Frailty recommendations and guidelines. An evaluation of implementability and critical appraisal of clinical applicability by the ISPRM Frailty Focus Group

Abstract

Objective: Aging is associated with an increased burden of multimorbidity and disease-related functional loss and disability, widely impacting patients and health care systems. Frailty is a major factor in age-related disability and is an important target for rehabilitation interventions, considering that is a reversible condition. Methods: A working group of members of the International Society of Physical Medicine and Rehabilitation, responding to the World Health Organization (WHO) 2030 call for action to strengthen rehabilitation, was established to assess the quality and implementability of the existing guidelines for the rehabilitation of frailty. Guidelines were retrieved using a systematic search on Pubmed, Scopus, and Web of Science and from the reference lists of screened articles. The included guidelines were evaluated using the AGREE II to assess their quality and using the AGREE-REX to assess their clinical credibility and implementability. Guidelines with a score >4 in the AGREE II item evaluating the overall quality of the guideline were considered for endorsement. Finally, 9 external reviewers evaluated the applicability of each recommendation from the endorsed guidelines, providing comments about the barriers and facilitators for their implementation in their country. Results: Ten guidelines were retrieved and evaluated by the working group, of which 4 guidelines, that is, the WHO Guidelines on Integrated Care for Older People, the FOCUS guidelines, the Asia-Pacific Clinical Practice Guidelines for the Management of Frailty, and the ICFSR International Clinical Practice Guidelines for Identification and Management of Frailty, were considered for endorsement. All these guidelines were rated as of adequate quality and implementability. Conclusion: The WHO Guidelines on Integrated Care for Older People (24), the ICFSR International Clinical Practice Guidelines for Identification and Management of Frailty (15), the FOCUS guidelines (25), and the Asia-Pacific Clinical Practice Guidelines (14) for the Management of Frailty have the best quality and applicability of the existing guidelines on the management of frailty, we suggest that should be employed to define the standards of care for patients with frailty. There are barriers to their implementation, as stated by our experts, to take into account, and some of them are country or region-specific. Screening for frailty, exercise, nutrition, pharmacological management, social and psychological support, management of incontinence, and overall comprehensive clinical management are the best tools to face frailty.