Identification of Frailty in Primary Care: Feasibility and Acceptability of Recommended Case Finding Tools Within a Primary Care Integrated Seniors’ Program

Abstract

Frailty-a dynamic and multidimensional state of increased vulnerability-often remains undetected in primary care until its late presentation when a seemingly minor event results in significant health crisis (Moody, Lyndon, & Grant, 2017) affecting an individual's level of function and independence (Di Pollina et al., 2017; Landi et al., 2004). Frailty is associated with an aging population, with prevalence rates in Canada of 25% in those 65 years of age up to 50% in those above 80 years (Muscedere et al., 2016), and results in higher usage of emergency departments, hospital admissions, social dependency, and caregiver burden (Xue, 2011). Although the prevalence of frailty increases with age, it is not an inevitable part of aging; and, with early recognition and targeted intervention, it can be mitigated (Harrison, Clegg, Conroy, & Young, 2015). Major international agencies recommend case finding for frailty in older adults as part of routine clinical practice (British Geriatrics Society [BGS], 2014; Dent et al., 2017; National Institute for Health and Care Excellence, 2016). Case finding implies a systematic search for those at risk of frailty (e.g., those who require additional health and social services; British Columbia Ministry of Health, 2017). Ideally, frailty case finding tools should be valid, short (Morley et al., 2013), simple to use, and easy to interpret by nonspecialist staff (Clegg, Rogers, & Young, 2015). However, despite the abundance of existing tools, 848153G GMXXX10.1177/2333721419848153Gerontology and Geriatric MedicineAbbasi et al.

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

“…Moreover, it had the highest acceptability rating for both patients and administering nurses, and was rated first for five of six individual criteria ranked by nurses. These findings for the P7 are consistent with respect to completion rate, skills, equipment, time to complete, space requirements and provider acceptability as a previous study conducted in general practice [26]. Recent research has also indicated that it returns relatively high diagnostic and predictive accuracy in primary care settings [13,[42][43][44], although more replication studies are needed to ensure generalisability.…”

“…Our findings lend weight to the viewpoint that rapid frailty screening instruments of the type included within this study are more practical to implement than reference standards within busy general practice settings. It has frequently been asserted within the frailty literature that GPs and their teams need to be able to implement simple, rapid frailty screening due to time constraints [4,12,25,26,42]. Our results show that screening instruments took consistently less time to implement than the reference standards, which in the case of the FP also required physical space and equipment that may not be readily available within most general practice settings.…”

“…The criteria included time to implement, space required, skills required, equipment required, acceptability to patient, and acceptability to administering nurse, and were based on the feasibility. areas identified by Orsmond and Cohen that were most pertinent to the research objectives [20], together with alignment with the most common feasibility elements explored in previous frailty research [24][25][26]. Participants were also asked to verbally explain reasons for their ratings.…”

“…Feasibility studies address the question of whether an intervention can work in practice, and typically focus on process considerations rather than outcomes [20]. Only a small number of studies have addressed the feasibility of frailty screening within general practice settings [21][22][23][24][25][26], and these have generally addressed electronic means of frailty identification and assessment rather than administered instruments. Those which have assessed administered instruments have tended to focus on a single instrument [24,25], rather than comparing multiple instruments simultaneously.…”

“…Those which have assessed administered instruments have tended to focus on a single instrument [24,25], rather than comparing multiple instruments simultaneously. Although one study did assess the feasibility of two administered instruments (PRISMA-7 and Gait Speed) alongside an electronic Frailty Index (eFI), it did not incorporate both patient and provider perspectives [26]. Consequently, the aim of our study was to assess the feasibility and acceptability of several widely used frailty screening instruments within a general practice context.…”