Reversing Frailty Levels in Primary Care Using the CARES Model

Abstract

BackgroundThe purpose of this manuscript was to evaluate the effectiveness of the Community Actions and Resources Empowering Seniors (CARES) model in measuring and mitigating frailty among community-dwelling older adults.MethodsThe CARES model is based on a goal-oriented multidisciplinary primary care plan which combines a comprehensive geriatric assessment (CGA) with health coaching. A total of 51 older adults (82 ± 7 years; 33 females) participated in the pilot phase of this initiative. Frailty was measured using the Clinical Frailty Scale (CFS) and the Frailty Index (FI-CGA) at baseline and at six-month follow-up.ResultsThe FI-CGA at follow-up (0.21 ± 0.08) was significantly lower than the FI-CGA at baseline (0.24 ± 0.08), suggesting an average reduction of 1.8 deficits. Sixty-one per cent of participants improved their FI-CGA and 38% improved CFS categories. Participants classified as vulnerable/frail at baseline were more responsive to the intervention compared to non-frail participants.ConclusionPilot data showed that it is feasible to assess frailty in primary care and that the CARES intervention might have a positive effect on frailty, a promising finding that requires further investigations. General practitioners who participate in the CARES model can now access their patients’ FI-CGA scores at point of service through their electronic medical records.

Prevalence of depressed mood and loss of interest among community‐dwelling older people: Large‐scale questionnaire survey and visiting intervention

“…22 In a primary care setting, frailty can be reversed by goal-oriented, multidisciplinary primary care that incorporates five strategies: (i) early identification of vulnerable older adults; (ii) collaborative health assessments; (iii) wellness plans; (iv) coaching; and (v) ongoing assessments. 23 More simply, exercise is also reported to reverse frailty. 24 All of these strategies are helped by good moods and interest in the outside world, suggesting that collaboration between geriatrics and geriatric psychiatry is required to prevent frailty.…”

Frailty in family practice/primary health care: Care and management

“…Most components of physical activity (i.e., strength, balance, coordination, flexibility and endurance exercises) and their combination with each other and prehabilitation interventions were found to be effective (33,34). Systematic reviews and meta-analyses evaluating multicomponent physical activities showed positive effects on frailty (33)(34)(35)(36), physical functioning and daily activities of living (37)(38)(39)(40) and reduction on falls by improving walking, balance, and strength (39,41). Positive effects of physical activity on cognition, emotion and social network were found (42,43).…”

Using an Electronic Comprehensive Geriatric Assessment and Health Coaching to Prevent Frailty in Primary Care: The CARES Model

“…In the preliminary study, there was a statistically significant decrease in the FI-CGA score of participating seniors (Figure 3). On average, the senior's frailty index score -from the baseline CGA to the 6-month post CGA -decreased by 0.032 [38,39]. These pilot data inspired Fraser Health to spread their CARES model proof of concept into other communities.…”

“…The project is called the Community Action and Resources Empowering Seniors (CARES; Figure 1), which is based on research evidence that frailty can be delayed and potentially prevented outright [5,37]. The CARES program is a four step evidence-based initiative that decreases the impact of frailty on health resources while promoting healthy aging [38,39]. It partners with primary care physicians and early frail seniors health coaches to prevent frailty and support healthy aging for seniors "at risk" for frailty.…”