Original Article

Trauma Providers’ Perceptions of Frailty Assessment: A Mixed-Methods Analysis of Knowledge, Attitudes, and Beliefs

Authors: Thomas H. Shoultz, MD, Megan Moore, PhD, MSW, May J. Reed, MD, Stephen J. Kaplan, MD, MPH, Itay Bentov, MD, PhD, Catherine Hough, MD, Lisa A. Taitsman, MD, MPH, Steven H. Mitchell, MD, Grace E. So, BA, Saman Arbabi, MD, MPH, Herb Phelan, MD, Tam Pham, MD
diagnostic:291446

Abstract

Objectives: Quality improvement in geriatric trauma depends on timely identification of frailty, yet little is known about providers’ knowledge and beliefs about frailty assessment. This study sought to understand trauma providers’ understanding, beliefs, and practices for frailty assessment.

Methods: We developed a 20-question survey using the Health Belief Model of health behavior and surveyed physicians, advanced practice providers, and trainees on the trauma services at a single institution that does not use formal frailty screening of all injured seniors. Results were analyzed via mixed methods.

Results: One hundred fifty-one providers completed the survey (response rate 92%). Respondents commonly included calendar age as an integral factor in their determinations of frailty but also included a variety of other factors, highlighting limited definitional consensus. Respondents perceived frailty as important to older adult patient outcomes, but assessment techniques were varied because only 24/151 respondents (16%) were familiar with current formal frailty assessment tools. Perceived barriers to performing a formal frailty screening on all injured older adults included the burdensome nature of assessment tools, insufficient training, and lack of time. When prompted for solutions, 20% of respondents recommended automation of the screening process by trained, dedicated team members.

Conclusions: Providers seem to recognize the impact that a diagnosis of frailty has on outcomes, but most lack a working knowledge of how to assess for frailty syndrome. Some providers recommended screening by designated, formally trained personnel who could notify decision makers of a positive screen result.
Posted in: Other Primary Geriatric Topics2

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Bagshaw SM, Stelfox HT, Johnson JA, et al. Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study. Crit Care Med 2015;43:973-982.
2. Joseph B, Pandit V, Zangbar B, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg 2014;149:766-772.
3. Joseph B, Pandit V, Zangbar B, et al. Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis. J Am Coll Surg 2014;219:10-17.e1.
4. Legner VJ, Massarweh NN, Symons RG, et al. The significance of discharge to skilled care after abdominopelvic surgery in older adults. Ann Surg 2009;249:250-255.
5. Hakkarainen TW, Arbabi S, Willis MM, et al. Outcomes of patients discharged to skilled nursing facilities after acute care hospitalizations. Ann Surg 2016;263:280-285.
6. Davidson GH, Hamlat CA, Rivara FP, et al. Long-term survival of adult trauma patients. JAMA 2011;305:1001-1007.
7. Rodriguez-Manas L, Feart C, Mann G, et al. Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Sci 2013;68:62-67.
8. Cryer H, Calland JF, Chow W, et al. ACS TQIP Geriatric Trauma Management Guidelines. https://www.facs.org/~/media/files/quality%20programs/trauma/tqip/geriatric%20guide%20tqip.ashx. Accessed December 17, 2018.
9. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Theory at a glance. A guide for health promotion, 2nd ed. https://www.sbccimplementationkits.org/demandrmnch/wp-content/uploads/2014/02/Theory-at-a-Glance-A-Guide-For-Health-Promotion-Practice.pdf. Published 2005. Accessed September 1, 2016.
10. Kozar RA, Arbabi S, Stein DM, et al. Injury in the aged: geriatric trauma care at the crossroads. J Trauma Acute Care Surg 2015;78:1197-1209.
11. Mosenthal AC. Trauma palliative care best practice guidelines. Podium presentation at TQIP Annual Scientific Meeting and Training. Champions Gate, FL. November 5-7, 2016.
12. Mosenthal AC, Weissman DE, Curtis JR, et al. Integrating palliative care in the surgical and trauma intensive care unit: a report from the Improving Palliative Care in the Intensive Care Unit (IPAL-ICU) Project Advisory Board and the Center to Advance Palliative Care. Crit Care Med 2012;40:1199-1206.
13. Schermer CR, Moyers TB, Miller WR, et al. Trauma center brief interventions for alcohol disorders decrease subsequent driving under the influence arrests. J Trauma 2006;60:29-34.
14. Gentilello LM, Rivara FP, Donovan DM, et al. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg 1999;230:473-483.
15. Gentilello LM, Ebel BE, Wickizer TM, et al. Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg 2005;241:541-550.
16. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004;24:105-112.