The feasibility, acceptability and appropriateness of screening for frailty in Australians aged 75 years and over attending Australian general practice

Jennifer Job; Caroline Nicholson; Debra Clark; Julia Arapova; Claire Jackson

doi:10.1071/PY23173

RESEARCH ARTICLE (Open Access)

Next Contents Vol 30(3)

The feasibility, acceptability and appropriateness of screening for frailty in Australians aged 75 years and over attending Australian general practice

Jennifer Job

^A ^* , Caroline Nicholson ^A , Debra Clark ^B , Julia Arapova ^C and Claire Jackson ^A ^D

+ Author Affiliations

- Author Affiliations

^A Centre for Health System Reform and Integration, University of Queensland-Mater Research Institute, Royal Brisbane & Women’s Hospital, Level 8, Health Sciences Building, Building 16/901, Brisbane, Qld 4029, Australia.

^B Sydney North Health Network, Level 5, Tower 2/475 Victoria Avenue, Chatswood, NSW 2067, Australia.

^C Brisbane South Primary Health Network, Building 20, Garden City Office Park, 2404 Logan Road, Eight Mile Plains, Qld 4113, Australia.

^D General Practice Clinical Unit, University of Queensland, Royal Brisbane & Women’s Hospital, Level 8, Health Sciences Building, Building 16/901, Brisbane, Qld 4006, Australia.

^* Correspondence to: j.job@mater.uq.edu.au

Australian Journal of Primary Health 30, PY23173 https://doi.org/10.1071/PY23173

Submitted: 13 September 2023 Accepted: 24 April 2024 Published: 13 May 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Globally, frailty is associated with a high prevalence of avoidable hospital admissions and emergency department visits, with substantial associated healthcare and personal costs. International guidelines recommend incorporation of frailty identification and care planning into routine primary care workflow to support patients who may be identified as pre-frail/frail. Our study aimed to: (1) determine the feasibility, acceptability, appropriateness and determinants of implementing a validated FRAIL Scale screening Tool into general practices in two disparate Australian regions (Sydney North and Brisbane South); and (2) map the resources and referral options required to support frailty management and potential reversal.

Methods

Using the FRAIL Scale Tool, practices screened eligible patients (aged ≥75 years) for risk of frailty and referred to associated management options. The percentage of patients identified as frail/pre-frail, and management options and referrals made by practice staff for those identified as frail/pre-frail were recorded. Semi-structured qualitative interviews were conducted with practice staff to understand the feasibility, acceptability, appropriateness and determinants of implementing the Tool.

Results

The Tool was implemented by 19 general practices in two Primary Health Networks and 1071 consenting patients were assessed. Overall, 80% of patients (n = 860) met the criterion for frailty: 33% of patients (n = 352) were frail, and 47% were pre-frail (n = 508). They were predominantly then referred for exercise prescription, medication reviews and geriatric assessment. The Tool was acceptable to staff and patients and compatible with practice workflows.

Conclusions

This study demonstrates that frailty is identified frequently in Australians aged ≥75 years who visit their general practice. It’s identification, linked with management support to reverse or reduce frailty risk, can be readily incorporated into the Medicare-funded annual 75+ Health Assessment.

Keywords: determinants, healthy ageing, hospital avoidance, implementation, older persons, primary care, risk of frailty, screening.

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