Is primary health care capable of addressing frailty?

Abstract

An 86-year-old lady presents to her primary care physician for a regular follow-up. She visits her physicians every three months for follow-up of her hypertension and high cholesterol. She mentions that she feels too tired lately. After a quick review, the practitioner reassures her, explaining that the symptoms are part of usual aging and sends her back home. Two days later, the lady falls at home and suffers a hip fracture. On reviewing her chart by the geriatric liaison team in the hospital, in Tripoli, Lebanon it becomes clear that the patient never received a comprehensive geriatric assessment and has the criteria of a frailty syndrome. It is clear that her primary care physician was not sensitive or well equipped to deal with this geriatric syndrome. One of the century’s major achievements is the continued increase in life expectancy. However, the additional years of life do not always correspond to years of healthy life, which may result in an increase in frailty [1]. Early detection of the condition is critical for assisting older adults in regaining function and avoiding the negative consequences associated with frailty [2]. Despite the critical nature of diagnosing frailty, there is no conclusive evidence or consensus regarding whether routine screening should be implemented in primary care. A variety of screening and assessment instruments have been developed from a biopsychosocial perspective, with frailty defined as a dynamic state caused by deficiencies in any of the physical, psychological, or social domains that contribute to health [3]. Frailty should be identified and addressed through the use of a comprehensive and integrated approach to care. To accomplish this goal, primary health care (PHC) must serve as the fulcrum around which care is delivered, not just to the old and frail, but to all individuals, by emphasizing a life-course and patient-centered approach centered on integrated, community-based care [4]. Personnel in primary health should be trained to address frailty not just clinically, but also in a societal context. Additionally, health professionals should contribute to community-based frailty education and training, promoting community-based interventions that assist older adults and their caregivers in preventing and managing frailty. Frailty is becoming more prevalent. Around 10% of people over the age of 65 and 25–50% of those over the age of 85 are frail. There is an immediate need to develop a primary care assessment instrument that is considered the gold standard for assessment. Frailty phenotype [5], Short Physical Performance Battery (SPPB) [4] and Edmonton frail scale are some suggestions [4]. There is a need to develop educational strategies to educate health care professionals at all levels about frailty prevention and management. There are few publications that discuss the evidence for and viability of educational/training programs for frailty prevention and/ or management [6]. To address the growing epidemic of frailty, health care planners (worldwide) are refocusing their health care workforce capacities. Thus, increasing awareness, knowledge, and skills among a diverse group of professionals involved in the social and medical care of older adults is critical for developing an efficient and effective integrated frailty prevention approach (FPA) [3]. Physicians, nurses, and other medical personnel should be trained in recognizing preand frailty symptoms and implementing evidence-based interventions for prevention and management [7]. Only a few studies have been conducted to determine the efficacy of education and training programs for health care professionals addressing older adults’ functional abilities in a variety of care settings * A. Abyad [email protected] http://www.meama.com http://www.menaaa.org http://www.mejfm.com http://www.me-jaa.com