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Kerminen H, Huhtala H, Jäntti P, Valvanne J, Jämsen E. Frailty Index and functional level upon admission predict hospital outcomes: an interRAI-based cohort study of older patients in post-acute care hospitals. BMC Geriatr 2020; 20:160. [PMID: 32370740 PMCID: PMC7201739 DOI: 10.1186/s12877-020-01550-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Geriatric assessment upon admission may reveal factors that contribute to adverse outcomes in hospitalized older patients. The purposes of this study were to derive a Frailty Index (FI-PAC) from the interRAI Post-Acute Care instrument (interRAI-PAC) and to analyse the predictive ability of the FI-PAC and interRAI scales for hospital outcomes. METHODS This retrospective cohort study was conducted by combining patient data from interRAI-PAC with discharge records from two post-acute care hospitals. The FI-PAC was derived from 57 variables that fulfilled the Frailty Index criteria. Associations of the FI-PAC and interRAI-PAC scales (ADLH for activities of daily living, CPS for cognition, DRS for mood, and CHESS for stability of health status) with hospital outcomes (prolonged hospital stay ≥90 days, emergency department admission during the stay, and in-hospital mortality) were analysed using logistic regression and ROC curves. RESULTS The cohort included 2188 patients (mean age (SD) 84.7 (6.3) years) who were hospitalized in two post-acute care hospitals. Most patients (n = 1691, 77%) were discharged and sent home. Their median length of stay was 35 days (interquartile range 18-87 days), and 409 patients (24%) had a prolonged hospital stay. During their stay, 204 patients (9%) were admitted to the emergency department and 231 patients (11%) died. The FI-PAC was normally distributed (mean (SD) 0.34 (0.15)). Each increase of 0.1 point in the FI-PAC increased the likelihood of prolonged hospital stay (odds ratio [95% CI] 1.91 [1.73─2.09]), emergency admission (1.24 [1.11─1.37]), and in-hospital death (1.82 [1.63─2.03]). The best instruments for predicting prolonged hospital stay and in-hospital mortality were the FI-PAC and the ADLH scale (AUC 0.75 vs 0.72 and 0.73 vs 0.73, respectively). There were no differences in the predictive abilities of interRAI scales and the FI-PAC for emergency department admission. CONCLUSIONS The Frailty Index derived from interRAI-PAC predicts adverse hospital outcomes. Its predictive ability was similar to that of the ADLH scale, whereas other interRAI-PAC scales had less predictive value. In clinical practice, assessment of functional ability is a simple way to assess a patient's prognosis.
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Affiliation(s)
- Hanna Kerminen
- Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), Tampere University, P.O. Box 100, 33014, Tampere, Finland. .,Centre of Geriatrics, Tampere University Hospital, Central Hospital, P.O. Box 2000, 33521, Tampere, Finland.
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland
| | - Pirkko Jäntti
- Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), Tampere University, P.O. Box 100, 33014, Tampere, Finland
| | - Jaakko Valvanne
- Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), Tampere University, P.O. Box 100, 33014, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), Tampere University, P.O. Box 100, 33014, Tampere, Finland.,Centre of Geriatrics, Tampere University Hospital, Central Hospital, P.O. Box 2000, 33521, Tampere, Finland
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Kaeppeli T, Rueegg M, Dreher-Hummel T, Brabrand M, Kabell-Nissen S, Carpenter CR, Bingisser R, Nickel CH. Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Ann Emerg Med 2020; 76:291-300. [PMID: 32336486 DOI: 10.1016/j.annemergmed.2020.03.028] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE We validate the Clinical Frailty Scale by examining its independent predictive validity for 30-day mortality, ICU admission, and hospitalization and by determining its reliability. We also determine frailty prevalence in our emergency department (ED) as measured with the Clinical Frailty Scale. METHODS This was a prospective observational study including consecutive ED patients aged 65 years or older, from a single tertiary care center during a 9-week period. To examine predictive validity, association with mortality was investigated through a Cox proportional hazards regression; hospitalization and ICU transfer were investigated through multivariable logistic regression. We assessed reliability by calculating Cohen's weighted κ for agreement of experts who independently assigned Clinical Frailty Scale levels, compared with trained study assistants. Frailty was defined as a Clinical Frailty Scale score of 5 and higher. RESULTS A total of 2,393 patients were analyzed in this study, of whom 128 died. Higher frailty levels were associated with higher hazards for death independent of age, sex, and condition (medical versus surgical). The area under the curve for 30-day mortality prediction was 0.81 (95% confidence interval [CI] 0.77 to 0.85), for hospitalization 0.72 (95% CI 0.70 to 0.74), and for ICU admission 0.69 (95% CI 0.66 to 0.73). Interrater reliability between the reference standard and the study team was good (weighted Cohen's κ was 0.74; 95% CI 0.64 to 0.85). Frailty prevalence was 36.8% (n=880). CONCLUSION The Clinical Frailty Scale appears to be a valid and reliable instrument to identify frailty in the ED. It might provide ED clinicians with useful information for decisionmaking in regard to triage, disposition, and treatment.
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Affiliation(s)
- Tobias Kaeppeli
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marco Rueegg
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Dreher-Hummel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Søren Kabell-Nissen
- Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland.
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Frailty and Associated Outcomes and Resource Utilization Among Older ICU Patients With Suspected Infection. Crit Care Med 2020; 47:e669-e676. [PMID: 31135504 DOI: 10.1097/ccm.0000000000003831] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Suspected infection and sepsis are common conditions seen among older ICU patients. Frailty has prognostic importance among critically ill patients, but its impact on outcomes and resource utilization in older patients with suspected infection is unknown. We sought to evaluate the association between patient frailty (defined as a Clinical Frailty Scale ≥ 5) and outcomes of critically ill patients with suspected infection. We also evaluated the association between frailty and the quick Sequential Organ Failure Assessment score. DESIGN Analysis of a prospectively collected registry. SETTING Two hospitals within a single tertiary care level hospital system between 2011 and 2016. PATIENTS We analyzed 1,510 patients 65 years old or older (at the time of ICU admission) and with suspected infection at the time of ICU admission. Of these, 507 (33.6%) were categorized as "frail" (Clinical Frailty Scale ≥ 5). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was in-hospital mortality. A total of 558 patients (37.0%) died in-hospital. Frailty was associated with increased risk of in-hospital death (adjusted odds ratio, 1.81 [95% CIs, 1.34-2.49]). Frailty was also associated with higher likelihood of discharge to long-term care (adjusted odds ratio, 2.06 [95% CI, 1.50-2.64]) and higher likelihood of readmission within 30 days (adjusted odds ratio, 1.83 [95% CI, 1.38-2.34]). Frail patients had increased ICU resource utilization and total costs. The combination of frailty and quick Sequential Organ Failure Assessment greater than or equal to 2 further increased the risk of death (adjusted odds ratio, 7.54 [95% CI, 5.82-9.90]). CONCLUSIONS The presence of frailty among older ICU patients with suspected infection is associated with increased mortality, discharge to long-term care, hospital readmission, resource utilization, and costs. This work highlights the importance of clinical frailty in risk stratification of older ICU patients with suspected infection.
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Aranha ANF, Smitherman HC, Patel D, Patel PJ. Association of Hospital Readmissions and Survivability With Frailty and Palliative Performance Scores Among Long-Term Care Residents. Am J Hosp Palliat Care 2020; 37:716-720. [PMID: 32116000 DOI: 10.1177/1049909120907602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Frailty and palliative performance scores are 2 markers used in the measurement of functional decline in oncology and hospice care. OBJECTIVE To evaluate the frailty and palliative performance scores of a long-term care resident community and determine whether frailty and palliative performance scores can predict hospital readmissions (HR) and survivability of the long-term care resident. METHODS One hundred seventy-one long-term care residents from 2 urban facilities were evaluated for functional decline using the Clinical Frailty Scale (CFS) and Palliative Performance Scale (PPS). Sociodemographic, HR, and survival data for 1 year from study initiation were recorded. RESULTS The 171 long-term care residents, of lower socioeconomic status, primarily Medicare/Medicaid or dual-eligible, evaluated for functional decline using the CFS and PPS, had mean age of 73.1 years, 52.6% female, 94.7% African American, with 18.1% having HR and 87.1% surviving more than a year. There was a negative association between age and HR (P = .384). Among functional evaluation scales, CFS was positively associated with age (P = .013) but not PPS (P = .673). The residents scored 6.0 ± 1.2 on CFS and 52.8 ± 13.2 on PPS (%) with those residents readmitted to hospital having poorer outcomes. Readmission to hospital and survivability of the long-term care resident were both strongly associated with CFS (P = .001) and PPS (P = .001). CONCLUSION There is a strong association between the 2 markers used in the measurement of functional decline-Frailty measured by CFS and Palliative Performance Score measured by PPS. Frailty and palliative performance scores can strongly predict HR and survivability of the long-term care resident.
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Affiliation(s)
- Anil N F Aranha
- Department of Diversity and Inclusion, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Medical Education, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Internal Medicine/Geriatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Herbert C Smitherman
- Diversity and Community Affairs, Wayne State University School of Medicine, Detroit, MI, USA
| | - Dhaval Patel
- Department of Internal Medicine/Geriatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pragnesh J Patel
- Department of Internal Medicine/Geriatrics, Wayne State University School of Medicine, Detroit, MI, USA
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A Pilot Study of the Clinical Frailty Scale to Predict Frailty Transition and Readmission in Older Patients in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051582. [PMID: 32121380 PMCID: PMC7084649 DOI: 10.3390/ijerph17051582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is gaining increasing acceptance due to its simplicity and applicability. AIMS This pilot study aims to examine the role of CFS in identifying the prevalence of frailty, frailty transition, and the impact of frailty on readmission after discharge in older hospitalized patients. METHODS Patients aged ≥60 admitted to the geriatric ward of a hospital in Vietnam were recruited from 9/2018-3/2019 and followed for three months. Frailty was assessed before discharge and after three months, using the CFS (robust: score 1-2, pre-frail: 3-4, and frail: ≥5). Multivariate logistic regression was applied to investigate the associated factors of frailty transition and the impact of frailty on readmission. RESULTS There were 364 participants, mean age 74.9, 58.2% female. At discharge, 4 were robust, 160 pre-frail, 200 frail. Among the 160 pre-frail participants at discharge, 124 (77.5%) remained pre-frail, and 36 (22.5%) became frail after 3 months. Age (adjusted OR1.09, 95% CI 1.03-1.16), number of chronic diseases (adjusted OR 1.37, 95% CI 1.03-1.82), and polypharmacy at discharge (adjusted OR 3.68, 95% CI 1.15-11.76) were significant predictors for frailty after 3 months. A frailty status at discharge was significantly associated with increased risk of readmission (adjusted OR2.87, 95% CI 1.71-4.82). CONCLUSIONS Frailty was present in half of the participants and associated with increased risk of readmission. This study suggests further studies to explore the use of the CFS via phone calls for monitoring patients' frailty status after discharge, which may be helpful for older patients living in rural and remote areas.
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56
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Chua XY, Toh S, Wei K, Teo N, Tang T, Wee SL. Evaluation of clinical frailty screening in geriatric acute care. J Eval Clin Pract 2020; 26:35-41. [PMID: 30632249 DOI: 10.1111/jep.13096] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND While frailty status is an attractive risk stratification tool, the evaluation of frailty in acute care can be challenging as some inpatients are unable to complete performance-based tests as part of frailty assessment and some tools may lack discriminative ability and categorize majority of cohorts as "frail". In this study, we evaluated the feasibility of frailty screening with the simple clinical frailty scale (CFS) by different clinicians, and its association with mortality and rehospitalization in a geriatric acute care setting. METHODS This study took place in Geriatric Medicine Department of a General Hospital in Singapore. We analysed records of 314 inpatients aged 70 years and older. At baseline, premorbid frailty was assessed using the CFS of the Canadian Study on Health and Aging. Demographic characteristics and other variables were retrieved from their medical records. Primary outcomes were mortality and rehospitalization during the 6-month follow-up. Survival analysis was used to compare the time to death and rehospitalization among CFS categories (1-4: nonfrail, 5-6: mild-moderate frail, and 7-8: severe frail). RESULTS CFS showed a high inter-rater reliability when used by different clinicians. In the Cox proportional hazard model controlling for age, gender, Charlson comorbidity index, modified severity of illness index, and discharge placements, severe frailty determined by CFS (HR = 2.09, 95% CI = 1.01-4.33, P = 0.047) and CFS scores (HR = 1.27, 95% CI = 1.05-1.53, P = 0.012) were significantly associated with higher mortality until 6-month postdischarge, but not rehospitalization. CONCLUSION Frailty status determined by CFS adds to disease severity and comorbidity in predicting short-term mortality but not rehospitalization in older inpatients who received geriatric acute care in our setting. CFS is reliable and has the potential to be incorporated into routine screening to better identify, communicate, and address frailty in the acute settings.
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Affiliation(s)
- Xin Ying Chua
- Geriatric Education and Research Institute, Singapore
| | - Sabrina Toh
- Khoo Teck Puat Hospital, National Healthcare Group, Singapore
| | - Kai Wei
- Geriatric Education and Research Institute, Singapore
| | - Nigel Teo
- Geriatric Education and Research Institute, Singapore
| | - Terence Tang
- Khoo Teck Puat Hospital, National Healthcare Group, Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute, Singapore.,Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
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58
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Marincowitz C, Lecky FE, Allgar V, Hutchinson P, Elbeltagi H, Johnson F, Quinn E, Tarantino S, Townend W, Kolias AG, Sheldon TA. Development of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study. J Neurotrauma 2020; 37:324-333. [PMID: 31588845 PMCID: PMC6964807 DOI: 10.1089/neu.2019.6652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
International guidelines recommend routine hospital admission for all patients with mild traumatic brain injury (TBI) who have injuries on computed tomography (CT) brain scan. Only a small proportion of these patients require neurosurgical or critical care intervention. We aimed to develop an accurate clinical decision rule to identify low-risk patients safe for discharge from the emergency department (ED) and facilitate earlier referral of those requiring intervention. A retrospective cohort study of case notes of patients admitted with initial Glasgow Coma Scale 13-15 and injuries identified by CT was completed. Data on a primary outcome measure of clinically important deterioration (indicating need for hospital admission) and secondary outcome of neurosurgery, intensive care unit admission, or intubation (indicating need for neurosurgical admission) were collected. Multi-variable logistic regression was used to derive models and a risk score predicting deterioration using routinely reported clinical and radiological candidate variables identified in a systematic review. We compared the performance of this new risk score with the Brain Injury Guideline (BIG) criteria, derived in the United States. A total of 1699 patients were included from three English major trauma centers. A total of 27.7% (95% confidence interval [CI], 25.5-29.9) met the primary and 13.1% (95% CI, 11.6-14.8) met the secondary outcomes of deterioration. The derived clinical decision rule suggests that patients with simple skull fractures or intracranial bleeding <5 mm in diameter who are fully conscious could be safely discharged from the ED. The decision rule achieved a sensitivity of 99.5% (95% CI, 98.1-99.9) and specificity of 7.4% (95% CI, 6.0-9.1) to the primary outcome. The BIG criteria achieved the same sensitivity, but lower specificity (5%). Our empirical models showed good predictive performance and outperformed the BIG criteria. This would potentially allow ED discharge of 1 in 20 patients currently admitted for observation. However, prospective external validation and economic evaluation are required.
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Affiliation(s)
- Carl Marincowitz
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Fiona E. Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Victoria Allgar
- Hull York Medical School, John Hughlings Jackson Building, University of York, Heslington, United Kingdom
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Hadir Elbeltagi
- Emergency Department, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Faye Johnson
- Salford Royal Hospital, Acute Research Delivery Team, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Eimhear Quinn
- Emergency Department, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Silvia Tarantino
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Will Townend
- Emergency Department, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Trevor A. Sheldon
- Department of Health Sciences, University of York, Alcuin Research Resource Centre, Heslington, United Kingdom
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Yoshioka N, Takagi K, Morishima I, Morita Y, Uemura Y, Inoue Y, Umemoto N, Shibata N, Negishi Y, Yoshida R, Tanaka A, Ishii H, Murohara T. Influence of Preadmission Frailty on Short- and Mid-Term Prognoses in Octogenarians With ST-Elevation Myocardial Infarction. Circ J 2019; 84:109-118. [DOI: 10.1253/circj.cj-19-0467] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | - Yosuke Inoue
- Department of Cardiology, Tosei General Hospital
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital
| | - Naoki Shibata
- Department of Cardiology, Ichinomiya Municipal Hospital
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Ruka Yoshida
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Ng SCW, Kwan YH, Yan S, Tan CS, Low LL. The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns. BMC Health Serv Res 2019; 19:931. [PMID: 31801537 PMCID: PMC6894210 DOI: 10.1186/s12913-019-4769-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we propose that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. In this study, we segmented a high-risk population with the aim to identify and characterize a patient subgroup with the highest 30-day and 90-day hospital readmission and mortality. METHODS We extracted data from our transitional care program (TCP), a Hospital-to-Home program launched by the Singapore Ministry of Health, from June to November 2018. Latent class analysis (LCA) was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess the association of class membership on 30- and 90-day all-cause readmission and mortality. RESULTS Among 752 patients, a 3-class best fit model was selected: Class 1 "Frail, cognitively impaired and physically dependent", Class 2 "Pre-frail, but largely physically independent" and Class 3 "Physically independent". The 3 classes have distinct demographics, medical and socioeconomic characteristics (p < 0.05), 30- and 90-day readmission (p < 0.05) and mortality (p < 0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR = 2.04, 95%CI: 1.21-3.46, p = 0.008), 30- (OR = 6.92, 95%CI: 1.76-27.21, p = 0.006) and 90-day mortality (OR = 11.51, 95%CI: 4.57-29.02, p < 0.001). CONCLUSIONS We identified a subgroup with the highest readmission and mortality risk amongst high-risk patients. We also found a lack of interventions in our TCP that specifically addresses increased frailty and poor cognition, which are prominent features in this subgroup. These findings will help to inform future program modifications and strengthen existing transitional healthcare structures currently utilized in this patient cohort.
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Affiliation(s)
| | - Yu Heng Kwan
- Duke-NUS Medical School, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Shi Yan
- Duke-NUS Medical School, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore.
- Department in Family Medicine and Continuing Care, Population Health and Integrated Care Office, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
- Singhealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore.
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Clark S, Shaw C, Padayachee A, Howard S, Hay K, Frakking TT. Frailty and hospital outcomes within a low socioeconomic population. QJM 2019; 112:907-913. [PMID: 31386153 DOI: 10.1093/qjmed/hcz203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clinical frailty scales (CFS) predict hospital-related outcomes. Frailty is more common in areas of higher socioeconomic disadvantage, but no studies exclusively report on the impact of CFS on hospital-related outcomes in areas of known socioeconomic disadvantage. AIMS To evaluate the association of the CFS with hospital-related outcomes. DESIGN Retrospective observational study in a community hospital within a disadvantaged area in Australia (Social Economic Index for Areas = 0.1%). METHODS The CFS was used in the emergency department (ED) for people aged ≥ 75 years. Frailty was defined as a score of ≥4. Associations between the CFS and mortality, admission rates, ED presentations and length of stay (LOS) were analysed using regression analyses. RESULTS Between 11 July 2017 and 31 March 2018, there were 5151 ED presentations involving 3258 patients aged ≥ 75 years. Frail persons were significantly more likely to be older, represent to the ED and have delirium compared with non-frail persons. CFS was independently associated with 28-day mortality, with odds of mortality increasing by 1.5 times per unit increase in CFS (95% CI: 1.3-1.7). Frail persons with CFS 4-6 were more likely to be admitted (OR: 1.2; 95% CI: 1.0-1.5), have higher geometric mean LOS (1.43; 95% CI 1.15-1.77 days) and higher rates of ED presentations (IRR: 1.12; 95% CI 1.04-1.21) compared with non-frail persons. CONCLUSIONS The CFS predicts community hospital-related outcomes in frail persons within a socioeconomic disadvantage area. Future intervention and allocation of resources could consider focusing on CFS 4-6 as a priority for frail persons within a community hospital setting.
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Affiliation(s)
- S Clark
- Emergency Department, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - C Shaw
- Emergency Department, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - A Padayachee
- Projects and Service Partnerships, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - S Howard
- Nursing Informatics, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - K Hay
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - T T Frakking
- Caboolture Hospital, Research Development Unit, Queensland Health, McKean St, Caboolture, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
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Shinohara M, Wada R, Yao S, Yano K, Akitsu K, Koike H, Kinoshita T, Yuzawa H, Suzuki T, Fujino T, Ikeda T. Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty. J Arrhythm 2019; 35:795-803. [PMID: 31844468 PMCID: PMC6898529 DOI: 10.1002/joa3.12231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/23/2019] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The safety and efficacy of an oral anticoagulant (OAC) treatment and the difference between direct OACs (DOACs) and warfarin in nonsevere frail elderly patients with AF are unclear. METHODS This was a retrospective and observational study of 354 patients over 80 years of age with nonsevere frailty who were diagnosed with AF and treated with OACs. Nonsevere frailty was defined as a clinical frailty scale score of <7. Bleeding and thromboembolic events during the OAC treatment were followed up. RESULTS Of 354 patients enrolled, 273 (77.1%) received DOACs and 81 (22.9%) received warfarin. Of 273 patients receiving DOACs, there were 210 (76.9%) prescribed with appropriate doses of DOACs. Of 81 warfarin-treated patients, 53 (65.4%) were prescribed an appropriate dose of warfarin. During a follow-up of 33.1 (14.0-51.0) months, 15 patients (1.5/100 person-years) had bleeding events and 10 (1.0/100 person-years) had thromboembolic events while on an OAC treatment. The incidence ratio of bleeding events in patients receiving DOACs was lower than that in those receiving warfarin (1.0/100 person-years vs 2.9/100 person-years, hazard ratio [HR]: 0.26, 95% confidence interval [CI]: 0.07-0.91, P = .036). There was no significant difference in the incidence of thromboembolic events between the DOAC and warfarin treatment groups (0.88/100 person-years vs 1.4/100 person-years, HR: 0.63, 95% CI: 0.16-2.57, P = .52). CONCLUSIONS OACs are substantially safe and effective for preventing thromboembolic events in nonsevere frail patients over 80 years of age. Particularly, DOACs can be used more safely than warfarin.
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Affiliation(s)
- Masaya Shinohara
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Ryou Wada
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Shintaro Yao
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Kensuke Yano
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Katsuya Akitsu
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Hideki Koike
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Toshio Kinoshita
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Hitomi Yuzawa
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Takeya Suzuki
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Tadashi Fujino
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
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The Predictive Value of the Clinical Frailty Scale on Discharge Destination and Complications in Older Hip Fracture Patients. J Orthop Trauma 2019; 33:497-502. [PMID: 31188261 DOI: 10.1097/bot.0000000000001518] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether the Clinical Frailty Scale (CFS), a validated frailty tool, was associated with discharge destination. Secondary objectives were to determine whether the CFS was associated with in-hospital complications and length of stay. DESIGN This is a 5-year retrospective cohort study. SETTING The study took place at an academic Level 1 trauma center. PATIENTS/PARTICIPANTS All patients 65 years of age and older admitted with an isolated hip fracture were included (N = 423). INTERVENTION Preadmission CFS was determined as part of routine clinical care prospectively and abstracted from the chart. MAIN OUTCOME MEASUREMENTS We collected demographic and process data associated with adverse outcomes (age, sex, time to surgery, and mode of anesthesia) and used multivariable logistic regression to determine the association between CFS with discharge destination, in-hospital complications, and length of stay. RESULTS Preadmission frailty was independently associated with adverse discharge destination (adjusted odds ratio 23.0; 95% confidence interval, 3.0-173.5) and in-hospital complications (adjusted odds ratio 4.8; 95% confidence interval, 2.1-10.8) in greater magnitude than traditional risk factors such as age, male sex, time to surgery, and mode of anesthesia. There was a dose-response relationship between increasing frailty and length of stay (P < 0.001). CONCLUSIONS Preadmission frailty as quantified by the CFS is associated with discharge destination, in-hospital complications, and length of stay. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Moth EB, Blinman P, Stefanic N, Naganathan V, Grimison P, Stockler MR, Beale P, Martin A, Kiely BE. Estimating survival time in older adults receiving chemotherapy for advanced cancer. J Geriatr Oncol 2019; 11:617-625. [PMID: 31501013 DOI: 10.1016/j.jgo.2019.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE We determined the accuracy of oncologists' estimates of expected survival time (EST) for older adults with advanced cancer, and explored predictors of survival from a geriatric assessment (GA). METHODS Patients aged ≥65 years starting a new line of palliative chemotherapy were eligible. For each patient at enrolment, oncologists estimated EST and rated frailty (Canadian Study on Health and Aging Clinical Frailty Scale, 1 = very fit, to 7 = severely frail), and a researcher completed a GA. We anticipated estimates of EST to be: imprecise [<33% between 0.67 and 1.33 times the observed survival time (OST)]; unbiased (approximately 50% of participants living longer than their EST); and, useful for estimating individualised worst-case (10% living ≤¼ times their EST), typical (50% living half to double EST), and best-case (10% living ≥3 times EST) scenarios for survival time. Logistic regression was used to identify independent predictors of OST. RESULTS The 102 participants [median age 74 years, vulnerable to frail (4-7 on scale) 35%] had a median OST of 15 months. 30% of estimates of EST were within 0.67-1.33 times the OST. 54% of participants lived longer than their EST, 9% lived ≤1/4 of their EST and 56% lived half to double their EST. Follow-up was insufficient to observe those living ≥3 times their EST. Independent predictors of OST were frailty (HR 4.16, p < .0001) and cancer type (p = .003). CONCLUSIONS Oncologists' estimates of EST were imprecise, but unbiased and accurate for formulating scenarios for survival. A pragmatic frailty rating was identified as a potentially useful predictor of OST.
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Affiliation(s)
- Erin B Moth
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - Prunella Blinman
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | | | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter Grimison
- University of Sydney, Sydney, Australia; Chris O'Brien Lifehouse, Sydney, Australia
| | - Martin R Stockler
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Philip Beale
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | | | - Belinda E Kiely
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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Mather S, Hanley M. The development of an acute frailty team. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-3-s75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mather S, Hanley M. The development of an acute frailty team. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-3s-s75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Li Y, Pederson JL, Churchill TA, Wagg AS, Holroyd-Leduc JM, Alagiakrishnan K, Padwal RS, Khadaroo RG. Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study. CMAJ 2019; 190:E184-E190. [PMID: 29565018 DOI: 10.1503/cmaj.161403] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Frailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients. METHODS We prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer than 3 activities of daily living. Preadmission frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale as "well" (score 1 or 2), "vulnerable" (score 3 or 4) or "frail" (score 5 or 6). We assessed composite end points of 30-day and 6-month all-cause readmission or death by multivariable logistic regression. RESULTS Of 308 patients (median age 75 [range 65-94] yr, median Clinical Frailty Score 3 [range 1-6]), 168 (54.5%) were classified as vulnerable and 68 (22.1%) as frail. Ten (4.2%) of those classified as vulnerable or frail received a geriatric consultation. At 30 days after discharge, the proportions of patients who were readmitted or had died were greater among vulnerable patients (n = 27 [16.1%]; adjusted odds ratio [OR] 4.60, 95% confidence interval [CI] 1.29-16.45) and frail patients (n = 12 [17.6%]; adjusted OR 4.51, 95% CI 1.13-17.94) than among patients who were well (n = 3 [4.2%]). By 6 months, the degree of frailty independently and dose-dependently predicted readmission or death: 56 (33.3%) of the vulnerable patients (adjusted OR 2.15, 95% CI 1.01-4.55) and 37 (54.4%) of the frail patients (adjusted OR 3.27, 95% CI 1.32-8.12) were readmitted or had died, compared with 11 (15.3%) of the patients who were well. INTERPRETATION Vulnerability and frailty were prevalent in older patients undergoing surgery and unlikely to trigger specialized geriatric assessment, yet remained independently associated with greater risk of readmission for as long as 6 months after discharge. Therefore, the degree of frailty has important prognostic value for readmission. TRIAL REGISTRATION FOR PRIMARY STUDY ClinicalTrials.gov, no. NCT02233153.
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Affiliation(s)
- Yibo Li
- Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta
| | - Jenelle L Pederson
- Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta
| | - Thomas A Churchill
- Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta
| | - Adrian S Wagg
- Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta
| | - Jayna M Holroyd-Leduc
- Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta
| | - Kannayiram Alagiakrishnan
- Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta
| | - Raj S Padwal
- Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta
| | - Rachel G Khadaroo
- Departments of Surgery (Li, Pederson, Churchill, Khadaroo), Medicine (Wagg, Alagiakrishnan, Padwal) and Critical Care Medicine (Khadaroo), University of Alberta; Alberta Seniors Health Strategic Clinical Network (Wagg, Alagiakrishnan), Alberta; Departments of Medicine (Holroyd-Leduc) and Community Health Sciences (Holroyd-Leduc), University of Calgary, Calgary, Alta.; Alberta Diabetes Institute (Padwal), Edmonton, Alta.
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Faller JW, Pereira DDN, de Souza S, Nampo FK, Orlandi FDS, Matumoto S. Instruments for the detection of frailty syndrome in older adults: A systematic review. PLoS One 2019; 14:e0216166. [PMID: 31034516 PMCID: PMC6488093 DOI: 10.1371/journal.pone.0216166] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022] Open
Abstract
Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.
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Affiliation(s)
- Jossiana Wilke Faller
- Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil
- * E-mail:
| | - David do Nascimento Pereira
- Program in Health Promotion and Care in Hospital Care of the Medical School of the University of São Paulo, São Paulo, Brazil
| | - Suzana de Souza
- Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil
| | - Fernando Kenji Nampo
- Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil
| | - Fabiana de Souza Orlandi
- Department of Gerontology of the Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Silvia Matumoto
- Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil
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Chong E, Chia JQ, Law F, Chew J, Chan M, Lim WS. Validating a Standardised Approach in Administration of the Clinical Frailty Scale in Hospitalised Older Adults. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2019. [DOI: 10.47102/annals-acadmedsg.v48n4p115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: We developed a Clinical Frailty Scale algorithm (CFS-A) to minimise inter-rater variability and to facilitate wider application across clinical settings. We compared the agreement, diagnostic performance and predictive utility of CFS-A against standard CFS. Materials and Methods: We retrospectively analysed data of 210 hospitalised older adults (mean age, 89.4 years). Two independent raters assessed frailty using CFS-A. Agreement between CFS-A raters and with previously completed CFS was determined using Cohen’s Kappa. Area under receiver operator characteristic curves (AUC) for both measures were compared against the Frailty Index (FI). Independent associations between these measures and adverse outcomes were examined using logistic regression. Results: Frailty prevalence were 81% in CFS and 96% in CFS-A. Inter-rater agreement between CFS-A raters was excellent (kappa 0.90, P <0.001) and there was moderate agreement between CFS-A and standard CFS (kappa 0.42, P <0.001). We found no difference in AUC against FI between CFS (0.91; 95% CI, 0.86-0.95) and CFS-A (0.89; 95% CI, 0.84-0.95; P <0.001). Both CFS (OR, 3.59; 95% CI, 2.28-5.67; P <0.001) and CFS-A (OR, 4.31; 95% CI, 2.41-7.69; P <0.001) were good predictors of mortality at 12 months. Similarly, CFS (OR, 2.59; 95% CI, 1.81-3.69; P <0.001) and CFS-A (OR, 3.58; 95% CI, 2.13-6.02; P <0.001) were also good predictors of institutionalisation and/or mortality after adjusting for age, sex and illness severity. Conclusion: Our study corroborated the results on inter-rater reliability, diagnostic performance and predictive validity of CFS-A which has the potential for consistent and efficient administration of CFS in acute care settings.
Key words: Assessment, Frailty, Geriatric, Inpatient, Risk
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Arai Y, Kimura T, Takahashi Y, Hashimoto T, Arakawa M, Okamura H. Preoperative frailty is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery. Gen Thorac Cardiovasc Surg 2019; 67:917-924. [PMID: 30953315 DOI: 10.1007/s11748-019-01121-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/01/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Preoperative frailty affects the progression of cardiac rehabilitation (CR) after cardiovascular surgery. Different frailty assessment measures are available. However, it remains unclear which tool most likely predicts the progress of CR. Our aim was to evaluate preoperative frailty using different methods and to identify the predictors in the progress of postoperative CR. METHODS Eighty-nine patients underwent elective cardiovascular surgery at our institution between May 2016 and April 2018. Mortality cases and patients without evaluation of preoperative frailty were excluded. This study included the remaining 78 patients. We divided the patients into two groups: 47 patients who achieved 100 m walking within 7 days after surgery (successful CR group) and 31 patients who achieved 100 m walking later than 8 days after surgery (delayed CR group). Preoperative frailty was assessed using the Kaigo-Yobo Check-List, Cardiovascular Health Study, Short Physical Performance Battery, and Clinical Frailty Scale. RESULTS The prevalence of frailty defined by these four measures was higher in the delayed CR group. The delayed CR group had lower nutritional status, serum hemoglobin level, serum albumin level, and psoas muscle index. Multivariable analysis demonstrated the Kaigo-Yobo Check-List score as an independent predictor for delayed CR (odds ratio 1.53, 95% confidence interval 1.18-1.98, p = 0.001) and Clinical Frailty Scale as an independent predictor for discharge to a health care facility (odds ratio 3.70, 95% confidence interval 1.30-10.51, p = 0.014). CONCLUSIONS Among the various tools for assessing frailty, the Kaigo-Yobo Check-List was most likely to predict the progress of postoperative CR after elective cardiovascular surgery.
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Affiliation(s)
- Yasuhiro Arai
- Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Toru Kimura
- Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Yuki Takahashi
- Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Takashi Hashimoto
- Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Mamoru Arakawa
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-Ku, Tokyo, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-Ku, Tokyo, Japan.
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Yoshioka N, Takagi K, Morita Y, Yoshida R, Nagai H, Kanzaki Y, Furui K, Yamauchi R, Komeyama S, Sugiyama H, Tsuboi H, Morishima I. Impact of the clinical frailty scale on mid-term mortality in patients with ST-elevated myocardial infarction. IJC HEART & VASCULATURE 2019; 22:192-198. [PMID: 30963094 PMCID: PMC6437299 DOI: 10.1016/j.ijcha.2019.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 12/22/2022]
Abstract
Background "Frailty" is associated with poor prognosis in ST-elevated myocardial infarction (STEMI). However, there is little data regarding the impact of the Canadian Study of Health and Aging Clinical Frailty Scale (CFS), a simple and semiquantitative tool for assessing frailty, on mid-term mortality in STEMI patients. Methods A total of 354 consecutive STEMI patients (mean age 69.8 ± 12.4 years; male 76.6%) who underwent percutaneous intervention between July 2014 and March 2017 were retrospectively reviewed. The study endpoint was mid-term mortality according to the CFS classification. Furthermore, in order to clarify the impact of CFS upon admission on mid-term mortality, the independent predictors of all-cause death were evaluated. Results Patients were categorized into three groups (CFS 1-3, n = 281; CFS 4-5, n = 62; and CFS 6-7, n = 11). During the study period (median 474 days), all-cause death was observed in 39 patients. After multivariate Cox regression analysis, higher CFS (adjusted hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.43-3.85, p < 0.001), higher Killip score (adjusted HR 2.46, 95%CI 1.30-5.78, p = 0.002), and lower serum albumin level (adjusted HR 4.29, 95%CI 2.16-8.51, p < 0.001) were significantly associated with an increased risk of all-cause death. Conclusion In conclusion, severe frailty was associated with mid-term mortality in STEMI patients who underwent PCI.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ruka Yoshida
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroaki Nagai
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Shotaro Komeyama
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hiroki Sugiyama
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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Assessment of the bleeding risk of anticoagulant treatment in non-severe frail octogenarians with atrial fibrillation. J Cardiol 2019; 73:7-13. [DOI: 10.1016/j.jjcc.2018.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 05/04/2018] [Accepted: 05/14/2018] [Indexed: 11/18/2022]
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Okada M, Okada K, Fujii K. Influence of polypharmacy on heart rate variability in older adults at the Hiroshima Atomic Bomb Survivors Recuperation Research Center, Japan. PLoS One 2018; 13:e0209081. [PMID: 30540860 PMCID: PMC6291139 DOI: 10.1371/journal.pone.0209081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many studies have identified the risk of polypharmacy, but physiological evidence and methods of evaluation in these studies were poor. The relationship between polypharmacy and heart rate variability in older adults remains unclear. We investigated the relationship between polypharmacy in older adults, including atomic bomb survivors, and heart rate variability. METHODS We surveyed 56 older adults who did not need nursing care assistance in the Hiroshima Atomic Bomb Survivors Recuperation Center. Chronic diseases, types of medication, and lifestyle were assessed, and heart rate variability at rest was measured. We calculated heart rate variability indices including standard deviation of normal-to-normal RR intervals (SDNN), total power (TP), and very low frequency (VLF) and analyzed the relationship between the number of daily medication types and heart rate variability indices in older adults. The differences in heart rate variability indices were analyzed using six medications as a cut-off point. RESULTS Participants included 36 atomic bomb survivors and 20 non-atomic bomb survivors. The mean number of medication types was 3.6±3.4 (mean±standard deviation). SDNN, TP, and VLF decreased with an increased number of medications in all participants (P<0.01). When the standard of polypharmacy was set to more than six types of medications, SDNN, TP, and VLF were significantly lower in older adults who took six or more medications. Additionally, the mean number of medication types among atomic bomb survivors was higher than that of non-atomic bomb survivors (P = 0.008). The SDNN was significantly lower when atomic bomb survivors took six or more medications (P<0.001). CONCLUSIONS We found that a lower heart rate variability in older adults, including atomic bomb survivors, is associated with polypharmacy. We showed physiological evidence of the influence of polypharmacy, which may be important for the healthy life expectancy and prognosis in older adults.
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Affiliation(s)
- Masahiro Okada
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, Japan
- * E-mail:
| | - Kosuke Okada
- Department of Internal Medicine COOP Saeki Hospital, 3-11-29 Yahata-higashi, Saeki-ku, Hiroshima, Japan
| | - Kohyu Fujii
- Department of Food and Dietetics, Hiroshima Bunka Gakuen Two-Year College, 3-5-1 Nagatsukanishi, Asaminami-ku, Hiroshima, Japan
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Frailty Status Affects the Decision for Long-Term Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation. Drugs Aging 2018; 35:897-905. [PMID: 30203312 DOI: 10.1007/s40266-018-0587-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Elderly patients are underrepresented in the studies concerning anticoagulation therapy (AT) in atrial fibrillation (AF), while patients' frailty status is lacking in most of the studies. OBJECTIVE Our objective was to evaluate AT in AF elderly patients and study the effect of patients' frailty status on their long-term AT. METHODS We conducted an observational prospective study that enrolled consecutive AF patients (≥ 75 years) who were hospitalized in the Department of Internal Medicine of the University Hospital of Heraklion, Crete, Greece from 1 June 2015 to 1 June 2016. We recorded the AT on admission and at discharge, all-cause mortality, and hospital readmission in a follow-up period of 1 year after hospital discharge. Frailty status was assessed by pre-established scores. RESULTS One hundred and four consecutive patients (49% male; median age 87 years) were enrolled, 78 (78.8%) of whom received AT at discharge. Patients who did not receive AT at discharge had a higher HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older age, Reduced platelet count or function, Re-bleeding, Hypertension, Anemia, Genetic factors, Excessive fall risk and Stroke) score (5.5 ± 1.15 vs. 4.79 ± 1.68; p = 0.032), a lower Katz score (2.48 ± 2.23 vs. 4.08 ± 2.25; p = 0.006), and a higher Clinical Frailty Scale score (7 ± 1.95 vs. 5.57 ± 2.05; p = 0.006). Sixty-five patients (62.5%) were readmitted to a hospital during the follow-up period. In-hospital death occurred in five patients (4.8%) and 57 patients (57.6%) died within the follow-up period. CONCLUSION A high percentage of the elderly AF patients did not receive AT, even at discharge. Patients who did not receive AT at discharge had higher bleeding and frailty scores. In the 1-year follow-up period after hospital discharge, high all-cause mortality and a high number of hospital readmissions were recorded.
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Gibson JA, Crowe S. Frailty in Critical Care: Examining Implications for Clinical Practices. Crit Care Nurse 2018; 38:29-35. [PMID: 29858193 DOI: 10.4037/ccn2018336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Frailty is an aging-related, multisystem clinical state characterized by loss of physiological reserves and diminished capacity to withstand exposure to stressors. Frailty increases the risk of serious adverse outcomes, compared with that of nonfrail people of the same age. Adverse outcomes can be severe and may include procedural complications, delirium, significant functional decline and disability, prolonged hospital length of stay, extended recovery periods, and death. As older adults make up a continually growing proportion of hospitalized patients, critical care nurses need to understand how to recognize frailty and be familiar with related clinical practice implications. Such knowledge underpins effective organization and delivery of care strategies aimed at minimizing harm and maximizing positive outcomes for frail older adults. Drawing from recent literature, this article explores frailty and critical illness by discussing 2 dominant models of the concept. Using a clinical case study, links between frailty and critical care nursing practices are highlighted and clinical considerations are explored.
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Affiliation(s)
- Jennifer A Gibson
- Jennifer A. Gibson is a doctoral candidate at the University of British Columbia and a patient care manager in the Heart Centre at St Paul's Hospital in Vancouver, Canada. .,Sarah Crowe is a clinical nurse specialist in critical care at Fraser Health Authority in Surrey, Canada.
| | - Sarah Crowe
- Jennifer A. Gibson is a doctoral candidate at the University of British Columbia and a patient care manager in the Heart Centre at St Paul's Hospital in Vancouver, Canada.,Sarah Crowe is a clinical nurse specialist in critical care at Fraser Health Authority in Surrey, Canada
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Morton S, Isted A, Avery P, Wang J. Is Frailty a Predictor of Outcomes in Elderly Inpatients with Acute Kidney Injury? A Prospective Cohort Study. Am J Med 2018; 131:1251-1256.e2. [PMID: 29626429 DOI: 10.1016/j.amjmed.2018.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Frailty and acute kidney injury are independently associated with an increased risk of morbidity and mortality. The degree of frailty can be assessed by the Clinical Frailty Score (CFS). This study assessed whether an individual's CFS was associated with acute kidney injury in acute elderly medical admissions and recorded the short-term outcomes. METHODS This was a single-center prospective observational cohort study. All patients aged ≥65 years admitted under an acute medical take over 12 nonconsecutive days were included. Patient demographics, comorbidities, baseline CFS, and renal status on admission were recorded. Outcomes of death, length of stay, and hospital re-attendance were assessed 2 weeks following admission. RESULTS Of 164 patients (77 males), 19% had acute kidney injury on admission and 22% were considered severely frail. Severe frailty was associated with acute kidney injury (P = .01) and death within 2 weeks (P = .01). Two-week mortality was highest among patients with both (36%). CONCLUSION The incidence of acute kidney injury in "severely frail" acutely unwell elderly patients is significantly higher and associated with an increased short-term mortality. The CFS may be useful in acute illness to guide clinical decisions in elderly patients.
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Affiliation(s)
| | | | | | - Joe Wang
- St George's Hospital, London, UK.
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77
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Kezirian AC, McGregor MJ, Stead U, Sakaluk T, Spring B, Turgeon S, Slater J, Murphy JM. Advance Care Planning in the Nursing Home Setting: A Practice Improvement Evaluation. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2018; 14:328-345. [PMID: 30653404 DOI: 10.1080/15524256.2018.1547673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study evaluated a practice improvement initiative conducted over a 6 month period in 15 Canadian nursing homes. Goals of the initiative included: (1) use the Plan-Do-Study-Act (PDSA) model to improve advance care planning (ACP) within the sample of nursing homes; (2) investigate whether improved ACP practice resulted in a change in residents' hospital use and ACP preferences for home-based care; (3) engage participating facilities in regular data collection to inform the initiative and provide a basis for reflection about ACP practice and; (4) foster a team-based participatory care culture. The initiative entailed two cycles of learning sessions followed by implementation of ACP practice improvement projects in the facilities using a PDSA approach by participating clinicians (e.g., physicians, social workers, nurses). Clinicians reported significantly increased confidence in many dimensions of ACP activities. Rates of hospital use and resident preference for home-based care did not change significantly. The initiative established routine data collection of outcomes to inform practice change, and successfully engaged physicians and non-physician clinicians to work together to improve ACP practices. Results suggest recurrent PDSA cycles that engage a 'critical mass' of clinicians may be warranted to reinforce the standardization of ACP in practice.
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Affiliation(s)
- Alexis C Kezirian
- a Department of Family Practice , University of British Columbia , Vancouver , British Columbia , Canada
| | - Margaret J McGregor
- a Department of Family Practice , University of British Columbia , Vancouver , British Columbia , Canada
- b Family Practice Research Office , Vancouver Coastal Health Research Institute's Centre for Clinical Epidemiology and Evaluation , Vancouver , British Columbia , Canada
- e Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Umilla Stead
- c Practice Support Program, General Practice Services Committee , Government of British Columbia and Doctors of British Columbia , Vancouver , British Columbia , Canada
| | - Timothy Sakaluk
- a Department of Family Practice , University of British Columbia , Vancouver , British Columbia , Canada
| | - Beverly Spring
- a Department of Family Practice , University of British Columbia , Vancouver , British Columbia , Canada
| | - Sue Turgeon
- a Department of Family Practice , University of British Columbia , Vancouver , British Columbia , Canada
| | - Jay Slater
- a Department of Family Practice , University of British Columbia , Vancouver , British Columbia , Canada
| | - Janice M Murphy
- d Health Research Consultant , Balfour , British Columbia , Canada
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Shimizu K, Sadatomo T, Hara T, Onishi S, Yuki K, Kurisu K. Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma. Geriatr Gerontol Int 2018; 18:1173-1176. [DOI: 10.1111/ggi.13436] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/19/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Kiyoharu Shimizu
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Takashi Sadatomo
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Takeshi Hara
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Shumpei Onishi
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Kiyoshi Yuki
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical Sciences; Hiroshima University; Hiroshima Japan
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Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc 2018. [PMID: 28648901 DOI: 10.1016/j.jamda.2017.04.018] [Citation(s) in RCA: 374] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. METHODS An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RECOMMENDATIONS Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. CONCLUSIONS The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
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Affiliation(s)
- Elsa Dent
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Christopher Lien
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Chin Wong
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jean Woo
- The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Birong Dong
- Geriatrics Center Huaxi Hospital, Sichuan University, Chengdu, China
| | - Shelley de la Vega
- University of the Philippines College of Medicine, Manila, Philippines; Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Philip Jun Hua Poi
- Division of Geriatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Chang Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Li Cao
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Piu Chan
- Department of Geriatrics, Neurology, and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Edward Leung
- Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | | | - Linda P Fried
- Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University, St. Louis, MO
| | | | - Leon Flicker
- Western Australia Center for Health and Aging, University of Western Australia, Perth, Australia
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Carvalho TC, Valle APD, Jacinto AF, Mayoral VFDS, Boas PJFV. Impact of hospitalization on the functional capacity of the elderly: A cohort study. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.170143] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To verify the trajectory of the functional capacity of elderly persons hospitalized due to clinical conditions in a university hospital. Method: A descriptive, prospective cohort study was conducted between 2015 and 2016. Elderly patients admitted to the Hospital das Clínicas of Botucatu Medical School (Unesp), Brazil, were evaluated for the functional assessment of basic activities of daily living (BADL) using the Katz scale, nutritional status (body mass index (BMI)) and presence of the Frailty Syndrome (FS) (Fried criteria). A description of the trajectory of functional capacity was carried out at four times: 15 days before admission (T0), at admission (T1), at hospital discharge (T2) and 30 days after discharge (T3). Results: 99 elderly people with a mean age of 74 (+7.35) years, 59.6% of whom were male, were evaluated. Of these, 81.8% presented functional independence at T0, 45.5% at T1, 57.6% at T2 and 72.8% at T3. According to their functional trajectories, 28.2% of the elderly lost functional capacity between T0 and T3. There was an association between worsening of functional capacity between T0 and T3 and the FS (RR 4.56; 95% CI 1.70-12.26, p=0.003). Conclusion: Elderly patients have worse functional capacity at hospital discharge than before hospitalization. About 28.0% of the elderly had worse functional capacity 30 days after discharge than 15 days before admission. The elderly with Frailty Syndrome have a greater risk for worse functional capacity results 30 days after discharge.
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81
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Mudge AM, Douglas C, Sansome X, Tresillian M, Murray S, Finnigan S, Blaber CR. Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study. BMJ Support Palliat Care 2018; 8:213-220. [DOI: 10.1136/bmjspcare-2017-001441] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/04/2023]
Abstract
ObjectivesPeople with serious life-limiting disease benefit from advance care planning, but require active identification. This study applied the Gold Standards Framework Proactive Identification Guidance (GSF-PIG) to a general hospital population to describe high-risk patients and explore prognostic performance for 12-month mortality.MethodsProspective cohort study conducted in a metropolitan teaching hospital in Australia. Hospital inpatients on a single day aged 18 years and older were eligible, excluding maternity and neonatal, mental health and day treatment patients. Data sources included medical record and structured questions for medical and nursing staff. High-risk was predefined as positive response to the surprise question (SQ) plus two or more SPICT indicators of general deterioration. Descriptive variables included demographics, frailty and functional measures, treating team, advance care planning documentation and hospital utilisation. Primary outcome for prognostic performance was 12-month mortality.ResultsWe identified 540 eligible inpatients on the study day and 513 had complete data (mean age 60, 54% male, 30% living alone, 19% elective admissions). Of these, 191 (37%) were high-risk; they were older, frailer, more dependent and had been in hospital longer than low-risk participants. Within 12 months, 92 participants (18%) died (72/191(38%) high-risk versus 20/322(6%) low-risk, P<0.001), providing sensitivity 78%, specificity 72%, positive predictive value 38% and negative predictive value 94%. SQ alone provided higher sensitivity, adding advanced disease indicators improved specificity.ConclusionsThe GSF-PIG approach identified a large minority of hospital inpatients who might benefit from advance care planning. Future studies are needed to investigate the feasibility, cost and impact of screening in hospitals.
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Yanagita I, Fujihara Y, Eda T, Tajima M, Yonemura K, Kawajiri T, Yamaguchi N, Asakawa H, Nei Y, Kayashima Y, Yoshimoto M, Kitajima Y, Harada M, Araki Y, Yoshimoto S, Aida E, Yanase T, Nawata H, Muta K. Low glycated hemoglobin level is associated with severity of frailty in Japanese elderly diabetes patients. J Diabetes Investig 2018; 9:419-425. [PMID: 28556518 PMCID: PMC5835456 DOI: 10.1111/jdi.12698] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/01/2017] [Accepted: 05/23/2017] [Indexed: 12/16/2022] Open
Abstract
AIMS/INTRODUCTION Previously, a study using a narrowly defined (physical base) frailty scale reported that both good and bad (U-shaped curve) glycated hemoglobin (HbA1c) levels were frailty risk factors in patients with type 2 diabetes mellitus. However, no such studies in Japan have shown this. We aimed to evaluate the frailty risk factors including HbA1c in elderly Japanese patients with type 2 diabetes mellitus using a broadly defined (both physical and psychosocial base) frailty scale, the Clinical Frailty Scale (CFS). MATERIALS AND METHODS We randomly enrolled 132 elderly patients with type 2 diabetes mellitus (aged ≥65 years) and categorized the patients into nine stages of frailty using CFS. Because no patient had CFS 9, patients with a CFS score of 1-4 and 5-8 were defined as non-frail and frail, respectively. We attempted to identify the risk factors of frailty by investigating the association between CFS stage and various patient factors. RESULTS Multiple regression analysis showed that an increase in age, low levels of albumin, high-density lipoprotein cholesterol, systolic blood pressure, HbA1c, total cholesterol, and bodyweight were statistically significant and strong independent risk factors for frailty, suggesting that reverse metabolism owing to malnutrition in elderly type 2 diabetes mellitus patients might be involved. CONCLUSIONS HbA1c level was not a U-shaped risk for frailty, suggesting that relatively good glycemic control might be more important for frailty than poor control in elderly type 2 diabetes mellitus patients.
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Affiliation(s)
- Ikumi Yanagita
- Muta HospitalFukuokaJapan
- Department of Endocrinology and Diabetes MellitusFaculty of MedicineFukuoka UniversityFukuokaJapan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Toshihiko Yanase
- Department of Endocrinology and Diabetes MellitusFaculty of MedicineFukuoka UniversityFukuokaJapan
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Theou O, Park GH, Garm A, Song X, Clarke B, Rockwood K. Reversing Frailty Levels in Primary Care Using the CARES Model. Can Geriatr J 2017; 20:105-111. [PMID: 28983384 PMCID: PMC5624254 DOI: 10.5770/cgj.20.274] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The purpose of this manuscript was to evaluate the effectiveness of the Community Actions and Resources Empowering Seniors (CARES) model in measuring and mitigating frailty among community-dwelling older adults. Methods The CARES model is based on a goal-oriented multidisciplinary primary care plan which combines a comprehensive geriatric assessment (CGA) with health coaching. A total of 51 older adults (82 ± 7 years; 33 females) participated in the pilot phase of this initiative. Frailty was measured using the Clinical Frailty Scale (CFS) and the Frailty Index (FI-CGA) at baseline and at six-month follow-up. Results The FI-CGA at follow-up (0.21 ± 0.08) was significantly lower than the FI-CGA at baseline (0.24 ± 0.08), suggesting an average reduction of 1.8 deficits. Sixty-one per cent of participants improved their FI-CGA and 38% improved CFS categories. Participants classified as vulnerable/frail at baseline were more responsive to the intervention compared to non-frail participants. Conclusion Pilot data showed that it is feasible to assess frailty in primary care and that the CARES intervention might have a positive effect on frailty, a promising finding that requires further investigations. General practitioners who participate in the CARES model can now access their patients’ FI-CGA scores at point of service through their electronic medical records.
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Affiliation(s)
- Olga Theou
- Department of Geriatric Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS
| | | | | | | | - Barry Clarke
- Department of Family Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS
| | - Kenneth Rockwood
- Department of Geriatric Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS
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Kelly S, O'Brien I, Smuts K, O'Sullivan M, Warters A. Prevalence of frailty among community dwelling older adults in receipt of low level home support: a cross-sectional analysis of the North Dublin Cohort. BMC Geriatr 2017; 17:121. [PMID: 28592236 PMCID: PMC5463412 DOI: 10.1186/s12877-017-0508-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/23/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is increasing demand for formal government funded home help services to support community-dwelling older people in Ireland, yet limited information exists on the health profiles of this group, especially regarding frailty. Our aim was to profile a large cohort of adults in receipt of low level home help and to determine the prevalence of frailty. METHODS A total 1312 older adults, (≥ 65 years) in receipt of low level home help (< 5 h per week) were reviewed by community nurses and frailty was assessed using the Clinical Frailty Scale (CFS) in this cross-sectional study. Characteristics of the group were compared between males and females and prevalence of frailty was reported according to gender and principal care. Associations between frailty and a number of variables were explored using bivariate and regression analysis. RESULTS The cohort of low level home-help users was a mean age of 82.1 (SD 7.3) years, predominantly female (70.6%) and over half (69.2%) lived alone. The prevalence of frailty in this population was 41.5%, with subjects primarily considered mildly (23.2%) or moderately frail (14.5%) by the CFS. A further 38.4% were classed as vulnerable. The degree of frailty did not differ significantly across the younger categories aged 65-84 years. However, in the oldest age groups, namely 90-94 and >95 years, moderate frailty was significantly higher relative to the younger groups (21% and 34%, p < 0.05, p < 0.01 respectively). Home help hours significantly correlated with frailty (rs = 0.371, p < 0.001) and functional dependency (rs = 0.609, p < 0.001), but only weakly with age (rs = 0.101, p = 0.034). Based on regression analysis, determinants of frailty included greater dependency (Barthel score), higher home help hours, non-self-caring and communication difficulty, all of which significantly contributed to the model, with a r squared value of 0.508. CONCLUSION A high prevalence of frailty (41.5%) was documented in this population which associated with higher home help utilisation. Frailty was associated with greater functional dependency, but not strongly with chronological age, until after 90 years. These findings highlight opportunities for developing intervention strategies targeted at ageing in place among home help users.
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Affiliation(s)
- Sara Kelly
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland
| | - Irene O'Brien
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland
| | - Karla Smuts
- North Dublin Home Care Ltd., 2 Malahide Road, Fairview, Dublin 3, Ireland.,Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Maria O'Sullivan
- Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Austin Warters
- Health Service Executive Healthcare Facility, Ballymun, Dublin 9, Ireland.
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Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, Tsuchikane E, Suzuki T, Otsuka T, Kohsaka S, Tada N, Yamanaka F, Naganuma T, Araki M, Shirai S, Watanabe Y, Hayashida K, Yashima F, Inohara T, Kakefuda Y, Arai T, Yanagisawa R, Tanaka M, Kawakami T, Maekawa Y, Takashi K, Yoshitake A, Iida Y, Yamazaki M, Shimizu H, Yamada Y, Jinzaki M, Tsuruta H, Itabashi Y, Murata M, Kawakami M, Fukui S, Sano M, Fukuda K, Hosoba S, Sato H, Teramoto T, Kimura M, Sago M, Tsunaki T, Watarai S, Tsuzuki M, Irokawa K, Shimizu K, Kobayashi T, Okawa Y, Miyasaka M, Enta Y, Shishido K, Ochiai T, Yamabe T, Noguchi K, Saito S, Kawamoto H, Onishi H, Yabushita H, Mitomo S, Nakamura S, Yamawaki M, Akatsu Y, Honda Y, Takama T, Isotani A, Hayashi M, Kamioka N, Miura M, Morinaga T, Kawaguchi T, Yano M, Hanyu M, Arai Y, Tsubota H, Kudo M, Kuroda Y, Kataoka A, Hioki H, Nara Y, Kawashima H, Nagura F, Nakashima M, Sasaki K, Nishikawa J, Shimokawa T, Harada T, Kozuma K. Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. Circulation 2017; 135:2013-2024. [DOI: 10.1161/circulationaha.116.025630] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/01/2017] [Indexed: 12/14/2022]
Abstract
Background:
The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.
Methods:
We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.
Results:
Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077,
P
=0.007), albumin (ρ=−0.22,
P
<0.001), gait speed (ρ=−0.28,
P
<0.001), and grip strength (ρ=−0.26,
P
<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%,
P
<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49;
P
<0.001).
Conclusions:
In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.
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Affiliation(s)
- Tetsuro Shimura
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Masanori Yamamoto
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Seiji Kano
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Ai Kagase
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Atsuko Kodama
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Yutaka Koyama
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Etsuo Tsuchikane
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Takahiko Suzuki
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Toshiaki Otsuka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Shun Kohsaka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Norio Tada
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Futoshi Yamanaka
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Toru Naganuma
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Motoharu Araki
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Shinichi Shirai
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Yusuke Watanabe
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | - Kentaro Hayashida
- From Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan (T. Shimura, M.Y., A. Kagase, A. Kodama, E.T., T. Suzuki); Department of Cardiology, Nagoya Heart Center, Japan (M.Y., S. Kano, Y.K.); Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.); Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan (T.O.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (S. Kohsaka, K.H.); Department of Cardiology, Sendai
| | | | - Taku Inohara
- Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shogo Fukui
- Keio University School of Medicine, Tokyo, Japan
| | - Motoaki Sano
- Keio University School of Medicine, Tokyo, Japan
| | | | - Soh Hosoba
- Toyohashi Heart Center, Toyohashi, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yui Akatsu
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yosuke Honda
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Takuro Takama
- Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yugo Nara
- Teikyo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | - Ken Kozuma
- Teikyo University School of Medicine, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW Many frailty screening instruments have been proposed due to the lack of consensus on a unified operational definition of frailty. This review reports on recent frailty screening tools in addition to revisiting the frailty concept. RECENT FINDINGS Although there are two representative frailty models, both have issues that prevent them from being implemented in clinical settings despite their remarkable advantages. Due to their different characteristics, these models are thought to be complementary rather than substitutive. The recent introduction of frailty identification into primary care and specific clinical settings has led to both a focus on its importance and the development of new screening methods. SUMMARY The phenotype model is rather faithfully based on biological change with aging, while the deficit model comprehensively captures risk of disability. Most of the current frailty screening tools are based on these models. Screening tools based on the former model primarily capture declines in physical functions, whereas screening tools based on the latter model involve questionnaires that examine functional impairments in multiple domains. Implementation of a model in a clinical setting depends on both the model characteristics and the clinical settings.
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Affiliation(s)
- Shosuke Satake
- aDepartment of Frailty Research, Center for Gerontology and Social Science bDepartment of Comprehensive Geriatric Medicine, National Center for Geriatrics and Gerontology, Aichi, Japan
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