With the ageing of the population we face an increasing number of older patients in hospitals. Frail older patients are at risk for adverse outcomes such as functional decline, readmission and mortality. We should therefore focus on assessing frailty to reduce adverse outcomes by implementing preventive interventions. In Dutch clinical practice the Safety Management System (VMS) frailty instrument is used for this purpose.
The overall goal of this thesis of Frederike Oud is to assess the value of some frequently applied instruments for frailty in older hospitalized patients, with a special focus on the VMS frailty instrument.
This thesis highlights a number of important issues in frailty assessment. First of all, it appears that there are different objectives for assessment in clinical practice. For example a frailty assessment is done to select patients for geriatric assessment or in shared decision making. Second, the group of older patients who are frail is very diverse; between patients there are major differences in type of problems that contribute to frailty (cognitive problems, risk of falling or malnutrition).
This thesis recommends a tailored approach to improve the assessment of frailty in older hospital patients. The assessment must be adapted to the purpose of screening and the specific population: in addition to assessing frailty, we should also identify the problems that contribute to the patient's frailty. The VMS frailty instrument is a good example of a frailty assessment instrument that identifies specific problems and can be adapted to specific goals and populations.
