Pilot study protocol : Developing a frailty index

A review of the literature reveals numerous international studies which have investigated frailty, and its determinants. The majority of the studies available have been conducted in North America, Mexico, and Canada. Studies within the European Union have been sporadic and limited. These studies all focused on profoundly frail and old participants; failing to address the issue of understanding the full spectrum of frailty. These countries differ to Wales with regards to financial, health and social determinants including alcoholism, drug abuse and obesity levels. Less developed countries suffer childhood diseases such as diphtheria and polio, which are still prevalent causing disability. Prevalence data specific to Wales with regard to the age and determinants of frailty are not available. Reference [1] produced a screening tool to determine a person's frailty status. Typical categories are non frail = 0 deficit, pre-frail = 1-2, deficits and frail = 3-5 deficits [1]. The Fried screening tool is widely used to identify physical manifestations of frailty to predict disability and death. However, the screening tool developed by Fried [1] does not include psychological or cognitive components [2]. More recent research into the concept of frailty have recommended inclusion of cognitive impairment to improve the predictive validity of the Fried [1] screening tool for adverse health outcomes [3]. Therefore, consensus on a universal definition and measure remains elusive. Subsequently recommendations highlighting the need for a frailty index to enable identification of those who are frail have been put forward: to promote health, well-being and subsequent healthy ageing. This pilot study will assess process and procedure prior to the full study of which it is anticipated will identify which determinants predict frailty, and the domains of frailty (physical, psychological, social and cognitive) within a sample of people over the age of 18 years in order to develop a frailty index. Aim: To pilot test the methods, methodologies and procedures to gather the information needed to develop an operational frailty index in Wales prior to applications for ethical approval for the full study. Objectives: • To enable the researcher to assess the strengths and weaknesses of the recruitment and data collection process. • To assess the average time taken for the data gathering process. • To inform the development of questions for the in-depth interview from the individual case notes. • To identify the optimal operation of the recording equipment and the length of the interview process. The study design: • Explanatory mixed methods design (quantitative and qualitative). Methods: Phase 1- Case control method which involves documentary analysis of a sample of 30 case notes representative of frail people (case), age and gender matched with 30 non-frail people (control) (total combined no = 60): to gather information which may indicate predisposing factors of frailty including health and social data. Phase 2 - 1 in-depth semi structured Interpretive Hermeneutic Phenomenological interview (IHP) with a frail participant. Anticipated outcomes: The feasibility conducting a study through mixed methods case note search (case control) and in-depth interview. Identification of participants, consent procedures and process. A greater understanding of the methods, methodologies and procedures to develop an operational frailty index.