Vision of the management of frailty in primary health care

Abstract

Primary Care (PC) and community are the priority health sites for the detection and management of frailty. There are good guidelines (Strategy and consensus of the National Health Service, ADVANTAGE European Joint Action, recommendations of the Program of Prevention and Health Promotion Activities of the Spanish Society of Family and Community Medicine PAPPS-semFYC, Fisterra guideline); however, its implementation is not taking place with the expected magnitude or speed, also considering the influence of the COVID-19 pandemic.

The detection and management of frailty requires multidisciplinary work by professionals who usually carry out their activity at the first level of care (physicians, nurses, social workers), with others whose integration is advisable (nutritionists, physiotherapists, etc.); and counting on others of reference (geriatricians). On the other hand, it is necessary to work with comprehensive approaches based on good coordination between PC and the Community, with various experiences in this regard. The support by the Information and Communication Technologies (ICT) can be very interesting, with tools for both users and careers (e.g., VIVIFRAIL), as well as for social and health professionals (e.g., VALINTAN or WHO ICOPE-Handbook App).

Strategies to intervene in fragility in a more effective and systematic way must be consolidated: with an adequate professional training, establishment of campaigns and dissemination ways for visualizing its relevance and extend their intervention, prioritization of the most effective programmed assistance activities (highlighting fragility), multidisciplinary work with coordination and participation of the different healthcare and community levels and of the patients themselves, and providing the PC with adequate resources.