How does the EFS work?
The following provides a vision of how the Edmonton Frail Scale can be integrated into your care setting or research protocols.
Frailty is a general health state that matters to patients, their families, and their health care team. Frailty is very common in the last years of life, but often unrecognized. By measuring frailty, we:
Acknowledge when frailty is present. If so, ensure there is a care and support plan in place. Any individual who lives with frailty should ensure daily physical activity, adequate nutrition, and strong social networks.
Understand the severity. The severity of frailty helps anticipate future health trajectories and should factor into care decisions when they become acutely unwell, or consider undergoing high risk procedures or starting medications with known toxicities.
Discover particular aspects of frailty that need attention. While the EFS helps to identify frailty and estimate its severity, it also informs care by identifying the component issues.
The EFS can easily be used as part of a coordinated plan of care. Case finding should be conducted using a measure that is most appropriate to the care setting. In different settings, it may make sense to use a different measure such as the CFS, the EFI, the PRISMA-7, or gait speed for rapid case-finding. The EFS itself can be used for case-finding to avoid using multiple frailty measures. If frailty is suspected, the EFS will help to confirm it, assess the severity, and define the components.
In this way, the EFS can then further define the care plan. There are nine domains covered by the EFS, each of which might inform further activities, as suggested below:
Here are some practical suggestions on how each EFS item can begin to inform a care plan:
A) Cognition
If there are minor or major errors on the clock drawing test, consider the following:
Rule out delirium
Do further cognitive testing to diagnose other cognitive problems.
Involve other team members such as an occupational therapist
B) General Health Status
If there have been multiple hospitalizations, consider the following:
What is the integrated plan of care in the community?
Does the individual have the right supports to stay out of hospital?
If the individual describes their health as fair or poor, consider:
Having a conversation to understand the individual and families goals and values
Ensuring that personal care goals and preferences are documented and shared with the right individuals
Reviewing current care and supports to ensure it is what the person wants.
Revisiting the care and support plan regularly
C) Functional Independence
If the individual requires help for two or more instrumental activities of daily living, consider:
Further testing of more basic activities of daily living
An assessment by occupational therapy or physiotherapy to better define their needs
A review of formal and informal supports to address unmet needs
D) Social Support
If the person states that they do not have someone who they can count on to meet their needs, consider:
Meeting with the person, family or friends to better understand and strategize
Exploring more formal care arrangements
Involving appropriate voluntary and spiritual care options
Consultation with a social worker or transition coordinator
Ensure that elder neglect or abuse has been ruled out.
E) Medication Use
If the individual uses five or more prescription medications, or if there is an apparent problem with medication adherence, consider:
A structured review of each medication, looking for evidence of a prescribing cascade
A deprescribing process using validated criteria or online decision aids
Use of compliance aids such as a blister-pack, a dossette, or a reminder strategy
Referral to a pharmacist
F) Nutrition
If there is evidence of unintended weight loss, consider the following:
Assess nutrition risk (example: Canadian Nutrition Screening Tool)
Refer to a dietician
Provide assistance for intake of food and fluids
Provide nutritional supplementation
Refer to a speech language pathologist to assess aspiration risk
Refer to a dentist and/or denturist to assess oral health
Arrange for structured meals (protected time, socialization)
G) Mood
If the individual “often feels sad or depressed”, consider:
Screening for depression (example: Geriatric Depression Scale)
Exploring non-pharmacologic strategies (socialization, recreational therapy)
Consulting a psychiatrist
H) Continence
Rule out acute causes such as infections, medications
Check post-void residual to rule out retention
Scheduled toileting
Recommend continence products
Referral to a continence clinic
I) Functional Performance
If the Timed Up and Go is >10 seconds (and especially if >20sec), consider the following:
Conduct a fall risk assessment
Check orthostatic blood pressures
Assess home safety and address home hazards
Minimize physical restraint use
Address footware and assess for walking aids
Consult Occupational Therapy and/or Physiotherapy
Employ fall alert and other communication devices for immobile individual.
