Andy Clegg is a senior lecturer at Leeds University, and a consultant geriatrician at Bradford Royal Infirmary. Here, he discusses his recent Age & Ageing paper on a new breakthrough in frailty care.
Frailty is a condition that is common in older age. It develops because as we get older our bodies change, and can lose their inbuilt reserves. These changes mean that older people with frailty can experience sudden, dramatic changes in their health when they have an illness or injury.
International guidelines recommend that frailty should be identified routinely so that a more holistic approach to care can be taken, and effective treatments provided. However, the main difficulty with identifying frailty routinely is that the tools that are available, such as measuring walking speed, grip strength, or frailty questionnaires require additional resource, and might be inaccurate.
We have therefore developed an electronic frailty index (eFI) that uses data that is routinely available in the GP electronic health record to identify and severity grade frailty. We have tested the eFI using data from around one million UK patients in two large research databases (ResearchOne and THIN). The eFI enables identification of older people who are fit, and those with mild, moderate and severe frailty. It accurately predicts risk of nursing home admission, hospital admission, length of hospital stay and mortality. The eFI therefore represents a major advance in frailty care because, for the first time, it enables identification of frailty using routinely available data, without the need for an additional clinical assessment.
The eFI has been implemented into the SystmOne GP electronic health record and implementation into the two other main UK GP electronic health records (EMISWeb and Vision) is at an advanced stage. The eFI is being used by GPs across the country to develop better, more proactive care pathways for older people with frailty to improve health and wellbeing in later life. Examples include using the eFI to develop a tiered community frailty service for older people, identify patients for pharmacist-led medication reviews, and identify patients for proactive falls prevention treatment. The full report of the development and testing of the eFI is available here.
For more information on how the eFI is being used, and case examples, visit http://www.improvementacademy.org/improving-quality/healthy-ageing.html