The need for frailty assessments and intervention as part of holistic occupational therapy practice

Abstract

Are occupational therapists competent to perform frailty assessments?  This opinion piece asserts the argument for including frailty assessments as a routine component for baseline assessments, particularly in older individuals, or those who may be considered to be frail.  Some regulatory bodies for occupational therapy, such as the Canadian Occupational Therapy Association have included frailty assessment and intervention as a core competency.  Frailty is multidimensional and the risk increases with age.  There are numerous risk factors that have been identified in the development of the frailty syndrome, including clinical, biological, lifestyle and sociodemographic factors.  This paper offers some suggestions for the assessment of frailty, including questionnaires and informal methods.  It is recommended that frailty education be included in the undergraduate curricula of occupational therapists in South Africa, and other undergraduate programmes in Africa.  An overview of the advantages and disadvantages of standardised and unstandardised assessment tools should also be included as part of the programme.  Frailty can be prevented with timely screening and interventions.  It is concluded that frailty assessments should form part of the baseline assessment package of all aging individuals, and especially those who may have one or more or the risk factors.

Implications for practice:

Frailty is a clinical syndrome - particularly in older adults - that is associated with adverse health outcomes.  It should be incorporated into occupational therapy practice as it impacts function directly.  The authors argue that:

• Frailty adversely impacts on the ability of individuals to care for themselves and perform their daily occupations
• Frailty measures should form part of a baseline assessment, especially in older adults
• Frailty assessments need to be conducted in those who display one of more of the risk factors, which includes immobility, incontinence, delirium and an individual who has had one or more falls
• Frailty can be prevented by timely screening and focussed interventions.