Introduction

In Canada, according to the Canadian Frailty Network there is over 1.6 million Canadians who are living with frailty, which represents about 1 in 4 individuals over 65 years of age (1).

Frailty is a clinically recognized multidimensional syndrome characterized by a loss reserve that results in an increased state of vulnerability (2, 3). Frailty is caused by multiple causes and factors ranging from physical, psychological, social, or a combination. Common conditions that contribute to frailty include: nutritional status/ weight loss, physical performance (gait speed, grip strength), physical activity, subjective energy levels, number of comorbidities, mood, cognition/ motor processing, urinary incontinence, activities of daily living, medication management, social support, self-rated health (3).

Currently, Canada, has only 198,220 long term care (LTC) beds, despite having over 6.8 million adults aged 65 years and older (4). In LTC settings, 3 in 5 residents are women, over 50% of residents are persons over 84 years of age, and 1 in 10 newly admitted residents in LTC could have potentially been cared for at home (5).

In care settings such LTC, do not currently identify and assess frailty as a standard clinical practice (3, 6). The only active frailty guidelines in Canada are the BC Guidelines, which help tailor assessments of frailty and offer person-centred frailty management strategies (7, 8). The benefit of assessing frailty in LTC differs from other care settings. The goal of screening for frailty among residents is two-fold. For example, screening might help to identify frailty or function as a way to measure frailty severity (8). Evidence suggests that higher frailty scores increase in LTC settings place residents at an increased risk of hospitalization, emergency visits, and depression (8). Therefore, it is important to identify frailty in LTC in order to inform Person-Centred Decisions (e.g., early interventions to prevent or slow further decline, prompts meaningful discussions regarding goals of care, informs prognosis to assist in care planning well before end of life, allows early access to innovative care processes, leads to avoidance of inappropriately aggressive medical treatments, provides a helpful way to determine the impact of therapies) (3).

There are multiple validated frailty tools for research and clinical decision-making. For example, the Clinical Frailty Scale (CFS) evaluates frailty among older adults by incorporating clinical judgment in domains such as mobility, energy, physical activity, and function (9). The Case-Finding for Complex Chronic Conditions in Seniors over 75+ (C5-75), assess frailty and associated health conditions in family practice (10). Frailty Index, is a quantitative individual measure of frailty, which is expressed as a proportion of the total number of age-related health deficits that are considered in primary care (11). The Edmonton Frail Scale is multidimensional index with nine subscales that can be used to estimate frailty severity and improve care planning (12). The Frailty Tool can be used to assess mortality and disability risk following cardiac procedures (13). Lastly, the Fried Frailty Phenotype is a five criteria assessment of physical frailty (14).

References

1. Canadian Frailty Network. 2024. Frailty Matters. Kingston, Ontario: [Website] https://www.cfn-nce.ca/frailty-matters/#1574890408921-bde36ff7-f581

2. Wykle, M. L., & Gueldner, S. H. (2010). Aging well: gerontological education for nurses and other health professionals. Jones & Bartlett Publishers. Page 239 and 551-558

3. Rolfson, D. B., Heckman, G. A., Bagshaw, S. M., Robertson, D., Hirdes, J. P., & Canadian Frailty Network. (2018). Implementing frailty measures in the Canadian healthcare system. The Journal of frailty & aging, 7, 208-216.

4. Canadian Institute for Health Information (CIHI). 2021. How many long-term care beds are there in Canada? [Website] https://www.cihi.ca/en/how-many-long-term-care-beds-are-there-in-canada

5. Canadian Institute for Health Information (CIHI). 2021. How many long-term care beds are there in Canada? [Website] https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en&_ga=2.142168304.355519058.1710529093-752798305.1710529093#!/indicators/082/new-long-term-care-residents-who-potentially-could-have-been-cared-for-at-home/;mapC1;mapLevel2;/

6. Canadian Frailty Network. 2024. Assessing Frailty. How Screening for Frailty Helps. Kingston, Ontario: [Website] https://www.cfn-nce.ca/frailty-matters/how-screening-for-frailty-helps/

7. British Columbia Ministry of Health. 2017. Frailty in Older Adults – Early Identification and Management. Retrieved from https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/frailty-full_guideline.pdf

8. Muscedere, J., Andrew, M. K., Bagshaw, S. M., Estabrooks, C., Hogan, D., Holroyd-Leduc, J., … & Tholl, B. (2016). Screening for frailty in Canada’s health care system: a time for action. Canadian Journal on Aging/La Revue canadienne du vieillissement, 35(3), 281-297.

9. Rockwood, K., & Theou, O. (2020). Using the clinical frailty scale in allocating scarce health care resources. Canadian Geriatrics Journal, 23(3), 210.

10. Lee, L., Patel, T., Hillier, L. M., Locklin, J., Milligan, J., Pefanis, J., … & Boscart, V. (2018). Frailty screening and case-finding for complex chronic conditions in older adults in primary care. Geriatrics, 3(3), 39.

11. Mitnitski, A., Song, X., Skoog, I., Broe, G. A., Cox, J. L., Grunfeld, E., & Rockwood, K. (2005). Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. Journal of the American Geriatrics Society, 53(12), 2184-2189.

12. Rolfson, D. B., Majumdar, S. R., Tsuyuki, R. T., Tahir, A., & Rockwood, K. (2006). Validity and reliability of the Edmonton Frail Scale. Age and ageing, 35(5), 526-529.

13. Afilalo, J., Lauck, S., Kim, D. H., Lefèvre, T., Piazza, N., Lachapelle, K., … & Perrault, L. P. (2017). Frailty in older adults undergoing aortic valve replacement: the FRAILTY-AVR study. Journal of the American College of Cardiology, 70(6), 689-700.