Abstract
• Frailty is an important consideration in the health and wellbeing of older adults, particularly as it is associated with a risk of falls, and mental health difficulties such as depression.
• After Option appraisal of various frailty assessment tools we chose Edmonton frail scale which consists of 9 domains ( Ref: ROLFSON DB, ET AL, VALIDITY AND RELIABILITY OF THE EDMONTON FRAIL SCALE, AGE AND AGEING 2006; 35 (5): 526–529 DOI: 10.1093/AGEING/AFL041).
Abstract
• This was a feasibility study exploring the use of the Edmonton frail scale (EFS) among patients with highly complex mental health needs within a Psychiatric Inpatient Setting with a view to develop a service integration process leading to further research.
• Completion rate of the assessment was 55% as the domains requiring patient participation for cognitive and physical performance assessment were difficult to complete for this cohort of patients.
• It is feasible to use EFS in this setting but older adults with psychiatric disorders may benefit from having an adapted assessment of the cognitive and functional domains to promote complete administration of EFS Results
• 118 assessments were administered to 45 patients, over a 12-month period (months 1, 6 and 12).
• There was a 55% assessment completion rate.
• This was largely attributed to the challenges of administering two components of the EFS; the cognitive domain (Clock Drawing test) whose completion rate was 32%, and the Functional Performance Domain (Timed Get Up and Go Test).
• It was quite difficult for patients with highly complex mental health needs to understand and comply with the assessment instructions in the above domains
. • Average age was 73.5 years and 29 out of 45 patients were found to have moderate or severe frailty.
• 24 out of 29 patients with moderate or severe frailty had documentation of DNACPR discussions in their clinical records.
• Falls incidences did not change significantly during the year of implementation.
Conclusions
• It is feasible to use EFS in an inpatient psychiatric facility, particularly one where the patients have highly complex mental health needs.
• The findings also indicate that this population has a high prevalence of moderate to severe frailty.
• The continued use of the EFS as a holistic assessment tool would enable the MDT to focus on the areas/domains in which a patient is identified to be deteriorating.
• To improve the tool’s completion rate alternative assessments for cognition and functional ability (Clock drawing test and timed get up and go test) need to be explored.
Acknowledgements This project could not have been done without engagement of staff and patients, and support of Dr Muthusamy Natarajan, CD of Neuropsychiatry division and Agnieszka