151
|
Singer JP, Lederer DJ, Baldwin MR. Frailty in Pulmonary and Critical Care Medicine. Ann Am Thorac Soc 2016; 13:1394-404. [PMID: 27104873 PMCID: PMC5021078 DOI: 10.1513/annalsats.201512-833fr] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/22/2016] [Indexed: 02/07/2023] Open
Abstract
Conceptualized first in the field of geriatrics, frailty is a syndrome characterized by a generalized vulnerability to stressors resulting from an accumulation of physiologic deficits across multiple interrelated systems. This accumulation of deficits results in poorer functional status and disability. Frailty is a "state of risk" for subsequent disproportionate declines in health status following new exposure to a physiologic stressor. Two predominant models have emerged to operationalize the measurement of frailty. The phenotype model defines frailty as a distinct clinical syndrome that includes conceptual domains such as strength, activity, wasting, and mobility. The cumulative deficit model defines frailty by enumerating the number of age-related things wrong with a person. The biological pathways driving frailty include chronic systemic inflammation, sarcopenia, and neuroendocrine dysregulation, among others. In adults with chronic lung disease, frailty is independently associated with more frequent exacerbations of lung disease, all-cause hospitalization, declines in functional status, and all-cause mortality. In addition, frail adults who become critically ill are more likely develop chronic critical illness or severe disability and have higher in-hospital and long-term mortality rates. The evaluation of frailty appears to provide important prognostic information above and beyond routinely collected measures in adults with chronic lung disease and the critically ill. The study of frailty in these populations, however, requires multipronged efforts aimed at refining clinical assessments, understanding the mechanisms, and developing therapeutic interventions.
Collapse
Affiliation(s)
- Jonathan P. Singer
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - David J. Lederer
- Department of Medicine and
- Department of Epidemiology, Columbia University Medical Center, New York, New York; and
| | - Matthew R. Baldwin
- Department of Medicine, Columbia University Medical Center, New York, New York
| |
Collapse
|
152
|
Walsh TS, Salisbury L, Donaghy E, Ramsay P, Lee R, Rattray J, Lone N. PReventing early unplanned hOspital readmission aFter critical ILlnEss (PROFILE): protocol and analysis framework for a mixed methods study. BMJ Open 2016; 6:e012590. [PMID: 27354086 PMCID: PMC4932276 DOI: 10.1136/bmjopen-2016-012590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Survivors of critical illness experience multidimensional disabilities that reduce quality of life, and 25-30% require unplanned hospital readmission within 3 months following index hospitalisation. We aim to understand factors associated with unplanned readmission; develop a risk model to identify intensive care unit (ICU) survivors at highest readmission risk; understand the modifiable and non-modifiable readmission drivers; and develop a risk assessment tool for identifying patients and areas for early intervention. METHODS AND ANALYSIS We will use mixed methods with concurrent data collection. Quantitative data will comprise linked healthcare records for adult Scottish residents requiring ICU admission (1 January 2000-31 December 2013) who survived to hospital discharge. The outcome will be unplanned emergency readmission within 90 days of index hospital discharge. Exposures will include pre-ICU demographic data, comorbidities and health status, and critical illness variables representing illness severity. Regression analyses will be used to identify factors associated with increased readmission risk, and to develop and validate a risk prediction model. Qualitative data will comprise recorded/transcribed interviews with up to 60 patients and carers recently experiencing unplanned readmissions in three health board regions. A deductive and inductive thematic analysis will be used to identify factors contributing to readmissions and how they may interact. Through iterative triangulation of quantitative and qualitative data, we will develop a construct/taxonomy that captures reasons and drivers for unplanned readmission. We will validate and further refine this in focus groups with patients/carers who experienced readmissions in six Scottish health board regions, and in consultation with an independent expert group. A tool will be developed to screen for ICU survivors at risk of readmission and inform anticipatory interventions. ETHICS AND DISSEMINATION Data linkage has approval but does not require ethical approval. The qualitative study has ethical approval. Dissemination with key healthcare stakeholders and policymakers is planned. TRIAL REGISTRATION NUMBER UKCRN18023.
Collapse
Affiliation(s)
- Timothy S Walsh
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Lisa Salisbury
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Eddie Donaghy
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Pamela Ramsay
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Robert Lee
- Usher Institute, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Janice Rattray
- Department of Nursing Studies, University of Dundee, Dundee, UK
| | - Nazir Lone
- University Department of Anaesthesia, Critical Care, and Pain Medicine, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
- Usher Institute, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
153
|
Bagshaw M, Majumdar SR, Rolfson DB, Ibrahim Q, McDermid RC, Stelfox HT. A prospective multicenter cohort study of frailty in younger critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:175. [PMID: 27263535 PMCID: PMC4893838 DOI: 10.1186/s13054-016-1338-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/12/2016] [Indexed: 01/08/2023]
Abstract
Background Frailty is a multidimensional syndrome characterized by loss of physiologic and cognitive reserve that heightens vulnerability. Frailty has been well described among elderly patients (i.e., 65 years of age or older), but few studies have evaluated frailty in nonelderly patients with critical illness. We aimed to describe the prevalence, correlates, and outcomes associated with frailty among younger critically ill patients. Methods We conducted a prospective cohort study of 197 consecutive critically ill patients aged 50–64.9 years admitted to intensive care units (ICUs) at six hospitals across Alberta, Canada. Frailty was defined as a score ≥5 on the Clinical Frailty Scale before hospitalization. Multivariable analyses were used to evaluate factors independently associated with frailty before ICU admission and the independent association between frailty and outcome. Results In the 197 patients in the study, mean (SD) age was 58.5 (4.1) years, 37 % were female, 73 % had three or more comorbid illnesses, and 28 % (n = 55; 95 % CI 22–35) were frail. Factors independently associated with frailty included not being completely independent (adjusted OR [aOR] 4.4, 95 % CI 1.8–11.1), connective tissue disease (aOR 6.0, 95 % CI 2.1–17.0), and hospitalization within the preceding year (aOR 3.3, 95 % CI 1.3–8.1). There were no significant differences between frail and nonfrail patients in reason for admission, Acute Physiology and Chronic Health Evaluation II score, preference for life support, or treatment intensity. Younger frail patients did not have significantly longer (median [interquartile range]) hospital stay (26 [9–68] days vs. 19 [10–43] days; p = 0.4), but they had greater 1-year rehospitalization rates (61 % vs. 40 %; p = 0.02) and higher 1-year mortality (33 % vs. 20 %; adjusted HR 1.8, 95 % CI 1.0–3.3; p = 0.039). Conclusions Prehospital frailty is common among younger critically ill patients, and in this study it was associated with higher rates of mortality at 1 year and with rehospitalization. Our data suggest that frailty should be considered in younger adults admitted to the ICU, not just in the elderly. Additional research is needed to further characterize frailty in younger critically ill patients, along with the ideal instruments for identification. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1338-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Bagshaw
- Division of Critical Care Medicine (University of Alberta Hospital), Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.
| | - Sumit R Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-112 Clinical Sciences Building, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Darryl B Rolfson
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 13-103 Clinical Sciences Building, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Quazi Ibrahim
- Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - Robert C McDermid
- Department of Medicine, Faculty of Medicine and Dentistry, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - H Tom Stelfox
- Department of Critical Care Medicine, Faculty of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| |
Collapse
|
154
|
Assessment and Utility of Frailty Measures in Critical Illness, Cardiology, and Cardiac Surgery. Can J Cardiol 2016; 32:1157-65. [PMID: 27476983 DOI: 10.1016/j.cjca.2016.05.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 01/07/2023] Open
Abstract
Frailty is a clearly emerging theme in acute care medicine, with obvious prognostic and health resource implications. "Frailty" is a term used to describe a multidimensional syndrome of loss of homeostatic reserves that gives rise to a vulnerability to adverse outcomes after relatively minor stressor events. This is conceptually simple, yet there has been little consensus on the operational definition. The gold standard method to diagnose frailty remains a comprehensive geriatric assessment; however, a variety of validated physical performance measures, judgement-based tools, and multidimensional scales are being applied in critical care, cardiology, and cardiac surgery settings, including open cardiac surgery and transcatheter aortic value replacement. Frailty is common among patients admitted to the intensive care unit and correlates with an increased risk for adverse events, increased resource use, and less favourable patient-centred outcomes. Analogous findings have been described across selected acute cardiology and cardiac surgical settings, in particular those that commonly intersect with critical care services. The optimal methods for screening and diagnosing frailty across these settings remains an active area of investigation. Routine assessment for frailty conceivably has numerous purported benefits for patients, families, health care providers, and health administrators through better informed decision-making regarding treatments or goals of care, prognosis for survival, expectations for recovery, risk of complications, and expected resource use. In this review, we discuss the measurement of frailty and its utility in patients with critical illness and in cardiology and cardiac surgery settings.
Collapse
|
155
|
Abstract
As Canada's population ages, frailty - with its increased risk of functional decline, deterioration in health status, and death - will become increasingly common. The physiology of frailty reflects its multisystem, multi-organ origins. About a quarter of Canadians over age 65 are frail, increasing to over half in those older than 85. Our health care system is organized around single-organ systems, impairing our ability to effectively treat people having multiple disorders and functional limitations. To address frailty, we must recognize when it occurs, increase awareness of its significance, develop holistic models of care, and generate better evidence for its treatment. Recognizing how frailty impacts lifespan will allow for integration of care goals into treatment options. Different settings in the Canadian health care system will require different strategies and tools to assess frailty. Given the magnitude of challenges frailty poses for the health care system as currently organized, policy changes will be essential.
Collapse
|
156
|
Garrouste-Orgeas M, Ruckly S, Grégoire C, Dumesnil AS, Pommier C, Jamali S, Golgran-Toledano D, Schwebel C, Clec'h C, Soufir L, Fartoukh M, Marcotte G, Argaud L, Verdière B, Darmon M, Azoulay E, Timsit JF. Treatment intensity and outcome of nonagenarians selected for admission in ICUs: a multicenter study of the Outcomerea Research Group. Ann Intensive Care 2016; 6:31. [PMID: 27076186 PMCID: PMC4830777 DOI: 10.1186/s13613-016-0133-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Outcome of very elderly patients admitted in intensive care unit (ICU) was most often reported for octogenarians. ICU admission demands for nonagenarians are increasing. The primary objective was to compare outcome and intensity of treatment of octogenarians and nonagenarians. Methods We performed an observational study in 12 ICUs of the Outcomerea™ network which prospectively upload data into the Outcomerea™ database. Patients >90 years old (case patients) were matched with patients 80–90 years old (control patients). Matching criteria were severity of illness at admission, center, and year of admission. Results A total of 2419 patients aged 80 or older and admitted from September 1997 to September 2013 were included. Among them, 179 (7.9 %) were >90 years old. Matching was performed for 176 nonagenarian patients. Compared with control patients, case patients were more often hospitalized for unscheduled surgery [54 (30.7 %) vs. 42 (23.9 %), p < 0.01] and had less often arterial monitoring for blood pressure [37 (21 %) vs. 53 (30.1 %), p = 0.04] and renal replacement therapy [5 (2.8 %) vs. 14 (8 %), p = 0.05] than control patients. ICU [44 (25 %) vs. 36 (20.5 %), p = 0.28] or hospital mortality [70 (39.8 %) vs. 64 (36.4 %), p = 0.46] and limitation of life-sustaining therapies were not significantly different in case versus control patients, respectively. Only 16/176 (14 %) of case patients were transferred to a geriatric unit. Conclusion This multicenter study reported that nonagenarians represented a small fraction of ICU patients. When admitted, these highly selected patients received similar life-sustaining treatments, except RRT, than octogenarians. ICU and hospital mortality were similar between the two groups. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0133-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maité Garrouste-Orgeas
- Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France. .,Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine, Bichat University Hospital, Paris, France.
| | | | - Charles Grégoire
- Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France
| | - Anne-Sylvie Dumesnil
- Medical-Surgical ICU, AP-HP, Antoine Béclère University Hospital, Clamart, France
| | | | - Samir Jamali
- Medical-Surgical, General Hospital, Dourdan, France
| | | | - Carole Schwebel
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | - Christophe Clec'h
- Medical-Surgical ICU, AP-HP, Avicennes University Hospital, Bobigny, France
| | - Lilia Soufir
- Service de Réanimation et de médecine intensive, Medical-Surgical ICU, Saint Joseph Hospital Network, 185 rue Raymond Losserand, 75014, Paris, France
| | - Muriel Fartoukh
- Medical ICU, AP-HP, Tenon University Hospital, Paris, France
| | - Guillaume Marcotte
- Medical-Surgical ICU, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Laurent Argaud
- Medical ICU, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Bruno Verdière
- Medical-Surgical ICU, Delafontaine University Hospital, Saint Denis, France
| | - Michael Darmon
- Medical-Surgical ICU, Saint Etienne University Hospital, Saint Priest en Jarez, France
| | - Elie Azoulay
- Medical ICU, AP-HP, Saint Louis University Hospital, Paris, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine, Bichat University Hospital, Paris, France.,Department of Biostatistics, Outcomerea, Paris, France.,Medical ICU, AP-HP, Bichat University Hospital, Paris, France
| |
Collapse
|
157
|
Shankar-Hari M, Ambler M, Mahalingasivam V, Jones A, Rowan K, Rubenfeld GD. Evidence for a causal link between sepsis and long-term mortality: a systematic review of epidemiologic studies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:101. [PMID: 27075205 PMCID: PMC4831092 DOI: 10.1186/s13054-016-1276-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/31/2016] [Indexed: 12/29/2022]
Abstract
Background In addition to acute hospital mortality, sepsis is associated with higher risk of death following hospital discharge. We assessed the strength of epidemiological evidence supporting a causal link between sepsis and mortality after hospital discharge by systematically evaluating the available literature for strength of association, bias, and techniques to address confounding. Methods We searched Medline and Embase using the following ‘mp’ terms, MESH headings and combinations thereof - sepsis, septic shock, septicemia, outcome. Studies published since 1992 where one-year post-acute mortality in adult survivors of acute sepsis could be calculated were included. Two authors independently selected studies and extracted data using predefined criteria and data extraction forms to assess risk of bias, confounding, and causality. The difference in proportion between cumulative one-year mortality and acute mortality was defined as post-acute mortality. Meta-analysis was done by sepsis definition categories with post-acute mortality as the primary outcome. Results The literature search identified 11,156 records, of which 59 studies met our inclusion criteria and 43 studies reported post-acute mortality. In patients who survived an index sepsis admission, the post-acute mortality was 16.1 % (95 % CI 14.1, 18.1 %) with significant heterogeneity (p < 0.001), on random effects meta-analysis. In studies reporting non-sepsis control arm comparisons, sepsis was not consistently associated with a higher hazard ratio for post-acute mortality. The additional hazard associated with sepsis was greatest when compared to the general population. Older age, male sex, and presence of comorbidities were commonly reported independent predictors of post-acute mortality in sepsis survivors, challenging the causality relationship. Sensitivity analyses for post-acute mortality were consistent with primary analysis. Conclusions Epidemiologic criteria for a causal relationship between sepsis and post-acute mortality were not consistently observed. Additional epidemiologic studies with recent patient level data that address the pre-illness trajectory, confounding, and varying control groups are needed to estimate sepsis-attributable additional risk and modifiable risk factors to design interventional trials. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1276-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, ICU support Offices, 1st Floor, East Wing, St Thomas' Hospital, London, SE1 7EH, UK. .,Division of Asthma, Allergy and Lung Biology, Kings College London, London, SE1 9RT, UK.
| | - Michael Ambler
- Guy's and St Thomas' NHS Foundation Trust, ICU support Offices, 1st Floor, East Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Viyaasan Mahalingasivam
- Guy's and St Thomas' NHS Foundation Trust, ICU support Offices, 1st Floor, East Wing, St Thomas' Hospital, London, SE1 7EH, UK
| | - Andrew Jones
- Guy's and St Thomas' NHS Foundation Trust, ICU support Offices, 1st Floor, East Wing, St Thomas' Hospital, London, SE1 7EH, UK.,Division of Asthma, Allergy and Lung Biology, Kings College London, London, SE1 9RT, UK
| | - Kathryn Rowan
- Intensive Care National Audit & Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Gordon D Rubenfeld
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, D5 03, Toronto, Ontario, M4N 3M5, Canada
| |
Collapse
|
158
|
Jolley SE, Bunnell AE, Hough CL. ICU-Acquired Weakness. Chest 2016; 150:1129-1140. [PMID: 27063347 DOI: 10.1016/j.chest.2016.03.045] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/09/2016] [Accepted: 03/24/2016] [Indexed: 12/17/2022] Open
Abstract
Survivorship after critical illness is an increasingly important health-care concern as ICU use continues to increase while ICU mortality is decreasing. Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay. Newfound impairment is associated with increased health-care costs and use, reductions in health-related quality of life, and prolonged unemployment. Weakness, critical illness neuropathy and/or myopathy, and muscle atrophy are common in patients who are critically ill, with up to 80% of patients admitted to the ICU developing some form of neuromuscular dysfunction. ICU-acquired weakness (ICUAW) is associated with longer durations of mechanical ventilation and hospitalization, along with greater functional impairment for survivors. Although there is increasing recognition of ICUAW as a clinical entity, significant knowledge gaps exist concerning identifying patients at high risk for its development and understanding its role in long-term outcomes after critical illness. This review addresses the epidemiologic and pathophysiologic aspects of ICUAW; highlights the diagnostic challenges associated with its diagnosis in patients who are critically ill; and proposes, to our knowledge, a novel strategy for identifying ICUAW.
Collapse
Affiliation(s)
- Sarah E Jolley
- Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Aaron E Bunnell
- Department of Rehabilitation Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
| |
Collapse
|
159
|
Provencher V, Sirois MJ, Émond M, Perry JJ, Daoust R, Lee JS, Griffith LE, Batomen Kuimi BL, Despeignes LR, Wilding L, Allain-Boulé N, Lebon J. Frail older adults with minor fractures show lower health-related quality of life (SF-12) scores up to six months following emergency department discharge. Health Qual Life Outcomes 2016; 14:40. [PMID: 26956158 PMCID: PMC4782387 DOI: 10.1186/s12955-016-0441-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Minor fractures (e.g. wrist, ankle) are risk factors for lower physical health-related quality of life (HRQoL) in seniors. Recent studies found that measures of frailty were associated with decreased physical and mental HRQoL in older people. As most people with minor fractures go to emergency departments (EDs) for treatment, measuring their frailty status in EDs may help stratify their level of HRQoL post-injury and provide them with appropriate health care and services after discharge. This study thus examines the HRQoL of seniors visiting EDs for minor fractures at 3 and 6 months after discharge, according to their frailty status. METHODS This prospective sub-study was conducted within the larger Canadian Emergency Team Initiative (CETI) cohort. Independent seniors (≥65 years) were recruited in 7 Canadian EDs after treatment for various minor fractures. Frailty status in the ED phase was assessed by the Canadian Study of Health and Aging--Clinical Frailty Scale (CSHA-CFS). The SF-12 questionnaire was completed at 3 and 6 months after ED discharge to ascertain HRQoL. Demographic and clinical data were collected. Linear mixed models were used to test for differences between frailty levels and HRQoL outcomes, controlling for confounding variables and repeated measures over time. RESULTS The sample comprised 334 participants with minor fractures. Prevalence of frailty was as follows: 56.6 % very fit-well; 32.3 % well with treated comorbidities-apparently vulnerable; and 11.1 % mildly-moderately frail. After adjusting for confounding variables, the frailest group showed significantly lower mean HRQoL scores than the fittest group on the physical scale at 3 months (49.3 ± 3.7 vs 60.9 ± 2.0) and 6 months (48.7 ± 3.8 vs 61.1 ± 1.8), as well as on the mental scale at 3 months (59.5 ± 4.4 vs 69.6 ± 1.9). Analyses exploring differences in proportion of patients with HRQoL < 50/100 between the three groups produced similar results. CONCLUSIONS Older adults with minor fractures who were frail had lower physical and mental HRQoL scores at 3 and 6 months after ED discharge than their fittest counterparts. Measuring the frailty status of older adults who suffered a minor fracture in ED might help clinical decision-making at the time of discharge by providing them with appropriate health care and services to improve their HRQoL in the following months.
Collapse
Affiliation(s)
- Véronique Provencher
- Université de Sherbrooke, and Centre de recherche sur le vieillissement, Sherbrooke, QC, Canada.
| | - Marie-Josée Sirois
- Université Laval, and Centre de Recherche du CHU de Québec, Quebec, QC, Canada.
| | - Marcel Émond
- Université Laval, and Centre de Recherche du CHU de Québec, Quebec, QC, Canada.
| | - Jeffrey J Perry
- University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Raoul Daoust
- Université de Montréal, and Research Center, Hôpital du Sacré-Cœur de Montréal , Montréal, QC, Canada.
| | - Jacques S Lee
- University of Toronto, and Sunnybrook Health Science Center, Toronto, ON, Canada.
| | | | | | | | - Laura Wilding
- University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Nadine Allain-Boulé
- Université Laval, and Centre de Recherche du CHU de Québec, Quebec, QC, Canada.
| | - Johan Lebon
- Université Laval, and Centre de Recherche du CHU de Québec, Quebec, QC, Canada.
| |
Collapse
|
160
|
Puts MTE, Toubasi S, Atkinson E, Ayala AP, Andrew M, Ashe MC, Bergman H, Ploeg J, McGilton KS. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a protocol for a scoping review of the literature and international policies. BMJ Open 2016; 6:e010959. [PMID: 26936911 PMCID: PMC4785293 DOI: 10.1136/bmjopen-2015-010959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/11/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION With ageing comes increased vulnerability such that older adults' ability to recover from acute illnesses, fall-related injuries and other stresses related to the physical ageing processes declines. This increased vulnerability, also known as frailty, is common in older adults and associated with increased healthcare service use and adverse health outcomes. Currently, there is no overview of available interventions to prevent or reduce the level of frailty (as defined by study's authors) which will help healthcare providers in community settings caring for older adults. We will address this gap by reviewing interventions and international policies that are designed to prevent or reduce the level of frailty in community-dwelling older adults. METHODS AND ANALYSIS We will conduct a scoping review using the updated guidelines of Arksey and O'Malley to systematically search the peer-reviewed journal articles to identify interventions that aimed to prevent or reduce the level of frailty. We will search grey literature for international policies. The 6-stage scoping review model involves: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarising and reporting the results and (6) consulting with key stakeholders. ETHICS AND DISSEMINATION Our scoping review will use robust methodology to search for available interventions focused on preventing or reducing the level of frailty in community-dwelling older adults. We will consult with stakeholders to find out whether they find the frailty interventions/policies useful and to identify the barriers and facilitators to their implementation in Canada. We will disseminate our findings to relevant stakeholders at local, national and international levels by presenting at relevant meetings and publishing the findings. Our review will identify gaps in research and provide healthcare providers and policymakers with an overview of interventions that can be implemented to prevent or postpone frailty.
Collapse
Affiliation(s)
- Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Samar Toubasi
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Esther Atkinson
- Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada
| | - Ana Patricia Ayala
- Gerstein Information Science Centre, University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maureen C Ashe
- Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Katherine S McGilton
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
161
|
The Effect of Age in the Association between Frailty and Poor Sleep Quality: A Population-Based Study in Community-Dwellers (The Atahualpa Project). J Am Med Dir Assoc 2016; 17:269-71. [PMID: 26832127 DOI: 10.1016/j.jamda.2015.12.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess the effect of age in the association between poor sleep quality and frailty status. DESIGN AND SETTING Population-based, cross-sectional study conducted in Atahualpa, a rural village located in coastal Ecuador. METHODS Out of 351 Atahualpa residents aged ≥ 60 years, 311 (89%) were interviewed with the Pittsburgh Sleep Quality Index (PSQI) and the Edmonton Frail Scale (EFS). The independent association between PSQI and EFS scores was evaluated by the use of a generalized linear model adjusted for relevant confounders. A contour plot with Shepard interpolation was constructed to assess the effect of age in this association. RESULTS Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers. Mean score in the EFS was 5 ± 3 points, with 46% individuals classified as robust, 23% as prefrail, and 31% as frail. In the fully adjusted model, higher scores in the PSQI were significantly associated with higher scores in the EFS (β 0.23; 95% CI 0.11-0.35; P < .0001). Several clusters depicted the strong effect of age in the association between PSQI and EFS scores. Older individuals were more likely to have high scores in the EFS and the PSQI, and younger individuals had low EFS scores and were good sleepers. Clusters of younger individuals who were poor sleepers and had high EFS scores accounted for the independent association between PSQI and EFS scores. CONCLUSIONS This study shows the strong effect of age in the association between poor sleep quality and frailty status.
Collapse
|
162
|
Del Brutto OH, Mera RM, Cagino K, Fanning KD, Milla-Martinez MF, Nieves JL, Zambrano M, Sedler MJ. Neuroimaging signatures of frailty: A population-based study in community-dwelling older adults (the Atahualpa Project). Geriatr Gerontol Int 2016; 17:270-276. [DOI: 10.1111/ggi.12708] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine; Universidad Espíritu Santo - Ecuador; Guayaquil Ecuador
| | | | - Kristen Cagino
- School of Medicine; Stony Brook University; New York New York USA
| | | | | | | | | | - Mark J Sedler
- School of Medicine; Stony Brook University; New York New York USA
| |
Collapse
|
163
|
|
164
|
Hwang AC, Liu LK, Lee WJ, Chen LY, Peng LN, Lin MH, Chen LK. Association of Frailty and Cardiometabolic Risk Among Community-Dwelling Middle-Aged and Older People: Results from the I-Lan Longitudinal Aging Study. Rejuvenation Res 2015; 18:564-72. [PMID: 26556635 DOI: 10.1089/rej.2015.1699] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to evaluate the association of cardiometabolic risk and frailty through a community-based aging cohort in Taiwan In total, 1839 participants (men, 47.5%; mean age 63.9 ± 9.3 years) from the first wave of the I-Lan longitudinal cohort study, recruited between August of 2011 and August of 2013, were retrieved for the analysis of this cross-sectional study. Frailty was defined by Cardiovascular Health Study (CHS) criteria, encompassing un-intentional weight loss, slow walk speed, poor grip strength, exhaustion, and low activity. Comparisons between cardiometabolic risk and frailty status were performed after adjustment for age, hormone parameters, functional measurements, and skeletal muscle mass. Independent association of cardiometabolic risk and frailty status was identified through the multivariate logistic regression model. We found that the prevalence of frailty and pre-frial were 6.8% and 40.5%, respectively. Adjustments for age, blood pressure, low-density lipoprotein cholesterol (LDL-C), uric acid, creatinine, and carotid intima media thickness were not significantly associated with frailty. However, lower total cholesterol and high-density lipoprotein cholesterol (HDL-C), higher high-sensitivity C-reactive protein (hsCRP) and glycemia profiles were significantly associated with frailty. For hormone parameters, dehydroepiandrosterone sulfate (DHEA-S), insulin-like growth factor-1 (IGF-1), and free androgen index were not significantly associated with frailty after age adjustment. In a multivariate logistic regression model, abdominal obesity, homeostasis model assessment of insulin resistance (HOMA-IR), and hsCRP were significantly associated with frailty. The odds ratio (OR) for frailty was 3.57 (95% confidence interval [CI] 1.88-6.78, p < 0.001), 1.30 (95% CI 1.02-1.66, p = 0.032), and 1.66 (95% CI 1.10-2.49, p = 0.016), respectively, in a fully adjusted model. Conversely, higher total cholesterol was associated with a lower prevalence of frailty (OR = 0.44, 95% CI 0.22-0.89, p = 0.023) in the final model. In this study, abdominal obesity, insulin resistance, and inflammation were significantly associated with frailty, and the effect was independent of functional measurement and decline of skeletal muscle mass. An integrated approach targeted at cardiometabolic aging and frailty is needed in clinical practice.
Collapse
Affiliation(s)
- An-Chun Hwang
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan .,3 Institute of Public Health, National Yang Ming University , Taipei, Taiwan
| | - Li-Kuo Liu
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| | - Wei-Ju Lee
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan .,4 Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch , I-Lan, Taiwan
| | - Liang-Yu Chen
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| | - Li-Ning Peng
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| | - Ming-Hsien Lin
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| | - Liang-Kung Chen
- 1 Center for Geriatrics and Gerontology, Taipei Veterans General Hospital , Taipei, Taiwan .,2 Aging and Health Research Center, National Yang Ming University , Taipei, Taiwan
| |
Collapse
|
165
|
Key Measurement and Feasibility Characteristics When Selecting Outcome Measures. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0099-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
166
|
Frail or not? That is the question. Crit Care Med 2015; 43:1138-9. [PMID: 25876114 DOI: 10.1097/ccm.0000000000000892] [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]
|