CFN landmark article on frailty assessment published

November 29, 2016

In June 2015 at the National Frailty Forum, for the first time in Canada, CFN gathered researchers, members of the public, clinicians, policy-leaders, NGOs, industry leaders, healthcare administrators, HQP and international healthcare professionals to catalyze the development of a national strategy on frailty.

As a result of the initial Forum, a landmark paper was published in the Canadian Journal on Aging – Screening for frailty in Canada’s Health Care System: A Time for Action. The open-access paper articulates the rationale, possible strategies and potential pitfalls for the systematic implementation of frailty screening and assessment within the Canadian healthcare system.

Muscedere J, Andrew MK, Bagshaw SMEstabrooks CHogan DHolroyd-Leduc JHowlett SLahey WMaxwell CMcNally MMoorhouse P, Rockwood KRolfson DSinha STholl B. Screening for Frailty in Canada’s Health Care System: A Time for Action. Canadian Journal on Aging. 2016 Sept; 35(3):281-297. doi: 10.1017/S0714980816000301. Epub 2016 May 23.

Abstract: As Canada’s population ages, frailty – with its increased risk of functional decline, deterioration in health status, and death – will become increasingly common. The physiology of frailty reflects its multisystem, multi-organ origins. About a quarter of Canadians over age 65 are frail, increasing to over half in those older than 85. Our health care system is organized around single-organ systems, impairing our ability to effectively treat people having multiple disorders and functional limitations. To address frailty, we must recognize when it occurs, increase awareness of its significance, develop holistic models of care, and generate better evidence for its treatment. Recognizing how frailty impacts lifespan will allow for integration of care goals into treatment options. Different settings in the Canadian health care system will require different strategies and tools to assess frailty. Given the magnitude of challenges frailty poses for the health care system as currently organized, policy changes will be essential.

Five multi-disciplinary working groups were also struck to consider the social, ethical/legal, policy and knowledge translation, and social policy implications of frailty.

Working Groups and Co-Leads

Identification of frailty for improved advance care planning and end-of-life care

James Downar, University of Toronto

John You, McMaster University

Tools for evidence-based frailty screening

John Hirdes, University of Waterloo

Darryl Rolfson, University of Alberta

Ethical and legal implications of frailty screening

Mary McNally, Dalhousie University

William Lahey, University of King’s College

Health policy and socio-economic implications of frailty screening

Bill Tholl & Jennifer Kitts, HealthCareCAN

Social and Societal Implications of frailty screening

Melissa Andrew, Dalhousie University

The second National Forum was held May 12-13, 2016, and the outcomes of the deliberations of these groups were presented for feedback, as part of panels including government officials, representatives of national groups like the CMA, CIHI and CFHI, and, of course, citizens and caregivers. The papers from the working groups will be published in a special supplement to the Canadian Journal of Aging.