Frailty screening among older adults receiving home care packages: a study of feasibility and prevalence
Amy Waller A B C G , Andrea Coda A B C D , Mariko Carey A B C , Amy Davis E and Matthew Clapham F
+ Author Affiliations
- Author Affiliations
A Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
B Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia.
C Hunter Medical Research Institute, New Lambton Heights, NSW 2285, Australia.
D School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
E Integratedliving Australia, New Lambton, NSW 2285, Australia.
F Clinical Research Design and Statistics Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW 2285, Australia.
G Corresponding author. Email: amy.waller@newcastle.edu.au
Australian Journal of Primary Health 27(3) 202-207 https://doi.org/10.1071/PY20200
Submitted: 4 September 2020 Accepted: 24 May 2021 Published: 16 June 2021
Abstract
Home care packages (HCPs) aim to support older people to remain in their homes for as long as possible. Early detection and management of frailty in community-dwelling older people may prevent or delay transfer to residential aged care. This suggests that it is important to establish mechanisms for identifying frailty among older adults. This study examined the feasibility of obtaining self-reported level of frailty from a sample of older adults receiving HCPs from an Australian aged care provider. The prevalence of frailty and sociodemographic and clinical correlates were assessed. Customers aged ≥65 years receiving an HCP from an aged care and disability service provider in New South Wales (n = 158; 53.5% consent rate) completed a survey during their scheduled visit. The mean (±s.d.) total score on the Edmonton Frail Scale was 7.3 ± 2.4 (range 1–13). The prevalence of frailty was 45% (5% ‘severe frailty’, 14% ‘moderate frailty’, 26% ‘mild frailty’). Clients who had fallen in the past year had, on average, a 1.0-point higher frailty score (95% confidence interval 0.16–1.90) than those who had not. Given the high proportion of adults in our sample who were identified as frail, regular standardised assessments of frailty may assist community aged care providers to provide early intervention to reduce the risk of falls within this group of clients.
Keywords: public health practice, aged health services, patient-centred care, home care packages, older people, frailty, community aged care, falls prevention programs.
References
Agency for Clinical Innovation (2020) Frailty screening and assessment tools. (ACI: Sydney, NSW, Australia) Available at https://aci.health.nsw.gov.au/resources/frailty-taskforce/reports/frailty-screening-and-assessment-tools [Verified 12 May 2021]Australian Government Department of Health and Ageing (DoHA) (2020) Home Care Packages Program operational manual: a guide for home care providers. (DoHA: Canberra, ACT, Australia) Available at https://www.health.gov.au/sites/default/files/documents/2021/02/home-care-packages-program-operational-manual-a-guide-for-home-care-providers_1.pdf [Verified 12 May 2021]
Australian Institute of Health and Welfare (AIHW) (2018) Older Australians at a glance. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance [Verified 12 May 2021]
Australian Institute of Health and Welfare (AIHW) (2019a) Aged care. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports/australias-welfare/aged-care [Verified 12 May 2021]
Australian Institute of Health and Welfare (AIHW) (2019b) Trends in hospitalised injury due to falls in older people 2007–08 to 2016–17. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-due-to-falls [Verified 12 May 2021]
Borges MK, Canevelli M, Cesari M, Aprahamian I (2019) Frailty as a predictor of cognitive disorders: a systematic review and meta-analysis. Frontiers in Medicine 6, 26
| Frailty as a predictor of cognitive disorders: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 30838210PubMed |
Burgess S, Hercus C (2017) Final report: Frailty in community dwelling older people – using frailty screening as the canary in the coal mine. (Benetas: Melbourne, Vic., Australia) Available at https://www.benetas.com.au/assets/documents/Frailty-Report-abridged.pdf [Verified 12 May 2021]
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012) Prevalence of frailty in community‐dwelling older persons: a systematic review. Journal of the American Geriatrics Society 60, 1487–1492.
| Prevalence of frailty in community‐dwelling older persons: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22881367PubMed |
Dent E, Dal Grande E, Price K, Taylor AW (2017a) Frailty and usage of health care systems: results from the South Australian Monitoring and Surveillance System (SAMSS). Maturitas 104, 36–43.
| Frailty and usage of health care systems: results from the South Australian Monitoring and Surveillance System (SAMSS).Crossref | GoogleScholarGoogle Scholar | 28923175PubMed |
Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L (2017b) The Asia-Pacific clinical practice guidelines for the management of frailty. Journal of the American Medical Directors Association 18, 564–575.
| The Asia-Pacific clinical practice guidelines for the management of frailty.Crossref | GoogleScholarGoogle Scholar | 28648901PubMed |
Dwyer R, Stoelwinder J, Gabbe B, Lowthian J (2015) Unplanned transfer to emergency departments for frail elderly residents of aged care facilities. Journal of the American Medical Directors Association 16, 551–562.
| Unplanned transfer to emergency departments for frail elderly residents of aged care facilities.Crossref | GoogleScholarGoogle Scholar | 25933726PubMed |
Finnegan S, Bruce J, Seers K (2019) What enables older people to continue with their falls prevention exercises? A qualitative systematic review. BMJ Open 9, e026074
| What enables older people to continue with their falls prevention exercises? A qualitative systematic review.Crossref | GoogleScholarGoogle Scholar | 30992291PubMed |
Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C, Arora S, Street A, Parker S, Roberts HC, Bardsley M, Conroy S (2018) Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records. Lancet 391, 1775–1782.
| Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records.Crossref | GoogleScholarGoogle Scholar | 29706364PubMed |
Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL (2018) Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Journal of the American Medical Association 319, 1705–1716.
| Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force.Crossref | GoogleScholarGoogle Scholar | 29710140PubMed |
Hogan DB, Hogan DB, Maxwell CJ, Afilalo J, Arora RC, Bagshaw SM, Basran J, Bergman H, Bronskill SE, Carter CA, Dixon E, Hemmelgarn B, Madden K, Mitnitski A, Rolfson D, Stelfox HT, Tam-Tham H, Wunsch H (2017) A scoping review of frailty and acute care in middle-aged and older individuals with recommendations for future research. Canadian Geriatrics Journal 20, 22–37.
| A scoping review of frailty and acute care in middle-aged and older individuals with recommendations for future research.Crossref | GoogleScholarGoogle Scholar | 28396706PubMed |
Hopewell S, Adedire O, Copsey BJ, Boniface GJ, Sherrington C, Clemson L, Close JC, Lamb SE (2018) Multifactorial and multiple component interventions for preventing falls in older people living in the community. The Cochrane Database of Systematic Reviews 7, CD012221
| Multifactorial and multiple component interventions for preventing falls in older people living in the community.Crossref | GoogleScholarGoogle Scholar | 30035305PubMed |
Hopewell S, Copsey B, Nicolson P, Adedire B, Boniface G, Lamb S (2020) Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants. British Journal of Sports Medicine 54, 1340–1350.
| Multifactorial interventions for preventing falls in older people living in the community: a systematic review and meta-analysis of 41 trials and almost 20 000 participants.Crossref | GoogleScholarGoogle Scholar | 31434659PubMed |
Kojima G (2018) Frailty as a predictor of nursing home placement among community-dwelling older adults: a systematic review and meta-analysis. Journal of Geriatric Physical Therapy 41, 42–48.
| Frailty as a predictor of nursing home placement among community-dwelling older adults: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 27341327PubMed |
Kurrle S, Bateman C, Cumming A, Pang G, Patterson S, Temple A (2019) Implementation of a model of care for hospitalised older persons with cognitive impairment in six New South Wales hospitals. Australasian Journal on Ageing 38, 98–106.
| Implementation of a model of care for hospitalised older persons with cognitive impairment in six New South Wales hospitals.Crossref | GoogleScholarGoogle Scholar | 31496063PubMed |
Lowthian J, Turner L, Joe A, Pearce C, Brijnath B, Browning C, Shearer M, Mazza D (2018) Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: a retrospective cohort study using routinely collected hospital data. Emergency Medicine Australasia 30, 494–502.
| Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: a retrospective cohort study using routinely collected hospital data.Crossref | GoogleScholarGoogle Scholar | 29346836PubMed |
Morley JE, Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J (2013) Frailty consensus: a call to action. Journal of the American Medical Directors Association 14, 392–397.
| Frailty consensus: a call to action.Crossref | GoogleScholarGoogle Scholar | 23764209PubMed |
Morley JE, Arai H, Cao L, Dong B, Merchant RA, Vellas B, Visvanathan R, Woo J (2017) Integrated care: enhancing the role of the primary health care professional in preventing functional decline: a systematic review. Journal of the American Medical Directors Association 18, 489–494.
| Integrated care: enhancing the role of the primary health care professional in preventing functional decline: a systematic review.Crossref | GoogleScholarGoogle Scholar | 28549703PubMed |
Morris R, O’Riordan S (2017) Prevention of falls in hospital. Clinical Medicine (London, England) 17, 360–362.
| Prevention of falls in hospital.Crossref | GoogleScholarGoogle Scholar |
Nyman SR, Victor CR (2012) Older people’s participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age and Ageing 41, 16–23.
| Older people’s participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review.Crossref | GoogleScholarGoogle Scholar | 21875865PubMed |
Ofori-Asenso R, Chin KL, Mazidi M, Zomer E, Ilomaki J, Zullo AR, Gasevic D, Ademi Z, Korhonen MJ, LoGiudice D, Bell JS, Liew D (2019) Global incidence of frailty and prefrailty among community-dwelling older adults: a systematic review and meta-analysis. JAMA Network Open 2, e198398
| Global incidence of frailty and prefrailty among community-dwelling older adults: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 31825501PubMed |
Podsiadlo D, Richardson S (1991) The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society 39, 142–148.
| The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons.Crossref | GoogleScholarGoogle Scholar | 1991946PubMed |
Puts MTE, Toubasi S, Andrew MK, Ashe MC, Ploeg J, Atkinson E, Ayala AP, Roy A, Rodríguez Monforte M, Bergman H, McGilton K (2017) Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Age and Ageing 46, 383–392.
| Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies.Crossref | GoogleScholarGoogle Scholar | 28064173PubMed |
Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K (2006) Validity and reliability of the Edmonton Frail Scale. Age and Ageing 35, 526–529.
| Validity and reliability of the Edmonton Frail Scale.Crossref | GoogleScholarGoogle Scholar | 16757522PubMed |
Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN (2003) The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Care and Research 49, 156–163.
| The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research.Crossref | GoogleScholarGoogle Scholar | 12687505PubMed |
Shankar KN, Treadway NJ, Taylor AA, Breaud AH, Peterson EW, Howland C (2017) Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall. Injury Epidemiology 4, 18
| Older adult falls prevention behaviors 60 days post-discharge from an urban emergency department after treatment for a fall.Crossref | GoogleScholarGoogle Scholar | 28626848PubMed |
Stow D, Spiers G, Matthews FE, Hanratty B (2019) What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review. Palliative Medicine 33, 399–414.
| What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review.Crossref | GoogleScholarGoogle Scholar | 30775957PubMed |
Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, Armstrong JJ, Rockwood J (2018) What do we know about frailty in the acute care setting? A scoping review. BMC Geriatrics 18, 139
| What do we know about frailty in the acute care setting? A scoping review.Crossref | GoogleScholarGoogle Scholar | 29898673PubMed |
Thompson MQ, Theou O, Adams RJ, Tucker GR, Visvanathan R (2018a) Frailty state transitions and associated factors in South Australian older adults. Geriatrics & Gerontology International 18, 1549–1555.
| Frailty state transitions and associated factors in South Australian older adults.Crossref | GoogleScholarGoogle Scholar |
Thompson MQ, Theou O, Karnon J, Adams RJ, Visvanathan R (2018b) Frailty prevalence in Australia: findings from four pooled Australian cohort studies. Australasian Journal on Ageing 37, 155–158.
| Frailty prevalence in Australia: findings from four pooled Australian cohort studies.Crossref | GoogleScholarGoogle Scholar | 29314622PubMed |
van Gaans D, Dent E (2018) Issues of accessibility to health services by older Australians: a review. Public Health Reviews 39, 20
| Issues of accessibility to health services by older Australians: a review.Crossref | GoogleScholarGoogle Scholar | 30027001PubMed |
Vieira ER, Palmer RC, Chaves PHM (2016) Prevention of falls in older people living in the community. BMJ (Clinical Research Ed.) 353, i1419
| Prevention of falls in older people living in the community.Crossref | GoogleScholarGoogle Scholar |
You EC, Dunt D, Doyle C (2016) What is the role of a case manager in community aged care? A qualitative study in Australia. Health & Social Care in the Community 24, 495–506.
| What is the role of a case manager in community aged care? A qualitative study in Australia.Crossref | GoogleScholarGoogle Scholar |
