Detection of Frailty

SUNFRAIL Tool for early identification of frailty and multimorbidity has been designed by a multidisciplinary team of experts and needs to be validated. The tool includes nine questions selected from evidence based tools already adopted in health services in the European Union and in the US, to identity frailty according to the bio-(physical), psycho (cognitive and psychological) and social domains.

The ageing population in Europe results in an increased demand for health and social care. Coupled with reduced resources for health and social services in many countries, the access to care for patients with frailty and multimorbidity is often hampered, especially for patients from lower socio-economic groups. This poses additional problems in terms of equity of care, and calls for a strengthening of early prevention and care of frailty, and the appropriate management of multimorbidity with the most cost-effective measures.

The most used methods to detect frailty are the definitions proposed by Fried and colleagues which consists of five criteria (mostly related to muscle function and weight loss) and tested in selected individuals of the US population, and the Frailty Index proposed and validated by Rockwood in Canadian Studies.

More recently, other questionnaires and evaluation tools have been developed from the frailty phenotype and tested in the US (the FRAIL questionnaire) and in France (Gerontopole Frailty Screening Tool), each one with its specificities and characteristics. While the FRAIL questionnaire is trying to simplify the phenotype approach, the Gerontopole Frailty Screening Tool is aimed at better taking into account the General Practitioner’s perception of physical frailty and diffuses such evaluation in primary care. However, these instruments are not consistently used across EU countries. Moreover they do not take into account the bio-psycho social paradigm of frailty, and their ability to capture the complexity of frailty is still unknown. Thus, there is a great need to develop a novel approach to detecting and managing frailty, based on the complete evaluation of biomedical and bio psycho social aspects.

Further, the standardisation of the existing procedures to detect frailty and to manage multimorbidity, together with the development of new integrated techniques will allow for the creation of standardised interventions and approaches to this relevant health issue.

Designing randomised, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report.

Cesari, M. et.al (2014) The frailty phenotype and the frailty index: different instruments for different purposes, Age and Ageing, 43(1): 10-12

Santos-Eggiman, B, et.al (2009), Prevalence of frailty in middle-aged and older community-dwelling europeans living in 10 countries, Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 64(6): 675-81

Ferrucci, L. et.al (2004), Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older people: a consensus report, Journal of the American Geriatrics Society, 52(4): 625-34