Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

COVID-19 pandemic has reminded how older adults with frailty are particularly exposed to adverse outcomes. In the acute care setting, consideration of evidence-based practice related to frailty screening and management is needed to improve the care provided to aging populations. It is important to assess for frailty in acute care so as to establish treatment priorities and goals for the individual. Our study explored understanding on frailty and practice of frailty screening among different acute care professionals in Singapore, and identify barriers and facilitators concerning frailty screening and its implementation.

Methods

A qualitative study using focus group discussion among nurses and individual interviews among physicians from four departments (Accident & Emergency, Anesthesia, General Surgery, Orthopedics) in three acute hospitals from the three public health clusters in Singapore. Participants were recruited through purposive sampling of specific clinicians seeing a high proportion of older patients at the hospitals. Thematic analysis of the data was performed using NVIVO 12.0.

Results

Frailty was mainly but inadequately understood as a physical and age-related concept. Screening for frailty in acute care was considered important to identify high risk patients, to implement targeted treatment and care, and to support decision making and prognosis estimation. Specific issues related to screening, management and implementation were identified: cooperation from patient/caregivers, acceptance from healthcare workers/hospital managers, need for dedicated resources, guidelines for follow-up management and consensus on the scope of measurement for different specialties.

Conclusion

Our findings indicated the need for 1) frailty-related education program for patients/care givers and stakeholders 2) inter-professional collaboration to develop integrated approach for screening and management of hospital patients with frailty and 3) hospital-wide consensus to adopt a common frailty screening tool.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02686-w.

Related collections

Most cited references 42

Record: found
Abstract: found
Article: found

Frailty in elderly people

Andrew B. Clegg, John Young, Steve Iliffe … (2013)

Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.

0 comments Cited 1766 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

A global clinical measure of fitness and frailty in elderly people.

Kenneth Rockwood, Xiaowei Song, Chris MacKnight … (2005)

There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.

0 comments Cited 1643 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Book Chapter: not found

Qualitative data analysis for applied policy research

Jane Ritchie, Liz Spencer (1994)

0 comments Cited 964 times – based on 0 reviews

Bookmark

All references

Author and article information

Contributors

Shiou Liang Wee: weeshiouliang@gmail.com

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 17 January 2022

Publication date PMC-release: 17 January 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 58

Affiliations

[1 ]GRID grid.512761.6, Geriatric Education and Research Institute, ; Yishun, Singapore

[2 ]GRID grid.415203.1, ISNI 0000 0004 0451 6370, Khoo Teck Puat Hospital, ; Yishun, Singapore

[3 ]GRID grid.413815.a, ISNI 0000 0004 0469 9373, Changi General Hospital, ; Simei, Singapore

[4 ]GRID grid.508010.c, Woodlands Health Campus, ; Yishun, Singapore

[5 ]GRID grid.459815.4, ISNI 0000 0004 0493 0168, Ng Teng Fong General Hospital, ; Jurong East, Singapore

[6 ]GRID grid.486188.b, ISNI 0000 0004 1790 4399, Health and Social Sciences Cluster, , Singapore Institute of Technology, ; Dover, Singapore

[7 ]Yishun, Singapore

Article

Publisher ID: 2686

DOI: 10.1186/s12877-021-02686-w

PMC ID: 8762449

PubMed ID: 35039007

SO-VID: dd3dc898-386d-4848-b2c1-bc352d0fc152

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 27 November 2020

Date accepted : 1 December 2021

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: frailty screening,perspective,healthcare providers,implementation

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: frailty screening, perspective, healthcare providers, implementation

Comments

Comment on this article

scite_

Cited by 11

See all cited by

Most referenced authors 889

See all reference authors

Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study

Read this article at

Abstract

Background

Methods

Results

Conclusion

Supplementary Information

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 42

Frailty in elderly people

A global clinical measure of fitness and frailty in elderly people.

Qualitative data analysis for applied policy research

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 360

Cited by 11

Most referenced authors 889