Read Standard 1: Identification of frailty

Ageing and frailty standards
Healthcare Improvement Scotland

Standard statement

Organisations have systems in place to identify older people living with frailty at the earliest opportunity.

Rationale

Identifying frailty early enables timely interventions that can significantly improve a person’s quality of life. Early detection of frailty in the community or hospital setting should lead to preventative measures, such as promoting physical activity and good nutrition.27 This proactive approach can reduce the risk of falls, hospitalisations and other complications associated with frailty.28,29 Early identification facilitates personalised care planning and discussions about accessing social care support. Early identification also supports future care planning and care around death.6,29

Large-scale identification of frailty can be used to plan services at a strategic level. Tools such as the electronic Frailty Index (eFI) use routine health record data to calculate a score based on a predicted frailty level.30 Electronic population-based risk stratification can identify people who are likely to be living with frailty.31 It should be used alongside tools such as a clinical frailty scale to evaluate frailty on an individual basis.6 Identifying and confirming the level of frailty that someone is living with in any setting should support timely access to further assessment, investigations, treatment and coordinated care.27,32,33 Identification of frailty should be undertaken in line with Standard 10. 

Digital technology, including artificial intelligence, can help identify and manage frailty.34 As technology advances, organisations should ensure that it is used appropriately and ethically.35,36 This includes artificial intelligence, large-scale data modelling and digital information systems. 18, 37-39 Organisations should work in partnership to test and evaluate screening and identification tools appropriate to different care setting.

Organisations should identify care partners and unpaid carers who may be providing practical day to day support. This supports assessment of their own care needs and what might happen if they were unable to continue providing care.40,41

 

Criteria

1.1

Organisations use population-based risk stratification tools to:

  • identify the prevalence and characteristics of frailty in their population
  • inform strategic planning, including workforce planning
  • implement effective prevention and healthy active ageing policies
  • proactively offer early intervention and prevention activity to individuals.
1.2

Organisations proactively identify frailty in individual older people who they are aware have:

  • experienced a significant change in their health or care
  • moved between health and social care services.
1.3

Organisations identify frailty using an approach that is:

  • based on current evidence of risk factors for frailty
  • validated or recommended by professional organisations
  • relevant to the care setting.
1.4

Staff are trained and knowledgeable about the use of clinical frailty scores in all health and care settings.

1.5

Organisations have processes in place to proactively identify frailty in older people in the community who experience:

  • unintended weight loss
  • falls
  • changes in their cognition or memory
  • fatigue and muscle weakness
  • reduction in mobility or activities of daily living
  • bladder and bowel issues.
1.6

Hospitals screen for frailty as part of all assessment, attendance and admission processes.

1.7

Dementia is identified as early as possible and confirmed through:

  • brief cognitive tests, where indicated
  • neuroimaging, where indicated
  • collateral history (eg from unpaid carers or care partners)
  • clinical examination.
1.8

Unpaid carers and care partners of older people with frailty are identified as part of initial screening and assessments and offered support.

1.9

Information gained from frailty screening is recorded and shared securely with:

  • the person
  • appropriate staff and agencies across the health and social care system
  • unpaid carers or care partners as appropriate.

What does this standard mean for...

What does the standard mean for people?

  • Organisations will be able to identify and respond early to changes in your health.
  • You will be offered care and support that is right for you as early as possible.
  • The people who help you will be identified and supported as early as possible.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

  • have knowledge and skills to identify frailty using validated tools
  • proactively recognise and identify frailty in the people they care for
  • share relevant information about people living with frailty with other health and care professionals
  • identify unpaid carers and care partners and help them receive the support they need.

What does the standard mean for the organisation?

Organisations:

  • work collaboratively to test and improve screening tools specific to their population
  • provide staff with role-appropriate training in the identification of frailty
  • ensure screening for frailty is routinely undertaken amongst relevant population groups
  • ensure information about a potential diagnosis of frailty is shared appropriately to support multidisciplinary working.

Examples of what meeting this standard might look like

  • System-wide use of clinical risk stratification, frailty scores and electronic Frailty Index (eFI) in relevant settings.
  • National, regional and local improvement work on frailty screening tools and processes.
  • Use of frailty screening during unplanned admissions to hospital.
  • Data on frailty prevalence included in strategic commissioning plans.
  • Evidence of data on frailty improvement used to inform strategic decision making.
  • Participation in national forums for raising awareness of frailty.
  • Identification flowcharts and decision making tools based on screening outcomes.