Why should we assess the degree of frailty in primary care?

Résumé fourni par la source

Caring for people living with frailty is core business for general practice.When identifying frailty, clinicians often say they 'know it when they see it'. 1 Increasingly, primary care is encouraged to assess frailty more explicitly: to name it, score it, and code it.Many question what value this adds.1,2 Here, we outline why we believe identifying and communicating the degree of frailty is a key aspect in delivering personalised care to older people within primary care. What is frailty?Frailty describes a person's vulnerability to adverse health outcomes.More specifically, it expresses reduced ability to resist potentially damaging stress ('robustness'), such as an infection, a drug side effect, or a fall, coupled with delayed or incomplete recovery following a physiological insult ('resilience').3 Practically, these events manifest as delirium, falls, reduced mobility, social withdrawal, and loss of independence.Often acting together, these factors increase the need for care.4 These events often feel sudden and unexpected to patients and relatives.However, frailty assessment allows us to judge the likelihood of these acute events and, with the benefit of continuity, understand a patient's trajectory.A proactive approach to frailty, informed by an accurate assessment of frailty severity, allows these events to be anticipated, planned for, or prevented, and for future care needs to be planned for and delivered in ways that align with patients' values and priorities.5 Why assess frailty severity?Frailty is not all or nothing: it exists by degree.The prognosis, trajectory, and care needs of someone with mild frailty are vastly different from someone living with severe frailty.Being specific and accurate about an individual's frailty status can facilitate care that reflects this.In addition, identifying frailty at the population level can aid more effective allocation and commissioning of services, reflecting the fact that people with more severe frailty have both an increased requirement for health and social care services in general, and a greater need for services that are attuned to their specific needs.Passive measures such as the Electronic Frailty Index, now in its second iteration, can be helpful in stratifying practice populations to identify people at greatest risk of frailty.6 However, to identify frailty at an individual level, different tools are required.A good option is the Clinical Frailty Scale, a 9-point scale reflecting high-order age-related deficits that tend to accumulate as people age (Figure 1).7 This tool allows an individual-level assessment of frailty, informed by their level of functional independence.From this can come a more precise and accurate assessment of an individual's degree of frailty.It does, however, require clinical assessment.Access to primary care and proactive approaches to frailty identification are therefore central to effective frailty assessment.This is particularly important given the inextricable links between frailty, socioeconomic deprivation, and social vulnerability.8,9

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