Ethical and Legal Implications of Frailty Screening

Feminist approach to geriatric care: comprehensive geriatric assessment, diversity and intersectionality

Despite being a collection of holistic assessment tools, the comprehensive geriatric assessment primarily focuses on the social category of age during the assessment and disregards for example gender. This article critically reviews the standardized testing process of the comprehensive geriatric assessment in regard to diversity-sensitivity. I show that the focus on age as social category during the assessment process might potentially hinder positive outcomes for people with diverse backgrounds of older patients in relation to other social categories, such as race, gender or socio-economic background and their influence on the health of the patient as well as the assessment and its outcomes. I suggest that the feminist perspective of intersectionality with its multicategorical approach can enhance the diversity-sensitivity of the comprehensive geriatric assessment, and thus improve the treatment of older patients and their quality of life. By suggesting an intersectional-based approach, this article contributes to debates about justice and diversity in medical philosophy and advocates for the normative value of diversity in geriatric medicine.

Identification of Frailty in Primary Care: Feasibility and Acceptability of Recommended Case Finding Tools Within a Primary Care Integrated Seniors' Program

Background: Case finding for frailty is recommended as part of routine clinical practice. We aimed to test feasibility and acceptability of three recommended case finding tools in primary care as part of an integrated seniors’ program. Method: Program of Research to Integrate Services for the Maintenance of Autonomy-7 (PRISMA-7), 4-m walk test, and electronic frailty index (eFI) were used as frailty case finding tools for a target population of community-dwelling seniors ≥65 years of age enrolled in a seniors’ program within an academic primary care clinic in Alberta, Canada. Feasibility was measured by percent completion rate and requirements for training/equipment/space/time, and acceptability by health care providers was measured using focus groups. Results: Eighty-five patients underwent case finding and 16 health care providers participated in the focus groups. Completion rate for PRISMA-7, 4-m walk test, and eFI was 97.6%, 93%, and 100%, respectively. No special training or equipment was required for PRISMA-7; brief training, equipment, and space were required for 4-m walk test. Both tools took less than 5 min to complete. Despite eFI requiring 10 to 20 min/patient chart, providers found it less intrusive. Conclusion: Despite feasibility of the tests, acceptance was higher for tools with minimal clinic interruption, low requirements for resources, and those with added benefit.