Prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries: A mixed method systematic review.

BACKGROUND: Frailty is increasingly becoming a public health concern, especially among vulnerable populations. Older migrants from Low- and Middle-Income Countries to High Income Countries present with poorer health and are at increased risk of becoming frail. This review aims to explore the prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five electronic databases were comprehensively searched for relevant literature published from January 1, 2000, to April 30, 2023. Quality appraisal for the quantitative studies was done with the Joanna Brigg's critical appraisal tool for analytic cross-sectional studies, and the qualitative studies were assessed with the Critical Appraisal Skill Program tool for qualitative studies. RESULT: Seven studies met the inclusion criteria. Frailty was assessed using modified versions of the Frailty Phenotype and Frailty Index. The prevalence of frailty using the Frailty Phenotype was 16.6 %, and 17 % to 61.9 % according to the Frailty Index. The perceptions and experiences of frailty were characterised by chronic ill-health and a review of healthy pre-migration and early migration lives. CONCLUSION: Despite the variation in frailty assessment methods, the high prevalence of frailty among older migrants was highlighted across the included studies. The perceptions and experiences of frailty reflect a state of resignation which can complicate the state of frailty. There is the need for ongoing research among migrant groups to identify their predisposition to frailty for early intervention.

IMPAACT: IMproving the PArticipAtion of older people in policy decision-making on common health CondiTions - a study protocol.

INTRODUCTION: Rapid population ageing is a demographic trend being experienced and documented worldwide. While increased health screening and assessment may help mitigate the burden of illness in older people, issues such as misdiagnosis may affect access to interventions. This study aims to elicit the values and preferences of evidence-informed older people living in the community on early screening for common health conditions (cardiovascular disease, diabetes, dementia and frailty). The study will proceed in three Phases: (1) generating recommendations of older people through a series of Citizens' Juries; (2) obtaining feedback from a diverse range of stakeholder groups on the jury findings; and (3) co-designing a set of Knowledge Translation resources to facilitate implementation into research, policy and practice. Conditions were chosen to reflect common health conditions characterised by increasing prevalence with age, but which have been underexamined through a Citizens' Jury methodology. METHODS AND ANALYSIS: This study will be conducted in three Phases-(1) Citizens' Juries, (2) Policy Roundtables and (3) Production of Knowledge Translation resources. First, older people aged 50+ (n=80), including those from traditionally hard-to-reach and diverse groups, will be purposively recruited to four Citizen Juries. Second, representatives from a range of key stakeholder groups, including consumers and carers, health and aged care policymakers, general practitioners, practice nurses, geriatricians, allied health practitioners, pharmaceutical companies, private health insurers and community and aged care providers (n=40) will be purposively recruited for two Policy Roundtables. Finally, two researchers and six purposively recruited consumers will co-design Knowledge Translation resources. Thematic analysis will be performed on documentation and transcripts. ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Torrens University Human Research Ethics Committee. Participants will give written informed consent. Findings will be disseminated through development of a policy brief and lay summary, peer-reviewed publications, conference presentations and seminars.

Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology.

Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and biomarker panels for frailty screening and diagnosis, using artificial intelligence to identify frailty, and investigating the altered response to medications by older adults with frailty. Other areas with novel developments included exercise (including technology-based exercise), multidimensional interventions, person-centred and integrated care, assistive technologies, analysis of frailty transitions, risk-factors, clinical guidelines, COVID-19, and potential future treatments. This review identified a strong need for the implementation and evaluation of cost-effective, community-based interventions to manage and prevent frailty. Our findings highlight the need to better identify and support older adults with frailty and involve those with frailty in shared decision-making regarding their care.

My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity.

BACKGROUND: Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team. OBJECTIVE: To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity. DESIGN: We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers. SETTING AND PARTICIPANTS: Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care. RESULTS: A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking. DISCUSSION AND CONCLUSIONS: Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity. PATIENT OR PUBLIC CONTRIBUTION: Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.

Does CGA Improve Health Outcomes in the Community? An Umbrella Review.

OBJECTIVES: To perform an umbrella review of systematic reviews with meta-analyses (MAs) examining the effectiveness of comprehensive geriatric assessment (CGA) delivered within community settings to general populations of community-dwelling older people against various health outcomes. DESIGN: Umbrella review of MAs of randomized controlled trials (RCTs). SETTING AND PARTICIPANTS: Systematic reviews with MAs examining associations between CGA conducted within the community and any health outcome, where participants were community-dwelling older people with a minimum mean age of 60 years or where at least 50% of study participants were aged ≥60 years. Studies focusing on residential care, hospitals, post-hospital care, outpatient clinics, emergency department, or patients with specific conditions were excluded. METHODS: We examined CGA effectiveness against 12 outcomes: not living at home, nursing home admission, activities of daily living (ADLs) and instrumental ADLs (IADLs), physical function, falls, self-reported health status, quality of life, frailty, mental health, hospital admission, and mortality, searching the MEDLINE/PubMed, Cochrane Library, CINAHL, Embase databases from January 1, 1999, to August 10, 2022. AMSTAR-2 was used to assess the quality of included systematic reviews, including risk of bias. RESULTS: We identified 10 MAs. Only not living at home (combined mortality and nursing home admission) demonstrated concordance between effect direction, significance, and magnitude. Significant effects were more typically observed in earlier rather than later studies. CONCLUSION AND IMPLICATIONS: Given the widespread adoption of CGA as a component of usual care within geriatric medicine, the lack of strong evidence demonstrating the protective effects of CGA may be indicative of a cohort effect. If so, future RCTs examining CGA effectiveness are unlikely to demonstrate significant findings. Future studies of CGA in the community should focus on implementation and adherence to key components. TRIAL REGISTRATION: Study protocol registered in PROSPERO 2020 CRD42020169680.

The Use of Digital Technologies in the Inpatient Setting to Promote Communication During the Early Stage of an Infectious Disease Outbreak: A Scoping Review.

Background: Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks. Aim: This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak. Methods: There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search. Results: Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement. Conclusion: Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies.

Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study.

BACKGROUND: Frailty is a highly prevalent clinical syndrome increasing older people's vulnerability to risk of adverse outcomes. Better frailty identification through expanded screening implementation has been advocated within general practice settings, both internationally and within Australia. However, little is known about practitioner perceptions of the feasibility of specific instruments, and the underlying motivations behind those perceptions. Consequently, the purpose of this study was to explore the attitudes and perceptions of a convenience and volunteer sample of Australian general practitioners (GPs) and practice nurses (PNs) towards common frailty screening instruments. METHODS: The feasibility of several frailty screening instruments (PRISMA-7 [P7], Edmonton Frail Scale [EFS], FRAIL Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC] and Timed Up and Go [TUG]) to 43 Australian GPs and PNs was assessed. The study adopted a concurrent embedded mixed-methods design incorporating quantitative (ranking exercise) and qualitative (content analysis) data collection integrated during the analysis phase. RESULTS: Practitioners assessed multi-dimensional instruments (EFS, GFI, KC) as having relatively higher clinical utility, better integration into existing assessment processes and stronger links to intervention over uni-dimensional (GST, TUG) and simple (FQ, P7) instruments. CONCLUSIONS: While existing frailty screening instruments show promise as an initial step in supporting better care for older people, all the included instruments were associated with perceived advantages and disadvantages. Ultimately, clinicians will need to weigh several factors in their selection of the optimal screening instrument. Further translational research, with a focus on contextual fit, is needed to support clinical decision-making on the selection of instruments for frailty screening.

Association of frailty with health service utilisation and health care expenditure in sub-Saharan Africa: evidence from Côte d'Ivoire.

BACKGROUND: Frailty, a syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe. However, little is known about the health service impacts of frailty in low-income countries (LICs), and in particular, sub-Saharan Africa (SSA). This study explores the relationship between frailty and health service 1) utilisation and 2) expenditure within Côte d'Ivoire. METHODS: Participants aged 50 years and over participated in the Living Condition, Health and Resilience among the Elderly study. Frailty was assessed using a 30-item Frailty Index (FI). The association between frailty and self-reported health service utilisation was analysed for general practitioners (GPs), specialists, overnight hospitalisations, traditional practitioners and self-medication. Expenditure over the previous month included consulting, medications, hospitalisations and total expenditure. RESULTS: Among participants [n = 860, mean age (SD) = 61.8 (9.7) years, 42.9% female], 60.0% were frail, 22.8% pre-frail and 17.2% robust. The mean (SD) FI was 0.28 (0.17). Increased health service utilisation was associated with frailty for GP attendance, traditional practitioners and self-medication but not specialists or overnight hospitalisation. Pre-frailty and frailty were associated with increased total health service expenditure, with frailty also associated with aggregate consulting costs and medications. CONCLUSIONS: Although frailty is associated with health service utilisation and expenditure in a variety of contexts, the study results suggest that such impacts may vary across the globe. The experience of frailty in LICs is likely to differ from that experienced elsewhere due to cultural traditions, attitudes to the health system, and accessibility, with more research needed.

Communicating with older adults with long-term conditions about self-management goals: A systematic review and thematic synthesis.

OBJECTIVE: To synthesise a body of fine-grained observational research on communication between healthcare professionals (HCPs), older adults, and carers regarding self-management goals and actions. METHODS: We conducted a systematic review, searching nine electronic databases and the grey literature. Two reviewers independently selected for inclusion following a two-stage process and studies and discrepancies were resolved through consultation with the review team. RESULTS: 898 records were retrieved, and eight studies were included in the review. Aggregative thematic analysis resulted in 13 categories of communication practices across three decision-making domains: (1) initiating: actions occurring prior to the commitment point; (2) proposing: putting forward a course of action; and (3) committing and closing: committing (or not) to the course of action. CONCLUSIONS: Despite an increasing emphasis on the importance of personalised care planning and shared decision-making (SDM) to support older people's health and wellbeing, HCPs did not consistently practice this approach and, in some cases, worked in opposition to it. PRACTICE IMPLICATIONS: We encourage HCPs to prepare older adults to engage actively with SDM and the goal setting process by employing patient-centred communication resources. These could assist with identifying different types of goals that are realistic and relevant to patients in daily life.

Understanding consumer perceptions of frailty screening to inform knowledge translation and health service improvements.

BACKGROUND AND OBJECTIVES: despite growing support for the clinical application of frailty, including regular frailty screening for older adults, little is known about how older adults perceive frailty screening. The purpose of this study was to examine older adults' perspectives on frailty screening to inform knowledge translation and service improvements for older adults with frailty. RESEARCH DESIGN: interpretive descriptive qualitative design. PARTICIPANTS: a total of 39 non-frail (18%), pre-frail (33%) and frail or very frail (49%) South Australian older adults aged 62-99 years, sampled from community, assisted living and residential aged care settings. METHODS: seven focus groups were conducted and analysed by two independent investigators using inductive thematic analysis. RESULTS: three themes were identified. First, older adults question the necessity and logic of an objective frailty measure. Second, older adults believe any efforts at frailty screening need to culminate in an action. Third, older adults emphasise that frailty screening needs to be conducted sensitively given negative perceptions of the term frailty and the potential adverse effects of frailty labelling. DISCUSSION AND IMPLICATIONS: previous screening experiences and underlying beliefs about the nature of frailty as inevitable shaped openness to, and acceptance of, frailty screening. Findings correspond with previous research illuminating the lack of public awareness of frailty and the nascent stage of frailty screening implementation. Incorporating consumer perspectives, along with perspectives of other stakeholder groups when considering implementing frailty screening, is likely to impact uptake and optimise suitability-important considerations in person-centred care provision.

Feasibility and acceptability of commonly used screening instruments to identify frailty among community-dwelling older people: a mixed methods study.

BACKGROUND: Frailty exposes older people to an elevated risk of a range of negative outcomes. Emerging evidence that frailty can be effectively treated within community settings has stimulated calls for more proactive screening within primary care. Assessing feasibility is a critical preliminary step in assessing the efficacy of interventions such as screening. However, few studies have explored the feasibility and acceptability of administering frailty screening instruments within general practice, and even fewer have incorporated patient perspectives. Our study had three objectives: To 1) assess overall feasibility of the instruments (completion time and rate); 2) assess patient acceptability towards the instruments; and 3) assess the feasibility and acceptability of the instruments to administering nurses. METHODS: The feasibility and acceptability of several frailty screening instruments (PRISMA-7, Edmonton Frail Scale, FRAIL Scale Questionnaire, Gait Speed, Groningen Frailty Indicator, Reported Edmonton Frail Scale and Kihon Checklist) was explored within the context of a larger diagnostic test accuracy (DTA) study. Completion time and rate was collected for all participants (N = 243). A sub-sample of patients (n = 30) rated each instrument for ease of completion and provided comment on perceived acceptability. Lastly, five of six administering nurses involved in the DTA study participated in semi-structured face-to-face interviews, rating the instruments against several feasibility and acceptability criteria (time, space, equipment, skill required to implement, acceptability to patients and nurses, ease of scoring) and providing comment on their responses. RESULTS: The PRISMA-7 returned the highest overall feasibility and acceptability, requiring minimal space, equipment, skills and time to implement, and returning the fastest completion rate and highest patient and nurse acceptability rating. All screening instruments were faster to implement than the two reference standards (Fried's Frailty Phenotype and Frailty Index). Self-administered instruments were subject to lower rates of completion than nurse-administered instruments. CONCLUSIONS: This study has demonstrated that a number of commonly used frailty screening instruments are potentially feasible for implementation within general practice. Ultimately, more research is needed to determine how contextual factors, such as differences in individual patient and clinician preferences, setting and system factors, impact on the feasibility of screening in practice.

Older adults' understandings and perspectives on frailty in community and residential aged care: an interpretive description.

OBJECTIVES: Despite growing interest in frailty as a significant public health challenge, comparatively little is known about how older adults perceive and experience frailty, limiting the effectiveness of strategies to improve frailty management and prevention. The objective of this study was to understand how older people, including frail older persons in residential aged care, perceive and understand frailty through an interpretive-descriptive qualitative study. SETTING: Aged care facility, community-based university for older persons and an aged care auxiliary care group in a large metropolitan centre in South Australia. PARTICIPANTS: 39 non-frail, prefrail, frail and very frail South Australian older adults. METHODS: Seven focus groups were conducted. Participants completed one of two frailty instruments depending on setting and indicated whether they self-identified as frail. Data were analysed inductively and thematically by two independent investigators. RESULTS: Frailty was described according to three schemas of (1) the old and frail: a static state near the end of life; (2) frailty at any age: a disability model; and (3) frailty as a loss of independence: control, actions and identity. In addition, a theme was identifying linking mindset, cognition and emotion to frailty. The term frailty was viewed negatively and was often implicated with personal choice. There was little correlation between frailty assessments and whether participants self-identified as frail. CONCLUSIONS: Aside from a disability model, views of frailty as unmodifiable permeated older persons' diverse perspectives on frailty and are likely to impact health behaviours. To our knowledge, this is among the largest qualitative studies examining consumer perceptions of frailty and contributes a clinically relevant schema linking age, prevention and modifiability from a consumer perspective.

Factors influencing communication about frailty in primary care: A scoping review.

OBJECTIVE: To summarise the available evidence on the factors influencing communication about frailty in the primary care setting. METHODS: We conducted a scoping review, searching five electronic databases (PubMed, Scopus, CINAHL, PsycINFO, and ProQuest) for studies addressing communication about frailty in primary care practice. Reference list and grey literature searching was conducted to identify additional articles. A narrative descriptive method was used to synthesise the findings. RESULTS: The search identified 3185 articles and 37 were included in the review. We identified five categories of factors influencing communication about frailty at the consumer, healthcare provider, and system levels: (1) consumer perceptions, information needs, and communication preferences; (2) healthcare providers' knowledge, capacities, and attitudes; (3) clinical communication skills and training; (4) availability of information and communication technologies; and (5) care coordination, collaboration, and case management. CONCLUSION: Findings offer considerations for the design and delivery of initiatives to improve communication about frailty in primary care both at the local clinical level and at the broader level of healthcare service delivery. PRACTICE IMPLICATIONS: Healthcare providers and systems require practical, evidence-informed guidance regarding the development of a systematic approach to the quality and timing of communication about frailty in healthcare encounters.

Commonly Used Screening Instruments to Identify Frailty Among Community-Dwelling Older People in a General Practice (Primary Care) Setting: A Study of Diagnostic Test Accuracy.

BACKGROUND: Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried's Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire. METHODS: DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility.We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21]. RESULTS: We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2-94.3]; Sp: 73.4% [66.5-79.6]) and REFS (Se: 87.5% [73.2-95.8]; Sp: 75.5% [68.8-81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria. CONCLUSIONS: Two screening instruments-the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.

Diagnostic test accuracy of self-reported screening instruments in identifying frailty in community-dwelling older people: A systematic review.

Against a backdrop of aging populations worldwide, it has become increasingly important to identify frailty screening instruments suitable for community settings. Self-reported and/or administered instruments might offer significant simplicity and efficiency advantages over clinician-administered instruments, but their comparative diagnostic test accuracy has yet to be systematically examined. The aim of this systematic review was to determine the diagnostic test accuracy of self-reported and/or self-administered frailty screening instruments against two widely accepted frailty reference standards (the frailty phenotype and the Frailty Index) within community-dwelling older adult populations. We carried out a systematic search of the Embase, CINAHL, MEDLINE, PubMed, Web of Science, PEDro, PsycINFO, ProQuest Dissertations, Open Grey and GreyLit databases up to April 2017 (with an updated search carried out over May-July 2018) to identify studies reporting comparison of self-reported and/or self-administered frailty screening instruments against an appropriate reference standard, with a minimum sensitivity threshold of 80% and specificity threshold of 60%. We identified 24 studies that met our selection criteria. Four self-reported screening instruments across three studies met minimum sensitivity and specificity thresholds. However, in most cases, study design considerations limited the reliability and generalizability of the results. Additionally, meta-analysis was not carried out, because no more than three studies were available for any of the unique combinations of index tests and reference standards. Although the present study has shown that a number of self-reported frailty screening instruments reported sensitivity and specificity within a desirable range for community application, additional diagnostic test accuracy studies are required. Geriatr Gerontol Int 2020; 20: 14-24.

Should we screen for frailty in primary care settings? A fresh perspective on the frailty evidence base: A narrative review.

With older adults living longer, health service providers have increasingly turned their attention towards frailty and its significant consequences for health and well-being. Consequently, frailty screening has gained momentum as a possible health policy answer to the question of what can be done to prevent frailty's onset and progression. However, who should be screened for frailty, where and when remains a subject of extensive debate. The purpose of this narrative review is to explore the dimensions of this question with reference to Wilson and Jungner's time-tested and widely accepted principles for acceptable screening within community settings. Although the balance of the emerging evidence to support frailty screening is promising, significant gaps in the evidence base remain. Consequently, when assessed against Wilson and Jungner's principles, extensive population screening does not appear to be supported by the evidence. However, screening for the purpose of case-finding may prove useful among older adults.

Application of an electronic Frailty Index in Australian primary care: data quality and feasibility assessment.

BACKGROUND: The primary care setting is the ideal location for identifying the condition of frailty in older adults. AIMS: The aim of this pragmatic study was twofold: (1) to identify data items to extract the data required for an electronic Frailty Index (eFI) from electronic health records (EHRs); and (2) test the ability of an eFI to accurately and feasibly identify frailty in older adults. METHODS: In a rural South Australian primary care clinic, we derived an eFI from routinely collected EHRs using methodology described by Clegg et al. We assessed feasibility and accuracy of the eFI, including complexities in data extraction. The reference standard for comparison was Fried's frailty phenotype. RESULTS: The mean (SD) age of participants was 80.2 (4.8) years, with 36 (60.0%) female (n = 60). Frailty prevalence was 21.7% by Fried's frailty phenotype, and 35.0% by eFI (scores > 0.21). When deriving the eFI, 85% of EHRs were perceived as easy or neutral difficulty to extract the required data from. Complexities in data extraction were present in EHRs of patients with multiple health problems and/or where the majority of data items were located other than on the patient's summary problem list. DISCUSSION: This study demonstrated that it is entirely feasible to extract an eFI from routinely collected Australian primary care data. We have outlined a process for extracting an eFI from EHRs without needing to modify existing infrastructure. Results from this study can inform the development of automated eFIs, including which data items to best access data from.

Diagnostic test accuracy of self-reported frailty screening instruments in identifying community-dwelling older people at risk of frailty and pre-frailty: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The question of this systematic review is: What is the diagnostic test accuracy of self-reported frailty screening instruments among community-dwelling older people against any of the following reference standard tests: the frailty phenotype, frailty index and comprehensive geriatric assessment?