expe-
ing the percentages of problems identified by the PSTs and rienced at least one episode of dizziness in the previous
2016 MA Healthcare Ltd

qualitative in the review of the free text to identify problems
that patients were experiencing.
To determine the reliability of a screening tool, it is neces-
sary to determine if the tool measures what it is supposed
to measure in a consistent manner (Blaxter et al, 2010).
Consistency is linked to the replicability of a tool and the
12 months. Four patients within the SDA had an evident
postural drop, as documented in the clinical letter to GP.
However, upon review, it was noted that none of the postural
drop patients had been referred to the falls and dizziness
pathway. This was because they all refused to attend for rea-
sons such as it was a one off episode,it was because I got up

338 British Journal of Community Nursing July 2016 Vol 21, No 7


too quickly and I live too far away. It would not have been
appropriate to refer eight of the patients, for reasons such as
they were already on a physiotherapy waiting list, were con-
fused at the PST, were already attending physiotherapy, or
required a repeat blood pressure review from the GP before
further action was taken. ECCN action is shown in Figure 3.
Twenty-six patients selected yes to having fallen in
the last 12 months. Four of these patients were already
attending a local falls and dizziness class; the issue was
being addressed and the patients were satisfied with the
outcome. One patient was on the waiting list already as
they had been referred by the GP to a falls and dizziness
service. One patient had circled yes in error. Fourteen
patients refused a referral. The problem with one patient
was believed to be due to low vision and a referral to the
local sensory service was made. One patient had already
had their medication reviewed by GP and felt the situa-
tion had improved. One patient had extremely high blood
pressure when the ECCN attended and the duty doctor
was called to address the situation. The MDT reviewed
one patient and it was suggested medication should be
introduced. One patient could not walk great distances
but was still mobile so required a blue badge. One patient
deemed their falls to be mechanical and did not want any
further intervention.
Regarding the question about how many falls a patient
has had, there were nine N/A responses and 11 blanks. The
remainder was made up of people who had experienced falls
in the past 12 months to a varying degree. The number of
falls patients had is shown in Figure 4.
Of the 20 patients who experienced 12 falls, three were
already attending a group, a further three were on the wait-
ing list and one patient asked to be referred for a blue badge
for their car (entitling them to use disabled parking spaces)
so they did not have to walk great distances. As for the three
patients who refused any intervention, one patient was
instead referred to a local sensory services organisation as
their falls were likely to be secondary to low vision. Four
patients needed a medication review by the GP to either
lower or introduce medication. Four patients were referred
to a falls and dizziness group or a physiotherapist and one
patient attributed their falls to osteoporosis and the ECCN
requested bone protection for that patient via the GP in
line with the Scottish Intercollegiate Guidelines Network
(SIGN) (2003) guideline in effect at the time. Of the five
patients who experienced 34 falls, one refused input of
any sort, one required a medication review, one had had a
medication review by GP in the previous six months and felt
the situation had improved and the other two were already
attending a falls group.
Despite the findings of the PST in terms of red flags, the
number of people who refused a referral to physiotherapy
2016 MA Healthcare Ltd
was quite high.This is because yes answers to Q6Q10 (see
Figure 1) would be classed as red flags yet often very little
could be done to change this.
In addition, Q6Q8 were concerned with patients abil-
ity to manage steps and stairs.The questions aimed to ascer-
tain if patients had problems and whether an intervention,
British Journal of Community Nursing July 2016 Vol 21, No 7
CARE OF THE OLDER PERSON
such as installing a handrail, could be made. However, the
Excel spreadsheet was not sophisticated enough to offset
this against differing response couplets. The response rates
to these questions were high as people understood if they
had steps or stairs in their home. Again, these sorts of ques-
tions relied on a weighted numerical scoring where, for
example, if a patient had selected yes to dizziness, steps
and stairs, and difficulty in climbing them, a red flag score
would have been high as the potential for risk is there.
Another problem with the stairs questions was that if a
patient was having severe problems, rehousing might not
always be an option.
As demonstrated in the findings above, many new issues
were identified and action was taken in the form of referral
to appropriate services or follow-up from GP. Due to this
being an SDA study, the researcher does not have access to
patient records to review the long-term outcomes for the
patients as a result of the interventions received.
Since researching the development of screening tools
throughout this SDA, the researcher now believes that Q11
and Q12 should each consist of two separate questions.
Patients who have difficulties washing may not have dif-
ficulties dressing; likewise, patients who are unable to make
a hot drink may be able to prepare a meal. As Bowling
and Ebrahim (2010) highlighted, screening tools should
never have two questions in one sentence as this can lead
to confusion.
Another issue recurred during home visits was that
patients had already sought medical advice on certain
red flag areas. Perhaps an option so patients could say if
they had already discussed the issue they were concerned
about with their GP, or were being treated elsewhere for
said problem, would have been beneficial. This may have
prevented unnecessary ECCN visits, unless of course the
patient had other red flags. However, this could have made
the PST longer and some patients may have been less
inclined to complete it.
As no PST existed in the researchers working area and
a new one had to be created that had not been tested
for reliability and validity, the researcher accepts that there
are notable, significant flaws in the tool. The PST would
have benefited from patient feedback to assess how patients
understood the rationale for the tool and the ECCN visit.
The high return rate of the PST may be attributed to
the covering letter and SAE, as demonstrated in the lit-
erature review. The researcher believes that the 299 visits
that occurred as a result of the screening tool were more
effective than visiting the 815 over-75s registered at the
GP surgery.
The question remains over whether these were the correct
299 patients visited and the 45 paired data sets would indicate
that, yes, they were.The patients who were visited received a
multitude of inputs and had many issues that would not have
been addressed otherwise. However, the researcher remains
certain that, after reading the literature and exploring the
development of a reliable and valid screening tool, many
patients were excluded as a result of non-participation and
possibly self-satisficing the responses.
339
CARE OF THE OLDER PERSON
KEY POINTS
Shifting the balance of care from a reactive model to a more proactive model
ww
could help identify those at risk of frailty of pre-frailty and avert a crisis
A primary care team introduced a postal screening tool to screen for
ww
frailty and pre-frailty and offer individuals an in-depth domiciliary review
by an advanced practitioner
Patients understood the questions that were being asked. However, there
ww
were discrepancies between their answers and the findings of patient
assessments and these highlight the need for the postal screening tool to
be refined in light of this secondary data analysis
Discussion
The PST was intended to identify patients for further inves-
tigation by the ECCN. The ECCN could provide specialist
advice on an older personss needs and concerns and sup-
port long-term conditions and case management to prevent
hospitalisation and early admission to residential care.
McClane (2006) acknowledged that, no matter how accu-
rate the clinician is, the usual 15-minute clinical visit does
not provide enough data relating to the actual and unmet
needs of an elderly person in the community. The average
assessment from the ECCN lasted anything from 45 minutes
to 120 minutes with follow-up as required from the GP (not
the ECCN because of the limitations of the ECCN project).
No PST exists that has been identified as the gold standard
(Metzethlin et al, 2010a). It appears that tools and question-
naires are compiled with little regard given to patient com-
prehension. Ultimately, patient suitability and comprehen-
sion should be the focus of all health professionals. In terms
of comprehension, the PST scored well when assessed using
the Flesch-Kincaid grade (5.8) and for Flesch Reading ease
(68.9%).The referrals that were made by the ECCN as a result
of the responses to the PST would suggest that patients had
understood the questions. However, there were discrepancies
when reviewing the physiotherapy responses; this highlights
the need for the PST to be refined in light of this SDA. Perhaps
it is worthwhile to make note of some of the factors that
should be considered when creating, adapting or reviewing
a tool for screening; these could include a pilot phase, patient
interviewing, sensitivity and inclusion, missing values and their
meaning, Flesch readability, weighted numerical scoring and
ease of completion. Patient understanding should lead to better
patient care and satisfaction.
As nurses continue to extend and expand their scope of
practice to deliver effective services and enhance patient care, it
is likely that more advanced practitioner posts will come in to
being, with nurses making autonomous decisions for the ben-
efit of their patients (Royal College of Nursing (RCN, 2010).
The healthcare quality strategy for NHS Scotland (Scottish
Government, 2010b) envisages that nurses will provide safe,
effective, timely, person-centred care in the most appropri-
ate place delivered by the right person with the right skills,
time and time again. These skills are likely to include clinical
examination, ordering diagnostic investigations (blood tests,
X-rays, spirometry etc), prescribing and collaborating with
340
other health professionals across the MDT while using lead-
ership skills (RCN, 2010).
Since completion of this SDA, the researcher has acknowl-
edged further publications such as the British Geriatrics
Societys (BGS) (2014) report Fit for Frailty, which recog-
nises all older people should be assessed for the presence
of frailty when face-to-face with a health professional. The
BGS (2014) also recommends the use of the PRISMA 7,
Groningen Frailty Indicator and the gait speed and timed up
and go test but does not advocate routine population screen-
ing for elderly persons. The reason behind not supporting
this type of screening is the predicted high cost and the low
specificity of available tools (BGS, 2014). The BGS (2014)
advocates the use of comprehensive geriatric assessment,
which was part of the domiciliary review by the ECCNs.
Conclusion
Enough evidence appears to exist to support the implementa-
tion of a PST in primary care (van Hout et al, 2005;Wagner et
al, 2006; Drennan et al, 2007; Rache et al, 2007; Rubenstein
et al, 2007; Metzethlin et al, 2010a; 2010b; Barreto, 2012).
While the researcher may have demonstrated that a PST
can be a successful way of identifying patients in need of
further input, much work is needed to design a PST that
provides reliable, effective results time after time. If the
researcher were to continue with her studies in this field,
she would like access to the larger data set to review this data
and make comparisons against various patient demographics,
such as age, gender and location (i.e. rural/urban/deprived/
wealthy area, or even house/flat).The researcher would then
focus on the development of a new, adapted tool and apply
a test and re-test approach to ensure reliability (Blaxter et
al, 2010; Gerrish and Lacey, 2010, Ross; 2012). It may be
impossible to design a perfect screening tool: some issues
may always need to be discussed face to face and some things
(particularly in relation to health matters) may be too subtle
to be recorded in questionnaire form.
Changes in the economic climate, population demograph-
ics and government policy are all contributing to the rapid
movement of health care from hospitals into the commu-
nity (Longstaff, 2013). A shift in philosophy, attitudes and
approaches is required to move away from measuring success
by how much health care is provided to measuring success
by how many older people can be enabled to stay independ-
ent and well at home without the need for care and support
(Scottish Government, 2010c).
New ways of joint working between the NHS, third sector
and independent sectors mean that innovative ideas and an
improvement in the services and support options available
to older people in communities across Scotland can become
a reality (Scottish Government, 2013).
Screening the elderly population to identify those at risk
2016 MA Healthcare Ltd
is certainly one innovative method as opposed to offering
services to healthy individuals. To support such new initia-
tives, a shift in resources from secondary care to primary
care needs to continue to support the preventive measures
required and change the focus of service delivery. This was
the rationale behind the screening tool for over75s. BJCN
British Journal of Community Nursing July 2016 Vol 21, No 7

Accepted for publication: 23 May 2016
Declaration of interest: none
Acknowledgement: the author would like to thank her ex-colleagues
for their belief in trialling this project and the time they dedicated to
the service.Their positivity, knowledge, enthusiasm and commitment
to the Elderly Care Community Nurse Project made it all worth-
while. Special recognition goes to Dr. Newnham (Geriatrician and
Unit Clinical Director), Anne-Marie Jackson (fellow ECCN) and
the multidisciplinary team based at Woodend Hospital, Aberdeen.
Barreto Pde S (2012) Participation bias in postal surveys among older adults:
the role played by self-reported health, physical functional decline and frailty.
Arch Gerontol Geriatr 55(3): 5928
Bell J (2010) Doing Your Dissertation: a Guide for First-Time Researchers in Education,
Health and Social Science. 5th edn. McGraw Hill/Open University Press,
Maidenhead
Blaxter L, Hughes C,Tight M (2010) How To Research. 4th edn. Open University
Press, Maidenhead
Bowling A, Ebrahim S, eds (2005) Handbook of Health Research Methods:
Investigation, Measurement and Analysis. McGraw-Hill Professional Publishing,
Maidenhead
British Geriatics Society (2014) Fit for Frailty. Consensus Best Practice Guidelines
for the Care of Older People Living with Frailty in Community and Outpatient
Settings. BGS, London. http://www.bgs.org.uk/campaigns/fff/fff_full.pdf
(accessed 24 May 2016)
Drennan V, Iliffe S, Tai SS, Lenihan P, Deave T (2007) Can primary care identify
an at risk group in the older population. Br J Community Nurs 12(4):
1428
Gerrish K, Lacey A (2010) The Research Process in Nursing. 6th edn. Wiley-
Blackwell, Chichester
Holloway I, Wheeler S (2010) Qualitative Research in Nursing and Healthcare. 3rd
edn. Wiley-Blackwell, Chichester
Information Services Division Scotland (2010) SPARRA. ISD, Edinburgh. http://
www.isdscotland.org/Health-Topics/Health-and-Social-Community-Care/
SPARRA/ (accessed 24 May)
Longstaff F (2013) The case for renewed investment in the district nursing spe-
cialist practitioner qualification. Br Journal Community Nurs 18(9): 44650
McClane KS (2006) Screening instruments for use in a complete geriatric
assessment. Clin Nurse Spec 20(4): 2017
Metzelthin SF, van Rossum E, de Witte LP, Hendriks MR, Kempen GI (2010a)
The reduction of disability in community-dwelling frail older people: design
of a two-arm cluster randomized controlled trial. BMC Public Health 10:
511
Metzelthin SF, Danils R, van Rossum E, de Witte L, van den Heuvel WJ,
Kempen GI (2010b) The psychometric properties of three self-report screen-
ing instruments for identifying frail older people in the community. BMC
Public Health 10: 176
Meyer T, Deck R, Raspe H (2007) Problems completing questionnaires on
Would you like to write for the British
Journal of Community Nursing?
2016 MA Healthcare Ltd
Phone: 020 7501 6716 | Email: bjcn@markallengroup.com | Or write to: BJCN, St Judes Church, Dulwich Road, London SE24 0PB
British Journal of Community Nursing July 2016 Vol 21, No 7
CARE OF THE OLDER PERSON
health status in medical rehabilitation patients. J Rehabil Med 39(8): 6339
National Records of Scotland (2015) Projected Population of Scotland (2014-based).
National Population Projections by Sex and Age, with UK Comparisons. National
Records of Scotland, Edinburgh. www.nrscotland.gov.uk/files/statistics/
population-projections/2014-based/pp14.pdf (accessed 24 May 2016)
NHS Choices (2015) Dizziness (Light-Headedness). www.nhs.uk/Conditions/
dizziness/Pages/Introduction.aspx (accessed 24 May 2016)
NHS Education for Scotland (2016) Advanced Nursing Practice Toolkit. http://
www.advancedpractice.scot.nhs.uk/ (accessed 3 June 2016)
NHS Scotland (2015) HEAT Targets Due for Delivery in 2014/15.
Summary of Performance. NHS Scotland, Edinburgh. www.gov.scot/
Resource/0048/00483995.pdf (accessed 24 May 2016)
Polgar S, Thomas SA (2008) Introduction to Research in the Health Sciences.
5th edn. Churchill Livingstone Elsevier, Edinburgh
Rache M1, Hbert R, Dubois MF (2008) PRISMA-7: a case-finding tool
to identify older adults with moderate to severe disabilities. Arch Gerontol
Geriatr 47(1): 918
Ross T (2012) A Survival Guide for Health Research Methods. McGraw Hill/Open
University Press, Maidenhead
Royal College of Nursing (2010) Advanced Nurse Practitioners: an RCN Guide to
the Advanced Nurse Practitioner Role, Competencies and Programme Accreditation.
RCN, London
Rubenstein LZ, Alessi CA, Josephson KR, Trinidad Hoyl M, Harker JO,
Pietruszka FM (2007) A randomized trial of a screening, case finding, and
referral system for older veterans in primary care. J Am Geriatr Soc 55(2):
16674
Scottish Intercollegiate Guidelines Network (2003) Management of Osteoporosis:
a National Clinical Guideline [now replaced]. SIGN, Edinburgh
Scottish Intercollegiate Guidelines Network (2015) SIGN 142. Management of
Osteoporosis and the Prevention of Fragility Fractures. www.sign.ac.uk/guidelines/
fulltext/142/index.html (accessed 24 May 2016)
Scottish Government (2007) All Our Futures. Planning for a Scotland with an Ageing
Population. Scottish Government, Edinburgh
Scottish Government (2010a) Anticipatory Care Planning. Frequently Asked
Questions. Scottish Government, Edinburgh. http://www.gov.scot/
Publications/2010/04/13104128/1 (accessed 3 June 2016)
Scottish Government (2010b) The Healthcare Quality Strategy for NHS
Scotland. Scottish Gover nment, Edinburgh. http://www.gov.scot/
Publications/2010/05/10102307/0 (accessed 3 June 2016)
Scottish Government (2010c) Reshaping Care for Older People. A Programme
For Change 20112021. Scottish Government, Edinburgh. www.gov.scot/
Resource/0039/00398295.pdf (accessed 24 May)
Scottish Government (2013) Reshaping Care for Older People. Getting on. Scottish
Government, Edinburgh. http://www.gov.scot/Resource/0043/00434007.
pdf (accessed 24 May)
van Hout HP, Nijpels G, van Marwijk HW, Jansen AP, Vant Veer PJ, Tybout W,
Stalman WA (2005) Design and pilot results of a single blind randomized
controlled trial of systematic demand-led home visits by nurses to frail elderly
persons in primary care [ISRCTN05358495]. BMC Geriatr 5: 11
Wagner JT, Bachmann LM, Boult C, Harari D, von Renteln-Kruse W, Egger
M, Beck JC, Stuck AE (2006) Predicting the risk of hospital admission in
older personsvalidation of a brief self-administered questionnaire in three
European countries. J Am Geriatr Soc 54(8): 12716
We provide support and advice for first-time writers
and want to hear from you. Get in touch and we will
send you a copy of our author guidelines.
341
Copyright of British Journal of Community Nursing is the property of Mark Allen Publishing
Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.