Background: Frailty is an emerging global concern that has major implications for clinical practice and public health. As people get older and the prevalence of frailty increases, there is an increased need for innovative care models that would address special needs of frail older adults. Implementing standardized frailty screening to determine the prevalence of frailty is the first step in evaluating for potential resources needed to address this problem.
Objective: The objectives of this QI project were to increase providers’ knowledge about frailty, implement standardized frailty assessment, and establish the prevalence and the severity of frailty in a population of homebound older persons enrolled in a home-based primary care program.
Method: The QI project interventions included a teaching module about frailty, implementation of assessment using FRAIL scale, and the analysis of the outcome of the assessment.
Results: There were a total of 97 screenings performed in the period of 12 weeks. The patients’ mean age was 85.9 (SD +/- 8.3). The prevalence of frailty in the older patients who were enrolled in the HBPCP at the time of the QI project’s implementation was 94%. Six (6.4%) patients were found to have severe frailty, 32 (34%) were moderately frail, and 50 (53%) were categorized with mild frailty. No correlation (p = .10) between the frailty score and age was found when the relationship was examined using Pearson correlation (r = .18) or Spearman’s rank correlation (ρ = .18). To determine whether greater severity of frailty correlated with the increased likelihood of making the diagnosis and documenting the diagnosis in the EHR, data were analyzed using the chi-square test. No significant correlations were observed between frailty score (p = .18), age (p = .95), and providers’ compliance with documenting the diagnosis in the EHR.
Conclusion: Most homebound patients who are enrolled in home-based primary care programs are frail. Implementing individualized interventions to address frailty in this population could improve care outcomes, patient satisfaction, and reduce healthcare utilization and costs.
References 1) Ensrud, K. E., Kats, A. M., Schousboe, J. T., Taylor, B. C., Cawthon, P. M., Hillier, T. A., Yaffe, K., Cummings, S.R., Cauley, J.A., Langsetmo, L., for the Study of Osteoporotic Fractures. (2018). Frailty phenotype and healthcare costs and utilization in older women. Journal of the American Geriatrics Society, 66(7), 1276-1283. https://doi-org.ucsf.idm.oclc.org/10.1111/jgs.15381 2) Ensrud, K. E., Kats, A. M., Schousboe, J. T., Taylor, B. C., Vo, T. N., Cawthon, P. M., Hoffman, A.R., Langsetmo, L., for the Osteoporotic Fractures in Men Study (MrOS). (2020). Frailty phenotype and healthcare costs and utilization in older men. Journal of the American Geriatrics Society, 68(9), 2034-2042. https://doi-org.ucsf.idm.oclc.org/10.1111/jgs.16522 3) Cesari, M., Calvani, R., & Marzetti, E. (2017). Frailty in Older Persons. Clinics in geriatric medicine, 33(3), 293–303. https://doi.org/10.1016/j.cger.2017.02.002 4) Cesari, M., Prince, M., Thiyagarajan, J. A., De Carvalho, I. A., Bernabei, R., Chan, P., Gutierrez-Robledo, L. M., Michel, J. P., Morley, J. E., Ong, P., Rodriguez Manas, L., Sinclair, A., Won, C. W., Beard, J., & Vellas, B. (2016). Frailty: An Emerging Public Health Priority. Journal of the American Medical Directors Association, 17(3), 188–192. https://doi.org/10.1016/j.jamda.2015.12.016
After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.