The Edmonton frail scale: a feasibility study on assessing frailty among older adults with multimorbidity in Norwegian primary health care.

Abstract

The growing prevalence of multimorbidity and frailty, driven by an ageing population and changing health trends, is placing significant pressure on healthcare systems. Frailty assessments provide valuable insights into patient vulnerability, allowing for early interventions to prevent functional decline and reduce hospitalisations. Despite their importance, standardised frailty assessment instruments are not widely used in primary care. This study investigated the feasibility of using one such instrument, the multidimensional Edmonton Frail Scale (EFS), in Norwegian primary healthcare. This feasibility study involved 14 healthcare professionals (10 physiotherapists and four nurses) from primary healthcare in three Norwegian municipalities. Participants were trained to use the EFS to assess and generate frailty scores. Four focus group interviews explored these professionals' experiences of using the EFS with home-dwelling older adults with multimorbidity. The EFS scores were analysed with descriptive statistics, and the interview data underwent reflexive thematic analysis. Through interview analysis, we identified three main themes: (i) enabling collaborative planning, (ii) facilitating comprehensive assessments, and (iii) integrating and understanding EFS competently. The assessment of frailty using the EFS among home-dwelling older adults with multimorbidity (n = 86) revealed scores ranging from 2 to 14, with 2% of these adults categorised as fit, 18% as pre-frail and 80% as frail. Most participants failed the clock test, and many had been hospitalised in the past year. Despite these challenges, 83% reported very good or fair self-perceived health, though the EFS scores indicated significant dependency in daily activities. Polypharmacy was common, with three-quarters of patients taking five or more medications. Additionally, recent weight loss, mobility issues and sadness or depression were frequently reported. The EFS supported collaborative care planning by identifying frailty domains, facilitating tailored interventions to address challenges such as polypharmacy, mobility issues, emotional well-being, and dependency in daily activities. The themes of collaborative care, comprehensive assessments, and competent integration highlight the EFS's potential as a multidimensional instrument for routine use in primary care. With proper healthcare professional training, the EFS can promote person-centred care, improve overall care quality and support the early detection and prevention of complications, addressing the complex needs of older adults with multimorbidity.