Judah Goldstein

Paramedic

Canada

Doctorate Title: The assessment of frailty in community-dwelling older adults: a feasibility and validation study.

Doctorate Description: The assessment of frailty is challenging in the presence of diverging views on its clinical measurement. Frailty is a state of vulnerability, multidimensional, and dynamic. Frail older adults have a diminished physiological reserve and ability to respond to stress (environmental or pathophysiological) making them susceptible to adverse health outcomes. Even so, there is the potential for frailty prevention, treatment and improvement in health status. A valid and feasible measure of frailty is necessary for advancing knowledge. The frailty index (FI) incorporates many of the agreed upon properties of frailty (e.g., multifactorial, diminished reserves, can be graded). Its main detractor in the clinical setting is the need for at least 30-40 items. Many frailty assessment tools aim to reduce the instrument to a few criteria, and this can be problematic for accurately grading fitness/ frailty. The objective of this thesis was to evaluate frailty assessment in the emergency medical services (EMS) setting. A series of studies were conducted in order to 1) evaluate how frailty is currently assessed by EMS, 2) to describe EMS use by older adults and, 3) to evaluate the feasibility and validity of a FI based upon the view of a carer. In the first study, it was determined that no frailty measures are currently being used by EMS, however, risk-screening tools were evident and these may identify frail older adults. The second study confirmed that older adults were high users of EMS in a Canadian provincial EMS system. In the final study, a survey completed by care partners and based upon comprehensive geriatric assessment [Care Partner – Comprehensive Geriatric Assessment (CP-CGA)] was developed and subsequently assessed as a means to construct a FI. The CP-CGA was deemed feasible in the EMS and geriatric outpatient setting. The FI based upon the CP-CGA demonstrated properties similar to other FIs and was predictive of adverse outcomes. Older adults are frequent users of EMS so it is imperative that EMS providers have the knowledge and tools to care for this demographic appropriately. The CP-CGA may be a useful assessment tool and method for identifying and managing frailty in older EMS patients.