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      Geriatric Services Hub — A Collaborative Frailty Management Model between The Hospital and Community Providers

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          Abstract

          Background

          Frailty is an important geriatric syndrome especially with ageing populations. Frailty can be managed or even reversed with community-based interventions delivered by a multi-disciplinary team. Innovation is required to find community frailty models that can deliver cost-effective and feasible care to each local context.

          Objectives

          We share pilot data from our Geriatric Service Hub (GSH) which is a novel frailty care model in Singapore that identifies and manages frailty in the community, supported by a hospital-based multi-disciplinary team.

          Methods

          We describe in detail our GSH model and its implementation. We performed a retrospective data analysis on patient characteristics, uptake, prevalence of frailty and sarcopenia and referral rates for multi-component interventions.

          Results

          A total of 152 persons attended between January 2020 to May 2021. Majority (59.9%) were female and mean age was 81.0 ± 7.1 years old. One-fifth (21.1%) of persons live alone. Mean Charlson Comorbidity Index was 5.2 ± 1.8. Based on the clinical frailty risk scale (CFS), 31.6% were vulnerable, 51.3% were mildly frail and 12.5% were moderately frail. Based on SARC-F screening, 45.3% were identified to be sarcopenic whilst 56.9% had a high concern about falling using the Falls-Efficacy Scale-International. BMD scans were done for 41.4% of participants, of which 58.7% were started on osteoporosis treatment. In terms of referrals to allied health professionals, 87.5% were referred for physiotherapy, 71.1% for occupational therapy and 50.7% to dieticians.

          Conclusion

          The GSH programme demonstrates a new local model of partnering with community service providers to bring comprehensive population level frailty screening and interventions to pre-frail and frail older adults. Our study found high rates of frailty, sarcopenia and fear of falling in community-dwelling older adults who were not presently known to geriatric care services.

          Electronic Supplementary Material

          Supplementary material is available in the online version of this article at 10.14283/jfa.2023.23.

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          Most cited references23

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          Frailty in elderly people

          Andrew B. Clegg, John Young, Steve Iliffe … (2013)
          Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.
          Article 0 comments Cited 1903 times – based on 0 reviews     Review now
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            A global clinical measure of fitness and frailty in elderly people.

            Kenneth Rockwood, Xiaowei Song, Chris MacKnight … (2005)
            There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.
            Article 0 comments Cited 1759 times – based on 0 reviews     Review now
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              Frailty consensus: a call to action.

              John E. Morley, Bruno Vellas, G van Kan … (2013)
              Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
              Article 0 comments Cited 751 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Li Feng Tan: tanlifeng@gmail.com , li_feng_tan@nuhs.edu.sg
                Journal
                Journal ID (nlm-ta): J Frailty Aging
                Journal ID (iso-abbrev): J Frailty Aging
                Title: The Journal of Frailty & Aging
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 2260-1341
                ISSN (Electronic): 2273-4309
                Publication date (Electronic): 11 April 2023
                Pages: 1-6
                Affiliations
                GRID grid.466910.c, ISNI 0000 0004 0451 6215, Alexandra Health Pte Ltd: National Healthcare Group, ; Singapore, Singapore
                Article
                Publisher ID: 23
                DOI: 10.14283/jfa.2023.23
                PMC ID: 10111077
                SO-VID: 3c326b74-7bf5-43ed-8bd5-958706ad2c4d
                Copyright © © Serdi 2023
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 18 November 2022
                Date accepted : 5 March 2023
                Categories
                Subject: Original Research

                Keywords: frailty,comprehensive geriatric assessment,community care,multi-disciplinary team care
                Data availability:
                Keywords: frailty, comprehensive geriatric assessment, community care, multi-disciplinary team care

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