Canadian Frailty Assessment Pathway Comes to the iPhone

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 failure to thrive.

How can providers assess frailty?

There is no “one” diagnostic test for frailty and numerous clinical tools exist. A group of Canadian providers, founded by Dr. Paige Moorhouse and Dr. Laurie Mallery, in Halifax have pioneered what they call the Palliative and Therapeutic Harmonization (PATH) assessment. The main focus of PATH is to put frailty front and center of evidence-based decision making in the geriatric population. This not only enables better care of patients with dementia but even decision making on care of frail individuals on common topics such as diabetes and hyperlipidemia treatment.  

The PATH group has now released an app that allows providers and collaterals (family and friends of potential frail patients) to complete the assessment on an iOS device. The PATH assessment is an evidence-based validated process that creates a standardized, printable summary of core frailty domains (utilizing a mini-cog as part of the assessment) including cognition, mobility, and function performed rapidly at the point of care.

The PATH Frailty app is now one of three other validated frailty assessments we have reviewed on iMedicalApps. Previously, we favorably reviewed the Essential Frailty Toolset (EFT) which is predictive of one-year mortality and disability of seven different frailty tools in patients undergoing cardiovascular surgeries as well as the highly regarded Edmonton Frail Scale. A 2006 publication by Rolfson, et al. found the Edmonton Frail Scale both valid and reliable. Other alternatives include the simple mnemonic FRAIL and the Hopkins Frailty Assessment. Here on iMedicalApps we have reviewed numerous additional geriatrics apps including many from the American Geriatrics Society, like Geriatrics at Your Fingertips, Multimorbidity/MCC GEMS, and iGeriatrics. None of these apps include any of the validated assessments for frailty.

Evidence-based medicine

The app intuitively calculates the evidence-based PATH Frailty Assessment and mini-cog utilizing information from both the medical provider and collaterals (family/friends of the patient) to calculate a reliable frailty assessment. The PATH website includes links to supporting literature for the PATH assessment and some information on how to respond to the results. The app does not include any information about PATH (after the 1st use), nor links to the website or literature, and the links out for follow-up on the results only show blank PDFs. Ideally, these issues will be fixed in a subsequent version of the app.

Who would benefit from this app?

Any healthcare provider who cares for geriatric patients including students, NPs, PAs, geriatricians, primary care providers, and providers performing frailty assessments.

Price

Free

Likes

  • Slick user interface that uniquely combines collateral input with the mini-cog
  • Detailed instructions to guide collaterals/providers on performing assessment
  • Evidence-based process with good representation in the literature

Dislikes

  • No references included in the app and not links from app to the PATH website
  • Information on how to interpret the results that the app connects to is blank
  • Not available for Android

Overall

A useful and unique frailty assessment app the brings the published literature alive on any iOS (but not Android) device. App intuitively combines both collateral (family/friend) input along with patient answers to the mini-cog and other assessments to calculate and overall PATH frailty assessment for the patient. The process appears to have a robust evidence base in the literature to support its use, but the app falls short on providing follow-up/actionable information based on the PATH frailty assessment results. Providers should consider comparing the app to the Edmonton Frail Scale and the Essential Frailty Toolset (EFT) previously reviewed here on iMedicalApps.

Overall Score

  • 4.5 stars

User Interface

  • 4.5 stars

Intuitive interface that automatically calculates both the mini-cog and PATH assessment (which can be performed remotely by a family member or on the app). App provides detailed explanations as each assessment is performed.

Multimedia Usage

  • 4.0 stars

App includes built-in mini-cog and PATH assessment with options for collateral input via code sent to the provider. App links out to PATH website, but follow-up link to PDFs are blank. App would benefit by including links to the literature supporting the PATH assessment.

Price

  • 5 stars

App is free.

Real World Applicability

  • 4.5 stars

For providers caring for geriatric patients and/or geriatric assessment team members, all can use the PATH Frailty app at the point of care. The app still could be improved with more information within the app/on the web for follow-up after the assessments as well as an Android version.

Device Used For Review

  • iPhone 8 running iOS 12.1.4

Available for download for iPhone and iPad. Not available for Android at this time.

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.