Use of Screening Tools for Frailty and Sarcopenia amongst Older Persons in Medical Outpatient Clinics to Facilitate Care Integration

Abstract

Objectives: The importance of screening for frailty and sarcopenia has grown. They have both been shown to be associated with disability, mortality and poor healthcare outcomes. With increasing subspecialisation in tertiary healthcare institutions, at risk older adults often receive fragmented care from organ-specific subspecialists. Several tools to do so exist and this study aimed to examine if the SARC-F and Edmonton frail screening tools are useful in clinical practice to identify at risk patients for intervention. Methods: This is a cross-sectional study of patients attending medical specialist outpatient clinics at the National University Hospital, Singapore from May 2015 to August 2016. Frailty and sarcopenia were identified using the Edmonton Frail Scale and SARC-F questionnaires respectively. Other clinically relevant data including basic demographics, presence of caregiver, number of follow-ups, medications and hospital readmissions in the past 1 year, Charlson's comorbidity index and their Modified Barthel's Index were collected. Results: A total of 115 patients 65years old and above were screened. The mean age of all patients was 76.6±6.5 years. 52.2% were female and 75.7% (n=87) were of Chinese ethnicity. 50% (n=57) of patients were independent and did not require a caregiver. Of the sample,44% (n=51) of patients were sarcopenic while 27% (n=31) were classified as frail. 23% (n=27) were both frail and sarcopenic. Women were more likely to be frail (67.7% vs 32.3%, p=0.042) and sarcopenic (58.3% vs 29.0%, p=0.001). Sarcopenic patients had a higher Charlson Comorbidities Index (5.0 vs 6.6, p=0.001) and lower modified Barthel's Index (33 vs 78, p=0.001). Being sarcopenic was associated with a higher likelihood of having a caregiver (p=0.001) with an increasing dependence on children and domestic helpers. They had an average of 3.0 medical specialty follow ups compared to 2.3 follow ups for non-sarcopenic patients (p=0.004). Sarcopenia was significantly associated with polypharmacy (74.5% vs 42.1%, p=0.001), more than 2 hospital readmissions within a year (23.5% vs 9.4%, p=0.043), a higher number of falls (1.20 vs 0.17, p<0.001) and falls with significant consequences (0.14 vs. 0.02, p<0.001). Frail patients similarly had a higher Charlson Comorbidities Index (6.7 vs 5.3, p=0.013) and lower Modified Barthel's Index (78 vs 97, p<0.001). They had 2.9 vs 2.1 specialty follow ups (p = 0.032). Frailty is associated with polypharmacy (87.1% vs. 45.2%, p<0.001), more than 2 hospital readmissions yearly (66.7% vs 33.3%, p<0.001), a higher number of falls (1.39 vs 0.35, p=0.001) and falls with significant consequences (0.16 vs 0.04, p=0.019). Conclusions: The prevalence of frailty and sarcopenia among elderly patients is high. Both syndromes are predictors of recurrent hospital admissions, polypharmacy, multiple medical clinic appointments, higher rate of falls and falls with serious consequences. Using simple screening tools to identify such at risk elderly to facilitate streamlining of care and care integration is likely to be beneficial and cost effective in the long run.