Identifying frailty in primary care: A systematic review.

AIM: Identification of frailty in the primary care setting could be improved with the availability of easily identifiable markers of frailty. The purpose of this article was to systematically review markers for frailty or risk tools that have been validated in the ambulatory care setting. METHODS: Medline, PubMed, CIHAHL and Embase databases were searched up to March 2016 for studies on frailty markers in community-dwelling individuals 65 years or older. Studies were included for review if they were carried out in primary care or outpatient settings, used a validated definition of frailty, compared two or more markers, and used randomized controlled trial, quasi-experimental or prospective cohort designs. RESULTS: Of the 3405 titles screened, 12 were retained for review. All of the studies were prospective cohort designs. Studies most frequently assessed biological markers, such as immune, inflammation, endocrine biomarkers and metabolic syndrome markers. Not one specific marker was repeatedly identified as a definitive marker for frailty. CONCLUSIONS: There is a lack of psychometrically sound and clinically useful frailty markers. There is a need for further research to identify highly sensitive, specific and accurate markers that are feasible to use in the context of busy primary care practice. Geriatr Gerontol Int 2017; 17: 1358-1377.

Patients living with disabilities: The need for high-quality primary care.

OBJECTIVE: To compare the potential risk factors for lower-quality primary care, the potential markers of unmet needs in primary care, and the willingness to participate in future research among primary care patients with versus without physical disabilities. DESIGN: A waiting room survey using a convenience sample. SETTING: A family health team (FHT) in Kitchener-Waterloo, Ont, with a designated Mobility Clinic. PARTICIPANTS: A total of 40 patients seen at the FHT Mobility Clinic and 80 patients from the general patient population of the same FHT. MAIN OUTCOME MEASURES: Socioeconomic status and social capital, number of self-reported emergency department visits and hospitalizations in the preceding year, and willingness of the patients in the 2 groups to participate in future research studies. RESULTS: Patients from the Mobility Clinic were more than twice as likely to be receiving benefits or social assistance (75.0% vs 32.1%, P < .001), were twice as likely to report an annual household income of less than $40000 (58.6% vs 29.2%, P = .006), and were more likely to report their health status to be fair or poor (42.5% vs 16.2%, P = .002). Half of Mobility Clinic patients had visited the emergency department at least once in the preceding year, compared with 29.7% in the general patient population (P = .027). When asked if they would be willing to provide their health card number in the future so that it could be linked to health care data for research, 82.5% of Mobility Clinic patients agreed versus 55.0% of those in the general patient population (P = .004). CONCLUSION: In this study, patients with disabilities were at a social disadvantage compared with their peers without disabilities and were more likely to use the emergency department, suggesting that they had unmet health needs. Future research should continue to explore this patient population and to investigate if an interprofessional primary health care team approach focused on patients with disabilities can help to increase quality of care.