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Morandi A, Zambon A, Crippa M, Re M, Riva L, Lombardi F, Mazzola P, Scaccabarozzi G, Bellelli G. Predicting 60-Day Mortality in a Home-Care Service: Development of a New Inter-RAI 49-Frailty Index in Patients with Chronic Disease and without a Cancer Diagnosis. J Am Med Dir Assoc 2024; 25:521-525.e6. [PMID: 38081326 DOI: 10.1016/j.jamda.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE Frailty Index (FI) is used to define the level of frailty in various clinical settings. Fifteen- and 26-item FIs have been demonstrated to predict 1-year mortality and intensity of care in home care (HC) and palliative home care (PHC). The objective of this study was to develop a new FI to predict the 60-day risk of death or transition to a PHC service after the initiation of an HC service in patients with chronic disease and without a cancer diagnosis. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Patients 18 years and older followed in an HC service of a "Frailty Department-Local Palliative Care Network" from January 1, 2017, to October 31, 2021. METHODS A 49-item FI (FI-49) was developed selecting variables within the standardized international Residential Assessment Instrument assessments (interRAI-HC) and compared to existing FIs with 15 and 26 variables. RESULTS A total of 2099 patients were included in the study with a median age of 80.0 years (IQR: 72.0-86.0) and a predominantly female population (62.4%). Among these patients, 8% died or were transferred to PHC within the 60-day follow-up. The FI-49 demonstrated a higher ability to predict 60-day mortality (C index 0.8165, 95% CI 0.7848-0.8481) compared to the 26- and 15-item FI. An FI-49 cutoff of 0.33 was also selected to provide clinicians with a more practical approach (C-index of 0.7044, 95% CI 0.6796-0.7292). CONCLUSION AND IMPLICATION The FI-49 is a good predictor of short-term mortality or transition to palliative care among older patients referred to an HC service. The automatic calculation of this tool could facilitate more appropriate care planning and the correct allocation of healthcare resources, especially considering the rapid ageing of the population.
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Affiliation(s)
- Alessandro Morandi
- Intermediate Care and Rehabilitazion, Azienda Speciale Cremona Solidale, Cremona, Italy; REFiT Bcn research group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain.
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy; Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Massimo Re
- Frailty Department, Local Network of Palliative Care, ASST, Lecco, Italy
| | - Luca Riva
- Frailty Department, Local Network of Palliative Care, ASST, Lecco, Italy
| | - Fabio Lombardi
- Frailty Department, Local Network of Palliative Care, ASST, Lecco, Italy
| | - Paolo Mazzola
- Acute Geriatric Unit, IRCCS Foundation San Gerardo, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Giuseppe Bellelli
- Acute Geriatric Unit, IRCCS Foundation San Gerardo, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Scarlata S, Zotti S, Finamore P, Osadnik CR, Scichilone N, Antonelli Incalzi R, Claudio P, Cesari M. Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns. Aging Clin Exp Res 2023; 35:2573-2581. [PMID: 37644258 DOI: 10.1007/s40520-023-02535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood. AIMS To evaluate the association between frailty index and 5-year mortality across different "spirometric" patterns and the variation in their occurring frailty determinants. METHODS This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex. RESULTS Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10-3.32) for the overall cohort, 2.24 (95% CI 1.48-3.40) for obstructive defects, 2.45 (95% CI 1.12-5.36) for restrictive defects, and 2.79 (95% CI 1.41-3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37-2.84) for the overall cohort, 2.08 (95% CI 1.37-3.18) for obstructive defects, 2.27 (95% CI 1.04-1.17) for restrictive defects, and 2.21 (95% CI 1.20-3.08) for mixed airflow defects. CONCLUSION Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases.
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Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Sonia Zotti
- Department of Medicine and Surgery, Internship Program in Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Panaiotis Finamore
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Moorooduc Hwy, Frankston, Melbourne, VIC, 3199, Australia
- Monash Lung and Sleep Department, Monash Health, 246 Clayton Road, CLAYTON, Melbourne, VIC, 3168, Australia
| | - Nicola Scichilone
- PROMISE Department, University of Palermo, Via del Vespro 133, 90127, Palermo, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Pedone Claudio
- Operative Research Unit of Geriatrics, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milano, Italy
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Kleinenberg-Talsma N, van der Lucht F, Jager-Wittenaar H, Krijnen W, Finnema E. Development of a frailty index from the Dutch public health monitor 2016 and investigation of its psychometric properties: a cross-sectional study. Arch Public Health 2023; 81:78. [PMID: 37118785 PMCID: PMC10142448 DOI: 10.1186/s13690-023-01093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Frailty in older adults is an increasing challenge for individuals, health care organizations and public health, both globally and in The Netherlands. To focus on frailty prevention from a public health perspective, understanding of frailty status is needed. To enable measurement of frailty within a health survey that currently does not contain an established frailty instrument, we aimed to construct a frailty index (FI) and investigate its psychometric properties. METHODS We conducted a cross-sectional study using data from the Dutch Public Health Monitor (DPHM), including respondents aged ≥ 65 years (n = 233,498). Forty-two health deficits were selected based on literature, previously constructed FIs, face validity and standard criteria for FI construction. Deficits were first explored by calculating Cronbach's alpha, point-polyserial correlations, and factor loadings. Thereafter, we used the Graded Response Model (GRM) to assess item difficulty, item discrimination, and category thresholds. RESULTS Cronbach's alpha for the 42 items was 0.91. Thirty-seven deficits showed strong psychometric properties: they scored above the cutoff values for point-polyserial correlations (0.3) or factor loadings (0.4) and had moderate to very high discrimination parameters (≥ 0.65). These deficits were retained in the scale. Retaining the deficits with favorable measurement properties and removing the remaining deficits resulted in the FI-HM37. CONCLUSION The FI-HM37 was developed, an FI with 37 deficits indicative of frailty, both statistically and conceptually. Our results indicate that health monitors can be used to measure frailty, even though they were not directly designed to do so. The GRM is a suitable approach for deficit selection, resulting in a psychometrically strong scale, that facilitates assessment of frailty levels using the DPHM.
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Affiliation(s)
- Nanda Kleinenberg-Talsma
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Science in Healthy Ageing and Healthcare (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
| | - Fons van der Lucht
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Centre for Health and Society, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Aletta Jacobs School of Public Health, FAITH research, Groningen, The Netherlands
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Faculty of Physical Education and Physiotherapy, Department Physiotherapy and Human Anatomy, Research Unit Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wim Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Evelyn Finnema
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Department of Health Science, Section of Nursing Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
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Mayo NE, Aubertin-Leheudre M, Mate K, Figueiredo S, Fiore JF, Auais M, Scott SC, Morais JA. Development of a Frailty Ladder Using Rasch Analysis: If the Shoe Fits. Can Geriatr J 2023; 26:133-143. [PMID: 36865407 PMCID: PMC9953502 DOI: 10.5770/cgj.26.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background The current measurement approach to frailty is to create an index of frailty status, rather than measure it. The purpose of this study is to test the extent to which a set of items identified within the frailty concept fit a hierarchical linear model (e.g., Rasch model) and form a true measure reflective of the frailty construct. Methods A sample was assembled from three sources: community organization for at-risk seniors (n=141); colorectal surgery group assessed post-surgery (n=47); and hip fracture assessed post-rehabilitation (n=46). The 234 individuals (age 57 to 97) contributed 348 measurements. The frailty construct was defined according to the named domains within commonly used frailty indices, and items drawn to reflect the frailty came from self-report measures. Performance tests were tested for the extent to which they fit the Rasch model. Results Of the 68 items, 29 fit the Rasch model: 19 self-report items on physical function and 10 performance tests, including one for cognition; patient reports of pain, fatigue, mood, and health did not fit; nor did body mass index (BMI) nor any item representing participation. Conclusion Items that are typically identified as reflecting the frailty concept fit the Rasch model. The Frailty Ladder would be an efficient and statistically robust way of combining results of different tests into one outcome measure. It would also be a way of identifying which outcomes to target in a personalized intervention. The rungs of the ladder, the hierarchy, could be used to guide treatment goals.
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Affiliation(s)
- Nancy E. Mayo
- Department of Medicine, McGill University, Montreal, QC,Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC,School of Physical and Occupational Therapy, McGill University, Montreal, QC
| | - Mylène Aubertin-Leheudre
- Département des Sciences de l’activité physique, Faculté des Sciences, Université du Québec à Montréal, Montréal, QC,Centre de recherche de l’institut universtaire de Gériatrie de Montréal, Montréal, QC
| | - Kedar Mate
- Department of Medicine, McGill University, Montreal, QC
| | - Sabrina Figueiredo
- Health Care Quality Program, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Julio Flavio Fiore
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC,Department of Surgery, McGill University, Montreal, QC,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC
| | - Mohammad Auais
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, ON
| | - Susan C. Scott
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC
| | - José A. Morais
- Department of Medicine, McGill University, Montreal, QC,Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC
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Weber A, Müller I, Büchi AE, Guler SA. Prevalence and assessment of frailty in interstitial lung disease - a systematic review and meta-analysis. Chron Respir Dis 2023; 20:14799731231196582. [PMID: 37746859 PMCID: PMC10521296 DOI: 10.1177/14799731231196582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/01/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Frailty is a multisystem dysregulation that challenges homeostasis and increases vulnerability towards stressors. In patients with interstitial lung diseases (ILD) frailty is associated with poorer lung function, greater physical impairment, and higher symptom burden. Our understanding of the prevalence of frailty in ILD and consequently its impact on the ILD population is limited. OBJECTIVE AND METHODS We aimed to systematically review frailty assessment tools and to determine frailty prevalence across different ILD cohorts. Meta-analyses were used to calculate the pooled prevalence of frailty in the ILD population. RESULTS We identified 26 studies (15 full-texts, 11 conference abstracts) including a total of 4614 patients with ILD. The most commonly used frailty assessment tools were the Fried Frailty Phenotype (FFP), the Short Physical Performance Battery (SPPB), and the cumulative Frailty Index (FI). Data allowed for meta-analyses of FFP and SPPB prevalence. The pooled prevalence of frailty was 35% (95% CI 25%-45%) by FFP, and 19% (95% CI 12%-28%) by SPPB. CONCLUSIONS Frailty is common in ILD, with considerable variability of frailty prevalence depending on the frailty assessment tool used. These findings highlight the importance of frailty in ILD and the need for a standardized approach to frailty assessment in this population.
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Affiliation(s)
- Angela Weber
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ilena Müller
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annina E. Büchi
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabina A. Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
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6
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Abey-Nesbit R, Bergler U, Pickering JW, Nishtala PS, Jamieson H. Development and validation of a frailty index compatible with three interRAI assessment instruments. Age Ageing 2022; 51:6653477. [PMID: 35930721 DOI: 10.1093/ageing/afac178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND a Frailty Index (FI) calculated by the accumulation of deficits is often used to quantify the extent of frailty in individuals in specific settings. This study aimed to derive a FI that can be applied across three standardised international Residential Assessment Instrument assessments (interRAI), used at different stages of ageing and the corresponding increase in support needs. METHODS deficit items common to the interRAI Contact Assessment (CA), Home Care (HC) or Long-Term Care Facilities assessment (LTCF) were identified and recoded to form a cumulative deficit FI. The index was validated using a large dataset of needs assessments of older people in New Zealand against mortality prediction using Kaplan Meier curves and logistic regression models. The index was further validated by comparing its performance with a previously validated index in the HC cohort. RESULTS the index comprised 15 questions across seven domains. The assessment cohort and their mean frailty (SD) were: 89,506 CA with 0.26 (0.15), 151,270 HC with 0.36 (0.15) and 83,473 LTCF with 0.41 (0.17). The index predicted 1-year mortality for each of the CA, HC and LTCF, cohorts with area under the receiver operating characteristic curves (AUCs) of 0.741 (95% confidence interval, CI: 0.718-0.762), 0.687 (95%CI: 0.684-0.690) and 0.674 (95%CI: 0.670-0.678), respectively. CONCLUSIONS the results for this multi-instrument FI are congruent with the differences in frailty expected for people in the target settings for these instruments and appropriately associated with mortality at each stage of the journey of progressive ageing.
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Affiliation(s)
| | - Ulrich Bergler
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Prasad S Nishtala
- Centre for Therapeutic Innovation, Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Braude P, McCarthy K, Strawbridge R, Short R, Verduri A, Vilches-Moraga A, Hewitt J, Carter B. Frailty is associated with poor mental health 1 year after hospitalisation with COVID-19. J Affect Disord 2022; 310:377-383. [PMID: 35568322 PMCID: PMC9091159 DOI: 10.1016/j.jad.2022.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Frailty is associated with long-term physical deterioration after COVID-19. Mental health recovery has been less well investigated. Early studies have shown minimal effect from the virus, although studies have not focused on whether people living with frailty may have different psychiatric outcomes. We aimed to examine the effect of living with frailty on mental health outcomes one year after hospital with COVID-19. METHODS We undertook a multicentre cross-sectional study of people admitted with COVID-19. We assessed quality of life (ICECAP-O and MRC), psychiatric symptoms including: generalised anxiety (GAD-7), depression (Patient Health Questionnaire-9), and trauma (Trauma Screening Questionnaire). Frailty was measured using the Clinical Frailty Scale (CFS). We used a multivariable mixed-effects logistic and linear regression to examine the adjusted odds ratio (aOR) and adjusted mean difference (aMD). RESULTS From eight hospitals 224 participants consented. Median follow-up time from admission 358 days (IQR 153-418), mean age 63.8 (SD = 13.7), 34.8% female (n = 78), and 43.7% living with frailty (n = 98 CFS 4-8). People living with frailty were significantly more likely to have symptoms of anxiety aOR = 5.72 (95% CI 1.71-19.13), depression aOR = 2.52 (95% CI 1.59-14.91), post-traumatic stress disorder aMD = 1.16 (95% CI 0.47, 1.85), and worse quality of life aMD = 1.06 (95% CI 0.76-1.36). LIMITATIONS Patient-rated symptoms were captured rather than formal mental health diagnoses. CFS has not been validated in under 65-year-olds. CONCLUSIONS Living with frailty is associated with significant psychiatric morbidity and reduced wellbeing one year after COVID-19 hospital admission. We recommend clinical follow-up after COVID-19 for people living with frailty should include a psychiatric assessment.
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Affiliation(s)
- Philip Braude
- CLARITY (Collaborative Ageing Research) Group, NHS, Bristol, UK.
| | | | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, PO74, King's College London, De Crespigny Park, London SE5 8AZ, UK,National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Roxanna Short
- CLARITY (Collaborative Ageing Research) Group, NHS, Bristol, UK,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alessia Verduri
- University of Modena and Reggio Emilia - Hospital Policlinico Modena, Italy
| | | | | | - Ben Carter
- CLARITY (Collaborative Ageing Research) Group, NHS, Bristol, UK,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
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Pérez-Zepeda MU, Campos-Fajardo S, Cano-Gutierrez C. COVID-19 related mortality in older adults: analysis of the first wave in Colombia and Mexico. Rev Panam Salud Publica 2021; 45:e109. [PMID: 34475888 PMCID: PMC8369102 DOI: 10.26633/rpsp.2021.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/01/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The aim of this study is to describe the mortality among older adults in the first wave of COVID-19 in Colombia and Mexico. METHODS This is an observational, prospective study on data obtained from open data sets that are publicly available on the websites of the health ministries of the respective countries. COVID-19 cases, age, sex, date to mortality, and mortality itself were analyzed with Kaplan-Meier curves and Cox regressions. RESULTS Data on 1 779 877 individuals were analyzed, 58.2% from Mexico, with a higher frequency of men for both countries, and 11.7% were older adults. Survival curves show a continuous increase in mortality for Mexico, with higher rates for older adults, while for Colombia the mortality was observed up to 50 days of the follow-up. Finally, hazard ratios were higher for older adults in both countries. Colombia implemented a rigid curfew for older adults, and the effect on mortality is clear from the survival curves. CONCLUSIONS This finding shows the potential benefit that public policies could have on older adults.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Instituto Nacional de GeriatríaMexico CityMexicoInstituto Nacional de Geriatría, Mexico City, Mexico
| | - Santiago Campos-Fajardo
- Pontificia Universidad JaverianaBogotáColombiaPontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Cano-Gutierrez
- Hospital Universitario San IgnacioBogotáColombiaHospital Universitario San Ignacio, Bogotá, Colombia
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9
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Salinas-Escudero G, Carrillo-Vega MF, García-Peña C, Martínez-Valverde S, Jácome-Maldonado LD, Cesari M, Pérez-Zepeda MU. Last Year of Life, Frailty, and Out-of-Pocket Expenses in Older Adults: A Secondary Analysis of the Mexican Health and Aging Study. J Appl Gerontol 2021; 41:462-470. [PMID: 34180291 DOI: 10.1177/07334648211024790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the association of frailty with out-of-pocket expenses (OOPEs) during the last year of life of Mexican older adults. METHODS Cross-sectional secondary analysis of the Mexican Health and Aging Study (MHAS), a representative population-based cohort study. Health care expenses were estimated, and a probit model was used to estimate the probability that older adults had OOPE. A general linear model was applied to explain OOPE magnitudes. RESULTS A total of 55.8% of individuals reported having OOPE with a mean of 3,261 USD. Average OOPE for hospitalization during the last year of life was 7,011.9 USD. Older adults taking their own medical decisions during the last year of life expended less than those who did not. CONCLUSION No affiliation to health services, frailty, and health decision-making by others increased the probability of OOPE. The magnitude is determined by age, hospitalization, medical visits, affiliation, frailty, and health decision-making by others.
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Affiliation(s)
| | | | | | | | | | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
| | - Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Ciudad de México, México
- Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Universidad Anáhuac México Campus Norte, Mexico City, Mexico
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10
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Rodríguez-Queraltó O, Guerrero C, Formiga F, Calvo E, Lorente V, Sánchez-Salado JC, Llaó I, Mateus G, Alegre O, Ariza-Solé A. Geriatric Assessment and In-Hospital Economic Cost of Elderly Patients With Acute Coronary Syndromes. Heart Lung Circ 2021; 30:1863-1869. [PMID: 34083151 DOI: 10.1016/j.hlc.2021.05.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/27/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Elderly patients with acute coronary syndromes (ACS) are at higher risk for complications and health care resources expenditure. No previous study has assessed the specific contribution of frailty and other geriatric syndromes to the in-hospital economic cost in this setting. METHOD Unselected patients with ACS aged ≥75 years were prospectively included. A comprehensive geriatric assessment was performed during hospitalisation. Hospitalisation-related cost per patient was calculated with an analytical accountability method, including hospital stay-related expenditures, interventions, and consumption of devices. Expenditure was expressed in Euros (2019). The contribution of geriatric syndromes and clinical factors to the economic cost was assessed with a linear regression method. RESULTS A total of 194 patients (mean age 82.6 years) were included. Mean length of hospital stay was 11.3 days. The admission-related economic cost was €6,892.15 per patient. Most of this cost was attributable to hospital length of stay (77%). The performance of an invasive strategy during the admission was associated with economic cost (p=0.008). Of all the ageing-related variables, comorbidity showed the most significant association with economic cost (p=0.009). Comorbidity, disability, nutritional risk, and frailty were associated with the hospital length of stay-related component of the economic cost. The final predictive model of economic cost included age, previous heart failure, systolic blood pressure, Killip class at admission, left main disease, and Charlson index. CONCLUSIONS Management of ACS in elderly patients is associated with a significant economic cost, mostly due to hospital length of stay. Comorbidity mostly contributes to in-hospital resources expenditure, as well as the severity of the coronary event.
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Affiliation(s)
| | - Carme Guerrero
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Calvo
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victòria Lorente
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Isaac Llaó
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Mateus
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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11
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Andrés-Esteban EM, Quintana-Diaz M, Ramírez-Cervantes KL, Benayas-Peña I, Silva-Obregón A, Magallón-Botaya R, Santolalla-Arnedo I, Juárez-Vela R, Gea-Caballero V. Outcomes of hospitalized patients with COVID-19 according to level of frailty. PeerJ 2021; 9:e11260. [PMID: 33954054 PMCID: PMC8051355 DOI: 10.7717/peerj.11260] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background The complications from coronavirus disease 2019 (COVID-19) have been the subject of study in diverse scientific reports. However, many aspects that influence the prognosis of the disease are still unknown, such as frailty, which inherently reduces resistance to disease and makes people more vulnerable. This study aimed to explore the complications of COVID-19 in patients admitted to a third-level hospital and to evaluate the relationship between these complications and frailty. Methods An observational, descriptive, prospective study was performed in 2020. A sample of 254 patients from a database of 3,112 patients admitted to a high-level hospital in Madrid, Spain was analyzed. To assess frailty (independent variable) the Clinical Frailty Scale (CFS) was used. The outcome variables were sociodemographic and clinical, which included complications, length of stay, intensive care unit (ICU) admission and prognosis. Results A total of 13.39% of the patients were pre-frail and 17.32% were frail. Frail individuals had a shorter hospital stay, less ICU admission, higher mortality and delirium, with statistical significance. Conclusion Frailty assessment is a crucial approach in patients with COVID-19, given a higher mortality rate has been demonstrated amongst frail patients. The CFS could be a predictor of mortality in COVID-19.
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Affiliation(s)
- Eva María Andrés-Esteban
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Universidad Rey Juan Carlos, Madrid, Madrid, Spain
| | - Manuel Quintana-Diaz
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Karen Lizzette Ramírez-Cervantes
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Departamento de Prevención, Asociación Española contra el Cáncer, Madrid, Madrid, Spain
| | | | - Alberto Silva-Obregón
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Servicio de Medicina Intensiva, Hospital Universitario de Guadalajara, Guadalajara, Guadalajara, Spain
| | - Rosa Magallón-Botaya
- Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zargoza, Aragón, Spain
| | - Ivan Santolalla-Arnedo
- Universidad de La Rioja, Centro de Investigación Biomédica de La Rioja-CIBIR, Logroño, La Rioja, Spain
| | - Raúl Juárez-Vela
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Universidad de La Rioja, Centro de Investigación Biomédica de La Rioja-CIBIR, Logroño, La Rioja, Spain
| | - Vicente Gea-Caballero
- Nursing School La Fe., Adscript center of Universidad de Valencia., Valencia, Valencia, Spain.,Research Group GREIACC, Health Research Institute La Fe., Valencia, Valencia, Spain
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12
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Pérez-Zepeda MU, Godin J, Armstrong JJ, Andrew MK, Mitnitski A, Kirkland S, Rockwood K, Theou O. Frailty among middle-aged and older Canadians: population norms for the frailty index using the Canadian Longitudinal Study on Aging. Age Ageing 2021; 50:447-456. [PMID: 32805022 DOI: 10.1093/ageing/afaa144] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND frailty is a public health priority now that the global population is ageing at a rapid rate. A scientifically sound tool to measure frailty and generate population-based reference values is a starting point. OBJECTIVE in this report, our objectives were to operationalize frailty as deficit accumulation using a standard frailty index (FI), describe levels of frailty in Canadians ≥45 years old and provide national normative data. DESIGN this is a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data. SETTING/PARTICIPANTS about 51,338 individuals (weighted to represent 13,232,651 Canadians), aged 45-85 years, from the tracking and comprehensive cohorts of CLSA. METHODS after screening all available variables in the pooled dataset, 52 items were selected to construct an FI. Descriptive statistics for the FI and normative data derived from quantile regressions were developed. RESULTS the average age of the participants was 60.3 years (95% confidence interval [CI]: 60.2-60.5), and 51.5% were female (95% CI: 50.8-52.2). The mean FI score was 0.07 (95% CI: 0.07-0.08) with a standard deviation of 0.06. Frailty was higher among females and with increasing age, and scores >0.2 were present in 4.2% of the sample. National normative data were identified for each year of age for males and females. CONCLUSIONS the standardized frailty tool and the population-based normative frailty values can help inform discussions about frailty, setting a new bar in the field. Such information can be used by clinicians, researchers, stakeholders and the general public to understand frailty, especially its relationship with age and sex.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Instituto Nacional de Geriatría, Mexico City, Mexico
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan Edo. de México
| | - Judith Godin
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University Thunder Bay Campus, Ontario, Canada
| | - Melissa K Andrew
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Arnold Mitnitski
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
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13
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Salminen M, Viljanen A, Eloranta S, Viikari P, Wuorela M, Vahlberg T, Isoaho R, Kivelä SL, Korhonen P, Irjala K, Löppönen M, Viikari L. Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people. Aging Clin Exp Res 2020; 32:2013-2019. [PMID: 31654244 PMCID: PMC7532963 DOI: 10.1007/s40520-019-01383-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/11/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is a lack of agreement about applicable instrument to screen frailty in clinical settings. AIMS To analyze the association between frailty and mortality in Finnish community-dwelling older people. METHODS This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. RESULTS Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and FI (5.97 [4.13-8.64], and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). DISCUSSION Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. CONCLUSIONS FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.
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Affiliation(s)
- Marika Salminen
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland.
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku, 20014, Turku, Finland.
| | - Anna Viljanen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
- Municipality of Lieto Health Care Centre, Hyvättyläntie 7, 21420, Lieto, Finland
| | - Sini Eloranta
- Faculty of Medicine, Department of Nursing Science, University of Turku, 20014, Turku, Finland
- Turku University of Applied Science, Health and Well-being, Joukahaisenkatu 3, 20520, Turku, Finland
| | - Paula Viikari
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Maarit Wuorela
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Raimo Isoaho
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku, 20014, Turku, Finland
- City of Vaasa, Social and Health Care, Ruutikellarintie 4, 65101, Vaasa, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku, 20014, Turku, Finland
- Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, 00014, Helsinki, Finland
| | - Päivi Korhonen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku, 20014, Turku, Finland
| | - Kerttu Irjala
- Faculty of Medicine, Department of Clinical Medicine, Unit of Clinical Chemistry, TYKSLAB, 20521, Turku, Finland
| | - Minna Löppönen
- City of Raisio, Social and Health Care for Elderly, Sairaalakatu 5, 21200, Raisio, Finland
| | - Laura Viikari
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
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14
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Price A, Barlow-Pay F, Duffy S, Pearce L, Vilches-Moraga A, Moug S, Quinn T, Stechman M, Braude P, Mitchell E, Myint PK, Verduri A, McCarthy K, Carter B, Hewitt J. Study protocol for the COPE study: COVID-19 in Older PEople: the influence of frailty and multimorbidity on survival. A multicentre, European observational study. BMJ Open 2020; 10:e040569. [PMID: 32994260 PMCID: PMC7526029 DOI: 10.1136/bmjopen-2020-040569] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION This protocol describes an observational study which set out to assess whether frailty and/or multimorbidity correlates with short-term and medium-term outcomes in patients diagnosed with COVID-19 in a European, multicentre setting. METHODS AND ANALYSIS Over a 3-month period we aim to recruit a minimum of 500 patients across 10 hospital sites, collecting baseline data including: patient demographics; presence of comorbidities; relevant blood tests on admission; prescription of ACE inhibitors/angiotensin receptor blockers/non-steroidal anti-inflammatory drugs/immunosuppressants; smoking status; Clinical Frailty Score (CFS); length of hospital stay; mortality and readmission. All patients receiving inpatient hospital care >18 years who receive a diagnosis of COVID-19 are eligible for inclusion. Long-term follow-up at 6 and 12 months is planned. This will assess frailty, quality of life and medical complications.Our primary analysis will be short-term and long-term mortality by CFS, adjusted for age (18-64, 65-80 and >80) and gender. We will carry out a secondary analysis of the primary outcome by including additional clinical mediators which are determined statistically important using a likelihood ratio test. All analyses will be presented as crude and adjusted HR and OR with associated 95% CIs and p values. ETHICS AND DISSEMINATION This study has been registered, reviewed and approved by the following: Health Research Authority (20/HRA1898); Ethics Committee of Hospital Policlinico Modena, Italy (369/2020/OSS/AOUMO); Health and Care Research Permissions Service, Wales; and NHS Research Scotland Permissions Co-ordinating Centre, Scotland. All participating units obtained approval from their local Research and Development department consistent with the guidance from their relevant national organisation.Data will be reported as a whole cohort. This project will be submitted for presentation at a national or international surgical and geriatric conference. Manuscript(s) will be prepared following the close of the project.
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Affiliation(s)
- Angeline Price
- Ageing and Complex Medicine, Salford Royal NHS Trust, Salford, UK
| | - Fenella Barlow-Pay
- Department of Anaesthetics, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| | - Siobhan Duffy
- General Surgery, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
| | - Lyndsay Pearce
- General Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Susan Moug
- General Surgery, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
- University of Glasgow, Glasgow, UK
| | - Terry Quinn
- Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Philip Braude
- Medicine for Older People, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Emma Mitchell
- Medicine for Older People, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | | | | | - Kathryn McCarthy
- General Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Ben Carter
- Biostatistics and Health Informatics, King's College London, London, UK
- King's College London, London, UK
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15
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Hewitt J, Carter B, Vilches-Moraga A, Quinn TJ, Braude P, Verduri A, Pearce L, Stechman M, Short R, Price A, Collins JT, Bruce E, Einarsson A, Rickard F, Mitchell E, Holloway M, Hesford J, Barlow-Pay F, Clini E, Myint PK, Moug SJ, McCarthy K. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. LANCET PUBLIC HEALTH 2020; 5:e444-e451. [PMID: 32619408 PMCID: PMC7326416 DOI: 10.1016/s2468-2667(20)30146-8] [Citation(s) in RCA: 435] [Impact Index Per Article: 108.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 02/08/2023]
Abstract
Background The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients with COVID-19 who were admitted to hospital and investigate its association with mortality and duration of hospital stay. Methods This was an observational cohort study conducted at ten hospitals in the UK and one in Italy. All adults (≥18 years) admitted to participating hospitals with COVID-19 were included. Patients with incomplete hospital records were excluded. The study analysed routinely generated hospital data for patients with COVID-19. Frailty was assessed by specialist COVID-19 teams using the clinical frailty scale (CFS) and patients were grouped according to their score (1–2=fit; 3–4=vulnerable, but not frail; 5–6=initial signs of frailty but with some degree of independence; and 7–9=severe or very severe frailty). The primary outcome was in-hospital mortality (time from hospital admission to mortality and day-7 mortality). Findings Between Feb 27, and April 28, 2020, we enrolled 1564 patients with COVID-19. The median age was 74 years (IQR 61–83); 903 (57·7%) were men and 661 (42·3%) were women; 425 (27·2%) had died at data cutoff (April 28, 2020). 772 (49·4%) were classed as frail (CFS 5–8) and 27 (1·7%) were classed as terminally ill (CFS 9). Compared with CFS 1–2, the adjusted hazard ratios for time from hospital admission to death were 1·55 (95% CI 1·00–2·41) for CFS 3–4, 1·83 (1·15–2·91) for CFS 5–6, and 2·39 (1·50–3·81) for CFS 7–9, and adjusted odds ratios for day-7 mortality were 1·22 (95% CI 0·63–2·38) for CFS 3–4, 1·62 (0·81–3·26) for CFS 5–6, and 3·12 (1·56–6·24) for CFS 7–9. Interpretation In a large population of patients admitted to hospital with COVID-19, disease outcomes were better predicted by frailty than either age or comorbidity. Our results support the use of CFS to inform decision making about medical care in adult patients admitted to hospital with COVID-19. Funding None.
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Affiliation(s)
- Jonathan Hewitt
- Division of Population Medicine, Department of Surgery, Cardiff University, Cardiff, UK; Aneurin Bevan University Health Board, Caerphilly, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Arturo Vilches-Moraga
- Ageing and Complex Medicine Department, Salford Royal NHS Trust, Manchester, UK; Ageing and Complex Medicine Department, Manchester University, Manchester, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Philip Braude
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alessia Verduri
- Respiratory Unit, University of Modena and Reggio Emilia, University Hospital of Modena Policlinico, Modena, Italy
| | - Lyndsay Pearce
- Department of Colorectal Surgery, Salford Royal NHS Trust, Manchester, UK
| | - Michael Stechman
- Division of Population Medicine, Department of Surgery, Cardiff University, Cardiff, UK
| | - Roxanna Short
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Angeline Price
- Ageing and Complex Medicine Department, Salford Royal NHS Trust, Manchester, UK
| | | | - Eilidh Bruce
- Department of Vascular Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Alice Einarsson
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
| | - Frances Rickard
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Emma Mitchell
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mark Holloway
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - James Hesford
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Enrico Clini
- Respiratory Unit, University of Modena and Reggio Emilia, University Hospital of Modena Policlinico, Modena, Italy
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Susan J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Kathryn McCarthy
- Department of Surgery and Care of the Elderly, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
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16
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Subbe CP. Age matters for cardiac arrests? No meaningful interpretation of results is possible without understanding context. Resuscitation 2020; 151:211-212. [PMID: 32304803 DOI: 10.1016/j.resuscitation.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Christian P Subbe
- Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor and Senior Clinical Lecturer, School of Medical Sciences, Bangor University, Bangor, UK.
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17
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Chao CT, Wang J, Chien KL. Both pre-frailty and frailty increase healthcare utilization and adverse health outcomes in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2018; 17:130. [PMID: 30261879 PMCID: PMC6158921 DOI: 10.1186/s12933-018-0772-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022] Open
Abstract
Background Diabetes mellitus (DM) correlates with accelerated aging and earlier appearance of geriatric phenotypes, including frailty. However, whether pre-frailty or frailty predicts greater healthcare utilization in diabetes patients is unclear. Methods From the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000) between 2004 and 2010, we identified 560,795 patients with incident type 2 DM, categorized into patients without frailty, or with 1, 2 (pre-frail) and ≥ 3 frailty components, based on FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and body weight Loss). We examined their long-term mortality, cardiovascular risk, all-cause hospitalization, and intensive care unit (ICU) admission. Results Among all participants (56.4 ± 13.8 year-old, 46.1% female, and 84.8% community-dwelling), 77.8% (n = 436,521), 19.2% (n = 107,757), 2.7% (n = 15,101), and 0.3% (n = 1416) patients did not have or had 1, 2 (pre-frail), and ≥ 3 frailty components (frail), respectively, with Fatigue and Illness being the most common components. After 3.14 years of follow-up, 7.8% patients died, whereas 36.6% and 9.1% experienced hospitalization and ICU stay, respectively. Cox proportional hazard modeling discovered that patients with 1, 2 (pre-frail), and ≥ 3 frailty components (frail) had an increased risk of mortality (for 1, 2, and ≥ 3 components, hazard ratio [HR] 1.05, 1.13, and 1.25; 95% confidence interval [CI] 1.02–1.07, 1.08–1.17, and 1.15–1.36, respectively), cardiovascular events (HR 1.05, 1.15, and 1.13; 95% CI 1.02–1.07, 1.1–1.2, and 1.01–1.25, respectively), hospitalization (HR 1.06, 1.16, and 1.25; 95% CI 1.05–1.07, 1.14–1.19, and 1.18–1.33, respectively), and ICU admission (HR 1.05, 1.13, and 1.17; 95% CI 1.03–1.07, 1.08–1.14, and 1.06–1.28, respectively) compared to non-frail ones. Approximately 6–7% risk elevation in mortality and healthcare utilization was noted for every frailty component increase. Conclusion Pre-frailty and frailty increased the risk of mortality and cardiovascular events, and entailed greater healthcare utilization in patients with type 2 DM. Electronic supplementary material The online version of this article (10.1186/s12933-018-0772-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.,Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan.
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18
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Easton JF, Stephens CR, Román-Sicilia H, Cesari M, Pérez-Zepeda MU. Anthropometric measurements and mortality in frail older adults. Exp Gerontol 2018; 110:61-66. [PMID: 29775746 DOI: 10.1016/j.exger.2018.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 03/09/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND As the number of older adults increases, so does the number of frail older adults. Although anthropometry has been widely used as a way to stratify the overall mortality risk of a person, the significance of these measurements becomes blurred in the case of frail older adults who have changes in body composition. Therefore, the aim of this study is to determine the association of anthropometric measurements (body mass index, knee-adjusted height body mass index, waist-to-hip ratio and calf circumference) with mortality risk in a group of older Mexican adults. METHODS This is a longitudinal analysis of the Mexican Health and Aging sub-sample (with biomarkers, n = 2573) from the first wave in 2001, followed-up to the last available wave in 2015. Only frail 50-year or older adults (Frailty Index with a cut-off value of 0.21 or higher, was used) were considered for this analysis (n = 1298). A survival analysis was performed with Kaplan-Meier curves and Cox regression models (unadjusted and adjusted for confounding). Socio-demographic, health risks, physical activity and comorbidities were variables used for adjusting the multivariate models. RESULTS From the total sample of 1298 older adults, 32.5% (n = 422) died during follow-up. The highest hazard ratio in the adjusted model was for calf circumference 1.31 (95% confidence interval 1.02-1.69, p = 0.034). Other measurements were not significant. CONCLUSIONS Anthropometric measurements have different significance in frail older adults, and these differences could have implications on adverse outcomes. Calf circumference has a potential value in predicting negative health outcomes.
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Affiliation(s)
- Jonathan F Easton
- C3 - Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico; Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Christopher R Stephens
- C3 - Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico; Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Heriberto Román-Sicilia
- C3 - Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community, University of Milan, Milan, Italy
| | - Mario Ulises Pérez-Zepeda
- Geriatric Epidemiologic Research Department, Instituto Nacional de Geriatría, Mexico; Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
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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: 370] [Impact Index Per Article: 61.7] [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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Martínez-Velilla N, Herce PA, Herrero ÁC, Gutiérrez-Valencia M, Sáez de Asteasu ML, Mateos AS, Zubillaga AC, Beroiz BI, Jiménez AG, Izquierdo M. Heterogeneity of Different Tools for Detecting the Prevalence of Frailty in Nursing Homes: Feasibility and Meaning of Different Approaches. J Am Med Dir Assoc 2017; 18:898.e1-898.e8. [PMID: 28757333 DOI: 10.1016/j.jamda.2017.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The identification of frail individuals has been recognized as a priority for the effective implementation of healthy aging strategies. Only a limited number of studies have examined frailty in nursing homes, and there is a big heterogeneity in the methods used. The primary objective of this study was to determine the prevalence and feasibility of different frailty screening tools in nursing homes as well as its relationship with multimorbidity and disability. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis from a concurrent cohort study, which included 110 participants aged over 65 years and with different degrees of disability at 2 nursing homes. MEASUREMENTS The study used 4 different frailty scales: The Fried frailty criteria, the imputed Fried frailty criteria, the Rockwood clinical frailty scale, and the frailty in nursing home scale, and we analyzed their relationship with disability and multimorbidity. RESULTS The mean age of the study population was 86.3 years (standard deviation 7.3), and 71.8% were female. Most residents had a high percentage of cognitive and functional impairment, multimorbidity, and risk of malnutrition. The following prevalence rates for frailty were determined: 71.8% (62.8, 79.4), 42.7% (33.9, 52.1), and 36.4% (23.8, 51.1) as per according to the Rockwood clinical frailty scale, frailty in nursing home scale, and Fried index (95% confidence interval), respectively. In the case of the Fried index, the prevalence of frailty is based on the percentage of patients meeting the criteria, which is 40% due to the large number of missing values. After the imputation of variables with the multivariate imputation by chained equation software, the prevalence of frailty increased to 66.4% (57.1, 74.5). We observed different statistically significant associations between the frailty scales and the clinical and demographic variables, and also with disability and multimorbidity. CONCLUSIONS Most residents of nursing homes are likely to be frail, but there is no single operational definition of frailty. Although all measures of frailty had similar associations with the clinical variables of the study, there are important conceptual differences that must be considered in addressing the relationships between frailty, disability, and multimorbidity. Further research is required, and homogeneous frailty criteria must be used so that studies and interventions can be compared.
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Affiliation(s)
- N Martínez-Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red (CIBER) en Fragilidad y Envejecimiento Saludable, Spain.
| | | | - Álvaro Casas Herrero
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red (CIBER) en Fragilidad y Envejecimiento Saludable, Spain
| | - Marta Gutiérrez-Valencia
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España
| | | | | | | | - Berta Ibáñez Beroiz
- Navarrabiomed-Departamento de Salud-Universidad Pública de Navarra, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Arkaitz Galbete Jiménez
- Navarrabiomed-Departamento de Salud-Universidad Pública de Navarra, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Mikel Izquierdo
- Instituto de Investigación Sanitaria Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red (CIBER) en Fragilidad y Envejecimiento Saludable, Spain; Department of Health Sciences, Public University of Navarre, Pamplona, Spain
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Dent E, Dal Grande E, Price K, Taylor AW. Frailty and usage of health care systems: Results from the South Australian Monitoring and Surveillance System (SAMSS). Maturitas 2017; 104:36-43. [PMID: 28923175 DOI: 10.1016/j.maturitas.2017.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/13/2017] [Accepted: 07/12/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Little is known about frailty and its impact on health-care systems. Using large-scale population health surveillance data, this study determined the prevalence of frailty, its associated factors, and the impact it places on health care services. STUDY DESIGN A cross-sectional snapshot of the 2013-2015 South Australian Monitoring and Surveillance System (SAMSS) database was used, focusing on individuals aged ≥65years. Frailty was assessed by the Frailty Index (FI), and classified as robust (scores≤0.1), pre-frail (>0.1 to ≤0.25), and frail (>0.25). RESULTS 7207 people (53.7% female) were included; mean (SD) age was 74.8 (7.17) years. The mean (SD) FI score was 0.23 (0.11), with a 99% upper limit of 0.53. Over a third (36.3% (95% CI 34.8-37.9)) were classified as frail and over half (53.6% (95% CI 52.0-55.1)) as pre-frail. Frailty was less common in rural areas, and was associated with age, lower education level, and higher socioeconomic disadvantage. After adjustment for confounders, multivariable analyses showed a gradient effect by frailty classification with regard to both hospital- and non-hospital-based services. Frail older adults were more likely to present to hospital Emergency Departments (EDs) than their pre-frail or robust counterparts, yet visited the GP at the same rate as older adults with pre-frailty. CONCLUSION Frail older adults were higher users of health care services, with the exception of GPs. Knowledge of the health service usage patterns of frail older adults can be used to direct public health policy and plan future GP provision.
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Affiliation(s)
- Elsa Dent
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Australia; School of Public Health, The University of Adelaide, Adelaide, Australia.
| | | | - Kay Price
- School of Nursing and Midwifery, University of South Australia, Adelaide, Australia.
| | - Anne W Taylor
- School of Medicine, The University of Adelaide, Adelaide, Australia.
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A Frailty Index from Next-of-Kin Data: A Cross-Sectional Analysis from the Mexican Health and Aging Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6069374. [PMID: 28503570 PMCID: PMC5414507 DOI: 10.1155/2017/6069374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 01/07/2023]
Abstract
Objectives. To construct a frailty index from next-of-kin information of the last year of life of community-dwelling 50 years old or older adults and test its association with health services utilization. Methods. Cross-sectional analysis from next-of-kin data available from the last wave of the Mexican Health and Aging Study (MHAS). Measurements. Along with descriptive statistics, the frailty index (FI) was tested in regression models to assess its association with adverse outcomes previous to death: number of hospitalized days in the previous year and number of visits to a physician in the previous year, in unadjusted and adjusted models. Results. From a total of 2,649 individuals the mean of age was 74.8 (±11.4) and 56.3% (n = 1,183) were women. The mean of the FI was of 0.279 (±SD 0.131, R = 0.0–0.738) and distribution was biased to the right. There was a significant association (p < 0.001) between the FI and number of hospitalized days (β = 45.7, 95% CI 36.1–55.4, p < 0.001) and for the number of visits to a physician (β = 25.93, 95% CI 19.27–32.6, p < 0.001) both models adjusted for age and sex. Conclusion. The FI constructed with next-of-kin data showed similar characteristics to similar indexes of older adults. It was independently associated with health care use.
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Canevelli M, Cesari M, Remiddi F, Trebbastoni A, Quarata F, Vico C, de Lena C, Bruno G. Promoting the Assessment of Frailty in the Clinical Approach to Cognitive Disorders. Front Aging Neurosci 2017; 9:36. [PMID: 28286480 PMCID: PMC5323399 DOI: 10.3389/fnagi.2017.00036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/10/2017] [Indexed: 12/02/2022] Open
Affiliation(s)
- Marco Canevelli
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de ToulouseToulouse, France; Institut du Vieillissement, Université de Toulouse III Paul SabatierToulouse, France
| | - Francesca Remiddi
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
| | | | - Federica Quarata
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
| | - Carlo Vico
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
| | - Carlo de Lena
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
| | - Giuseppe Bruno
- Department of Neurology and Psychiatry, Sapienza University of Rome Rome, Italy
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Morley JE. The Future of Long-Term Care. J Am Med Dir Assoc 2017; 18:1-7. [DOI: 10.1016/j.jamda.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
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Cesari M, Nobili A, Vitale G. Frailty and sarcopenia: From theory to clinical implementation and public health relevance. Eur J Intern Med 2016; 35:1-9. [PMID: 27491586 DOI: 10.1016/j.ejim.2016.07.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/25/2022]
Abstract
The sustainability of healthcare systems is threatened by the increasing (absolute and relative) number of older persons referring to clinical services. Such global phenomenon is questioning the traditional paradigms of medicine, pushing towards the need of new criteria at the basis of clinical decision algorithms. In this context, frailty has been advocated as a geriatric condition potentially capable of overcoming the weakness of chronological age in the identification of individuals requiring adapted care due to their increased vulnerability to stressors. Interestingly, frailty poses itself beyond the concept of nosological conditions due to the difficulties at correctly framing traditional diseases in the complex and heterogeneous scenario of elders. Thus, frailty may play a key role in public health policies for promoting integrated care towards biologically aged individuals, currently presenting multiple unmet clinical needs. At the same time, the term frailty has also been frequently used in the literature for framing a physical condition of risk for (mainly functional) negative endpoints. The combination of such physical impairment with an organ-specific phenotype (e.g., the age-related skeletal muscle decline or sarcopenia) may determine the assumptions for the development of a clinical condition to be used as potential target for ad hoc interventions against physical disability. In the present article, we present the background of frailty and sarcopenia, and discuss their potentialities for reshaping current clinical and research practice in order to promote holistic approach to older patients, solicit personalization of care, and develop new targets for innovative interventions.
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Affiliation(s)
- Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Université de Toulouse III Paul Sabatier, Toulouse, France.
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, IRCCS, Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Giovanni Vitale
- Dipartimento di Scienze Cliniche e di Comunità (DISCCO), Università di Milano, Milano, Italy; Laboratorio di Ricerche Endocrino-Metaboliche, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Milano, Italy
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Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs. PLoS One 2016; 11:e0161456. [PMID: 27537684 PMCID: PMC4990295 DOI: 10.1371/journal.pone.0161456] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/05/2016] [Indexed: 01/15/2023] Open
Abstract
Background Frailty Index, defined as an individual’s accumulated proportion of listed health-related deficits, is a well-established metric used to assess the health status of old adults; however, it has not yet been developed in Taiwan, and its local related structure factors remain unclear. The objectives were to construct a Taiwan Frailty Index to predict mortality risk, and to explore the structure of its factors. Methods Analytic data on 1,284 participants aged 53 and older were excerpted from the Social Environment and Biomarkers of Aging Study (2006), in Taiwan. A consensus workgroup of geriatricians selected 159 items according to the standard procedure for creating a Frailty Index. Cox proportional hazard modeling was used to explore the association between the Taiwan Frailty Index and mortality. Exploratory factor analysis was used to identify structure factors and produce a shorter version–the Taiwan Frailty Index Short-Form. Results During an average follow-up of 4.3 ± 0.8 years, 140 (11%) subjects died. Compared to those in the lowest Taiwan Frailty Index tertile (< 0.18), those in the uppermost tertile (> 0.23) had significantly higher risk of death (Hazard ratio: 3.2; 95% CI 1.9–5.4). Thirty-five items of five structure factors identified by exploratory factor analysis, included: physical activities, life satisfaction and financial status, health status, cognitive function, and stresses. Area under the receiver operating characteristic curves (C-statistics) of the Taiwan Frailty Index and its Short-Form were 0.80 and 0.78, respectively, with no statistically significant difference between them. Conclusion Although both the Taiwan Frailty Index and Short-Form were associated with mortality, the Short-Form, which had similar accuracy in predicting mortality as the full Taiwan Frailty Index, would be more expedient in clinical practice and community settings to target frailty screening and intervention.
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Abstract
The survival of HIV-infected persons has been increasing over the last years, thanks to the implementation of more effective pharmacological and non-pharmacological interventions. Nevertheless, HIV-infected persons are often "biologically" older than their "chronological" age due to multiple clinical, social, and behavioral conditions of risk. The detection in this population of specific biological features and syndromic conditions typical of advanced age has made the HIV infection an interesting research model of accelerated and accentuated aging. Given such commonalities, it is possible that "biologically aged" HIV-positive persons might benefit from models of adapted and integrated care developed over the years by geriatricians for the management of their frail and complex patients. In this article, possible strategies to face the increasingly prevalent geriatric syndromes in HIV-infected persons are discussed. In particular, it is explained the importance of shifting from the traditional disease-oriented approach into models of care facilitating a multidisciplinary management of frailty.
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Affiliation(s)
- Matteo Cesari
- a Gérontopôle , Centre Hospitalier Universitaire de Toulouse , Toulouse , France.,b Université de Toulouse III Paul Sabatier , Toulouse , France
| | - Emanuele Marzetti
- c Department of Geriatrics , Neurosciences and Orthopedics, Catholic University of the Sacred Heart , Rome , Italy
| | - Marco Canevelli
- d Memory Clinic, Department of Neurology and Psychiatry , Sapienza University , Rome , Italy
| | - Giovanni Guaraldi
- e Department of Medical and Surgical Sciences for Adults and Children , Clinic of Infectious Diseases, University of Modena and Reggio Emilia , Modena , Italy
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