Indicators of frailty in the elderly at home and frailty measurement instruments

A comprehensive, multidisciplinary and international approach

On 31 January 2011, MADOPA held a second international seminar on the indicators of frailty in elderly people living at home and frailty measurement instruments.

This seminar had three main aims:

• To describe: compile a list of the different indicators of frailty, especially indicators of frailty in the home environment
• To understand: identify the theoretical models and reasons governing the construction of frailty measurement instruments
• To take action: select appropriate indicators and identify courses of action to prevent, detect and monitor frailty in the home environment

The first presentation by Hervé Michel, Director of MADoPA, reviewed the different ways of measuring frailty. There are two main opposing approaches: that of Linda Fried based on 5 physical indicators and that of Rockwood which incorporates up to 70 indicators covering signs, symptoms, illnesses and inabilities. There are many indicators therefore that can be used to characterise the process of frailty progression or reversal, including physical indicators such as grip strength, walking speed, physical inactivity, weight and diet.

The following presentations illustrated various approaches to measuring frailty in elderly people living at home that have been implemented in France and in Canada:

• At the Caisse Nationale d’Assurance Vieillesse, France’s National Pension Fund, Sylvie Renaut has drawn inspiration from the Strawbridge model and research by the Swiss SWILSOO team to integrate the cognitive factor into the measurement of frailty in the home environment.
• Professor Jean-Luc Novella from Reims Teaching Hospital, presented the frailty evaluation chart developed in the Champagne-Ardenne region of France, which is based on work by a Belgian team and the SEGA (Short Emergency Geriatric Assessment).
• On the basis of the Linda Fried model tested as part of the FRèLE survey, Professor François Béland from the University of Montréal showed that, subject to the survey’s final results, the areas within which elderly people move around is a predictor of frailty in elderly people living at home.
• To provide input for thought about measuring the social aspects of frailty, Pierre Castelein from the Haute Ecole Libre de Bruxelles presented the instruments used in the disability context to measure habits and quality of life.
• Lastly, a round table chaired by Doctor Philippe Dejardin (Les Arcades Prevention Centre) with Professor Bernard Cassou (AP-HP, the Paris Hospitals Authority), Doctor Monique Ferry (INSERM, French National Health and Medical Research Institute) and Doctor Pierre-Olivier Lang (Geneva Teaching Hospitals), reviewed the different indicators of frailty in the elderly and outlined ideas for action to be examined in greater depth at the next seminar scheduled for May 2011 in Paris.