The following is a summary of “Perspectives on the representation of frailty in the electronic frailty index,” published in the January 2024 issue of Primary Care by Thandi, et al.
Frailty is characterized by heightened vulnerability due to a combination of physical, social, and cognitive factors, leading to a greater susceptibility to negative health outcomes and increased healthcare costs. While the UK’s 36-factor electronic frailty index (eFI) has been developed to quantify frailty using electronic medical records, its direct application in Canadian primary care requires adaptation due to differing clinical terminologies. For a study, researchers sought to validate the content of the eFI for the Canadian context, specifically in British Columbia, by assessing its relevance from the perspectives of primary care clinicians and older adults.
A modified Delphi method was employed, involving three iterative rounds of questionnaires administered to a panel of 23 experts. The panel comprised five family physicians, five nurse practitioners, five nurses, four allied health professionals, and four older adults. These groups were selected for their direct involvement in interprofessional primary care for older adults. Panelists rated each of the 36 eFI factors on a scale of 0–10 based on their perceived importance and provided justifications for their ratings. They also had the opportunity to propose additional factors for inclusion, which underwent similar rating processes across two Delphi rounds.
Consensus, a rating of ≥8 by over 80% of the panelists, was achieved for 33 of the 36 eFI factors. Factors like hypertension, thyroid disorder, and peptic ulcer did not meet the consensus criteria, mainly due to their perceived treatability or lack of direct association with frailty. Additional factors suggested by the panelists that gained consensus included various social determinants of health, such as cancer, challenges in healthcare access, chronic pain, mental health challenges, and substance use/misuse. Notably, a 100% retention rate was observed across all three Delphi rounds.
The study revealed variations in the conceptualization of frailty among participants, emphasizing the challenges in identifying frailty within community and primary care settings. Social determinants of health significantly influenced clinicians’ assessments and perceptions of frailty. The insights will guide the subsequent phases of a comprehensive mixed-methods study to develop a tailored frailty screening tool for Canadian primary care. The early detection of frailty can refine decision-making processes, facilitate discussions about care goals, mitigate frailty progression, and ultimately optimize both patient outcomes and healthcare expenditure.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02225-z
