A time for action
Canadian Frailty Network believes that the prevalence of frailty in Canada requires a shift from a single-system illness focus. We need to screen all older adults who meet pre-specified age thresholds or population based thresholds when they come into contact with the health care system.
Tools for assessing frailty are readily available and should be incorporated into routine practice. Importantly, the tools commonly used to measure frailty often lend themselves to the identification of possible interventions. Doing so will enable care professionals to tailor interventions for older adults at greater risk of rapid loss of functional status, hospitalization, institutionalization, falls, delirium or death; potentially preventing or significantly delaying negative health results, and preventing unnecessary and unwanted interventions by improving care at end of life. This will lead to outcomes desired by older adults: to remain in their homes and communities and to be as functional as possible for as long as possible. Recognizing how frailty impacts the life span will allow for better integration of the individual’s goals of care into potential treatment options.
Different settings in the Canadian health care system will require different strategies and tools to assess for frailty. The tools in primary care may be different that those in long term care or acute care or critical care. Moreover, the societal, ethical and legal implications of screening for frailty will need to be addressed. Given the magnitude of the challenges that frailty poses for the health care system as it is currently organized, a shift in health policy and planning is needed that includes but is not limited to the implementation of frailty screening tools across care settings; new training and qualification frameworks for caregivers and health care professionals; and adapted funding models.
The exposure of patients, caregivers and health care professionals to evidence-based frailty screening that embraces rehabilitative and social supports will spur changes in health care practices that underpin broader system improvements and more sustainable health funding models