Frailty, intervention and clinical uncertainty - improving communication and shared decision making

Background. Frailty results from loss of physiologic reserve. Affected individuals are at greater risk of adverse health outcomes in both surgical and non surgical settings. Furthermore, potential to benefit from intervention likely diminishes with increasing frailty, though threshhold of “effectiveness” will be intervention specific. Despite the need to individualise decisions in context of clinical uncertainty, no method of quantifying frailty, particularly in the peri-operative period, has yet been incorporated into routine clinical practice. To improve communication and insight for decision making we developed a novel assessment tool (ARIA – Assessment of Robustness in Ageing), a graphically displayed distillation of the Comprehensive Geriatric Assessment, designed to be readily administered.

Objectives. To determine usability and effectiveness in portraying clinical impression of frailty, and whether this may improve insight for shared decision making.

Methods. Sixty assessments undertaken in potentially frail, community dwelling older people.

Results. Mean age 84.4y, 66.6% female. Median time for assessment was 30 minutes. 85% of participants agreed or strongly agreed that the assessment was a good representation of their level of health and that undertaking this was a good use of time. 74% agreed or strongly agreed that the assessment helped clarify what might lie ahead in terms of future health and decisions that may need to be made. For assessors, 88% of assessments were seen as a good use of time and provided a good or very good representation of the individual's frailty. Results in 75% of assessments were found to be easy to discuss with participants.

Conclusion. ARIA is readily administered. Participants and clinicians identify strongly with this portrayal which appears to promote insight and may facilitate shared decision making.

Timothy J Frendin FRACP Physician

Blaithin P Page FRCS Surgeon

Benjamin Duffus MHSc Quality Improvement Advisor