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Yang M, Liu Y, Miura KW, Matsumoto M, Jiao D, Zhu Z, Li X, Cui M, Zhang J, Qian M, Huang L, Anme T. Identification and prediction of frailty among community-dwelling older Japanese adults based on Bayesian network analysis: a cross-sectional and longitudinal study. BMC Public Health 2024; 24:2141. [PMID: 39113011 PMCID: PMC11304620 DOI: 10.1186/s12889-024-19697-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 08/06/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Frailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults. METHODS We conducted a cross-sectional and longitudinal study using data from the "Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC)," which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs). RESULTS At baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model's AUC was 0.943 (95%CI 0.913-0.974), indicating good discrimination, with Hosmer-Lemeshow (H-L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model's AUC was 0.722 (95%CI 0.656-0.788), indicating moderate discrimination, with H-L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%. CONCLUSION Frailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social relationships. BNs facilitate the identification of interrelationships among these variables, quantify the influence of key factors. However, further research is required to validate the proposed model.
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Affiliation(s)
- Mengjiao Yang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Cardiovascular Surgery. Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Yang Liu
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | | | | | - Dandan Jiao
- Department of Nursing, The First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, 471003, China
| | - Zhu Zhu
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- School of Nursing, Hangzhou Normal University, Hangzhou, 311121, China
| | - Xiang Li
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- College of Child Development and Education, Zhejiang Normal University, Hangzhou, 311231, China
| | - Mingyu Cui
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Jinrui Zhang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Meiling Qian
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Lujiao Huang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Clinical Nutrition, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 3058577, Japan.
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Fereydooni A, Johnson CE, Brooke BS, Arya S. Decision making in the frail vascular surgery patient: A scoping review. Semin Vasc Surg 2024; 37:224-239. [PMID: 39152001 DOI: 10.1053/j.semvascsurg.2024.04.003] [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: 02/19/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 08/19/2024]
Abstract
Increasing evidence highlights the adverse impact of frailty and reduced physiologic reserve on surgical outcomes. Therefore, identification of frailty is essential for older adults being evaluated for vascular surgery procedures. Numerous frailty assessment tools are available to quantify the level of frailty and assist in preoperative decision making for these older patients. This review evaluates traditional and novel frailty metrics for their scientific validation, limitations, and clinical utility in vascular surgery decision-making.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Cj350i, MC 5639, Palo Alto, CA, 94304
| | - Cali E Johnson
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Shipra Arya
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Cj350i, MC 5639, Palo Alto, CA, 94304; Surgery Service Line, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA.
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Aronson L. Beyond Code Status. N Engl J Med 2024; 390:1451-1453. [PMID: 38647052 DOI: 10.1056/nejmp2314068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Louise Aronson
- From the Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco
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Hiriscau EI, Cauli O, Donca V, Marinescu LA, Macarie AE, Avram L, Cancel OG, Donca S, Buzdugan EC, Crisan DA, Bodolea C. The Association between Functional Health Patterns and Frailty in Hospitalized Geriatric Patients. Geriatrics (Basel) 2024; 9:41. [PMID: 38667508 PMCID: PMC11050315 DOI: 10.3390/geriatrics9020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
This study investigates the association between the Functional Health Pattern Assessment Screening Tool (FHPAST) and frailty in hospitalized geriatric patients. One hundred and forty patients (mean age 78.2 years, age range 65-90) were screened for frailty using the Frail Scale during hospitalization in the geriatric unit. Among them, 57 patients were identified as prefrail (40.7%), and 83 were identified as frail (59.3%). A comparative analysis between groups in terms of the FHPAST components covering health risk, general well-being, and health promotion was performed. Correlations between FHAPST components, socio-demographic data, frailty criteria, as well as logistic regression to identify variables that better predict frailty were also sought. Frailty was mainly associated with difficulty urinating, limitations in performing activities of daily living and walking, physical discomfort, less positive feelings in controlling one's own life, lower compliance with recommendations from the healthcare provider, and engagement in seeking healthcare services. Patients with difficulty urinating and walking had a probability of 4.38 times (OR = 4.38, CI 95% [1.20-15.94]), p = 0.025) and 65.7 times (OR = 65.7, CI 95% [19.37-223.17], p < 0.001) higher of being frail rather than prefrail. The relationship between frailty and prefrailty in hospitalized geriatric patients and components of nursing Functional Health Patterns (FHP) has yet to be explored. This study provides evidence of the most prevalent needs of frail geriatric patients in hospital settings.
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Affiliation(s)
- Elisabeta Ioana Hiriscau
- Nursing Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400083 Cluj-Napoca, Romania;
- Intensive Care Unit Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania;
| | - Omar Cauli
- Nursing Department, University of Valencia, 46010 Valencia, Spain
| | - Valer Donca
- Geriatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (V.D.); (L.-A.M.); (A.-E.M.); (L.A.)
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Luminita-Aurelia Marinescu
- Geriatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (V.D.); (L.-A.M.); (A.-E.M.); (L.A.)
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Antonia-Eugenia Macarie
- Geriatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (V.D.); (L.-A.M.); (A.-E.M.); (L.A.)
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Lucretia Avram
- Geriatric Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (V.D.); (L.-A.M.); (A.-E.M.); (L.A.)
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Oana-Gabriela Cancel
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Steliana Donca
- Geriatric Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania; (O.-G.C.); (S.D.)
| | - Elena-Cristina Buzdugan
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (E.-C.B.); (D.-A.C.)
- Internal Medicine Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Dana-Alina Crisan
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania; (E.-C.B.); (D.-A.C.)
- Internal Medicine Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Constantin Bodolea
- Intensive Care Unit Department, University Clinical Municipal Hospital, 400139 Cluj-Napoca, Romania;
- Intensive Care Unit Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania
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Wang L, Zhang X, Liu X. Association between the frailty index and readmission risk in hospitalised elderly Chinese patients: a retrospective cohort study. BMJ Open 2024; 14:e076861. [PMID: 38417955 PMCID: PMC10900421 DOI: 10.1136/bmjopen-2023-076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES Frailty is a common and important concern of the ageing population. This study examined the association between the frailty index and negative outcomes of hospitalised elderly Chinese patients. DESIGN Retrospective cohort study. SETTING Geriatrics Department of Peking University First Hospital. PARTICIPANTS 470 hospitalised elderly patients. MAIN OUTCOMES AND MEASURES Frailty was measured using a 30-item deficit-accumulation frailty index. The outcomes were the hospitalisation duration and readmission. RESULTS The frailty index was available for 470 patients: 72 (15.32%) were categorised as robust, 272 (57.87%) as prefrail and 126 (26.81%) as frail. The frail group had a longer hospital stay than the robust and prefrail groups. After adjustment for age, sex and cause of hospitalisation at baseline, frailty remained a strong independent risk factor for all-cause readmission and cardiocerebrovascular disease readmission (HR 2.41, 95% CI 1.49 to 3.91, p<0.001; HR 4.92, 95% CI 1.47 to 6.31, p<0.001, respectively). CONCLUSIONS The frailty index predicted a longer length of stay and higher all-cause and cardiocerebrovascular disease readmission risk in hospitalised elderly patients.
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Affiliation(s)
- Lina Wang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xiaolin Zhang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- Geriatric Department, Peking University First Hospital, Beijing, China
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Lundgren M, Segernäs A, Nord M, Alwin J, Lyth J. Reasons for hospitalisation and cumulative mortality in people, 75 years or older, at high risk of hospital admission: a prospective study. BMC Geriatr 2024; 24:176. [PMID: 38378482 PMCID: PMC10877827 DOI: 10.1186/s12877-024-04771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND A small proportion of the older population accounts for a high proportion of healthcare use. For effective use of limited healthcare resources, it is important to identify the group with greatest needs. The aim of this study was to explore frequency and reason for hospitalisation and cumulative mortality, in an older population at predicted high risk of hospital admission, and to assess if a prediction model can be used to identify individuals with the greatest healthcare needs. Furthermore, discharge diagnoses were explored to investigate if they can be used as basis for specific interventions in the high-risk group. METHODS All residents, 75 years or older, living in Östergötland, Sweden, on January 1st, 2017, were included. Healthcare data from 2016 was gathered and used by a validated prediction model to create risk scores for hospital admission. The population was then divided into groups by percentiles of risk. Using healthcare data from 2017-2018, two-year cumulative incidence of hospitalisation was analysed using Gray´s test. Cumulative mortality was analysed with the Kaplan-Meier method and primary discharge diagnoses were analysed with standardised residuals. RESULTS Forty thousand six hundred eighteen individuals were identified (mean age 82 years, 57.8% women). The cumulative incidence of hospitalisation increased with increasing risk of hospital admission (24% for percentiles < 60 to 66% for percentiles 95-100). The cumulative mortality also increased with increasing risk (7% for percentiles < 60 to 43% for percentiles 95-100). The most frequent primary discharge diagnoses for the population were heart diseases, respiratory infections, and hip injuries. The incidence was significantly higher for heart diseases and respiratory infections and significantly lower for hip injuries, for the population with the highest risk of hospital admission (percentiles 85-100). CONCLUSIONS Individuals 75 years or older, with high risk of hospital admission, were demonstrated to have considerable higher cumulative mortality as well as incidence of hospitalisation. The results support the use of the prediction model to direct resources towards individuals with highest risk scores, and thus, likely the greatest care needs. There were only small differences in discharge diagnoses between the risk groups, indicating that interventions to reduce hospitalisations should be personalised. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03180606, first posted 08/06/2017.
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Affiliation(s)
- Moa Lundgren
- Primary Health Care Centre Finspång, Finspång, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anna Segernäs
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Ekholmen, Linköping, Sweden
| | - Magnus Nord
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Valla, Linköping, Sweden
| | - Jenny Alwin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Van Hollebeke M, Chohan K, Adams CJ, Fisher JH, Shapera S, Fidler L, Goligher EC, Martinu T, Wickerson L, Mathur S, Singer LG, Reid WD, Rozenberg D. Clinical implications of frailty assessed in hospitalized patients with acute-exacerbation of interstitial lung disease. Chron Respir Dis 2024; 21:14799731241240786. [PMID: 38515270 PMCID: PMC10958799 DOI: 10.1177/14799731241240786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Approximately 50% of patients with interstitial lung disease (ILD) experience frailty, which remains unexplored in acute exacerbations of ILD (AE-ILD). A better understanding may help with prognostication and resource planning. We evaluated the association of frailty with clinical characteristics, physical function, hospital outcomes, and post-AE-ILD recovery. METHODS Retrospective cohort study of AE-ILD patients (01/2015-10/2019) with frailty (proportion ≥0.25) on a 30-item cumulative-deficits index. Frail and non-frail patients were compared for pre- and post-hospitalization clinical characteristics, adjusted for age, sex, and ILD diagnosis. One-year mortality, considering transplantation as a competing risk, was analysed adjusting for age, frailty, and Charlson Comorbidity Index (CCI). RESULTS 89 AE-ILD patients were admitted (median: 67 years, 63% idiopathic pulmonary fibrosis). 31 were frail, which was associated with older age, greater CCI, lower 6-min walk distance, and decreased independence pre-hospitalization. Frail patients had more major complications (32% vs 10%, p = .01) and required more multidisciplinary support during hospitalization. Frailty was not associated with 1-year mortality (HR: 0.97, 95%CI: [0.45-2.10]) factoring transplantation as a competing risk. CONCLUSIONS Frailty was associated with reduced exercise capacity, increased comorbidities and hospital complications. Identifying frailty may highlight those requiring additional multidisciplinary support, but further study is needed to explore whether frailty is modifiable with AE-ILD.
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Affiliation(s)
- Marine Van Hollebeke
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Karan Chohan
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Colin J. Adams
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jolene H. Fisher
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Shane Shapera
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lee Fidler
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Sunnybrook Health Science Center, Toronto, ON, Canada
| | - Ewan C. Goligher
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Tereza Martinu
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa Wickerson
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Lianne G. Singer
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - W. Darlene Reid
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Division of Respirology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Misquitta K, Reid N, Hubbard RE, Gordon EH. Factors associated with entry to residential care in frail older inpatients. Australas J Ageing 2023; 42:720-727. [PMID: 37573545 DOI: 10.1111/ajag.13231] [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: 04/27/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To examine factors that may influence the risk of discharge to a residential aged care facility (RACF) in a population of frail older inpatients. METHODS We analysed data from 5846 inpatients aged over 60 years from 27 hospitals in Queensland, Australia, admitted from independent living and referred for geriatric consultation. Patients underwent an interRAI Acute Care Comprehensive Geriatric Assessment by trained nurses. Frailty was assessed using a 52-item frailty index (FI). Risk/protective factors were determined a priori. Logistic regression assessed the relationship between factors and discharge destination, adjusted for FI, age, sex and hospital. Frailty × risk/protective factor interactions were performed. RESULTS Patients had a mean (SD) age of 79.7 (8.2) years and a mean (SD) FI of 0.44 (0.14). Twenty-nine per cent (n = 1678) of patients were discharged to an RACF. Each 0.1 increment in FI increased the risk of discharge to an RACF by 54% (OR 1.54, 95% CI 1.40-1.68, p < 0.01). Being married or in a de facto relationship had protective effects up to an FI of 0.7, whereas behavioural and psychological symptoms of dementia (BPSD) increased the risk of RACF discharge up to an FI of 0.7. Female sex, faecal incontinence and living alone did not influence the relationship between frailty and discharge destination. CONCLUSIONS The association between frailty and discharge to RACF has previously been recognised but here we found that risk and protective factors can influence this association. Whether early identification and management of mutable factors can reduce discharge to RACF should be addressed in future studies.
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Affiliation(s)
- Karen Misquitta
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Emily H Gordon
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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Knight T, Atkin C, Kamwa V, Cooksley T, Subbe C, Holland M, Sapey E, Lasserson D. The impact of frailty and geriatric syndromes on metrics of acute care performance: results of a national day of care survey. EClinicalMedicine 2023; 66:102278. [PMID: 38192597 PMCID: PMC10772156 DOI: 10.1016/j.eclinm.2023.102278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 01/10/2024] Open
Abstract
Background Frailty is associated with a range of adverse clinical outcomes in the acute hospital setting. We sought to determine whether frailty and related factors affected clinical processes such as time to assessment during emergency hospital admission within the National Health Service (NHS) in the UK. Methods The Society for Acute Medicine Benchmarking Audit (SAMBA) is an annual cross-sectional day of care survey. SAMBA 2022 was conducted on Thursday 23rd June 2022. We assessed whether the Clinical Frailty Scale (CFS) and presence of a geriatric syndrome affected performance against nationally recognised clinical quality indicators based on time to initial assessment and time to consultant review. CFS was graded into robust (CFS1-3), mild (CFS 4-5), moderate (CFS 6), severe (CFS7-8) and terminal illness (CFS 9). Plausible values were created for missing variables using multi-level multiple imputation. The association was described using mixed effect generalised linear models adjusting for initial National Early Warning Score 2 (NEWS2) and time of arrival. Findings A total of 152 hospitals provided patient level data relating to 7248 emergency medical admissions. Patients with mild, moderate and severe frailty were less likely to be assessed within 4 h of arrival (adjusted OR, mild 0.79, 95% CI 0.68-0.96, moderate 0.67 95% CI 0.53-0.84, severe, 0.75 95% CI 0.58-0.96, terminally ill 0.59 95% CI 0.23-1.43) and less likely to be achieve the clinical quality indicator for consultant review (adjusted OR, mild 0.69 95% CI 0.58-0.83, moderate 0.55 95% CI 0.44-0.70, severe 0.54 95% CI 0.41-0.69, terminally ill 0.76 95% CI 0.42-1.5). Patients with geriatric syndromes were also less likely to be assessed within 4 h of arrival (adjusted OR 0.66 95% CI 0.56-0.76) or by a consultant within the recommended time frame (adjusted OR 0.45 95% CI 0.39-0.51). The difference was partially explained by differential use of SDEC pathways. Sub-group analysis of 5148 patients assessed outside of SDEC areas demonstrated patients with geriatric syndromes (adjusted OR 0.71, 95% CI 0.60-0.83), but not frailty defined by CFS were less likely to be assessed within 4 h of arrival. Moderate and severe frailty and the presence of a geriatric syndrome were associated with a decreased likelihood of achieving the consultant review standard (moderate, adjusted OR 0.75, 95% CI 0.59-0.94, severe adjusted OR 0.75 95% CI 0.58-0.96, geriatric syndrome adjusted OR 0.59, 95% CI 0.50-0.69). Interpretation Frailty is associated with delayed clinical assessment. This association may suggest a systemic issue with clinical prioritisation, with important implications for acute care policy. Funding The database for SAMBA is funded by the Society for Acute Medicine.
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Affiliation(s)
- Thomas Knight
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, UK
| | - Catherine Atkin
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, UK
| | - Vicky Kamwa
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, UK
| | - Tim Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - Chris Subbe
- School of Medical and Health Sciences, Bangor University, UK
| | - Mark Holland
- School of Clinical and Biomedical Sciences, University of Bolton, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, UK
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Garcia-Pérez D, Vena-Martínez A, Robles-Perea L, Roselló-Padullés T, Espaulella-Panicot J, Arnau A. Prognostic Value of a New Tool (the 3D/3D+) for Predicting 30-Day Mortality in Emergency Department Patients Aged 75 Years and Older. J Clin Med 2023; 12:6469. [PMID: 37892606 PMCID: PMC10607455 DOI: 10.3390/jcm12206469] [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: 09/01/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
The 3D/3D+ multidimensional geriatric assessment tool provides an optimal model of emergency care for patients aged 75 and over who attend the Emergency Department (ED). The baseline, or static, component (3D) stratifies the degree of frailty prior to the acute illness, while the current, or dynamic, component (3D+) assesses the multidimensional impact caused by the acute illness and helps to guide the choice of care facility for patients upon their discharge from the ED. The objective of this study was to evaluate the prognostic value of the 3D/3D+ to predict short- and long-term adverse outcomes in ED patients aged 75 years and older. Multivariable logistic regression models were used to identify the predictors of mortality 30 days after 3D/3D+ assessment. Two hundred and seventy-eight patients (59.7% women) with a median age of 86 years (interquartile range: 83-90) were analyzed. According to the baseline component (3D), 83.1% (95% CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) presented alterations in 60.1% (95% CI: 54.1-65.9). The choice of care facility at ED discharge indicated by the 3D/3D+ was considered appropriate in 96.4% (95% CI: 93.0-98.0). Thirty-day all-cause mortality was 19.4%. Delirium and functional decline were the dimensions on the 3D/3D+ that were independently associated with 30-day mortality. These two dimensions had an area under receiver operating characteristic of 0.80 (95% CI: 0.73-0.86) for predicting 30-day mortality. The 3D/3D+ tool enhances the provision of comprehensive care by ED professionals, guides them in the choice of patients' discharge destination, and has a prognostic validity that serves to establish future therapeutic objectives.
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Affiliation(s)
- Dolors Garcia-Pérez
- Emergency Service, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
- Doctoral Program in Medicine and Biomedical Sciences, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), 08500 Vic, Spain
- Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVIC-UCC), 08500 Vic, Spain; (J.E.-P.); (A.A.)
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
| | - Anabelén Vena-Martínez
- UFISS Geriatric Emergncy Service, Hospital Universitari de Santa Maria de Lleida, 25008 Lleida, Spain;
| | - Laura Robles-Perea
- Emergency Service, Hospital de Figueres (Fundació Salut Empordà), 17600 Figueres, Spain;
| | | | - Joan Espaulella-Panicot
- Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVIC-UCC), 08500 Vic, Spain; (J.E.-P.); (A.A.)
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
- Geriatric and Palliative Care Service, Consorci Hospitalari Vic, Fundació Hospital de la Santa Creu de Vic, 08500 Vic, Spain
| | - Anna Arnau
- Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVIC-UCC), 08500 Vic, Spain; (J.E.-P.); (A.A.)
- Central Catalonia Chronicity Research Group (C3RG), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IRIS-CC), 08500 Vic, Spain
- Research and Innovation Unit, Althaia Xarxa Assistencial Universitària de Manresa, 08243 Manresa, Spain
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11
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Ma Z, Wang J, He T, Zhu S, Sheng C, Ge Y, Yuan L. Correlation between preoperative frailty and postoperative delirium in elderly patients undergoing hip arthroplasty. Medicine (Baltimore) 2023; 102:e34785. [PMID: 37653780 PMCID: PMC10470691 DOI: 10.1097/md.0000000000034785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Postoperative delirium (POD) refers to acute brain dysfunction occurring within 7 days after operation or before discharge. Frailty refers to the state that the body's physiological reserve is insufficient, so that the compensative capacity to endogenous and exogenous stress stimuli decreases. The purpose of this study is to explore the association of preoperative frailty (PF) with POD in elderly patients undergoing hip arthroplasty. METHODS Totally 228 elderly patients (age ≥ 65 years) who received elective hip arthroplasty in the Ningbo No. 6 Hospital between December 2021 and June 2022 were enrolled. One day before surgery, the frailty phenotype scale was adopted for evaluation of patients' frailty. On the 1st-3rd day after operation, the confusion assessment method was adopted for evaluation of delirium, and the patients were grouped into a POD group and non-POD group. Logistic regression was conducted to analyze the correlation between PF and POD. RESULTS Among the patients, the incidence of PF was 30.70% (70/228), and the incidence of delirium within 3 days after operation was 25.88% (59/228). According to binary logistic regression analysis, PF, age, hypertension, diabetes mellitus, and preoperative sleep disorder were independent risk factors for POD in elderly patients undergoing hip arthroplasty (all P < .05). CONCLUSION PF is a crucial risk factor for POD in elderly patients undergoing hip arthroplasty.
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Affiliation(s)
- Zihan Ma
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Jianlin Wang
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Tianyi He
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Shaoxiong Zhu
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Chaoxu Sheng
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Yeying Ge
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Liyong Yuan
- Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
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12
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Kennard AL, Rainsford S, Glasgow NJ, Talaulikar GS. Use of frailty assessment instruments in nephrology populations: a scoping review. BMC Geriatr 2023; 23:449. [PMID: 37479978 PMCID: PMC10360289 DOI: 10.1186/s12877-023-04101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/09/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Frailty is a clinical syndrome of accelerated aging associated with adverse outcomes. Frailty is prevalent among patients with chronic kidney disease but is infrequently assessed in clinical settings, due to lack of consensus regarding frailty definitions and diagnostic tools. This study aimed to review the practice of frailty assessment in nephrology populations and evaluate the context and timing of frailty assessment. METHODS The search included published reports of frailty assessment in patients with chronic kidney disease, undergoing dialysis or in receipt of a kidney transplant, published between January 2000 and November 2021. Medline, CINAHL, Embase, PsychINFO, PubMed and Cochrane Library databases were examined. A total of 164 articles were included for review. RESULTS We found that studies were most frequently set within developed nations. Overall, 161 studies were frailty assessments conducted as part of an observational study design, and 3 within an interventional study. Studies favoured assessment of participants with chronic kidney disease (CKD) and transplant candidates. A total of 40 different frailty metrics were used. The most frequently utilised tool was the Fried frailty phenotype. Frailty prevalence varied across populations and research settings from 2.8% among participants with CKD to 82% among patients undergoing haemodialysis. Studies of frailty in conservatively managed populations were infrequent (N = 4). We verified that frailty predicts higher rates of adverse patient outcomes. There is sufficient literature to justify future meta-analyses. CONCLUSIONS There is increasing recognition of frailty in nephrology populations and the value of assessment in informing prognostication and decision-making during transitions in care. The Fried frailty phenotype is the most frequently utilised assessment, reflecting the feasibility of incorporating objective measures of frailty and vulnerability into nephrology clinical assessment. Further research examining frailty in low and middle income countries as well as first nations people is required. Future work should focus on interventional strategies exploring frailty rehabilitation.
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Affiliation(s)
- Alice L Kennard
- Department of Renal Medicine, The Canberra Hospital, Canberra Health Services, Building 15, Yamba Drive, Garran, ACT 2605, Australia.
- Australian National University, Canberra, ACT, Australia.
| | | | | | - Girish S Talaulikar
- Department of Renal Medicine, The Canberra Hospital, Canberra Health Services, Building 15, Yamba Drive, Garran, ACT 2605, Australia
- Australian National University, Canberra, ACT, Australia
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Kawamura K, Osawa A, Tanimoto M, Kagaya H, Matsuura T, Arai H. Clinical frailty scale is useful in predicting return-to-home in patients admitted due to coronavirus disease. BMC Geriatr 2023; 23:433. [PMID: 37442988 PMCID: PMC10347876 DOI: 10.1186/s12877-023-04133-4] [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: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The spread of the novel severe acute respiratory syndrome coronavirus 2 infection has been prolonged, with the highly contagious Omicron variant becoming the predominant variant by 2022. Many patients admitted to dedicated coronavirus disease 2019 (COVID-19) wards (COVID-19 treatment units) develop disuse syndrome while being treated in the hospital, and their ability to perform activities of daily living declines, making it difficult for hospitals to discharge them. This study aimed to investigate the relationship between the degree of frailty and home discharge of patients admitted to a COVID-19 treatment units. METHODS This study retrospectively examined the in-patient medical records of 138 patients (82.7 ± 7.6 years old) admitted to a COVID-19 treatment unit from January to December 2022. The end-point was to determine the patients' ability to be discharged from the unit directly to home; such patients were classified into the 'Home discharge' group and compared with those in the 'Difficulty in discharge' group. The degree of frailty was determined based on the Clinical Frailty Scale (CFS), and the relationship with the endpoint was analysed. A receiver operating characteristic (ROC) curve was created and the cut-off value was calculated with the possibility of home discharge as the state variable and CFS as the test variable. Logistic regression analysis was conducted with the possibility of home discharge as the dependent variable and CFS as the independent variable. RESULTS There were 75 patients in the Home discharge group and 63 in the Difficulty in discharge group. ROC analysis showed a CFS cut-off value of 6 or more, with a sensitivity of 70.7% and a specificity of 84.1%. The results of the logistic regression analysis showed a significant correlation between possibility of home discharge and CFS even after adjusting for covariates, with an odds ratio of 13.44. CONCLUSIONS Based on the evaluation of the degree of frailty conducted in the COVID-19 treatment unit, it was possible to accurately predict whether a patient could be discharged directly to home after treatment CFS could be an effective screening tool to easily detect patients requiring ongoing hospitalisation even after the acute phase of treatment.
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Affiliation(s)
- Koki Kawamura
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan.
| | - Aiko Osawa
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
| | - Masanori Tanimoto
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
| | - Hitoshi Kagaya
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
| | - Toshihiro Matsuura
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
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Lo Buglio A, Bellanti F, Capurso C, Vendemiale G. Controlling Nutritional Status (CONUT) Score as a Predictive Marker in Hospitalized Frail Elderly Patients. J Pers Med 2023; 13:1119. [PMID: 37511732 PMCID: PMC10381597 DOI: 10.3390/jpm13071119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
The Controlling Nutritional Status (CONUT) score is a simple screening tool able to detect altered nutritional status as well as to predict clinical adverse outcomes in specific populations. No data are available in frail patients. This study aims to investigate the predictive role of the CONUT score on mortality and length of stay (LOS) in frail patients admitted to an Internal Medicine Department. We consecutively enrolled 246 patients aged 65 years or older, divided into two groups based on frailty status. The two groups were further divided according to low (<5) or high (≥5) CONUT score. Length of stay (LOS) was higher in frail patients than not-frail patients, as well as in the frail group with high CONUT scores compared to the frail group with low CONUT scores. Multiple linear regression showed an increase of 2.1 days for each additional point to the CONUT score. In-hospital mortality was higher in frail compared to not-frail patients, but it did not differ between frail patients with high CONUT scores and frail patients with low CONUT scores. An analysis of the survival curve for 30-day mortality showed a higher mortality rate for frail/high-CONUT-score patients as compared to the not-frail/low-CONUT-score group. The CONUT score shows high prognostic value for higher LOS-but not mortality-in the clinical setting of internal medicine departments for old frail patients.
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Affiliation(s)
- Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Francesco Bellanti
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Cristiano Capurso
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
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Molina S, Martinez-Urrea A, Malik K, Libori G, Monzon H, Martínez-Camblor P, Almagro P. Medium and long-term prognosis in hospitalised older adults with multimorbidity. A prospective cohort study. PLoS One 2023; 18:e0285923. [PMID: 37267235 DOI: 10.1371/journal.pone.0285923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/04/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Data about long-term prognosis after hospitalisation of elderly multimorbid patients remains scarce. OBJECTIVES Evaluate medium and long-term prognosis in hospitalised patients older than 75 years of age with multimorbidity. Explore the impact of gender, age, frailty, physical dependence, and chronic diseases on mortality over a seven-year period. METHODS We included prospectively all patients hospitalised for medical reasons over 75 years of age with two or more chronic illnesses in a specialised ward. Data on chronic diseases were collected using the Charlson comorbidity index and a questionnaire for disorders not included in this index. Demographic characteristics, Clinical Frailty Scale, Barthel index, and complications during hospitalisation were collected. RESULTS 514 patients (46% males) with a mean age of 85 (± 5) years were included. The median follow-up was 755 days (interquartile range 25-75%: 76-1,342). Mortality ranged from 44% to 68%, 82% and 91% at one, three, five, and seven years. At inclusion, men were slightly younger and with lower levels of physical impairment. Nevertheless, in the multivariate analysis, men had higher mortality (p<0.001; H.R.:1.43; 95% C.I.95%:1.16-1.75). Age, Clinical Frailty Scale, Barthel, and Charlson indexes were significant predictors in the univariate and multivariate analysis (all p<0.001). Dementia and neoplastic diseases were statistically significant in the unadjusted but not the adjusted model. In a cluster analysis, three patterns of patients were identified, with increasing significant mortality differences between them (p<0.001; H.R.:1.67; 95% CI: 1.49-1.88). CONCLUSIONS In our cohort, individual diseases had a limited predictive prognostic capacity, while the combination of chronic illness, frailty, and physical dependence were independent predictors of survival.
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Affiliation(s)
- Siena Molina
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Ana Martinez-Urrea
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Komal Malik
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Ginebra Libori
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Helena Monzon
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Pablo Martínez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States of America
- Faculty of Health Sciences, Universidad Autonoma de Chile, Providencia, Chile
| | - Pere Almagro
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
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Boucher EL, Gan JM, Rothwell PM, Shepperd S, Pendlebury ST. Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts. EClinicalMedicine 2023; 59:101947. [PMID: 37138587 PMCID: PMC10149337 DOI: 10.1016/j.eclinm.2023.101947] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background Guidelines recommend routine frailty screening for all hospitalised older adults to inform care decisions, based mainly on studies in elective or speciality-specific settings. However, most hospital bed days are accounted for by acute non-elective admissions, in which the prevalence and prognostic value of frailty might differ, and uptake of screening is limited. We therefore did a systematic review and meta-analysis of frailty prevalence and outcomes in unplanned hospital admissions. Methods We searched MEDLINE, EMBASE and CINAHL up to 31/01/2023 and included observational studies using validated frailty measures in adult hospital-wide or general medicine admissions. Summary data on the prevalence of frailty and associated outcomes, measurement tools, study setting (hospital-wide vs general medicine), and design (prospective vs retrospective) were extracted and risk of bias assessed (modified Joanna Briggs Institute checklists). Unadjusted relative risks (RR; moderate/severe frailty vs no/mild) for mortality (within one year), length of stay (LOS), discharge destination and readmission were calculated and pooled, where appropriate, using random-effects models. PROSPERO CRD42021235663. Findings Among 45 cohorts (median/SD age = 80/5 years; n = 39,041,266 admissions, n = 22 measurement tools) moderate/severe frailty ranged from 14.3% to 79.6% overall (and in the 26 cohorts with low-moderate risk of bias) with considerable heterogeneity between studies (phet < 0.001) preventing pooling of results but with rates <25% in only 3 cohorts. Moderate/severe vs no/mild frailty was associated with increased mortality (n = 19 cohorts; RR range = 1.08-3.70), more consistently among cohorts using clinically administered tools (n = 11; RR range = 1.63-3.70; phet = 0.08; pooled RR = 2.53, 95% CI = 2.15-2.97) vs cohorts using (retrospective) administrative coding data (n = 8; RR range = 1.08-3.02; phet < 0.001). Clinically administered tools also predicted increasing mortality across the full range of frailty severity in each of the six cohorts that allowed ordinal analysis (all p < 0.05). Moderate/severe vs no/mild frailty was also associated with a LOS >8 days (RR range = 2.14-3.04; n = 6) and discharge to a location other than home (RR range = 1.97-2.82; n = 4) but was inconsistently related to 30-day readmission (RR range = 0.83-1.94; n = 12). Associations remained clinically significant after adjustment for age, sex and comorbidity where reported. Interpretation Frailty is common in older patients with acute, non-elective hospital admission and remains predictive of mortality, LOS and discharge home with more severe frailty associated with greater risk, justifying more widespread implementation of screening using clinically administered tools. Funding None.
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Affiliation(s)
- Emily L. Boucher
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Jasmine M. Gan
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Peter M. Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, UK
| | - Sarah T. Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre and Departments of Acute General (Internal) Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, UK
- Corresponding author. Wolfson Centre for Prevention of Stroke and Dementia, Wolfson Building, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Gilstrap L, Solomon N, Chiswell K, James O'Malley A, Skinner JS, Fonarow GC, Bhatt DL, Yancy CW, Devore AD. The Association Between Beta-blocker and Renin-Angiotensin System Inhibitor Use After Heart Failure With Reduced Ejection Fraction Hospitalization and Outcomes in Older Patients. J Card Fail 2023; 29:434-444. [PMID: 36516937 PMCID: PMC10798429 DOI: 10.1016/j.cardfail.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Beta-blockers (BB) and renin-angiotensin system inhibitors (RASi) are foundational for the treatment of heart failure with reduced ejection fraction (HFrEF). However, given the increased risk of side effects in older patients, uncertainty remains as to whether, on net, older patients benefit as much as the younger patients studied in trials. METHODS AND RESULTS Using the Get With The Guidelines-Heart Failure registry linked with Medicare data, overlap propensity weighted Cox proportional hazard models were used to examine the association between BB and RASi use at hospital discharge and 30-day and 1-year outcomes among patients with HFrEF. Among the 48,711 patients (aged ≥65 years) hospitalized with HFrEF, there were significant associations between BB and/or RASi use at discharge and lower rates of 30-day and 1-year mortality, including those over age 85 (30-day hazard ratio 0.56, 95% confidence interval 0.45-0.70; 1-year hazard ratio 0.69, 95% confidence interval 0.61-0.78). In addition, the magnitude of benefit associated with BB and/or RASi use after discharge did not decrease with advancing age. Even among the oldest patients, those over age 85, with hypotension, renal insufficiency or frailty, BB and/or RASi use at discharge was still associated with lower 1-year mortality or readmission. CONCLUSIONS Among older patients hospitalized with HFrEF, BB and/or RASi use at discharge is associated with lower rates of 30-day and 1-year mortality across all age groups and the magnitude of this benefit does not seem to decrease with advancing age. These data suggest that, absent a clinical contraindication, BB and RASi should be considered in all patients hospitalized with HFrEF before or at hospital discharge, regardless of age.
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Affiliation(s)
- Lauren Gilstrap
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Nicole Solomon
- Duke University Clinical Research Institute, Durham, North Carolina
| | - Karen Chiswell
- Duke University Clinical Research Institute, Durham, North Carolina
| | - A James O'Malley
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jonathan S Skinner
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Gregg C Fonarow
- University of California Los Angles, Division of Cardiology, Los Angeles, California
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Boston, Massachusetts
| | - Clyde W Yancy
- Northwestern University, Division of Cardiology, Chicago, Illinois
| | - Adam D Devore
- Duke University Clinical Research Institute, Durham, North Carolina.
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Louras N, Reading Turchioe M, Shafran Topaz L, Demetres MR, Ellison M, Abudu-Solo J, Blutinger E, Munjal KG, Daniels B, Masterson Creber RM. Mobile Integrated Health Interventions for Older Adults: A Systematic Review. Innov Aging 2023; 7:igad017. [PMID: 37090165 PMCID: PMC10114527 DOI: 10.1093/geroni/igad017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Indexed: 03/04/2023] Open
Abstract
Background and Objectives Mobile integrated health (MIH) interventions have not been well described in older adult populations. The objective of this systematic review was to evaluate the characteristics and effectiveness of MIH programs on health-related outcomes among older adults. Research Design and Methods We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, Social Work Abstracts, and The Cochrane Library through June 2021 for randomized controlled trials or cohort studies evaluating MIH among adults aged 65 and older in the general community. Studies were screened for eligibility against predefined inclusion/exclusion criteria. Using at least 2 independent reviewers, quality was appraised using the Downs and Black checklist and study characteristics and findings were synthesized and evaluated for potential bias. Results Screening of 2,160 records identified 15 studies. The mean age of participants was 67 years. The MIH interventions varied in their focus, community paramedic training, types of assessments and interventions delivered, physician oversight, use of telemedicine, and post-visit follow-up. Studies reported significant reductions in emergency call volume (5 studies) and immediate emergency department (ED) transports (3 studies). The 3 studies examining subsequent ED visits and 4 studies examining readmission rates reported mixed results. Studies reported low adverse event rates (5 studies), high patient and provider satisfaction (5 studies), and costs equivalent to or less than usual paramedic care (3 studies). Discussion and Implications There is wide variability in MIH provider training, program coordination, and quality-based metrics, creating heterogeneity that make definitive conclusions challenging. Nonetheless, studies suggest MIH reduces emergency call volume and ED transport rates while improving patient experience and reducing overall health care costs.
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Affiliation(s)
- Nathan Louras
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Leah Shafran Topaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Michelle R Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, USA
| | - Melani Ellison
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jamie Abudu-Solo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Erik Blutinger
- Department of Emergency Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Kevin G Munjal
- Department of Emergency Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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Checa-Lopez M, Rodriguez-Laso A, Carnicero JA, Solano-Jaurrieta JJ, Saavedra Obermans O, Sinclair A, Landi F, Scuteri A, Álvarez-Bustos A, Sepúlveda-Loyola W, Rodriguez-Manas L. Differential utility of various frailty diagnostic tools in non-geriatric hospital departments of several countries: A longitudinal study. Eur J Clin Invest 2023:e13979. [PMID: 36855840 DOI: 10.1111/eci.13979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/01/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND There is limited knowledge on the performance of different frailty scales in clinical settings. We sought to evaluate in non-geriatric hospital departments the feasibility, agreement and predictive ability for adverse events after 1 year follow-up of several frailty assessment tools. METHODS Longitudinal study with 667 older adults recruited from five hospitals in three different countries (Spain, Italy and United Kingdom). Participants were older than 75 years attending the emergency room, cardiology and surgery departments. Frailty scales used were Frailty Phenotype (FP), FRAIL scale, Tilburg and Groningen Frailty Indicators, and Clinical Frailty Scale (CFS). Analyses included the prevalence of frailty, degree of agreement between tools, feasibility and prognostic value for hospital readmission, worsening of disability and mortality, by tool and setting. RESULTS Emergency Room and cardiology were the settings with the highest frailty prevalence, varying by tool between 40.4% and 67.2%; elective surgery was the one with the lowest prevalence (between 13.2% and 38.2%). The tools showed a fair to moderate agreement. FP showed the lowest feasibility, especially in urgent surgery (35.6%). FRAIL, CFS and FP predicted mortality and readmissions in several settings, but disability worsening only in cardiology. CONCLUSIONS Frailty is a highly frequent condition in older people attending non-geriatric hospital departments. We recommend that based upon their current feasibility and predictive ability, the FRAIL scale, CFS and FP should be preferentially used in these settings. The low concordance among the tools and differences in prevalence reported and predictive ability suggest the existence of different subtypes of frailty.
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Affiliation(s)
- Marta Checa-Lopez
- Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - Angel Rodriguez-Laso
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Jose Antonio Carnicero
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Fundación de Investigación Biomédica de Hospital Universitario de Getafe, Madrid, Spain
| | - Juan Jose Solano-Jaurrieta
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and Geriatric Service, Monte Naranco Hospital, Oviedo, Spain
| | - Olga Saavedra Obermans
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and Geriatric Service, Monte Naranco Hospital, Oviedo, Spain
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail, Medici Medical Practice, Luton, UK.,School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| | - Angelo Scuteri
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alejandro Álvarez-Bustos
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Walter Sepúlveda-Loyola
- Masters and PhD Programme in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil.,Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago, Chile
| | - Leocadio Rodriguez-Manas
- Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain.,Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
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20
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Clinical factors associated with adverse clinical outcomes in elderly versus non-elderly COVID-19 emergency patients: a multi-center observational study. Int J Emerg Med 2023; 16:11. [PMID: 36814202 PMCID: PMC9944782 DOI: 10.1186/s12245-023-00482-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused over 6 million deaths worldwide. The elderly accounted for a large proportion of patients with their mortality rate largely higher than the non-elderly. However, limited studies have explored clinical factors associated with poor clinical outcomes in this important population. Therefore, this study aimed to determine factors independently associated with adverse clinical outcomes among COVID-19 elderly patients. METHODS We conducted a multicenter observational study at five emergency departments (EDs) in Thailand. Patients over 18 years old diagnosed with COVID-19 between January and December 2021 were included. We classified patients into elderly (age ≥ 65 years) and non-elderly (age < 65 years). The primary clinical outcome was in-hospital mortality. The secondary outcomes were endotracheal intubation and intensive care unit admission. We identified independent factors associating with these outcomes both in the whole population and separately by age group using multivariate logistic regression models. RESULTS A total of 978 patients were included, 519 (53.1%) were elderly and 459 (46.9%) were non-elderly, and 254 (26%) died at hospital discharge. The mortality rate was significantly higher in the elderly group (39.1% versus 14.3%, p<0.001)). In the elderly, age (adjusted odds ratio (aOR) 1.13; 95% confidence interval (CI) 1.1-1.2; p<0.001), male sex (aOR 3.64; 95%CI 1.5-8.8; p=0.004), do-not-resuscitate (DNR) status (aOR 12.46; 95%CI 3.8-40.7; p<0.001), diastolic blood pressure (aOR 0.96; 95%CI 0.9-1.0; p=0.002), body temperature (aOR 1.74; 95%CI 1.0-2.9; p=0.036), and Glasgow Coma Scale (GCS) score (aOR 0.71; 95%CI 0.5-1.0; p=0.026) were independent baseline and physiologic factors associated with in-hospital mortality. Only DNR status and GCS score were associated with in-hospital mortality in both the elderly and non-elderly, as well as the overall population. Lower total bilirubin was independently associated with in-hospital mortality in the elderly (aOR 0.34; 95%CI 0.1-0.9; p=0.035), while a higher level was associated with the outcome in the non-elderly. C-reactive protein (CRP) was the only laboratory factor independently associated with all three study outcomes in the elderly (aOR for in-hospital mortality 1.01; 95%CI 1.0-1.0; p=0.006). CONCLUSION Important clinical factors associated with in-hospital mortality in elderly COVID-19 patients were age, sex, DNR status, diastolic blood pressure, body temperature, GCS score, total bilirubin, and CRP. These parameters may aid in triage and ED disposition decision-making in this very important patient population during times of limited resources during the COVID-19 pandemic.
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21
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Pansarasa O, Mimmi MC, Davin A, Giannini M, Guaita A, Cereda C. Inflammation and cell-to-cell communication, two related aspects in frailty. Immun Ageing 2022; 19:49. [PMID: 36289502 PMCID: PMC9598012 DOI: 10.1186/s12979-022-00306-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 10/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frailty is a complex, multi-dimensional age-related syndrome that increases the susceptibility to adverse health outcomes and poor quality of life. A growing consensus supports the contribution of chronic inflammation and immune system alterations to frailty, however a clear role of such alterations remains to be elucidated. Furthermore, pro- and anti-inflammatory cytokines together with other signaling molecules might spread from activated cells to the adjacent ones through extracellular vesicles (EVs), which have also a role in cellular aging. The aim of the present research was to investigate if EVs play a role in the immune function in frailty. RESULTS: In 219 older adults aged 76-78 years, selected from the InveCe.Ab study (Abbiategrasso, Italy), we investigated inflammation and EVs-mediated intercellular communication. C-reactive protein (CRP) and pro- (IL-1β, IL-2, IL-6, IL-8, IL-12 p70, TNFα and IFNγ) and anti- (IL-4, IL-10, IL-13) inflammatory cytokines were evaluated on plasma of Frail and non-Frail subjects. We reported a significant increase in CRP, interleukin-1β and -6 (IL-1β, IL-6) and tumor necrosis factor alpha (TNFα) plasma levels in frailty. In female Fr subjects, we also reported an increase in interferon-gamma (IFN-γ) and, surprisingly, in IL-13, an anti-inflammatory cytokine, whose increase seems to oppose the inflammaging theory. An inflammatory panel (toll-like receptors 2 and 4 (TLR2 and TLR4), tumor necrosis factor receptors TNFRec5/CD 40 and TNFRec1B/CD120B) and a panel including receptors involved in cellular senescence (insulin-like growth factor 1 receptor (CD221) and interleukin 6 receptor (IL-6R)) were indeed analysed in plasma isolated large EVs (lEVs) from Frail (n = 20) and non-Frail (n = 20) subjects. In lEVs isolated from plasma of Frail subjects we reported an increase in TLR2 and TLR4, TNFRec5/CD 40 and TNFRec1B/CD120B, suggesting a chronic state of inflammation. In addition, CD221 and IL-6R increases in lEVs of Frail individuals. CONCLUSIONS To conclude, the pro-inflammatory status, notably the increase in circulating cytokines is pivotal to understand the potential mechanisms underlying the frailty syndrome. Moreover, cytokines release from EVs, mainly the large ones, into the extracellular space suggest their contribution to the formation of a pro-inflammatory and pro-senescent microenvironment that, in turn, can contribute to frailty.
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Affiliation(s)
- Orietta Pansarasa
- grid.419416.f0000 0004 1760 3107IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Maria Chiara Mimmi
- grid.419416.f0000 0004 1760 3107IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Annalisa Davin
- grid.428690.10000 0004 7473 8040Golgi Cenci Foundation, 20081 Abbiategrasso, Milan Italy
| | - Marta Giannini
- grid.419416.f0000 0004 1760 3107IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Antonio Guaita
- grid.428690.10000 0004 7473 8040Golgi Cenci Foundation, 20081 Abbiategrasso, Milan Italy
| | - Cristina Cereda
- grid.419416.f0000 0004 1760 3107IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy ,grid.428690.10000 0004 7473 8040Golgi Cenci Foundation, 20081 Abbiategrasso, Milan Italy
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22
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Kawamura K, Osawa A, Tanimoto M, Itoh N, Matsuura T, Kondo I, Arai H. Prediction of the possibility of return to home based on frailty assessment at the time of admission to the COVID-19 treatment unit. Geriatr Gerontol Int 2022; 22:815-817. [PMID: 35960002 PMCID: PMC9538938 DOI: 10.1111/ggi.14460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/14/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Koki Kawamura
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Aiko Osawa
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | | | - Naoki Itoh
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | | | - Izumi Kondo
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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23
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Morales-Puerto M, Ruiz-Díaz M, Aranda-Gallardo M, Morales-Asencio JM, Alcalá-Gutiérrez P, Rodríguez-Montalvo JA, León-Campos Á, García-Mayor S, Canca-Sánchez JC. Development of a Clinical Prediction Rule for Adverse Events in Multimorbid Patients in Emergency and Hospitalisation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148581. [PMID: 35886434 PMCID: PMC9324433 DOI: 10.3390/ijerph19148581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: There is currently a global consensus that the quality of comprehensive care for acutely hospitalised elderly people should include addressing functionality and mobility, cognitive status, prevention of pressure ulcers, urinary incontinence, falls and delirium, as well as pain control and medication-related problems. The aim of this study is to develop and validate a clinical prediction rule for multimorbid patients admitted to an acute care hospital unit for any of the five adverse events included in our vulnerability pentad: falls, pressure ulcers, urinary incontinence, pain and delirium. (2) Methods: Longitudinal analytical clinimetric study, with two cohorts. The study population will consist of multimorbid patients hospitalised for acute care, referred from the Emergency Room. A clinical prediction rule will be proposed, incorporating predictive factors of these five adverse outcomes described. This study has received funding, awarded in November 2020 (PI-0107-2020), and was approved in October 2019 by the Research Ethics Committee ″Costa del Sol″. (3) Conclusions: Preventing adverse events in hospitalised patients is particularly important for those with multimorbidity. By applying a clinical prediction rule to detect specific risks, an estimate can be obtained of their probability of occurrence.
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Affiliation(s)
- Marta Morales-Puerto
- Hospital Costa del Sol, Servicio Andaluz de Salud, Autovía A7, Km, 187 Marbella, 29603 Málaga, Spain; (M.M.-P.); (M.R.-D.); (P.A.-G.); (J.A.R.-M.); (J.C.C.-S.)
| | - María Ruiz-Díaz
- Hospital Costa del Sol, Servicio Andaluz de Salud, Autovía A7, Km, 187 Marbella, 29603 Málaga, Spain; (M.M.-P.); (M.R.-D.); (P.A.-G.); (J.A.R.-M.); (J.C.C.-S.)
| | - Marta Aranda-Gallardo
- Hospital Costa del Sol, Servicio Andaluz de Salud, Autovía A7, Km, 187 Marbella, 29603 Málaga, Spain; (M.M.-P.); (M.R.-D.); (P.A.-G.); (J.A.R.-M.); (J.C.C.-S.)
- Department of Nursing, Faculty of Health Sciences, Universidad de Málaga, C/Arquitecto Francisco Peñalosa 3, 29017 Málaga, Spain; (J.M.M.-A.); (Á.L.-C.); (S.G.-M.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
- Correspondence: ; Tel.: +34-6-97957591
| | - José Miguel Morales-Asencio
- Department of Nursing, Faculty of Health Sciences, Universidad de Málaga, C/Arquitecto Francisco Peñalosa 3, 29017 Málaga, Spain; (J.M.M.-A.); (Á.L.-C.); (S.G.-M.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Purificación Alcalá-Gutiérrez
- Hospital Costa del Sol, Servicio Andaluz de Salud, Autovía A7, Km, 187 Marbella, 29603 Málaga, Spain; (M.M.-P.); (M.R.-D.); (P.A.-G.); (J.A.R.-M.); (J.C.C.-S.)
| | - José Antonio Rodríguez-Montalvo
- Hospital Costa del Sol, Servicio Andaluz de Salud, Autovía A7, Km, 187 Marbella, 29603 Málaga, Spain; (M.M.-P.); (M.R.-D.); (P.A.-G.); (J.A.R.-M.); (J.C.C.-S.)
| | - Álvaro León-Campos
- Department of Nursing, Faculty of Health Sciences, Universidad de Málaga, C/Arquitecto Francisco Peñalosa 3, 29017 Málaga, Spain; (J.M.M.-A.); (Á.L.-C.); (S.G.-M.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Silvia García-Mayor
- Department of Nursing, Faculty of Health Sciences, Universidad de Málaga, C/Arquitecto Francisco Peñalosa 3, 29017 Málaga, Spain; (J.M.M.-A.); (Á.L.-C.); (S.G.-M.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - José Carlos Canca-Sánchez
- Hospital Costa del Sol, Servicio Andaluz de Salud, Autovía A7, Km, 187 Marbella, 29603 Málaga, Spain; (M.M.-P.); (M.R.-D.); (P.A.-G.); (J.A.R.-M.); (J.C.C.-S.)
- Department of Nursing, Faculty of Health Sciences, Universidad de Málaga, C/Arquitecto Francisco Peñalosa 3, 29017 Málaga, Spain; (J.M.M.-A.); (Á.L.-C.); (S.G.-M.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
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24
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Feist B, Feindt B, Kasprick L, Baerwald C, Simm A, Müller-Werdan U, Sultzer R, Behrens J. Prüfung des Screening-Tools GeriNOT. Z Gerontol Geriatr 2022; 56:201-208. [PMID: 35399117 DOI: 10.1007/s00391-022-02054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Geriatric-specific characteristics influence patient-relevant outcomes of inpatient hospital care in patients aged 70 years and older: prolonged length of stay, complications, increase in utilization of required services as well as mortality rates. OBJECTIVE The screening tool GeriNOT, identification of geriatric risk potential with 7 items, of which mobility and cognition are double-weighted, score 9 points, was tested for its predictive content and diagnostic quality. MATERIAL AND METHODS Diagnostic study from a retrospective, bicentric complete survey in all types of admission from 70 years with 2541 patient cases. Regression analyses in linked samples of the 7 items in GeriNOT and as noncombined end points: prolonged length of stay, complications, increase in need-based service at discharge and death. RESULTS Mean age ± SD: 77.0 ± 6.4 years. ROC analyses report at a cut-off value calculated using the Youden index of ≥ 4 points in 2541 cases: increase in need-based service at discharge (AUC = 0.693, 95% CI = 0.663-0.723, sensitivity 75.2%, specificity 59.7%), complications (AUC = 0.662, 95% CI = 0.636-0.688, sensitivity 64.2%, specificity 61.6%) and death (AUC = 0.734, 95% CI = 0.682-0.786, sensitivity 76.4%, specificity 57.5%). Possibly suitable for use as screening to identify geriatric risk potentials at a cut-off of ≥ 4 points. DISCUSSION Provide an initial filter screening with regard to mobility. Such identification could provide the involved persons with the opportunity for an improved treatment outcome by adapting the inpatient process. Prospective validation of GeriNOT needed.
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25
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Marinus N, Vigorito C, Giallauria F, Dendale P, Meesen R, Bokken K, Haenen L, Jansegers T, Vandenheuvel Y, Scherrenberg M, Spildooren J, Hansen D. Frailty Test Battery Development including Physical, Socio-Psychological and Cognitive Domains for Cardiovascular Disease Patients: A Preliminary Study. J Clin Med 2022; 11:jcm11071926. [PMID: 35407534 PMCID: PMC9014815 DOI: 10.3390/jcm11071926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/23/2023] Open
Abstract
Frailty is an age-related decline in physical, socio-psychological and cognitive function that results in extreme vulnerability to stressors. Therefore, this study aimed to elucidate which tests have to be selected to detect frailty in a comprehensive and feasible manner in cardiovascular disease (CVD) patients based on multivariate regression and sensitivity/specificity analyses. Patients (n = 133, mean age 78 ± 7 years) hospitalised for coronary revascularisation or heart failure (HF) were examined using the Fried and Vigorito criteria, together with some additional measurements. Moreover, to examine the association of frailty with 6-month clinical outcomes, hospitalisations and mortality up to 6 months after the initial hospital admission were examined. Some level of frailty was detected in 44% of the patients according to the Vigorito criteria and in 65% of the patients according to the Fried criteria. Frailty could best be detected by a score based on: sex, Mini Nutritional Assessment (MNA), Katz scale, timed up-and-go test (TUG), handgrip strength, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and total number of medications. Frailty and specific markers of frailty were significantly associated with mortality and six-month hospitalisations. We thus can conclude that, in patients with CVD, sex, MNA, Katz scale, TUG, handgrip strength, MMSE, GDS-15 and total number of medications play a key role in detecting frailty, assessed by a new time- and cost-efficient test battery.
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Affiliation(s)
- Nastasia Marinus
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Correspondence: ; Tel.: +32-(0)11-269203
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.V.); (F.G.)
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.V.); (F.G.)
- Faculty of Science and Technology, University of New England, Armidale, NSW 2350, Australia
| | - Paul Dendale
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Raf Meesen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Kevin Bokken
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Laura Haenen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Thomas Jansegers
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Yenthe Vandenheuvel
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Martijn Scherrenberg
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Joke Spildooren
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
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26
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Scherrenberg M, Marinus N, Giallauria F, Falter M, Kemps H, Wilhelm M, Prescott E, Vigorito C, De Kluiver E, Cipriano G, Dendale P, Hansen D. The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: a framework. Trends Cardiovasc Med 2022:S1050-1738(22)00023-8. [PMID: 35121082 DOI: 10.1016/j.tcm.2022.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the other hand also experience aging-related syndromes such as frailty. Despite being underrecognized, frailty is a critical, common, and co-existent condition among older CVD patients, leading to exercise intolerance and compromised adherence to cardiovascular rehabilitation. Moreover, frail patients need a different approach for CR and are at very high risk for adverse events, but yet are underrepresented in conventional CR. Fortunately, recent advances have been made in technology, allowing remote monitoring, coaching and supervision of CVD patients in secondary prevention programs with promising benefits. Similarly, we hypothesized that such programs should also be implemented to treat frailty in CVD patients. However, considering frail patients' particular needs and challenges, telerehabilitation interventions should thus be appropriately adapted. Our purpose is to provide, for the first time and based on expert opinions, a framework of how such a cardiac telerehabilitation program could be developed and implemented to manage a prevention and rehabilitation program for CVD patients with frailty.
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Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Nastasia Marinus
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, The Netherlands; Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, NW, Denmark
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium.
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27
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Conroy S, Thomas M. Urgent care for older people. Age Ageing 2022; 51:6146885. [PMID: 33620421 DOI: 10.1093/ageing/afab019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Geriatric medicine is the clinical specialty that focuses upon the care of older people-especially those with frailty (a state of increased vulnerability). In hospital, older people living with frailty are at high risk of developing a range of unpleasant outcomes such as delirium, falls, fractures, pressure sores and death. Comprehensive geriatric assessment is a form of holistic care that incorporates a specific set of clinical competencies that are able to reduce these adverse outcomes. Over the years, geriatric medicine has moved from being more of a community-based service towards a more acute specialty-encroaching now upon emergency department care. The challenge now is to work out how best to deliver geriatric care across the whole hospital (older people with frailty are not just cared for in geriatric wards!). The themed collection published on the Age & Ageing journal website outlines key articles that are attempting to develop solutions to this challenging conundrum. We hope that you enjoy reading them.
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Affiliation(s)
- Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Matt Thomas
- Department of Medicine for Older People, Poole Hospital, Poole BH15 2JB, UK
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Flaherty JH, Rodin MB, Morley JE. Changing Hospital Care For Older Adults: The Case for Geriatric Hospitals in the United States. Gerontol Geriatr Med 2022; 8:23337214221109005. [PMID: 35813982 PMCID: PMC9260589 DOI: 10.1177/23337214221109005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hospital care of frail older adults is far from optimal. Although some geriatric models of care have been shown to improve outcomes, the effect size is small and models are difficult to fully implement, sustain and replicate. The two root causes for these shortcomings are competing interests (high revenue generating diseases, procedures and surgeries) and current hospital cultures (for example a culture of safety that emphasizes bed alarms and immobility rather than frequent ambulation). Geriatric hospitals would be hospitals completely dedicated to the care of frail older patients, a group which is most vulnerable to the negative consequences of a hospitalization. They would differ from a typical adult hospital because they could implement evidence based principles of successful geriatric models of care on a hospital wide basis, which would make them sustainable and allow for scaling up of proven outcomes. Innovative structural designs, unachievable in a typical adult hospital, would enhance mobility while maintaining safety. Financial viability and stability would be a challenge but should be feasible, likely through affiliation with larger health care systems with other hospitals because of cost savings associated with geriatric models of care (decreased length of stay, increased likelihood of discharge home, without increasing costs).
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Affiliation(s)
- Joseph H. Flaherty
- Regional Medical Director of Geriatrics,
Envision Physician Services, Dallas, Texas, Division of Geriatrics, University of Texas Southwestern, Dallas, Texas, USA
| | - Miriam B. Rodin
- Division of Geriatrics, Department of
Internal Medicine, Saint Louis University, St Louis, Missouri
| | - John E. Morley
- Division of Geriatrics, Department of
Internal Medicine, Saint Louis University, St Louis, Missouri
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Hodgson P, Greaves J, Cook G, Fraser A, Bainbridge L. A study to introduce National Early Warning Scores (NEWS) in care homes: Influence on decision-making and referral processes. Nurs Open 2022; 9:519-526. [PMID: 34780677 PMCID: PMC8685833 DOI: 10.1002/nop2.1091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/06/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
AIM Early warning scores are commonly used in hospital settings, but little is known about their use in care homes. This study aimed to evaluate the impacts of National Early Warning Scores alongside other measures in this setting. DESIGN Convergent parallel design. METHODS Quantitative data from 276 care home residents from four care homes were used to analyse the relationship between National Early Warning Scores score, resident outcome and functional daily living (Barthel ADL (Barthel Index for Activities of Daily Living)) and Rockwood (frailty). Interviews with care home staff (N = 13) and care practitioners (N = 4) were used to provide qualitative data. RESULTS A statistically significant link between National Early Warning Scores (p = .000) and Barthel ADL (p = .013) score and hospital admissions was found, while links with Rockwood were insignificant (p = .551). Care home staff reported many benefits of National Early Warning Scores, including improved communication, improved decision-making and role empowerment. Although useful, due to the complexity of the resident population's existing health conditions, National Early Warning Scores alone could not act as a diagnostic tool.
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Affiliation(s)
- Philip Hodgson
- Northumbria University Faculty of Health and Life SciencesNewcastle upon TyneUK
| | - Jane Greaves
- Northumbria University Faculty of Health and Life SciencesNewcastle upon TyneUK
| | - Glenda Cook
- Northumbria University Faculty of Health and Life SciencesNewcastle upon TyneUK
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Wennberg AM, Yin W, Fang F, Pedersen NL, Hägg S, Jylhävä J, Modig K. Comparison of two different frailty scales in the longitudinal Swedish Adoption/Twin Study of Aging (SATSA). Scand J Public Health 2021:14034948211059958. [PMID: 34904462 DOI: 10.1177/14034948211059958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Although up to 25% of older adults are frail, assessing frailty can be difficult, especially in registry data. This study evaluated the utility of a code-based frailty score in registry data by comparing it to a gold-standard frailty score to understand how frailty can be quantified in population data and perhaps better addressed in healthcare. METHODS We compared the Hospital Frailty Risk Score (HFRS), a frailty measure based on 109 ICD codes, to a modified version of the Frailty Index (FI) Frailty Index (FI), a self-report frailty measure, and their associations with all-cause mortality both cross-sectionally and longitudinally (follow-up = 36 years) in a Swedish cohort study (n = 1368). RESULTS The FI and HFRS were weakly correlated (rho = 0.11, p < 0.001). Twenty-two percent (n = 297) of participants were considered frail based on published cut-offs of either measure. Only 3% (n = 35) of participants were classified as frail by both measures; 4% (n = 60) of participants were considered frail by only the HFRS; and 15% (n = 202) of participants were considered frail based only on the FI. Frailty as measured by the HFRS showed greater variance and no clear increase or decrease with age, while frailty as measured by the FI increased steadily with age. In adjusted Cox proportional hazard models, baseline HFRS frailty (HR = 1.17, 95% CI 0.92, 1.49) was not statistically significantly associated with mortality, while FI frailty was (HR = 2.89, 95% CI 1.61, 2.23). These associations were modified by age and sex. CONCLUSIONS The HFRS may not capture the full spectrum of frailty among community-dwelling individuals, particularly at younger ages, in Swedish registry data.
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Affiliation(s)
- Alexandra M Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Weiyao Yin
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Nancy L Pedersen
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Sara Hägg
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Juulia Jylhävä
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
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Ikonen JN, Eriksson JG, Salonen MK, Kajantie E, Arponen O, Haapanen MJ. The utilization of specialized healthcare services among frail older adults in the Helsinki Birth Cohort Study. Ann Med 2021; 53:1875-1884. [PMID: 34714205 PMCID: PMC8567908 DOI: 10.1080/07853890.2021.1941232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/04/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The association between frailty and specialized healthcare utilization is not well studied. We, therefore, examined the utilization of specialized healthcare services among frail Finnish older adults. METHODS A sub-sample of 1060 participants of the Helsinki Birth Cohort Study were followed prospectively for specialized healthcare utilization from nationwide registers between the years 2013 and 2017. The participants' frailty status was assessed according to Fried's criteria at a mean age of 71.0 (2.7 SD) years between the years 2011 and 2013. A negative binomial regression model was used to examine the association between frailty and the total number of visits, emergency visits, outpatient appointments separating the first outpatient appointments and the follow-up appointments, inpatient care including elective and non-elective hospital admissions and the total number of hospital days. We also calculated average length of stay (ALOS) and used the Kruskal-Wallis test to examine the differences between the groups. RESULTS After adjusting for covariates, frailty was significantly associated with the number of specialized healthcare visits (IRR 1.50, 95% CI = 1.04-2.15) and all subgroups of visits apart from follow-up outpatient appointments. Frailty was particularly strongly associated with the number of hospital days (IRR 5.24, 95% CI = 2.35-11.7) and notably with emergency visits (IRR = 2.26, 95% CI = 1.45-3.51) and hospital admissions (IRR 2.23, 95% CI = 1.39-3.56). Frail older adults had also higher ALOS compared to non-frail participants (p = .009). CONCLUSIONS Frailty increases the use of most specialized healthcare services. Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.KEY MESSAGEFrailty is associated with the utilization of most specialized healthcare services, the most expensive part of the healthcare in most high-income countries.The association of frailty with inpatient care is particularly strong.Preventative interventions against frailty are needed to decrease the burden on specialized healthcare systems.
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Affiliation(s)
- Jenni N. Ikonen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Johan G. Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Agency for Science, Technology and Research, Singapore Institute for Clinical Sciences, Singapore
| | - Minna K. Salonen
- Folkhälsan Research Center, Helsinki, Finland
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Eero Kajantie
- Department of Public Health Solutions, THL Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Otso Arponen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Markus J. Haapanen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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Moser A, Reinikainen M, Jakob SM, Selander T, Pettilä V, Kiiski O, Varpula T, Raj R, Takala J. Mortality prediction in intensive care units including premorbid functional status improved performance and internal validity. J Clin Epidemiol 2021; 142:230-241. [PMID: 34823021 DOI: 10.1016/j.jclinepi.2021.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Prognostic models are key for benchmarking intensive care units (ICUs). They require up-to-date predictors and should report transportability properties for reliable predictions. We developed and validated an in-hospital mortality risk prediction model to facilitate benchmarking, quality assurance, and health economics evaluation. STUDY DESIGN AND SETTING We retrieved data from the database of an international (Finland, Estonia, Switzerland) multicenter ICU cohort study from 2015 to 2017. We used a hierarchical logistic regression model that included age, a modified Simplified Acute Physiology Score-II, admission type, premorbid functional status, and diagnosis as grouping variable. We used pooled and meta-analytic cross-validation approaches to assess temporal and geographical transportability. RESULTS We included 61,224 patients treated in the ICU (hospital mortality 10.6%). The developed prediction model had an area under the receiver operating characteristic curve 0.886, 95% confidence interval (CI) 0.882-0.890; a calibration slope 1.01, 95% CI (0.99-1.03); a mean calibration -0.004, 95% CI (-0.035 to 0.027). Although the model showed very good internal validity and geographic discrimination transportability, we found substantial heterogeneity of performance measures between ICUs (I-squared: 53.4-84.7%). CONCLUSION A novel framework evaluating the performance of our prediction model provided key information to judge the validity of our model and its adaptation for future use.
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Affiliation(s)
- André Moser
- CTU Bern, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Ville Pettilä
- Division of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olli Kiiski
- Health and Care, Benchmarking Services, TietoEvry, Helsinki, Finland
| | - Tero Varpula
- Division of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka Takala
- Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract
Delirium and frailty are prevalent geriatric syndromes and important public health issues among older adults. The prevalence of delirium among hospitalized older adults ranges from 15% to 75%, while that of frailty ranges from 12% to 24%. The exact pathophysiology of these two conditions has not been clearly identified, although several hypotheses have been proposed. However, these conditions are considered to be multifactorial in etiology and are associated with inflammation related to aging, alterations in vascular systems, genetics, and nutritional deficiency. Furthermore, clinically, they are significantly associated with frailty, which increases the risk of delirium by almost two- to three-fold among hospitalized older adults. With their multifactorial etiology and unknown pathophysiology, current evidence supports more practical multicomponent patient-centered approaches to prevent and manage delirium with frailty among hospitalized older adults. These comprehensive and organized bundled approaches can identify high-risk patients with frailty and more effectively manage their delirium.
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Affiliation(s)
- Min Ji Kwak
- Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Corresponding author: Min Ji Kwak, MD, MS, DrPH Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St MSB 5.126, Houston, TX 77030, USA E-mail:
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Gagesch M, Edler K, Chocano-Bedoya PO, Abderhalden LA, Seematter-Bagnoud L, Meyer T, Bertschi D, Zekry D, Büla CJ, Gold G, Kressig RW, Stuck AE, Bischoff-Ferrari HA. Swiss Frailty Network and Repository: protocol of a Swiss Personalized Health Network's driver project observational study. BMJ Open 2021; 11:e047429. [PMID: 34261684 PMCID: PMC8280893 DOI: 10.1136/bmjopen-2020-047429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Early identification of frailty by clinical instruments or accumulation of deficit indexes can contribute to improve healthcare for older adults, including the prevention of negative outcomes in acute care. However, conflicting evidence exists on how to best capture frailty in this setting. Simultaneously, the increasing utilisation of electronic health records (EHRs) opens up new possibilities for research and patient care, including frailty. METHODS AND ANALYSIS The Swiss Frailty Network and Repository (SFNR) primarily aims to develop an electronic Frailty Index (eFI) from routinely available EHR data in order to investigate its predictive value against length of stay and in-hospital mortality as two important clinical outcomes in a study sample of 1000-1500 hospital patients aged 65 years and older. In addition, we will examine the correlation between the eFI and a test-based clinical Frailty Instrument to compare both concepts in Swiss older adults in acute care settings. As a Swiss Personalized Health Network (SPHN) driver project, our study will report on the characteristics and usability of the first nationwide eFI in Switzerland connecting all five Swiss University Hospitals' Geriatric Departments with a representative sample of patients aged 65 years and older admitted to acute care. ETHICS AND DISSEMINATION The study protocol was approved by the competent ethics committee of the Canton of Zurich (BASEC-ID 2019-00445). All acquired data will be handled according to SPHN's ethical framework for responsible data processing in personalised health research. Analyses will be performed within the secure BioMedIT environment, a national infrastructure to enable secure biomedical data processing, an integral part of SPHN. TRIAL REGISTRATION NUMBER NCT04516642.
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Affiliation(s)
- Michael Gagesch
- Department of Geriatrics, University Hospital Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Karin Edler
- Research Data Service Center, Clinical Trails Center, University Hospital Zurich, Zurich, Switzerland
| | - Patricia O Chocano-Bedoya
- Centre on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Lauren A Abderhalden
- Centre on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Laurence Seematter-Bagnoud
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health, Lausanne, Switzerland
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Tobias Meyer
- Universitäre Altersmedizin FELIX PLATTER, Basel, Switzerland
| | - Dominic Bertschi
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Dina Zekry
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe J Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Gabriel Gold
- Department of Rehabilitation and Geriatrics, University Hospitals Geneva, Geneva, Switzerland
| | - Reto W Kressig
- Universitäre Altersmedizin FELIX PLATTER, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Andreas E Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Heike A Bischoff-Ferrari
- Department of Geriatrics, University Hospital Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Reliability, Validity, and Feasibility of the Frail-VIG Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105187. [PMID: 34068227 PMCID: PMC8153117 DOI: 10.3390/ijerph18105187] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/20/2022]
Abstract
The study aimed to assess the reliability of the scores, evidence of validity, and feasibility of the Frail-VIG index. A validation study mixing hospitalized and community-dwelling older people was designed. Intraclass correlation coefficient (ICC) was used to assess the inter-rater agreement and the reliability. The construct validity of the Frail-VIG index with respect to the Frailty Phenotype (FP) was evaluated by calculating the area under the receiver operating characteristic curve (AUC-ROC). Convergent validity with the Clinical Frailty Scale (CFS) was assessed using Pearson's correlation coefficients. The feasibility was evaluated by calculating the average time required to administer the Frail-VIG index and the percentage of unanswered responses. A sample of 527 older people (mean age of 81.61, 56.2% female) was included. The inter-rater agreement and test-retest reliability were very strong: 0.941 (95% CI, 0.890 to 0.969) and 0.976 (95% CI, 0.958 to 0.986), respectively. Results indicated adequate convergent validity of the Frail-VIG index with respect to the FP, AUC-ROC 0.704 (95% CI, 0.622 to 0.786), and a moderate to strong positive correlation between the Frail-VIG index and CFS (r = 0.635, 95% CI, 0.54 to 0.71). The Frail-VIG index administration required an average of 5.01 min, with only 0.34% of unanswered responses. The Frail-VIG index is a reliable, feasible, and valid instrument to assess the degree of frailty in hospitalized and community-dwelling older people.
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Costantino G, Solbiati M, Elli S, Paganuzzi M, Massabò D, Montano N, Mancarella M, Cortellaro F, Cataudella E, Bellone A, Capsoni N, Bertolini G, Nattino G, Casazza G. Utility of hospitalization for elderly individuals affected by COVID-19. PLoS One 2021; 16:e0250730. [PMID: 33901228 PMCID: PMC8075227 DOI: 10.1371/journal.pone.0250730] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 12/29/2022] Open
Abstract
Background During the COVID-19 pandemic, the number of individuals needing hospital admission has sometimes exceeded the availability of hospital beds. Since hospitalization can have detrimental effects on older individuals, preference has been given to younger patients. The aim of this study was to assess the utility of hospitalization for elderly affected by COVID-19. We hypothesized that their mortality decreases when there is greater access to hospitals. Methods This study examined 1902 COVID-19 patients consecutively admitted to three large hospitals in Milan, Italy. Overall mortality data for Milan from the same period was retrieved. Based on emergency department (ED) data, both peak and off-peak phases were identified. The percentage of elderly patients admitted to EDs during these two phases were compared by calculating the standardized mortality ratio (SMR) of the individuals younger than, versus older than, 80 years. Results The median age of the patients hospitalized during the peak phase was lower than the median age during the off-peak phase (64 vs. 75 years, respectively; p <0.001). However, while the SMR for the younger patients was lower during the off-peak phase (1.98, 95% CI: 1.72–2.29 versus 1.40, 95% CI: 1.25–1.58, respectively), the SMR was similar between both phases for the elderly patients (2.28, 95% CI: 2.07–2.52 versus 2.48, 95% CI: 2.32–2.65, respectively). Conclusions Greater access to hospitals during an off-peak phase did not affect the mortality rate of COVID-19-positive elderly patients in Milan. This finding, if confirmed in other settings, should influence future decisions regarding resource management of health care organizations.
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Affiliation(s)
- Giorgio Costantino
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Monica Solbiati
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
- * E-mail:
| | - Silvia Elli
- Università degli Studi di Milano, Milan, Italy
| | | | | | - Nicola Montano
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Marta Mancarella
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Cortellaro
- ASST Santi Paolo e Carlo, Pronto Soccorso e Degenza Breve San Carlo, Milan, Italy
| | - Emanuela Cataudella
- ASST Santi Paolo e Carlo, Pronto Soccorso e Degenza Breve San Carlo, Milan, Italy
| | - Andrea Bellone
- ASST Grande Ospedale Metropolitano Niguarda, Medicina d’Urgenza e Pronto Soccorso, Milan, Italy
| | - Nicolò Capsoni
- ASST Grande Ospedale Metropolitano Niguarda, Medicina d’Urgenza e Pronto Soccorso, Milan, Italy
| | - Guido Bertolini
- Laboratorio di Epidemiologia Clinica, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giovanni Nattino
- Laboratorio di Epidemiologia Clinica, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”, Università degli Studi di Milano, Milan, Italy
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Li CM, Lin CH, Li CI, Liu CS, Lin WY, Li TC, Lin CC. Frailty status changes are associated with healthcare utilization and subsequent mortality in the elderly population. BMC Public Health 2021; 21:645. [PMID: 33794860 PMCID: PMC8017879 DOI: 10.1186/s12889-021-10688-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 03/23/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study determined (1) whether a change in frailty status after a 1 year follow up is associated with healthcare utilization and evaluated (2) whether a change in frailty status after a 1 year follow up and health care utilization are associated with all-cause mortality in a sample of Taiwan population. METHODS This work is a population-based prospective cohort study involving residents aged ≥65 years in 2009. A total of 548 elderly patients who received follow-ups in the subsequent year were included in the current data analysis. Fried frailty phenotype was measured at baseline and 1 year. Information on the outpatient visits of each specialty doctor, emergency care utilization, and hospital admission during the 2 month period before the second interview was collected through standardized questionnaires administered by an interviewer. Deaths were verified by indexing to the national database of deaths. RESULTS At the subsequent 1 year follow-up, 73 (13.3%), 356 (64.9%), and 119 (21.7%) elderly participants exhibited deterioration, no change in status, and improvement in frailty states, respectively. Multivariate logistic analysis showed the high risk of any type of outpatient use (odds ratios [OR] 1.94, 95% confidence interval [CI] 1.02-3.71) among older adults with worse frailty status compared with those who were robust at baseline and had unchanged frailty status after 1 year. After multivariate adjustment, participants with high outpatient clinic utilization had significantly higher mortality than those with low outpatient clinic visits among unchanged pre-frail or frail (hazard ratios [HR] 2.79, 95% CI: 1.46-5.33) and frail to pre-frail/robust group (HR 9.32, 95% CI: 3.82-22.73) if the unchanged robustness and low outpatient clinic visits group was used as the reference group. CONCLUSIONS The conditions associated with frailty status, either after 1 year or at baseline, significantly affected the outpatient visits and may have increased medical expenditures. Combined change in frailty status and number of outpatient visits is related to increased mortality.
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Affiliation(s)
- Chia-Ming Li
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC. .,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Andrew MK, MacDonald S, Godin J, McElhaney JE, LeBlanc J, Hatchette TF, Bowie W, Katz K, McGeer A, Semret M, McNeil SA. Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness. J Am Geriatr Soc 2021; 69:696-703. [PMID: 33294986 PMCID: PMC7984066 DOI: 10.1111/jgs.16950] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND/OBJECTIVES Influenza is associated with significant morbidity and mortality, particularly for older adults. Persistent functional decline following hospitalization has important impacts on older adults' wellbeing and independence, but has been under-studied in relation to influenza. We aimed to investigate persistent functional change in older adults admitted to hospital with influenza and other acute respiratory illness (ARI). DESIGN Protective observational cohort study. SETTING Canadian Immunization Research Network Serious Outcomes Surveillance Network 2011 to 2012 influenza season. PARTICIPANTS A total of 925 patients aged 65 and older admitted to hospital with influenza and other ARI. MEASUREMENTS Influenza was laboratory-confirmed. Frailty was measured using a Frailty index (FI). Functional status was measured using the Barthel index (BI); moderate persistent functional decline was defined as a clinically meaningful loss of ≥10 to <20 points on the 100-point BI. Catastrophic disability (CD) was defined as a loss of ≥20 points, equivalent to full loss of independence in two basic activities of daily living. RESULTS Five hundred and nineteen (56.1%) were women; mean age was 79.4 (standard deviation=8.4) years. Three hundred and forty-six (37.4%) had laboratory-confirmed influenza. Influenza cases had lower baseline function (BI = 77.0 vs 86.9, P < .001) and higher frailty (FI = 0.23 vs 0.20, P < .001) than those with other ARI. A total of 8.4% died, 8.2% experienced persistent moderate functional decline, and 9.9% experienced CD. Higher baseline frailty was associated with increased odds of experiencing functional decline, CD, and death. The experience of functional decline and CD, and its association with frailty, was the same for influenza and other ARI. CONCLUSION Functional loss in hospital is common among older adults; for some this functional loss is persistent and catastrophic. This highlights the importance of prevention and optimal management of acute declines in health, including influenza, to avoid hospitalization. In the case of influenza, for which vaccines exist, this raises the potential of vaccine preventable disability.
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Affiliation(s)
- Melissa K. Andrew
- Geriatric Medicine Research, Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Canadian Center for VaccinologyHalifaxNova ScotiaCanada
| | - Sarah MacDonald
- Department of Family MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Judith Godin
- Geriatric Medicine Research, Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Jason LeBlanc
- Canadian Center for VaccinologyHalifaxNova ScotiaCanada
- Department of PathologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Todd F. Hatchette
- Canadian Center for VaccinologyHalifaxNova ScotiaCanada
- Department of Medicine (Infectious Diseases)Dalhousie UniversityHalifaxNova ScotiaCanada
| | - William Bowie
- Department of Medicine (Infectious Diseases)University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kevin Katz
- North York General HospitalTorontoOntarioCanada
| | | | - Makeda Semret
- McGill University Health Centre Research InstituteMontrealQuebecCanada
| | - Shelly A. McNeil
- Canadian Center for VaccinologyHalifaxNova ScotiaCanada
- Department of Medicine (Infectious Diseases)Dalhousie UniversityHalifaxNova ScotiaCanada
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Lo AX, Heinemann AW, Gray E, Lindquist LA, Kocherginsky M, Post LA, Dresden SM. Inter-rater Reliability of Clinical Frailty Scores for Older Patients in the Emergency Department. Acad Emerg Med 2021; 28:110-113. [PMID: 32141671 DOI: 10.1111/acem.13953] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/31/2020] [Accepted: 03/01/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Alexander X. Lo
- From the Department of Emergency MedicineNorthwestern University ChicagoIL
- the Center for Health Services and Outcomes ResearchNorthwestern University ChicagoIL
| | - Allen W. Heinemann
- From the Department of Emergency MedicineNorthwestern University ChicagoIL
- the Center for Health Services and Outcomes ResearchNorthwestern University ChicagoIL
- the Department of Physical Medicine and RehabilitationNorthwestern University ChicagoIL
| | - Elizabeth Gray
- the Department of Preventive Medicine Division of BiostatisticsNorthwestern University ChicagoIL
| | - Lee A. Lindquist
- and the Division of General Internal Medicine and Geriatrics Department of Internal MedicineNorthwestern University ChicagoIL
| | - Masha Kocherginsky
- the Department of Preventive Medicine Division of BiostatisticsNorthwestern University ChicagoIL
| | - Lori A. Post
- From the Department of Emergency MedicineNorthwestern University ChicagoIL
- Department of Medical Social SciencesNorthwestern University ChicagoIL
- Buehler Center for Health Policy and Economics Northwestern University Chicago IL
| | - Scott M. Dresden
- From the Department of Emergency MedicineNorthwestern University ChicagoIL
- the Center for Health Services and Outcomes ResearchNorthwestern University ChicagoIL
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Ueshima J, Maeda K, Ishida Y, Shimizu A, Inoue T, Nonogaki T, Matsuyama R, Yamanaka Y, Mori N. SARC-F Predicts Mortality Risk of Older Adults during Hospitalization. J Nutr Health Aging 2021; 25:914-920. [PMID: 34409971 DOI: 10.1007/s12603-021-1647-x] [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] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the association between SARC-F scores and the in-hospital mortality risk among older patients admitted to acute care hospitals. DESIGN Single-center retrospective study. SETTING A university hospital. PARTICIPANTS All consecutive patients aged older than 65 were admitted and discharged from the study hospital between July 2019 and September 2019. MEASUREMENTS Relevant patient data included age, sex, body mass index, nutritional status, fat-free mass, disease, activities of daily living (ADL), duration of hospital stay, SARC-F, and occurrence of death within 30 days of hospitalization. The diseases that caused hospitalization and comorbidities (Charlson Comorbidity Index; CCI) were obtained from medical records. The Eastern Cooperative Oncology Group-performance status (PS) was used to determine ADL, and the in-hospital mortality rate within 30 days of hospitalization as the outcome. RESULTS We analyzed 2,424 patients. The mean age was 75.9±6.9 and 55.5% were male. Fifty-three in-hospital mortalities occurred among the participants within the first 30 days of hospitalization. Patients who died in-hospital were older, had poorer nutritional status and severer PS scores, and more comorbidities than those who did not. A SARC-F score of ≥4 predicted a higher mortality risk within those 30 days with the following precision: sensitivity 0.792 and specificity 0.805. There were significantly more deaths in Kaplan-Meier curves regarding a score of SARC-F≥4 than a score of SARC-F<4 (p<0.001). Cox proportional hazard analysis was used to identify the clinical indicators most associated with in-hospital mortality. SARC-F≥4 (Hazard Ratio: HR 5.65, p<0.001), CCI scores (HR1.11, p=0.004), and infectious and parasitic diseases (HR3.13, p=0.031) were associated with in-hospital mortality. The SARC-F items with significant in-hospital mortality effects were assistance with walking (HR 2.55, p<0.001) and climbing stairs (HR 2.46, p=0.002). CONCLUSION The SARC-F questionnaire is a useful prognostic indicator for older adults because a SARC-F ≥4 score during admission to an acute care hospital predicts in-hospital mortality within 30 days of hospitalization.
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Affiliation(s)
- J Ueshima
- Keisuke Maeda, M.D., Ph.D. Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan, Phone: +81-562-46-2311; FAX: +81-562-44-8518, E-mail:
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Lo SY, Zhang M, Hubbard RE, Gnjidic D, Redston MR, Hilmer SN. Development and validation of a frailty index based on data routinely collected across multiple domains in NSW hospitals. Australas J Ageing 2020; 40:184-194. [PMID: 33340206 DOI: 10.1111/ajag.12888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/18/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE(S) To develop and validate a frailty index (FI) that covers multiple domains, using routine hospital data. To investigate the FI's validity, after excluding medication-related items (FI-ExMeds), for studies of frailty and polypharmacy. METHODS A FI was derived from routine NSW hospital data following standard published guidance. In a development cohort (151 inpatients ≥ 70 years), the FI was correlated with the Reported Edmonton Frail Scale (REFS) using Pearson's R. Validity and distribution of FI and FI-ExMeds, and correlation with each other, were evaluated in a validation cohort (999 inpatients ≥ 75 years). RESULTS The mean FI for the development cohort was 0.27 (SD 0.09). The FI showed moderate linear correlation with the REFS (n = 148, R = 0.52, P < .001). In the validation cohort, mean FI (n = 993) and FI-ExMeds (n = 990) were both 0.28 (SD 0.11). FI-ExMeds showed high linear correlation with the FI (n = 990, R = 0.99, P < .001). CONCLUSION This multi-domain FI is comparable to REFS, with adequate redundancy to exclude deficits for specific analyses.
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Affiliation(s)
- Sarita Y Lo
- Laboratory of Ageing and Pharmacology, Faculty of Medicine and Health, Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Meggie Zhang
- Laboratory of Ageing and Pharmacology, Faculty of Medicine and Health, Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Discipline of Pharmacology, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, Centre for Health Services Research, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health and Charles Perkins Centre, Sydney School of Pharmacy, University of Sydney, NSW, Australia
| | - Mitchell R Redston
- Laboratory of Ageing and Pharmacology, Faculty of Medicine and Health, Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine, University of Notre Dame, Darlinghurst, NSW, Australia
| | - Sarah N Hilmer
- Laboratory of Ageing and Pharmacology, Faculty of Medicine and Health, Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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Martinez-Peromingo J, Castañeda A, Muñana A, Baeza ME, de Peralta P, Fuentes C, Barba R. Acute care for elderly patients in a functional impairment prevention unit. Rev Clin Esp 2020; 220:548-552. [PMID: 31780072 DOI: 10.1016/j.rce.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine whether the care of patients with moderate dependency who were hospitalised in a functional impairment prevention unit (FIPU) was superior to that of a conventional unit (CU) in terms of functional impairment and mean stay. METHODS We conducted a single-centre, retrospective, controlled intervention study that compared acute treatment in an FIPU and in conventional wards. The study included 466 elderly patients with moderate dependence (Barthel index, 30-70) and older than 75 years. Of these, 280 were included in the intervention group and 186 in the control group. The primary outcomes were loss of functionality attributable to the hospitalisation (measured by the loss of ambulation and urinary continence) and differences in the length of stay. RESULTS The patients hospitalised in the FIPU showed less functional impairment as determined by the loss of urinary continence (2.1% of the FIPU patients vs. 9.7% of the CU patients; p<.01) and the loss of walking ability (2.1% vs. 25.3%; p<.01). The patients hospitalised in the FIPU had a shorter mean stay (7.4 vs. 8.5 days; p<.05), with 1 day less of stay than the CU patients. CONCLUSION The acute care of elderly patients with moderate dependency in an FIPU was independently associated with less functional decline and shorter stays.
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Affiliation(s)
| | - A Castañeda
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - A Muñana
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - M E Baeza
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - P de Peralta
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - C Fuentes
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - R Barba
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España.
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Martinez-Peromingo J, Castañeda A, Muñana A, Baeza M, de Peralta P, Fuentes C, Barba R. Acute care for elderly patients in a functional impairment prevention unit. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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44
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The potential for complex computational models of aging. Mech Ageing Dev 2020; 193:111403. [PMID: 33220267 DOI: 10.1016/j.mad.2020.111403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/24/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022]
Abstract
The gradual accumulation of damage and dysregulation during the aging of living organisms can be quantified. Even so, the aging process is complex and has multiple interacting physiological scales - from the molecular to cellular to whole tissues. In the face of this complexity, we can significantly advance our understanding of aging with the use of computational models that simulate realistic individual trajectories of health as well as mortality. To do so, they must be systems-level models that incorporate interactions between measurable aspects of age-associated changes. To incorporate individual variability in the aging process, models must be stochastic. To be useful they should also be predictive, and so must be fit or parameterized by data from large populations of aging individuals. In this perspective, we outline where we have been, where we are, and where we hope to go with such computational models of aging. Our focus is on data-driven systems-level models, and on their great potential in aging research.
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Katiyar V, Sharma R, Tandon V, Goda R, Ganeshkumar A, Suri A, Chandra PS, Kale SS. Impact of frailty on surgery for glioblastoma: a critical evaluation of patient outcomes and caregivers' perceptions in a developing country. Neurosurg Focus 2020; 49:E14. [PMID: 33002866 DOI: 10.3171/2020.7.focus20482] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors aimed to evaluate the impact of age and frailty on the surgical outcomes of patients with glioblastoma (GBM) and to assess caregivers' perceptions regarding postdischarge care and challenges faced in the developing country of India. METHODS This was a retrospective study of patients with histopathologically proven GBM from 2009 to 2018. Data regarding the clinical and radiological characteristics as well as surgical outcomes were collected from the institute's electronic database. Taking Indian demographics into account, the authors used the cutoff age of 60 years to define patients as elderly. Frailty was estimated using the 11-point modified frailty index (mFI-11). Patients were divided into three groups: robust, with an mFI score of 0; moderately frail, with an mFI score of 1 or 2; and severely frail, with an mFI score ≥ 3. A questionnaire-based survey was done to assess caregivers' perceptions about postdischarge care. RESULTS Of the 276 patients, there were 93 (33.7%) elderly patients and 183 (66.3%) young or middle-aged patients. The proportion of severely frail patients was significantly more in the elderly group (38.7%) than in the young or middle-aged group (28.4%) (p < 0.001). The authors performed univariate and multivariate analysis of associations of different short-term outcomes with age, sex, frailty, and Charlson Comorbidity Index. On the multivariate analysis, only frailty was found to be a significant predictor for in-hospital mortality, postoperative complications, and length of hospital and ICU stay (p < 0.001). On Cox regression analysis, the severely frail group was found to have a significantly lower overall survival rate compared with the moderately frail (p = 0.001) and robust groups (p < 0.001). With the increase in frailty, there was a concomitant increase in the requirement for readmissions (p = 0.003), postdischarge specialist care (p = 0.001), and help from extrafamilial sources (p < 0.001). Greater dissatisfaction with psychosocial and financial support among the caregivers of severely frail patients was seen as they found themselves ill-equipped to provide postdischarge care at home (p < 0.001). CONCLUSIONS Frailty is a better predictor of poorer surgical outcomes than chronological age in terms of duration of hospital and ICU stay, postoperative complications, and in-hospital mortality. It also adds to the psychosocial and financial burdens of the caregivers, making postdischarge care challenging.
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Pérez-Zepeda MU, Carrillo-Vega MF, Theou O, Jácome-Maldonado LD, García-Peña C. Hospital Complications and Frailty in Mexican Older Adults: An Emergency Care Cohort Analysis. Front Med (Lausanne) 2020; 7:505. [PMID: 33134303 PMCID: PMC7550456 DOI: 10.3389/fmed.2020.00505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives: To describe the association of frailty level on admittance to the Emergency Department (ED) with various hospital complications including delirium, low phase angle, and low handgrip strength. Design: Prospective cohort. Setting: ED rooms of two public general hospitals in Mexico City. Participants: A total of 548 persons 60 years or older who were admitted to the ED and who were alive during follow-up testing at home were included. Measurements: A 32-item frailty index (FI) was measured on admission to the ED. Outcome measures included delirium, phase angle, and hand grip strength measured during different stages of the hospitalization (i.e., from admission to the ED through to follow-up at home). Results: From this final sample, mean age was 76 years (± SD 7.2) and 58.4% (n = 320) were women. Mean waiting time in the ED was 5.1 h (± SD 6.2), the average stay in the ED was 99.9 (±68.2) h, and 274 subjects (50%) were admitted to a general ward after ED admission. FI was not associated with phase angle and was negatively associated with handgrip strength at admission to ED (β = −3.97, confidence interval [CI] 95% −5.56 −2.38, p < 0.001), discharge from ED (β = −3.94, CI 95% −5.97 −1.90, p < 0.001), and discharge from hospital (β = −4.93, CI 95% −7.68 −2.18, p = 0.01). FI was positively associated with delirium (β = 3.68, CI 95% 1.53–5.83, p < 0.01). Conclusion: Higher frailty at ED admission was associated with lower hand grip strength and delirium during hospitalization in Mexican older adults.
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Affiliation(s)
- Mario Ulises Pérez-Zepeda
- Dirección de Investigación, Instituto Nacional de Geriatría, México City, México.,Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan de Degollado, Mexico
| | | | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.,School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | | | - Carmen García-Peña
- Dirección de Investigación, Instituto Nacional de Geriatría, México City, México
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Wang T, Zhao Y, Guo A. Association of swallowing problems with frailty in Chinese hospitalized older patients. Int J Nurs Sci 2020; 7:408-412. [PMID: 33195752 PMCID: PMC7644548 DOI: 10.1016/j.ijnss.2020.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/24/2020] [Accepted: 09/14/2020] [Indexed: 12/27/2022] Open
Abstract
Objective To estimate the prevalence of dysphagia and frailty among hospitalized older patients and to analyze the relationship between dysphagia and frailty in these people. Methods Data were collected on 386 participants aged 65 and older in a general hospital from April to December 2017. Patients were asked to complete a self-designed demographic questionnaire. Frailty and swallowing function assessments were performed using the Fried frailty phenotype and the 30-ml water swallowing test, respectively. Multiple stepwise logistic regression analyses were used to identify the association between frailty and dysphagia. Results Dysphagia developed in 31.1% of older people, and 24.4% developed frailty. Frailty was statistically significantly related with dysphagia. Dysphagia was more prevalent in frail and pre-frail patients (48.9% and 32.4%, respectively) than those who were non-frail (13.6%). In multivariate analyses, frail(OR, 5.420; 95% CI, 2.684–10.944;P<0.001) and history of choking/coughing while drinking(OR, 2.954; 95% CI, 1.844–4.733;P<0.001)were associated with dysphagia.result. Conclusions Frailty is associated with dysphagia. More attention should be paid to frailty and dysphagia of the elderly and further studies are needed to evaluate the correlated mechanism and develop targeted nursing interventions.
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Affiliation(s)
- Tiantian Wang
- Department of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yanwei Zhao
- Department of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Aimin Guo
- School of Nursing, Peking Union Medical College, Beijing, China
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Davis GM, DeCarlo K, Wallia A, Umpierrez GE, Pasquel FJ. Management of Inpatient Hyperglycemia and Diabetes in Older Adults. Clin Geriatr Med 2020; 36:491-511. [PMID: 32586477 PMCID: PMC10695675 DOI: 10.1016/j.cger.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Diabetes is one of the world's fastest growing health challenges. Insulin therapy remains a useful regimen for many elderly patients, such as those with moderate to severe hyperglycemia, type 1 diabetes, hyperglycemic emergencies, and those who fail to maintain glucose control on non-insulin agents alone. Recent clinical trials have shown that several non-insulin agents as monotherapy, or in combination with low doses of basal insulin, have comparable efficacy and potential safety advantages to complex insulin therapy regimens. Determining the most appropriate diabetes management plan for older hospitalized patients requires consideration of many factors to prevent poor outcomes related to dysglycemia.
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Affiliation(s)
- Georgia M Davis
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Kristen DeCarlo
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Chicago, IL 60611, USA
| | - Amisha Wallia
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Chicago, IL 60611, USA
| | - Guillermo E Umpierrez
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Francisco J Pasquel
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA.
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Poss J, McGrail K, McGregor MJ, Ronald LA. Long-Term Care Facility Ownership and Acute Hospital Service Use in British Columbia, Canada: A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 21:1490-1496. [PMID: 32646822 DOI: 10.1016/j.jamda.2020.04.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/26/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Previous studies report higher hospitalization rates in for-profit compared with nonprofit long-term care facilities (LTCFs), but have not included staffing data, a major potential confounder. Our objective was to examine the effect of ownership on hospital admission rates, after adjusting for facility staffing levels and other facility and resident characteristics, in a large Canadian province (British Columbia). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Our cohort included individuals resident in a publicly funded LTCF in British Columbia at any time between April 1, 2012 and March 31, 2016. MEASURES Health administrative data were extracted from multiple databases, including continuing care, hospital discharge, and Minimum Data Set (MDS 2.0) assessment records. Cox extended hazards regression was used to estimate hospitalization risk associated with facility- and resident-level factors. RESULTS The cohort included 49,799 residents in 304 LTCF facilities (116 publicly owned and operated, 99 for-profit, and 89 nonprofit) over the study period. Hospitalization risk was higher for residents in for-profit (adjusted hazard ratio [adjHR] 1.34; 95% confidence interval [CI] 1.29-1.38) and nonprofit (adjHR 1.37; 95% CI 1.32-1.41) facilities compared with publicly owned and operated facilities, after adjustment for staffing, facility size, urban location, resident demographics, and case mix. Within subtypes, risk was highest in single-site facilities: for-profit (adjHR 1.42; 95% CI 1.36-1.48) and nonprofit (adjHR 1.38, 95% CI 1.33-1.44). CONCLUSIONS AND IMPLICATIONS This is the first Canadian study using linked health data from hospital discharge records, MDS 2.0, facility staffing, and ownership records to examine the adjusted effect of facility ownership characteristics on hospital use of LTCF residents. We found significantly lower adjHRs for hospital admission in publicly owned facilities compared with both for-profit and nonprofit facilities. Our finding that publicly owned facilities have lower hospital admission rates compared with for-profit and nonprofit facilities can help inform decision-makers faced with the challenge of optimizing care models in both nursing homes and hospitals as they build capacity to care for aging populations.
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Affiliation(s)
- Jeffrey Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margaret J McGregor
- Community Geriatrics, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa A Ronald
- Community Geriatrics, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Nghiem S, Sajeewani D, Henderson K, Afoakwah C, Byrnes J, Moyle W, Scuffham P. Development of frailty measurement tools using administrative health data: A systematic review. Arch Gerontol Geriatr 2020; 89:104102. [DOI: 10.1016/j.archger.2020.104102] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/23/2022]
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