Frailty Screening and Management for Older Australians in General Practice: Mixed Methods Evaluation.

Abstract

Background: Frailty increases with age and is associated with increased vulnerability to adverse health outcomes. International guidelines recommend screening for frailty in primary care; however, this is not routine practice in Australia. Once identified, frailty progression has the potential to be halted or reversed with early intervention. The FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) Scale Tool, a simple and validated screening and management tool, offers a feasible approach for integration into the Australian health assessment for those aged 75 years and older (75+HA), which can be performed annually by primary care providers.

Objective: This study explores the rates of frailty, resources required to support management, and the determinants of implementing frailty screening and providing management for older Australians at the 75+HA.

Methods: A mixed methods evaluation was conducted in 24 general practices across 2 Australian Primary Health Network regions, Sydney North and Brisbane South. The FRAIL Scale Tool was implemented during the 75+ health assessment, and data were collected on FRAIL Scale scores, hospitalization rates, recommended frailty interventions, and barriers to frailty management. Practice staff perceptions of the long-term sustainment of the FRAIL Scale Tool were assessed using the Provider Report of Sustainment Scale. Semistructured qualitative interviews were conducted with practice staff and patients, exploring barriers and enablers to implementing frailty screening and management. Guided by the Consolidated Framework for Implementation Research, transcripts were coded and themes developed.

Results: Of the 1484 patients aged ≥75 years who were screened, 223 (15%) patients were frail, 616 (41.5%) patients were prefrail, and 645 (43.5%) patients were robust. People who were frail were more likely to be female, older, and have more prescribed medications. Of those screened as frail, 23 (11%) had a nonelective hospitalization in the 3 months prior to screening compared with 28 (5%) who screened as prefrail and 5 (1%) who screened as robust (P=.012). Management recommendations commonly included medication reviews, aged care packages, assessment for depression, and exercise programs. Barriers identified to accessing interventions included health, transport, cost, and time. Survey and qualitative findings highlighted that the FRAIL Scale Tool was easy to use, integrated well into existing workflows as part of the 75+HA, and sustained use would be supported by software integration. Patients valued the assessment and tailored health support offered by trusted primary care providers.

Conclusions: Incorporating the FRAIL Scale Tool into the annual health assessment for people aged 75 years and older provides a funded opportunity for addressing frailty in general practice. Patients and staff value the Tool's simplicity and the opportunity to raise awareness and manage frailty proactively. Incorporating the Tool into practice software systems would enhance adoption. Broader implementation research in diverse settings and with Aboriginal and Torres Strait Islander populations is needed to improve frailty prevention and management.