The Prevalence of Frailty in Older Adults Referred to Primary Care Physiotherapy and the Influence of Frailty Screening on the Clinical Practice of Physiotherapists : A Mixed Methods Study

Introduction

Globally, the proportion of the population of older adults (aged 65 and older) is growing rapidly. Frailty is a state of increased vulnerability to poor resolution of homeostasis following a stress and is the most problematic expression of population ageing. Physiotherapy is a heavily utilised social and community care service by older adults in the Republic of Ireland. An increasing number of older adults, with the potential presence of frailty, are likely to present to Primary Care physiotherapy services.

Aims and Objectives

The primary aim was to estimate the prevalence of frailty in older adults referred to Primary Care Physiotherapy, using the Edmonton Frail Scale. A secondary aim was to explore the acceptability of the Edmonton Frail Scale to physiotherapists and the influence of frailty screening on clinical practice of physiotherapists working with older adults in Primary Care.

Methods

A mixed methods study was undertaken. The prevalence of frailty among older adults referred to Primary Care physiotherapy was identified through an observational cross-sectional study. A sample of convenience of older adults referred to the Primary Care domiciliary physiotherapy service in North Dublin, Community Healthcare Organisation Dublin North City and County, were screened for frailty by physiotherapists, using the Edmonton Frail Scale. A qualitative study, using focus group interviews, explored the perspectives of a purposeful sample of physiotherapists on the influence of frailty screening on clinical practice.

Results

A total of 100 older adults were screened for frailty using the EFS, mean age 80.3 (±7.4) years 64% (n=64) female. The prevalence of frailty of the sample of older adults was 43% (n=43). The prevalence of pre-frailty and non-frailty was 26% (n=26) and 31% (n=31), respectively. No association was found between frailty and age, gender or living arrangement (OR 0.81,

0.44, 0.93, respectively) (p>0.05). The focus group interviews of Primary Care physiotherapists (n=8) found that the Edmonton Frail Scale is acceptable to the practice of physiotherapists in Primary Care. However, the need for an integrated multidisciplinary approach and pathway of care, was highlighted as integral to the success of frailty screening and management. The implementation of the Edmonton Frail Scale as an objective measure of frailty, influenced physiotherapists’ clinical practice through an enhanced holistic approach to older adults, increased awareness on cognitive frailty and improving communication with the multidisciplinary team and the family of older adults.

Conclusion

The results of this study suggest that the prevalence of frailty is higher in community-dwelling older adults referred to Primary Care physiotherapy, than the general community-dwelling older adult population. Physiotherapists working in a Primary Care setting are well placed to screen for frailty and pre-frailty as part of a Multidisciplinary Team, to identify older adults at risk of adverse health outcomes due to frailty.

Implication of Findings

The high prevalence of frailty and pre-frailty found in this study cohort highlights the importance of frailty screening by physiotherapists in the Primary Care setting. The implementation of the Edmonton Frail Scale into routine physiotherapy practice has the potential to improve the holistic management of community-dwelling older adults, through early identification of biopsychosocial risk factors associated with frailty. The results of this study indicate the need for further research into multidisciplinary approaches to frailty screening and the effectiveness of pathways of care for the management of frailty in the Primary Care setting.