Updated risk score better for identifying frailty, research shows

An updated version of a widely used frailty risk score will help GPs more accurately identify patients at risk, researchers have concluded.

The electronic frailty index version 2 (eFI2) is better able to predict risk of needing home care, hospital admission for fall or fracture, care home admission or death than the first version, a study has found.

Researchers have tweaked the tool to adjust the weighting to some of the variables, including 36 health conditions and number of prescriptions a patient has, which are used to predict frailty in the model.

It was then tested retrospectively in two large cohorts of patients – one in Bradford and one in Wales that together included 750,000 patients.

The results, reported in Age and Ageing, showed ‘robust prediction’ that was more accurate than the previous version.

Use of the updated index – which is already embedded into EMIS (now Optum) and accessible by 60% of GPs – could support the development of early interventions and better care pathways for older people with frailty, the team said.

It could include putting in place holistic assessment and treatment plans, falls prevention, targeted medicines reviews, and resistance exercise training, they continued.

Older people living with frailty account for around £6 billion of annual NHS spending. It is hoped the National Institute for Health Research funded update will maximise independence, prevent falls and reduce costs to the health service.

The first version of the eFI was developed at the University of Leeds and introduced in 2016.

Evaluation showed after just one year of use by NHS England, more than 25,000 people with frailty were referred to a falls service, with an estimated prevention of around 2,300 future falls.

It has also been estimated that in 2018 alone, these interventions saved the NHS nearly £7 million, the researchers said.

Study lead Professor Andrew Clegg, head of ageing and stroke research at the University of Leeds School of Medicine, and honorary consultant geriatrician at Bradford Royal Infirmary, said: ‘The eFI2 is a significant improvement on the original eFI and will be extremely valuable for helping GPs identify older people living with frailty so that they can be provided with personalised treatments to prevent costly loss of independence and falls in older age.

‘We are delighted that the eFI2 has already been made available to 60% of GPs and is an exemplar of the planned NHS “analogue to digital” shift.’

Co-author Professor Kate Walters, professor of primary care and epidemiology at University College London and a GP said: ‘The eFI2 has great potential as a simple tool to support GPs in identifying people living with frailty who may benefit from further support to help them stay independent.’