If you are chairing this conference, you could do a lot for older persons by helping to weaken the stereotype that to be old is to be frail. There are many others in the general population at risk for frailty eg. anorexic young persons, sedentary adults, advanced alcoholics, drug abusers, those with advanced cancer erc.

For physicians to do a first level screening of all thier clients with long term medical conditions would do two things: prevent more falls etc AND help destigmatize age.

Since first level screening takes only a few minutes this should not add much time to an office visit...in fact it might be possible for an assistant [nurse or other health care assistant] to do this screening while a client is waiting for their medical doctor to come into the room where they have been placed.

I think that if you could get more physicians to institute this practice as part of their regular screening like bp, temp - usually done before the physician arrives in he exam room, you would do much to lessen fractures from falls, auto accidents etc.,

Kate

Kate Lindemann

Senior Researcher Institute of Aging and Policy

Yes the older population should be screened early in primary care setting annually for any risk of frailty (medical and/or physical impairments). Early detection and prevention will reduce the risk of health status deterioration.

Every one is at some level of risk and thus screening all the older population is necessary. I am sure it does not take up too much time because nurse clinician can facilitate the administration.

Well, From my experience it is of benefit to screen for frailty because it alerts the care provider to many things that need to be done for the older adult or the family to prevent or control complications. Depending on the country where you are it is important to first be sure that health insurance or any other system will be able to pay for this service.

Again, I support such screenings but why just elders? There are many younger persons who are at risk for falls etc. as much as elders. eg. those with anorexia, bulimia, sedentary adults [eg many can not do even the basic balance exercise],

those with chronic or wasting illness

. To limit screenings just to elders is, to me, a bit short sighted....and such limiting reinforces stigma of being old. ( I have a web site osteopenia3.com and many persons in their 60 - late 80 subscribe to the newsletter. After years of practicing balance exercises each day, doing weight bearing exercises several times a week, eating alkaline diet these women are often in better shape than their younger counterparts.).

Good luck with your work.

YES, I completely agree that frailty to be merged into the health promotion programs for older people in the community. Like the case of dementia, the role of primary care physicians is of great importance. On the other hand, physical and cognitive frailty should be both paid attentions from the community settings, as well as the clinical settings.

I agree with this comments. There is another important topic: public health care costs. In Costa Rica we have a public health system but this system doesn`t have a lot of money, so if we do not screen older people at risk for falls, this could impact negatively the public costs. It`s critically important to do the screenings. 

I also agree with Kate. We should not only examine older people. According with the actual levels of sedentarism, we could screen people in their 30`s, 40`s and 50`s actually. It could give us an idea about the frailty progress.

My best wishes to all.

It is interesting that you raised this question. It was in 2012 that you asked this question on Research gate, is there any current update on this question from your side?

Well, I believe that it should be an essential component of geriatric care- all older persons should be screened for frailty. It is feasible because we now have simple scales that can help us to screen frail individuals, so that they could be provided with due care. Not only doing this will help us to identify frail adults, it will also help to improve clinical decision-making in the older adults regarding their medications. There is evidence of age-based decision making in older patients, whereby the chronological age of a patient may negatively impact the clinical decisions leading to age-bias in prescribing. We all know, that there exists a tremendous heterogeneity in health status of older people. Someone aged 60 years may be frail, with impaired renal and hepatic function, and requiring assistance due to functional and/or cognitive impairments. On the other hand, many of those aged 80 years are still fit, healthy, and living an independent life.

Now if this becomes a routine (compulsory) practice to screen all older persons for frailty, there are significant chances of improvements in prescribing medications. 

Now the next question that arises is AT WHAT AGE THIS SCREENING PROCESS TO BEGIN? Is it 70, 65, 50 years? For this I agree with Kate and Luis, why not start it as early as 30s.

Looking forward to hear your views and updates on that consensus meeting that you chaired!

Kind regards

Shamsher Singh

I think that the fragility in the old man is not synonymous with disease or alteration. In them, the risk of getting sick is greater, and it is advisable to monitor them, even to register periodic reviews of their health status for their medical records, which can be limited to very simple tests or functional tests.

When there is evidence or suspicion of disease should be used analytical tests of predictors of clinical risk. We use the CONUT method to monitor nutritional risks and the risk of disease or treatment, especially in chronic patients.

Kind regards

The question is quite old, but the answer for this question is yes. With simple tools the primary care physician may screen for frailty, and it is not very diffucult to perform. When we talk about frailty, we all know that frail older person you may easily recognise. As a nurse, I may point out that not only physician may screen for frailty,it may be done also by other health team members, eg. nurses.