Frailty evidence-practice gaps in acute care hospitals

Area of Science:

• Geriatric Medicine
• Hospital Administration
• Evidence-Based Practice

Background:

• Frailty is prevalent in hospitalized older individuals.
• Clinical practice guidelines for frailty management exist but show limited adoption in hospitals.
• A significant evidence-practice gap in frailty care within hospital settings is suspected.

Purpose of the Study:

• To identify and quantify the evidence-practice gap between frailty guidelines and current clinical practice in two hospitals.
• To assess the feasibility of using an audit tool for evaluating frailty management adherence.

Main Methods:

• A cross-sectional audit of 70 medical records of frail older patients admitted to two hospitals was performed.
• An audit tool based on the Asia Pacific Clinical Practice Guidelines for frailty management was utilized.
• Descriptive statistics were used for data analysis, and inter-rater reliability of the audit tool was assessed.

Main Results:

• Frailty assessment occurred in only 17% of cases in the acute setting.
• Guideline-recommended interventions, such as progressive resistance strength training (23%) and nutritional supplementation (26%), were infrequently provided.
• Medication reviews by pharmacy were high (84% admission, 93% discharge), and Vitamin D was prescribed to 57% of patients.

Conclusions:

• An audit tool proved feasible for assessing evidence-practice gaps in hospital frailty care.
• Understanding contextual barriers is crucial for developing effective implementation strategies.
• Dedicated staffing, education, training, and regular audits are recommended to improve guideline adherence for frailty management.