Intended for healthcare professionals


Identifying frailty in primary care

BMJ 2017; 358 doi: (Published 27 September 2017) Cite this as: BMJ 2017;358:j4478
  1. William Hamilton, professor of primary care diagnostics1,
  2. Jack Round, retired food technologist2
  1. 1University of Exeter Medical School, Exeter EX1 2LU, UK
  2. 2Birmingham, UK
  1. Correspondence to: W Hamilton w.hamilton{at}

Identifying a problem is acceptable only if there’s an effective solution

Frailty is a common accompaniment to aging, bringing reduced resilience to acute problems compared with healthier people.1 Recovery takes longer and is sometimes incomplete. Falls are frequent. Polypharmacy—much of it futile—is common.2 In theory, if frail people could be identified, some of these problems could be averted. This is the rationale behind the requirement for general practitioners in England to identify severely frail people on their lists, to review them for risk of falls, and to ensure their treatment is suitable.3 Frailty is not the same as mortality, although it shares several predictors. However, mortality is more amenable to prediction, so it may be worthy of consideration as a proxy for frailty.

In this issue, Hippisley-Cox and Coupland (doi:10.1136/bmj.j4208) have adapted their well oiled methods of examining a large English primary care database to produce a predictive algorithm for short term mortality (QMortality).4 They also develop a new classification of frailty, combining risk of death with risk of hospital admission (QFrailty categories), building on an existing electronic frailty index (EFI) from a similar …

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