A systematic review of frailty education programs for health care professionals

**Background:** Frailty is highly prevalent in community and hospital settings and is associated with significant costs. Despite WHO recommendations that all healthcare professionals receive frailty training, many clinicians remain unaware of the concept or do not routinely apply it. A 2017 systematic review found no published evaluations of frailty training programs. This review aimed to examine the effectiveness of such programs and detail participant feedback.

**Methods:** A systematic review was conducted following PRISMA recommendations (not preregistered). PubMed, Embase, PsycINFO, and CINAHL were searched from inception to 30 June 2021. Search terms included "frailty" combined with "education," "training," "teaching," or "program" and healthcare professional terms. Two authors independently performed screening, data extraction, and quality assessment using Joanna Briggs Institute critical appraisal tools. Broad inclusion criteria were used: any study type in English reporting on an education program with frailty as a primary focus, directed at any health professional/student, with an evaluation component. Narrative synthesis was performed; no meta-analysis was planned.

**Key Results:** Database searches yielded 1277 non-duplicated studies. After screening, 10 studies reporting on 9 frailty training programs were included, all published between 2018 and 2021. Quality assessment was moderate (mean 5.9/8 for cross-sectional studies; 8/10 for qualitative studies). Participant numbers ranged from 10 to 356 (median 30.5). Programs targeted medical students (2 studies), Emergency Department staff (3 studies), primary care professionals (1 study), and multidisciplinary staff working with older patients (3 studies). Most programs were short (single-day workshops or individual modules); only one involved extended training with shadowing and case discussions. All programs covered theoretical frailty knowledge including definitions, prevalence, and misconceptions. Frailty assessment tools were commonly taught, but frailty management strategies were covered by only two programs. All studies reported improved frailty awareness. Aijaz et al. reported frailty identification improved from 40% to 80% in an ED setting. Dowell et al. reported frailty screening increased from 60% to >80%. Donoghue et al. found 74% improvement in perceived frailty knowledge and 73% subjective improvement in ability to define frailty. Hesselink et al. demonstrated statistically significant improvement on multiple-choice examination and a 22% increase in documentation of patient social circumstances, functional abilities, and sensory capacity. Kotsani et al. reported 52% increased use of frailty tools, sustained at 3 months, though self-perceived ability to manage frailty dropped from 70% to 32% at 3 months. Participant feedback highlighted the value of multidisciplinary learning, group learning, case studies, enthusiastic leaders, and clinical exposure. The most common recommendation was teaching practical skills rather than purely theoretical content.

**Clinical Implications:** Frailty training programs are feasible and perceived as effective, but most assessed self-perceived efficacy rather than objective patient outcomes. Only one study assessed durability of changes beyond 3 months. Content focused heavily on frailty awareness rather than management strategies, which may limit impact on clinical practice. Barriers including time constraints, staffing, and stigma should be addressed in program design. The authors recommend systematic incorporation of frailty training into university and workplace education, with content covering not only awareness and assessment but also prevention and management, combined with longitudinal evaluation of patient outcomes.