National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia.
Torrens University Australia, Adelaide, Australia.
BMC Prim Care. 2022 Jun 27;23(1):160. doi: 10.1186/s12875-022-01778-9.
Frailty is a highly prevalent clinical syndrome increasing older people's vulnerability to risk of adverse outcomes. Better frailty identification through expanded screening implementation has been advocated within general practice settings, both internationally and within Australia. However, little is known about practitioner perceptions of the feasibility of specific instruments, and the underlying motivations behind those perceptions. Consequently, the purpose of this study was to explore the attitudes and perceptions of a convenience and volunteer sample of Australian general practitioners (GPs) and practice nurses (PNs) towards common frailty screening instruments.
The feasibility of several frailty screening instruments (PRISMA-7 [P7], Edmonton Frail Scale [EFS], FRAIL Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC] and Timed Up and Go [TUG]) to 43 Australian GPs and PNs was assessed. The study adopted a concurrent embedded mixed-methods design incorporating quantitative (ranking exercise) and qualitative (content analysis) data collection integrated during the analysis phase.
Practitioners assessed multi-dimensional instruments (EFS, GFI, KC) as having relatively higher clinical utility, better integration into existing assessment processes and stronger links to intervention over uni-dimensional (GST, TUG) and simple (FQ, P7) instruments.
While existing frailty screening instruments show promise as an initial step in supporting better care for older people, all the included instruments were associated with perceived advantages and disadvantages. Ultimately, clinicians will need to weigh several factors in their selection of the optimal screening instrument. Further translational research, with a focus on contextual fit, is needed to support clinical decision-making on the selection of instruments for frailty screening.
衰弱是一种普遍存在的临床综合征，会增加老年人发生不良后果的风险。在国际和澳大利亚国内，普遍提倡在全科医疗环境中通过扩大筛查实施来更好地识别衰弱。然而，人们对医生对具体工具的可行性的看法，以及这些看法背后的潜在动机知之甚少。因此，本研究旨在探讨澳大利亚全科医生（GP）和执业护士（PN）对常见衰弱筛查工具的态度和看法。
对 43 名澳大利亚 GP 和 PN 评估了几种衰弱筛查工具（PRISMA-7 [P7]、埃德蒙顿衰弱量表 [EFS]、衰弱问卷 [FQ]、步态速度测试 [GST]、格罗宁根衰弱指标 [GFI]、基洪检查表 [KC]和计时起立行走测试 [TUG]）的可行性。该研究采用了同时嵌入式混合方法设计，包括定量（排名练习）和定性（内容分析）数据收集，在分析阶段进行整合。
医生评估多维工具（EFS、GFI、KC）具有较高的临床效用，更好地融入现有的评估过程，并与干预措施的联系更强，而一维工具（GST、TUG）和简单工具（FQ、P7）则不然。
虽然现有的衰弱筛查工具作为支持更好地照顾老年人的初步步骤显示出了一定的前景，但所有纳入的工具都存在着优缺点。最终，临床医生需要在选择最佳筛查工具时权衡几个因素。需要进一步进行转化研究，重点关注情境适应性，以支持对选择衰弱筛查工具进行临床决策。
