People of any age may be frail. All it takes is for them to have a significant traumatic event or acquire several chronic illnesses – either scenario impacting them cognitively and/or functionally. And then they are frail, much less fit, and vulnerable to adverse outcomes and other declines. In that respect, the person who is frail has started on a trajectory of requiring clinically complex care and under PDPM will have several clinical characteristics that will increase their Case Mix Index and subsequent payments.
Frailty thus becomes a good indicator of future care needs and outcomes we all want to prevent or manage. Understanding and measuring frailty then becomes an important step in identifying risk, predicting outcomes, planning proactive approaches to care, and preparing for the likelihood that adverse events will occur in spite of your excellent care.
Measuring frailty is an opportunity to predict the risks of:
- Hospital readmission
- Length of stay
- Adverse health outcomes and functional changes
- Clinical outcomes: wounds, falls, delirium, mortality
Knowing the degree of risk has practical implications:
- Reduce inappropriate medications
- Avoid non-beneficial care
- Enhance quality in late life
- Inform Patient-Centered Care
- Mitigate Litigation
- Increase “Value”
If professionals understand the risks associated with frailty and if families are prepared for the possibility of decline the patient can receive care tailored to their current level of medical risk and can be afforded an opportunity to align their health care priorities and expectations with an objective and validated metric. If our frailty level is similar to the amount of fuel left in our gas tank then we all would want to know how far we can travel for our next trip. I might choose a shorter trip (less aggressive care) and stay closer to home (avoid hospitalization).