The Prevalence of Frailty in Older Adults Referred to Primary Care Physiotherapy and the Influence of Frailty Screening on the Clinical Practice of Physiotherapists : A Mixed Methods Study
Notice bibliographique
Résumé
IntroductionGlobally, the proportion of the population of older adults (aged 65 and older) is growing rapidly. Frailty is a state of increased vulnerability to poor resolution of homeostasis following a stress and is the most problematic expression of population ageing. Physiotherapy is a heavily utilised social and community care service by older adults in the Republic of Ireland. An increasing number of older adults, with the potential presence of frailty, are likely to present to Primary Care physiotherapy services. Aims and ObjectivesThe primary aim was to estimate the prevalence of frailty in older adults referred to Primary Care Physiotherapy, using the Edmonton Frail Scale. A secondary aim was to explore the acceptability of the Edmonton Frail Scale to physiotherapists and the influence of frailty screening on clinical practice of physiotherapists working with older adults in Primary Care. MethodsA mixed methods study was undertaken. The prevalence of frailty among older adults referred to Primary Care physiotherapy was identified through an observational cross-sectional study. A sample of convenience of older adults referred to the Primary Care domiciliary physiotherapy service in North Dublin, Community Healthcare Organisation Dublin North City and County, were screened for frailty by physiotherapists, using the Edmonton Frail Scale. A qualitative study, using focus group interviews, explored the perspectives of a purposeful sample of physiotherapists on the influence of frailty screening on clinical practice. ResultsA total of 100 older adults were screened for frailty using the EFS, mean age 80.3 (±7.4) years 64% (n=64) female. The prevalence of frailty of the sample of older adults was 43% (n=43). The prevalence of pre-frailty and non-frailty was 26% (n=26) and 31% (n=31), respectively. No association was found between frailty and age, gender or living arrangement (OR 0.81,0.44, 0.93, respectively) (p>0.05). The focus group interviews of Primary Care physiotherapists (n=8) found that the Edmonton Frail Scale is acceptable to the practice of physiotherapists in Primary Care. However, the need for an integrated multidisciplinary approach and pathway of care, was highlighted as integral to the success of frailty screening and management. The implementation of the Edmonton Frail Scale as an objective measure of frailty, influenced physiotherapists’ clinical practice through an enhanced holistic approach to older adults, increased awareness on cognitive frailty and improving communication with the multidisciplinary team and the family of older adults. ConclusionThe results of this study suggest that the prevalence of frailty is higher in community-dwelling older adults referred to Primary Care physiotherapy, than the general community-dwelling older adult population. Physiotherapists working in a Primary Care setting are well placed to screen for frailty and pre-frailty as part of a Multidisciplinary Team, to identify older adults at risk of adverse health outcomes due to frailty. Implication of FindingsThe high prevalence of frailty and pre-frailty found in this study cohort highlights the importance of frailty screening by physiotherapists in the Primary Care setting. The implementation of the Edmonton Frail Scale into routine physiotherapy practice has the potential to improve the holistic management of community-dwelling older adults, through early identification of biopsychosocial risk factors associated with frailty. The results of this study indicate the need for further research into multidisciplinary approaches to frailty screening and the effectiveness of pathways of care for the management of frailty in the Primary Care setting.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».