Facilitator’s Guide
Understanding Frailty: Screening, Diagnosis and Management
Authors
Lubna A. Nasr, MD
Department of Public Health, University of Miami Miller School of Medicine
Bruce W. Carter Miami VAMC, Miami, FL, USA
Raquel Aparicio-Ugarriza, PhD
ImFINE Research Group. Faculty of Physical Activity and Sport Science-INEF
Universidad Politécnica de Madrid, Madrid, Spain
Douglas Salguero, MD
Mount Sinai Medical Center, Miami, FL, USA.
Michael J. Mintzer, MD, AGSF
Director and Associate Director for Education & Evaluation
Miami Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA
Acknowledgements
The authors would like to thank:
Rose van Zuilen, PhD, and Corinne B. Ferrari for their help in reviewing the modules and including this frailty training as a component of the MS4 geriatrics clerkship
Overview
Frailty is a term widely used in clinical medicine but often ill-defined. The primary purpose of these modules is to teach learners the definition, screening modalities and diagnostic methods for frailty. In addition, the secondary purpose to is display healthcare issues of older adults commonly associated with frailty. These include comorbid conditions, social disruptions, end-of-life care, etc.
This training is composed of eight PowerPoint narrated and animated presentations. PowerPoint was chosen because of its ubiquitous availability to virtually all learners. The introduction presents the basics of frailty definition, screening and diagnosis. The subsequent seven case-based modules ask students to apply their knowledge. We recommend that learners complete a minimum of four modules starting with the introduction and ending with Case 7; learners are free to choose two modules from cases 1 through 6 and are welcome to complete all these optional cases. Finally, case 7 is the most complicated and longest module; if a learner uses the fully narrated and animated features, it will run approximately 25-minutes. To meet individual needs, learners have the option to disable audio (narration and dialog) on some or all of the screens. (These PowerPoint-based modules do not provide the option of varying the speed of audio tracks as in some programs). Most students can complete the minimum of 4 modules in 60-75 minutes; all the modules can be completed in 2-2.5 hours. The list of module titles is included in Learning Objectives below.
All cases use a standardized template. Navigation instructions are included in the Introduction; all cases follow the same instructions. Learners must start with the Introduction followed by cases in numerical sequence; cases become more complex with progression. In evaluating this curriculum, we used: Introduction, followed by Case 1, Case 5 and Case 7. Students can return to the Introduction module at anytime to review terms and definitions.
Materials and Supplies
Access to a computer with Microsoft PowerPoint or other compatible software is required. Headphones or earbuds may be needed if learning is occurring in a congregate environment or because of learner preference. This training requires no other special instructions, materials or supplies. The PowerPoint presentations can be easily uploaded to the school’s learning management system for assignment to learners.
Learning Objectives
Learning objectives are included in each case. These objectives also act as a “preview” for the content within the animated and interactive modules. The introduction has no learning objectives because it is a “definition of terms” module for frailty, sarcopenia, and frailty screening, diagnosis and management. These topics are specifically addressed within the learning objectives of the cases. There are 12 unique learning objectives. Some of the learning objectives appear in more than one case. This is intentional. It allows learners to apply their learning to a new clinical circumstance or a new domain of care. The learning objectives follow the statement, “After viewing this module, learners will be able to describe:” and are listed here by case:
Case 1: Mild Frailty
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Frailty can be diagnosed using accepted criteria and available tools
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Frailty can be managed with literature-based interventions that include exercise, nutritional support and optimized treatment of comorbid conditions
Case 2: Moderate Frailty and Falling
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Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
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Frailty is often associated with a reduction in socialization that is often remediable with optimized care across all domains as well as care coordination
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As is often the case in caring for patients with complex disease, it takes a team
Case 3: Frailty and Cognitive Symptoms
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Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
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Frailty is often associated with cognitive deterioration that is often remediable with optimized care across all domains
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As is often the case in caring for patients with complex disease, it takes a team
Case 4: Severe Frailty, Dependency and Palliative Care
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Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
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Frailty is often associated with dependency and the need to recommend palliative care
Case 5: Frailty and Depression
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Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
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Frailty is often associated with depression because both are common diseases
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Depression can affect frailty by amplifying the symptoms of co-morbid conditions
Case 6: Frailty and Major Neurocognitive Disorder
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Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
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Frailty coexisting with cognitive impairment need to be recognized early because of their mutual deleterious impact on function
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As is often the case in caring for patients with complex disease, it takes a team
Case 7: Frailty and Cancer
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Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
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The need to customized cancer care in frail patients based on comorbidities, function and prognosis
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The importance of the social domain in care planning for patients with frailty and cancer
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As is often the case in caring for patients with complex disease, it takes a team
Evaluation
During this curriculum evaluation, we used identical pre- and post-tests, containing seven questions with twenty correct answers, to measure learning. This pre-/post-test is available upon request. All questions were effective in discriminating an increase in learning. Learner comments on content, presentation and usability of the modules were overwhelmingly positive.
Use of These Modules
These modules are free for use for all teachers, instructors and trainers. They can be used as produced and be incorporated into an existing curriculum, in part or in full. When these frailty modules are used or included in another curriculum, questions from the pre-/post-test may be adapted for assessments of students’ learning. As with all student assessments, these questions would likely require revision after several years of use. If adapted versions of this curriculum, or parts of this curriculum, are published, attribution to original authors must be included and these new materials must be equally accessible to teachers, instructors and trainers as are the original materials. These materials may not be used or adapted for commercial purposes. (See Creative Commons criteria: CC BY-NC-SA [Attribution-NonCommercial-ShareAlike]).