Consider
Consider people who may be living with frailty [mild, moderate and severe] by understanding populations with a high prevalence of frailty and using frailty screening tools.
Approach
The mode of identification of people who may be living with frailty will be dependent on circumstances and can be done opportunistically or systematically. It should be undertaken by all professionals in contact with older people (e.g. health and social care workers, third sector, voluntary and support workers, wardens and staff in sheltered and extra care schemes).
The following groups have high rates of frailty [5, with modification]:
- People who are resident in care homes.
- People known to be living with dementia.
- People aged over 65 who have experienced one of the major frailty syndromes:
- Immobility (e.g. sudden change in mobility)
- Delirium (e.g. acute confusion, sudden worsening of confusion in someone with previous dementia or known memory loss).
- Incontinence (e.g. change in continence – new onset or worsening of urine or faecal incontinence).
- Susceptibility to side effects of medication.
- People aged 65 or above with multimorbidity due to 4 or more long term conditions.
- People on over 10 medications.
- People known to community nurses or social care and support services with continuous support needs.
- People on end of life (EOL) register or cancer care lists or with complex neurological problems (stroke, MS, Parkinson’s disease) or older people with severe mental illness.
- All people aged over 85.
- People who are housebound or living in sheltered schemes or extra care or in ‘ordinary’ housing with telecare aids (e.g. ‘life alarms’).
Frailty screening tools
The Electronic Frailty Index (eFI) can be used for screening the population of people aged 65 years and over on a GP register. Other methods to identify frailty in individuals include:
- PRISMA-7 (with a cut-off score of >3),
- Gait Speed (taking more than 5 seconds to walk 4 m using usual walking aids if appropriate)
- Timed Get up and Go Test (with a cut off score of 10s to get up from a chair, walk 3m, turn around and sit down, with walking aids if used)
- Edmonton Frailty Scale
- Clinical Frailty Scale
Resources
- Updated guidance on supporting Routine Frailty Identification and Frailty Care through the GP Contract 2017/2018 https://www.england.nhs.uk/wp-content/uploads/2017/04/supporting-guidance-on-frailty-update-sept-2017.pdf
- Toolkit for general practice in supporting older people living with frailty 2017 https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty.pdf
- Fit for Frailty (part 1), section 3 http://www.bgs.org.uk/campaigns/fff/fff_full.pdf
- iHUB (Health improvement Scotland) – slide deck ‘frailty tools’ screening and assessment comparators https://ihub.scot/media/3023/frailty-screening-and-assessment-tools-comparator.pdf
- NICE guidance: Multimorbidity: Clinical Assessment and Management https://www.nice.org.uk/guidance/ng56/resources/multimorbidity-clinical-assessment-and-management-pdf-1837516654789
Evidence
Groups of people with high prevalence of frailty
- XXX
Frailty ‘screening tools’
- There is no “gold standard” tool to both screen for and diagnose frailty. Therefore, in the absence of a “gold standard”, the instrument(s) to screen for and diagnose frailty should be chosen according to the clinical context. Potential tools include:
- Electronic Frailty Index (eFI) in general practice setting; Clinical Frailty Scale; Edmonton Frailty Scale; FRAIL Index
- Frailty phenotype; Inter-Frail; Prisma-7; Sherbrooke Postal Questionnaire
- Short Physical performance Battery (SPPB); Study of Osteoporotic Fractures Index (SOF); and
- Gait speed
- Advantage – Frailty at a population level: systematic review – http://advantageja.eu/images/WP5-Frailty-at-Population-Level-a-Systematic-Review-.pdf
Local stories
LINKS
Top Tips on ‘delivery and implementation’
XXXXXXXXXX
Top Tips on ‘workforce, skills and training’
XXXXXXXXXX
