Frailty in Primary Care

This chapter considers the pragmatic integration of frailty in primary care. While some patients present to primary care practitioners with relatively well-defined problems that can be managed by a single intervention and/or organ-specific specialist referral, others present with nonacute, poorly defined problems that are complex and rooted in multiple factors. The latter are often in need of a comprehensive geriatric assessment (CGA). CGA can have important positive impacts on the health of older people, but it is labor-intensive and costly. Therefore, patients at higher risk of adverse outcomes should have higher priority to publicly funded CGA services. Frailty is an age-independent marker of risk that fits the biopsychosocial model of primary care, and its use (as opposed to age alone) may promote equity of access to CGA services. A number of frailty assessment tools have been recommended for use in primary care. Some randomized controlled trials have shown that frailty screening in primary care, with subsequent CGA and intervention, can prevent adverse outcomes. However, this result has not been obtained with every screening tool, and comparative trials are ongoing. Meanwhile, primary care commissioners in the UK are establishing new frailty care pathways and developing frailty registers in primary care.