Frailty in Older Adults – Early Identification and Management (2017)
This updated BC guideline addresses the early identification and management of older adults with frailty or vulnerable to frailty. The guideline facilitates individualized assessment and provides a framework and tools to promote patient-centred strategies to manage frailty and prevent further functional decline. The primary focus of the guideline is the community-based primary care setting, although the tools and strategies included may be useful in other care contexts.

Key recommendations
•    Early identification and management of patients with frailty or who are vulnerable to frailty provides an opportunity to suggest appropriate preventive and rehabilitative actions (e.g., an exercise program, review of diet and nutrition, medication review) to be taken to slow, prevent, or even reverse decline associated with frailty.
•    Use of a diligent case-finding approach to identify patients with frailty, particularly among older adults who regularly or increasingly require health and social services, is recommended. However, routine frailty screening of the general population of older adults is not recommended.
•    Many patients with frailty can be assessed and managed in the primary care setting through a network of support, which may include family, caregivers, and community care providers. Coordinate care with other care providers and ensure patients and caregivers are referred to or connected with local health care and social services.
•    Polypharmacy is common in patients with frailty. Consider the benefits and harms of medications by conducting a medication review in all patients with frailty.
•    Initiate advance care planning discussions for patients with frailty or vulnerable to frailty.

Key resources that accompany this guideline
•    Appendix A: Frailty Assessment and Management Pathway
•    Appendix B: Sample Care Plan Template
•    Appendix C: Medication Review
•    Resource Guide for Older Adults and Caregivers 
•    Advance Care Planning Resource Guide

Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management (2017) 
This updated BC guideline provides recommendations for the diagnosis and management of COPD in adults who are 19 years and older. The guideline includes a COPD Flare-up Action Plan, a Patient Care Flow Sheet, and a Resource Guide for Patients.

New and amended key recommendations
•    Use spirometry to confirm airflow obstruction in all patients suspected of having COPD. [Amended, 2017]
•    Implement pharmacologic therapy in a stepwise approach and use the lowest step that achieves optimal control based on the patient’s severity of COPD. [New, 2017] 
•    Develop an exacerbation action plan with the patient for pharmacologic therapies including short-acting bronchodilators, oral corticosteroids, and antibiotics. [Amended, 2017]
•    Use routine follow-ups to evaluate the patient’s inhaler technique and adherence regularly. Evaluating inhaler technique is particularly important in patients who are older, frail, or cognitively impaired. [New, 2017]

Hormone Testing: Indications and Appropriate Use
See the recent guideline Hormone Testing: Indications and Appropriate Use (formerly known as Special Endocrine Testing) for recommendations on the appropriate indications for testing selected endocrine hormones in patients who are 19 years and older, mainly in a primary health care setting.

New BC Guidelines Mobile App
To download the new BC Guideline Mobile App for both Android and Apple devices, visit www.BCGuidelinesApp.ca.  [8]

To stay up to date with BC guidelines, visit the What’s New section on www.BCGuidelines.ca [9].