Assessing the Whole Person: Examining how Psychosocial Factors are currently considered within Frailty Screening Tools

Abstract

Background: Many operationalisations of frailty exclude psychosocial factors, despite considerable research on the links between frailty and these factors. This study examined older adult/caregiver (OA) and healthcare provider (HCP) perspectives on frailty screening, identify domains, conceptual frameworks and psychometric testing for identified frailty screening tools. Methods: 14 OA and 15 HCP completed audio-recorded interviews, which were transcribed verbatim and analyzed using inductive analysis. A systematic search of the literature was conducted following PRISMA guidelines. MEDLINE, CINAHL, EMBASE, and PsycInfo were searched from inception to December 31, 2018. The biopsychosocial model of health provided a framework for the domain mapping activity, and COSMIN’s Risk of Bias checklist was used to report psychometric properties of the tools to better understand frailty screening tools. Results: The interviews yielded several themes with associated subthemes: definitions and conceptualizations of frailty, factors contributing to frailty, and frailty screening. Sixty-seven frailty screening tools were identified in 79 articles. Screening tools assessed biological factors (100%), psychological factors (73%), social factors (52%) and contextual factors (78%). The frailty syndrome was the prominent framework used in identified studies (n=27). Reliability and validity information was available for 31 studies. Conclusions: When frailty screening tools address psychosocial and biomedical factors, there may be opportunities to enhance the effectiveness of screening through more individualized and patient centered approaches, leading to improved health outcomes.