Frailty

Tools and resources to assist health care providers with routinely identifying, documenting and communicating frailty in patient care settings.

Implementation

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 will screening be done?
  • Who will complete the screening?
  • Where will the Frailty Screen form be stored?
  • Are there other types of documentation that should indicate the frailty level?
  • How will knowing the frailty level affect other initial and ongoing assessment processes?
  • How will the care guidelines be used and incorporated into care planning?
  • Who will be responsible for ensuring frailty guidelines are considered in care planning?
  • Will the frailty screening and care guideline data be used for quality improvement initiatives?

When reviewing the cases below, think about the implementation process that could take place within your care setting.

Completing Case Studies

Use the following resources to work through the case studies below:

Study 1 - Community: Mrs. S.

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 walks and transfers without help and has had two falls within the past six months
  • VON is monitoring her medication and she has weekly home care for housekeeping
  • Her friend assists with banking
  • She no longer drives
  • She can prepare basic meals and a friend makes sure she is eating the food in her fridge
  • She picks out her own clothes and does not re-wear them
  • She is independent for bathing, toileting, and grooming
  • Mrs. S. seemed to be more confused than normal during a recent visit

Cognitive Frailty Level

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.

Frailty Level

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.

Study 2 - Emergency: Mr. M.

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.

Investigation

Mr. M.'s son provided a history:

  • On the day of the fall, Mr. M. appeared to be his usual self in terms of memory and thinking
  • Mr. M. has had six falls in the past six months. The latest fall was due to tripping over the bath mat
  • Mr. M is dependent for most iADLs (shopping, cooking, banking, housekeeping and driving)
  • Mr. M. does not use any mobility aids and is independent for most ADLs (feeding, grooming, and toileting)
  • His son has no concerns about short term memory, executive function or language

EHS and initial ED assessment reveal that:

  • Mr. M. has no concerns about his own memory
  • Mr. M is at cognitive baseline (no delirium)
  • On exam he is able to sit up and get out of bed without assistance
  • He has to use a bed pan in the ED
  • X-ray showed T12 compression fracture

Cognitive Frailty Level

On completion of the cognitive screening tool findings show:

  • Clock drawing normal
  • Recalled 2/3 words

Frailty Level

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.

Study 3 - Inpatient: Mrs. A.

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:

  • Mrs. A has a three year history of progressive decline in cognition, mobility and function
  • Mrs. A requires cueing to remember to bathe
  • Her daughter is unsure if Mrs. A should remain in her own home
  • Her daughter feels that Mrs. A is her usual self in terms of memory and thinking

Cognitive Frailty Level

Using the cognitive screening tool:

  • Mrs. A is able to recall 2/3 words (apple, penny, watch)
  • Her clock drawing is abnormal
  • When asked about current events, she is vague - "Lots happening in US." With cueing, she is unable to provide further details
  • She is able to name the Prime Minister of Canada