BackgroundThe purpose of this manuscript was to evaluate the effectiveness of the Community Actions and Resources Empowering Seniors (CARES) model in measuring and mitigating frailty among community-dwelling older adults.MethodsThe CARES model is based on a goal-oriented multidisciplinary primary care plan which combines a comprehensive geriatric assessment (CGA) with health coaching. A total of 51 older adults (82 ± 7 years; 33 females) participated in the pilot phase of this initiative. Frailty was measured using the Clinical Frailty Scale (CFS) and the Frailty Index (FI-CGA) at baseline and at six-month follow-up.ResultsThe FI-CGA at follow-up (0.21 ± 0.08) was significantly lower than the FI-CGA at baseline (0.24 ± 0.08), suggesting an average reduction of 1.8 deficits. Sixty-one per cent of participants improved their FI-CGA and 38% improved CFS categories. Participants classified as vulnerable/frail at baseline were more responsive to the intervention compared to non-frail participants.ConclusionPilot data showed that it is feasible to assess frailty in primary care and that the CARES intervention might have a positive effect on frailty, a promising finding that requires further investigations. General practitioners who participate in the CARES model can now access their patients’ FI-CGA scores at point of service through their electronic medical records.

Background: Frailty is characterized by loss of biological reserves and is associated with an increased risk of adverse health outcomes. Frailty can be operationalized using a Frailty Index (FI) based on the accumulation of health deficits; items under health evaluation in the well-established Comprehensive Geriatric Assessment (CGA) have been used to generate an FI-CGA. Traditionally, constructing the FI-CGA has relied on paper-based recording and manual data processing. As this can be time-consuming and error-prone, it limits widespread uptake of this proven type of frailty assessment. Here, we report the development of an electronic tool, the eFI-CGA, for use on personal computers by frontline healthcare providers, to collect CGA data and automate FI-CFA calculation. The ultimate goal is to support early identification and management of frailty at points-of-care, and make uptake in Electronic Medical Records (EMR) feasible and transparent. Methods: An electronic CGA (eCGA) form was implemented to operate on Microsoft's WinForms platform and coded using C# programming language. Users complete the eCGA form, from which items under the CGA evaluation are automatically retrieved and processed to output an eFI-CGA score. A user-friendly interface and secured data saving methods were implemented. The software was debugged and tested using systematically designed simulation data, addressing different logic, syntax, and application errors, and then tested with clinical assessment. The user manual and manual scoring were used as ground truth to compare eFI-CGA input and automated eFI score calculations. Frontline health-provider user feedback was incorporated to improve the end-user experience. Sepehri et al. Standalone eFI-CGA Results: The Standalone eFI-CGA software tool was developed and optimized for use on personal computers. The user interface adapted the design of paper-based CGA form to facilitate familiarity for clinical users. Compared to known scores, the software tool generated eFI-CGA scores with 100% accuracy to four decimal places. The eFI-CGA allowed secure data storage and retrieval of multiple types, including user input, completed eCGA form, coded items, and calculated eFI-CGA scores. It also permitted recording of actions requiring clinical follow-up, facilitating care planning. Application bugs were identified and resolved at various stages of the implementation, resulting in efficient system performance. Discussion: Accurate, robust, and reliable computerized frailty assessments are needed to promote effective frailty assessment and management, as a key tool in health care systems facing up to frailty. Our research has enabled the delivery of the standalone eFI-CGA software technology to empower effective frailty assessment and management by various healthcare providers at points-of-care, facilitating integrated care of older adults.

Frailty threatens the quality of life of seniors. As the leading cause for the disproportionate use of health care resources, frailty is a serious threat to the sustainability of the health care system. Mounting evidence suggests frailty can be prevented with early assessment and management. Primary care providers are well positioned to identify "at risk" seniors and enact care plans to prevent frailty from progressing. The Comprehensive Geriatric Assessment (CGA) has repeatedly demonstrated value in the clinical setting for enhanced outcomes for seniors. The Frailty Index (FI) is a reliable and sensitive measure of frailty that can be generated from the CGA (FI-CGA). Implementing the FI-CGA into the electronic medical records of primary care can enable the use of a reliable and valid measurement of frailty at point of service. Using the electronic FI-CGA in the clinic setting guides healthcare providers to make more meaningful and comprehensive healthcare decisions. Based on the degree of frailty, health coaching aims to both support the seniors competence in their self-management as well the adoption of health promoting behaviors like exercise and improved nutritional choices. The Community Actions and Resources Empowering Seniors (CARES) collaborative model in primary care aims to provide substantial healthcare cost savings over time by addressing frailty at early stages and decreasing costly hospital admissions. CARES further aims to improve the quality of life of seniors by generating a sense of empowerment and control over their risk for frailty through health coaching to adopt healthy aging strategies.

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Frailty is characterized by loss of biological reserves across multiple systems and associated with increased risks of adverse outcomes. A Frailty Index (FI) constructed using items from the Comprehensive Geriatric Assessment (CGA) has been validated in geriatric medicine settings to estimate the level of frailty. Traditionally, the CGA used a paper form and the CGA-based FI calculation was a manual process. Here, we reported building of an electronic version of the assessment on personal computers (PC), i.e., standalone eFI-CGA, to benefit frailty assessment at points of care. The eFI-CGA was implemented as a software tool on the WinForms platform. It automated the FI calculation by counting deficits accumulation across multiple domains assessing medical conditions, cognition, balance, and dependency of activities of daily living. Debugging, testing, and optimization were performed to enhance the software performance with respect to automation accuracy (processing algorithm), friendly user interface (user manual and feedback), and data quality control (missing data and value constraints). Systematically-designed simulation dataset and anonymous real-world cases were both applied. The optimized assessment tool resulted in fast and convenient conductance of the CGA, and a 100% accuracy rate of the eFI-CGA automation for up to four decimals. The stand-alone eFI-CGA implementation has provided a PC-based software tool for use by geriatricians and primary and acute care providers, benefiting early detection and management of frailty at points of care for older adults.