Appendices
Screening Toolbox
Case Studies
References
Privacy statementTerms of useThis website is for UK and Ireland Healthcare Professionals only.
Screening Toolbox
These resources were funded by Gilead Sciences Ltd and co-created between the Gilead Sciences HIV Standards Support Team, Cuttsy+Cuttsy and healthcare professionals specialising in the field of HIV and frailty.
Supporting clinical practice:
Our top questions for identifying those at risk
These could form part of an in-person or virtual consultation, or a pre-appointment call or questionnaire.
Activities of daily living, especially independence and mobility
Do you find yourself taking longer to do things, needing more support at home or facing issues getting out of the bath, dressing yourself independently or standing up from a chair without using your hands?*†
Fatigue, mood and cognition
How are your energy levels at the moment? Do you ever feel extremely tired or exhausted for no reason? Are you worried about your mood or your memory?†
Falls
Have you fallen in the last year or do you feel you’ve been falling unexpectedly recently?
Social/financial concerns
Are you happy with everything at home — any social or financial worries? Do you have someone at home or nearby to support you if needed?
Polypharmacy/side effects
Have there been any changes with the medicines you take since I last saw you — anything new, changed, stopped or causing you issues?
General worries, especially age-related
Is there anything worrying you as you’re getting older, e.g., incontinence issues? Or any other health problems that are on your mind or affecting you at the moment?†
*Remember to take existing disabilities into consideration when asking questions and interpreting people’s responses.
†Insight into these aspects could be captured simply by observing an individual’s movement and behaviour, particularly if you know them well and understand what’s normal for them.
Download Printable Resource†Insight into these aspects could be captured simply by observing an individual’s movement and behaviour, particularly if you know them well and understand what’s normal for them.
Supporting clinical practice:
FRAIL in HIV Training Poster
Many complex factors can put someone living with HIV at risk of frailty (or being less able to age well), and they aren’t always functional or physical. Look beyond physical signs of frailty, such as those outlined by the F.R.A.I.L. scale*…
F
Fatigue
Did they feel tired most or all of the time during the previous 4 weeks?
R
Resistance (strength)
Any difficulty walking up 10 steps alone without resting and without aids?
A
Ambulation (mobility)
Any difficulty walking several hundred metres alone with/without aids?
I
Illness
More than five illnesses from this list? Hypertension, diabetes mellitus, cancer, chronic lung disease, heart attack, congestive heart failure, angina, asthma, arthritis, stroke and kidney disease
L
Loss of weight
Weight loss of 5% or more?
…And also consider other risk factors in the context of H.I.V.:
H
Home
Any issues happening at home?
Social, financial, support issues?
Social, financial, support issues?
I
Impairment
Any other physical or mental health challenge or limitation in daily functioning? Any new or change in impairment? Any pre-existing disability?
Body function/structure including symptoms, incontinence, pain, memory/cognition, other issues?
Body function/structure including symptoms, incontinence, pain, memory/cognition, other issues?
V
Vulnerability
Anything else putting them at risk or making them less able to self-care or live well?
Polypharmacy/side effects, disability, mental health, mood/stress, stigma, alcohol/drug misuse, menopause, uncontrolled HIV, other worries?
Polypharmacy/side effects, disability, mental health, mood/stress, stigma, alcohol/drug misuse, menopause, uncontrolled HIV, other worries?
Regardless of the outcome of the frailty screen, any issues or vulnerabilities identified by the ‘H.I.V.’ acronym or equivalent questioning should be noted and explored further as soon as possible by a relevant service. This will help optimise an individual’s ability to age well and minimise the risk of frailty developing over time.
Refer to the F.R.A.I.L. in H.I.V. screening example for a more detailed example of how to use this framework in practice.
Although not yet evaluated in people living with HIV, the FRAIL scale has been recommended by EACS* to be used as a screening tool for frailty in people living with HIV. The FRAIL in HIV framework builds off the FRAIL scale; the framework has not been validated in any population and is not endorsed by any professional organisation.
Refer to the F.R.A.I.L. in H.I.V. screening example for a more detailed example of how to use this framework in practice.
Although not yet evaluated in people living with HIV, the FRAIL scale has been recommended by EACS* to be used as a screening tool for frailty in people living with HIV. The FRAIL in HIV framework builds off the FRAIL scale; the framework has not been validated in any population and is not endorsed by any professional organisation.
*Based on European AIDS Clinical Society Guidelines version 11.1 (October 2022).
Download PosterSupporting clinical practice:
F.R.A.I.L. in H.I.V. screening example
This is an example of how the ‘FRAIL in HIV’ framework could be used to screen patients as part of an annual health review or during a focussed ‘screening’ initiative. As well as the framework, there are suggested possible questions and supporting tests that may help you to identify key risk factors that may indicate risk of frailty.
Risk factor
Supporting questions and tests
Fatigue
Did they feel tired most or all of the time during the previous 4 weeks?
[1 point]
Possible questions
- Do you feel more tired than normal?
- Have you felt more tired than normal over the past 4 weeks (or 1 month)?
Resistance
Any difficulty walking up 10 steps alone without resting and without aids?
[1 point]
Possible question
- Can you walk up 10 steps alone without support?
Supporting tests
- Timed-Up-and-Go (≥12 secs = higher risk of falls)
or
- 5x Sit-to-Stand (>14 secs = higher risk of falls)
Ambulation
Any difficulty walking several hundred metres alone with/without aids?
[1 point]
Possible question
- Do you have any difficulty walking several hundred metres alone with/without aids?
Supporting test
- Gait speed (≤0.8 metres/second = frail)
Illness
More than five illnesses from this list?
Hypertension, diabetes mellitus, cancer, chronic lung disease, heart attack, congestive heart failure, angina, asthma, arthritis, stroke and kidney disease
Hypertension, diabetes mellitus, cancer, chronic lung disease, heart attack, congestive heart failure, angina, asthma, arthritis, stroke and kidney disease
[1 point]
Possible question
- How many significant long-term conditions or illnesses do you have?
Loss of weight
Weight loss of 5% or more?
[1 point]
Possible question
- Have you experienced any unexplained sudden or noticeable loss of weight recently?
Supporting test
- Measure weight (>5% loss = frail)
Risk factor
Supporting questions and tests
Home
Any social, financial or support issues?
Possible questions
- How are things at home?
- Do you have/have you had any concerns recently?
- Do you have any financial worries on your mind?
- Do you have anyone at home or nearby to support you if needed?
Impairment
Any physical/mental health challenge or limitation/disability in daily functioning?
Body function/structure including symptoms, incontinence, pain, memory/cognition, other issues?
Body function/structure including symptoms, incontinence, pain, memory/cognition, other issues?
Possible questions
- Do you have any issues getting out of the bath or dressing yourself independently?†
- Do you find yourself taking longer to do things or do you need more support or help at home?
- Are you worried about your mood or your memory?
- Is there anything worrying you as you’re getting older? Are there any other health problems that are on your mind?
- Has anything changed with the medicines you take since I last saw you — new, stopped, changed or any issues?
Supporting tests
Vulnerability
Anything else putting them at risk or making them less able to self-care or live well?
Polypharmacy/side effects, disability, mental health, mood/stress, stigma, substance abuse, menopause, uncontrolled HIV, other worries?
Polypharmacy/side effects, disability, mental health, mood/stress, stigma, substance abuse, menopause, uncontrolled HIV, other worries?
Although not yet evaluated in people living with HIV, the FRAIL scale has been recommended by EACS to be used as a screening tool for frailty in people living with HIV. The FRAIL in HIV framework builds off the FRAIL scale; the framework has not been validated in any population and is not endorsed by any professional organisation.
*Based on European AIDS Clinical Society Guidelines version 11.1 (October 2022).
†N.B.: Disabilities should be taken into consideration when performing any tests or screens for frailty.
Download screening example*Based on European AIDS Clinical Society Guidelines version 11.1 (October 2022).
†N.B.: Disabilities should be taken into consideration when performing any tests or screens for frailty.
Supporting clinical practice:
Illustrative ‘FRAIL in HIV’ framework
About the framwork and recommendations for use in practice
Our ‘FRAIL in HIV’ framework is adapted from the EACS 2022 algorithm for frailty screening. Following in-depth interviews with six expert collaborators, adaptations were made to the algorithm based on the reality of clinical practice and practical tips they shared. It was further inspired by the Comprehensive Geriatric Assessment and a review article by Sangarlangkarn A and Appelbaum J, 2020.46
Although not yet evaluated in people living with HIV, the FRAIL scale has been recommended by EACS to be used as a screening tool for frailty in people living with HIV. The FRAIL in HIV framework builds off the FRAIL scale; the framework has not been validated in any population and is not endorsed by any professional organisation.
The framework is meant to be illustrative. It aims to provide enough of a guide for services to follow in practice while still allowing flexibility for centres to choose a screening and assessment approach that fits best with their setting and the needs of their cohort.
The information is meant to be more indicative and illustrative of the elements that should be covered and measured as part of screening for frailty.
Some people may not need to formally measure, but for those that do, there is a list of available tools that can be used to measure various elements to 'build the picture' and make a holistic decision about next steps.
You will be able to access the various tools mentioned in the framework via the hyperlinks including in this guide.
Download frameworkAlthough not yet evaluated in people living with HIV, the FRAIL scale has been recommended by EACS to be used as a screening tool for frailty in people living with HIV. The FRAIL in HIV framework builds off the FRAIL scale; the framework has not been validated in any population and is not endorsed by any professional organisation.
The framework is meant to be illustrative. It aims to provide enough of a guide for services to follow in practice while still allowing flexibility for centres to choose a screening and assessment approach that fits best with their setting and the needs of their cohort.
The information is meant to be more indicative and illustrative of the elements that should be covered and measured as part of screening for frailty.
Some people may not need to formally measure, but for those that do, there is a list of available tools that can be used to measure various elements to 'build the picture' and make a holistic decision about next steps.
You will be able to access the various tools mentioned in the framework via the hyperlinks including in this guide.
HCP toolbox
Here are some of the tools, tests and resources you may find useful to support the identification of frailty in people living with HIV.
It is useful to review the various resources and determine which will be most useful and practical for your practice setting.
Click on the links to learn more about each resource. Please note that each link will take you to a third-party website. Gilead does not endorse or accept liability for sites controlled by third parties.
It is useful to review the various resources and determine which will be most useful and practical for your practice setting.
Click on the links to learn more about each resource. Please note that each link will take you to a third-party website. Gilead does not endorse or accept liability for sites controlled by third parties.
Frailty screening tools
Frailty assessment tools
Performance tests
Other tools, tests and surveys
Disability:
WHO 2.0 12-item disability assessment schedule (WHODAS)
Brown D et al., HIV, disability and rehabilitation. HIV Nursing 2020;20(3):77–86
Activities of daily living/general quality of life:
Activities of daily living
Short Form (SF)-36 Health Survey Questionnaire
EuroQol 5-Dimension, 5-Level health-related quality of life questionnaire (EQ-5D-5L)
Cognition:
MoCA
Depression:
Patient Health Questionnaire (PHQ-9)
Beck Depression Inventory-II (BDI-II)
Centre for Epidemiology Studies (CES-D)
Post-Traumatic Stress Disorder (PTSD):
Post-Traumatic Stress Disorder (PTSD): PTSD Checklist for DSM-5 (PCL-5)
Symptom burden:
HIV Symptom Index (HIS)
It is worth remembering that the majority of these tools are not specifically validated for use in people living with HIV. Some tools may also require a fee or subscription to utilise them.
