Abstract
BackgroundFrailty exposes older people to an elevated risk of a range of negative outcomes. Emerging evidence that frailty can be effectively treated within community settings has stimulated calls for more proactive screening within primary care. Assessing feasibility is a critical preliminary step in assessing the efficacy of interventions such as screening. However, few studies have explored the feasibility and acceptability of administering frailty screening instruments within general practice, and even fewer have incorporated patient perspectives. Our study had three objectives: To 1) assess overall feasibility of the instruments (completion time and rate); 2) assess patient acceptability towards the instruments; and 3) assess the feasibility and acceptability of the instruments to administering nurses.MethodsThe feasibility and acceptability of several frailty screening instruments (PRISMA-7, Edmonton Frail Scale, FRAIL Scale Questionnaire, Gait Speed, Groningen Frailty Indicator, Reported Edmonton Frail Scale and Kihon Checklist) was explored within the context of a larger diagnostic test accuracy (DTA) study. Completion time and rate was collected for all participants (N = 243). A sub-sample of patients (n = 30) rated each instrument for ease of completion and provided comment on perceived acceptability. Lastly, five of six administering nurses involved in the DTA study participated in semi-structured face-to-face interviews, rating the instruments against several feasibility and acceptability criteria (time, space, equipment, skill required to implement, acceptability to patients and nurses, ease of scoring) and providing comment on their responses.ResultsThe PRISMA-7 returned the highest overall feasibility and acceptability, requiring minimal space, equipment, skills and time to implement, and returning the fastest completion rate and highest patient and nurse acceptability rating. All screening instruments were faster to implement than the two reference standards (Fried’s Frailty Phenotype and Frailty Index). Self-administered instruments were subject to lower rates of completion than nurse-administered instruments.ConclusionsThis study has demonstrated that a number of commonly used frailty screening instruments are potentially feasible for implementation within general practice. Ultimately, more research is needed to determine how contextual factors, such as differences in individual patient and clinician preferences, setting and system factors, impact on the feasibility of screening in practice.
Highlights
Frailty exposes older people to an elevated risk of a range of negative outcomes
This study has demonstrated that a number of commonly used frailty screening instruments are potentially feasible for implementation within general practice
Defined as a geriatric condition characterised by increased susceptibility to external stressors [3,4,5], frailty brings an elevated risk of negative outcomes for older people, including falls, hospitalisation, residential care admission and mortality [6,7,8,9]
Summary
Frailty exposes older people to an elevated risk of a range of negative outcomes. Emerging evidence that frailty can be effectively treated within community settings has stimulated calls for more proactive screening within primary care. A small number of studies have addressed the feasibility of frailty screening within general practice settings [21,22,23,24,25,26], and these have generally addressed electronic means of frailty identification and assessment rather than administered instruments. The aim of our study was to assess the feasibility and acceptability of several widely used frailty screening instruments within a general practice context Within this aim, we had several objectives: 1) To assess the feasibility of the instruments with regard to time to complete and completion rates; 2) To assess the acceptability of the instruments to patients; and
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