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Mehdipour A, Malouka S, Beauchamp M, Richardson J, Kuspinar A. Measurement properties of the usual and fast gait speed tests in community-dwelling older adults: a COSMIN-based systematic review. Age Ageing 2024; 53:afae055. [PMID: 38517125 PMCID: PMC10958613 DOI: 10.1093/ageing/afae055] [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: 08/31/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE The gait speed test is one of the most widely used mobility assessments for older adults. We conducted a systematic review to evaluate and compare the measurement properties of the usual and fast gait speed tests in community-dwelling older adults. METHODS Three databases were searched: MEDLINE, EMBASE and CINAHL. Peer-reviewed articles evaluating the gait speed test's measurement properties or interpretability in community-dwelling older adults were included. The Consensus-based Standards for the selection of health Measurement Instruments guidelines were followed for data synthesis and quality assessment. RESULTS Ninety-five articles met our inclusion criteria, with 79 evaluating a measurement property and 16 reporting on interpretability. There was sufficient reliability for both tests, with intraclass correlation coefficients (ICC) generally ranging from 0.72 to 0.98, but overall quality of evidence was low. For convergent/discriminant validity, an overall sufficient rating with moderate quality of evidence was found for both tests. Concurrent validity of the usual gait speed test was sufficient (ICCs = 0.79-0.93 with longer distances) with moderate quality of evidence; however, there were insufficient results for the fast gait speed test (e.g. low agreement with longer distances) supported by high-quality studies. Responsiveness was only evaluated in three articles, with low quality of evidence. CONCLUSION Findings from this review demonstrated evidence in support of the reliability and validity of the usual and fast gait speed tests in community-dwelling older adults. However, future validation studies should employ rigorous methodology and evaluate the tests' responsiveness.
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Affiliation(s)
- Ava Mehdipour
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Selina Malouka
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Swart KM, van der Heijden AA, Blom MT, Overbeek JA, Nijpels G, van Hout HP, Elders PJ, Herings RM. Identification of frailty in primary care: accuracy of electronically derived measures. Br J Gen Pract 2023; 73:e752-e759. [PMID: 37487641 PMCID: PMC10394609 DOI: 10.3399/bjgp.2022.0574] [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: 11/18/2022] [Accepted: 04/04/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Routinely collected clinical data based on electronic medical records could be used to define frailty. AIM To estimate the ability of four potential frailty measures that use electronic medical record data to identify older patients who were frail according to their GP. DESIGN AND SETTING This retrospective cohort study used data from 36 GP practices in the Dutch PHARMO Data Network. METHOD The measures were the Dutch Polypharmacy Index, Charlson Comorbidity Index (CCI), Chronic Disease Score (CDS), and Frailty Index. GPs' clinical judgement of patients' frailty status was considered the reference standard. Performance of the measures was assessed with the area under the receiver operating characteristic curve (AUC). Analyses were done in the total population and stratified by age and sex. RESULTS Of 31 511 patients aged ≥65 years, 3735 (11.9%) patients were classified as frail by their GP. The CCI showed the highest AUC (0.79, 95% confidence interval [CI] = 0.78 to 0.80), followed by the CDS (0.69, 95% CI = 0.68 to 0.70). Overall, the measures showed poorer performance in males and females aged ≥85 years than younger age groups (AUC 0.55-0.58 in females and 0.57-0.60 in males). CONCLUSION This study showed that of four frailty measures based on electronic medical records in primary care only the CCI had an acceptable performance to assess frailty compared with frailty assessments done by professionals. In the youngest age groups diagnostic performance was acceptable for all measures. However, performance declined with older age and was least accurate in the oldest age group, thereby limiting the use in patients of most interest.
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Affiliation(s)
- Karin Ma Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, and Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, the Netherlands
| | - Amber Awa van der Heijden
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Marieke T Blom
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, and Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, the Netherlands
| | - Giel Nijpels
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Hein Pj van Hout
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Petra Jm Elders
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Ron Mc Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, and Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology & Data Science, Amsterdam, the Netherlands
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Cross-sectional and prospective associations between homocysteine and a frailty index: A post-hoc analysis of the multidomain Alzheimer's prevention trial (MAPT). Exp Gerontol 2023; 172:112066. [PMID: 36549548 DOI: 10.1016/j.exger.2022.112066] [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: 09/23/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Homocysteine (Hcy) has been associated with several health problems, including reduced physical capacity. No study appears to have looked at the role of Hcy values longitudinally on physical capacity deterioration in older adults. The objective is to examine cross-sectional and prospective associations between Hcy values and frailty in the elderly and investigate Hcy potential association with the onset of frailty. METHODS 769 community-dwelling older adults from the MAPT study were recruited for this study. Total Hcy was measured at baseline. Frailty was evaluated at 5 different collection timepoints: baseline, 6-month, 1-, 2-, and 3-year using a frailty index (FI) composed of 19 items. Linear regressions adjusted for all the confounders (age, gender, educational level, MAPT group allocation and Omega-3) were performed to examine the cross-sectional associations of homocysteine values with the FI. A cox model was used to test the association of Hcy with the onset of frailty. RESULTS Mean Hcy values (15.9 ± 5.6 μmol\L) were obtained from 769 community-dwelling adults (75.7 ± 4.6 years old). After adjustments, a significant (β = 0.002, (00002-0.003)) and positive association between baseline Hcy values and FI was found (ß = 0.002). Additionally, higher values of Hcy were associated with a worsening of FI after 3 years (ß = 0.002, p = 0.003). A significant association between baseline Hcy values and the likelihood of developing frailty was discovered by incident event analysis (HR: 1.04 (1.01-1.06), p = 0.004). CONCLUSION High levels of Hcy are associated with the fragility process in community-dwelling older adults.
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Sanchez-Sanchez JL, Carnicero-Carreño JA, Garcia-Garcia FJ, Álvarez-Bustos A, Rodríguez-Sánchez B, Rodríguez-Mañas L. Physical performance measures in frailty screening: diagnostic and prognostic accuracy in the Toledo Study of Healthy Ageing. Maturitas 2022; 165:18-25. [PMID: 35849911 DOI: 10.1016/j.maturitas.2022.07.004] [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: 07/12/2021] [Revised: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The present study aimed to explore the diagnostic and prognostic accuracy of standard and population-specific Physical Performance Measures (PPMs) cut-off points for frailty screening. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Population-based study including 2328 subjects from the Toledo Study of Healthy Aging (age = 76.37 ± 6.78). Data related to frailty status and PPMs was collected at baseline visit (2011-2013). Mortality and hospitalization were ascertained up to March 2019 and December 2017, respectively, whereas disability onset and worsening were evaluated in the 2015-2017 visit. METHODS Gait speed and Short Physical Performance Battery population-specific cut-off points for frailty were computed using receiver operating characteristics (ROC) curve analysis. Head-to-head comparison of associations with adverse events against existing reference values (SPPB≤6, GS < 0.8 m/s) and classical (Frailty Phenotype, Frailty Index) and newly incorporated frailty tools (12- and 5-item Frailty Trait Scale) were explored through logistic and Cox regressions. Predictive ability was compared through areas under the curves (AUCs) for disability onset/worsening and integrated AUCs for mortality and hospitalization (time-censoring adverse events). RESULTS PPMs population-specific cut-off points (SPPB ≤7 and GS ≤ 0.75 m/s for males; SPPB ≤4 and GS ≤ 0.5 for females) outperformed published reference thresholds in terms of diagnostic accuracy. Frailty identified through PPMs was associated with adverse events (death, hospitalization and incident disability) similarly to that assessed using the newly incorporated tools and showed similar prognostic accuracy (mortality [IAUCs≈0.7], hospitalization [IAUCs≈0.8] and disability onset/worsening [AUCs≈0.62]), except for the tool used to assess frailty. CONCLUSIONS Our results suggest that PPMs might serve as the first screen to identify candidates for further frailty assessment and exploration of underlying mechanisms, allowing opportunistic on-time screening in different settings (community and primary care) in which frailty instruments are rarely implementable.
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Affiliation(s)
- Juan Luis Sanchez-Sanchez
- Gerontopole of Toulouse, Institute of Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - José Antonio Carnicero-Carreño
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, Madrid, Spain; Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
| | - Francisco José Garcia-Garcia
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, Madrid, Spain; Geriatrics Department, Virgen del Valle Hospital, Toledo, Spain
| | | | | | - Leocadio Rodríguez-Mañas
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, Madrid, Spain; Geriatrics Department, Getafe University Hospital, Getafe, Spain
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Ambagtsheer RC, Casey MG, Lawless M, Archibald MM, Yu S, Kitson A, Beilby JJ. Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study. BMC PRIMARY CARE 2022; 23:160. [PMID: 35754037 PMCID: PMC9235102 DOI: 10.1186/s12875-022-01778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Frailty is a highly prevalent clinical syndrome increasing older people's vulnerability to risk of adverse outcomes. Better frailty identification through expanded screening implementation has been advocated within general practice settings, both internationally and within Australia. However, little is known about practitioner perceptions of the feasibility of specific instruments, and the underlying motivations behind those perceptions. Consequently, the purpose of this study was to explore the attitudes and perceptions of a convenience and volunteer sample of Australian general practitioners (GPs) and practice nurses (PNs) towards common frailty screening instruments. METHODS The feasibility of several frailty screening instruments (PRISMA-7 [P7], Edmonton Frail Scale [EFS], FRAIL Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC] and Timed Up and Go [TUG]) to 43 Australian GPs and PNs was assessed. The study adopted a concurrent embedded mixed-methods design incorporating quantitative (ranking exercise) and qualitative (content analysis) data collection integrated during the analysis phase. RESULTS Practitioners assessed multi-dimensional instruments (EFS, GFI, KC) as having relatively higher clinical utility, better integration into existing assessment processes and stronger links to intervention over uni-dimensional (GST, TUG) and simple (FQ, P7) instruments. CONCLUSIONS While existing frailty screening instruments show promise as an initial step in supporting better care for older people, all the included instruments were associated with perceived advantages and disadvantages. Ultimately, clinicians will need to weigh several factors in their selection of the optimal screening instrument. Further translational research, with a focus on contextual fit, is needed to support clinical decision-making on the selection of instruments for frailty screening.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia.
- Torrens University Australia, Adelaide, Australia.
| | - Mavourneen G Casey
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Michael Lawless
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Mandy M Archibald
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Solomon Yu
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Alison Kitson
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Justin J Beilby
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- Torrens University Australia, Adelaide, Australia
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Validation of the Kihon Checklist and the frailty screening index for frailty defined by the phenotype model in older Japanese adults. BMC Geriatr 2022; 22:478. [PMID: 35658843 PMCID: PMC9164897 DOI: 10.1186/s12877-022-03177-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/25/2022] [Indexed: 01/11/2023] Open
Abstract
Abstract
Background
The term “frailty” might appear simple, but the methods used to assess it differ among studies. Consequently, there is inconsistency in the classification of frailty and predictive capacity depending on the frailty assessment method utilised. We aimed to examine the diagnostic accuracy of several screening tools for frailty defined by the phenotype model in older Japanese adults.
Methods
This cross-sectional study included 1,306 older Japanese adults aged ≥ 65 years who underwent physical check-up by cluster random sampling as part of the Kyoto-Kameoka Study in Japan. We evaluated the diagnostic accuracy of several screening instruments for frailty using the revised Japanese version of the Cardiovascular Health Study criteria as the reference standard. These criteria are based on the Fried phenotype model and include five elements: unintentional weight loss, weakness (grip strength), exhaustion, slowness (normal gait speed), and low physical activity. The Kihon Checklist (KCL), frailty screening index (FSI), and self-reported health were evaluated using mailed surveys. We calculated the non-parametric area under the receiver operating characteristic curve (AUC ROC) for several screening tools against the reference standard.
Results
The participants’ mean (standard deviation) age was 72.8 (5.5) years. The prevalence of frailty based on the Fried phenotype model was 12.2% in women and 10.3% in men. The AUC ROC was 0.861 (95% confidence interval: 0.832–0.889) for KCL, 0.860 (0.831–0.889) for FSI, and 0.668 (0.629–0.707) for self-reported health. The cut-off for identifying frail individuals was ≥ 7 points in the KCL and ≥ 2 points in the FSI.
Conclusions
Our results indicated that the two instruments (KCL and FSI) had sufficient diagnostic accuracy for frailty based on the phenotype model for older Japanese adults. This may be useful for the early detection of frailty in high-risk older adults.
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Arrieta H, Rezola-Pardo C, Sanz B, Virgala J, Lacunza-Zumeta M, Rodriguez-Larrad A, Irazusta J. Improving the Identification of Frailty in Long-Term Care Residents: A Cross-Sectional Study. Biol Res Nurs 2022; 24:530-540. [PMID: 35574636 DOI: 10.1177/10998004221100797] [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
PURPOSE To compare the capacity of blood myostatin concentration and physical, cognitive, and affective function tests to predict frailty among long-term care (LTC) residents. METHODS This cross-sectional analysis used baseline data from three randomized controlled trials involving 260 older adults in 14 LTC centers. Serum myostatin levels were analyzed by enzyme-linked immunosorbent assay. Frailty, physical fitness, cognitive and affective functions were assessed using validated tests and scales. RESULTS The Timed Up and Go, gait speed, 6-minute walk, and Berg Balance Scale had excellent capabilities in identifying frail individuals in accordance with Fried's Frailty Phenotype (FFP). The best tests for identifying frailty in accordance with the Clinical Frailty Scale (CFS) were Timed Up and Go and Berg Balance Scale. For the Tilburg Frailty Indicator (TFI), the best tests were Quality of Life in Alzheimer's Disease (QoL-AD) and Goldberg Anxiety. Myostatin, along with physical, cognitive, and affective function tests, improved the capability of the hand grip, arm-curl, Montreal Cognitive Assessment, Goldberg Anxiety, Goldberg Depression, and QoL-AD to identify frailty according to FFP, while myostatin improved CFS-defined frailty identification by the hand grip, arm-curl, 6-minute walk test, Berg Balance Scale, 30-second chair-stand, gait speed, Montreal Cognitive Assessment, Goldberg Anxiety, and De Jong-Gierveld Loneliness Scale. CONCLUSION Among LTC residents, serum myostatin was associated with being frail according to FFP and CFS. However, this measure was less discriminating of frailty than physical fitness tests (for FFP and CFS) and affective function parameters (for TFI). However, evaluated concurrently with physical, cognitive, and affective parameters, myostatin improved the capabilities of these measures to predict CFS-defined frailty.
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Affiliation(s)
- Haritz Arrieta
- Department of Nursing II, Faculty of Medicine and Nursing, 83067University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
| | - Chloe Rezola-Pardo
- Department of Physiology, Faculty of Medicine and Nursing, 83067University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Begoña Sanz
- Department of Physiology, Faculty of Medicine and Nursing, 83067University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Janire Virgala
- Department of Physiology, Faculty of Medicine and Nursing, 83067University of the Basque Country (UPV/EHU), Leioa, Spain
| | | | - Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, 83067University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, 83067University of the Basque Country (UPV/EHU), Leioa, Spain
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Lette M, Stoop A, Nijpels G, Baan C, de Bruin S, van Hout H. Safety risks among frail older people living at home in the Netherlands - A cross-sectional study in a routine primary care sample. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e469-e477. [PMID: 33201562 PMCID: PMC9292903 DOI: 10.1111/hsc.13230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 08/28/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
Frail older people face a range of problems and risks that could undermine their ability to live safely at home. A comprehensive overview of these risks, from a multidimensional perspective, is currently lacking. This study aims to examine the prevalence of risks in multiple domains of life among frail older people living at home. We used cross-sectional data from 824 people aged 65 years and older, who received a comprehensive geriatric assessment (the interRAI Home Care [interRAI-HC]) between 2014 and 2018, as part of routine care from 25 general practices in the region of West-Friesland, the Netherlands. The interRAI-HC identifies amenable risks related to people's clinical conditions, functioning, lifestyle and behaviour, and social and physical environment. Descriptive statistics were used to examine population characteristics (age, gender, marital status, living arrangements and presence of chronic conditions) and prevalence of risks. Most common risks were related to people's clinical conditions (i.e cardio-respiratory health, urinary incontinence, pain), functioning (i.e. limitations in instrumental activities of daily living and mood) and social environment (i.e. limitations in informal care and social functioning). More than 80% of frail older people faced multiple risks, and often on multiple domains of life simultaneously. People experiencing multiple risks per person, and on multiple domains simultaneously, were more often widowed and living alone. The multidimensional character of risks among frail older people living at home implies that an integrated approach to care, comprising both health and social care, is necessary. Insight in the prevalence of these risks can give direction to care allocation decisions.
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Affiliation(s)
- Manon Lette
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical Centres – VU UniversityAmsterdamThe Netherlands
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- SIGRAAmsterdamThee Netherlands
| | - Annerieke Stoop
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical Centres – VU UniversityAmsterdamThe Netherlands
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical Centres – VU UniversityAmsterdamThe Netherlands
| | - Caroline Baan
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Simone de Bruin
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Hein van Hout
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam University Medical Centres – VU UniversityAmsterdamThe Netherlands
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Longobucco Y, Lauretani F, Gionti L, Tagliaferri S, Gobbens R, Kostka T, Palummeri E, Barbolini M, Maggio M. The role of the Sunfrail tool in the screening of frailty and in integrated community-hospital care pathways: a retrospective observational study. Aging Clin Exp Res 2022; 34:419-427. [PMID: 34302641 PMCID: PMC8847239 DOI: 10.1007/s40520-021-01931-x] [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] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
Background One of the most problematic expression of ageing is frailty, and an approach based on its early identification is mandatory. The Sunfrail-tool (ST), a 9-item questionnaire, is a promising instrument for screening frailty. Aims To assess the diagnostic accuracy and the construct validity between the ST and a Comprehensive Geriatric Assessment (CGA), composed by six tests representative of the bio-psycho-social model of frailty; To verify the discriminating power of five key-questions of the ST; To investigate the role of the ST in a clinical-pathway of falls’ prevention.
Methods In this retrospective study, we enrolled 235 patients from the Frailty-Multimorbidity Lab of the University-Hospital of Parma. The STs’ answers were obtained from the patient’s clinical information. A patient was considered frail if at least one of the CGAs’ tests resulted positive. Results The ST was associated with the CGA’s judgement with an Area Under the Curve of 0.691 (CI 95%: 0.591–0.791). Each CGA’s test was associated with the ST total score. The five key-question showed a potential discriminating power in the CGA’s tests of the corresponding domains. The fall-related question of the ST was significantly associated with the Short Physical Performance Battery total score (OR: 0.839, CI 95%: 0.766–0.918), a proxy of the risk of falling. Discussion The results suggest that the ST can capture the complexity of frailty. The ST showed a good discriminating power, and it can guide a second-level assessment to key frailty domains and/or clinical pathways. Conclusions The ST is a valid and easy-to-use instrument for the screening of frailty.
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Affiliation(s)
- Yari Longobucco
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, PR, Italy.
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, PR, Italy
- Geriatric Clinic Unit, Medicine-Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma, Italy
| | - Luciano Gionti
- San Giuseppe Moscati Hospital, Caserta Local Health Trust, Caserta, Italy
| | - Sara Tagliaferri
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, PR, Italy
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Healthy Ageing Research Centre (HARC), Lodz, Poland
| | | | - Mirca Barbolini
- European Commission (DG Santè), Brussels, Belgium
- Catholic University of the Sacred Heart, Rome, Italy
| | - Marcello Maggio
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, PR, Italy
- Geriatric Clinic Unit, Medicine-Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma, Italy
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10
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Whitlock EL. Frailty: More Than the Sum of Its Parts? Anesth Analg 2021; 133:1090-1093. [PMID: 34673722 DOI: 10.1213/ane.0000000000005672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Elizabeth L Whitlock
- From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, California
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11
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Van Damme JK, Lemmon K, Oremus M, Neiterman E, Stolee P. Understanding Frailty Screening: a Domain Mapping Exercise. Can Geriatr J 2021; 24:154-161. [PMID: 34079610 PMCID: PMC8137461 DOI: 10.5770/cgj.24.401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Many definitions and operationalisations of frailty exclude psychosocial factors, such as social isolation and mental health, despite considerable evidence of the links between frailty and these factors. This study aimed to investigate the health domains covered by frailty screening tools. Methods A systematic search of the literature was conducted in accordance with PRISMA guidelines. MEDLINE, CINAHL, EMBASE, and PsycInfo were searched from inception to December 31, 2018. Data related to the domains of each screening tool were extracted and mapped onto a framework based on the biopsychosocial model of Lehmans et al. (2009) and Wade & Halligans (2017). Results Sixty-seven frailty screening tools were captured in 79 articles. All screening tools assessed biological factors, 73% assessed psychological factors, 52% assessed social factors, and 78% assessed contextual factors. Under half (43%) of the tools evaluated all four domains, 33% evaluated three of four domains, 12% reported two of four domains, and 13% reported one domain (biological). Conclusion This review found considerable variation in the assessment domains covered by frailty screening tools. Frailty is a broad construct, and frailty screening tools need to cover a wide variety of domains to enhance screening and outcomes assessment.
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Affiliation(s)
- Jill K Van Damme
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
| | - Kassandra Lemmon
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
| | - Mark Oremus
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
| | - Elena Neiterman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1
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12
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Stolee P, Elliott J, Giguere AM, Mallinson S, Rockwood K, Sims Gould J, Baker R, Boscart V, Burns C, Byrne K, Carson J, Cook RJ, Costa AP, Giosa J, Grindrod K, Hajizadeh M, Hanson HM, Hastings S, Heckman G, Holroyd-Leduc J, Isaranuwatchai W, Kuspinar A, Meyer S, McMurray J, Puchyr P, Puchyr P, Theou O, Witteman H. Transforming primary care for older Canadians living with frailty: mixed methods study protocol for a complex primary care intervention. BMJ Open 2021; 11:e042911. [PMID: 33986044 PMCID: PMC8126280 DOI: 10.1136/bmjopen-2020-042911] [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: 12/31/2022] Open
Abstract
INTRODUCTION Older Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and services, but often this care is not well coordinated. Older adults and their family caregivers are the experts in their own needs and preferences, but often do not have a chance to participate fully in treatment decisions or care planning. As a result, older adults may have health problems that are not properly assessed, managed or treated, resulting in poorer health outcomes and higher economic and social costs. We will be implementing enhanced primary healthcare approaches for older patients, including risk screening, patient engagement and shared decision making and care coordination. These interventions will be tailored to the needs and circumstances of the primary care study sites. In this article, we describe our study protocol for implementing and testing these approaches. METHODS AND ANALYSIS Nine primary care sites in three Canadian provinces will participate in a multi-phase mixed methods study. In phase 1, baseline information will be collected through questionnaires and interviews with patients and healthcare providers (HCPs). In phase 2, HCPs and patients will be consulted to tailor the evidence-based interventions to site-specific needs and circumstances. In phase 3, sites will implement the tailored care model. Evaluation of the care model will include measures of patient and provider experience, a quality of life measure, qualitative interviews and economic evaluation. ETHICS AND DISSEMINATION This study has received ethics clearance from the host academic institutions: University of Calgary (REB17-0617), University of Waterloo (ORE#22446) and Université Laval (#MP-13-2019-1500 and 2017-2018-12-MP). Results will be disseminated through traditional means, including peer-reviewed publications and conferences and through an extensive network of knowledge user partners. TRIAL REGISTRATION NUMBER NCT03442426;Pre-results.
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Affiliation(s)
- Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Anik Mc Giguere
- Department of Family Medicine and Emergency Medicine, Universite Laval, Laval, Quebec, Canada
| | - Sara Mallinson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joanie Sims Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Catherine Burns
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Kerry Byrne
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Judith Carson
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Justine Giosa
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heather M Hanson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Stephanie Hastings
- Alberta Health Services, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | | | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for exceLlence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Josephine McMurray
- School of Business and Economics/Health Studies, Wilfred Laurier University, Waterloo, Ontario, Canada
| | - Phyllis Puchyr
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Peter Puchyr
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly Witteman
- Department of Family Medicine and Emergency Medicine, Universite Laval, Laval, Quebec, Canada
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13
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Ambagtsheer RC, Visvanathan R, Dent E, Yu S, Schultz TJ, Beilby J. Commonly Used Screening Instruments to Identify Frailty Among Community-Dwelling Older People in a General Practice (Primary Care) Setting: A Study of Diagnostic Test Accuracy. J Gerontol A Biol Sci Med Sci 2021; 75:1134-1142. [PMID: 31689342 DOI: 10.1093/gerona/glz260] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried's Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire. METHODS DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility.We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21]. RESULTS We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2-94.3]; Sp: 73.4% [66.5-79.6]) and REFS (Se: 87.5% [73.2-95.8]; Sp: 75.5% [68.8-81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria. CONCLUSIONS Two screening instruments-the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Torrens University Australia, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria
| | - Solomon Yu
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy J Schultz
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Justin Beilby
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Torrens University Australia, Adelaide, South Australia, Australia
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14
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Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C. Predictive performance of 7 frailty instruments for short-term disability, falls and hospitalization among Chinese community-dwelling older adults: A prospective cohort study. Int J Nurs Stud 2021; 117:103875. [PMID: 33621721 DOI: 10.1016/j.ijnurstu.2021.103875] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/26/2020] [Accepted: 01/01/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Frailty becomes a great challenge with population aging. The proactive identification of frailty is considered as a rational solution in the community. Previous studies found that frailty instruments had insufficient predictive accuracy for adverse outcomes, but they mainly focused on long-term outcomes and constructed frailty instruments based on available data not original forms. The predictive performance of original frailty instruments for short-term outcomes in community-dwelling older adults remains unknown. OBJECTIVE To examine the predictive performance of seven frailty instruments in their original forms for 1-year incident outcomes among community-dwelling older adults. DESIGN A prospective cohort study. SETTINGS A total of 22 communities were selected by a stratified sampling method from one Chinese city. PARTICIPANTS A total of 749 older adults aged ≥ 60 years (mean age of 69.2 years, 69.8% female) were followed up after 1 year. METHODS Baseline frailty was assessed by three purely physical dimensional instruments (i.e. Frailty Phenotype, the Study of Osteoporotic Fracture and FRAIL Scale) and four multidimensional instruments (i.e. Frailty Index, Groningen Frailty Indicator, Tilburg Frailty Indicator and Comprehensive Frailty Assessment Instrument), respectively. Outcomes included incident disability, falls, hospitalization and the combined outcome at 1-year follow-up. The receiver operating characteristic curves were plotted to assess the predictive performance of frailty instruments. RESULTS The areas under the curves of seven frailty instruments in predicting incident outcomes ranged from 0.55 [95% confidence interval (CI): 0.51-0.60] to 0.67 (95% CI: 0.61-0.72), with high specificity (72.3-99.2%) and low sensitivity (4.0-49.6%). Four multidimensional instruments had much higher sensitivity (20.9-49.6% versus 4.0-11.7%) than three purely physical dimensional instruments. Overall, the Frailty Index was more accurate than some instruments in predicting incident outcomes, while several self-report instruments had comparable predictive accuracy to the Frailty Index for all (FRAIL Scale) or some (Groningen Frailty Indicator and Tilburg Frailty Indicator) of the incident outcomes. CONCLUSIONS All frailty instruments have inadequate predictive accuracy for short-term outcomes among community-dwelling older adults. The Frailty Index roughly performs better but self-report instruments are comparable to the Frailty Index for all or some of the outcomes. An accurate frailty instrument needs to be developed, and the simple self-report instruments could be used temporarily as practical and efficient tools in primary care.
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Affiliation(s)
- Huaxin Si
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yaru Jin
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaoyu Tian
- School of Nursing, Shandong University, No. 44 Wenhuaxi Road, Lixia District, Jinan 250012, China
| | - Xinyi Liu
- School of Nursing, Shandong University, No. 44 Wenhuaxi Road, Lixia District, Jinan 250012, China
| | - Cuili Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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15
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Archibald MM, Lawless MT, Ambagtsheer RC, Kitson AL. Understanding consumer perceptions of frailty screening to inform knowledge translation and health service improvements. Age Ageing 2021; 50:227-232. [PMID: 33006601 PMCID: PMC7793601 DOI: 10.1093/ageing/afaa187] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES despite growing support for the clinical application of frailty, including regular frailty screening for older adults, little is known about how older adults perceive frailty screening. The purpose of this study was to examine older adults' perspectives on frailty screening to inform knowledge translation and service improvements for older adults with frailty. RESEARCH DESIGN interpretive descriptive qualitative design. PARTICIPANTS a total of 39 non-frail (18%), pre-frail (33%) and frail or very frail (49%) South Australian older adults aged 62-99 years, sampled from community, assisted living and residential aged care settings. METHODS seven focus groups were conducted and analysed by two independent investigators using inductive thematic analysis. RESULTS three themes were identified. First, older adults question the necessity and logic of an objective frailty measure. Second, older adults believe any efforts at frailty screening need to culminate in an action. Third, older adults emphasise that frailty screening needs to be conducted sensitively given negative perceptions of the term frailty and the potential adverse effects of frailty labelling. DISCUSSION AND IMPLICATIONS previous screening experiences and underlying beliefs about the nature of frailty as inevitable shaped openness to, and acceptance of, frailty screening. Findings correspond with previous research illuminating the lack of public awareness of frailty and the nascent stage of frailty screening implementation. Incorporating consumer perspectives, along with perspectives of other stakeholder groups when considering implementing frailty screening, is likely to impact uptake and optimise suitability-important considerations in person-centred care provision.
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Affiliation(s)
- Mandy M Archibald
- College of Nursing, Rady Faculty of Health Sciences , University of Manitoba, Winnipeg, Manitoba, Canada
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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16
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Dziubek W, Pawlaczyk W, Stefańska M, Waligóra J, Bujnowska-Fedak M, Kowalska J. Evaluation of Psychophysical Factors in Individuals with Frailty Syndrome Following a 3-Month Controlled Physical Activity Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217804. [PMID: 33113806 PMCID: PMC7662508 DOI: 10.3390/ijerph17217804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022]
Abstract
Background: The aim of the study was to compare the emotional state and strength-velocity parameters of patients with frailty and pre-frailty syndrome undertaking a 12-week training programme. Methods: The study was completed by 36 individuals, including 17 with frailty syndrome (FS) and 19 with pre-frailty syndrome (PFS). The age of the subjects ranged from 63 to 89 years, with a mean 69.2 years (±5.0). The Beck Depression Inventory (BDI), Spielberg’s State-Trait Anxiety Inventory (STAI), and Satisfaction with Life Scale (SWLS) were used. The strength of knee muscles was evaluated. The above tests were conducted at two time points: before the training sessions (T1); and after 12 weeks of regular training sessions (T2). Results: After completion of the training programme, statistically significant differences in BDI were observed between the PFS and FS groups (especially in somatic symptoms). Following the training, BDI values in the PFS group were significantly lower (fewer depressive symptoms) than in the FS group. The parameter values describing strength capacities of the lower limbs, both at T1 and T2, proved to be higher in the PFS group. Conclusions: In individuals with pre-frailty and frailty syndrome, the 3-month physical training programme improved the strength parameters of lower limb muscles. An improvement in mood and reduction in depressive symptoms were only observed in the group of subjects with pre-frailty syndrome. Rehabilitation programmes for people with frailty syndrome should include psychotherapeutic activities in addition to physical training in order to improve the psychophysical condition of patients.
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Affiliation(s)
- Wioletta Dziubek
- Department of Physiotherapy, University School of Physical Education, 51-612 Wroclaw, Poland; (W.D.); (M.S.); (J.K.)
| | | | - Małgorzata Stefańska
- Department of Physiotherapy, University School of Physical Education, 51-612 Wroclaw, Poland; (W.D.); (M.S.); (J.K.)
| | - Joanna Waligóra
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland; (J.W.); (M.B.-F.)
| | - Maria Bujnowska-Fedak
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland; (J.W.); (M.B.-F.)
| | - Joanna Kowalska
- Department of Physiotherapy, University School of Physical Education, 51-612 Wroclaw, Poland; (W.D.); (M.S.); (J.K.)
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17
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Salminen M, Viljanen A, Eloranta S, Viikari P, Wuorela M, Vahlberg T, Isoaho R, Kivelä SL, Korhonen P, Irjala K, Löppönen M, Viikari L. Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people. Aging Clin Exp Res 2020; 32:2013-2019. [PMID: 31654244 PMCID: PMC7532963 DOI: 10.1007/s40520-019-01383-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/11/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is a lack of agreement about applicable instrument to screen frailty in clinical settings. AIMS To analyze the association between frailty and mortality in Finnish community-dwelling older people. METHODS This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. RESULTS Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and FI (5.97 [4.13-8.64], and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). DISCUSSION Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. CONCLUSIONS FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.
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Affiliation(s)
- Marika Salminen
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland.
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku, 20014, Turku, Finland.
| | - Anna Viljanen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
- Municipality of Lieto Health Care Centre, Hyvättyläntie 7, 21420, Lieto, Finland
| | - Sini Eloranta
- Faculty of Medicine, Department of Nursing Science, University of Turku, 20014, Turku, Finland
- Turku University of Applied Science, Health and Well-being, Joukahaisenkatu 3, 20520, Turku, Finland
| | - Paula Viikari
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Maarit Wuorela
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Raimo Isoaho
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku, 20014, Turku, Finland
- City of Vaasa, Social and Health Care, Ruutikellarintie 4, 65101, Vaasa, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku, 20014, Turku, Finland
- Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, 00014, Helsinki, Finland
| | - Päivi Korhonen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku, 20014, Turku, Finland
| | - Kerttu Irjala
- Faculty of Medicine, Department of Clinical Medicine, Unit of Clinical Chemistry, TYKSLAB, 20521, Turku, Finland
| | - Minna Löppönen
- City of Raisio, Social and Health Care for Elderly, Sairaalakatu 5, 21200, Raisio, Finland
| | - Laura Viikari
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland
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18
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Clinical judgment versus geriatric assessment for frailty in older patients with cancer. J Geriatr Oncol 2020; 11:1138-1144. [DOI: 10.1016/j.jgo.2020.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/01/2020] [Accepted: 05/27/2020] [Indexed: 12/27/2022]
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19
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Bloemhoff A, Schoon Y, Smulders K, Akkermans R, Vloet LCM, van den Berg K, Berben SAA. Older persons are frailer after an emergency care visit to the out-of-hours general practitioner cooperative in the Netherlands: a cross-sectional descriptive TOPICS-MDS study. BMC FAMILY PRACTICE 2020; 21:171. [PMID: 32819281 PMCID: PMC7441648 DOI: 10.1186/s12875-020-01220-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/14/2020] [Indexed: 12/02/2022]
Abstract
Background In the Netherlands, community-dwelling older people with primary care emergency problems contact the General Practitioner Cooperative (GPC) after hours. However, frailty remains an often unobserved hazard with adverse health outcomes. The aim of this study was to provide insight into differences between older persons with or without GPC emergency care visits (reference group) regarding frailty and healthcare use. Methods A cross-sectional descriptive study design was based on data from the public data repository of The Older Persons and Informal Caregivers Survey Minimum Dataset (TOPICS-MDS). Frailty in older persons (65+ years, n = 32,149) was measured by comorbidity, functional and psychosocial aspects, quality of life and a frailty index. Furthermore, home care use and hospital admissions of older persons were identified. We performed multilevel logistic and linear regression analyses. A random intercept model was utilised to test differences between groups, and adjustment factors (confounders) were used in the multilevel analysis. Results Compared to the reference group, older persons with GPC contact were frailer in the domain of comorbidity (mean difference 0.52; 95% CI 0.47–0.57, p < 0.0001) and functional limitations (mean difference 0.53; 95% CI 0.46–0.60, p < 0.0001), and they reported less emotional wellbeing (mean difference − 4.10; 95% CI -4.59- -3.60, p < 0.0001) and experienced a lower quality of life (mean difference − 0.057; 95% CI -0.064- -0.050, p < 0.0001). Moreover, older persons more often reported limited social functioning (OR = 1.50; 95% CI 1.39–1.62, p < 0.0001) and limited perceived health (OR = 1.50, 95% CI 1.39–1.62, p < 0.0001). Finally, older persons with GPC contact more often used home care (OR = 1.37; 95% CI 1.28–1.47, p < 0.0001) or were more often admitted to the hospital (OR = 2.88; 95% CI 2.71–3.06, p < 0.0001). Conclusions Older persons with out-of-hours GPC contact for an emergency care visit were significantly frailer in all domains and more likely to use home care or to be admitted to the hospital compared to the reference group. Potentially frail older persons seemed to require adequate identification of frailty and support (e.g., advanced care planning) both before and after a contact with the out-of-hours GPC.
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Affiliation(s)
- Anneke Bloemhoff
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Yvonne Schoon
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kien Smulders
- General Practitioners Cooperative Gelderse Vallei, Ede, The Netherlands
| | - Reinier Akkermans
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lilian C M Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Karin van den Berg
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sivera A A Berben
- Eastern Regional Emergency Healthcare Network, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.,Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Thompson MQ, Theou O, Tucker GR, Adams RJ, Visvanathan R. FRAIL scale: Predictive validity and diagnostic test accuracy. Australas J Ageing 2020; 39:e529-e536. [PMID: 32748992 DOI: 10.1111/ajag.12829] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the predictive validity of the FRAIL scale for mortality, and diagnostic test accuracy (DTA) against the frailty phenotype (FP). MEASUREMENT Frailty was measured in 846 community-dwelling adults (mean age 74.3 [SD 6.3] years, 54.8% female) using a modified FRAIL scale and modified FP. Mortality was matched to death records. RESULTS The FRAIL scale demonstrated significant predictive validity for mortality up to 10 years (Frail adjHR: 2.60, P < .001). DTA findings were acceptable for specificity (86.8%) and Youden index (0.50), but not sensitivity (63.6%), or area under the receiver operator curve (auROC) (0.75). DTA estimates were more acceptable when a cut-point of ≥2 characteristics was used rather than ≥3 in the primary DTA analysis. CONCLUSION The FRAIL scale is a valid predictor of mortality. DTA estimates depend on FRAIL scale cut-point used. This instrument is a potentially useful frailty screening tool.
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Affiliation(s)
- Mark Q Thompson
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Olga Theou
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Graeme R Tucker
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia.,Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Aged and Extended Care Services, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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21
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Maltais M, De Souto Barreto P, Hooper C, Payoux P, Rolland Y, Vellas B. Association Between Brain β-Amyloid and Frailty in Older Adults. J Gerontol A Biol Sci Med Sci 2020; 74:1747-1752. [PMID: 30629123 DOI: 10.1093/gerona/glz009] [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: 09/06/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We sought to determine whether cortical and regional β-amyloid (Aβ) were cross-sectionally and prospectively associated with change in frailty status in older adults. METHODS We used data from 269 community-dwelling participants from the Multidomain Alzheimer's Preventive Trial (MAPT) who were assessed for brain Aβ using positron-emission tomography scan. Regional and cortical-to-cerebellar standardized uptake value ratios were obtained. Frailty was assessed by a frailty index composed of 19 items not directly linked to cognition and Alzheimer's disease. RESULTS A significant and positive cross-sectional and prospective relationship was found for Aβ in the anterior putamen (cross-sectional: β = 0.11 [0.02-0.20], p = .02; prospective: β = 0.11 [0.03-0.19], p = .007), posterior putamen (cross-sectional: β = 0.12 [0.009-0.23], p = .03; prospective: β = 0.11 [0.02-0.21], p = .02), and precuneus regions (cross-sectional: β = 0.07 [0.01-0.12], p = .01; prospective: β = 0.07 [0.01-0.12], p = .01) with increasing frailty. CONCLUSIONS This study has found new information regarding cross-sectional and prospective positive associations between region-specific brain Aβ deposits and worsening frailty. The potential mechanisms involved require further investigation.
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Affiliation(s)
- Mathieu Maltais
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France
| | - Philipe De Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR INSERM, 1027 University of Toulouse III, France
| | - Claudie Hooper
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France
| | - Pierre Payoux
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse INSERM, UPS, France.,Nuclear Medicine Department, CHU Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR INSERM, 1027 University of Toulouse III, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France.,UMR INSERM, 1027 University of Toulouse III, France
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22
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Xiang W, Cheng Y, Li Z, Han J, Li K. Cross-cultural adaptation and validation of the Groningen Frailty Indicator in Chinese nursing home residents. Aging Clin Exp Res 2020; 32:1035-1042. [PMID: 30900215 DOI: 10.1007/s40520-019-01178-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/14/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Frail older people are more likely to develop negative health outcomes. Previous studies have indicated that the Groningen Frailty Indicator is a practical frailty screening instrument with good psychometric properties; however, it has never been implemented in Chinese nursing homes. AIMS To cross-culturally adapt and validate the Groningen Frailty Indicator in Chinese nursing home residents. METHODS The participants were 192 residents from nursing homes. Reliability was analyzed by internal consistency and test-retest methods. Convergent validity was assessed using Spearman rank correlations between the GFI domains and activities of daily living, the mini nutritional assessment, the Mini-mental state examination, the Social Support Rating Scale, the 20-item Epidemiologic Studies Depression Scale and the Short Form 36 mental component summary. Criterion validity was investigated by performing a receiver operating characteristics curve analysis. RESULTS The Chinese GFI achieved semantic, idiomatic, and experiential equivalence. It had a high response rate among nursing home elders. It also showed good internal consistency (ICC = 0.712) and excellent test-retest reliability. Regarding construct validity, it presented good known-group divergent validity based on age. The correlations between the GFI domains and their corresponding measures were consistent as hypothesized, demonstrating convergent validity of the GFI. Using the Fried frailty phenotypes as reference criteria, the Chinese GFI showed satisfactory diagnostic accuracy for frailty (AUC = 0.823) and prefrailty (AUC = 0.791). The optimal cutoff point was 4 for frailty and 3 for prefrailty. CONCLUSIONS The GFI was successfully adapted for Chinese nursing home residents and presented acceptable validity and reliability.
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23
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Ambagtsheer RC, Archibald MM, Lawless M, Kitson A, Beilby J. Feasibility and acceptability of commonly used screening instruments to identify frailty among community-dwelling older people: a mixed methods study. BMC Geriatr 2020; 20:152. [PMID: 32321431 PMCID: PMC7178952 DOI: 10.1186/s12877-020-01551-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/05/2020] [Indexed: 12/04/2022] Open
Abstract
Background Frailty exposes older people to an elevated risk of a range of negative outcomes. Emerging evidence that frailty can be effectively treated within community settings has stimulated calls for more proactive screening within primary care. Assessing feasibility is a critical preliminary step in assessing the efficacy of interventions such as screening. However, few studies have explored the feasibility and acceptability of administering frailty screening instruments within general practice, and even fewer have incorporated patient perspectives. Our study had three objectives: To 1) assess overall feasibility of the instruments (completion time and rate); 2) assess patient acceptability towards the instruments; and 3) assess the feasibility and acceptability of the instruments to administering nurses. Methods The feasibility and acceptability of several frailty screening instruments (PRISMA-7, Edmonton Frail Scale, FRAIL Scale Questionnaire, Gait Speed, Groningen Frailty Indicator, Reported Edmonton Frail Scale and Kihon Checklist) was explored within the context of a larger diagnostic test accuracy (DTA) study. Completion time and rate was collected for all participants (N = 243). A sub-sample of patients (n = 30) rated each instrument for ease of completion and provided comment on perceived acceptability. Lastly, five of six administering nurses involved in the DTA study participated in semi-structured face-to-face interviews, rating the instruments against several feasibility and acceptability criteria (time, space, equipment, skill required to implement, acceptability to patients and nurses, ease of scoring) and providing comment on their responses. Results The PRISMA-7 returned the highest overall feasibility and acceptability, requiring minimal space, equipment, skills and time to implement, and returning the fastest completion rate and highest patient and nurse acceptability rating. All screening instruments were faster to implement than the two reference standards (Fried’s Frailty Phenotype and Frailty Index). Self-administered instruments were subject to lower rates of completion than nurse-administered instruments. Conclusions This study has demonstrated that a number of commonly used frailty screening instruments are potentially feasible for implementation within general practice. Ultimately, more research is needed to determine how contextual factors, such as differences in individual patient and clinician preferences, setting and system factors, impact on the feasibility of screening in practice.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia. .,Torrens University Australia, GPO Box 2025, Adelaide, SA, 5000, Australia.
| | - Mandy M Archibald
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Lawless
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Justin Beilby
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, Australia.,Torrens University Australia, GPO Box 2025, Adelaide, SA, 5000, Australia
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Hegendörfer E, Vaes B, Van Pottelbergh G, Matheï C, Verbakel J, Degryse JM. Predictive Accuracy of Frailty Tools for Adverse Outcomes in a Cohort of Adults 80 Years and Older: A Decision Curve Analysis. J Am Med Dir Assoc 2019; 21:440.e1-440.e8. [PMID: 31678074 DOI: 10.1016/j.jamda.2019.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the predictive performance of 3 frailty identification tools for mortality, hospitalization, and functional decline in adults aged ≥80 years using risk reclassification statistics and decision curve analysis. DESIGN Population-based, prospective cohort. SETTING BELFRAIL study, Belgium. PARTICIPANTS 560 community-dwelling adults aged ≥80 years. MEASUREMENTS Frailty by Cardiovascular Health Study (CHS) phenotype, Longitudinal Aging Study Amsterdam (LASA) markers, and Groeningen Frailty Indicator (GFI); mortality until 5.1 ± 0.25 years from baseline and hospitalization until 3.0 ± 0.25 years; and functional status assessed by activities of daily living at baseline and after 1.7 ± 0.21 years. RESULTS Frailty prevalence was 7.3% by CHS phenotype, 21.6% by LASA markers, and 22% by GFI. Participants determined to be frail by each tool had a significantly higher risk for all-cause mortality and first hospitalization. For functional decline, only frail by GFI had a higher adjusted odds ratio. Harrell 's C-statistic for mortality and hospitalization and area under receiver operating characteristic curve for functional decline were similar for all tools and <0.70. Reclassification statistics showed improvement only by LASA markers for hospitalization and mortality. In decision curve analysis, all tools had higher net benefit than the 2 default strategies of "treat all" and "treat none" for mortality risk ≥20%, hospitalization risk ≥35%, and functional decline probability ≥10%, but their curves overlapped across all relevant risk thresholds for these outcomes. CONCLUSIONS AND IMPLICATIONS In a cohort of adults aged ≥80 years, 3 frailty tools based on different conceptualizations and assessment sources had comparable but unsatisfactory discrimination for predicting mortality, hospitalization, and functional decline. All showed clinical utility for predicting these outcomes over relevant risk thresholds, but none was significantly superior. Future research on frailty tools should include a focus on the specific group of adults aged ≥80 years, and the predictive accuracy for adverse outcomes of different tools needs a comprehensive assessment that includes decision curve analysis.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain, Belgium.
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Catharina Matheï
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Jan Verbakel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain, Belgium
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Jankowska-Polańska B, Uchmanowicz B, Kujawska-Danecka H, Nowicka-Sauer K, Chudiak A, Dudek K, Rosińczuk J. Assessment of frailty syndrome using Edmonton frailty scale in Polish elderly sample. Aging Male 2019; 22:177-186. [PMID: 29571272 DOI: 10.1080/13685538.2018.1450376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The aim of the study was to assess the incidence and severity of the frailty syndrome assessed with the Edmonton Frailty Scale. This is a cross-sectional study conducted among 382 patients (236 men and 146 women, mean age 71.9 years). The Edmonton Frailty Scale was administered during the patient's admission to the hospital. The Polish adaptation was performed using the standard methodology. The Cronbach's alpha coefficient for the whole Edmonton Frailty Scale was 0.709. The mean correlation between positions and the overall result was r = 0.180. There were no statistically significant differences between women and men in the area of Edmonton Frailty Scale mean score (p < 0.05). The socio-clinical analysis, showed statistically significant differences in the age of respondents, educational attainment, occupational activity, number of drugs taken and co-occurrence of chronic diseases. A higher values of the Edmonton Frailty Scale were indicated for individuals >70 years than for those <70 years (p < 0.001). The Edmonton Frailty Scale proved to be a reliable tool which may be used in the Polish population. The use of this questionnaire for frailty syndrome may be helpful in everyday clinical practice.
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Affiliation(s)
- Beata Jankowska-Polańska
- a Department of Clinical Nursing, Faculty of Health Sciences , Wroclaw Medical University , Wroclaw , Poland
| | - Bartosz Uchmanowicz
- a Department of Clinical Nursing, Faculty of Health Sciences , Wroclaw Medical University , Wroclaw , Poland
| | - Hanna Kujawska-Danecka
- b Clinic of Internal Medicine, Connective Tissue Diseases and Geriatrics, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Katarzyna Nowicka-Sauer
- c Department of Family Medicine, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Anna Chudiak
- a Department of Clinical Nursing, Faculty of Health Sciences , Wroclaw Medical University , Wroclaw , Poland
| | - Krzysztof Dudek
- d Department of Logistics and Transport Systems, Faculty of Mechanical Engineering , Wroclaw University of Technology , Wroclaw , Poland
| | - Joanna Rosińczuk
- e Department of Nervous System Diseases, Faculty of Health Sciences , Wroclaw Medical University , Wroclaw , Poland
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Meyer AM, Siri G, Becker I, Betz T, Bödecker AW, Robertz JW, Krause O, Benzing T, Pilotto A, Polidori MC. The Multidimensional Prognostic Index in general practice: One-year follow-up study. Int J Clin Pract 2019; 73:e13403. [PMID: 31408241 DOI: 10.1111/ijcp.13403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/23/2019] [Accepted: 08/08/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Older patients' health problems in general practice (GP) can often not be assigned to a specific disease, requiring a paradigm shift to goal-oriented, personalised care for clinical decision making. PURPOSE To investigate the predictive value of the comprehensive geriatric assessment (CGA)-based Multidimensional Prognostic Index (MPI) in a GP setting with respect to the main healthcare indicators during the 12 months following initial evaluation. METHODS One hundred twenty-five consecutive patients aged 70 years and older were enrolled in a GP and followed up to one year. All patients underwent a CGA based on which the MPI was calculated and subdivided into three risk groups (MPI-1, 0-0.33 = low risk, MPI-2, 0.34-0.66 = moderate risk and MPI-3, 0.67-1, severe risk). Grade of Care (GC), hospitalization rate, mortality, nursing home admission, use of home care services, falls, number of general practitioner contacts (GPC), of geriatric resources (GR) and geriatric syndromes (GS) during the 12 months following initial evaluation were collected. RESULTS The MPI was significantly associated with number of GS (P < .001), GR (P < .001), GC (P < .001) as well as with the average number of GPC per year (mean 10.4, P = .046). Interestingly, the clinical judgement of the general practitioner, in this case knowing his patients for 16 years on average, was associated with adverse outcomes to a similar extent than the prediction offered by the MPI (GP/adverse outcomes and MPI/adverse outcomes P < .001). CONCLUSION The MPI is strongly associated with adverse outcomes in older GP patients and strongly predicts the number of GPC up to one year after initial evaluation. Considering the feasibility and the strong clinimetric properties of the MPI, its collection should be encouraged as early as possible to disclose risk conditions, implement tailored preventive strategies and improve cost-effectiveness of healthcare resources use.
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Affiliation(s)
- Anna Maria Meyer
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Giacomo Siri
- Scientific Directorate-Biostatistics, E.O. Galliera Hospital, Genova, Italy
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Thomas Betz
- Institute for General Practice, Academic training practive, University Hospital of Cologne, Cologne, Germany
| | - August W Bödecker
- Institute for General Practice, University Hospital of Cologne, Cologne, Germany
| | - Jörg W Robertz
- Institute for General Practice, University Hospital of Cologne, Cologne, Germany
| | - Olaf Krause
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Thomas Benzing
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- CECAD, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- CECAD, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Moraes DC, Lenardt MH, Seima MD, Mello BHD, Setoguchi LS, Setlik CM. Postural instability and the condition of physical frailty in the elderly. Rev Lat Am Enfermagem 2019; 27:e3146. [PMID: 31038639 PMCID: PMC6528635 DOI: 10.1590/1518-8345.2655-3146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 02/03/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the relationship between postural instability and the condition and markers of physical frailty of the elderly people in outpatient geriatric and gerontology care. METHOD a cross-sectional study with a sample of 381 elderly subjects. Physical frailty was evaluated by the frailty phenotype and postural instability through the Berg Balance Scale. Univariate analyses consisted in Chi-square tests, and multivariate analyses used the Forward Stepwise method, which resulted in a model of physical frailty associated with postural instability. RESULTS among the participants, 56 (14.7%) were frail, 217 (57%) pre-frail, and 68 (28.3%) non-frail. Pre-frailty (p < 0.001), frailty (p = 0.000), and the markers hand grip strength (p = 0.0008), unintentional weight loss (p = 0.0094), level of physical activity (p = 0.0001), fatigue/exhaustion (p = 0.0001), and gait speed (p = 0.0001) were associated with postural instability. CONCLUSION the presence of postural instability determines a greater chance of the elderly being frail or pre-frail. This result favors the planning of gerontological nursing care and strengthens the treatment plan under a specific approach.
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Affiliation(s)
- Dayana Cristina Moraes
- Hospital Nossa Senhora do Pilar, Unidade de Terapia Intensiva, Curitiba, PR, Brasil.,Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil
| | - Maria Helena Lenardt
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil
| | - Marcia Daniele Seima
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.,Prefeitura de São José dos Pinhais, Departamento de Atenção à Saúde, São José dos Pinhais, PR, Brasil
| | - Bruno Henrique de Mello
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.,Hospital Nossa Senhora das Graças, Unidade de Terapia Intensiva, Curitiba, PR, Brasil
| | - Larissa Sayuri Setoguchi
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Clarice Maria Setlik
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.,Hospital Nossa Senhora das Graças, Unidade de Internação, Curitiba, PR, Brasil
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28
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Ambagtsheer RC, Beilby JJ, Visvanathan R, Dent E, Yu S, Braunack-Mayer AJ. Should we screen for frailty in primary care settings? A fresh perspective on the frailty evidence base: A narrative review. Prev Med 2019; 119:63-69. [PMID: 30594533 DOI: 10.1016/j.ypmed.2018.12.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 12/22/2018] [Accepted: 12/24/2018] [Indexed: 11/27/2022]
Abstract
With older adults living longer, health service providers have increasingly turned their attention towards frailty and its significant consequences for health and well-being. Consequently, frailty screening has gained momentum as a possible health policy answer to the question of what can be done to prevent frailty's onset and progression. However, who should be screened for frailty, where and when remains a subject of extensive debate. The purpose of this narrative review is to explore the dimensions of this question with reference to Wilson and Jungner's time-tested and widely accepted principles for acceptable screening within community settings. Although the balance of the emerging evidence to support frailty screening is promising, significant gaps in the evidence base remain. Consequently, when assessed against Wilson and Jungner's principles, extensive population screening does not appear to be supported by the evidence. However, screening for the purpose of case-finding may prove useful among older adults.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Trans-disciplinary Research To Achieve Healthy Ageing, Adelaide, South Australia, Australia; Torrens University Australia, Adelaide, South Australia, Australia.
| | - Justin J Beilby
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Trans-disciplinary Research To Achieve Healthy Ageing, Adelaide, South Australia, Australia; Torrens University Australia, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Trans-disciplinary Research To Achieve Healthy Ageing, Adelaide, South Australia, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Solomon Yu
- National Health and Medical Research Council of Australia Centre of Research Excellence Frailty Trans-disciplinary Research To Achieve Healthy Ageing, Adelaide, South Australia, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Annette J Braunack-Mayer
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; School of Health and Society, Faculty of Social Sciences, University of Wollongong, New South Wales, Australia
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29
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Binotto MA, Lenardt MH, Rodríguez-Martínez MDC. Physical frailty and gait speed in community elderly: a systematic review. Rev Esc Enferm USP 2018; 52:e03392. [PMID: 30570081 DOI: 10.1590/s1980-220x2017028703392] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 06/04/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify the outcomes of studies on gait speed and its use as a marker of physical frailty in community elderly. METHOD Systematic review of the literature performed in the following databases: LILACS, SciELO, MEDLINE/PubMed, ScienceDirect, Scopus and ProQuest. The studies were evaluated by STROBE statement, and the PRISMA recommendations were adopted. RESULTS There were 6,303 studies, and 49 of them met the inclusion criteria. Of the total number of studies, 91.8% described the way of measuring gait speed. Of these, 28.6% used the distance of 4.6 meters, and 34.7% adopted values below 20% as cutoff points for reduced gait speed, procedures in accordance with the frailty phenotype. Regarding the outcomes, in 30.6% of studies, there was an association between gait speed and variables of disability, frailty, sedentary lifestyle, falls, muscular weakness, diseases, body fat, cognitive impairment, mortality, stress, lower life satisfaction, lower quality of life, napping duration, and poor performance in quantitative parameters of gait in community elderly. CONCLUSION The results reinforce the association between gait speed, physical frailty and health indicator variables in community elderly.
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Affiliation(s)
- Maria Angélica Binotto
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brasil.,Universidade Estadual do Centro-Oeste, Departamento de Educação Física, Guarapuava, PR, Brasil
| | - Maria Helena Lenardt
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brasil
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Palmer K, Villani ER, Vetrano DL, Cherubini A, Cruz-Jentoft AJ, Curtin D, Denkinger M, Gutiérrez-Valencia M, Guðmundsson A, Knol W, Mak DV, O'Mahony D, Pazan F, Petrovic M, Rajkumar C, Topinkova E, Trevisan C, van der Cammen TJM, van Marum RJ, Wehling M, Ziere G, Bernabei R, Onder G. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med 2018; 10:9-36. [PMID: 32720270 DOI: 10.1007/s41999-018-0124-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/24/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa. METHODS A systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I2 statistic and publication bias with Egger's and Begg's tests. RESULTS Thirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR = 1.52; 95% CI 1.32-1.79) and frail persons (pooled OR = 2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR = 1.95; 95% CI 1.41-2.70) and frail (OR = 6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR = 1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty. CONCLUSIONS Polypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals. PROSPERO REGISTRATION NUMBER CRD42018104756.
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Affiliation(s)
- Katie Palmer
- Fondazione Ospedale San Camillo IRCCS, Via Alberoni 70, 30126, Venezia, Italia.
| | - Emanuele R Villani
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L Vetrano
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.,Aging Research Center, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Denis Curtin
- Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Michael Denkinger
- Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau and Geriatric Research Unit, Ulm University, Ulm, Germany
| | - Marta Gutiérrez-Valencia
- Department of Pharmacy, Navarrabiomed, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Navarra, Spain
| | - Adalsteinn Guðmundsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Department of Geriatrics, Landspitali University Hospital, Reykjavík, Iceland
| | - Wilma Knol
- Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diane V Mak
- Department of Geriatric Medicine, Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Denis O'Mahony
- Department of Medicine, Department of Geriatric Medicine, University College Cork, Cork University Hospital, Cork, Ireland
| | - Farhad Pazan
- Institute for Clinical Pharmacology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Petrovic
- Department of Internal Medicine, Section of Geriatrics, Ghent University, Ghent, Belgium
| | - Chakravarthi Rajkumar
- Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, General Faculty Hospital, Prague, Czech Republic
| | - Catarina Trevisan
- Department of Medicine, Geriatrics Division, University of Padova, Padua, Italy
| | - Tischa J M van der Cammen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Academic Department of Geriatrics, Brighton and Sussex Medical School, Brighton, East Sussex, UK
| | - Rob J van Marum
- Department of General Practice and Old Age Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Geriatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Martin Wehling
- Medical Faculty Mannheim, Clinical Pharmacology, University of Heidelberg, Heidelberg, Germany
| | - Gijsbertus Ziere
- Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roberto Bernabei
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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de Souto Barreto P, Rolland Y, Maltais M, Vellas B. Associations of Multidomain Lifestyle Intervention with Frailty: Secondary Analysis of a Randomized Controlled Trial. Am J Med 2018; 131:1382.e7-1382.e13. [PMID: 29969614 DOI: 10.1016/j.amjmed.2018.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/16/2018] [Accepted: 06/21/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The objective of this study was to investigate whether a long-term multidomain lifestyle intervention was associated with the severity and incidence of frailty in older adults. METHODS A 3-year randomized controlled trial was conducted among 1637 French community dwellers age ≥70: 821 controls and 816 who received a multidomain lifestyle intervention (cognitive training, nutrition counseling, and advice on physical activity). The intervention involved 12 2-hour sessions (in the first 2 months) followed by a 1-hour session each month until the study end. Controls received the usual care but did not receive any personalized lifestyle intervention. A frailty index (FI; range = 0-1, higher is worse) composed of 32 items was calculated at baseline, 6 months, 1 year, 2 years, and 3 years and constituted our main endpoint. FI ≥ 0.25 defined frailty. The 4 outcomes were severity of frailty (continuous FI score), incident frailty, incidence of persistent frailty (frailty at 2 consecutive time points), and reversibility of frailty (from frailty to nonfrailty). RESULTS Mixed-effect linear regression did not find a significant effect of the multidomain intervention on FI score. Frailty incidence occurred in 241 of 1146 subjects (138 controls and 103 in the multidomain group), whereas incidence of persistent frailty occurred in 75 of 1042 subjects (48 controls and 27 in the multidomain group). Cox models adjusted for baseline FI scores showed that compared with controls, subjects in the multidomain group had a decreased risk of developing both frailty (hazard ratio 0.72; 95% confidence interval, 0.55-0.93) and persistent frailty (hazard ratio 0.53; 95% confidence interval, 0.33-0.85). CONCLUSIONS This multidomain lifestyle intervention was associated with a reduced risk of developing frailty but did not affect the severity of frailty in community-dwelling older adults.
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Affiliation(s)
- Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France; Unité Mixte de Recherche (UMR) Institut National de la Santé et de la recherche médicale (INSERM) 1027, University of Toulouse III, France.
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France; Unité Mixte de Recherche (UMR) Institut National de la Santé et de la recherche médicale (INSERM) 1027, University of Toulouse III, France
| | - Mathieu Maltais
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France; Unité Mixte de Recherche (UMR) Institut National de la Santé et de la recherche médicale (INSERM) 1027, University of Toulouse III, France
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Yaman H, Ünal Z. The validation of the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey. Electron Physician 2018; 10:7266-7272. [PMID: 30258559 PMCID: PMC6140991 DOI: 10.19082/7266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background The screening of frailty in older adults is an important issue in the preventive approach in medicine. Frailty is one of the leading causes of morbidity and premature mortality in older adults. Objective The aim of this study was to validate the PRISMA-7 questionnaire in community-dwelling elderly people living in Antalya, Turkey. Methods This study was cross-sectional and observational in nature and was conducted in Antalya (Turkey) from February 2016 to April 2017. One hundred fifty patients participated in this study. PRISMA-7 and the CSHA Clinical Frailty Scale were applied to these patients along with a questionnaire on socio-demographics. No translations were available for the PRISMA-7 or the CSHA in Turkish language. The PRISMA-7 and the CSHA Clinical Frailty Scale were translated by two translators to Turkish language; after compilation and agreeing to one Turkish translation, the text was translated back by two translators to English. The translation was then compiled to one text and compared with the original text. After agreement on the translation, both translations were piloted in 10 elderly people. The final form has been applied in this study. Data of the ten piloted patients have not been included into the dataset. Data were analyzed by IBM-SPSS version 22, using descriptive statistics, Pearson product-moment correlation, and receiver operator characteristic (ROC) analysis. The level of significance was set at 0.05. Results Our study showed that participants were in average vulnerability to frailty. The test-retest reliability score for the PRISMA-7 Scale and for the CSHA Clinical Frailty Scale were (r= 99.2; p<0.001) and (r=97.5; p<0.05), respectively. After using CSHA Clinical Frailty Scale as a reference standard, PRISMA-7 showed that the area under ROC curve (AUC) was 0.903; which is the best accuracy; and medium level for internal consistency (Cronbach’s α =0.714) as a measure for reliability. A cut-off point of 4 or higher for PRISMA-7revealed high sensitivity (81.5%) and specificity (88.2%) for frailty. Conclusion We would recommend PRISMA-7 as a reliable and valid instrument, with high-level accuracy in the screening process of frailty.
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Affiliation(s)
- Hakan Yaman
- MD in Family Medicine, Former Professor of Akdeniz University, Konyaaltı-Antalya, Turkey
| | - Zeynep Ünal
- MSC of Bioinformatics; PhD Candidate in Econometrics, Institute of Social Sciences, Akdeniz University, Antalya, Turkey
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Ambagtsheer RC, Thompson MQ, Archibald MM, Casey MG, Schultz TJ. Diagnostic test accuracy of self-reported frailty screening instruments in identifying community-dwelling older people at risk of frailty and pre-frailty: a systematic review protocol. ACTA ACUST UNITED AC 2018; 15:2464-2468. [PMID: 29035957 DOI: 10.11124/jbisrir-2017-003363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
REVIEW QUESTION/OBJECTIVE The question of this systematic review is: What is the diagnostic test accuracy of self-reported frailty screening instruments among community-dwelling older people against any of the following reference standard tests: the frailty phenotype, frailty index and comprehensive geriatric assessment?
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Affiliation(s)
- Rachel C Ambagtsheer
- 1National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, Australia 2Torrens University Australia, Adelaide, Australia 3The Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence
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van Blijswijk SCE, Blom JW, de Craen AJM, den Elzen WPJ, Gussekloo J. Prediction of functional decline in community-dwelling older persons in general practice: a cohort study. BMC Geriatr 2018; 18:140. [PMID: 29898672 PMCID: PMC6001140 DOI: 10.1186/s12877-018-0826-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A first step to offer community-dwelling older persons proactive care is to identify those at risk of functional decline within a year. This study investigates the predictive value of registered information, questionnaire and GP-opinion on functional decline. METHODS In this cohort study, embedded within the ISCOPE-trial, participants (≥75 years) completed the ISCOPE-screening questionnaire on four health domains. GPs gave their opinion on vulnerability of participants. Functional status was measured at baseline and 12 months (Groningen Activities Restriction Scale [GARS]). The outcome was functional decline (death, nursing home admission, 10% with greatest functional decline). The predictive value of pre-selected variables (age, sex, polypharmacy, multimorbidity, living situation; GPs' opinion on vulnerability, number of domains with problems [ISCOPE-score]) was compared with the area under the curves (AUC) for logistic regression models. RESULTS 2018 of the 2211 participants (median age 82.1 years [IQR 78.8-86.5], 68.0% female, median GARS 31 [IQR 24-41]) were visited at 12 months (median GARS 34 [IQR 26-44]). 394 participants (17.8%) had functional decline (148 died, 45 nursing home admissions, 201 with greatest functional decline). The AUC for age and sex was 0.602, increasing to 0.620 (p = 0.029) with polypharmacy, multimorbidity and living situation. The GPs' opinion added more (AUC 0.672, p < 0.001) than the ISCOPE-score (AUC 0.649, p = 0.007). AUC with all variables was 0.686 (p = 0.016), and 0.643 for GPs' opinion alone. CONCLUSIONS The GPs' opinion and ISCOPE-score improve this prediction model for functional decline based on readily available variables. GPs could identify older patients for further assessment with their clinical judgement. TRIAL REGISTRATION Netherlands trial register, NTR1946 . Registered 10 August 2009.
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Affiliation(s)
- Sophie C E van Blijswijk
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Bucher S, Al-Salameh A, Panjo H, Becquemont L, Ringa V. Looking younger, dying later: General practitioners' intuitive clinical impression predicts mortality. Prev Med 2018; 111:28-34. [PMID: 29474849 DOI: 10.1016/j.ypmed.2018.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/29/2018] [Accepted: 02/19/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Sophie Bucher
- General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, Le Kremlin-Bicêtre, France; CESP, INSERM U1018, INED, Université Paris-Saclay, Université Parie-Sud, UVSQ, Villejuif, France.
| | - Abdallah Al-Salameh
- CESP, INSERM U1018, INED, Université Paris-Saclay, Université Parie-Sud, UVSQ, Villejuif, France; Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, INSERM Center for immunology of viral infections and autoimmune diseases, Assistance Publique-Hôpitaux de Paris, Hopital Bicêtre, Le Kremlin Bicêtre, France
| | - Henri Panjo
- CESP, INSERM U1018, INED, Université Paris-Saclay, Université Parie-Sud, UVSQ, Villejuif, France
| | - Laurent Becquemont
- Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, INSERM Center for immunology of viral infections and autoimmune diseases, Assistance Publique-Hôpitaux de Paris, Hopital Bicêtre, Le Kremlin Bicêtre, France
| | - Virginie Ringa
- CESP, INSERM U1018, INED, Université Paris-Saclay, Université Parie-Sud, UVSQ, Villejuif, France
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Korenvain C, Famiyeh IM, Dunn S, Whitehead CR, Rochon PA, McCarthy LM. Identifying frailty in primary care: a qualitative description of family physicians' gestalt impressions of their older adult patients. BMC FAMILY PRACTICE 2018; 19:61. [PMID: 29759070 PMCID: PMC5952517 DOI: 10.1186/s12875-018-0743-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/23/2018] [Indexed: 12/03/2022]
Abstract
Background Many tools exist to guide family physicians’ impressions about frailty status of older adults, but no single tool, instrument, or set of criteria has emerged as most useful. The role of physicians’ subjective impressions in frailty decisions has not been studied. This study explores how family physicians conceptualize frailty, and the factors that they consider when making subjective decisions about patients’ frailty statuses. Methods Descriptive qualitative study of family physicians who practice in a large urban academic family medicine center as they participated in one-on-one “think-aloud” interviews about the frailty status of their patients aged 80 years and over. Of 23 eligible family physicians, 18 shared their impressions about the frailty status of their older adult patients and the factors influencing their decisions. Interviews were audio-recorded, transcribed, and thematically analyzed. Results Four themes were identified, the first of which described how physicians conceptualized frailty as a spectrum and dynamic in nature, but also struggled to conceptualize it without a formal definition in place. The remaining three themes described factors considered before determining patients’ frailty statuses: physical characteristics (age, weight, medical conditions), functional characteristics (physical, cognitive, social) and living conditions (level of independence, availability of supports, physical environment). Conclusions Family physicians viewed frailty as multifactorial, dynamic, and inclusive of functional and environmental factors. This conceptualization can be useful to make comprehensive and flexible evaluations of frailty status in conjunction with more objective frailty tools. Electronic supplementary material The online version of this article (10.1186/s12875-018-0743-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clara Korenvain
- Women's College Hospital, 76 Grenville Street, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada
| | - Ida-Maisie Famiyeh
- Women's College Hospital, 76 Grenville Street, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada
| | - Sheila Dunn
- Women's College Hospital, 76 Grenville Street, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,The Wilson Centre, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada
| | - Cynthia R Whitehead
- Women's College Hospital, 76 Grenville Street, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,Women's College Research Institute, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
| | - Paula A Rochon
- Women's College Hospital, 76 Grenville Street, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,The Wilson Centre, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada
| | - Lisa M McCarthy
- Women's College Hospital, 76 Grenville Street, Toronto, ON, Canada. .,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada. .,Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada. .,The Wilson Centre, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada.
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Kim S, Won CW, Kim BS, Kim S, Yoo J, Byun S, Jang HC, Cho BL, Son SJ, Lee JH, Park YS, Choi KM, Kim HJ, Lee SG. EuroQol Visual Analogue Scale (EQ-VAS) as a Predicting Tool for Frailty in Older Korean Adults: The Korean Frailty an Aging Cohort Study (KFACS). J Nutr Health Aging 2018; 22:1275-1280. [PMID: 30498837 DOI: 10.1007/s12603-018-1077-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study was conducted to determine the cutoff value and efficacy of the EuroQol Visual Analogue Scale (EQ-VAS) for predicting frailty. DESIGN The EQ-VAS medians (Interquartile Range) were compared and analyzed against the FFI. PARTICIPANTS The subjects were 1471 older adults aged 70 to 84 years who had completed both EQ-VAS and Fried Frailty index (FFI) in the first baseline year (2016) of the Korean Frailty and Aging Cohort Study. RESULTS Of the 1471 subjects,600 were classified as robust, 716 as pre-frail, and 155 as frail. The median EQ-VAS scores were 80.00 (20.00) for robust, 75.00 (25.00) for pre-frail, and 60.00 (25.00) for frail subjects.The medians of all five components of the FFI, weight loss (70.00 vs. 80.00), grip strength (70.00 vs. 80.00), exhaustion (70.00 vs. 80.00), walking velocity (70.00 vs. 80.00), and physical activity (70.00 vs. 80.00), were lower in the abnormal groups. We tested the efficacy of EQ-VAS as a diagnostic tool to predict frailty, and the area under the curve of EQ-VAS was 0.71 withthe optimal cut-off value of 72. CONCLUSION EQ-VAS presented negative correlation with FFI, and the optimal cut off value for frailty was 72. These results suggest that EQ-VAS is a valuable tool for assessing frailty andmay be a good predictor of frailty in Korean elderly population.
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Affiliation(s)
- S Kim
- Chang Won Won, MD. Ph.D, Elderly Frailty Research Center, Department of Family Medicine, Kyung Hee University College of Medicine, Kyungheedaero 23, Dongdaemun-gu, Seoul, 02447 Republic of Korea.Tel: +82 2 958 8700; E-mail:
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Bongue B, Buisson A, Dupre C, Beland F, Gonthier R, Crawford-Achour É. Predictive performance of four frailty screening tools in community-dwelling elderly. BMC Geriatr 2017; 17:262. [PMID: 29126383 PMCID: PMC5681791 DOI: 10.1186/s12877-017-0633-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 10/08/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study compares the performance of four frailty screening tools in predicting relevant adverse outcome (disability, institutionalization and mortality) in community-dwelling elderly. METHODS Our study involved a secondary analysis of data from the FréLE cohort study. We focused on the following four frailty screening tools: the abbreviated Comprehensive Geriatric Assessment (aCGA), the Groningen Frailty Indicator (GFI), the Vulnerable Elders Survey-13 (VES-13) and the Fried scale. We used the Barberger-Gateau scale to assess disability. For comparison, we determined the capacity of these tools to predict the occurrence of disability, institutionalization or death using the receiver operating characteristic (ROC) curve. We also determined the threshold at which an optimal balance between sensitivity and specificity was reached. Odds ratios (ORs) were calculated to compare the risk of adverse outcome in the frail versus non-frail groups. RESULTS In total, 1643 participants were included in the mortality analyses; 1224 participants were included in the analyses of the other outcomes (74.5% of the original sample). The mean age was 77.7 years, and 48.1% of the participants were women. The prevalence of frailty in this sample ranged from 15.0% (Fried) to 52.2% (VES-13). According to the Barberger-Gateau scale, 643 (52.5%) participants were fully independent; 392 (32.0%) were mildly disabled; 118 (9.6%) were moderately disabled; and 71 (5.8%) were severely disabled. The tool with the greatest sensitivity for predicting the occurrence of disability, mortality and institutionalization was VES-13, which showed sensitivities of 91.0%, 89.7% and 92.3%, respectively. The values for the area under the curve (AUC) of the four screening tools at the proposed cut-off points ranged from 0.63 to 0.75. The odds (univariate and multivariate analysis) of developing a disability were significantly greater among the elderly identified as being frail by all four tools. CONCLUSION The multivariate analyses showed that the VES-13 may predict the occurrence of disability, mortality and institutionalization. However, the AUC analysis showed that even this tool did not have good discriminatory ability. These findings suggest that despite the high number of frailty screening tools described in the literature, there is still a need for a screening tool with high predictive performance.
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Affiliation(s)
- Bienvenu Bongue
- Centre Technique d'Appui et de Formation des Centres d'Examens de Santé (CETAF), 67-69 Avenue de Rochetaillée, 42100, Saint-Etienne, France. .,EA 4607, Laboratoire SNA-EPIS, Université Jean Monnet, Saint-Étienne, France.
| | - Aurélie Buisson
- Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de la Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France
| | - Caroline Dupre
- Centre Technique d'Appui et de Formation des Centres d'Examens de Santé (CETAF), 67-69 Avenue de Rochetaillée, 42100, Saint-Etienne, France
| | - François Beland
- SOLIDAGE, McGill University - Université de Montréal Research Group on Frailty and Aging, Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Canada
| | - Régis Gonthier
- Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de la Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France
| | - Émilie Crawford-Achour
- Département de Gérontologie Clinique, CHU de Saint Etienne, Hôpital de la Charité, 44 rue Pointe Cadet, 42000, Saint-Etienne, France.,EA 4607, Laboratoire SNA-EPIS, Université Jean Monnet, Saint-Étienne, France
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Lansbury LN, Roberts HC, Clift E, Herklots A, Robinson N, Sayer AA. Use of the electronic Frailty Index to identify vulnerable patients: a pilot study in primary care. Br J Gen Pract 2017; 67:e751-e756. [PMID: 28947622 PMCID: PMC5647918 DOI: 10.3399/bjgp17x693089] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/14/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Identifying frailty is key to providing appropriate treatment for older people at high risk of adverse health outcomes. Screening tools proposed for primary care often involve additional workload. The electronic Frailty Index (eFI) has the potential to overcome this issue. AIM To assess the feasibility and acceptability of using the eFI in primary care. DESIGN AND SETTING Pilot study in one suburban primary care practice in southern England in 2016. METHOD Use of the eFI on the primary care TPP SystmOne database was explained to staff at the practice where a comprehensive geriatric assessment (CGA) clinic was being trialled. The practice data manager ran an eFI report for all patients (n = 6670). Date of birth was used to identify patients aged ≥75 years (n = 589). The eFI was determined for patients attending the CGA clinic (n = 18). RESULTS Practice staff ran the eFI reports in 5 minutes, which they reported was feasible and acceptable. The eFI range was 0.03 to 0.61 (mean 0.23) for all patients aged ≥75 years (mean 83 years, range 75 to 102 years). For CGA patients (mean 82 years, range 75 to 94 years) the eFI range was 0.19 to 0.53 (mean 0.33). Importantly, the eFI scores identified almost 12% of patients aged ≥75 years in this practice to have severe frailty. CONCLUSION It was feasible and acceptable to use the eFI in this pilot study. A higher mean eFI in the CGA patients demonstrated construct validity for frailty identification. Practice staff recognised the potential for the eFI to identify the top 2% of vulnerable patients for avoiding unplanned admissions.
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Affiliation(s)
- Lynn N Lansbury
- Academic Geriatric Medicine, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton
| | - Helen Clare Roberts
- Academic Geriatric Medicine, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, and University Hospital Southampton NHS Foundation Trust, Southampton
| | - Esther Clift
- Health Education England (Wessex), Faculty of Health Sciences, University of Southampton, Southampton
| | | | | | - Avan A Sayer
- National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre, and professor of geriatric medicine, Academic Geriatric Medicine, NIHR Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton, Ageing, Geriatrics and Epidemiology, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, and National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre in Ageing and Chronic Disease, Newcastle upon Tyne NHS Foundation Trust and Newcastle University, Newcastle upon Tyne
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Risi L, Brown J, Sugarhood P, Depala B, Olowosoyo A, Tomu C, Gonzalez L, Munoz-Cobo M, Adekunle O, Ogwal O, Evans E, Shah A. The Handy Approach - Quick Integrated Person Centred Support Preparation. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:u214461.w5681. [PMID: 28674610 PMCID: PMC5483530 DOI: 10.1136/bmjquality.u214461.w5681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cost effective care requires comprehensive person-centred formulation of solutions. The East London NHS Foundation Trust Community Health Services in Newham have piloted models of Integrated Care called 'Virtual Wards' which aim to keep people living with multiple long-term conditions, well at home by minimising system complexity. These Virtual Wards comprise Interdisciplinary Teams (IDTs) with a General Practitioner (GP) seconded to provide leadership. Historically assessments have been dominated by biomedical approaches with disability emphasised over personal aspirations and ability. New professional skills are needed to organise information from diverse approaches into a common framework, which can enable agreed goals of care to be delivered collaboratively. From June 2014 to January 2016 we aimed to improve the documentation of person-centred goals of care in 100% of our assessments. Change ideas were tested and team development addressed to improve documentation of aspirations for care for people being referred and if achieved, then to test ideas to improve coproduction of care. Change ideas included Enhanced Clinical Supervision (ECS) by a GP with additional expert skills; Flash Teaching (FT) defined as five-minute weekly discussion on topics generated from the case-mix to develop a shared understanding of Integrated Care; Structured Formulation using a novel, quick, integrated assessment framework called the Handy Approach (HA) with the hand as a memory prompt to bring the personal together with the mental, social and physical domains and finally we tested focusing on 'Team Primacy' (mutual regard within the team) to embed behaviour change. 181 cases were tracked and documentation of personal aspirations for care by case showed: ECS 0/21 (0%); FT 5/50 (10%); ECS/FT plus the HA 35/83 (42%); Team Primacy plus ECS/FT/HA 27/27 (100%). By January 2016 prompted by using the Handy Approach in a highly functional team, all members of the IDT consistently documented personal aspirations.
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Morris JN, Howard EP, Steel KR. Development of the interRAI home care frailty scale. BMC Geriatr 2016; 16:188. [PMID: 27871235 PMCID: PMC5117529 DOI: 10.1186/s12877-016-0364-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/13/2016] [Indexed: 12/22/2022] Open
Abstract
Background The concept of frailty, a relative state of weakness reflecting multiple functional and health domains, continues to receive attention within the geriatrics field. It offers a summary of key personal characteristics, providing perspective on an individual’s life course. There have been multiple attempts to measure frailty, some focusing on physiologic losses, others on specific diseases, disabilities or health deficits. Recently, multidimensional approaches to measuring frailty have included cognition, mood and social components. The purpose of this project was to develop and evaluate a Home Care Frailty Scale and provide a grounded basis for assessing a person’s risk for decline that included functional and cognitive health, social deficits and troubling diagnostic and clinical conditions. Methods A secondary analysis design was used to develop the Home Care Frailty Scale. The data set consisted of client level home care data from service agencies around the world. The baseline sample included 967,865 assessments while the 6-month follow-up sample of persons still being served by the home care agencies consisted of 464,788 assessments. A pool of 70 candidate independent variables were screened for possible inclusion and 16 problem outcomes referencing accumulating declines and clinical complications served as the dependent variables. Multiple regression techniques were used to analyze the data. Results The resulting Home Care Frailty Scale consisted of a final set of 29 items. The items fall across 6 categories of function, movement, cognition and communication, social life, nutrition, and clinical symptoms. The prevalence of the items ranged from a high of 87% for persons requiring help with meal preparation to 3.7% for persons who have experienced a recent decline in the amount of food eaten. Conclusions The interRAI Home Care Frailty Scale is based on a strong conceptual foundation and in our analysis, performed as expected. Given the use of the interRAI Home Care Assessment System in multiple, diverse countries, the Home Care Frailty Scale will have wide applicability to support program planning and policy decision-making impacting home care clients and their formal and informal caregivers throughout the world.
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Affiliation(s)
- John N Morris
- Quality of Care and Health-Care Standards Program, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Elizabeth P Howard
- Northeastern University, Bouve College of Health Sciences, School of Nursing, Boston, MA, USA.
| | - Knight R Steel
- Hackensack University Medical Center (emeritus), Hackensack, NJ, USA
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