Health services, and particularly GPs, face a major challenge in how best to provide high quality and appropriate care to growing numbers of frail older adults, and also how to reduce the risk of further frailty. Health services tend to be “reactive” and to adapt care only after a patient is already frail, which can lead to an unnecessary increase in ill-health and emergency hospitalizations. Knowledge about a patient’s level and history of frailty could instead help services be pro-active in identifying patients where preventative actions would be most beneficial and in selecting individually tailored interventions that can have maximum benefit.
Recently, a “frailty index” was developed that can be quickly computed using a patient’s electronic health record. We will use this measure in conjunction with the CPRD to gain a better understanding of the extent and nature of frailty in the UK, including degrees of frailty and how these vary by age, sex, socio-economic group, medical conditions and region; how frailty progresses in individuals over time; whether there are distinct sub-types of frailty, such as physical and mental; and relationships between frailty and health outcomes including hospitalisation and death.
Advances in healthcare have increased lifespans for millions of people, but an important consequence is that increasing numbers of people are living with long-term conditions and progressive frailty. Health services tend to take a “reactive” approach which can lead to unnecessary increased disease burden and emergency hospitalizations. This has led to calls for a more pro-active approach. A general frailty indicator that can stratify patients by their overall risk of adverse health outcomes could help GPs in identifying cases where preventative actions would be most beneficial and where targeted interventions, such as supported self-management, assessment and goal-setting, or forms of homecare, can have maximum benefit.
The electronic Frailty Index (eFI) is a tool recently developed by the NIHR York and Humberside CLAHRC for constructing a measure of patient frailty from the primary care health record. We will implement this measure in the CPRD, to characterise the epidemiology of patient frailty, including incidence and prevalence and how these vary by age, sex, area deprivation, medical conditions and region; how frailty progresses in individuals over time; whether there are distinct sub-domains of frailty, such as physical and cognitive; relationships between frailty, receipt of drug treatments, and health outcomes including hospitalisation and death.
Evangelos Kontopantelis - Chief Investigator - University of Manchester
David Reeves - Corresponding Applicant - University of Manchester
Andrew Clegg - Collaborator - University of Leeds
Darren Ashcroft - Collaborator - University of Manchester
Harm Van Marwijk - Collaborator - Brighton and Sussex Medical School
HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation