Frailty experts call for annual screening for over-65s

A new framework aiming to address ‘substantial variation’ in managing frailty, which reportedly affects more than one in five older adults, has recommended annual screening for all over-65s.
 
The suggestion is among 19 consensus statements designed for addressing frailty, which were published this month in The Medical Journal of Australia.
 
‘Frailty screening for older adults should be done annually using a validated, reliable screening tool that is easy to apply, leads to treatment recommendations and allows any progression in frailty to be tracked over time,’ authors wrote.  
 
Covering health promotion and screening, nutrition, exercise, social activities, medicine optimisation, as well as the management of severe frailty, the work was developed by 77 healthcare experts including Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care.
 
Authors say their work aims to address the lack of an integrated framework, which has led to too much variation in the approach to what they describe as ‘a growing public health challenge’.
 
‘To mitigate these variations and establish unified guidance, the aim of the study was to use a consensus-based approach to develop evidence-informed and consumer-focused national consensus statements to guide clinicians and healthcare professionals in delivering consistent, proactive and person-centred frailty care across community settings in Australia,’ they wrote.
 
‘More than 20% of older adults are estimated to be living with frailty, experiencing declines in physical function, cognition and nutritional status, and facing a heightened risk of hospitalisation, loss of independence and entry into residential aged care.
 
‘As the population ages and the prevalence of multimorbidity increases, the prevalence of frailty is expected to rise substantially.’
 
The development of the statements was led by University of Queensland researchers and includes feedback from six consumers with lived experience of frailty, with researchers describing the condition as ‘dynamic and potentially modifiable’.
 
‘With timely identification and appropriate intervention, frailty can often be prevented, delayed or even reversed,’ they state.
 
Dr Anthony Marinucci, the Chair of RACGP Specific Interests Aged Care, welcomes the work, saying its strength lies in bringing six areas of care together.
 
‘Frailty is often recognised too late or reactively, after a fall, hospital admission or functional decline, when opportunities to prevent deterioration may already have been missed,’ he told newsGP.
 
Dr Marinucci said he supports the principle of annual screening, but the key would be in its implementation.
 
‘Screening alone does not prevent frailty,’ he said.
 
‘It is only useful if it leads to practical action: exercise, nutrition, medication review, social connection and care planning.
 
‘The headline may be annual screening, but the most clinically useful parts for GPs are the broader management recommendations; particularly medicines optimisation, nutrition and exercise, and care planning for severe frailty.
 
‘Frailty management should not default to rest and risk avoidance.’
 
He also emphasised the importance of medication review, but warned against it being framed as only deprescribing, noting ‘under-treatment is also common in frailty’.
 
The authors noted some limitations of the work, including that it concentrates on clinical recommendations rather than any systemic reform that might be needed to make them work.
 
It also acknowledges a lack of representation from key priority populations, including Aboriginal and Torres Strait Islander people and those from culturally and linguistically diverse backgrounds.
 
However, for Dr Marinucci, the statements are ‘a helpful national framework’ overall.
 
‘The next challenge is turning it into something practical and properly supported and funded in everyday general practice,’ he said.
 
‘General practice is well placed to identify and track frailty over time, but this needs funded time, team-based care and accessible referral pathways.
 
‘Otherwise, we risk identifying need without giving patients or clinicians the means to respond.’
 
The RACGP Silver Book for GPs caring for older people in the community and residential aged care is available on the college’s website.
 
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