Perhaps one of life’s most bewildering experiences is watching your loved one – who has overcome the many challenges of a long life – become frail and vulnerable with age.
Unfortunately, many older adults actually become even frailer in direct response to their challenges with navigating the health care system.
A new medical tool has the potential to alter this harsh landscape, however. It’s catching geriatricians’ attention, and it’s important for caregivers as well. The Electronic Frailty Index (eFI) is a software application designed to comprehensively assess an older person’s level of frailty. This tool can be embedded into the electronic health record, making this vital measurement easily accessible to geriatricians and other medical providers who care for older adults.
As a caregiver, it’s important to understand how this tool can benefit your loved one so you can advocate on their behalf at their next geriatrician appointment.
What is frailty and why is it important?
Frailty is a measure of an older adult’s vulnerability to poor medical outcomes. The common belief (even among medical professionals) is that frailty correlates with age, but this is not necessarily the case; age alone does not determine whether an older adult has the functional or physiological reserve needed to bounce back from surgery, infection, trauma or other crisis.
Understanding one’s level of frailty is crucial in medical decision-making. In some cases, additional services or a specialized medical regimen will mean the difference between survival or death after a crisis.
Until now, the only quick and easily accessible test for frailty was the “eyeball test,” where the physician quickly reads an older adult’s medical record and assesses their current state to determine their level of frailty. However, this rudimentary process is subjective and unreliable in most cases.
For example, in one eFI study, nearly half (40%) of older patients were reclassified after the scientists compared the objective eFI data to the subjective “eyeball test” evaluations.
How the eFI helps geriatricians assess frailty to improve health care outcomes
The eFI scans and mobilizes pre-existing electronic medical record data to create a holistic, accurate picture of the true state of the patient’s health.
Instead of relying solely on diagnosis codes, the eFI incorporates additional data points such as blood tests, vital signs, and physical and cognitive function measures, among other values. This ensures the measure of frailty is not simply a reiteration of the collection of current diagnosis codes but a precise holistic reflection of the true frailty status of the older adult.
Nicholas Pajewski, biostatistician and co-creator of the eFI, explained:
“It [the eFI] is a view towards the whole person versus subdividing people into their diagnoses, which is how medicine typically works. You go to a cardiologist for your heart problem, you go to an endocrinologist to manage your diabetes, etc. The geriatricians and primary care physicians are often much more focused on the integrative whole. I think the frailty index fits in that space.”
In addition to assessing frailty, the eFI also predicts health care use and outcomes, including factors such as emergency department visits, hospitalizations and falls. Research found that numbers of injurious falls and hospitalizations correlate with levels of frailty; frail older adults have on average eight more incidences of hospitalizations and six times as many falls as those who are not frail.
“We also found that the frail are more likely to die—a higher frailty index suggests higher mortality”, said Kate Callahan, MD, MS, associate professor of gerontology and geriatric medicine, and co-creator of the eFI.
Older adults, as well as their geriatricians and caretakers, eagerly await the projected advancements to the tool.
“There’s a vast opportunity,” Pajewski said. “The utility of the eFI is that it creates a tool that can be deployed across a health system, and that it would allow the language of frailty to be prevalent across all of those operations.”
Be sure to ask about the eFI at your loved one’s next medical appointment so that you can advocate even more for their health and well-being. The eFI promises much-needed coordination and refinement of care for older adults—and not a moment too soon. Ultimately, it will allow frail older adults to live longer, safer, healthier, and more fulfilling lives.