Frailty is Here
Frailty. It is becoming more and more entrenched in our healthcare vocabulary. Frailty is emerging as a concept in geriatrics and gerontology and is increasingly being utilized more frequently in diagnosis, clinical decisions and provision of care. Yet, a lack of understanding is still at times proving to be an issue in providing optimal care. Frailty Assessments in clinical settings-most widely used are in oncology, cardiology, surgery, and trauma. But, there is no absolute definition of frailty nor is there complete consensus on how to assess frailty. The term Frailty is however, accepted by many in the medical community as a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiological systems. The progression to later stages of frailty often signals a loss of autonomy, dependence on others and reduction in physical and cognitive function. Despite the many frailty scales available and utilized, types of frailty do present commonalities such as physical, cognitive, social and emotional support. Multiple scales have been developed and, when compared, many share common characteristics. (Theou 2014 JAGS)
The Comprehensive Geriatric Assessment CGA is one assessment that is regarded as a comprehensive assessment that is described as a process and not a singular event. CGA is interdisciplinary, multidimensional, produces problem lists, implements integrated plans for treatment, rehabilitation and supports. CGA assessment components include all aspects of a person’s life to include the physical, psychological, cognitive, social and functional aspects.
A systematic review confirms that frailty increases with age: among community dwelling older adults, frailty prevalence is 15.7% in those aged 80 to 84, and increases to 26.1% in those over age 85 years. (Collard 2012 JAGS)
In older patients undergoing an operation, frailty predicts postoperative complications, length of stay and discharge to a facility. (Makary 2010 JACS)In order to ensure healthcare consumers are charged fairly for their costs of care CMS has developed the CMS Hierarchical Condition Category (HCC) cost prediction model. This is, along with a developed Claims Based Frailty Index (CFI) has been tested as a predictor of clinical outcomes. Whiles studies indicate CMS-HCC + CFI is showing significantly improved accuracy of different levels of frailty the cost model is still far from perfected. Life expectancy in persons living with frailty will increase, as will the cost of providing care for them. A perfected claims based frailty index to better predict cost and a more standardized comprehensive screening process to pair frailty with appropriate services and care are inching towards reality.
For more information, please reach out to our Senior Director of Continuing Care & Long Term Care: