Quantifying risk: How CIHI’s frailty risk measure supports care planning for Canada’s seniors

In 2023–2024, more than 40% of hospitalized seniors in Canada were at risk for frailty, according to new data released by the Canadian Institute for Health Information (CIHI). As Canada’s senior population continues to grow, health systems must better understand and address frailty to improve patient outcomes.

Why frailty matters

Frailty is a state of health where a person’s overall well-being and ability to function independently are reduced, and their vulnerability to deterioration is increased. People with frailty often have multiple health conditions or symptoms, reducing resilience to minor health challenges. The condition is complex to diagnose, often requiring comprehensive assessments by a geriatrician. However, research shows that frailty can sometimes be prevented, postponed or even reduced with the right interventions.

Measuring frailty to improve care planning

Understanding how many patients live with or are at higher risk for frailty is a challenge for health systems. However, frailty is important for health system planners to consider, as people living with frailty are more likely to have worse health outcomes and longer and more frequent hospitalizations. To address this unique challenge, CIHI first released the CIHI Hospital Frailty Risk Measure (HFRM) in 2021. This contextual measure uses hospital data to estimate the number of patients at different levels of frailty risk, providing hospital and health system planners with new information to make informed decisions. 

Supporting frailty care planning with data

Mélanie Josée Davidson, Director, Health System Performance, CIHI, emphasizes the importance of frailty data: “We know from our users that population-based frailty data is something they need but often don’t have. Caring for individuals with frailty once they are in hospital can be complex and resource-intensive, so good patient experiences and health outcomes require planning and service evaluation, which the CIHI HFRM can support.” 

Unlike a diagnostic screening tool, the CIHI HFRM is a retrospective assessment used to support frailty care planning at an aggregate level. The CIHI HFRM offers a quantifiable way to measure frailty from a hospitalized population approach and can be used to support capacity-building for adults at risk of frailty. This can be used to inform services available to people living with frailty in Canadian communities and to inform coordinated frailty care in hospitals.

Real-world impact on understanding frailty

As Senior Practice Consultant, Alberta Health Services, Tara Sawchuk uses the CIHI HFRM in her work on the Elder Friendly Care project. The mandate of the project is to improve the care, health outcomes and experiences of seniors in acute care. She finds the data valuable for engaging leadership and front-line staff in discussions about frailty care planning. The CIHI HFRM is an extremely helpful measure she can use to compare her facility-level data with national patient frailty averages. Tara presents the HFRM data as a measure of complexity and vulnerability, remarking, “the data raises the importance of frailty assessments to understand risk and drives preventive or restorative interventions. The potential to impact patient outcomes resonates with leadership teams.” 

Dana Corsi, Regional Rehab and Alternate Level of Care (ALC) Lead, North East Specialized Geriatric Centre, in Ontario is focused on supporting the planning and implementation of best practice care for older adults living with or at risk for frailty.  Like Tara, Dana also uses the CIHI HFRM to engage health system leaders in discussions about frailty care planning.

Dana further explains that the CIHI HFRM is key to understanding what standard of care is required to meet a patient’s needs. With frailty data, health care providers can then determine their ability to deliver that standard of care across the care continuum. “This tool helps us demonstrate why that standard of care is so critical and expands our awareness of the target population for acute care right now. It also informs what model of care is required,” Dana notes. 

Looking ahead: Improving care for seniors living with frailty

The information provided by the CIHI HFRM is key to improving care for seniors. With early intervention and proper planning, frailty can often be prevented or managed more effectively. “With frailty-informed care, it’s essential to know where a patient’s health was before they got sick or hospitalized,” states Dana. 

She often references her 92-year-old father-in-law, Frank, as an example of the importance of patient-centred frailty care. After being hospitalized, Frank’s condition was far from his experience as an active senior who — only 2 weeks prior — had played 18 holes of golf at a charity tournament.

Both Tara and Dana stress that with early intervention, proper planning and coordinated care, frailty can often be prevented or managed more effectively. Tara points out that “we can do a lot to prevent frailty from progressing and, if we are astute with planning, we can often prevent it from happening in the first place. In acute care, we often have patients who have experienced recent decline. Frailty is dynamic. Often, recent decline can be reversed.”

Special thanks to Tara Sawchuk, Senior Practice Consultant, Alberta Health Services, and Dana Corsi, Regional Rehab and ALC Lead, North East Specialized Geriatric Centre, for their contributions to this article. 

For more information:

• Frailty among hospitalized seniors (data tables and visual profiles)