Five reasons for the failure of frailty screening in primary care: lessons from the experience with ICOPE monitor step 1

Abstract

Background

In 2019, the World Health Organization (WHO) set the goal of reducing the number of dependent older people worldwide. To meet this objective, the Gérontopôle (centre on ageing) of Toulouse, France, implemented the WHO ICOPE Monitor digital application for frailty screening in older people. However, frailty screening in primary care remains limited.

In this qualitative study, the aim was to identify the factors that limit the use of ICOPE Monitor and the social representations surrounding its use, or not, by healthcare professionals.

Methods

The data was collected through observations, individual interviews and focus groups with healthcare professionals from two French primary care communities that include 449 healthcare professionals. Data analysis was based on the principles of grounded theory.

Results

Data analysis revealed a low use of ICOPE Monitor by healthcare professionals. Only 12% (56 of 449) of the healthcare professionals working in the two primary care communities followed the ICOPE training course. At the training end, 95% of the 56 healthcare professionals who underwent training expressed an interest in using ICOPE Monitor. However, only 10/56 healthcare professionals performed at least one ICOPE step 1 screening, but without the 6-month follow-up. After 2 months of use, difficulties were reported during the seventeen interviews and two focus groups, linked to the many definitions of the term “frailty”, the target population, the use of digital technology, time and financial constraints, and the lack of dedicated professionals.

Conclusions

The study highlighted the social and financial obstacles hindering the use of ICOPE Monitor and more broadly, the implementation of frailty screening by primary care practitioners.

Trial registration

NCT05541731 (ClinicalTrials.gov ID), registration date on 20,220,913.

Introduction

In 2019, the World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) handbook guidance on person-centred assessment and pathways in primary care with the goal of reducing the number of dependent older people worldwide [1]. This framework is structured in five steps and its objective is to maintain or restore the functional capacities of people aged 60 and over, in order to slow autonomy loss and promote healthy ageing [2]. The first step is to identify frailty through the assessment of six intrinsic capacity domains (vision, hearing, mobility, vitality, cognitive capacity, and psychological capacity) using the ICOPE Monitor digital application.

In France, the Gérontopôle (centre on ageing) of Toulouse has been implementing this framework and the ICOPE Monitor tool [3]. Although the tool usefulness has been widely recognised, its adoption by French healthcare professionals is difficult. As a result, the quantitative targets set for 2024 by the Toulouse Gérontopôle were far from being achieved in February 2023: only 30,239 older people entered the programme compared with the 200,000 planned inclusions [4]. Moreover, no qualitative analysis has been carried out among healthcare professionals who use this tool.

Therefore, the main objective of this qualitative study was to evaluate the feasibility and limitations of using the ICOPE Monitor digital tool for frailty screening in people older than 70 years of age in real-life primary care settings in two territorial and professional health communities (communautés professionnelles territoriales de santé; CPTS). Since 2016, in France, CPTS organise the coordinated local primary care services in a defined area (i.e., territory). The secondary sociological objective was to explore the healthcare professionals’ social representations, behaviours and relational dynamics concerning the use, or non-use, of this digital application for frailty screening.

Methods

This qualitative study was designed to collect information on the healthcare professionals’ representations and experiences concerning frailty screening.

The study was conducted by a sociologist (NP) trained in qualitative research methods (PhD). She had no previous relationship with any of the participants.The methodological approach followed the grounded theory methodology in which qualitative data are collected and then coded to allow the emergence of themes [5].

This study followed the consolidated criteria for reporting qualitative research (COREQ) and complied with all relevant items.

Population

The study was carried out at two CPTS located in an urban (Brest) and semi-rural area (Iroise) of the Brittany region, Western France. These CPTS include 449 healthcare professionals and 204,981 patients among whom 28,968 are older than 70 years of age. This age threshold was chosen for the study following the French National High Authority of Health recommendations according to which “the prevalence of frailty is low before the age of 70 years” [6].

In December 2022, one of the authors (AG) presented the study at the general meeting of the two CPTS that had agreed to participate in the project. Following this presentation, the 449 healthcare professionals who worked at these two CPTS were invited (e-mail message, poster, and newsletter) to participate in a training course on the use of ICOPE Monitor, with the aim of recruiting participants for the study. Those who were interested, were invited to attend one of ten training sessions, held between January and June 2023, either in person or by videoconference. These sessions were led by a geriatrician (AG) and a general practitioner (JYLR), lasted two hours, and brought together between one and eight healthcare professionals. The session started by defining frailty according to the criteria described by Fried et al. [7]. Then, it used the e-learning approach developed by the Toulouse Gérontopôle to present the ICOPE programme, its content and the different steps, and particularly how to complete step 1 (https://www.icope.fr/pro/formation). Participants were invited to download the ICOPE Monitor application (version 2.x) live. The geriatrician also presented the healthcare services available in the region (e.g. day hospital, memory consultations) that are guaranteed and accessible to everybody and coordinated.

The study inclusion criteria were to be a primary care professional who belonged to one of the two CPTS and who agreed to take part in the study on a voluntary basis.

Two months after the training course, the sociologist (NP) performed semi-structured interviews with a representative sample of primary care professionals who participated in the training session. Interviewees were selected using a purposive sampling strategy based on the following criteria: profession, gender, age, location and exercise mode (e.g. employee, private practice) (Table 1).

Table 1.

Characteristics of interviews with healthcare professionals (semi-structured interviews) (n = 17)

Profession	Age	Gender	Setting of data collection	Date of interview	Professional experience (years)	Exercise mode	CPTS	ICOPE application use	Position	Understood ICOPE value
CPTS manager	31	Female	University	11/04/23	1	Employee	Brest	No	Neutral	Yes
Nurse	54	Female	CPTS	25/04/23	31	Private Practice	Brest	Yes	Positive	Yes
Pharmacist	54	Male	University	11/05/23	25	Manager	Brest	No	Positive	No
General practitioner	57	Male	Videoconference	13/05/23	28	Private Practice	Brest	No	Negative	No
Pharmacist 2	34	Male	Videoconference	23/05/23	4	Employee	Iroise	No	Positive	Yes
General practitioner 2	40	Female	University	26/05/23	11	Private Practice	Iroise	No	Positive	Yes
Nurse specialised in chronic diseases 1	39	Female	Videoconference	31/05/23	17	Employee	Iroise	No	Neutral	No
Nurse specialised in chronic diseases 2	42	Female	Videoconference	06/06/23	19	Employee	Brest	No	Neutral	No
Manager, structure for home help in a rural area	38	Female	Videoconference	28/07/23	1	Employee	Iroise	No	Positive	No
Speech therapist	39	Female	Videoconference	01/08/23	15	Private Practice	Iroise	No	Neutral	No
Home helper	48	Female	Work place	11/08/23	6	Employee	Iroise	Yes	Positive	Yes
Home helper	58	Female	Workplace	17/08/23	27	Employee	Iroise	No	Neutral	Non
Home helper	35	Female	Workplace	21/08/23	4	Employee	Iroise	Yes	Positive	Yes
Physiotherapist	41	Female	Workplace	21/08/23	19	Private Practice	Iroise	No	Positive	Yes
Orthoptist	52	Female	Workplace	21/08/23	28	Private Practice	Brest	No	Neutral	No
Nurse	47	Female	Videoconference	24/08/23	22	Private Practice	Iroise	Yes	Positive	Yes
Home helper	59	Female	Workplace	31/08/23	37	Employee	Iroise	Yes	Positive	No
Total mean	45	14 women, 82%			17	9 employees, 52%	11 Iroise, 64%	5 yes, 29%	10 positive, 52%	8 yes, 47%

After the interview data analysis and theme identification, on 9 November 2023, a focus group was organised and conducted at each CPTS with volunteer healthcare professionals to discuss the themes identified in the interviews. All focus group participants were familiar with the ICOPE program through their professional experience. Four had previously participated in ICOPE training sessions, and three had been individually interviewed during an earlier phase of the study (Table 2).

Table 2.

Characteristics of the people who participated in the focus groups (n = 10)

Job	Gender	ICOPE training	Interviewees	Exercise mode	CPTS	ICOPE application use	Position	Understood ICOPE interest
Nurse	Woman	Yes	Yes	Private practice	Brest	Yes	Positive	Yes
Pharmacist	Man	Yes	Yes	Manager	Brest	No	Positive	No
Local manager of social activities for older adults	Woman	No	No	Employee	Brest	No	Neutral
Stand-in CPTS manager	Woman	No	No	Employee	Brest	No	Neutral
Department head - Administration	Woman	Yes	No	Employee	Iroise	No	Positive	No
Nurse	Woman	Yes	Yes	Private practice	Iroise	Yes	Positive	Yes
CPTS manager	Woman	No	No	Employee	Iroise	No	Neutral
Project manager URPS* - Measure 5**	Woman	No	No	Employee	Iroise	No	Positive
Geriatric care pathway nurse	Woman	No	No	Employee	Iroise	No	Neutral
Adjoint director - Amitiés d’Armor nursing home	Woman	No	No	Employee	Iroise	No	Neutral
Total mean		4	3			5	10

*URPS, regional association of healthcare professionals

 **Measure 5, measure for generalising specific care pathways for older adults in order to avoid emergency admissions

Data collection

Data were collected through field notes, observation, individual interviews and focus groups.

A thematic approach was followed. The main objective was to explore the healthcare professionals’ experiences and perceptions concerning the ICOPE Monitor frailty detection tool and to describe the social dynamics and meanings attributed to these experiences.

First, after being introduced, the sociologist attended all ten training sessions as a non-participant observer. The aim was to gain insights into the healthcare professionals’ opinions about the tool and frailty screening.

Second, interviews took place between 11 April and 31 August 2023. The aim was to assess the feasibility of frailty screening and to collect the healthcare professionals’ opinions on frailty screening/prevention. In the absence of a model in the literature, the interview guide was developed by triangulation that involved a geriatrician, a general practitioner and a sociologist (Table 3).

Table 3.

Interview guide

Thank you for your time. Before we begin this interview, which is complementary to the ICOPE training course you have attended, I would like to remind you that it is recorded and anonymous. Your answers will be used only for research, and will never be linked to your first or last name. For about 1 h, we will discuss various topics related to this application. I’m looking for your feedback. What’s important to me is to understand your point of view, how you see things. Primer: Can you tell me about your career to date?
THEME	Questions – Additional questions to go deeper
Training	1. How did you know about the ICOPE framework? 2. Why did you register to follow this training course? How did you find the training course? Influence of the training modality?
ICOPE application	1. Have you used the application? With whom, how many times, on which medium format, when, why? inclusion difficulties? If not, why? 2. Would you like to tell me how did it go? Time, interactions, difficulties? How did you overcome them? Examples of specific situations 3. What do you think about the tool? Ergonomics, qualities, weak points, strong points, value, appropriation, training of other professionals? 4. What are your suggestions for improving the tool? Expectations? improvements?
Research	1. Before ICOPE, did you already test other health applications? Circumstances, experience, utilisation, self-assessment, follow-up, care pathway, effect on the relationship with patients? 2. What do you think about health innovations? E-health tools? Expected effects in terms of health outcomes? 3. Has ICOPE increased your knowledge? About older adults? Frailty? Skills? 4. What are, in your opinion, the most important features for the success of this approach? Obstacles and levers? Differences among territories? CPTS relevance as levers?
Professional practices	1. Is screening part of your professional practice? 2. And multidisciplinary work? 3. Has ICOPE influenced your professional practice? Relationship with patients, with other professionals, constraints, positive points, care pathway, workload, communication tools? Tools to improve your practices? Capacity to assess?
Older adults	1. What is the place of older adults among your patients? Figures, management difficulties, adherence to the ICOPE programme, place of helpers, place of the older adult? 2. What is the place of dependent individuals? 3. How would you define frailty? The label ‘frail’, frailty screening, its value? A priority? 4. In your practice, do you witness age-related discriminations? And you, do you feel discriminated concerning your work with older adults?
Prevention	1. Have you already participated in prevention interventions? Interest in general, for older adults, place in your routine/relative to curative interventions, difficulties: difficult to implement? Several actors? 2. In your opinion, which impact could the ICOPE programme have in terms of prevention? Efficacity? Structuring side of the tool? 3. Overall, are you satisfied with the ICOPE programme? Would you recommend it? To whom? At what time? Would you like to better explain?
WOULD YOU LIKE TO ADD SOMETHING ELSE?
SOCIOLOGICAL PART
Work place, exercise mode (alone, multiprofessional health centre, in a group). Volume of activity (/week), years of professional experience. Number of collaborators, insertion in professional networks, CPTS.

Third, the focus groups allowed, through iterative coding during the analysis, to verify the thematic saturation and validate the results.

The Toulouse Gérontopôle, which manages the national ICOPE database, sent the number of frailty screenings carried out by healthcare professionals during the 15 months after their initial inclusion for the training course (i.e., until 19 April 2024).

Data analysis

All training sessions were audio recorded and processed with the Sonal software. All interviews were also recorded, fully transcribed and analysed using NVivo (QSR International, 2023). The transcripts were sent to the interviewees for review. They did not send back any comment or correction. The same approach was used for both focus groups.

The analysis of the qualitative data was based on the grounded theory principles: coding, identifying categories, and constant comparison. Codes and categories were discussed regularly by the research team to ensure rigour and consistency. Observational data were coded and analysed concomitantly with the interview and focus group transcripts. Field notes provided contextual information that enriched the understanding of the participants’ experiences and perceptions. The triangulation of observational data with the interview and focus group findings strengthened the analysis validity by integrating multiple perspectives and enhancing the depth of interpretation of the barriers to the primary care practitioners’ use of ICOPE Monitor.

Ethical aspects

The authors confirm that all methods were carried out in accordance with the relevant national guidelines and regulations. The participants’ oral consent was collected at the start of each interview/focus group. All audio recordings were destroyed after transcription and anonymisation.

Results

Between 19 January, 2023 and 19 April, 2024, 56/449 (12.5%) healthcare professionals followed one of the ten training sessions on step 1 of the ICOPE programme. Moreover, ten of them (i.e., 2% of all CPTS professionals) carried out frailty screening on 15 older adults (step 1). However, despite reminders, none of the people screened underwent the follow-up 6 months later, as required by the ICOPE framework. Seventeen healthcare professionals who participated in the training sessions (14 women and 3 men) were interviewed in semi-structured interviews that lasted 51 min, on average. Their mean age was 45 years and they had diverse professional backgrounds (Table 1). The group comprised both employees (n = 8) and self-employed (n = 9) healthcare professionals. Five of them had used the ICOPE Monitor application at least once.

Of the ten professionals who took part in the two focus groups, four had participated in the training course and three of them were interviewed.

Five main themes emerged (Fig. 1) on the reasons for not using ICOPE Monitor, although 95% of interviewees had a positive opinion of this tool/programme at the end of the training course.

Fig. 1.

Themes identified by the analysis of the interviews and focus group discussions

Representations of frailty

The first theme concerned the diversity of definitions of “frailty” and the negative connotations associated with this label. Healthcare professionals described it as a multifactorial process that is confused with the onset of dependency. They did not see it as a pathology that required immediate action, but as a condition that needed to be followed by healthcare professionals and families. Specifically, 94% of the interviewed healthcare professionals interpreted frailty as a negative concept. The semantic analysis revealed the use of terms, such as “risk”, “loss”, “difficulty”, “problem”, “imbalance”, “decline” and “disorders”, to describe this vague and negative concept. This negatively affected its recognition by healthcare professionals.

The unattainable target

Whatever the definition of frailty, healthcare professionals thought that targeting apparently robust older adults was not adapted to their practice. Indeed, the interviewed nurses and paramedical staff (speech therapists, orthoptists, physiotherapists) said that most of their patients already presented some loss of autonomy: “The patients we see have already been identified.” (nurse from the Brest CPTS). This predominant perspective highlights the limited practical value of frailty screening in patients who are already included in routine care.

Ambivalence of healthcare professionals concerning digital technology

The interviewed professionals were aware of the ongoing demographic changes (ageing population) and the economic, social and healthcare challenge of delaying dependency in older adults. The integration of digital technology, notably the ICOPE application, emerged as a potential response to the physicians’ shortage and the need to detect frailty in older adults. Similarly, the opinions on the digital tool expressed during the training sessions were mostly positive: ergonomic, functional, intuitive, interface on the phone adapted to dematerialised mobile practices, rapid and autonomous access. However, the analysis of the interviewees’ feedback concerning the application use revealed a number of technical and organisational obstacles: the need of a secure telephone for home helpers, and the need to enter an e-mail address, password and social security number. For healthcare professionals working in networks, such as pharmacists, access to the application was complicated because they had to exit their business software, installed on all monitors, to launch the ICOPE application. The two nurses specialised in chronic diseases said that they had never used the application because they preferred other questionnaires, which they considered more exhaustive. Overall, the professionals questioned the added value of the ICOPE tool compared with their own frailty detection grids. In their opinion, the digital tool relegated the healthcare professional’s qualities of empathy to a secondary position, undermining the healthcare-patient relationship. They all felt that they did not need a standardised tool, particularly a digital one, to identify frailty.

Professional organisation: treating versus screening

In France, the work organisation of healthcare professionals is primarily focused on care and not on prevention. General practitioner 2 said: “People come to us with other needs and until we have addressed these needs, they will not be able to access prevention.” This means that they did not have the time and the financial resources for preventive actions, which were always relegated to a second place by all the interviewed professionals. They systematically put forward the financial argument because preventive actions are not listed in the French healthcare system fee list. Prevention activity plans clashed with the daily practice realities, highlighting the difficulty of reconciling disease care and screening.

Ultimately, time constraints and reimbursement policies contribute to the marginalisation of preventive activities in primary care.

The professional classes

The social space within the CPTS was characterised by a multiplicity of professional actors. A hierarchy of professional discourse emerged within this complex social space, reflecting clear distinctions between different categories of healthcare professionals. This hierarchy of professional legitimacy, rooted in regulations and day-to-day practices, contributes to shape social dynamics to such an extent that some paramedics and home helpers did not feel legitimate to engage in prevention actions. They suggested that the task of identifying frailty should be entrusted to professionals outside the healthcare system. Pharmacist 2 said: “It seems to me that the ICOPE tool can be used by professionals who are not necessarily healthcare professionals (…), a family member or a person could self-assess, and that seems interesting to me.” This highlights how deep-rooted professional hierarchies and perceptions of legitimacy within the CPTS influence the roles individuals assume in frailty prevention, potentially limiting a broader participation in these crucial early detection efforts.

Discussion

Although the ICOPE Monitor digital application was praised for its functionality, it was not used by thetrained primary care professionals. Despite its nationwide rollout in summer 2025 [8], our qualitative analysis reveals persistent barriers to implementation in primary care.

First, although the standard definition of frailty was presented during the training session (i.e., a reduction of the physiological reserves leading to increased risk of adverse outcomes) [9], healthcare professionals interpreted the term variably, as previously reported in France [10–12]. Moreover, they often associated it with a negative and complex concept. This is in line with literature data that emphasise frailty elusive and multidimensional nature [13]. However, the effective coordination and integration of healthcare and social services, one of the WHO ICOPE framework objectives, requires a shared and accepted definition of frailty.

Second, the lack of funding for screening procedures and prevention activities was another major obstacle to the use of ICOPE in primary care. A prospective study was carried out at the Toulouse Gérontopôle on ICOPE implementation in the French healthcare system found that between 1 January 2020 and 18 November 2021, 1,711 healthcare professionals were trained in Occitanie (the region in which Toulouse is located), 10,903 older adults underwent the basic screening (step 1) and 70.4% of eligible participants had the 6-month follow-up [14]. Conversely, in the present study, only 12.5% of primary care professionals attended training, despite a proactive approach and strong communication, and the 6-month follow-up was not carried out. These differences could be explained by the different contexts: primary care professionals (this study) and day hospital where screening tests are regularly carried out (previous study). Moreover, their frailty screening campaign was coupled with the vaccination against COVID-19, and the frailty screening test was also carried out by older adults or their family. Nevertheless, like in the present study, the study at the Toulouse Gérontopôle reported an uptake almost ten times lower than expected, despite the financial support for screeners. In addition, linking prevention and care activities is a major challenge for healthcare professionals in France. Lack of time and human resources is a recurring obstacle that exacerbates recruitment difficulties. Financial constraints, particularly for healthcare professionals that are paid on a fee-for-service basis, underline the need to financially recognise preventive activities. Despite these challenges, some of the interviewed professionals, such as pharmacists, expressed a growing interest in prevention, while nurses and home helpers concentrated more on curative medical interventions.

The duality of screening and detection highlighted divergent approaches and objectives, reflecting the tension between medical tradition and contemporary concerns. The identification of frailty, which is often neglected and not very visible, takes place mainly at home, thus requiring an intuitive, qualitative approach [15]. This process raises cultural challenges linked to the perceptions of frailty and age. Therefore, prevention faces a number of challenges linked to the differences in healthcare professions, practices and objectives within the healthcare field [16].

Third, the ICOPE application was not routinely implemented because it was considered non-essential, restrictive and introducing a distance between patient and user. This lack of legitimacy limits its acceptability by healthcare professionals. Digital healthcare is at the crossroad of economic concerns, technology and healthcare. According to Michel Foucault, acceptability results from a set of conditions that make a set of practices acceptable [17].

This study found that although the ICOPE application was appreciated, its routine implementation was hindered mainly by time and financial constraints and also by questions about the application reliability and usefulness, concerns about the healthcare professional-patient relationship, data confidentiality and the healthcare professional’s status.

The reluctance to use the screening tool could also be linked to uncertainties about the subsequent, less standardised steps (in-depth assessment and care planning). Nevertheless, some professionals recognised the value of identifying frailty in older adults, while others saw the tool as a means of justification or persuasion.

Our analysis highlighted that integration and acceptance of digital tools in healthcare requires sociological considerations that go beyond technical aspects, as also supported by recent literature on barriers and facilitators to the use of digital health technologies by healthcare professionals [18].

Fourth, this study found that the population actually concerned by frailty screening often showed little interest or perceived the initiative as anxiety-causing. Many articles have described the ICOPE framework [14, 19, 20]. However, only one study investigated the difficulties encountered by healthcare professionals in reaching the target audience of non-dependent individuals over 60 years of age [21]. The authors explained that healthy, robust older adults often do not feel concerned by frailty prevention, although they are the primary target of the ICOPE framework. As most of them are not routinely followed by geriatricians, they recommend that all healthcare professionals working with older adults should adopt the ICOPE programme. The refusals observed by professionals and the quantitative data from the present study suggest that it would be interesting to further develop the practice of self-assessment using the ICOPE Monitor application.

Fifth, the healthcare professionals’ attitudes towards frailty ranged from fatalism to monitoring, empathy and anticipation, reflecting their respective specialties. The actors’ multiplicity generates social dynamics that are under construction, particularly among paramedical staff, some of whom expressed a divergence between their professional identity and ICOPE actions. Prevention disrupts the established order in this social class [22] that brings together different professionals focused on people’s care, creating a separation between prevention and care. In addition, the introduction of a new tool, which according to M. Callon is both a technical and “relational” instrument, can modify social dynamics, while maintaining some pre-existing asymmetries [23]. Although pharmacists and home helpers expressed a particular interest in screening tests, neither group had integrated the ICOPE application into their daily practice. These professions aspired to be recognised and legitimised as healthcare professionals and preventionists.

This sociological analysis revealed a hierarchy of roles, a complex dynamic among healthcare professionals, and societal issues that should be taken into account to improve the coordination and effectiveness of prevention interventions. A real involvement of managers and decisions-makers is required to promote and encourage the engagement of professionals in the ICOPE process and the change of their practices [20, 24].

Limitations

This study has several methodological limitations.

A selection bias may have occurred, as participants were volunteers already familiar with frailty prevention. Despite this, only 12% attended the training course, ten performed some frailty screenings, and none completed the 6-month follow-up. Some professional groups, such as social workers and nursing assistants, were non exhaustively represented. Only the perspectives of carers were collected, regardless of the perspectives of older adults, which could have enriched the findings leading to a possible information bias. In addition, a confusion bias may have occurred, as some participants might have conflated frailty screening, which is performed in robust individuals, with assessments of already frail persons.

Regarding transferability, the study was conducted in a single region, and its inclusion criteria may limit the generalisability of the results to other contexts or healthcare systems.

Finally, only the ICOPE Monitor (Step 1) was evaluated, without comparison to other validated frailty screening methods.

Among its strengths, this is, to our knowledge, the first study to use the ICOPE Monitor in primary care, providing valuable real-world insights into implementation challenges.

Practical recommendations

Based on the results of this study and the obstacles identified, several practical suggestions could facilitate frailty prevention and the adoption of digital tools in primary care.

Addressing the semantic question surrounding the term “frailty” among healthcare and social sector professionals and the concerned individuals is necessary to adapt communication strategies and improve acceptance of frailty screening [15].

Expanding screening training beyond traditional healthcare professionals to include social sector actors and local authorities is important given the growing shortage of healthcare workers.

Designing digital tools for broad and inclusive use ensures user-friendliness for a wide range of users, including healthcare professionals, older adults, and caregivers.

Strengthening the culture of prevention among professionals and the public highlights the importance of frailty early identification and monitoring, thereby promoting healthy ageing and adherence to prevention programmes.

Enhancing training in geriatrics and gerontology during healthcare professional education, with a focus on frailty prevention, fosters interprofessional collaboration and empowers practitioners, consistent with the recommendations by Sum et al. [20].

Allocating adequate and sustainable resources supports ambitious and effective frailty prevention measures and their integration into professional practice [24].

Conclusion

This study revealed that in France, primary care professionals do not routinely use the ICOPE Monitor application (step 1) for frailty screening in > 70-year-old people. Several factors help to explain this situation: diverse and often negative representations of frailty; difficulty in reaching the target group of non-dependent older adults; technological barriers related to acceptability and tool legitimacy; time constraints and lack of financial recognition for preventive activities; and professional and social hierarchical dynamics that limit collaboration and communication in prevention.

Given these challenges, it is necessary to rethink frailty identification approaches in primary care, for instance through the intervention of actors dedicated to prevention. Their role would be to establish a relationship of trust with older adults and to use digital tools as a complementary support for a more personalised and effective monitoring. In addition, future qualitative studies should investigate the targeted people’s willingness to undergo frailty screening.

Abbreviations

CPTS

Territorial and professional health communities (communautés professionnelles territoriales de santé)

COREQ

Consolidated Criteria for Reporting Qualitative Research

ICOPE

Integrated Care for Older People

WHO

World Health Organization

Authors’ contributions

The individual contributions of the authors were as followed: NP: observed the participants’ training, data acquisition, analysis and interpretation, writing- original draft preparation, writing-review and editing, validation. AG: concept and design, conceptualization, methodology, supervised the training of participants, writing-review and editing, validation. ALG: writing-review and editing. AT: writing-review and editing. JYLR: funding acquisition, supervision, concept and design, methodology, supervised the training of participants, writing-review and editing, validation. All authors have read and agreed to the published version of the manuscript.

Funding

This study was supported by a grant from the French Ministry of Health (ReSP-IR 2021, RESP_IR2021_B_LERESTE).

Data availability

The datasets used and analysed during the current study are available from the corresponding author on reasonable request. All data generated during this study are included in this published article.

Declarations

Ethics approval and consent to participate

The clinical study was performed in accordance with the Declaration of Helsinki and approved by the ethics committee of Brest University Hospital in December 2022 (number B2022CE.31). The written informed consent was obtained from all of the participants. All audio recordings were destroyed after transcription and anonymization.

Consent for publication

N/A.

Competing interests

The authors declare no competing interests.