Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines

Frailty is now a well-recognized and common syndrome among older persons. Frailty is a syndrome which increases the risk of an older person to develop disability or to die when exposed either to physical or psychosocial stressors. Although frailty, disability and multimorbidity often coexist and interact, they are distinct and separate concepts. Growing evidence suggests that each of these interrelated conditions is preventable and their associated complications manageable. However, early identification is imperative as once disability and multimorbidity occur, frailty in less likely to be prevented or reversed. As such it should be distinguished from persons with disability in their activities of daily living. The conditions leading to the frailty syndrome should have some degree of reversibility, thus distinguishing it from multimorbidity. Recently, the International Conference of Frailty and Sarcopenia Research (ICFSR) formulated evidence-based guidelines for the identification and management of physical frailty. Physical frailty was originally defined and validated by Fried et al. This definition included measurements of low activity level, slowness of walking, muscle weakness, exhaustion and weight loss. This approach differs from that of Rockwood and Mitnitski which used the number of “deficits” (signs, symptoms, clinical conditions) to determine a frailty index. Primary care represents the entry point into the health care system for many older adults who may be pre-frail and frail. A shortage of geriatricians and the higher frequency of frailty in community settings call for primary care clinicians (general practitioners, generalists, family physicians) to increasingly assess and manage older adults at risk for frailty or who are already frail.

The purpose of this paper is to suggest practical frailty screening and management strategies in primary care settings. We will also discuss the characteristics of these instruments and their applicability to primary care. For the sake of consistency hereafter, we will refer to clinicians delivering primary care as primary care providers.