Guide to using the Frailty 5 Checklist
| CHECKLIST ITEM | TOPIC | QUESTIONS |
|---|---|---|
| Feelings | Mood | If signs and symptoms of depression are present, consider using the Two-Question Screen: “In the past month have you often been bothered by feeling down or depressed or hopeless?” and “In the past month have you experienced little interest or pleasure in doing things?”3 |
| Cognition | Were any concerns identified by the patient, caregiver, or family? If yes, screen with the MMSE, MOCA, or RUDAS | |
| Pain | Do you have any pain? If so, where? | |
| Flow | Constipation | How often do you move your bowels? Is your stool hard or lumpy? Do you have to strain with bowel movements? |
| Urinary incontinence | Do you ever leak urine? | |
| Function and falls | Activities of daily living | Do you need help with or has anyone taken over any of your usual activities? Review basic activities of daily living: DEATH (dressing, eating, ambulation, toileting, hygiene) Review instrumental activities of daily living: SHAFT (shopping, housework, accounting, food preparation, transportation) |
| Falls | Have you had any falls in the past year? Consider the frequency, context, and characteristics of the falls. Consider if there are abnormalities of gait or balance4 | |
| “Farmacy” | Medication review | Review prescribed and unprescribed medications and how they are taken |
| Medication adherence | How often do you not take or forget to take this medication? | |
| Deprescribing | Provider to consider the following: Are there any medications that are not currently needed and can be reduced or discontinued? Are there medications being used to treat the patient to targets that are inappropriate for frail older adults (for conditions such as diabetes mellitus, hypertension, and high cholesterol levels)? Deprescribing guidelines and algorithms are available from https://deprescribing.org/resources/deprescribing-guidelines-algorithms | |
| Future and family | Supports | Whom do you rely on for support and assistance? |
| SDM | Who is your SDM or POA for personal care and POA for finances? Does the named SDM align with the legal hierarchy? Have you discussed your goals and values with your SDM or POA? | |
| Goals of care | What is your understanding of your condition? What do you hope for and value in the remaining years of your life? What are your preferences for care in case of a life-threatening illness? The Speak Up campaign provides advance care planning tools at www.advancecareplanning.ca |
MMSE—Mini-Mental State Examination, MOCA—Montreal Cognitive Assessment, POA—power of attorney, RUDAS—Rowland Universal Dementia Assessment Scale, SDM—substitute decision maker.