Barriers to the identification of frailty in hospital: a survey of UK clinicians

Abstract

Despite numerous national campaigns, frailty remains under-recognised in the hospital setting. We performed a survey of hospital-based clinicians across the UK to identify barriers to the identifi cation and best practice management of frailty in hospital. A total of 402 clinicians were surveyed across a range of grades, specialties and hospitals. Responses highlighted variable awareness and personal understanding of frailty, particularly among junior doctors and clinicians in non-medical specialties. Although 74% of responders agreed frailty assessments should be undertaken for all older people admitted to hospital, only 36% felt this was currently feasible with available resources. Free-text responses highlighted limited education, the perceived subjectivity of frailty assessments, scepticism as to their utility in the hospital setting, and defi ciencies in service provision. This was the fi rst survey of UK hospital clinicians regarding frailty assessments. Results highlight multiple areas for improvement and engagement.

Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts

“… 12 Barriers to screening include uncertainty about the clinical utility of identifying frailty in acutely unwell patients, limited awareness of frailty tools and insufficient resources, with lack of evidence synthesis on frailty in the acute hospital setting likely a contributing factor. 13 , 14 Most admissions to hospital are unplanned, predominantly to non-specialist general (internal) medicine services, where multi-morbidity and complex care needs are common. However, current guidance is based mostly on studies conducted in outpatient and specialty-specific or elective settings where the prevalence and prognostic value of frailty may differ.…”

A classification tree to assist with routine scoring of the Clinical Frailty Scale

“…In the UK, outside geriatrics and frailty services, few clinicians receive formal frailty identification training; many lack confidence in this, and desire more frailty education [ 11 ]. When used against a background of care rationing more than for the development of a traditional care plan, the results might not always reflect expert geriatrician judgement [ 12 ].…”

A systematic review of frailty education programs for health care professionals

“…The majority of programs' content focused on introducing frailty and increasing frailty awareness, which is important, but likely to only be part of the solution of bridging the knowledge‐practice gap for optimising the management of frailty. Barriers related to the system (time, staffing), patient perceptions (fear of stigma), and teams (poor collaboration) contributed strongly, and could form part of an interactive discussion in frailty education programs 12,28,29 . Another key concern is that there is currently no consensus as to a standardized tool for frailty measurement with 89 different measures utilized in the acute care setting alone, as described in a 2018 scoping review 30 .…”

“…Barriers related to the system (time, staffing), patient perceptions (fear of stigma), and teams (poor collaboration) contributed strongly, and could form part of an interactive discussion in frailty education programs. 12 , 28 , 29 Another key concern is that there is currently no consensus as to a standardized tool for frailty measurement with 89 different measures utilized in the acute care setting alone, as described in a 2018 scoping review. 30 While some health systems will advocate for specific tools (e.g., the electronic frailty index is automatically generated for all adults aged 65 years and over who attend a GP for primary care in the UK 31 ), other frailty training program developers will need to identify the tool(s) most appropriate or relevant to the program participants and setting.…”