Frailty Spotlight: Canadian Frailty Network

For this week’s newsletter, our team sat down with two titans in frailty research, Dr. John Muscedere and Dr. Perry Kim of Canadian Frailty Network. John has served as the Scientific Director of Canadian Frailty Network since 2013 and Perry currently serves as Canadian Frailty Network’s Assistant Scientific Director.Canadian Frailty NetworkPatient Pattern
We really appreciate both of you for making time for our conversation this morning. Jumping right in, can you provide our readers with a little background information on the Canadian Frailty Network?

John Muscedere, MD, FRCPC
Sure. Canadian Frailty Network came together to address vulnerability in late life. It originally started in the acute care setting but over the years it evolved to encompass all settings of care and now we’re across the country. We’ve catalyzed research in most of the provinces across the country and the territories. We have 47 member institutions, we’ve funded over 400 research scientists and our mailing list is over 4,000 people at the latest count. We’ve had a big impact and what we want to do is improve care for people living with frailty through its identification and, more importantly, targeting detailed care plans for the determinants of frailty and how to best mitigate risk and improve care going forward.

Patient Pattern
Thank you Dr. Muscedere. From your perspective, why is it so important to identify frailty in aging adults?

John
It’s important for a couple of reasons. One is that frailty is not readily apparent and you can’t deal with things that you do not measure. In very advanced stages of frailty, it may become readily apparent but in the early stages it may not. Also, if you have a measurement of frailty, you can put in place practices that you can then identify whether it’s progressing, whether it’s being mitigated, or regressing because frailty is really a dynamic state, it is not a fixed state. The other thing is that frailty is not inevitable as we age. So actually keeping track of people who may be developing frailty, or in the early stages, may allow you to do things that will actually stop it from progressing. We think that it’s incredibly important to measure such that you can target the appropriate care plan for the severity of frailty that’s identified.

Patient Pattern
That’s a great answer. We could not have said it better. Our next question relates to the programs and offerings of the Canadian Frailty Network. Can you share some of the offerings available to interested parties?

Perry Kim, PhD
Our offerings are actually quite unique and diverse. We fund a lot of different initiatives– we’ve launched the request for proposals, research grants, as well as knowledge translation initiatives over the last number of years. All of these are focusing on frailty, of course. We also have highly qualified personnel or training programs for not only undergraduates and graduate students but also another program for interdisciplinary fellowships, as we call them, for PhDs, postdocs, and early-career investigators. We train the next generation of frailty care providers if you will. That’s something that we do quite a bit of that also involves mentoring. It’s not just funding these individuals but it’s that we also have online programs where we match these individuals with mentorship in terms of frailty so they can get a unique perspective on, again, all the things that John has mentioned. In terms of why it’s important, a lot of these undergraduate and graduate students are working in the area of older adults, but not necessarily frailty. With this mentoring partnership, they’re able to learn much more than they ever would have through a normal PhD program in terms of the actual discipline that they’re in. We’re really proud of that.

We’d like to also talk about one of the things that we’re doing now, something that’s sort of ambitious and unique, which is what we call the Kingston Development Center. It’s all about taking our AVOID Frailty public health campaign initiative and actually trying to implement it in the real-world situation where we’re going to see if these things benefit older adults in terms of preventing frailty or reversing the early stages of frailty. John, of course, could elaborate more on that but that’s some of the things that we’re working on. So far, we’ve been very successful because, not to toot our own horn, but I think we’ve played a pretty key role in getting frailty out there in terms of researchers knowing what frailty is, and publicizing the fact that Canadian researchers were very early in terms of frailty research and identifying frailty as an important component in care practices.

Patient Pattern
Thank you for that and I can attest that our team at Patient Pattern has referenced research coming out of CFN many times over the years. Are there any particular success stories or highlights from any of the programs that you’d like to share? How do you measure that success?

Perry
As I mentioned earlier, in our training program, the HQP program as we call it, there have been a number of success stories in terms of how we’ve been able to fund early-career investigators and students. We’ve seen their progression over the years from being a student, to actually holding a faculty position, to now being a part of CFN in terms of working on some of our committees, and then also doing research. We have a number of examples of how we’ve changed the trajectory of a person’s career. We’ve been able to do that because we’ve been in existence for a number of years now and have been able to follow some of these individuals. Qualitatively, that’s been a really good success story for us. Our success stories in terms of some of the research projects that we were able to catalyze measure success or impact in various ways. One is to look at how we impact the researchers’ career trajectory as well as how we’ve affected their ability to get additional follow-on funding. We’ve been able to sort of map how our initial funding through our RFPs or research grants have translated to additional larger funding from organizations in Canada and elsewhere, and that’s allowed that initial pilot project to actually flourish, scale, and spread.

A perfect example would be something called Nav-CARE (nav-care.ca), where it’s all about reducing social isolation and helping individuals, especially those older individuals in rural communities, navigate the healthcare system. It was a program that we funded very early on, a number of years back, and they then received external funding from provincial and federal sources. Over a six or seven-year span, they were able to scale it within their province of Alberta and British Columbia, and then actually spread that across Canada with partners in different provinces. Those are some of the examples that come to mind. We also have other examples in terms of the acute-care setting, where we have funded multiple rounds for a particular project which is focused on malnutrition in the acute-care hospital, how to identify malnutrition early on as an individual enters the hospital, and how that information in terms of frailty can actually inform care in terms of nutritional guidance. That’s one of our bigger success stories because we funded multiple rounds of research that allowed the study to go from a pilot all the way to really showing sustainability through a larger knowledge translation study.

Patient Pattern
It’s great to be able to see the impact you’ve been able to make on these individuals’ lives, careers, and to be able to follow that trajectory over time. Our next question is actually the reverse of the previous question: have there been any notable obstacles or impediments that have stood in between Canadian Frailty Network and your mission?

John
I don’t think that people argue that frailty exists but the biggest argument, or the biggest obstacle, from a frailty point of view, is that there are so many frailty instruments out there. People argue, ‘well there are so many instruments, we still need to do further research on how to best identify it,’ and I think this heel needs to come down and use a smaller number of instruments to identify frailty and then act upon them.

It’s not the use of them sequentially over time and we’ve been increasingly advocating for, that we have an initiative where we’re trying to develop common data elements in core outcome measures, at least in frailty studies so that everybody does a frailty study somewhat the same. This allows you to actually compare one study to another. I think we’ve moved a huge way forward since when we first came on the scene, which was in 2012, but we still have a long ways to go towards that goal. The other big obstacle has been the denialistic approach that frailty is that you identify it and say “so what? it’s going to progress” and “so what, we can’t do anything about it,” which is completely, completely wrong. The flip side of that is also true, that frailty is not an inevitable stage of aging. It can be delayed. It’s not inevitable and there are people that survive well as they age without ever developing frailty. We need to go forward in that regard, so it’s more attitudinal in the inertia of the healthcare system and the social care system which have been probably the biggest obstacles for us.

Patient Pattern
It seems that you’ve been able to make quite a bit of progress on that front, which is great for the industry. Our next question for both of you is: If readers of this article are interested in learning more about frailty, where would you suggest they find more information about frailty and, specifically, your research?

Perry
I think the easiest way would be to go to our website, cfn-nce.ca. There you’ll find all sorts of information on frailty, the prevalency in Canada, and why it’s so important as we’ve discussed today. It also includes all of our research projects and knowledge translation projects as well. Interested parties can get a full indication of who does work in the area and that’s also important. Of course, they can also follow us on Facebook, Twitter, and LinkedIn as well. If they’d like they could also, of course, subscribe to the CFN mailing list to receive our newsletters as well. I think that’s a great place to begin the journey of learning about frailty.

John
I will also add that we do have webinars fairly frequently on various topics pertaining to frailty also accessible to our mailing list and website visitors. Those resources are open to anybody, wherever they live in the world.

Patient Pattern
Thank you, gentlemen, this has been a very informative look into the Canadian Frailty Network, all of the great work you are doing, and the wonderful research you are funding in Canada as well as internationally. Our very last question: is there anything else you’d like to share with our readers?

John
I’m trying to publicize the whole concept of frailty as much as possible. I think it’s become increasingly important and especially in the next few years. COVID really has highlighted that populations aren’t aging well, the vulnerability of populations and that we actually don’t know how vulnerable they are. Hopefully, this whole crisis, once it’s over, will spur a rethinking of our approach to aging, especially people who aren’t aging well, and takes into account and addresses their vulnerabilities much better.

Perry
I’ll just finish off, sort of related to our AVOID Frailty public health initiative, with the whole idea that frailty is sort of this collection of things that cause individuals to have a decrease in their activities of daily living and their function and so forth. One of the things that we’re trying to really push for is the idea that the community resources, beyond just healthcare, can play an integral role in the care of older adults. One of the things that we found very interesting over the last year and a half or so in the process of developing AVOID Frailty and initiating a collaboration with the Canadian Foundation for Health Innovation is the notion that people know what’s in their community in terms of the community resources. It’s clear that there isn’t a very good way of determining what’s around your area and within your community and so companies like yours and the companies that help map the resources within the community will be really beneficial in terms of caring for older adults and, as John said, especially in the times of COVID.

Patient Pattern
It’s certainly an uneasy time. With that said, we can’t thank both of you enough for spending the time with us today and sharing more about the Canadian Frailty Network with our readers.

John
Thanks for inviting us.

For more information about the Canadian Frailty Network:

Visit the CFN website at cfn-nce.ca

Join the CFN mailing list by clicking here.

Follow CFN on social media: Facebook, Twitter, LinkedIn.

View AVOID Frailty brochures by clicking here.

AVOID Frailty-Take Control! - Canadian Frailty Network