Editorial

Detecting Frailty in Primary Care: A Major Challenge for Primary Care Physicians

Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric syndromes (frailty, sarcopenia, anorexia of aging, and cognitive decline) will delay or avert the development of disability.

To identify simple screening programs available for primary health professionals to identify geriatric syndromes.

PubMed for the last 5 years and study authors.

A number of screening programs for early detection of geriatric syndromes have been developed for use by primary care health providers, for example, EasyCare, Gérontopôle Frailty Screening Tool, the Rapid Geriatric Assessment, the Kihon Checklist, and others.

This is an evolving area with limited information on the outcomes of intervention and possible harms.

Validated screening programs exist but more work is required to determine their utility in improving outcomes of older persons.

estimation of functional loss incidence and identification of risk factors associated with new disability onset in people aged 75 and older without severe dependence in a rural primary care setting.

Prospective cohort study of a representative sample of people aged 75 years or older without severe dependence (Barthel Index > 20 and Lawton Index > 1) at a primary care center, with a 12-month follow-up. The baseline geriatric assessment recorded activities of daily living (ADL), sociodemographic information, numbers of drugs prescribed, previous hospital admissions and falls, cognitive function, hearing and visual capacity, body mass index, blood pressure, and the Short Physical Performance Battery to evaluate lower limb function. ADL was re-assessed after 12 months, defining functional loss as a fall of ≥10 points on the Barthel Index and/or ≥2 instrumental activities of the Lawton Index. Bivariate and multivariate analyses using logistic regression models were conducted to identify factors independently associated with functional loss.

Mean age was 81.7 years, 58.7% of patients were men, and 23.4% presented functional loss at the 12-month follow-up. Variables identified as independent predictors of functional loss were hospital admissions (aOR 3.92; 95%CI: 1.35–11.39), cognitive impairment (aOR 2.60; 95%CI: 1.39–4.92) and lower limbs functional limitation (aOR 2.01; 95%CI: 1.02–3.97).

Our results support the use of performance batteries in primary care for identifying elderly persons at risk of functional decline; and they also highlight the relevance of appropriate management of hospital admissions and planned discharges in order to preserve patients’ functional status.

The frailty phenotype proposed by Fried and colleagues is a widely used frailty screening instrument, consisting of 5 components: weight loss, exhaustion, low grip strength, slow gait speed, and low physical activity. Although equally considered in the computation of the frailty phenotype score, each of the components may present a specific and different weight in clinical practice. The objective of this study was to estimate the weight of each frailty phenotype component in terms of age-related deficit accumulation, defined according to the frailty index (FI) proposed by Rockwood and colleagues.

Cross-sectional study.

Data were used from 484 frail older adults admitted to a geriatric day hospital unit of the Toulouse University Hospital.

The outcome measure was a 35-item FI based on data routinely collected as part of a clinical assessment. Descriptive statistics and linear regression analyses were used to determine which components of the frailty phenotype were most strongly associated with the FI.

The mean age of the participants was 83.2 (SD 6.0). All components of the frailty phenotype were significantly associated with the FI, but the magnitude of the associations varied. Linear regression analyses, adjusted for age, sex, and educational level showed that slow gait speed was the most informative component (B = 0.129, P < .001) and weight loss was the least informative component (B = 0.027, P = .037). The combination of slow gait speed and low physical activity was the most strongly associated with the FI (B = 0.144, P < .001).

Of the 5 components of the phenotype, slow gait speed seems to be the key indicator of frailty.