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New tool helps practice nurses assess frailty in older patients

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A new tool has been designed by UK researchers to help practice nurses and other primary care staff to assess which older patients are the most frail and vulnerable.

The researchers have developed what they have dubbed the electronic frailty index (eFI). It uses 36 indicators of frailty using routine data already held on GP databases.

“The pilot showed that running the eFI report was quick and simple”

Lynn Lansbury

These indicators include conditions such as anaemia, diabetes, heart and kidney problems, mobility issues and even social vulnerability.

The tool uses the codes that practices regularly assign to these conditions and flags up those patients who are at the most risk.

It then identifies older people who might be living with mild, moderate and severe frailty, and at increased risk of future nursing home or hospital admission, longer hospital stays and mortality.

The new tool will help GP surgeries provide better care to the most vulnerable patients, improve health service planning and potentially make better use of resources, said the researchers behind it.

They also noted that since July this year, identifying and managing patients with frailty has been in the GP contract and, therefore, part of the system in which practices generate income.

The eFI tool was developed by Dr Andrew Clegg, from the University of Leeds, and tested by Dr Lynn Lansbury, from the University of Portsmouth.

“Implementing the eFI as part of routine primary care practice could help improve the care of older people with frailty”

Andrew Clegg

Dr Lansbury trialled the tool last year in one practice – described as a suburban primary care practice in southern England – to demonstrate how it worked successfully in a busy primary care setting.

She said: “The pilot showed that running the eFI report was quick and simple and could identify patients with a high frailty score in just a few minutes. It was also more thorough.”

Dr Lansbury noted that, as well as identifying patients that the practices were expecting to see, it also revealed other patients not previously identified as at risk.

By identifying the most vulnerable patients, practices were better able to support them, which may improve their quality of life and reduce unplanned admissions to hospital and care homes, she said.

Writing in the British Journal of General Practice, she and the other researchers stated: “Practice staff ran the eFI reports in five minutes, which they reported was feasible and acceptable. Importantly, the eFI scores identified almost 12% of patients aged ≥75 years in this practice to have severe frailty.

“Practice staff recognised the potential for the eFI to identify the top 2% of vulnerable patients for avoiding unplanned admissions,” they added.

Following the trial, the eFI has now been made freely available to every general practice in England as part of a national implementation project.

Dr Clegg said: “Implementing the eFI as part of routine primary care practice could help improve the care of older people with frailty, through a holistic approach to their overall health conditions, quicker referrals and signposting to local authority and voluntary services.”

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