How to identify frailty in older patients

Frailty is common in older age, and there are strong links between frailty and the risk of dying. Older people with frailty are weaker and more delicate. They can experience sudden and dramatic changes in their health when they have an illness or injury. Reducing the risk of falls can help people to live at home, in safety, for longer.

NHS England says that early identification aids targeted support for older people living with frailty. 

Therefore, every medical professional needs to know how to identify frailty in their patients. As, when you know who your frail patients are, you can help them keep well for as long as possible, reducing their risk of:

• Falls
• Unplanned hospital admissions
• Anxiety, depression and poorer quality of life

In England, the GMS contract requires GP's to "identify populations at risk of being frail, by degree, using an evidence-based tool supplemented by clinical judgement".

As part of the electronic Frailty Index (eFI) calculator and an interactive eFI template. Together, they help you care for your older patients with severe frailty.

Unsure what an eFI is or looking for a new one for your business? Population Health Management Software combines interactive frailty index templates and more to manage your patients.

Here's our suggested method on how to identify frailty in your patients using the previously mentioned tools:

Identify patients

Run the eFI report to calculate the eFI for each patient. Vision's calculator uses over 2,000 codes grouped into 36 indicators to calculate the eFI. Each patient's eFI will be between zero and one:

Fit: 0.12 or lower.

Mild: between 0.12 and 0.25.

Moderate: between 0.25 and 0.36.

Severe: 0.36 or higher.

Review your severely frail patients

The eFI report builds a list of your frail patients, grouped by age range and their frailty level. The report makes it easy to identify your patients with moderate or severe frailty, but no eFI recorded. You can look at each patient's record or use the frailty template to decide if you need to review these patients.

The template makes it easy to record high-quality data quickly during medication reviews and falls assessments. You can set patient alerts where work is outstanding as well. You can also use the patient list to send review invitations to specific patients. Not only that, but you can print letters, but it's faster and cheaper to send them text messages. Remember that older people with moderate to severe frailty are often housebound, or only able to leave their home with help. You might need to organise home visits for these patients.

Encourage Summary Care Record consent

The NHS encourages frail patients to include additional information in their Summary Care Record (SCR). Adding this will make more detail available to health and care staff viewing the SCR, which can improve:

• The flow of information across the whole healthcare team.
• Safety for your healthcare team and patients.
• Care that your patients receive.

You can include additional information by changing the patient's consent status to: 'Express consent for medication, allergies, adverse reactions and additional information'.

Getting started

The EFI calculator and template are available on the GP IT Futures systems and services, so there is no cost to GP practices.

You can also find overview videos, a template for downloading the eFI template and much more help within the Vision+ help directly.

Vision+ is a feature-rich clinical decision support tool that interacts in real time at the point of care. It provides a framework for any type of decision support, giving clinicians clear best practice advice and recommendations, we also have BlueBayCT available for EMIS and TPP practices, if you would like to find out more from one of our experts, book a demo

How to identify frailty in younger people

It's easy to assume that only the elderly can be frail. The Lancet has published an article about frailty and pre-frailty in middle-aged people. Their findings are complex, but suggest a need to identify frailty and intervene much earlier. The Vision + eFI report includes groups of patients under 50 and between 50 and 65 years old. Although the GMS contract only requires you to look at over 65s, you may have younger patients to review as well.

How to identify frailty at a population level

CCGs, health boards and public health teams can manage frailty at scale. Depending on the application, such as Population Health Management Software,  this could help you to have complete oversight into the overall health of your patients by merging vital records from other healthcare providers into one location.