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As president of the Institute of Community Health Nursing (ICHN), I welcome this report on the Impact of Frailty on Public Health Nurse Service Utilisation in Ireland and I congratulate the authors led by Dr Lorna Roe, Trinity College Dublin. This is the second report the ICHN has commissioned from the TILDA Study Team and it provides a unique insight in to community nursing services for older people. The study also makes an important contribution to the implementation of “Making Evidence Work for Community Nursing”, the ICHN strategy to support evidence-informed policy and practice for nurses working in community. This strategy incorporates a number of other strands including building research capacity, making evidence more accessible,improving monitoring and evaluation, supporting the development of an infrastructure and maintaining and generating international links with community nursing globally. We welcome the findings from the report which highlight the complexity of the lives of people living in community who are frail and also of the intricacy of implementing public health nursing services. Eligibility for the public health nursing service for this group,which is confined to those with medical cards only, is highlighted as an important factor in accessing the service and the ICHN would welcome a broader debate around this issue. The findings show that more than half of public health nursing service users aged 65 years and older are frail. This finding highlights the ability of the public health nursing services to identify those who are frail and to take account of the complex socio-ecological environment in community. They also reflect the many different roles played by the public health nursing service in supporting older people to live in community including: health promotion, early identification and prevention of problems, case management and the provision of direct clinical nursing care. In the day-to-day implementation of a public health nursing service, these activities must be carefully balanced so that the important role of prevention and early identification is not lost in the overwhelming need to provide complex clinical care for an increasingly older and more dependant population. The ICHN concurs with the conclusions of the authors of the need for greater resources to be made available to support the assessment process of older people. We also support the need for further research to be conducted in this area. Johanna Downey, President ICHN

THE IMPACT OF FRAILTY ON PUBLIC HEALTH NURSE SERVICE UTILISATION: Findings from The Irish Longitudinal Study on Ageing (TILDA)