The Pictorial Fit-Frail Scale: Developing a  Visual Scale to Assess Frailty

Theou, Olga; Andrew, Melissa K.; Ahip, Sally Suriani; Squires, Emma; McGarrigle, Lisa; Blodgett, Joanna M.; Goldstein, Judah; Hominick, Kathryn; Godin, Judith; Hougan, Glen; Armstrong, Joshua; Wallace, Lindsay; Sazlina, Shariff-Ghazali; Moorhouse, Paige; Fay, Sherri; Visvanathan, Renuka; Rockwood, Kenneth

doi:10.5770/cgj.22.357

Cited by 26 publications

(27 citation statements)

References 18 publications

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“…Exactly how to optimize data collection and its incorporation into care planning from the start of the patient’s admission remains a compelling challenge. For this we are evaluating whether the Pictorial Fit-Frail Scale [ 23–25 ], which is being made widely available (specifically including to non-geriatricians), might facilitate the initial assessment of baseline function from informants.…”

Section: Discussionmentioning

confidence: 99%

The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine

et al. 2020

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Background we investigated whether two frailty tools predicted mortality among emergency department (ED) patients referred to internal medicine and how the level of illness acuity influenced any association between frailty and mortality. Methods two tools, embedded in a Comprehensive Geriatric Assessment (CGA), were the clinical frailty scale (CFS) and a 57-item deficit accumulation frailty index (FI-CGA). Illness acuity was assessed using the Canadian Triage and Acuity Scale (CTAS). We examined all-cause 30-day and 6-month mortality and time to death. Results in 808 ED patients (mean age ± SD 80.8 ± 8.8, 54.4% female), the mean FI-CGA score was 0.44 ± 0.14, and the CFS was 5.6 ± 1.6. A minority (307; 38%) were classified as having low acuity (CTAS: 1–2). The 30-day mortality rate was 17%; this increased to 34% at 6 months. Compared to well patients with low acuity, the risk of 30-day mortality was 22.5 times (95% CI: 9.35–62.12) higher for severely frail patients with high acuity; 53% of people with very severe frailty (CFS = 8) and high acuity died within 30 days. When acuity was low, the risk for 30-day mortality was significantly higher only among those with very high levels of frailty (CFS 7–9, FI-CGA > 0.5). When acuity was high, even lower levels of frailty (CFS 5–6, FI-CGA 0.4–0.5) were associated with higher 30-day mortality. Conclusions across levels of frailty, higher acuity increased mortality risk. When acuity was low, the risk was significant only when the degree of frailty was high, whereas when acuity was high, even lower levels of frailty were associated with greater mortality risk.

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Section: Discussionmentioning

confidence: 99%

The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine

et al. 2020

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“…It can be read in conjunction with two contemporary papers in the Canadian Geriatrics Society CME Journal ( 16 , 17 ) and with a paper on the Pictorial Fit-Frail Scale. ( 18 ) The latter can help to bridge between screening and assessment measures, and can itself be summarized by the Clinical Frailty Scale. Additional resources include “Top Tips to help you use the Clinical Frailty Scale” developed by our group, ( 19 ) a Clinical Frailty Scale App developed by the Acute Frailty Network in the UK ( 20 ) (this may be a useful alternative to the classification tree we are testing), a Clinical Frailty Scale Training Module developed by the AIMS Research Group at the Ottawa Hospital, ( 21 ) and a Clinical Frailty Scale Education Tool developed by the Non-Consultant Hospital Doctors of the Cork University Hospital.…”

Section: Discussionmentioning

confidence: 99%

Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources

2020

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The key idea behind the Clinical Frailty Scale (CFS) is that, as people age, they are more likely to have things wrong with them. Those things they have wrong (health deficits) can, as they accumulate, erode their ability to do the high order functions which define their overall health. These high order functions include being able to: think and do as they please; look after themselves; interact with other people; and move about without falling. The Clinical Frailty Scale brings that information together in one place. This paper is a guide for people new to the Clinical Frailty Scale. It also introduces an updated version (CFS version 2.0), with revised level names (e.g., “vulnerable” becomes “living with very mild frailty”) and minor edits to level descriptions. The key points discussed are that the Clinical Frailty Scale assays the baseline state, it is not widely validated in younger people or those with stable single-system disabilities, and it requires clinical judgement. The Clinical Frailty Scale is now commonly used as a triage tool to make important clinical decisions such as allocating scarce health care resources for COVID-19 management; therefore, it is important that the scale is used appropriately.

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“…42 Rapid assessment methods for evaluating function are available and may be well suited to this purpose. 43 , 44 …”

Section: Health Measures Used In Vaccine Trialsmentioning

confidence: 99%

Considering Frailty in SARS-CoV-2 Vaccine Development: How Geriatricians Can Assist

Andrew¹,

Schmader²,

Rockwood³

et al. 2021

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The COVID-19 pandemic has disproportionately impacted frail older adults, especially residents of long-term care (LTC) facilities. This has appropriately led to prioritization of frail older adults and LTC residents, and those who care for them, in the vaccination effort against COVID-19. Older adults have distinct immunological, clinical, and practical complexity, which can be understood through a lens of frailty. Even so, frailty has not been considered in studies of COVID-19 vaccines to date, leading to concerns that the vaccines have not been optimally tailored for and evaluated in this population even as vaccination programs are being implemented. This is an example of how vaccines are often not tested in Phase 1/2/3 clinical trials in the people most in need of protection. We argue that geriatricians, as frailty specialists, have much to contribute to the development, testing and implementation of COVID-19 vaccines in older adults. We discuss roles for geriatricians in ten stages of the vaccine development process, covering vaccine design, trial design, trial recruitment, establishment and interpretation of illness definitions, safety monitoring, consideration of relevant health measures such as frailty and function, analysis methods to account for frailty and differential vulnerability, contributions in regulatory and advisory roles, post-marketing surveillance, and program implementation and public health messaging. In presenting key recommendations pertinent to each stage, we hope to contribute to a dialogue on how to push the field of vaccinology to embrace the complexity of frailty. Making vaccines that can benefit frail older adults will benefit everyone in the fight against COVID-19.

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The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty

Cited by 26 publications

References 18 publications

The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine

The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine

Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources

Considering Frailty in SARS-CoV-2 Vaccine Development: How Geriatricians Can Assist

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