It is important to remember that the approach used for implementing frailty screening and care planning will be setting-dependent. As you navigate this guide, keep the following questions in mind:
When reviewing the cases below, think about the implementation process that could take place within your care setting.
Use the following resources to work through the case studies below:
Mrs. S. is an 83 year old woman with Alzheimer's disease who lives alone. She is presenting to her general practitioner with fever, dyspnea, cough, and myalgias. She tells her general practitioner that she has been sleeping a lot more over the last few days. Mrs. S. reports that she's managing on her own at home with no hired help. She appears unsteady on her feet.
A phone call to Mrs. S' daughter reveals:
Mrs. S.' daughter indicates that her mother is not at her cognitive baseline. Consider delirium and do not proceed with the cognitive screen. Mrs. S. is at the “at least at Vulnerable” cognitive level. Assess further regarding mobility and function.
Although Mrs. S is "At least at Vulnerable" in terms of cognition, based on the information obtained in the Background, Investigation, and Patient Overview sections above, we have determined that Mrs. S' overall frailty level is at Level 5 - Mild Frailty.
Mr. M. is an 80 year old male who arrives at the emergency department (ED) through Emergency Health Services (EHS). EHS reports that Mr. M. fell at home and his son found him lying on the floor. Mr. M complained of back pain when he was transferred to a stretcher. EHS reported Mr. M.'s vitals as normal and transported him to the ED. Upon admission to ED, Mr. M was given acetaminophen and dilaudid, then sent for X-ray.
Mr. M.'s son provided a history:
EHS and initial ED assessment reveal that:
On completion of the cognitive screening tool findings show:
Based on the information obtained in the Background, Investigation, and Patient Overview sections above, we have determined that Mr. M.'s frailty level is at Level 6 - Moderate Frailty.
Mrs. A. is a 92 year old female who lives alone. She was admitted to hospital with urosepsis. She has indicated that she is independent with all her instrumental daily activities (iADLs), with the exception of driving. Mrs. A.'s frailty level was not assessed in the Emergency Department because no collateral source was available. The inpatient unit health care team noted that her frailty level was not indicated and calls Mrs. A.'s daughter to get more information.
Mrs. A.'s daughter is contacted and able to provide additional information:
Using the cognitive screening tool: