The C5-75 Program: Meeting the Need for Efficient, Pragmatic Frailty Screening and Management in Primary Care

Abstract

Case-Finding for Complex Chronic Conditions in Seniors 75+ (C5-75) is a systematic approach to identify frailty using gait speed and hand-grip strength and to screen for co-morbid conditions. We identified the C5-75 features offering the highest yield for identifying frailty and to streamline the screening program. Analyses included 1,948 C5-75 assessments completed from 2013 to 2018. Age 85 or older, less than regular physical activity, and more than two falls in the previous six months had the strongest associations with frailty. Exempting patients under 85 who reported regular physical activity and less than two falls excluded 39.1 per cent of the cohort while maintaining a sensitivity of 95.2 per cent and a negative predictive value of 99.4 per cent for frailty. These findings provide insight into optimizing screening for frailty, making it more feasible to implement and to identify co-existing conditions that may contribute to or be affected by frailty.

A nurse‐led comprehensive geriatric assessment intervention in primary care: A feasibility cluster randomized controlled trial

“…Another option might be to consider screening for frailty based on gait speed and grip strength, which aims to identify those at the highest risk to poor outcomes. This approach has high levels of sensitivity and specificity and claims to be feasible in primary care practice (Lee et al, 2020).…”

“…Changes to international policy relating to frailty management in primary care (World Health Organization, 2017) is driving research and findings emerged from other studies conducted concurrently with this study. Four reviews (Frost et al, 2020; Garrard et al, 2020; Travers et al, 2019; Van der Elst et al, 2018) and two studies (Bleijenberg et al, 2017; Lee et al, 2020) provide guidance on methods of identification of frail people, as well as efficacy and content of CGA‐based interventions to manage older people with complex conditions in primary care. These demonstrated the scarcity of good quality primary care‐based studies and concluded that primary care‐based CGA was acceptable but provided variable outcome benefit (Garrard et al, 2020).…”

Assessing Risk among Frail Older Adults in Ontario, Canada, during the COVID-19 Pandemic: A Mixed Methods Evaluation of a Telephone Outreach Program

“…Virtual Risk Assessment. For this intervention, we focused on those individuals known to be at highest risk, as previously identifed as frail in the Case-Finding for Complex Chronic Conditions in Seniors 75+ (C5-75) program [14,15]. Te C5-75 screening program uses gait speed and hand-grip strength, a validated proxy in primary care for the Fried frailty phenotype criteria, to measure frailty as well as screening for common geriatric conditions associated with frailty that can lead to poor outcomes and contribute to health destabilization [16,17].…”