Made-in-Hamilton app helps clinicians and researchers measure frailty


Researcher Dr. Courtney Kennedy demonstrates the Fit-Frailty app for a patient.

HHS researcher Dr. Courtney Kennedy helped lead the development of the Fit-Frailty app, which helps health-care providers with decision-making and care planning for their frail patients.

A new made-in-Hamilton app is helping researchers and health-care providers measure frailty and function in older adults.

Frailty is a medical condition involving reduced function and health. When a person is frail, their body has less resilience to bounce back from illness. Physical inactivity, poor nutrition, social isolation and multiple medications can contribute to frailty.

Hamilton Health Sciences (HHS) researcher Dr. Courtney Kennedy, an occupational therapist who holds a PhD in clinical epidemiology, co-led the development of the Fit-Frailty app, which helps health-care providers with decision-making and care planning for their frail patients. Kennedy is also a coordinator for the HHS Hospital 2 Home program, which provides care for patients impacted by multiple chronic conditions who also face social and economic barriers to achieving good health.

Now, we’re putting the Fit-Frailty app out in the real world, with inpatients, to further test its practical use.” — Dr. Courtney Kennedy

The simple-to-use tool helps health-care providers identify the risk of frailty and age-related loss of muscle mass and strength in less than 15 minutes, through an in-person assessment. It incorporates disease-related, psychosocial, nutrition, and functional aspects of health and fitness, and includes cognitive and physical performance measures.

“The Fit-Frailty app measures levels of frailty, as well as any changes in a patient’s frailty level,” says Kennedy, who developed the app at the Geras Centre for Aging Research, a research institute at HHS that’s affiliated with McMaster University.

The app’s co-creators are Dr. George Ioannidis, deputy director of Geras; Dr. Alexandra Papaioannou, geriatrician and executive director of Geras; Dr. Jonathan Adachi, a rheumatologist and professor emeritus of medicine and Dr. Kenneth Rockwood from Dalhousie University, a professor of medicine and geriatrician who developed an internationally-recognized method for measuring frailty.

The Geras team built on Rockwood’s method by creating an interactive app that can be used at the point of care. They accomplished this by partnering with app developers at Mohawk College and the HHS Centre for Data Science and Digital Health (CREATE) team. CREATE works with hospital clinicians including physicians to develop new ideas and create digital solutions that fundamentally reimagine how health care is delivered. CREATE also works with organizations in both the public and private sector, from local start-ups to national agencies and international bodies.

The researchers received funding to develop the initial prototype from the HHS Foundation and the Centre for Aging and Brain Health Innovation.

A second version, which is fully virtual, was developed especially for researchers measuring frailty for their studies. “For the research world, results can be downloaded as a spreadsheet,” says Kennedy, a Geras scientist who has been involved in aging research for the past 20 years. She hopes to see other large academic health science institutions across Canada use the app for their clinical trials.

Evaluating frailty

Frailty screening for physical and cognitive ability isn’t done as part of standard medical care, and as a result may be overlooked. The app takes screening to the next level, because health-care providers can easily access it on their phone or tablet, says Kennedy, adding, “It’s portable and guides the clinician through the assessment process with features such automated timers and instructional videos built right in.”

HHS St. Peter’s Hospital restorative care allied health-care team members have been important clinical partners in the study.

Frail patients are at a higher risk of experiencing medical complications, resulting in longer hospital stays, and have a higher likelihood of being discharged to an assisted living facility, says Kennedy.

“Understanding their level of frailty across a frailty spectrum and identifying areas where intervention is needed can help doctors and other clinicians better assess a patient’s level of frailty and develop individualized care plans.”

The Fit-Frailty app project is an example of research and innovation being embedded in clinical care, adds Kennedy. It was first evaluated with outpatients at the Centre for Healthy Aging, located at HHS St. Peter’s Hospital, and is currently being assessed with inpatients at St. Peter’s restorative care unit. This latter work is being led by Aastha Relan, a masters student in health research methods, evidence and impact at McMaster.

Inpatients are assessed before starting their rehabilitation program and again just before being discharged to measure any improvements.

“The tool has already been tested and approved from a technical point of view, to ensure it’s easy to use and works well,” says Kennedy. “Now, we’re putting it out in the real world, with inpatients, to further test its practical use.”

It’s exciting to test the app in real-world settings with patients, adds Kennedy. “Researchers can’t exist in isolation, and we’re thrilled to try out this new innovation within our own walls at HHS.”


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