Comprehensive Geriatric Assessment in Primary Care

Comprehensive Geriatric Assessment - Frailty Index

A comprehensive geriatric assessment (CGA) of the participants' global health state, including their current and relevant past illnesses, medications, cognition, emotion, motivation, health attitude, communication, sleep, pain, control of life, strength, balance, mobility, activities and instrumental activities of daily living, quality of life, lifestyle, and social engagement are assessed. Information to inform the CGA is derived from participant interviews, structured assessments and tests, and medical record review. Each CGA item will be recoded to a scale from 0 to 1, with 0 representing no deficit and 1 representing the full deficit. The total Frailty Index score will be calculated by dividing the sum of the variables' recoded values (the sum of the deficits) by the number of variables measured for that person. The range of the frailty index score is between 0 and 1, where higher scores indicate greater frailty.

Health Questionnaire - Frailty Index

The health questionnaire includes questions related to self-rated health, chronic conditions, activities of daily living, instrumental activities of daily living, cognitive function, and mental health. Responses to each question will be coded on a scale from 0 to 1, with 0 representing no deficit and 1 representing the full deficit. The total health questionnaire Frailty Index score will be calculated by dividing the sum of the variables' coded values (the sum of the deficits) by the number of variables measured for that person. The range of the frailty index score is between 0 and 1, where higher scores indicate greater frailty.

Clinical Frailty Scale

The Clinical Frailty Scale (CFS) broadly stratifies degrees of fitness and frailty on a 9-point scale where higher scores indicate greater risk: 1-very fit; 2-fit; 3-managing well; 4-living with very mild frailty; 5- living with mild frailty; 6-living with moderate frailty; 7-living with severe frailty; 8- living with very severe frailty; and 9-terminally ill. The score is based on clinical judgment as part of the comprehensive geriatric assessment.

Pictorial Fit-Frail Scale

This is a brief, picture-based frailty assessment designed so patients, caregivers, or clinicians can rate current health status common across 14 domains (e.g., mobility, function, cognition, mood, nutrition, comorbidity) using simple visual panels. This scale will be completed separately by participants (self-administered version) and health care professionals (PFFS-HCP). For each domain, the level representing least or no impairment (first picture on the left) is scored 0, the next level (second picture from the left) as 1, etc. The minimum score for each domain is 0; the maximum score for each domain ranges from 2 to 5. Total Pictorial Fit-Frail Scale scores are calculated by summing the scores across domains. The final summed score ranges from 0 (no frailty; very fit) to 43 (severely frail).

Goal Attainment (PAHA Sub-Study)

Goals are constructed on a 5-point scale ranging from +2 (much better than the expected outcome) to -2 (much worse than the expected outcome), where the participant's baseline status is set as -1 and the expected outcome (i.e., desired goal) is set as 0. Goals are set at baseline with the Clinical Exercise Physiologist who reviews attainment status with participants at each follow-up. Mean Goal Attainment scores and proportion of goals achieved will be reported. Goal Attainment Scaling is individualized in that participants select goal that are personally relevant. Summarizing this individualized information is accomplished using a formula that accounts for the number of goals set and variations in attainment (total score range 17 - 82 with higher scores indicating greater goal achievement).

Qualitative experience of the eCGA and PAHA

Semi-structured interviews at 12 months will explore participants' experiences of the eCGA process and, for PAHA participants, the personalized exercise program (acceptability, feasibility, perceived benefits, and barriers). Transcripts will be analyzed using thematic analysis to identify key themes informing implementation.

Number of falls and fractures

Falls and fractures within the past year will be self-reported.

Transition to institution or higher level of care

Number of participants who changed their living arrangement during the study period (12-months), including transition to institution or higher level of care (e.g. from community to assisted living or from assisted living to nursing home)