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Screening for Frailty in Canada’s Health Care System: A Time for Action

  • John Muscedere (a1), Melissa K. Andrew (a2), Sean M. Bagshaw (a3), Carole Estabrooks (a4), David Hogan (a5), Jayna Holroyd-Leduc (a6), Susan Howlett (a7), William Lahey (a8), Colleen Maxwell (a9), Mary McNally (a10), Paige Moorhouse (a2), Kenneth Rockwood (a2), Darryl Rolfson (a11), Samir Sinha (a12), Bill Tholl (a13) and for the Canadian Frailty Network (CFN)...

As Canada’s population ages, frailty – with its increased risk of functional decline, deterioration in health status, and death – will become increasingly common. The physiology of frailty reflects its multisystem, multi-organ origins. About a quarter of Canadians over age 65 are frail, increasing to over half in those older than 85. Our health care system is organized around single-organ systems, impairing our ability to effectively treat people having multiple disorders and functional limitations. To address frailty, we must recognize when it occurs, increase awareness of its significance, develop holistic models of care, and generate better evidence for its treatment. Recognizing how frailty impacts lifespan will allow for integration of care goals into treatment options. Different settings in the Canadian health care system will require different strategies and tools to assess frailty. Given the magnitude of challenges frailty poses for the health care system as currently organized, policy changes will be essential.

Avec le vieillissement de la population canadienne, la fragilité – avec son risque accru du déclin fonctionnel, la détérioration de la santé, et le décès – devient de plus en plus répandue. La physiologie de la fragilité reflète son origine parmi organes et systèmes multiples. Environ un quart des Canadiens qui sont âgés de plus de 65 sont fragiles, augmentant à plus de la moitié de ceux âgés de plus de 85. Notre système de soins de santé est organisé pour gérer les systèmes mono-organes, ce qui nuit à notre capacité à traiter efficacement les personnes atteintes de troubles multiples et des limitations fonctionnelles. Pour faire face à la fragilité, il faut reconnaître quand elle se produit, accroître la sensibilisation à son importance, développer des modèles holistiques pour ses soins, et générer des meilleures preuves pour son traitement. La reconnaissance de la façon dont la fragilité impacte la durée de vie permettrait l’intégration des objectifs en matière de soins dans les options de traitement. Les différents organisations de soins responsables variées dans le système de soins de santé canadien nécessiteront des stratégies et outils différentes pour évaluer la fragilité. Les changements dans la politique sera essentiels, étant donné la portée et la complexité des défis que pose la fragilité au système de soins de santé comme cela est organisé actuellement.

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La correspondance et les demenades de tire-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: John Muscedere, MD, FRCPC Queen’s University – Critical Care Medicine 76 Stuart Street Kingston, ON K7L 2V7 (
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Canadian Journal on Aging / La Revue canadienne du vieillissement
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  • EISSN: 1710-1107
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