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Screening and assessment of frailty

FRESH have contributed to the development of the concept frailty in Sweden, a concept that is a better than concepts such as multimorbid and disabled when describing older people with at risk of developing large care needs (1). The research group has been active debating this, as well as the use of frailty as a means to identify older people with large care needs (2).

Screening instrument “FRESH”

We have developed a short screening instrument (3) to identify older people at risk of developing frailty and with the largest need of interventions. If you answer yes to two or more out of four criteria you are frail and have a need for comprehensive geriatric assessment, care and rehabilitation. Our research results show that the instrument has high sensitivity, specificity and predictive value (4). The screening instrument is implemented in acute care units in Gothenburg, and a collaboration has been initiated to develop the screening instrument for primary care.

How staff experience assessment of frailty
Research shows that the conditions for successful assessment of frail older people is continuum of care. this means integrated care with collaborations between professions and organisations. By working together the risk of missing important information is decreased.

Highly specialised health and social care is poorly adapted to the complex needs of frail older people and is more fragmented than integrated. This has been described in a recent study published by the research group. Health professionals describe that frail older people do not have the same opportunities to receive care as other people, because of a lack of guidelines and routines across organisations.


(1) Wilhelmson K, Dunér A, Eklund K, Gosman-Hedström G, Gustafsson H, Dahlin-Ivanoff S. Bättre vård och omsorg för multisjuka äldre kräver samverkan och ansvariga vårdgivare. Läkartidningen 2009;106:3273-4.

(2) Wilhelmson K, Eklund K, Gustafsson H, Larsson A-C, Landahl S, Dahlin-Ivanoff S. Skörhet bra begrepp för att hitta äldre med stort behov av vård och omsorg. Läkartidningen 2012;109(16):826-827

(2) Dahlin Ivanoff S, Ehrenberg A, Ekdahl A, Eklund Grönberg A, Oredsson S, Sjöstrand F, Wisten A. Akutvården måste klara också sköra åldringar. Dagens Nyheter, 2014. no 2014-01-03

(4) Eklund K, Wilhelmson K, Landahl S, Dahlin-Ivanoff S. Screening for frailty among older emergency department visitors: validation of the new FRESH-screening instrument. BMC Emerg Med 2016;16:27. doi: 10.1186/s12873-016-0087-0.

(5) Dahlin-Ivanoff S, Duner A, Eklund K, Wilhelmson K1, Lidén E, Holmgren E. Comprehensive geriatric assessment of frail older people: ideals and reality. Journal of Interprofessional Care. Accepted 27 July 2018. DOI: 10.1080/13561820.2018.1508130.

(3) Screeninginstrument

Synneve Dahlin-Ivanoff, Kajsa Eklund, Katarina Wilhelmson, Sten Landahl, Eva Holmgren, Eva Liden, Anna Duner

Page Manager: Josefin Bergenholtz|Last update: 2/11/2019

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