FRAIL CLINIC is a two-phase study which examines the prevalence of frailty in several clinical areas within a hospital using standard frailty questionnaires. The observational (Phase 1) phase is complete, and we are now moving forward into the interventional phase which has commenced in Spain already.
Details of Project
The aim of FRAIL CLINIC is to assess the feasibility and effectiveness of programmes designed to detect and manage frail older patients in high risk clinical settings, and thereby to avoid functional impairment and other associated adverse outcomes. These high risk settings will be medical wards (cardiology, oncology/oncohaematology or nephrology), major surgery wards and the emergency department. Therefore, the main aim is to improve the outcomes of frail older people who have previously remained undetected in these settings and to reduce functional decline, institutionalization, hospitalization and death.
The study involves three different countries within Europe (Spain, United Kingdom and Italy). The project coordinator is Professor Leocadio Rodríguez Mañas of Hospital Universitario de Getafe, Madrid, Spain, and the scientific coordinator of the study is Professor Sinclair of Diabetes Frail, Luton, UK. The participating centres are as follows:
|Hospital Universitario de Getafe
|Hospital Universitario Monte Naranco
|United Kingdom (Luton, England)
|Ospedale San Raffaele
|Università Cattólica del Sacro Cuore
Frailty, a condition characterised by increased vulnerability to minor stressors, affects more than 1 in 8 people aged over 70 years. Frailty often precedes the development of disability and other clinical outcomes, sometimes by several years. Whilst recovery from disability is unlikely, frailty is reversible and successful management of the condition has been shown through appropriate intervention strategies. Early identification of frailty is vital to enable an effective intervention process, preventing the progression to disability and improving quality of life for older people.
The main aim of the FRAIL CLINIC initiative is to improve poor outcomes in frail older people that have been previously undetected in settings of high risk. These poor outcomes include functional decline, institutionalisation, hospitalisation and death. This pathway of care should have a relevant impact on the sustainability of health and social systems by preventing functional decline and avoiding unnecessary interventions and their undesired secondary effects.
The FRAIL CLINIC project includes two consecutives phases: the first focussing on detection and quantification of frailty (observational phase) and the second phase focussing on management of frail patients using an integrated model of geriatric care (interventional phase).
Phase 1: Observational Phase
During this phase, the prevalence of frailty, the success of programmes for detection of frail patients in high risk clinical settings, and tools commonly used for assessment of frailty will be evaluated.
Phase 2: Interventional Phase
In the interventional phase, we will evaluate the performance of a usual geriatric model of care in these settings, in contrast with the traditional management (usual practice in each clinical non-geriatric setting).
Frailty assessment instruments measure different domains of the Frailty Syndrome. In frail older patients admitted into different clinical settings, compliance with the recommendations of the Geriatric medical team improves the functional status 3 months after hospitalisation and reduces mortality and readmissions 12 months after hospitalisation.