Frailty assessment for older adults at points of care: Validating the electronic comprehensive geriatric assessment / frailty index (eFI-CGA)

Frailty is characterized by loss of biological reserves across multiple organ systems resulting in an increased risk of death and other adverse outcomes. Mounting evidence suggests frailty may be modifiable and can be prevented and sometimes even reversed. Frailty guidelines recommend the early identification of frailty in "at risk" seniors to address modifiable variables. The Comprehensive Geriatric Assessment (CGA) is a well-established clinical tool used to determine older adults' medical, psychological, and functional capabilities. It provides key baseline data for identifying degrees of risk and establishing individual care plans. A deficit accumulation based frailty index can be calculated using CGA items (FI-CGA). Key to care planning, the FI-CGA precisely measures the level of frailty. Performing a CGA and calculating an FI-CGA typically requires extra work for front-line clinicians. Electronic healthcare tools offer a more time efficient, cost-effective alternative. In partnership with the world's experts in frailty, our team conducted a pilot study to develop an electronic CGA in the Electronic Medical Records system and to automate the simultaneous calculation of an eFI-CGA in primary care and family medicine. The EMR allows widespread use across the healthcare system, making an eCGA and eFI-CGA an example of how to provide efficient care for older adults. This project aims to establish the reliability and validity of the eFI-CGA for widespread use in the management of older adults (e.g. identifying at-risk individuals and monitoring frailty changes in relation to short-, medium-, and long-term outcomes). Determining the eFI-CGA to be a reliable and valid measurement of frailty may help healthcare providers make more meaningful and comprehensive healthcare decisions; improve patients' clinical outcomes and self-management competence; reducing costly hospital admissions and prolonged stays by providing a better chance to address frailty at an early stage.