Tavassoli N, Guyonnet S, Abellan Van Kan G, et al.
J Nutr Health Aging 2014;18:457-64
Publication date: May 1, 2014
The authors report on the first two years of operation of the Geriatric Frailty Clinic for Assessment of Frailty and Prevention of Disability (GFC), which was created in Toulouse, France, in 2011.
Individuals aged 65 years and older considered as frail by their physician (general practitioner, geriatrician or specialist) based on the Gérontopôle Frailty Screening Tool (GFST), an easy and quick screening tool, are invited to undergo a multidisciplinary evaluation at the GFC. A comprehensive assessment looking at cognition, physical function, nutritional status, mood, vision and hearing, continence, oral health, etc., is then performed to detect the potential causes for frailty and/or disability.
At the end of the evaluation, the team members propose to the patient (in agreement with the general practitioner) a personalized prevention plan (PPP) specifically tailored to his/her needs and resources. The GFC also provides the patient’s follow-up in close connection with family physicians.
During the first two year of operation of the GFC, 1,108 patients were recruited. Mean age was 83 years and the majority of patients (62%) were women. According to Fried’s criteria, 39% of patients were pre-frail and 54.5% were frail, indicating effective screening by treating physicians. Mean ADL (activities of daily living) score was 5.5. An objective state of protein-energy malnutrition was observed in 8% of patients, and 39.5% were at risk of malnutrition.
In almost two thirds of the patients, the GFC team found at least one medical condition which needed a new intervention, and for one third of the patients substantial therapeutic changes were recommended. A nutritional intervention was proposed for 62% of the patients, a physical activity intervention for 57% (624) and a social intervention for 26%.
The authors conclude that the development of such units specialized in evaluation, management and prevention of disability in frail older persons individuals may be an interesting option to support general practitioners, promote the quality of life of older people and increase life expectancy without disability.
As mentioned by Prof. John Morley in the accompanying editorial, this study demonstrates that general practitioners can screen for frailty and that, when frail persons are referred for a full geriatric assessment, a variety of treatable conditions are identified. Moreover, it the first study showing that aggressive management of frailty can potentially reduce progression to disability and other negative outcomes.