Top

Published in:

Open Access 01-12-2022 | Care | Research

Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study

Authors: Rachel C. Ambagtsheer, Mavourneen G. Casey, Michael Lawless, Mandy M. Archibald, Solomon Yu, Alison Kitson, Justin J. Beilby

Published in: BMC Primary Care | Issue 1/2022

Abstract

Background

Frailty is a highly prevalent clinical syndrome increasing older people’s vulnerability to risk of adverse outcomes. Better frailty identification through expanded screening implementation has been advocated within general practice settings, both internationally and within Australia. However, little is known about practitioner perceptions of the feasibility of specific instruments, and the underlying motivations behind those perceptions. Consequently, the purpose of this study was to explore the attitudes and perceptions of a convenience and volunteer sample of Australian general practitioners (GPs) and practice nurses (PNs) towards common frailty screening instruments.

Methods

The feasibility of several frailty screening instruments (PRISMA-7 [P7], Edmonton Frail Scale [EFS], FRAIL Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC] and Timed Up and Go [TUG]) to 43 Australian GPs and PNs was assessed. The study adopted a concurrent embedded mixed-methods design incorporating quantitative (ranking exercise) and qualitative (content analysis) data collection integrated during the analysis phase.

Results

Practitioners assessed multi-dimensional instruments (EFS, GFI, KC) as having relatively higher clinical utility, better integration into existing assessment processes and stronger links to intervention over uni-dimensional (GST, TUG) and simple (FQ, P7) instruments.

Conclusions

While existing frailty screening instruments show promise as an initial step in supporting better care for older people, all the included instruments were associated with perceived advantages and disadvantages. Ultimately, clinicians will need to weigh several factors in their selection of the optimal screening instrument. Further translational research, with a focus on contextual fit, is needed to support clinical decision-making on the selection of instruments for frailty screening.

Available only for authorised users

Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Eur J Intern Med. 2016;31:3–10. https://doi.org/10.1016/j.ejim.2016.03.007.CrossRefPubMed

Morley JE, Vellas B, Abellan van Kan G, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14:392–7. https://doi.org/10.1016/j.jamda.2013.03.022.CrossRefPubMedPubMedCentral

Dent E, Lien C, Lim WS, et al. The Asia-Pacific clinical practice guidelines for the Management of Frailty. J Am Med Dir Assoc. 2017;18:564–75. https://doi.org/10.1016/j.jamda.2017.04.018.CrossRefPubMed

Bergman H, Ferrucci L, Guralnik J, et al. Frailty: an emerging research and clinical paradigm--issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;62:731–7. https://doi.org/10.1093/gerona/62.7.731.CrossRefPubMed

Hogan DB, MacKnight C, Bergman H. Models, definitions, and criteria of frailty. Aging Clin Exp Res. 2003:3–29. https://doi.org/10.1016/B978-0-12-811353-0.00003-8.

Gobbens RJJ, van Assen MALM, Luijkx KG, et al. Determinants of frailty. J Am Med Dir Assoc. 2010;11:356–64. https://doi.org/10.1016/j.jamda.2009.11.008.CrossRefPubMed

Cesari M, Vellas B. Response to the letter to the editor: “what is missing in the validation of frailty instruments?”. J Am Med Dir Assoc. 2014;15:143–4. https://doi.org/10.1016/j.jamda.2013.11.012.CrossRefPubMed

Dent E, Morley JE, Cruz-Jentoft AJ, et al. Physical frailty: ICFSR international clinical practice guidelines for identification and management. J Nutr Heal Aging. 2019;23:771–87. https://doi.org/10.1007/s12603-019-1273-z.CrossRef

Turner G, Clegg A. Best practice guidelines for the management of frailty: a British geriatrics society, age UK and Royal College of general practitioners report. Age Ageing. 2014;43:744–7. https://doi.org/10.1093/ageing/afu138.CrossRefPubMed

10.

Reeves D, Pye S, Ashcroft DM, et al. The challenge of ageing populations and patient frailty: can primary care adapt? BMJ. 2018;362:k3349. https://doi.org/10.1136/BMJ.K3349.CrossRefPubMed

11.

Royal Australian College of General Practitioners (RACGP). RACGP aged care clinical guide (Silver Book). 5th ed; 2019.

12.

Archibald MM, Ambagtsheer R, Beilby J, et al. Perspectives of frailty and frailty Screening : protocol for a collaborative knowledge translation approach and qualitative study of stakeholder understandings and experiences. BMC Geriatr. 2017;17:87. https://doi.org/10.1186/s12877-017-0483-7.CrossRefPubMedPubMedCentral

13.

Lawson B, Sampalli T, Wood S, et al. Study protocol evaluating the implementation and feasibility of a web- based tool to support timely identification and Care for the Frail Population in primary healthcare settings. Int J Heal Policy Manag. 2017;6:377–82. https://doi.org/10.15171/ijhpm.2017.32.CrossRef

14.

Warner G, Lawson B, Sampalli T, et al. Applying the consolidated framework for implementation research to identify barriers affecting implementation of an online frailty tool into primary health care : a qualitative study. BMC Health Serv Res. 2018;18:395.CrossRef

15.

Abernethy G, Smyth W, Arnold-Nott C, et al. Investigation on the use and acceptability of the Edmonton frail scale in a rural primary care setting. Aust J Rural Health. 2018;26:449–50.CrossRef

16.

Keiren SMG, van Kempen JAL, Schers HJ, et al. Feasibility evaluation of a stepped procedure to identify community-dwelling frail older people in general practice. A mixed methods study. Eur J Gen Pract. 2014;20:107–13. https://doi.org/10.3109/13814788.2013.827167.CrossRefPubMed

17.

Abbasi M, Khera S, Dabravolskaj J, et al. Identification of frailty in primary Care : feasibility and acceptability of recommended case finding tools within a primary care integrated seniors ’ program. Gerontol Geriatr Med. 2019;5:1–7. https://doi.org/10.1177/2333721419848153.CrossRef

18.

Lansbury LN, Roberts HC, Clift E, et al. Use of the electronic frailty index to identify vulnerable patients: a pilot study in primary care. Br J Gen Pract. 2017;67:e751–6. https://doi.org/10.3399/bjgp17X693089.CrossRefPubMedPubMedCentral

19.

Ambagtsheer RC, Archibald MM, Lawless M, et al. Feasibility and acceptability of commonly used screening instruments to identify frailty among community-dwelling older people: a mixed methods study. BMC Geriatr. 2020;20:1–11. https://doi.org/10.1186/s12877-020-01551-6.CrossRef

20.

Ambagtsheer RC, Beilby J, Dabravolskaj J, et al. Application of an electronic frailty index in Australian primary care: data quality and feasibility assessment. Aging Clin Exp Res. 2019;31. https://doi.org/10.1007/s40520-018-1023-9.

21.

Drubbel I, Bleijenberg N, Kranenburg G, et al. Identifying frailty: do the frailty index and Groningen frailty Indicator cover different clinical perspectives? A cross-sectional study. BMC Fam Pract. 2013;14. https://doi.org/10.1186/1471-2296-14-64.

22.

Ambagtsheer RC, Beilby JJ, Visvanathan R, et al. Should we screen for frailty in primary care settings? A fresh perspective on the frailty evidence base: a narrative review. Prev Med. 2019;119:63–9. https://doi.org/10.1016/j.ypmed.2018.12.020.CrossRefPubMed

23.

Creswell JW. Research design: qualitative, quantitative, and mixed method approaches. 3rd ed. Thousand Oaks: SAGE Publications, Inc.; 2009.

24.

O’Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J Heal Serv Res Policy. 2008;13:92–8. https://doi.org/10.1258/jhsrp.2007.007074.CrossRef

25.

Zoom video communications Inc. Zoom [Software] 2018.

26.

Ambagtsheer RC, Archibald MM, Lawless M, et al. General practitioners’ perceptions, attitudes and experiences of frailty and frailty screening. Aust J Gen Pract. 2019;48:426–33. https://doi.org/10.31128/ajgp-11-18-4757.CrossRef

27.

Ambagtsheer RC, Visvanathan R, Dent E, et al. Commonly used screening instruments to identify frailty among community-dwelling older people in a general practice (primary care) setting: a study of diagnostic test accuracy. J Gerontol - Ser A Biol Sci Med Sci. 2020;75:1134–42. https://doi.org/10.1093/GERONA/GLZ260.CrossRef

28.

Ambagtsheer R, Visvanathan R, Cesari M, et al. Feasibility, acceptability and diagnostic test accuracy of frailty screening instruments in community-dwelling older people within the Australian general practice setting: a study protocol for a cross-sectional study. BMJ Open. 2017;7:e016663. https://doi.org/10.1136/bmjopen-2017-016663.CrossRefPubMedPubMedCentral

29.

Steverink N, Slaets JP, Schuurmans H, et al. Measuring frailty : developing and testing the GFI ( Groningen frailty Indicator ). Gerontologist. 2001;41:236.

30.

Arai H, Satake S. English translation of the Kihon checklist. Geriatr Gerontol Int. 2015;15:518–9. https://doi.org/10.1111/ggi.12397.CrossRefPubMed

31.

Sewo Sampaio PY, Sampaio RAC, Yamada M, et al. Comparison of frailty between users and nonusers of a day care center using the Kihon checklist in Brazil. J Clin Gerontol Geriatr. 2014;5:82–5. https://doi.org/10.1016/j.jcgg.2014.02.005.CrossRef

32.

Rolfson DB, Majumdar SR, Tsuyuki RT, et al. Validity and reliability of the Edmonton frail scale. Age Ageing. 2006;35:526–9. https://doi.org/10.1093/ageing/afl023.CrossRefPubMedPubMedCentral

33.

Raiche M, Hebert R, Dubois M-F. PRISMA-7: a case-finding tool to identify older adults with moderate to severe disabilities. Arch Gerontol Geriatr. 2008;47:9–18. https://doi.org/10.1016/j.archger.2007.06.004.CrossRefPubMed

34.

Morley JEE, Malmstrom TKK, Miller DKK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged african americans. J Nutr Heal Aging. 2012;16:601–8. https://doi.org/10.1007/s12603-012-0084-2.CrossRef

35.

Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.CrossRef

36.

Fritz S, Lusardi M. Walking speed: the sixth vital sign. J Geriatr Phys Ther. 2009;32:1–5. https://doi.org/10.1519/00139143-200932020-00002.CrossRef

37.

Castell M, Sánchez M, Julián R, et al. Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care. BMC Fam Pract. 2013;14:86. https://doi.org/10.1186/1471-2296-14-86.CrossRefPubMedPubMedCentral

38.

Abellan van Kan G, Rolland Y, Andrieu S, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an international academy on nutrition and aging (IANA) task force. J Nutr Heal Aging. 2009;13:881–9.CrossRef

39.

Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure, July 2016. Cat No 1270055005 2018. https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1270.0.55.005Main+Features1July 2016?OpenDocument. Accessed 15 Jan 2019.

40.

Archibald MM, Ambagtsheer RC, Casey MG, et al. Using zoom videoconferencing for qualitative data collection: perceptions and experiences of researchers and participants. Int J Qual Methods. 2019;18. https://doi.org/10.1177/1609406919874596.

41.

Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62:107–15. https://doi.org/10.1111/j.1365-2648.2007.04569.x.CrossRefPubMed

42.

Sutorius FL, Hoogendijk EO, Prins BAH, et al. Comparison of 10 single and stepped methods to identify frail older persons in primary care: diagnostic and prognostic accuracy. BMC Fam Pract. 2016;17:102. https://doi.org/10.1186/s12875-016-0487-y.CrossRefPubMedPubMedCentral

43.

Pialoux T, Goyard J, Lesourd B. Screening tools for frailty in primary health care: a systematic review. Geriatr Gerontol Int. 2012;12:189–97. https://doi.org/10.1111/j.1447-0594.2011.00797.x.CrossRefPubMed

44.

De Lepeleire J, Iliffe S, Mann E, et al. Frailty: an emerging concept for general practice. Br J Gen Pract. 2009;59:364–9. https://doi.org/10.3399/bjgp09X420653.CrossRef

45.

Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet. 2019;394:1365–75. https://doi.org/10.1016/S0140-6736(19)31786-6.CrossRefPubMed

46.

Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser a-Biological Sci Med Sci. 2001;56:M146–56. https://doi.org/10.1093/gerona/56.3.M146.CrossRef

47.

Mitnitski A, Mogilner A, Rockwood K. Accumulation of deficits as a proxy measure of aging. Sci World J. 2001;1:323–36.CrossRef

48.

Hamirudin AH, Ghosh A, Charlton K, et al. Trends in uptake of the 75+ health assessment in Australia: a decade of evaluation. Aust J Prim Health. 2015;21:423–8. https://doi.org/10.1071/PY14074.CrossRefPubMed

49.

Harris W, Lucas PV, Eyles H, et al. Paramedic assessment of Frailty : an exploratory study of perceptions of frailty assessment tools. Irish J Paramed. 2018;3:1–10.

50.

Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions : an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017:1–13. https://doi.org/10.1186/s12913-017-2031-8.

Title: Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study
Authors: Rachel C. Ambagtsheer
Mavourneen G. Casey
Michael Lawless
Mandy M. Archibald
Solomon Yu
Alison Kitson
Justin J. Beilby
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Care
Published in: BMC Primary Care / Issue 1/2022
Electronic ISSN: 2731-4553
DOI: https://doi.org/10.1186/s12875-022-01778-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Tools for early screening of autism spectrum disorders in primary health care – a scoping review

Virtual family physician care during COVID-19: a mixed methods study using health administrative data and qualitative interviews

General practitioners treating their own family members: a cross-sectional survey in Germany

The effect of shared decision-making on recovery from non-chronic aspecific low back pain in primary care; a post-hoc analysis from the patient, physician and observer perspectives

Genetics education in primary care residency training: satisfaction and current barriers

Quality of end-of-life care in general practice – a pre–post comparison of a two-tiered intervention