The FRAIL scale can be rolled into a 75+ health assessment or used opportunistically.
Trials of a new standardised assessment tool for frailty, the FRAIL scale, have shown great success across general practices in Australia for both staff and patients.
The tool was able to integrate comfortably into practice workflows, suggesting it can become part of routine clinical assessments in primary care. It was reportedly very easy to use, taking only two minutes, and patients were able to easily understand the link between their FRAIL Scale score and the management recommendations, which helped them see the relevance of the interventions they were recommended.
Participants reported that the specific questions in the FRAIL Scale were easier for patients than the broader questions asked in the 75+ HA, including for those from non-English speaking backgrounds.
The study stressed that frailty is very often associated with avoidable hospital admissions and utilisation of emergency services, and that the new validated tool can help pre-empt risk to avoid substantial healthcare costs in Australia.
The trials included over 1000 participants 75 and over from 19 general practices in North Sydney and South Brisbane, with 12 practices in North Sydney and seven in South Brisbane. Of these participants, the tool classified 33% as frail and 47% as pre-frail.
The tool assesses five components: how often fatigue is experienced, difficulty walking up 10 steps without resting, difficulty walking 300m unaided, number of illnesses, and weight loss in the last 12 months, with scores ranging from 0 to 5. A score of 3 or more indicates frailty, 1 to 2 indicates pre-frailty, and 0 indicates robustness.
The FRAIL Scale Tool commenced integration into general practice clinical support systems (Topbar integrated with Medical Director, Best Practice, and Zen Med software) in September 2021, and the data was collected in June 2023. The tool integrates into existing assessments, which streamlines the assessment process.
Some practices adopted opportunistic screening, using the tool during routine visits for other health checks or assessments. While GPs were often too busy to add frailty screening to their existing workload, practice nurses reported finding it easier to integrate the tool into their workflow and noted that their time is also Medicare-funded for the 75+ HA.
Integrating frailty screening into general practice as part of the annual 75+ HA is an ideal opportunity for early intervention, the study authors noted.
“General practice is a critical entry point into the healthcare system for many older adults at risk of becoming pre-frail or frail. Effective screening in primary care will facilitate early identification of frailty risk, allowing for timely and appropriate preventative and rehabilitative actions to mitigate or reverse frailty,” they said.
