Frailty continues to be a hot topic in geriatrics. The American Geriatrics Society defines frailty as “a state of increased vulnerability to stressors due to age-related declines in physiologic reserve across neuromuscular, metabolic, and immune systems.” The end state of frailty is a failure to thrive.

How can providers assess frailty? There is no “one” diagnostic test for frailty and numerous clinical tools exist. This summer in the Journal of the American College of Cardiology, the Essential Frailty Toolset (EFT) was found to be the most predictive of one-year mortality and disability of seven different frailty tools in patients undergoing cardiovascular surgeries.

As our population continues to age, providers, patients, and their families will continue to struggle with how best to assess and help frail geriatrics patients; the EFT helps providers tease out the association between frailty and surgical mortality.The advantages of the EFT include the ease of use, few components (four), and increasing literature supporting its validity. The EFT is not the only show in town. One of the best accepted of these is the Edmonton Frail Scale. A 2006 publication by Rolfson, et al. found the Edmonton Frail Scale both valid and reliable. Alternatives include the simple mnemonic FRAIL and the Hopkins Frailty Assessment. Previously, we reviewed an app that included the Edmonton Frail Scale; unfortunately, it has not yet been updated to work with the new Apple app store requirements for 64 bit only apps. Here on iMedicalApps, we have reviewed numerous additional geriatrics apps including many from the American Geriatrics Society, including Geriatrics at Your Fingertips, Multimorbidity/MCC GEMS, and iGeriatrics. None of these apps include any of the validated assessments for frailty.

Video Review

Evidence-based medicine

The app intuitively calculates the valid and reliable Essential Frailty Toolset (EFT) as well as the expanded EFT for use at the POC. The EFT was found to be the most sensitive and specific frailty tool at predicting post-op mortality in a recent study. The app provides this exact toolset for smart devices but fails to include any information about the supporting literature or how best to use the score.

Who would benefit from this frailty app?

Any healthcare provider who cares for geriatric patients including students, NP’s, PA’s, geriatricians, primary care providers, providers performing preop evaluations and surgeons.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.

  • Price
    • Free
    • Slick user interface with built-in calculators, illustrations, and timing capabilities.
    • Contains expanded toolset in addition to the more rapid calculator.
    • Brings recent evidence on frailty and its connection to operative mortality to the POC.
    • Available for iOS and Android.
  • Dislikes
    • No references.
    • Minimal information on how to interpret the results.
    • No information about the validity and reliability of the scale.
  • Overall

    A useful and unique calculator that brings recently published literature to the point of care. The app permits providers to geriatric patients and surgeons the ability to calculate the 1-yr mortality risk from common cardiovascular procedures due to a patient’s underlying frailty. This can be used with patients and their families at the point of care to assess and discuss surgical vs. non-surgical options. The app lacks the needed information about the Essential Frailty Toolset (EFT) to make it more useful to providers unfamiliar with the scale.

  • Overall Score
  • User Interface

    Intuitive interface that automatically calculates the EFT Score and 1-year mortality risk as well as built-in timers and illustrations for conducting the various steps of the EFT.

  • Multimedia Usage

    App includes built-in timers and calculators that are part of the EFT. App would benefit by including links to the literature supporting the EFT.

  • Price

    App is free.

  • Real World Applicability

    For providers caring for geriatric patients and/or those performing preoperative evaluations, the Frail Tool app brings the highly regarded Essential Frailty Toolset (EFT) to your smart device. I only wish the authors had provided more background on the studies supporting EFT, and how best to use the information.

  • Device Used For Review

    iPhone 8 running iOS 11.2

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