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Technology and health care for the elderly medical research studies

Focus on strategic priorities that have significant social impact.

FRA 2015-A-08

A scoping review of evidence for measuring frailty in pre-hospital and hospital settings

The plan for this project was to search a wide range of academic literature databases.

Research Results

Findings: A preliminary synthesis showed that 23% of the studies were done in a geriatric setting, 13% were done in Emergency Departments, 6% in Cardiology Units, 10% in Orthopedic Units, 10% in General Medicine, and 2% in a pre-hospital setting. 70% of the studies did not measure frailty but identified their patients as frail. 20% used a frailty scale, <1% used other scales to measure frailty, and 10% used other ways to measure frailty including clinical judgment. Among the studies that included a frailty scale the most commonly used were: Clinical Frailty Scale (13%) Frailty Index (13%), Frailty Phenotype (11%) and the ISAR (5%).

Impact of findings: The results from this study, in combination with other CFN funded work will greatly improve and help standardize the tools used to assess frailty in different care settings. Frail patients require adaptations of care, personalization of interventions, and modifications of standard protocols and as such, identifying frailty early in clinical care is vital. This scoping review has demonstrated that frailty is not just an issue in geriatric health care settings, suggesting that all clinicians working with the elderly need to be educated and trained to detect and assess frailty. In addition, the results showed that more than half of the studies examined identified their patients as frail without measuring frailty, which suggests that a better understanding, appreciation and awareness of frailty may be warranted.

Publications, presentations and webinars

About the Project

Not all older adults are frail but many are, particularly those seen in clinical settings. Frail patients require adaptations of care, personalization of interventions and modifications of standard protocols. As such, identifying frailty early in clinical care is vital. Various instruments have been developed to measure frailty. Consensus has not yet been reached on what should be measured and choosing among the many options available can be confusing to health care professionals. Currently, no reviews of the literature have been conducted with a general focus on frailty measures used in pre-hospital and in-hospital settings.

Here, the purpose was to conduct a review to identify and document the nature and extent of research evidence and practice related to measuring frailty in pre-hospital and in-hospital settings. In addition we collaborated with pre-hospital and in-hospital health care providers to develop ways to adapt the findings for application in their respective settings.

For more details on the project rationale, hypothesis, objectives and research plan, click here.

Project Team

Principal Investigator:

Olga Theou, PhD -- Nova Scotia Health Authority


Joshua Armstrong, PhD -- Dalhousie University

Judah Goldstein, PhD -- Emergency Health Services Nova Scotia

Jacques Lee, MD, FRCPC, MSc -- Sunnybrook Research Institute

Kenneth Rockwood, MD, FRCPC, FRCP -- Dalhousie University

Knowledge Users and Partners:

Beverly Douglas -- Nova Scotia Health Authority

Division of Emergency Medical Services

Emergency Health Services Nova Scotia

The QEII Foundation -- Fountain Family Innovation Fund

Project Contact: Olga Theou --

FRA 2015-A-08