Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway: a methodological guide and results of a large-scale deployment in the Netherlands

Abstract

Background: Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. Methods: The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. Results: In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cutoff scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. Conclusion: Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.

Perspectives of older adults, caregivers, healthcare providers on frailty screening in primary care: a systematic review and qualitative meta-synthesis

“…As for the screening, the pathway could be a two-step process to manage frailty-implementing multidimensional screening for all individuals and assessing frail ones [ 69 ]. In 2013, the Netherlands carried out mass screening using the PERSSILAA screening pathway, a two-step annual screening program, to identify older adults at risk of frailty [ 70 ]. Older adults first completed a self-screening questionnaire to screen their general health status, and then those who were at risk of becoming frail were invited for a face-to-face assessment.…”

Comparison of Frailty Screening Instruments in the Emergency Department

“…Such triage could improve the efficiency of acute hospital services for older people by allowing the cohorting of appropriate patients to older person’s or frailty-specific units, by promoting early allocation of CGA that can reduce mortality and institutionalisation and by facilitating re-direction to more appropriate care in the community such as hospital at home or day hospital services [52]. Given the growing importance of frailty from a public health perspective [53], the as-yet limited interventions to avoid delayed discharges or hospital readmissions [54] and the challenges of delivering integrated care to older people across settings [55], identifying frailty so early could make acute and community care [56] more responsive for all patients.…”

Early identification of frailty: Developing an international delphi consensus on pre-frailty

“…Most participants agreed that pre-frailty is age-associated, and might directly result in adverse outcomes without the need to transition to frailty. This is supported by several studies showing that pre-frailty results in increased healthcare utilisation [34], development of frailty [35], and higher mortality [36]. Consensus was established that pre-frailty is likely reversible and prevention of frailty is possible.…”