Professor Barbara Hanratty, Professor Louise Robinson, Professor Catherine Exley, Professor Fiona Mathews, Professor Steve Iliffe, Dr Stephen Barclay

NIHR SPCR - Funding and ongoing doctoral studies for Daniel Stow, 2015-19

As people are living longer, more and more people are dying with frailty. Estimates suggest that between one quarter and one half of all patients aged over 85 years are frail. It is important that health professionals recognise when a patient may be nearing the end of their lives, so that they can talk to them about the sort of care that would prefer, and where they would like to be treated during their final illness. It can be very difficult for a GP to know when a frail older person is likely to die, as their health may have been declining for some time. To help GPs identify and assess the severity of frailty amongst their patients, researchers have put together a simple tool in one of the GP computer systems. An electronic frailty index is calculated, using information recorded in patients’ electronic health records. There are now around three million people over 65 years with a frailty score available. The research in this proposal will look at whether the electronic frailty index would be useful to help GPs to identify their frail, older patients who may be approaching the end of life.

There will be three parts to this study. First, we will look at how the frailty score changes in the last few months of people’s lives, and whether it could signal the point at which palliative care should be considered. Second, we will examine a selection of patient notes, to see if we can detect any links between the frailty score, GP treatments and current recommendations for palliative care. Finally we will interview GPs to find out if they would find a frailty score easy to understand, and useful in practice. We will use the findings of the research to begin to influence what GPs do on a day-to-day basis, and also to develop future research.