Development of an instrument for the identification of frail older people as a target population for integrated care

• Published in: British journal of general practice 2013-03, Vol.63 (608), p.e225-e231
• Main Authors: van Kempen, Janneke A L, Schers, Henk J, Jacobs, Anne, Zuidema, Sytse U, Ruikes, Franca, Robben, Sarah H M, Melis, René J F, Olde Rikkert, Marcel G M
• Format: Article
• Language: English
• Subjects: Aged; Attitude of Health Personnel; Delivery of Health Care, Integrated; Feasibility Studies; Frail Elderly; Geriatric Assessment - methods; Health Services for the Aged; Health Services Needs and Demand; Humans; Netherlands; Patient Satisfaction; Pilot Projects; Surveys and Questionnaires
• ISSN: 0960-1643; 1478-5242
• DOI: 10.3399/bjgp13x664289

Primary care is increasingly interested in the identification of frailty, as it selects the target population for integrated care. However, instruments for the identification of frailty specifically validated for use in primary care are scarce. This study developed the Easycare Two-step Older persons Screening (Easycare-TOS), which provides a valid, efficient, and pragmatic screening procedure to identify frail older people. This paper aims to describe the development of the Easycare-TOS and the data from the pilot studies. Observational pilot study in seven academic GP practices in and around Nijmegen, The Netherlands. The Easycare-TOS was developed in a cyclic process with the input of stakeholders. In every cycle, the requirements were first defined, then translated into a prototype that was tested in a pilot study. The Easycare-TOS makes optimal use of prior knowledge of the GP, and the professionals' appraisal is decisive in the frailty decision, instead of a cut-off score. Further, it considers aspects of frailty, as well as aspects of the care context of the patient. The pilot data have shown that after step 1, two-thirds of the patients do not need further assessment, because they are judged as not frail, based on prior knowledge of the GP. The overall prevalence of frailty in this pilot study is 24%. Most professionals who participated in the pilot studies considered the time investment acceptable and the method to be of added value. The Easycare-TOS instrument meets the predefined efficiency, flexibility, and acceptability requirements for use as an identification instrument for frailty in primary care.