The Feasibility of Deriving the Electronic Frailty Index from Australian General Practice Records

Ebony T Lewis; Margaret Williamson; Lou P Lewis; Danielle Ní Chróinín; Elsa Dent; Maree Ticehurst; Ruth Peters; Rona Macniven; Magnolia Cardona

doi:10.2147/CIA.S384691

The Feasibility of Deriving the Electronic Frailty Index from Australian General Practice Records

Clin Interv Aging. 2022 Nov 3:17:1589-1598. doi: 10.2147/CIA.S384691. eCollection 2022.

Authors

Ebony T Lewis^{1

2

3}, Margaret Williamson^{1

4}, Lou P Lewis⁵, Danielle Ní Chróinín^{6

7}, Elsa Dent⁸, Maree Ticehurst^{5

9}, Ruth Peters^{2

3}, Rona Macniven¹, Magnolia Cardona^{10

11}

Affiliations

¹ School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia.
² School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia.
³ Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia.
⁴ Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia.
⁵ Matraville Medical Centre, Sydney, NSW, Australia.
⁶ Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia.
⁷ South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁸ Torrens University Australia, Adelaide, SA, Australia.
⁹ Royal Prince Alfred Hospital, Sydney, NSW, Australia.
¹⁰ Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
¹¹ Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia.

Abstract

Purpose: Frailty is a prevalent condition in older adults. Identification of frailty using an electronic Frailty Index (eFI) has been successfully implemented across general practices in the United Kingdom. However, in Australia, the eFI remains understudied. Therefore, we aimed to (i) examine the feasibility of deriving an eFI from Australian general practice records and (ii) describe the prevalence of frailty as measured by the eFI and the prevalence with socioeconomic status and geographic remoteness.

Participants and methods: This retrospective analysis included patients (≥70 years) attending any one of >700 general practices utilizing the Australian MedicineInsight data platform, 2017-2018. A 36-item eFI was derived using standard methodology, with frailty classified as mild (scores 0.13-0.24); moderate (0.25-0.36) or severe (≥0.37). Socioeconomic status (Socio-Economic Indexes for Areas (SEIFA) index)) and geographic remoteness (Australian Statistical Geography Standard (ASGC) remoteness areas) were also examined.

Results: In total, 79,251 patients (56% female) were included, mean age 80.0 years (SD 6.5); 37.4% (95% CI 37.0-37.7) were mildly frail, 16.7% (95% CI 16.4-16.9) moderately frail, 4.8% (95% CI 4.7-5.0) severely frail. Median eFI score was 0.14 (IQR 0.08 to 0.22); maximum eFI score was 0.69. Across all age groups, moderate and severe frailty was significantly more prevalent in females (P < 0.001). Frailty severity increased with increasing age (P < 0.001) and was strongly associated with socioeconomic disadvantage (P < 0.001) but not with geographic remoteness.

Conclusion: Frailty was identifiable from routinely collected general practice data. Frailty was more prevalent in socioeconomically disadvantaged groups, women and older patients and existed in all levels of remoteness. Routine implementation of an eFI could inform interventions to prevent or reduce frailty in all older adults, regardless of location.

Keywords: aged; electronic health records; family practice; frailty; geriatric assessment; primary health care.

MeSH terms

Aged
Aged, 80 and over
Australia / epidemiology
Electronic Health Records
Electronics
Feasibility Studies
Female
Frail Elderly
Frailty* / diagnosis
Frailty* / epidemiology
General Practice*
Geriatric Assessment / methods
Humans
Male
Retrospective Studies

Grants and funding

This study was funded by a grant from the School of Population Health at the University of New South Wales. The funder had no role in the study design, conduct, reporting or decision to publish.