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Chang GJ, Gunn HJ, Barber AK, Lowenstein LM, Dohan D, Broering J, Dockter T, Tan AD, Dueck A, Chow S, Neuman H, Finlayson E. Improving Surgical Care and Outcomes in Older Cancer Patients Through Implementation of a Presurgical Toolkit (OPTI-Surg)-Final Results of a Phase III Cluster Randomized Trial (Alliance A231601CD). Ann Surg 2024; 280:623-632. [PMID: 39069901 DOI: 10.1097/sla.0000000000006458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To assess the effect of a practice-level preoperative frailty screening and optimization toolkit (OPTI-Surg) on postoperative functional recovery and complications in elderly cancer patients undergoing major surgery. BACKGROUND Frailty is common in older adults. It increases the risk of poor postoperative functional recovery and complications. The potential for a practice-level screening/optimization intervention to improve outcomes is unknown. METHODS Thoracic, gastrointestinal, and urologic oncological surgery practices within the National Cancer Institute Community Oncology Research Program (NCORP) were randomized 1:1:1 to usual care (UC), OPTI-Surg, or OPTI-Surg with an implementation coach. OPTI-Surg consisted of the Edmonton Frail Scale and guided recommendations for referral interventions. Patients 70 years old or above undergoing curative intent surgery were eligible. The primary outcome was 8 weeks postoperative function (kcal/wk). The key secondary outcome was complications within 90 days. Mixed models were used to compare UC to the 2 OPTI-Surg arms combined. RESULTS From July 2019 to September 2022, 325 patients were enrolled in 29 practices. One hundred ninety-nine (64 UC, 135 OPTI-Surg) and 279 (78 UC, 201 OPTI-Surg) were evaluable for primary and secondary analysis, respectively. UC and OPTI-Surg patients did not significantly differ in total caloric expenditure (2.2 UC, 2.0 OPTI-Surg) after adjusting for baseline function ( P =0.53). UC and OPTI-Surg patients did not significantly differ in postoperative complications (25.6% UC, 35.3% OPTI-Surg, P =0.5). CONCLUSIONS Frailty assessment was successfully performed, but the OPTI-Surg intervention did not improve postoperative function nor reduce postoperative complications compared with UC. Future analysis will explore practice-level factors associated with toolkit implementation and the differences between the coaching and noncoaching arms.
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Affiliation(s)
- George J Chang
- Department of Colon and Rectal Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, the University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Heather J Gunn
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | - Lisa M Lowenstein
- Department of Health Services Research, the University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | | | - Travis Dockter
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Angelina D Tan
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Amylou Dueck
- Alliance Statistics and Data Management Center, Scottsdale, AZ
| | - Selina Chow
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | - Heather Neuman
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, CA
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Owodunni OP, Biala E, Sirisegaram L, Bettick D, Gearhart SL, Ehrlich AL. Validation of the Self-Reported Edmonton Frail Scale - Acute Care in Patients ≥ 65 Years Undergoing Surgery. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2024; 35:100383. [PMID: 38774884 PMCID: PMC11105164 DOI: 10.1016/j.pcorm.2024.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND Frailty is common in geriatric emergency surgery and associated with increased risk for poor postoperative outcomes. Frailty screening is challenging in emergency settings. The Edmonton Frail Scale (EFS) is a valid tool to screen for patients at high risk for poor postoperative outcomes. Recently, the EFS was modified to decrease dependence on staff to perform physical measures. This modification, the EFS-Acute Care (EFS-AC), has not been validated. We wish to assess the agreement between the EFS and the EFS-AC. STUDY DESIGN We performed a prospective cohort study from 10/2021 - 10/2022 screening 688 patients ≥ 65 years with both the EFS and EFS-AC preoperatively. We assessed the ability of the EFS-AC to discriminate frailty identified by the EFS and compared the association of both scales with loss of independence (LOI), hospital length of stay (LOS), ICU admissions, and ICU LOS. Receiver Operator Curves were used to estimate the discriminatory thresholds for LOI. RESULTS 688 patients with a median age 73 (IQR 68, 77) were enrolled. The EFS-AC was able to discriminate individuals' frailty status by the EFS with excellent agreement (AUC 0.971 [0.958, 0.983]). An EFS-AC threshold score of ≥ 6 points lead to 93.60% of individuals being correctly identified (77.87% sensitivity and 97.00% specificity). Both EFS and EFS-AC ≥ 6 were similarly associated with a higher risk for all clinical outcomes assessed and demonstrated similar ability to predict LOI. CONCLUSIONS The EFS-AC is a valid preoperative frailty screen, and due to its self-reported nature, can be administered in the acute care setting, during virtual visits, or through digital health apps. Real-time screening can assist with better understanding patient needs and lead to interventions to prevent poor hospital outcomes.
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Affiliation(s)
- Oluwafemi P Owodunni
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
- University of New Mexico School of Medicine, Emergency Medicine Albuquerque, NM, US
| | - Eduardo Biala
- Johns Hopkins University School of Medicine, Department of Medicine Division of Geriatric Medicine and Gerontology, Baltimore, MD
- University of Hawai'i at Mānoa John A Burns School of Medicine Honolulu, HI, US
| | - Luxey Sirisegaram
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- University of Toronto Temerty Faculty of Medicine, Department of Geriatric Medicine Toronto, ON, CA
| | - Dianne Bettick
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - Susan L Gearhart
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - April L Ehrlich
- Johns Hopkins University School of Medicine, Department of Medicine Division of Geriatric Medicine and Gerontology, Baltimore, MD
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Edwards L, Tesorero V, Zonouzi F, Santullo P, Owen P, Gordon AL. The use of frailty questionnaires in inpatients in two neurorehabilitation units in the East Midlands - A cross-sectional cohort study with follow-up to 1-year after discharge from inpatient rehabilitation. J R Coll Physicians Edinb 2024; 54:120-126. [PMID: 38578071 DOI: 10.1177/14782715241242509] [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] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Frailty correlates with poor clinical outcomes and is not routinely assessed in neurorehabilitation inpatient settings. METHODS We recruited adults from two neurorehabilitation units. We administered six validated tools for assessing frailty and collected data around length of stay, discharge, readmission and change in rehabilitation outcome measures. RESULTS Seventy-eight participants aged between 31 and 84 years were recruited with a range of neurological diagnoses. Frailty prevalence ranged between 23% and 46%, depending on the scale used, with little agreement between tools. Frailty status did not correlate with age, gender, length of stay, discharge destination and rehabilitation outcome measures. One-year readmission was higher in participants rated as frail by the Frail-Non-Disabled Questionnaire, the FRESH-screening questionnaire and the Clinical Frailty Scale. CONCLUSION Frailty ascertainment was variable depending on the tool used. Three frailty indices predicted readmission rate at 1 year but no other outcome measures. Therefore, frailty tools may have limited utility in this clinical population.
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Affiliation(s)
- Laura Edwards
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Academic Unit of Injury, Rehabilitation and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK
| | - Vina Tesorero
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fattaneh Zonouzi
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Piera Santullo
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Phoebe Owen
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam L Gordon
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Academic Unit of Injury, Rehabilitation and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
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4
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Lane H, Saunders R, Crookes K, Ang SGM, Bulsara C, Bulsara MK, Ewens B, Gallagher O, Gullick K, Haydon S, Hughes J, Nguyen KH, Seaman K, Etherton-Beer C. Prevalence of frailty and pain in hospitalised cancer patients: implications for older adult care. Intern Med J 2024; 54:671-674. [PMID: 38450876 DOI: 10.1111/imj.16351] [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: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 03/08/2024]
Abstract
A hospital-wide point prevalence study investigated frailty and pain in patients with a cancer-related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty-eight patients (19%) with cancer-related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent among cancer-related admissions, reinforcing the need for frailty screening and importance of pain assessment for patients with cancer.
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Affiliation(s)
- Heather Lane
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Kate Crookes
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Seng G M Ang
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Beverley Ewens
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Olivia Gallagher
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Karen Gullick
- Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Sue Haydon
- Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Jeff Hughes
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- PainChek Ltd, Sydney, New South Wales, Australia
| | - Kim-Huong Nguyen
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Ayoob A, Janakiram C. Prevalence of physical and oral frailty in geriatric patients in Kerala, India. J Oral Biol Craniofac Res 2024; 14:158-163. [PMID: 38347898 PMCID: PMC10859288 DOI: 10.1016/j.jobcr.2024.01.011] [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] [Received: 06/30/2023] [Revised: 12/12/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
Background Physical frailty is a condition where a person has decreased physical reserve and resilience to stressors. Oral frailty, on the other hand, refers to a decline in oral function in conjunction with reductions in cognitive and physical functioning. Poor oral health, encompassing factors such as functional, physiological, psychosocial, and therapeutic aspects, can lead to physical frailty. Objectives Assess the prevalence of physical and oral frailty in geriatric patients attending health centres in Kerala, India. Methodology . Design Cross-sectional study. Setting Amrita Institute of Medical Sciences (Kochi), Amrita Kripa Charitable Hospital (Wayanad) and Amrita Urban Health Centre in (Kaloor). Participants 250 geriatric participants above 60 years. Measurements The participants' physical frailty was evaluated using Fried's Frailty Phenotype, the Reported Edmonton Frail Scale, and sarcopenia screening. The assessment of oral frailty was based on several factors such as current dental status, chewing ability, tongue pressure, the Repetitive Saliva-Swallowing Test, Oral Diadokinetic rates, Xerostomia, and the Oral and Maxillofacial Index. The evaluation was using a questionnaire and clinical examination. Bivariate analysis was performed for additional variables, and multivariate analysis was utilized to examine the relationship between oral and physical frailty. Results 56 % of study participants were males, and the mean age was 68 ± 6.02 years. 34.4 % were physically frail, and the remaining were pre-frail using Fried Frailty Phenotype. 67 % showed oral frailty using the Oral and Maxillofacial Frailty Index (OMFI). Using six domains of the oral frailty status (Tanaka) showed that 74 % of individuals had an increased risk of new onset of physical frailty. In the adjusted model, individuals with mild oral frailty had lesser chances of being frail (OR = 0.509, 95 % CI = 0.274-1.946, p-value = 0.033). Conclusion The prevalence of physical frailty was 34.4 %, and oral frailty status was 74 %. The findings implied a need to include oral frailty assessments in the comprehensive general health screening for geriatric patients.
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Affiliation(s)
- Aneesa Ayoob
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, 682041, India
| | - Chandrashekar Janakiram
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, 682041, India
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6
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Mwangala PN, Nasambu C, Wagner RG, Newton CR, Abubakar A. Prevalence and Factors Associated With Frailty Among Older Adults Living With HIV Compared to Their Uninfected Peers From the Kenyan Coast. Int J Public Health 2024; 69:1606284. [PMID: 38426187 PMCID: PMC10901986 DOI: 10.3389/ijph.2024.1606284] [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: 06/06/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives: a) To document the prevalence and correlates of frailty among older adults living with HIV (OALWH) and their uninfected peers, and b) Investigate HIV status as an independent predictor of frailty. Methods: This cross-sectional study was conducted between 2020 and 2021 at the Kenyan coast among 440 older adults aged ≥50 years (257 OALWH). Frailty was assessed using the Reported Edmonton Frail Scale. Logistic regression was used to examine the correlates of frailty. Results: The prevalence of frailty was significantly higher among OALWH (24%) than their uninfected peers (13%). HIV seropositivity was not independently associated with frailty. Sleeping difficulties, ageism, higher waist/hip ratio, visiting traditional healers, HIV treatment change/interruption, prolonged illness following HIV diagnosis, and self-reported diabetes were significantly associated with higher odds of frailty. Residing in larger households, having higher income, having friends, being male and light physical activities were significantly associated with reduced odds of frailty. Conclusion: The prevalence of frailty is elevated among OALWH; however, factors other than HIV are predominant, particularly psychosocial factors. Multicomponent interventions are needed to prevent/delay and manage frailty in this setting.
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Affiliation(s)
- Patrick N. Mwangala
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Carophine Nasambu
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles R. Newton
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Department of Public Health, Pwani University, Kilifi, Kenya
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7
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Saunders R, Crookes K, Seaman K, Ang SGM, Bulsara C, Bulsara MK, Ewens B, Gallagher O, Graham R, Gullick K, Haydon S, Hughes J, Nguyen KH, O’Connell B, Scaini D, Etherton-Beer C. Frailty and pain in an acute private hospital: an observational point prevalence study. Sci Rep 2023; 13:3345. [PMID: 36849461 PMCID: PMC9971208 DOI: 10.1038/s41598-023-29933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency units) at an acute, private, 860-bed metropolitan hospital were eligible to participate. Frailty was assessed using the self-report modified Reported Edmonton Frail Scale. Current pain and worst pain in the last 24 h were self-reported using the standard 0-10 numeric rating scale. Pain scores were categorised by severity (none, mild, moderate, severe). Demographic and clinical information including admitting services (medical, mental health, rehabilitation, surgical) were collected. The STROBE checklist was followed. Data were collected from 251 participants (54.9% of eligible). The prevalence of frailty was 26.7%, prevalence of current pain was 68.1% and prevalence of pain in the last 24 h was 81.3%. After adjusting for age, sex, admitting service and pain severity, admitting services medical (AOR: 13.5 95% CI 5.7-32.8), mental health (AOR: 6.3, 95% CI 1. 9-20.9) and rehabilitation (AOR: 8.1, 95% CI 2.4-37.1) and moderate pain (AOR: 3.9, 95% CI 1. 6-9.8) were associated with increased frailty. The number of older patients identified in this study who were frail has implications for managing this group in a hospital setting. This indicates a need to focus on developing strategies including frailty assessment on admission, and the development of interventions to meet the care needs of these patients. The findings also highlight the need for increased pain assessment, particularly in those who are frail, for more effective pain management.Trial registration: The study was prospectively registered (ACTRN12620000904976; 14th September 2020).
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.
| | - Kate Crookes
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Karla Seaman
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia ,grid.1004.50000 0001 2158 5405Centre for Health Systems and Safety Research, Macquarie University, Sydney, Australia
| | - Seng Giap Marcus Ang
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Caroline Bulsara
- grid.266886.40000 0004 0402 6494School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, WA Australia ,grid.266886.40000 0004 0402 6494Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA Australia
| | - Max K. Bulsara
- grid.266886.40000 0004 0402 6494Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA Australia
| | - Beverley Ewens
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Olivia Gallagher
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Renée Graham
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Karen Gullick
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Sue Haydon
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Jeff Hughes
- PainChek Ltd, Sydney, NSW Australia ,grid.1032.00000 0004 0375 4078Curtin Medical School, Curtin University, Bentley, WA Australia
| | - Kim-Huong Nguyen
- grid.1003.20000 0000 9320 7537Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, QLD Australia
| | - Bev O’Connell
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Debra Scaini
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Christopher Etherton-Beer
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia, Crawley, WA Australia
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Löfgren D, Valachis A, Olivecrona M. Risk for morbidity and mortality after neurosurgery in older patients with high grade gliomas - a retrospective population based study. BMC Geriatr 2022; 22:805. [PMID: 36253725 PMCID: PMC9575213 DOI: 10.1186/s12877-022-03478-6] [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] [Received: 01/05/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Although high grade gliomas largely affect older patients, current evidence on neurosurgical complications is mostly based on studies including younger study populations. We aimed to investigate the risk for postoperative complications after neurosurgery in a population-based cohort of older patients with high grade gliomas, and explore changes over time. Methods In this retrospective study we have used data from the Swedish Brain Tumour Registry and included patients in Sweden age 65 years or older, with surgery 1999–2017 for high grade gliomas. We analysed number of surgical procedures per year and which factors contribute to postoperative morbidity and mortality. Results The study included 1998 surgical interventions from an area representing 60% of the Swedish population. Over time, there was an increase in surgical interventions in relation to the age specific population (p < 0.001). Postoperative morbidity for 2006–2017 was 24%. Resection and not having a multifocal tumour were associated with higher risk for postoperative morbidity. Postoperative mortality for the same period was 5%. Increased age, biopsy, and poor performance status was associated with higher risk for postoperative mortality. Conclusions This study shows an increase in surgical interventions over time, probably representing a more active treatment approach. The relatively low postoperative morbidity- and mortality-rates suggests that surgery in older patients with suspected high grade gliomas can be a feasible option. However, caution is advised in patients with poor performance status where the possible surgical intervention would be a biopsy only. Further, this study underlines the need for more standardised methods of reporting neurosurgical complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03478-6.
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Affiliation(s)
- David Löfgren
- Department of Oncology, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden.
| | - Antonios Valachis
- Department of Oncology, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden
| | - Magnus Olivecrona
- Department of Neurosurgery, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden
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Leininger S, Davis Micco RN. The Future of Assessing Frailty in the Patient With Advanced Heart Failure: A Review of Current Literature. Crit Care Nurs Q 2022; 45:359-375. [PMID: 35980798 DOI: 10.1097/cnq.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Frailty is becoming an important component of health care outcomes in patients with a diagnosis of heart failure. A literature search was completed to determine whether a best practice guideline existed to assess frailty in patients who were considering ventricular assist device placement. The literature search revealed that best practice guidelines did not exist. A second comprehensive literature search was completed specifically for frailty including the definition, criteria, assessment, and outcomes. The studies revealed that there were challenges with defining frailty, the age of frailty, assessments tools, and study designs. Cardiologists are primarily interested in screening for frailty, but other physician specialty practices are interested in a frailty screening tool as well. This article discusses the inconsistent research studies and the need for a valid and reliable tool to assess for frailty. It is important that nurse leaders and those working with heart failure patients determine the best practice guidelines for assessing frailty.
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Saunders R, Crookes K, Seaman K, Ang SGM, Bulsara C, Bulsara MK, Ewens B, Gallagher O, Graham RM, Gullick K, Haydon S, Hughes J, Atee M, Nguyen KH, O'Connell B, Scaini D, Etherton-Beer C. Effectiveness of nurse-led volunteer support and technology-driven pain assessment in improving the outcomes of hospitalised older adults: protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e059388. [PMID: 35725261 PMCID: PMC9214388 DOI: 10.1136/bmjopen-2021-059388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hospitalised older adults are prone to functional deterioration, which is more evident in frail older patients and can be further exacerbated by pain. Two interventions that have the potential to prevent progression of frailty and improve patient outcomes in hospitalised older adults but have yet to be subject to clinical trials are nurse-led volunteer support and technology-driven assessment of pain. METHODS AND ANALYSIS This single-centre, prospective, non-blinded, cluster randomised controlled trial will compare the efficacy of nurse-led volunteer support, technology-driven pain assessment and the combination of the two interventions to usual care for hospitalised older adults. Prior to commencing recruitment, the intervention and control conditions will be randomised across four wards. Recruitment will continue for 12 months. Data will be collected on admission, at discharge and at 30 days post discharge, with additional data collected during hospitalisation comprising records of pain assessment and volunteer support activity. The primary outcome of this study will be the change in frailty between both admission and discharge, and admission and 30 days, and secondary outcomes include length of stay, adverse events, discharge destination, quality of life, depression, cognitive function, functional independence, pain scores, pain management intervention (type and frequency) and unplanned 30-day readmissions. Stakeholder evaluation and an economic analysis of the interventions will also be conducted. ETHICS AND DISSEMINATION Ethical approval has been granted by Human Research Ethics Committees at Ramsay Health Care WA|SA (number: 2057) and Edith Cowan University (number: 2021-02210-SAUNDERS). The findings will be disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER ACTRN12620001173987.
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Crookes
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karla Seaman
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Seng Giap Marcus Ang
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Beverley Ewens
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Olivia Gallagher
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Renee M Graham
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karen Gullick
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Clinical Services, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Sue Haydon
- Clinical Services, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Jeff Hughes
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- PainChek, Sydney, New South Wales, Australia
| | - Mustafa Atee
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- The Dementia Centre, HammondCare, Wembley, Western Australia, Australia
| | - Kim-Huong Nguyen
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bev O'Connell
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Debra Scaini
- Clinical Services, Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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11
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Cole E, Aylwin C, Christie R, Dillane B, Farrah H, Hopkins P, Ryan C, Woodgate A, Brohi K. Multiple Organ Dysfunction in Older Major Trauma Critical Care Patients: A Multicenter Prospective Observational Study. ANNALS OF SURGERY OPEN 2022; 3:e174. [PMID: 36936724 PMCID: PMC10013163 DOI: 10.1097/as9.0000000000000174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022] Open
Abstract
The objective was to explore the characteristics and outcomes of multiple organ dysfunction syndrome (MODS) in older trauma patients. Background Severely injured older people present an increasing challenge for trauma systems. Recovery for those who require critical care may be complicated by MODS. In older trauma patients, MODS may not be predictable based on chronological age alone and factors associated with its development and resolution are unclear. Methods Consecutive adult patients (aged ≥16 years) admitted to 4 level 1 major trauma center critical care units were enrolled and reviewed daily until discharge or death. MODS was defined by a daily total sequential organ failure assessment score of >5. Results One thousand three hundred sixteen patients were enrolled over 18 months and one-third (434) were aged ≥65 years. Incidence of MODS was high for both age groups (<65 years: 64%, ≥65 years: 70%). There were few differences in severity, patterns, and duration of MODS between cohorts, except for older traumatic brain injury (TBI) patients who experienced a prolonged course of MODS recovery (TBI: 9 days vs no TBI: 5 days, P < 0.01). Frailty rather than chronological age had a strong association with MODS development (odds ratio [OR], 6.9; 95% confidence intervals [CI], 3.0-12.4; P < 0.001) and MODS mortality (OR, 2.1; 95% CI, 1.31-3.38; P = 0.02). Critical care resource utilization was not increased in older patients, but MODS had a substantial impact on mortality (<65 years: 17%; ≥65 years: 28%). The majority of older patients who did not develop MODS survived and had favorable discharge outcomes (home discharge ≥65 years NoMODS: 50% vs MODS: 15%; P < 0.01). Conclusions Frailty rather than chronological age appears to drive MODS development, recovery, and outcome in older cohorts. Early identification of frailty after trauma may help to predict MODS and plan care in older trauma.
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Affiliation(s)
- Elaine Cole
- From the Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, United Kingdom
| | - Chris Aylwin
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robert Christie
- From the Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, United Kingdom
- Barts Health NHS Trust, London, United Kingdom
| | - Bebhinn Dillane
- From the Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, United Kingdom
| | - Helen Farrah
- St Georges University Hospital NHS Trust, London, United Kingdom
| | - Phillip Hopkins
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Chris Ryan
- St Georges University Hospital NHS Trust, London, United Kingdom
| | - Adam Woodgate
- St Georges University Hospital NHS Trust, London, United Kingdom
| | - Karim Brohi
- From the Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, United Kingdom
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12
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Rasiah J, O'Rourke T, Dompé B, Rolfson D, Mansell B, Pereira R, Chan T, McDonald K, Summach A. Customizing a Program for Older Adults Living with Frailty in Primary Care. J Prim Care Community Health 2021; 12:21501327211034807. [PMID: 34315291 PMCID: PMC8323414 DOI: 10.1177/21501327211034807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coordination of primary care is essential to improving care delivery within
health systems, especially for older adults with increased health/social needs.
A program jointly funded by the Canadian Foundation for Healthcare Improvement
and Canadian Frailty Network, was implemented in a nurse practitioner-led clinic
to address the gap in frailty care for older adults. The clinic was situated
within a health and social services organization with a mandate to enhance the
quality of life of older adults living in the community. Through this program, a
frailty assessment pathway and social/clinical prescriptions were implemented
with necessary adaptations as a result of COVID-19.
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Affiliation(s)
- Jananee Rasiah
- University of Alberta, Edmonton, AB, Canada.,Athabasca University, Athabasca, AB, Canada
| | - Tammy O'Rourke
- Athabasca University, Athabasca, AB, Canada.,Sage Seniors Association, Health and Social Services, Edmonton, AB, Canada
| | - Brian Dompé
- Sage Seniors Association, Health and Social Services, Edmonton, AB, Canada
| | | | - Beth Mansell
- Sage Seniors Association, Health and Social Services, Edmonton, AB, Canada
| | - Rachel Pereira
- Sage Seniors Association, Health and Social Services, Edmonton, AB, Canada
| | - Titus Chan
- Sage Seniors Association, Health and Social Services, Edmonton, AB, Canada
| | - Karen McDonald
- Sage Seniors Association, Health and Social Services, Edmonton, AB, Canada
| | - Anne Summach
- University of Alberta, Edmonton, AB, Canada.,Sage Seniors Association, Health and Social Services, Edmonton, AB, Canada
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13
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Saunders R, Crookes K, Atee M, Bulsara C, Bulsara MK, Etherton-Beer C, Ewens B, Gallagher O, Graham RM, Gullick K, Haydon S, Nguyen KH, O'Connell B, Seaman K, Hughes J. Prevalence of frailty and pain in hospitalised adult patients in an acute hospital: a protocol for a point prevalence observational study. BMJ Open 2021; 11:e046138. [PMID: 33757956 PMCID: PMC7993156 DOI: 10.1136/bmjopen-2020-046138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Frailty and pain are associated with adverse patient clinical outcomes and healthcare system costs. Frailty and pain can interact, such that symptoms of frailty can make pain assessment difficult and pain can exacerbate the progression of frailty. The prevalence of frailty and pain and their concurrence in hospital settings are not well understood, and patients with cognitive impairment are often excluded from pain prevalence studies due to difficulties assessing their pain. The aim of this study is to determine the prevalence of frailty and pain in adult inpatients, including those with cognitive impairment, in an acute care private metropolitan hospital in Western Australia. METHODS AND ANALYSIS A prospective, observational, single-day point prevalence, cross-sectional study of frailty and pain intensity of all inpatients (excluding day surgery and critical care units) will be undertaken. Frailty will be assessed using the modified Reported Edmonton Frail Scale. Current pain intensity will be assessed using the PainChek smart-device application enabling pain assessment in people unable to report pain due to cognitive impairment. Participants will also provide a numerical rating of the intensity of current pain and the worst pain experienced in the previous 24 hours. Demographic and clinical information will be collected from patient files. The overall response rate of the survey will be reported, as well as the percentage prevalence of frailty and of pain in the sample (separately for PainChek scores and numerical ratings). Additional statistical modelling will be conducted comparing frailty scores with pain scores, adjusting for covariates including age, gender, ward type and reason for admission. ETHICS AND DISSEMINATION Ethical approval has been granted by Ramsay Health Care Human Research Ethics Committee WA/SA (reference: 2038) and Edith Cowan University Human Research Ethics Committee (reference: 2020-02008-SAUNDERS). Findings will be widely disseminated through conference presentations, peer-reviewed publications and social media. TRIAL REGISTRATION NUMBER ACTRN12620000904976.
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kate Crookes
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mustafa Atee
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
- The Dementia Centre, St Leonards, New South Wales, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Christopher Etherton-Beer
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
- WA Centre for Health & Ageing, University of Western Australia, Crawley, Western Australia, Australia
| | - Beverley Ewens
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Olivia Gallagher
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Renee M Graham
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karen Gullick
- Clinical Services, Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Sue Haydon
- Clinical Services, Hollywood Private Hospital, Nedlands 6009, Western Australia, Australia
| | - Kim-Huong Nguyen
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Bev O'Connell
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Karla Seaman
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Jeff Hughes
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
- PainChek Ltd, Bentley, Western Australia, Australia
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14
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Lowthian JA, Green M, Meyer C, Cyarto E, Robinson E, Mills A, Sutherland F, Hutchinson AM, Smit DV, Boyd L, Walker K, Newnham H, Rose M. Being Your Best: protocol for a feasibility study of a codesigned approach to reduce symptoms of frailty in people aged 65 years or more after transition from hospital. BMJ Open 2021; 11:e043223. [PMID: 33674372 PMCID: PMC7939014 DOI: 10.1136/bmjopen-2020-043223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The population is ageing, with increasing health and supportive care needs. For older people, complex chronic health conditions and frailty can lead to a cascade of repeated hospitalisations and further decline. Existing solutions are fragmented and not person centred. The proposed Being Your Best programme integrates care across hospital and community settings to address symptoms of frailty. METHODS AND ANALYSIS A multicentre pragmatic mixed methods study aiming to recruit 80 community-dwelling patients aged ≥65 years recently discharged from hospital. Being Your Best is a codesigned 6-month programme that provides referral and linkage with existing services comprising four modules to prevent or mitigate symptoms of physical, nutritional, cognitive and social frailty. Feasibility will be assessed in terms of recruitment, acceptability of the intervention to participants and level of retention in the programme. Changes in frailty (Modified Reported Edmonton Frail Scale), cognition (Mini-Mental State Examination), functional ability (Barthel and Lawton), loneliness (University of California Los Angeles Loneliness Scale-3 items) and nutrition (Malnutrition Screening Tool) will also be measured at 6 and 12 months. ETHICS AND DISSEMINATION The study has received approval from Monash Health Human Research Ethics Committee (RES-19-0000904L). Results will be disseminated through peer-reviewed journals, conference and seminar presentations. TRIAL REGISTRATION NUMBER ACTRN12620000533998; Pre-results.
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Affiliation(s)
- Judy A Lowthian
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
- School of Public Health and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Maja Green
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Clayton, Victoria, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Victoria, Australia
| | - Elizabeth Cyarto
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | | | - Amber Mills
- Inclusive Communities, Research and Policy Centre, Brotherhood of St Laurence, Collingwood, Victoria, Australia
| | | | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Safety Research, Monash Health-Deakin University Partnership, Melbourne, Victoria, Australia
| | - De Villers Smit
- School of Public Health and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Leanne Boyd
- Learning and Teaching, Nursing and Midwifery, Eastern Health, Box Hill, Victoria, Australia
| | - Katie Walker
- Emergency Medicine, Casey Hospital, Monash Health, Berwick, Victoria, Australia
- Health Services, Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Harvey Newnham
- Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Emergency and Acute Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Michael Rose
- Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Geriatric Medicine, Cabrini Health, Malvern, Victoria, Australia
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15
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Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
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16
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Roopsawang I, Thompson H, Zaslavsky O, Belza B. The Reported Edmonton Frail Scale-Thai version: Development and Validation of a Culturally-Sensitive Instrument. Nurs Health Sci 2020; 22:685-693. [PMID: 32170828 PMCID: PMC7497239 DOI: 10.1111/nhs.12713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/29/2022]
Abstract
Frailty may lead to increased vulnerability, disability, and adverse health outcomes in older adults. Early detection has been described as the best approach to manage frailty; however, frailty instruments are not widely available, particularly in the Thai language. The purpose of this cross-sectional study was to develop a culturally adapted Thai version of the Reported Edmonton Frail Scale and to validate the psychometric properties of the new instrument in hospitalized older Thai adults. Reliability and validity were examined. Participants completed questionnaires that included demographic and health information, and the Reported Edmonton Frail Scale-Thai version. Results revealed that the new instrument was reliable and had good content validity. Inter-rater reliability was strong. Confirmatory factor analysis showed a fair fit for the whole model, but most domains were strongly associated with frailty. On average, the instrument was completed under 7 minutes. The Thai version of the frailty instrument may be a practical tool for frailty evaluation, and could inform inpatient care, both locally and internationally; future research is needed to confirm predictability and feasibility in other clinical settings and populations.
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Affiliation(s)
- Inthira Roopsawang
- Department of Adult and Gerontological Nursing, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Hilaire Thompson
- Department of Biobehavioral Nursing and Health InformaticsSchool of Nursing, University of WashingtonSeattleWashingtonUSA
| | - Oleg Zaslavsky
- Department of Biobehavioral Nursing and Health InformaticsSchool of Nursing, University of WashingtonSeattleWashingtonUSA
| | - Basia Belza
- Department of Biobehavioral Nursing and Health InformaticsSchool of Nursing, University of WashingtonSeattleWashingtonUSA
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17
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Abstract
Frailty is a geriatric syndrome associated with adverse outcomes such as falls, disability, and mortality. Frailty is common and contributes to rising health care costs. Early screening and timely tailored intervention may effectively prevent or delay the adverse outcomes in older adults. Studies on frailty and its specific measurement tools are increasing in number, but the debate on the screening instruments remains. Currently, self-reported screening tools can identify frailty and predict the risk of adverse outcomes in older adults. Because they are easy to use and quickly provide information, self-reported frailty screening tools have significant implication in primary care settings and clinics. We reviewed the frailty screening instruments in older adults and proposed a two-step pathway for frailty identification, and to manage declines in intrinsic capacity as well as boost resilience.
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Affiliation(s)
- L Ma
- Dr. Lina Ma, Department of Geriatrics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing 100053, China. E-mail:
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18
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Adame Perez SI, Senior PA, Field CJ, Jindal K, Mager DR. Frailty, Health-Related Quality of Life, Cognition, Depression, Vitamin D and Health-Care Utilization in an Ambulatory Adult Population With Type 1 or Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Cross-Sectional Analysis. Can J Diabetes 2018; 43:90-97. [PMID: 30139571 DOI: 10.1016/j.jcjd.2018.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Frailty can cause increased vulnerability to adverse health outcomes, such as falls, fractures, depression and reduced health-related quality of life (HRQoL). This cross-sectional study compared the differences in body composition, HRQoL, mental health and cognitive and vitamin D (vitD) status with health-care utilization by frail and nonfrail adults with diabetes mellitus (type 1 and type 2) and with chronic kidney disease (stages 1 through 5). METHODS We studied adults with type 1 and type 2 diabetes and chronic kidney disease stages 1 through 5 who were participating in a longitudinal follow-up study (41 to 83 years of age; n=41). Body composition (dual-energy x-ray absorptiometry); vitD status (serum 25[OH]D3); frailty (Edmonton Frail Scale); depression (Major Depression Inventory); HRQoL (Short Form Health Survey-36); and cognitive status (Mini Mental State exam) were measured using validated tools. Participants who were on dialysis and had body weights >136 kg, and coinciding comorbidities known to influence vitD metabolism were excluded. RESULTS Frailty occurred in 17% of participants (n=7). Frail participants had lower lean body mass, lower HRQoL scores (individual and composite scores), more depression (p=<0.05) and higher numbers of health visits (total, inpatient and emergency) compared with nonfrail participants (p<0.05). No differences in health-care visit types or vitD status were noted between frail and nonfrail participants (p>0.05). CONCLUSIONS Frailty in an ambulatory population of adults with chronic kidney disease and diabetes is associated with low lean body mass, low HRQoL, greater depression and higher numbers of health-care visits.
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Affiliation(s)
- Stephany I Adame Perez
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Peter A Senior
- Department of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Northern Alberta Renal Program, Alberta Health Services and Department of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Diana R Mager
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
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