In session one we introduced the electronic Frailty Index (eFI) indicating that it could be more widely used as a means of alerting community staff to people who are already frail or maybe at risk of becoming frail. Not a lot of detail was given about the method used ‘behind the scene’ that make it valuable, this short blog aims to explain more about what it does.
The electronic frailty index (eFI) itself is a clinically validated tool that can identify people with frailty on a population basis using routinely collected primary care data. The eFI, which uses a cumulative deficit model for frailty. The Cumulative Deficit model assumes that an accumulation of deficits (ranging from symptoms e.g. loss of hearing or low mood, through clinical signs of illness as tremor, through to various diseases such as dementia) which primarily occur as you age combine to increase the likelihood of you becoming frail. Becoming frail increases the risk of an adverse outcome.
The team who proposed this model, led by Rockwood at Dalhousie University in Canada used it to develop a Clinical Frailty Scale which was used in a very large Canadian Study of Health and Aging (CSHA) as a way to summarise the overall level of fitness or frailty of an older adult after they had been evaluated by an experienced clinician.
Rockwood et al (2005) proposed that their clinical frailty scale (CFS) should be used after a comprehensive assessment of an older person had been carried out. They suggested this to validate that the scores given using the scale matched what was seen in clinical clinical practice.
Although introduced as a means of summarising a multidimensional assessment the CFS quickly evolved for clinical use, and has been widely taken up as a judgement-based tool to screen for frailty and to broadly stratify degrees of fitness and frailty. It is not a questionnaire, but a way to summarise information from a clinical encounter with an older person, in a context in which it is useful to screen for. It roughly quantifies the person’s overall health status. To find out more about the tool CLICK HERE
The electronic frailty index (eFI) uses a similar method to the CFS to segment the population into 4 categories; fit, mild, moderate and severe frailty. You can find a table that shows the on pages 2 and 3 of this document https://ihub.scot/media/6106/frailty-and-the-electronic-frailty-index.pdf
Being able to access the eFI and the data it creates for a GP’s population though is not something many of you can do currently so please remember that the simple screens for frailty introduced on the first day, that is the PRISMA 7 questionnaire and TUG. Remember using both prevents many false positives for frailty arising. They are both simple and quick to do.
What might alert you to Frailty? This list from Southern Health NHS Foundation Trust in England might help. They recommend screening in the event of
- Sudden change in mobility
- Delirium (acute confusion or suddenly worsening confusion)
- Sudden change in continence
- Reported side effects from medication