Feasibility of a telephone-based frailty and functional assessment during COVID-19 pandemic

ABSTRACT

Background: Frailty and functional status assessment is seldom done due to time constraints and increased reliance on telehealth during COVID-19 pandemic. With the goal of increasing its clinical use, this quality improvement project aimed to determine feasibility of telephone-based frailty and functional status measurement. Methods: In 9/2020-1/2021, we identified 85 patients with serious illness in an academic geriatrics clinic. A geriatric fellow assessed functional status and conducted the Mini Nutritional Assessment, telephone-MoCA and Geriatric Depression Scale by telephone. A deficit-accumulation frailty index (FI) was calculated using an electronic medical record (EMR)-based calculator (robust <0.15, pre-frail 0.15-0.24, mildly frail 0.25-0.34, moderately frail 0.35-0.44, and severely frail ≥0.45) and a standardized documentation was generated for providers. Primary outcome was feasibility defined as the proportion of assessments completed. Secondary outcomes included administration time and providers' perception of the assessment. Results: Seventy-one (83.5%) patients were successfully assessed. There were 7 (9.9%) robust, 17 (23.9%) pre-frail, 22 (40.0%) mildly frail, 12 (16.9%) moderately frail, and 13 (18.3%) severely frail patients. Assessments of functional and nutritional domains were completed by all patients. Cognitive and mood domains were obtained from 37 patients (52.1%). Top 3 patient-level barriers to cognitive and mood assessments included advanced dementia (n=10), perception that the assessment was lengthy (n=9), and hearing impairment (n=4). Average administration time was 28 minutes (SD 7) for the complete assessment and 18 minutes (SD 8) when cognition and mood were not assessed. All five providers found the information from the assessment easy to understand, useful in understanding patient's current health status and prognosis, and useful in making clinical decisions. Conclusion: Telephone-based frailty and functional status assessment is feasible in older adults with serious illness during COVID-19 pandemic. Use of templates and an FI calculator in EMR can improve its usability. Future research should investigate more feasible cognitive and mood assessment and the impact of the assessment on health outcomes, costs and resource utilization.