Early identification of frailty in older adults in primary care: a study protocol of a longitudinal cohort study

Population ageing increases frailty prevalence, a condition linked to higher disability risk. The Integrated Care for Older People (ICOPE) model promotes early frailty identification in primary care and integration of health, social, and community services. However, evidence of adaptations of ICOPE models in different contexts is scarce, as is knowledge of health literacy's (HL) role in frailty screening. This study protocol describes a project applying ICOPE indications to identify frail older individuals early, through a multiple-step process (first level screening and second level screening).

The study has a longitudinal cohort design, including the recruitment of all residents aged 75 years in a defined area in the city of Florence (Italy). During the first visit participants will complete a brief Frailty Questionnaire, perform the Chair Rise Test and answer one health literacy question (Single Item Screening - SILS). Those who will result positive for frailty, will attend a second visit with tests covering multiple frailty domains: nutritional, functional, cognitive, psychological status and level of autonomy and HL.

A statistically significant association is expected to be identified between positive first level screening and the domains assessed in the multidimensional assessment. Furthermore, low HL could be associated with an increased risk of frailty to evaluate the predictive validity of HL tools for early identification of at-risk individuals. The early identification of frailty, the analysis and the choice of performing the study in a primary care setting aim at defining targeted preventive interventions and strategies based on a multidisciplinary approach.