Frailty recommendations and guidelines: an evaluation of the implementability and a critical appraisal of clinical applicability by the ISPRM Frailty Focus Group.
Eleftheria Antoniadou, Emanuele Giusti, Paolo Capodaglio and 5 others
PMID 38656081WHAT IT FOUND
Four existing frailty guidelines were considered usable, with recommendations for screening, exercise, nutrition, medication review, home safety, swallowing and continence care.
Their strength varies, and many recommendations rest on low evidence.
Key findings
01After screening, 10 frailty rehabilitation guidelines were included, and four were considered for endorsement.
02External reviewers rated individual recommendations from the endorsed guidelines with a median applicability score of at least 4 on a 1 to 7 scale.
03The endorsed recommendations call for tailored multicomponent care, including exercise, nutrition, polypharmacy review, and fall risk management, even though the evidence is low.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This paper did not enroll patients or measure clinical outcomes. It appraised guideline documents and expert ratings. Several recommendations are explicitly low evidence, very low evidence, or conditional, so they are guideline recommendations rather than proven treatment effects. Applicability was rated by nine geriatric specialists, so it reflects expert judgment about local settings rather than patient outcomes. One endorsed guideline had poor AGREE II scores for stakeholder involvement, rigor of development, and editorial independence. The search was for published guidelines in February 2021, using PubMed, Scopus and Web of Science, plus known guidelines, so it may not capture all relevant guidance.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that exercise, nutrition, home modification, or continence treatment improves frailty outcomes. It is a guideline appraisal and practice guide, and several recommendations are based on low or very low evidence.