FRAILTOOLS represents a recently awarded European Union-funded project that can be summarised as a comprehensive validation of tools to screen and diagnose frailty in different clinical and social settings with the objective to provide assessment instruments for integrated care in older adults. The project leader is Professor Leocadio Rodriguez of Madrid, Spain and other partners involved are:
|Applicant No*||Applicant organisation Name||Country|
|1 (Coordinator)||Fundación para la Investigación Biomédica del Hospital Universitario de Getafe (FIBHUG)||Spain|
|2||Servicio Madrileño de Salud (SERMAS)||Spain|
|3||Diabetes Frail Ltd||United Kingdom|
|4||Centre Hospitalier Universitaire de Toulouse (CHUT)||France|
|5||Università Cattolica del Sacro Cuore (UCSC)||Italia|
|6||Jagiellonian University Medical College (JUMC)||Poland|
Frailty is an established and credible concept which provides the basis of many of the studies that Diabetes Frail and its associated partners in the consortium are involved with. Frailty provides the framework for the relationships between ageing, disease, vulnerability, disability, and dependency and allows a more insightful management approach of older people at risk of disability.
We should remember that frailty has the highest predictive power for disability in older people and is able to predict other undesired outcomes (death, hospitalization, falls, institutionalisation) in these same populations in a more accurate way than chronic disease. These characteristics, combined with its high prevalence in older people and its potential reversibility, make frailty the perfect target to overcome the challenge of disability in older adults.
Key aims in this project can be summarised as:
(A) The project will overcome the traditional disease-centered approach and place the focus on one of the main health-related problems in older people (disability) and its main risk factor, frailty;
(B) FRAILTOOLS will try to refine the epidemiological-based concept of frailty to make it useful in clinical settings, validating tools to detect frailty in settings where patients are at the highest risk to develop disability (screening and diagnosis), and to assess the evolution of frailty (prognostic biomarkers), thus bridging the gap between epidemiology and clinical practice and making the concept useful for preventing disability in daily practice
(C) The project will consist of a systematic approach to the use of various frailty assessment instruments with the aim of characterizing their role as screening or diagnostic tools in each clinical or social care setting in subjects with a wide variety of medical co-morbidities including diabetes mellitus. We will be examining the sensitivity, specificity and predictive values of each instrument but also their feasibility of use. This approach will allow us to provide validated tools and algorithms for each setting and along the settings, making a substantial contribution to the continued, coordinated and integrated care needed by these older adults
Complementing existing research
We expect the findings of FRAILTOOLS to complement the results of various other frailty-linked EU projects coordinated by members of the consortium of researchers.
These ongoing complementary studies are:
- a) providing more complex kit-tools to assess the risk of frailty and prognostic factors involved in its evolution to robustness or disability in populations with the help of –omics and other lab variables (Project Frailomic, funded by the FP-7 programme, led by Prof. L Rodriguez-Mañas);
- b) assessing the feasibility of the classical instruments to assess frailty in clinical settings different from the traditional units led by geriatricians but where many older patients attend (Project FRAIL CLINIC, funded by DG-SANCO, led by Prof. L Rodriguez-Mañas);
- c) assessing the efficacy of multimodal management embracing exercise, new clinical targets and an education program in the prevention of the evolution of frail to disability in older adults at high risk secondary to a disease (Project MID-FRAIL, funded by the FP-7, led by Prof. L Rodriguez-Mañas and Prof AJ Sinclair); and
- d) providing an operative definition of frailty with the aim of building a framework useful to the regulatory and advisory bodies in charge of the authorization of new drugs and pharmacovigilance, and evaluate the effectiveness of an intervention in older people characterized as frail using this definition (Project SPRINTT, funded by the IMI, led by Prof. Roberto Bernabei)
Summary of Key Recommendations
- Rockwood 35 items would be the more useful scale to predict adverse events in Geriatric Ward, however its feasibility is low.
- In Nursing Home, the tool with better capacity to predict adverse events with an also very good feasibility would be FTS 5.
- Frailty phenotype would be the best scale to be used in Primary Care (good predictive performance and good feasibility).
- Gerontopole Frailty Screening Tool would be the best tool to be implemented in Geriatric Outpatient.