Frailty Informed Care
Frailty is a state of reduced function and health which increases the risk of immobility, falls, incontinence, cognitive impairment, malnutrition, depression, and social isolation. It represents an accumulation of deficits that result in loss of function across multiple body systems, which leaves a person more vulnerable to new stressors.
Frailty awareness can facilitate recognition of and attention to patients' mobility and other support needs during encounters, while improving planning for effective transitions between encounters.
Clinical Frailty Scale
The Clinical Frailty Scale (CFS) is a single-value metric that uses images to help clinicians remember which level of baseline (convalescent) frailty might apply to a particular patient. Use of the CFS can increase awareness of a patient's resilience and their prospect for timely recovery without additional (e.g., physiotherapy, occupational therapy) supports.
Most Connect Care transition planning tools contain a link for viewing, entering and editing patients' Clinical Frailty Scale (CFS) scores.
Frailty Screening in Connect Care
Multidisciplinary team members (prescribers and non-prescribers) are encouraged to assign a baseline (convalescent or best function prior to any intercurrent illness triggering admission) CFS score as soon as possible (within 72 hours of admission) for inpatients aged 65 and older or for any patient with functional deficits or frailty syndromes. The initial assessment can be revised as more information becomes available during the inpatient encounter.
Frailty Actions
Patients with frailty do better with early multidisciplinary engagement (e.g., physiotherapy, occupational therapy, social work, transition coordinator consults), allocation of appropriate patient support resources, and possibly geriatric medicine consultation.
CFS 1-3: Minimal Frailty (well or managing well) --> Consider re-screening if baseline function degrades.
CFS 4-5: Mild Frailty --> Consider further assessment by multidisciplinary team members using the Edmonton Frail Scale (acute care) to better characterize early or emergent frailty.
CFS 6: Moderate Frailty --> Consider multidisciplinary frailty assessment and care optimization.
CFS 7+: Severe Frailty --> Consider Geriatric Medicine (or Geriatric Assessment Team if available) referral or consultation.
Edmonton Frail Scale
Patients with mild to moderate frailty scores may merit more detailed assessment with the Edmonton Frail Scale (acute care and community care variants available in Connect Care).
Frailty Order Set
Any patient with frailty (CFS 4+) could benefit from prescriber use of the "Frailty Adult" order set, available within inpatient encounters. This facilitates appropriate assessment, testing, intervention and consultation for patients screening positive for frailty.
Feedback Meaningful Use Metric
Feedback about trends in compliance with Frailty screening recommendations is addressed in Connect Care Meaningful Use Norms and the associated Meaningful Use Dashboard.