Perspectives on Frailty Screening, Management and Its Implementation Among Acute Care Providers in Singapore: A Qualitative Study

Abstract

Background Frailty has emerged to be a public health concern among aging populations. COVID-19 pandemic has reminded how the frailest individuals are particularly exposed to adverse outcomes. It is important to identify and manage frailty to delay functional decline and reduce unnecessary health utilizations. Our study explored understanding on frailty and practice of frailty screening among different acute care professionals in Singapore, (2) identify barriers and facilitators concerning frailty screening, management and its implementation.Methods A qualitative study using focus group discussion among nurses and individual interviews among physicians from four departments (Accident & Emergency, Anaethesia, General Surgery, Orthopedics) in three acute hospitals from the three public health clusters in Singapore. Participants were recruited through a combination of purposive, convenience and snowball approach with a directed approach by using NVIVO 12.0 to analyse the data. Result Frailty was mainly but inadequately understood as a physical and age-related concept. Screening for frailty in acute care was considered necessary to reduce adverse health outcomes. Specific issues related to screening, management and implementation identified were: cooperation from patient/caregivers, acceptance from healthcare workers/hospital managers, need for dedicated resources, guidelines for follow-up management and consensus on the scope of measurement for different specialties. Conclusion Our findings indicated the need for 1) education program for patients/care givers and stakeholders 2) hospital wide push to adopt and develop a uniform frailty screening tool and process and 3) applying relevant guidelines, developing whole of hospital approach and process for the management of frail patients.