Feasibility and acceptability of commonly used screening instruments to identify frailty among community-dwelling older people: a mixed methods study

Abstract

Background: Frailty exposes older people to an elevated risk of a range of negative outcomes. Emerging evidence that frailty can be effectively treated within community settings has stimulated calls for more proactive screening within primary care. Assessing feasibility is a critical preliminary step in assessing the efficacy of interventions such as screening. However, few studies have explored the feasibility and acceptability of administering frailty screening instruments within general practice, and even fewer have incorporated patient perspectives. Our study had three objectives: To 1) assess overall feasibility of the instruments (completion time and rate); 2) assess patient acceptability towards the instruments; and 3) assess the feasibility and acceptability of the instruments to administering nurses. Methods: The feasibility and acceptability of several frailty screening instruments (PRISMA-7, Edmonton Frail Scale, FRAIL Scale Questionnaire, Gait Speed, Groningen Frailty Indicator, Reported Edmonton Frail Scale and Kihon Checklist) was explored within the context of a larger diagnostic test accuracy (DTA) study. Completion time and rate was collected for all participants (N = 243). A sub-sample of patients (n = 30) rated each instrument for ease of completion and provided comment on perceived acceptability. Lastly, five of six administering nurses involved in the DTA study participated in semi-structured face-to-face interviews, rating the instruments against several feasibility and acceptability criteria (time, space, equipment, skill required to implement, acceptability to patients and nurses, ease of scoring) and providing comment on their responses. Results: The PRISMA-7 returned the highest overall feasibility and acceptability, requiring minimal space, equipment, skills and time to implement, and returning the fastest completion rate and highest patient and nurse acceptability rating. All screening instruments were faster to implement than the two reference standards (Fried's Frailty Phenotype and Frailty Index). Self-administered instruments were subject to lower rates of completion than nurse-administered instruments. (Continued on next page)Conclusions: This study has demonstrated that a number of commonly used frailty screening instruments are potentially feasible for implementation within general practice. Ultimately, more research is needed to determine how contextual factors, such as differences in individual patient and clinician preferences, setting and system factors, impact on the feasibility of screening in practice.

Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study

“…Frailty screening within general practice contexts, followed by timely intervention, shows potential for driving more person-centred and responsive care for older people [ 8 , 19 ]. However, to be implemented effectively, screening instruments must be both accurate and feasible within primary care settings.…”

“…However, little is known about practitioner attitudes towards specific screening instruments currently used within the primary care sector [ 12 ], with the exception of a few notable studies [ 13 – 20 ]. Where the feasibility of frailty screening instruments has been assessed, studies have tended to focus on accuracy, fit-for-purpose, dimensions/domains represented, time and equipment requirements [ 1 , 19 , 21 , 22 ]. In particular, application of a mixed methods design to specifically explore general practitioner (GP) and practice nurse (PN) perceptions of frailty screening instruments and the reasons for those perceptions has been under-utilised.…”

Performance-Based Screening Tools for Physical Frailty in Community Settings

“…Selfassessment questionnaires seem to be even faster to implement, they are simple and inexpensive. However, their weakness resides in lower rates of completion compared to instruments administered by health workers [236]. The proposed screening scheme for frailty in the elderly in Slovenia.…”

Interweaving Arts-Based, Qualitative and Mixed Methods Research: Showcasing Integration and Knowledge Translation Through Material and Narrative Reflection

“…We have published extensively on the research and theoretical perspectives associated with this research program, and since those materials are readily available elsewhere, we do not replicate those writings here (Ambagtsheer et al, 2020;Ambagtsheer et al, 2017;Archibald, Lawless et al, 2017;Archibald, Lawless, Gill, & Chehade, 2020;Ambagtsheer et al, 2019;. Pertinent to this writing however are the predominant findings of the work, the higher-level concepts related to the program of research collectively, and the reflections germane to the topic of study, in order to delineate the relationships between these and the various artistic approaches undertaken.…”