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Wagg A, Heckman G, Northwood M, Hirdes J. The clinical advantages of making our hospitals older adult friendly. Can J Cardiol 2024:S0828-282X(24)01008-0. [PMID: 39368705 DOI: 10.1016/j.cjca.2024.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 09/03/2024] [Accepted: 09/19/2024] [Indexed: 10/07/2024] Open
Abstract
Older adults (≥65 years old), now comprise half of the inpatient population. Catering for the needs of this group requires consideration of the processes of care, the inpatient environment and care practices operating in our hospitals. Older adults are often multimorbid, more likely than older adults in the community to be malnourished and have coexistent physical and cognitive impairments. These older adults are at great risk of suffering hospital associated harms or being designated as "bed blockers", partly due to inadequate understanding of their needs, a failure of recognition or an unwillingness to address them. The adoption of older adult friendly care presents considerable opportunity to transform the manner in which care is delivered in order to mitigate avoidable harms and optimize outcomes for older adults. This review explores the nature of our older adult inpatients, the implications of older adult friendly care, the requirement for true interprofessional care, the advantages of systematic assessment which spans pre-hospital to post-hospital care and highlights specific interventions to deal with in hospital problems which differentially impair health related outcomes for older adults. As such it raises awareness of the needs of older adults under cardiological to improve outcomes for hospitalized older adults.
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Affiliation(s)
- Adrian Wagg
- Professor, Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - George Heckman
- Schlegel Research Chair in Geriatric Medicine, Assistant Clinical Professor of Medicine, University of Waterloo, Waterloo, Ontario, Canada
| | - Melissa Northwood
- Assistant Professor, Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John Hirdes
- Professor, School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Kraut RY, Youngson E, Sadowski CA, Bakal JA, Faulder D, Korownyk CS, Vucenovic A, Eurich DT, Manca DP, Lundby C, Kivi P, Manville M, Garrison SR. Antihypertensive deprescribing in frail long-term care residents (OptimizeBP): protocol for a prospective, randomised, open-label pragmatic trial. BMJ Open 2024; 14:e084619. [PMID: 39209778 PMCID: PMC11404250 DOI: 10.1136/bmjopen-2024-084619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Although antihypertensive medication use is common among frail older adults, observational studies in this population suggest blood pressure (BP) lowering may convey limited benefit and perhaps even harm. This protocol describes an antihypertensive deprescribing trial in frail older adults powered for mortality and morbidity outcomes. METHODS AND ANALYSIS Design: Prospective, parallel, randomised, open-label pragmatic trial.Participants: Long-term care (LTC) residents ≥70 years of age, diagnosed with hypertension, with mean systolic BP <135 mm Hg, ≥1 daily antihypertensive medication and no history of congestive heart failure.Setting: 18 LTC facilities in Alberta, Canada, with eligible residents identified using electronic health services data.Intervention: All non-opted-out eligible residents are randomised centrally by a provincial health data steward to either usual care, or continually reducing antihypertensives provided an upper systolic threshold of 145 mm Hg is not exceeded. Deprescribing is carried out by pharmacists/nurse practitioners, using an investigator-developed algorithm.Follow-up: Provincial healthcare databases tracking hospital, continuing care and community medical services.Primary outcome: All-cause mortality.Secondary outcome: Composite of all-cause mortality or all-cause unplanned hospitalisation/emergency department visit.Tertiary outcomes: All-cause unplanned hospitalisation/emergency department visit, non-vertebral fracture, renal insufficiency and cost of care. Also, as assessed roughly 135-days postrandomisation, fall in the last 30 days, worsening cognition, worsening activities of daily living and skin ulceration.Process outcomes: Number of daily antihypertensive medications (broken down by antihypertensive class) and average systolic and diastolic BP over study duration.Primary outcome analysis: Cox proportional hazards survival analysis.Sample size: The trial will continue until observation of 247 primary outcome events has occurred.Current status: Enrolment is ongoing with ~400 randomisations to date (70% female, mean age 86 years). ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Alberta Health Ethics Review Board (Pro00097312) and results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05047731.
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Affiliation(s)
- Roni Y Kraut
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
- The Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, Alberta, Canada
| | - Cheryl A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
- The Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, Alberta, Canada
| | - Douglas Faulder
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christina S Korownyk
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
| | - Ana Vucenovic
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Donna P Manca
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Carina Lundby
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
| | - Paul Kivi
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret Manville
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Island Health, Victoria, British Columbia, Canada
| | - Scott R Garrison
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Pragmatic Trials Collaborative, University of Alberta, Edmonton, Alberta, Canada
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Egbujie BA, Turcotte LA, Heckman GA, Morris JN, Hirdes JP. Functional Decline in Long-Term Care Homes in the First Wave of the COVID-19 Pandemic: A Population-based Longitudinal Study in Five Canadian Provinces. J Am Med Dir Assoc 2024; 25:282-289. [PMID: 37839468 DOI: 10.1016/j.jamda.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to examine whether functional decline accelerated during the first wave of the COVID-19 pandemic (March to June 2020) for persons in long-term care facilities (LTCs) in Canada compared with the pre-pandemic period. DESIGN We conducted a population-based longitudinal study of persons receiving care in LTC homes in 5 Canadian provinces before and during the COVID-19 pandemic. SETTING AND PARTICIPANTS Residents in 1326 LTC homes within the Canadian provinces of Alberta, British Columbia, Manitoba, Newfoundland & Labrador, and Ontario between January 31, 2019, and June 30, 2020, with activities of daily living Hierarchy scale less than 6 and so, who still have potential for decline (6 being the worst of the 0-6 scale). METHODS We fit a generalized estimating equation model with adjustment for repeated measures to obtain the adjusted odds of functional decline between COVID period exposed and unexposed pre-pandemic residents. RESULTS LTC residents experienced slightly higher rates of functional decline during the first wave of the COVD-19 pandemic compared with the pre-pandemic period (23.3% vs 22.3%; P < .0001). The adjusted odds of functional decline were slightly greater during the pandemic (odds ratio [OR], 1.17; 95% CI, 1.15-1.20). Likewise, residents receiving care in large homes (OR, 1.20; 95% CI, 1.17-1.24) and urban-located LTC homes (OR, 1.20; 95% CI, 1.17-1.23), were more likely to experience functional decline during the COVID-19 pandemic. The odds of functional decline were also only significantly higher during the pandemic for LTC home residents in British Columbia (OR, 1.17; 95% CI, 1.11-1.23) and Ontario (OR, 1.25; 95% CI, 1.21-1.29). CONCLUSIONS AND IMPLICATIONS This study provides evidence that the odds of experiencing functional decline were somewhat greater during the first wave of the COVID-19 pandemic. It highlights the need to maintain physical activity and improve nutrition among older adults during periods of stress. The information would be helpful to health administrators and decision-makers seeking to understand how the COVID-19 pandemic and associated public health measures affected LTC residents' health outcomes.
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Affiliation(s)
- Bonaventure A Egbujie
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Luke A Turcotte
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John N Morris
- Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Pan C, Luo H, Cheung G, Zhou H, Cheng R, Cullum S, Wu C. Identifying Frailty in Older Adults Receiving Home Care Assessment Using Machine Learning: Longitudinal Observational Study on the Role of Classifier, Feature Selection, and Sample Size. JMIR AI 2024; 3:e44185. [PMID: 38875533 PMCID: PMC11041467 DOI: 10.2196/44185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/22/2023] [Accepted: 01/01/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Machine learning techniques are starting to be used in various health care data sets to identify frail persons who may benefit from interventions. However, evidence about the performance of machine learning techniques compared to conventional regression is mixed. It is also unclear what methodological and database factors are associated with performance. OBJECTIVE This study aimed to compare the mortality prediction accuracy of various machine learning classifiers for identifying frail older adults in different scenarios. METHODS We used deidentified data collected from older adults (65 years of age and older) assessed with interRAI-Home Care instrument in New Zealand between January 1, 2012, and December 31, 2016. A total of 138 interRAI assessment items were used to predict 6-month and 12-month mortality, using 3 machine learning classifiers (random forest [RF], extreme gradient boosting [XGBoost], and multilayer perceptron [MLP]) and regularized logistic regression. We conducted a simulation study comparing the performance of machine learning models with logistic regression and interRAI Home Care Frailty Scale and examined the effects of sample sizes, the number of features, and train-test split ratios. RESULTS A total of 95,042 older adults (median age 82.66 years, IQR 77.92-88.76; n=37,462, 39.42% male) receiving home care were analyzed. The average area under the curve (AUC) and sensitivities of 6-month mortality prediction showed that machine learning classifiers did not outperform regularized logistic regressions. In terms of AUC, regularized logistic regression had better performance than XGBoost, MLP, and RF when the number of features was ≤80 and the sample size ≤16,000; MLP outperformed regularized logistic regression in terms of sensitivities when the number of features was ≥40 and the sample size ≥4000. Conversely, RF and XGBoost demonstrated higher specificities than regularized logistic regression in all scenarios. CONCLUSIONS The study revealed that machine learning models exhibited significant variation in prediction performance when evaluated using different metrics. Regularized logistic regression was an effective model for identifying frail older adults receiving home care, as indicated by the AUC, particularly when the number of features and sample sizes were not excessively large. Conversely, MLP displayed superior sensitivity, while RF exhibited superior specificity when the number of features and sample sizes were large.
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Affiliation(s)
- Cheng Pan
- Department of Computer Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Huiquan Zhou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Reynold Cheng
- Department of Computer Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Sarah Cullum
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Chuan Wu
- Department of Computer Science, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Kasiukiewicz A, Wojszel ZB. The Prevalence of the Frailty Syndrome in a Hospital Setting-Is Its Diagnosis a Challenge? A Comparison of Four Frailty Scales in a Cross-Sectional Study. J Clin Med 2023; 13:86. [PMID: 38202093 PMCID: PMC10780177 DOI: 10.3390/jcm13010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The study aimed to assess the prevalence of the frailty syndrome in older patients hospitalized in the geriatric ward depending on the diagnostic criteria used, the feasibility of particular diagnostic scales in hospitalized patients, and their compatibility; 416 patients (81.2 ± 6.91 years) admitted to the Department of Geriatrics of Hospital of the Ministry of the Interior and Administration in Bialystok within eight months were included in the study. Four diagnostic scales were used to identify the frailty syndrome: Fried criteria, 7-point Clinical Frailty Scale (CFS), 40-item Frailty Index (FI), and FRAIL Scale. Depending on the scale, the prevalence of frailty syndrome varied from 26.8% (FRAIL Scale), 52.3% (Clinical Frailty Scale), and 58.1% (Fried criteria) up to 62.9% (Frailty Index). We observed the highest feasibility for CFS (100%) and the lowest for the Fried scale (79.8%). The highest level of agreement was found between the CFS and Frailty Index, with 80.3% consistent ratings (Cohen Kappa 0.6). Patients in the geriatric ward are characterized by a high prevalence of frailty, although it differs depending on the criteria. The most difficult to use in daily practice was the Fried scale, while the Clinical Frailty Scale was determined feasible in all patients.
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Affiliation(s)
- Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Department of Geriatrics, Marian Zyndram Koscialkowski Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Department of Geriatrics, Marian Zyndram Koscialkowski Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
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Dash D, Mowbray FI, Poss JW, Aryal K, Stall NM, Hirdes JP, Hillmer MP, Heckman GA, Bowdish DME, Costa AP, Jones A. The association between frailty, long-term care home characteristics and COVID-19 mortality before and after SARS-CoV-2 vaccination: a retrospective cohort study. Age Ageing 2023; 52:afad229. [PMID: 38163287 DOI: 10.1093/ageing/afad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/19/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The relative contributions of long-term care (LTC) resident frailty and home-level characteristics on COVID-19 mortality has not been well studied. We examined the association between resident frailty and home-level characteristics with 30-day COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination in LTC. METHODS We conducted a population-based retrospective cohort study of LTC residents with confirmed SARS-CoV-2 infection in Ontario, Canada. We used multi-level multivariable logistic regression to examine associations between 30-day COVID-19 mortality, the Hubbard Frailty Index (FI), and resident and home-level characteristics. We compared explanatory models before and after vaccine availability. RESULTS There were 11,179 and 3,655 COVID-19 cases in the pre- and post-vaccine period, respectively. The 30-day COVID-19 mortality was 25.9 and 20.0% during the same periods. The median odds ratios for 30-day COVID-19 mortality between LTC homes were 1.50 (95% credible interval [CrI]: 1.41-1.65) and 1.62 (95% CrI: 1.46-1.96), respectively. In the pre-vaccine period, 30-day COVID-19 mortality was higher for males and those of greater age. For every 0.1 increase in the Hubbard FI, the odds of death were 1.49 (95% CI: 1.42-1.56) times higher. The association between frailty and mortality remained consistent in the post-vaccine period, but sex and age were partly attenuated. Despite the substantial home-level variation, no home-level characteristic examined was significantly associated with 30-day COVID-19 mortality during either period. INTERPRETATION Frailty is consistently associated with COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination. Home-level characteristics previously attributed to COVID-19 outcomes do not explain significant home-to-home variation in COVID-19 mortality.
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Affiliation(s)
- Darly Dash
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Fabrice I Mowbray
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Komal Aryal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Nathan M Stall
- Division of General Internal Medicine and Geriatrics, Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Michael P Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Dawn M E Bowdish
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph's Health Care Hamilton, Hamilton, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Misquitta K, Reid N, Hubbard RE, Gordon EH. Factors associated with entry to residential care in frail older inpatients. Australas J Ageing 2023; 42:720-727. [PMID: 37573545 DOI: 10.1111/ajag.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To examine factors that may influence the risk of discharge to a residential aged care facility (RACF) in a population of frail older inpatients. METHODS We analysed data from 5846 inpatients aged over 60 years from 27 hospitals in Queensland, Australia, admitted from independent living and referred for geriatric consultation. Patients underwent an interRAI Acute Care Comprehensive Geriatric Assessment by trained nurses. Frailty was assessed using a 52-item frailty index (FI). Risk/protective factors were determined a priori. Logistic regression assessed the relationship between factors and discharge destination, adjusted for FI, age, sex and hospital. Frailty × risk/protective factor interactions were performed. RESULTS Patients had a mean (SD) age of 79.7 (8.2) years and a mean (SD) FI of 0.44 (0.14). Twenty-nine per cent (n = 1678) of patients were discharged to an RACF. Each 0.1 increment in FI increased the risk of discharge to an RACF by 54% (OR 1.54, 95% CI 1.40-1.68, p < 0.01). Being married or in a de facto relationship had protective effects up to an FI of 0.7, whereas behavioural and psychological symptoms of dementia (BPSD) increased the risk of RACF discharge up to an FI of 0.7. Female sex, faecal incontinence and living alone did not influence the relationship between frailty and discharge destination. CONCLUSIONS The association between frailty and discharge to RACF has previously been recognised but here we found that risk and protective factors can influence this association. Whether early identification and management of mutable factors can reduce discharge to RACF should be addressed in future studies.
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Affiliation(s)
- Karen Misquitta
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Emily H Gordon
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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Gordon EH, Peel NM, Hubbard RE, Reid N. Frailty in younger adults in hospital. QJM 2023; 116:845-849. [PMID: 37467071 PMCID: PMC10593383 DOI: 10.1093/qjmed/hcad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/13/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Even though frailty has been extensively measured in the acute care setting, relatively little is known about the frailty of younger adult inpatients. AIM This study aimed to measure frailty in a sample of hospitalized adults aged 18 years and over and to examine how frailty in younger adult inpatients differs from middle-aged and older adult inpatients. DESIGN Secondary analyses of prospectively collected cohort data. METHODS Research nurses assessed 910 patients at admission to four Australian hospitals using the interRAI Acute Care instrument. Comparison of frailty index (FI) scores and domains was conducted across three age groups: younger (18-49 years), middle-aged (50-69 years) and older adults (≥70 years). Multivariable logistic regression examined risk of prolonged length of stay and unfavourable discharge destination. RESULTS Younger adults (n = 214; 23.5%) had a mean (SD) FI of 0.19 (0.10). Approximately 27% (n = 57) of younger adults were frail (FI > 0.25). Mood and behaviour, health symptoms and syndromes, nutrition and pain were the most frequently affected domains in younger adults and 50% had ≥3 comorbidities. Frailty increased the risk of long length of stay (odds ratio (OR) = 1.77, P < 0.001) but not the risk of an unfavourable discharge (OR = 1.40, P = 0.20) in younger adults. CONCLUSIONS This study showed that frailty is prevalent in younger patients admitted to acute care and is associated with adverse outcomes. This study was a critical first step towards establishing an understanding of frailty in younger hospitalized adults.
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Affiliation(s)
- E H Gordon
- From the Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - N M Peel
- From the Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - R E Hubbard
- From the Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - N Reid
- From the Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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9
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King SJ, Reid N, Brown SJ, Brodie LJ, Sia ADH, Chatfield MD, Francis RS, Peel NM, Gordon EH, Hubbard RE. A prospective, observational study of frailty, quality of life and dialysis in older people with advanced chronic kidney disease. BMC Geriatr 2023; 23:664. [PMID: 37845618 PMCID: PMC10580596 DOI: 10.1186/s12877-023-04365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Frailty is prevalent in older people with chronic kidney disease (CKD) and robust evidence supporting the benefit of dialysis in this setting is lacking. We aimed to measure frailty and quality of life (QOL) longitudinally in older people with advanced CKD and assess the impact of dialysis initiation on frailty, QOL and mortality. METHODS Outpatients aged ≥65 with an eGFR ≤ 20ml/minute/1.73m2 were enrolled in a prospective observational study and followed up four years later. Frailty status was measured using a Frailty Index (FI), and QOL was evaluated using the EuroQol 5D-5L instrument. Mortality and dialysis status were determined through inspection of electronic records. RESULTS Ninety-eight participants were enrolled. Between enrolment and follow-up, 36% of participants commenced dialysis and 59% died. Frailty prevalence increased from 47% at baseline to 86% at follow-up (change in median FI = 0.22, p < 0.001). Initiating dialysis was not significantly associated with change in FI. QOL declined from baseline to follow-up (mean EQ-5D-5L visual analogue score of 70 vs 63, p = 0.034), though commencing dialysis was associated with less decline in QOL. Each 0.1 increment in baseline FI was associated with 59% increased mortality hazard (HR = 1.59, 95%CI = 1.20 to 2.12, p = 0.001), and commencing dialysis was associated with 59% reduction in mortality hazard (HR = 0.41, 95%CI = 0.20 to 0.87, p = 0.020) irrespective of baseline FI. CONCLUSIONS Frailty increased substantially over four years, and higher baseline frailty was associated with greater mortality. Commencing dialysis did not affect the trajectory of FI but positively influenced the trajectory of QOL from baseline to follow-up. Within the limitations of small sample size, our data suggests that frail participants received similar survival benefit from dialysis as non-frail participants.
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Affiliation(s)
- Shannon J King
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia.
- Western Australian Country Health Service, Busselton Health Campus, West Busselton, WA, 6280, Australia.
| | - Natasha Reid
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Sarah J Brown
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Cairns and Hinterland Hospital and Health Service, Brisbane City, QLD, Australia
| | - Lucinda J Brodie
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Aaron D H Sia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Kidney and Transplantations Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mark D Chatfield
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Ross S Francis
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Kidney and Transplantations Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Nancye M Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Emily H Gordon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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10
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Fujita K, Lo SY, Hubbard RE, Gnjidic D, Hilmer SN. Comparison of a multidomain frailty index from routine health data with the hospital frailty risk score in older patients in an Australian hospital. Australas J Ageing 2023; 42:480-490. [PMID: 36511440 PMCID: PMC10946514 DOI: 10.1111/ajag.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/18/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Frailty is an important determinant of health-care needs and outcomes for people in hospital. OBJECTIVES To compare characteristics and predictive ability of a multidomain frailty index derived from routine health data (electronic frailty index-acute hospital; eFI-AH) with the hospital frailty risk score (HFRS). METHODS This retrospective study included 6771 patients aged ≥75 years admitted to an Australian metropolitan tertiary referral hospital between October 2019 and September 2020. The eFI-AH and the HFRS were calculated for each patient and compared with respect to characteristics, agreement, association with age and ability to predict outcomes. RESULTS Median eFI-AH was 0.17 (range 0-0.66) whilst median HFRS was 3.2 (range 0-42.9). Moderate agreement was shown between the tools (Pearson's r 0.61). After adjusting for age and gender, both models had associations with long hospital stay, in-hospital mortality, unplanned all-cause readmission and fall-related readmission. Specifically, the eFI-AH had the strongest association with in-hospital mortality (adjusted odds ratio (aOR) 2.81, 95% confidence intervals (CI) 2.49-3.17), whilst the HFRS was most strongly associated with long hospital stay (aOR 1.20, 95% CI 1.18-1.21). Both tools predicted hospital stay >10 days with good discrimination and calibration. CONCLUSIONS Although the eFI-AH and the HFRS did not consistently identify the same inpatients as frail, both were associated with adverse outcomes and they had comparable predictive ability for prolonged hospitalisation. These two constructs of frailty may have different implications for clinical practice and health service provision and planning.
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Affiliation(s)
- Kenji Fujita
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and HealthThe University of SydneyKolling Institute, Royal North Shore HospitalSydneyNew South WalesAustralia
| | - Sarita Y. Lo
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and HealthThe University of SydneyKolling Institute, Royal North Shore HospitalSydneyNew South WalesAustralia
| | - Ruth E. Hubbard
- Centre for Health Services ResearchFaculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Danijela Gnjidic
- Sydney Pharmacy SchoolFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Sarah N. Hilmer
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and HealthThe University of SydneyKolling Institute, Royal North Shore HospitalSydneyNew South WalesAustralia
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11
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Greeley B, Low H, Kelly R, McDermid R, Song X. Preserving the discreteness of deficits during coding leads to a lower frailty index in individuals living in long-term care. Mech Ageing Dev 2023; 214:111851. [PMID: 37453658 DOI: 10.1016/j.mad.2023.111851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
This study assesses two coding approaches on the frailty index (FI). Two FI were calculated using 43 variables from 29,758 older adults (84.6 ± 8 years old; 64 % female) in long-term care. Scores were coded as 0, 0.5, or 1 regardless of the number of levels (grouped), or preserved (e.g., a 4 level variable was coded as 0, 0.33, 0.67, or 1; discrete). Grouped and discrete FI were compared with each ordinal variable removed but all other ordinal variables included. This was repeated until 28 unique (14 grouped, 14 discrete) FI had been constructed each with one ordinal variable removed per FI. FI was correlated to age and mortality separated by sex. The median grouped (0.302 (0.221-0.372)) was higher relative to the discrete (0.237 (0.170-0.307)) FI. The discrete (r = 0.91, r = 0.87) and grouped (r = 0.93, r = 0.87) FI showed similar relationships to age and mortality. Removal of any ordinal variable reduced grouped FI by 0.004 or 0.016, whereas removal led to both increases (range: 0.003-0.001) and reductions (range: 0.002-0.008) for discrete FI. A grouped approach inflates FI. A discrete approach provides a more accurate measure of frailty.
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Affiliation(s)
- Brian Greeley
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Hilary Low
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Ronald Kelly
- Long-term Care and Assisted Living Access, Fraser Health, New Westminster, British Columbia, Canada
| | - Robert McDermid
- Critical Care, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Xiaowei Song
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada.
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12
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Scholer AJ, Marcus R, Garland-Kledzik M, Chang SC, Khader A, Santamaria-Barria J, Jutric Z, Wolf R, Goldfarb M. Validating biologic age in selecting elderly patients with pancreatic cancer for surgical resection. J Surg Oncol 2023; 127:394-404. [PMID: 36321409 PMCID: PMC10092356 DOI: 10.1002/jso.27121] [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: 07/19/2022] [Revised: 09/03/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Selecting frail elderly patients with pancreatic cancer (PC) for pancreas resection using biologic age has not been elucidated. This study determined the feasibility of the deficit accumulation frailty index (DAFI) in identifying such patients and its association with surgical outcomes. METHODS The DAFI, which assesses frailty based on biologic age, was used to identify frail patients using clinical and health-related quality-of-life data. The characteristics of frail and nonfrail patients were compared. RESULTS Of 242 patients (median age, 75.5 years), 61.2% were frail and 32.6% had undergone pancreas resection (surgery group). Median overall survival (mOS) decreased in frail patients (7.13 months, 95% confidence interval [CI]: 5.65-10.1) compared with nonfrail patients (16.1 months, 95% CI: 11.47-34.40, p = 0.001). In the surgery group, mOS improved in the nonfrail patients (49.4%; 49.2 months, 95% CI: 29.3-79.9) compared with frail patients (50.6%, 22.1 months, 95% CI: 18.3-52.4, p = 0.10). In the no-surgery group, mOS was better in nonfrail patients (54%; 10.81 months, CI 7.85-16.03) compared with frail patients (66%; 5.45 months, 95% CI: 4.34-7.03, p = 0.02). CONCLUSIONS The DAFI identified elderly patients with PC at risk of poor outcomes and can identify patients who can tolerate more aggressive treatments.
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Affiliation(s)
- Anthony J Scholer
- Division of Surgical Oncology, University of South Carolina School of Medicine, Greenville, South Carolina, USA
| | - Rebecca Marcus
- Department of Surgery, Saint John's Cancer Institute at Providence St. John's Health Center, Santa Monica, California, USA
| | - Mary Garland-Kledzik
- Division of Surgical Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Shu-Chin Chang
- Department of Surgery, Medical Data Research Center, Providence Saint Joseph Health, Oregon, Portland, USA
| | - Adam Khader
- Department of Surgery, Division of Surgical Oncology, Hunter Holmes McGuire Veterans Affair Medical Center, Richmond, Virginia, USA
| | - Juan Santamaria-Barria
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Zeljka Jutric
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California Irvine Medical Center, Orange, California, USA
| | - Ronald Wolf
- Department of Surgery, Division of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, University of California Irvine Medical Center, Orange, California, USA
| | - Melanie Goldfarb
- Department of Surgery, Saint John's Cancer Institute at Providence St. John's Health Center, Santa Monica, California, USA
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13
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Saunders R, Crookes K, Seaman K, Ang SGM, Bulsara C, Bulsara MK, Ewens B, Gallagher O, Graham R, Gullick K, Haydon S, Hughes J, Nguyen KH, O’Connell B, Scaini D, Etherton-Beer C. Frailty and pain in an acute private hospital: an observational point prevalence study. Sci Rep 2023; 13:3345. [PMID: 36849461 PMCID: PMC9971208 DOI: 10.1038/s41598-023-29933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency units) at an acute, private, 860-bed metropolitan hospital were eligible to participate. Frailty was assessed using the self-report modified Reported Edmonton Frail Scale. Current pain and worst pain in the last 24 h were self-reported using the standard 0-10 numeric rating scale. Pain scores were categorised by severity (none, mild, moderate, severe). Demographic and clinical information including admitting services (medical, mental health, rehabilitation, surgical) were collected. The STROBE checklist was followed. Data were collected from 251 participants (54.9% of eligible). The prevalence of frailty was 26.7%, prevalence of current pain was 68.1% and prevalence of pain in the last 24 h was 81.3%. After adjusting for age, sex, admitting service and pain severity, admitting services medical (AOR: 13.5 95% CI 5.7-32.8), mental health (AOR: 6.3, 95% CI 1. 9-20.9) and rehabilitation (AOR: 8.1, 95% CI 2.4-37.1) and moderate pain (AOR: 3.9, 95% CI 1. 6-9.8) were associated with increased frailty. The number of older patients identified in this study who were frail has implications for managing this group in a hospital setting. This indicates a need to focus on developing strategies including frailty assessment on admission, and the development of interventions to meet the care needs of these patients. The findings also highlight the need for increased pain assessment, particularly in those who are frail, for more effective pain management.Trial registration: The study was prospectively registered (ACTRN12620000904976; 14th September 2020).
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Affiliation(s)
- Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.
| | - Kate Crookes
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Karla Seaman
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia ,grid.1004.50000 0001 2158 5405Centre for Health Systems and Safety Research, Macquarie University, Sydney, Australia
| | - Seng Giap Marcus Ang
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Caroline Bulsara
- grid.266886.40000 0004 0402 6494School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, WA Australia ,grid.266886.40000 0004 0402 6494Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA Australia
| | - Max K. Bulsara
- grid.266886.40000 0004 0402 6494Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA Australia
| | - Beverley Ewens
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Olivia Gallagher
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Renée Graham
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Karen Gullick
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Sue Haydon
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Jeff Hughes
- PainChek Ltd, Sydney, NSW Australia ,grid.1032.00000 0004 0375 4078Curtin Medical School, Curtin University, Bentley, WA Australia
| | - Kim-Huong Nguyen
- grid.1003.20000 0000 9320 7537Faculty of Medicine and Biomedical Sciences, The University of Queensland, Saint Lucia, QLD Australia
| | - Bev O’Connell
- grid.1038.a0000 0004 0389 4302Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA Australia
| | - Debra Scaini
- grid.414296.c0000 0004 0437 5838Hollywood Private Hospital, Nedlands, WA Australia
| | - Christopher Etherton-Beer
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia, Crawley, WA Australia
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14
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Turcotte LA, Heckman G, Rockwood K, Vetrano DL, Hébert P, McIsaac DI, Rhynold E, Mitchell L, Mowbray FI, Larsen RT, Hirdes JP. External validation of the hospital frailty risk score among hospitalised home care clients in Canada: a retrospective cohort study. Age Ageing 2023; 52:7024514. [PMID: 36735847 PMCID: PMC9897298 DOI: 10.1093/ageing/afac334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Hospital Frailty Risk Score (HFRS) is scored using ICD-10 diagnostic codes in administrative hospital records. Home care clients in Canada are routinely assessed with Resident Assessment Instrument-Home Care (RAI-HC) which can calculate the Clinical Frailty Scale (CFS) and the Frailty Index (FI). OBJECTIVE Measure the correlation between the HFRS, CFS and FI and compare prognostic utility for frailty-related outcomes. DESIGN Retrospective cohort study. SETTING Alberta, British Columbia and Ontario, Canada. SUBJECTS Home care clients aged 65+ admitted to hospital within 180 days (median 65 days) of a RAI-HC assessment (n = 167,316). METHODS Correlation between the HFRS, CFS and FI was measured using the Spearman correlation coefficient. Prognostic utility of each measure was assessed by comparing measures of association, discrimination and calibration for mortality (30 days), prolonged hospital stay (10+ days), unplanned hospital readmission (30 days) and long-term care admission (1 year). RESULTS The HFRS was weakly correlated with the FI (ρ 0.21) and CFS (ρ 0.28). Unlike the FI and CFS, the HFRS was unable to discriminate for 30-day mortality (area under the receiver operator characteristic curve (AUC) 0.506; confidence interval (CI) 0.502-0.511). It was the only measure that could discriminate for prolonged hospital stay (AUC 0.666; CI 0.661-0.673). The HFRS operated like the FI and CFI when predicting unplanned readmission (AUC 0.530 CI 0.526-0.536) and long-term care admission (AUC 0.600; CI 0.593-0.606). CONCLUSIONS The HFRS identifies a different subset of older adult home care clients as frail than the CFS and FI. It has prognostic utility for several frailty-related outcomes in this population, except short-term mortality.
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Affiliation(s)
- Luke Andrew Turcotte
- Address correspondence to: Luke Andrew Turcotte, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University and Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden, & Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Paul Hébert
- Université de Montréal et Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Daniel I McIsaac
- Departments of Anesthesiology & Pain Medicine, University of Ottawa, and The Ottawa Hospital; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth Rhynold
- Section of Geriatric Medicine, University of Manitoba and Prairie Mountain Health, Manitoba, Canada
| | - Lori Mitchell
- Home Care Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Fabrice Immanuel Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rasmus T Larsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Copenhagen, Denmark
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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15
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Egbujie BA, Northwood M, Turcotte LA, McArthur C, Berg K, Heckman GA, Wagg AS, Hirdes JP. Predictors of improvement in urinary incontinence in the postacute setting: A Canadian cohort study. Neurourol Urodyn 2022; 41:1749-1763. [PMID: 36040456 PMCID: PMC9805031 DOI: 10.1002/nau.25018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine factors associated with improvement in urinary incontinence (UI) for long-stay postacute, complex continuing care (CCC) patients. DESIGN A retrospective cohort investigation of patients in a CCC setting using data obtained from the Canadian Institute for Health Information's Continuing Care Reporting System collected with interRAI Minimum Data Set 2.0. SETTING AND PARTICIPANTS Individuals aged 18 years and older, were admitted to CCC hospitals in Ontario, Canada, between 2010 and 2018. METHODS Multivariable logistic regression was used to determine the independent effects of predictors on UI improvement, for patients who were somewhat or completely incontinent on admission and therefore had the potential for improvement. RESULTS The study cohort consisted of 18 584 patients, 74% (13 779) of which were somewhat or completely incontinent upon admission. Among those patients with potential for improvement, receiving bladder training, starting a new medication 90 days prior (odds ratio, OR: 1.54 [95% confidence interval, CI: 1.36-1.75]), and triggering the interRAI Urinary Incontinence Clinical Assessment Protocol to facilitate improvement (OR: 1.36 [95% CI: 1.08-1.71]) or to prevent decline (OR: 1.32 [95% CI: 1.13-1.53]) were the strongest predictors of improvement. Conversely, being totally dependent on others for transfer (OR: 0.62 [95% CI: 0.42-0.92]), is rarely or never understood (OR: 0.65 [95% CI: 0.50-0.85]), having a major comorbidity count of ≥3 (OR: 0.72 [95% CI: 0.59-0.88]), Parkinson's disease, OR: 0.77 (95% CI: 0.62-0.95), Alzheimer/other dementia, OR: 0.83 (95% CI: 0.74-0.93), and respiratory infections, OR: 0.57 (95% CI: 0.39-0.85) independently predicted less likelihood of improvement in UI. CONCLUSIONS AND IMPLICATIONS Findings of this study suggest that improving physical function, including bed mobility, and providing bladder retraining have strong positive impacts on improvement in UI for postacute care patients. Evidence generated from this study provides useful care planning information for care providers in identifying patients and targeting the care that may lead to better success with the management of UI.
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Affiliation(s)
| | | | - Luke A. Turcotte
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Caitlin McArthur
- School of PhysiotherapyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Katherine Berg
- Department of Physical TherapyUniversity of TorontoTorontoOntarioCanada
| | - George A. Heckman
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada,Schlegel Research Chair in Geriatric MedicineSchlegel‐University of Waterloo Research Institute for AgingWaterlooOntarioCanada
| | - Adrian S. Wagg
- Department of Medicine, Division of Geriatric MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - John P. Hirdes
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
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16
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Shah NV, Kim DJ, Patel N, Beyer GA, Hollern DA, Wolfert AJ, Kim N, Suarez DE, Monessa D, Zhou PL, Eldib HM, Passias PG, Schwab FJ, Lafage V, Paulino CB, Diebo BG. The 5-factor modified frailty index (mFI-5) is predictive of 30-day postoperative complications and readmission in patients with adult spinal deformity (ASD). J Clin Neurosci 2022; 104:69-73. [PMID: 35981462 DOI: 10.1016/j.jocn.2022.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is limited research regarding the association between the mFI-5 and postoperative complications among adult spinal deformity (ASD) patients. METHODS Using the National Surgical Quality Improvement Project (NSQIP) database, patients with Current Procedural Terminology (CPT) codes for > 7-level fusion or < 7-level fusion with International Classification of Diseases, Ninth Revision (ICD-9) codes for ASD were identified between 2008 and 2016. Univariate analyses with post-hoc Bonferroni correction for demographics and preoperative factors were performed. Logistic regression assessed associations between mFI-5 scores and 30-day post-operative outcomes. RESULTS 2,120 patients met criteria. Patients with an mFI-5 score of 4 or 5 were excluded, given there were<20 patients with those scores. Patients with mFI-5 scores of 1 and 2 had increased 30-day rates of pneumonia (3.5 % and 4.3 % vs 1.6 %), unplanned postoperative ventilation for > 48 h (3.1 % and 4.3 % vs 0.9 %), and UTIs (4.4 % and 7.4 % vs 2.0 %) than patients with a score of 0 (all, p < 0.05). Logistic regression revealed that compared to an mFI-5 of 0, a score of 1 was an independent predictor of 30-day reoperations (OR = 1.4; 95 % CI 1.1-18). A score of 2 was an independent predictor of overall (OR = 2.4; 95 % CI 1.4-4.1) and related (OR = 2.2; 95 % CI 1.2-4.1) 30-day readmissions. A score of 3 was not predictive of any adverse outcome. CONCLUSION The mFI-5 score predicted complications and postoperative events in the ASD population. The mFI-5 may effectively predict 30-day readmissions. Further research is needed to identify the benefits and predictive value of mFI-5 as a risk assessment tool.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA.
| | - David J Kim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Neil Patel
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - George A Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Douglas A Hollern
- Department of Orthopedic Surgery, USC Verdugo Hills Hospital, Los Angeles, CA, USA
| | - Adam J Wolfert
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Nathan Kim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Daniel E Suarez
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Dan Monessa
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Peter L Zhou
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Hassan M Eldib
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA
| | - Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA; Department of Orthopaedic Surgery, New York Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, USA; Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
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17
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Abey-Nesbit R, Bergler U, Pickering JW, Nishtala PS, Jamieson H. Development and validation of a frailty index compatible with three interRAI assessment instruments. Age Ageing 2022; 51:6653477. [PMID: 35930721 DOI: 10.1093/ageing/afac178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND a Frailty Index (FI) calculated by the accumulation of deficits is often used to quantify the extent of frailty in individuals in specific settings. This study aimed to derive a FI that can be applied across three standardised international Residential Assessment Instrument assessments (interRAI), used at different stages of ageing and the corresponding increase in support needs. METHODS deficit items common to the interRAI Contact Assessment (CA), Home Care (HC) or Long-Term Care Facilities assessment (LTCF) were identified and recoded to form a cumulative deficit FI. The index was validated using a large dataset of needs assessments of older people in New Zealand against mortality prediction using Kaplan Meier curves and logistic regression models. The index was further validated by comparing its performance with a previously validated index in the HC cohort. RESULTS the index comprised 15 questions across seven domains. The assessment cohort and their mean frailty (SD) were: 89,506 CA with 0.26 (0.15), 151,270 HC with 0.36 (0.15) and 83,473 LTCF with 0.41 (0.17). The index predicted 1-year mortality for each of the CA, HC and LTCF, cohorts with area under the receiver operating characteristic curves (AUCs) of 0.741 (95% confidence interval, CI: 0.718-0.762), 0.687 (95%CI: 0.684-0.690) and 0.674 (95%CI: 0.670-0.678), respectively. CONCLUSIONS the results for this multi-instrument FI are congruent with the differences in frailty expected for people in the target settings for these instruments and appropriately associated with mortality at each stage of the journey of progressive ageing.
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Affiliation(s)
| | - Ulrich Bergler
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Prasad S Nishtala
- Centre for Therapeutic Innovation, Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Thomas T, Patel B, Mitchell J, Whitmer A, Knoche E, Gupta P. Treating advanced lung cancer in older veterans with comorbid conditions and frailty. Semin Oncol 2022; 49:S0093-7754(22)00044-6. [PMID: 35853764 DOI: 10.1053/j.seminoncol.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/07/2022] [Accepted: 06/11/2022] [Indexed: 11/11/2022]
Abstract
Advanced lung cancer is a deadly malignancy that is a common cause of death among Veterans. Significant advancements in lung cancer therapeutics have been made over the past decade and survival outcomes have improved. The Veteran population is older, has more medical comorbidities and frailty compared to the general population. These factors must be accounted for when evaluating patients for treatment and selecting treatment options. This article explores the impact of these important issues in the management of advanced lung cancer. Recent clinical trials leading to the approval of modern therapies will be outlined and treatment outcomes specific to older patients discussed. The impact of key comorbidities that are common in Veterans and their impact on lung cancer treatment will be reviewed. There is no gold standard frailty index for assessment of frailty in patients with advanced lung cancer and the ability to predict tolerability and benefit from systemic therapies. Currently available systemic therapies are associated with higher risk of adverse events and lower potential for clinically meaningful improvement in outcomes. Future research needs to focus on designing better frailty indices and developing novel therapies that are safer and more effective therapies for frail patients, who constitute a considerable proportion of individuals diagnosed with lung cancer.
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Affiliation(s)
- Theodore Thomas
- Medicine Service, Saint Louis Veterans Health Administration Medical Center, St. Louis, Missouri; Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
| | - Bindiya Patel
- Medicine Service, Saint Louis Veterans Health Administration Medical Center, St. Louis, Missouri; Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Joshua Mitchell
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Alison Whitmer
- Medicine Service, Saint Louis Veterans Health Administration Medical Center, St. Louis, Missouri
| | - Eric Knoche
- Medicine Service, Saint Louis Veterans Health Administration Medical Center, St. Louis, Missouri; Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Pankaj Gupta
- Medicine Service, VA Long Beach Healthcare System, Long Beach, California; Department of medicine, University of California Irvine, Irvine, California
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The Older Persons' Index of Multiple Deprivation: Measuring the deprivation circumstances of older populations in Aotearoa New Zealand. Health Place 2022; 76:102850. [PMID: 35777248 DOI: 10.1016/j.healthplace.2022.102850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 11/22/2022]
Abstract
Existing indices of multiple deprivation exclude indicators specifically relevant to the population aged ≥65 years. In this study we create a whole-of-population cohort of people aged ≥65 years living in private dwellings and who completed the 2013 New Zealand Census of Populations and Dwellings to create an Older Persons' Index of Multiple Deprivation (OPIMD). We combined 22 indicators representing 6 domains of deprivation (Income, Housing, Health, Assets, Connectedness and Geographic access) to establish this individual-level measure of deprivation. We used smoking data from the census to validate the OPIMD and describe the geography of the OPIMD by District Health Board, contrasting these patterns with a conventional area deprivation index. The OPIMD has the potential to inform policies concerning resource allocation for the older population. An accompanying website with an interactive atlas and an online OPIMD calculator is available for wider use of the data. Further research is required to explore associations between the OPIMD and other major health and social outcomes affecting this population.
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Bloomfield K, Wu Z, Tatton A, Calvert C, Peel N, Hubbard R, Jamieson H, Hikaka J, Boyd M, Bramley D, Connolly MJ. An interRAI derived frailty index predicts acute hospitalizations in older adults residing in retirement villages: A prospective cohort study. PLoS One 2022; 17:e0264715. [PMID: 35235598 PMCID: PMC8890727 DOI: 10.1371/journal.pone.0264715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/11/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities. Design Prospective cohort study. Setting and participants 34 RVs across two district health boards in Auckland, Aotearoa New Zealand (NZ). 577 participants, mean age 81 years; 419 (73%) female; 410 (71%) NZ European, 147 (25%) other European, 8 Asian (1%), 7 Māori (1%), 1 Pasifika (<1%), 4 other (<1%). Methods interRAI-CHA FI tool was used to stratify participants into fit (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) and severe (>0.36) frail groups at baseline (the latter two grouped due to low numbers of severely frail). Primary outcome was acute hospitalization; secondary outcomes included long-term care (LTC) entry and mortality. The relationship between frailty and outcomes were explored with multivariable Cox regression, estimating hazard ratios (HRs) and 95% confidence intervals (95%CIs). Results Over mean follow-up of 2.5 years, 33% (69/209) of fit, 58% (152/260) mildly frail and 79% (85/108) moderate-severely frail participants at baseline had at least one acute hospitalization. Compared to the fit group, significantly increased risk of acute hospitalization were identified in mildly frail (adjusted HR = 1.88, 95%CI = 1.41–2.51, p<0.001) and moderate-severely frail (adjusted HR = 3.52, 95%CI = 2.53–4.90, p<0.001) groups. Similar increased risk in moderate-severely frail participants was seen in LTC entry (adjusted HR = 5.60 95%CI = 2.47–12.72, p<0.001) and mortality (adjusted HR = 5.06, 95%CI = 1.71–15.02, p = 0.003). Conclusions and implications The FI derived from interRAI-CHA has robust predictive validity for acute hospitalization, LTC entry and mortality. This adds to the growing literature of use of interRAI tools in this way and may assist healthcare providers with rapid identification of frailty.
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Affiliation(s)
- Katherine Bloomfield
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
- * E-mail:
| | - Zhenqiang Wu
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Waitematā District Health Board, Auckland, New Zealand
| | | | - Nancye Peel
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna Hikaka
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Martin J. Connolly
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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Pearson E, Siskind D, Hubbard RE, Gordon EH, Coulson EJ, Warren N. Frailty and severe mental illness: A systematic review and narrative synthesis. J Psychiatr Res 2022; 147:166-175. [PMID: 35051715 DOI: 10.1016/j.jpsychires.2022.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Emerging evidence suggests that people with severe mental illness (SMI) have an increased risk of frailty. We conducted a systematic review to investigate the prevalence and correlates of frailty, as well as the efficacy of frailty interventions, in this population. METHODS We searched databases from inception to 21 September 2021 for studies that assessed or intervened for frailty in relation to an SMI diagnosis. A narrative synthesis explored the characteristics and adverse health outcomes associated with frailty and the efficacy of interventions. The prevalence of frailty was investigated, and its relationship with age was analysed by a meta-regression. RESULTS Twenty-five studies involving 2499 patients, primarily older adults, were included in the narrative synthesis. Frailty was associated with higher rates of physical comorbidity, cognitive deficits, falls and mortality among those with SMI. The efficacy of a yoga intervention was investigated in one study, without sustained reductions in frailty. The prevalence of frailty varied between 10.2 and 89.7% and was high in comparison to the general population. CONCLUSIONS The prevalence of frailty was high in those with SMI and ranged widely due to heterogeneity of study populations. Assessing frailty enables the identification of patients who could benefit from interventions and assists in treatment-related decision making. Further research is required to develop appropriate frailty interventions for this population.
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Affiliation(s)
- Ella Pearson
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia.
| | - Dan Siskind
- Metro South Addiction and Mental Health Services, Brisbane, Queensland, Australia; School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Geriatrics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Emily H Gordon
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Geriatrics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Elizabeth J Coulson
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Nicola Warren
- Metro South Addiction and Mental Health Services, Brisbane, Queensland, Australia; School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
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22
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Predictors of short- and long-term mortality among acutely admitted older patients: role of inflammation and frailty. Aging Clin Exp Res 2022; 34:409-418. [PMID: 34255297 PMCID: PMC8847174 DOI: 10.1007/s40520-021-01926-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frailty, demographic and clinical variables linked to incident diseases (e.g., dehydration, inflammation) contribute to poor outcomes in older patients acutely hospitalized. Their predictivity on short-, intermediate- and long-term mortality in a comprehensive model has been scarcely investigated. AIMS To test the performance of a predictive tool considering frailty and inflammation as well as age, sex and impaired hydration status on 1-year mortality in acutely admitted older patients. METHODS Retrospective observational study including 529 medical patients (age 84.6 ± 7.3 years). At hospital admission, frailty was assessed by the Multidimensional Prognostic Index (MPI). The Glasgow Prognostic Score (GPS) was used to grade systemic inflammation. Serum osmolarity was calculated to assess hydration. RESULTS After adjusting for age, sex, GPS and osmolarity, the severe-risk MPI was a strong predictor for 1-year mortality (OR 4.133; 95% CI 2.273-7.516; p < 0.001). Age > 85 years, male sex, GPS-2 and serum osmolarity > 300 mOsm/L were independent predictors of mortality in the same multivariable model. The MPI alone showed a moderate discrimination power (AUC 0.678; 95% CI 0.628-0.729; p < 0.001) on 1-year mortality, which increased by 12.5% after the addition of the above predictors in the fully adjusted regression model (AUC 0.763; 95% CI 0.719-0.807; p < 0.001). The severe-risk MPI adjusted for the same factors was also an independent predictor of mortality after 60 and 180 days since hospital admission. DISCUSSION Inflammation and impaired hydration are potentially modifiable risk factors for severe outcomes in older acutely hospitalized patients. A model combining GPS, age, gender, and plasma osmolarity improved the accuracy of MPI at admission in predicting long-term mortality.
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23
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Tsay T, Shugrue N, Charles D, Migneault D, McManus R, Gruman C, Robison J. Predictors of Frailty Change in Home and Community-Based Services Populations. J Am Med Dir Assoc 2021; 23:838-844. [PMID: 34419475 DOI: 10.1016/j.jamda.2021.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/26/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES With unprecedented demand for Medicaid long-term services and supports, states are seeking to allocate resources in the most efficient way. Understanding the prevalence of frailty and how it varies across home and community-based services (HCBS) populations can assist states with more precise identification of individuals most in need of services. Early identification of individuals more likely to experience frailty changes could allow for enhanced care planning to prevent or slow the progression of decline. DESIGN Longitudinal study. SETTING AND PARTICIPANTS Data from Connecticut's assessment tool (based on interRAI-HC) were analyzed at 2 time points for 16,309 individuals receiving HCBS. The sample included assessments completed between November 1, 2017 and July 15, 2020 across 4 groups: older adults 65+ years old meeting nursing facility level of care (NF LOC), older adults 65+ years old not meeting NF LOC, individuals with acquired brain injury, and individuals <65 years old with physical disability. METHODS We measured frailty using the Frailty Index (FI) and examined change in FI between baseline and follow-up. A change in FI score of at least ±0.03 was classified as a clinically meaningful change. We compared predictors of clinically meaningful decline or improvement using multivariate logistic regression. RESULTS In our sample, 54% of individuals experienced a clinically meaningful change: 42% declined and 12% improved. Individuals receiving in-home care services had lower odds of improvement across all HCBS groups and multiple frailty categories with odds ratios ranging from 0.35 to 0.68. Frail older adults 65+ years old meeting nursing facility level of care receiving physical therapy were 21% less likely to experience decline and 1.4 times more likely to improve. CONCLUSIONS AND IMPLICATIONS The nature of HCBS support provided can impact changes in frailty status. More reactive services such as in-home care may contribute to frailty decline while rehabilitative services such as physical therapy may protect against decline.
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Affiliation(s)
- Tiffany Tsay
- Virginia Commonwealth University School of Medicine Richmond, VA, USA.
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24
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Mowbray FI, Manlongat D, Correia RH, Strum RP, Fernando SM, McIsaac D, de Wit K, Worster A, Costa AP, Griffith LE, Douma M, Nolan JP, Muscedere J, Couban R, Foroutan F. Prognostic association of frailty with post-arrest outcomes following cardiac arrest: A systematic review and meta-analysis. Resuscitation 2021; 167:242-250. [PMID: 34166743 DOI: 10.1016/j.resuscitation.2021.06.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/28/2021] [Accepted: 06/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To synthesize the current evidence examining the association between frailty and a series of post-arrest outcomes following the provision of cardiopulmonary resuscitation (CPR). DATA SOURCES We searched MEDLINE, PubMed (exclusive of MEDLINE), EMBASE, CINAHL, and Web of Science from inception to August 2020 for observational studies that examined an association between frailty and post-arrest health outcomes, including in-hospital and post-discharge mortality. We conducted citation tracking for all eligible studies. STUDY SELECTION Our search yielded 20,480 citations after removing duplicate records. We screened titles, abstracts and full-texts independently and in duplicate. DATA EXTRACTION The prognosis research strategy group (PROGRESS) and the critical appraisal and data extraction for systematic review of prediction modelling studies (CHARMS) guidelines were followed. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) instrument. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) recommendations for prognostic factor research. DATA SYNTHESIS Four studies were included in this review and three were eligible for statistical pooling. Our sample comprised 1,134 persons who experienced in-hospital cardiac arrest (IHCA). The mean age of the sample was 71 years. The study results were pooled according to the specific frailty instrument. Three studies used the Clinical Frailty Scale (CFS) and adjusted age (our minimum confounder); the presence of frailty was associated with an approximate three-fold increase in the odds of dying in-hospital after IHCA (aOR = 2.93; 95% CI = 2.43-3.53, high certainty). Frailty was also associated with decreased incidence of ROSC (return of spontaneous circulation) and discharge home following IHCA. One study with high risk of bias used the Hospital Frailty Risk Score and reported a 43% decrease in the odds of discharge home for patients with frailty following IHCA. CONCLUSION High certainty evidence was found for an association between frailty and in-hospital mortality following IHCA. Frailty is a robust prognostic factor that contributes valuable information and can inform shared-decision making and policies surrounding advance care directives. Registration: PROSPERO Registration # CRD42020212922.
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Affiliation(s)
- Fabrice I Mowbray
- Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada.
| | - Donna Manlongat
- College of Nursing, Wayne State University, 5557 Cass Ave, Detroit, MI 48202, USA.
| | - Rebecca H Correia
- Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada.
| | - Ryan P Strum
- Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada.
| | - Shannon M Fernando
- Department of Emergency Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, Ontario K1H 8M5, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, Ontario K1H 8M5, Canada.
| | - Daniel McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, 451 Smyth Rd #2044, Ottawa, Ontario K1H 8M5, Canada; The Ottawa Hospital School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Rm 101, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Kerstin de Wit
- Division of Emergency Medicine, Department of Medicine, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4L8, Canada.
| | - Andrew Worster
- Division of Emergency Medicine, Department of Medicine, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4L8, Canada.
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada; St. Joseph's Health System, 50 Charlton Ave. E, Hamilton, Ontario L8N 4A6, Canada.
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, McMaster University, 175 Longwood Rd. S, Hamilton, Ontario L8P 0A1, Canada; McMaster Institute for Research on Aging, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4L8, Canada.
| | - Matthew Douma
- Department of Critical Care Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta T6G 2R3, Canada.
| | - Jerry P Nolan
- Resuscitation Medicine, Warwick Medical School, University of Warwick, Medical School Building, Coventry CV4 7HL, United Kingdom; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, United Kingdom.
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, 99 University Ave, Kingston, Ontario K7L 3N6, Canada.
| | - Rachel Couban
- Department of Anesthesia, McMaster University, 1280 Main St. W, Hamilton, Ontario L8S 4L8, Canada.
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, 661 University Ave, Toronto, Ontario M5G 1X8, Canada.
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Turcotte LA, Zalucky AA, Stall NM, Downar J, Rockwood K, Theou O, McArthur C, Heckman G. Baseline Frailty as a Predictor of Survival After Critical Care: A Retrospective Cohort Study of Older Adults Receiving Home Care in Ontario, Canada. Chest 2021; 160:2101-2111. [PMID: 34139208 DOI: 10.1016/j.chest.2021.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The extent to which the degree of baseline frailty, as measured using standardized multidimensional health assessments before hospital admission, predicts survival among older adults after admission to an ICU, remains unclear. RESEARCH QUESTION Is baseline frailty an independent predictor of survival among older adults receiving care in an ICU? STUDY DESIGN AND METHODS Retrospective cohort study of community-dwelling older adults (age, ≥ 65 years) receiving public home services who were admitted to any ICU in Ontario, Canada, between April 1, 2009, and March 31, 2015. All individuals underwent an inter-Resident Assessment Instrument-Home Care (RAI-HC) assessment completed within 180 days of ICU admission. These assessments were linked to hospital discharge abstract records. Patients were categorized using frailty measures each calculated from the RAI-HC: a classification tree version of the Clinical Frailty Scale; the Frailty Index-Acute Care; and the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale. One-year survival models were used to compare their performance. Patients were stratified based on the receipt of mechanical ventilation in the ICU. RESULTS Of 24,499 individuals admitted to an ICU within 180 days of a RAI-HC assessment, 26.4% (n = 6,467) received mechanical ventilation. Overall, 43.0% (95% CI, 42.4%-43.6%) survived 365 days after ICU admission. In general, among the overall cohort and both mechanical ventilation subgroups, mortality hazards increased with the severity of baseline frailty. Models predicting survival 30, 90, and 365 days after admission to an ICU that adjusted for one of the frailty measures were more discriminant than reference models that adjusted only for age, sex, major clinical category, and area income quintile. INTERPRETATION Severity of baseline frailty is associated independently with survival after ICU admission and should be considered when determining goals of care and treatment plans for people with critical illness.
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Affiliation(s)
- Luke Andrew Turcotte
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.
| | | | - Nathan M Stall
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON
| | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, NS, Canada
| | - Olga Theou
- Physiotherapy and Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
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Abey-Nesbit R, Peel NM, Matthews H, Hubbard RE, Nishtala PS, Bergler U, Deely JM, Pickering JW, Schluter PJ, Jamieson HA. Frailty of Māori, Pasifika, and Non-Māori/Non-Pasifika Older People in New Zealand: A National Population Study of Older People Referred for Home Care Services. J Gerontol A Biol Sci Med Sci 2021; 76:1101-1107. [PMID: 33075128 DOI: 10.1093/gerona/glaa265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of frailty in indigenous populations. We developed a frailty index (FI) for older New Zealand Māori and Pasifika who require publicly funded support services. METHODS An FI was developed for New Zealand adults aged 65 and older who had an interRAI Home Care assessment between June 1, 2012 and October 30, 2015. A frailty score for each participant was calculated by summing the number of deficits recorded and dividing by the total number of possible deficits. This created a FI with a potential range from 0 to 1. Linear regression models for FIs with ethnicity were adjusted for age and sex. Cox proportional hazards models were used to assess the association between the FI and mortality for Māori, Pasifika, and non-Māori/non-Pasifika. RESULTS Of 54 345 participants, 3096 (5.7%) identified as Māori, 1846 (3.4%) were Pasifika, and 49 415 (86.7%) identified as neither Māori nor Pasifika. New Zealand Europeans (48 178, 97.5%) constituted most of the latter group. Within each sex, the mean FIs for Māori and Pasifika were greater than the mean FIs for non-Māori and non-Pasifika, with the difference being more pronounced in women. The FI was associated with mortality (Māori subhazard ratio [SHR] 2.53, 95% CI 1.63-3.95; Pasifika SHR 6.03, 95% CI 3.06-11.90; non-Māori and non-Pasifika SHR 2.86, 95% CI 2.53-3.25). CONCLUSIONS This study demonstrated differences in FI between the ethnicities in this select cohort. After adjustment for age and sex, increases in FI were associated with increased mortality. This suggests that FI is predictive of poor outcomes in these ethnic groups.
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Affiliation(s)
| | - Nancye M Peel
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Hector Matthews
- Māori and Pacific Health, Canterbury District Health Board, Christchurch, New Zealand
| | - Ruth E Hubbard
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Ulrich Bergler
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanne M Deely
- Canterbury District Health Board, Christchurch, New Zealand
| | - John W Pickering
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Philip J Schluter
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,School of Health Sciences and Child Wellbeing Research Institute, University of Canterbury, Christchurch, New Zealand
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
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27
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O'Leary JJ, Reid N, Hubbard RE, Peel NM. Prevalence and factors associated with Advance Health Directives in frail older inpatients. Intern Med J 2021; 52:1160-1166. [PMID: 33961731 DOI: 10.1111/imj.15338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/30/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Advance health directives (AHDs) can be used to explore and document patient preferences for treatment and are therefore an important aspect of care planning. AIMS To investigate the prevalence and factors associated with AHDs among older inpatients. METHODS This retrospective study included 6449 patients, aged ≥65 years referred for specialist geriatric consultation between 2007 and 2018 in Queensland, Australia. The interRAI-Acute Care Comprehensive Geriatric Assessment tool was used to calculate a frailty index (FI), range 0-1, based on 52 possible deficits, and categorised into intervals of 0.1 for analysis. FI was also grouped according to previously reported cut points: fit (FI ≤0.25), moderately frail (FI >0.25-0.4), frail (FI >0.4-0.6) and severely frail (FI >0.6). RESULTS An AHD was present in 1032/6449 (16.0%) patients. Those with an AHD were significantly frailer than those without an AHD (mean FI 0.52 vs 0.45; p < 0.001). Higher frailty (OR:1.34(1.27-1.40)), older age (OR:1.04(1.03-1.05)), living in an institution (OR:1.33(1.01-1.73)), and recent hospitalisation (OR:1.42(1.23-1.62)) were significantly associated with higher prevalence of AHDs. Prevalence of AHD increased over time, from 7.6%(n = 66) in 2008 to 35.4%(n = 99) in 2017. CONCLUSION The presence of AHDs is associated with sociodemographic factors, as well as higher frailty levels. Prevalence of AHDs among inpatients has increased over the past decade but remains modest. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- James Joseph O'Leary
- The University of Queensland - Ochsner Clinical School, Louisiana, USA.,The University of Queensland Faculty of Medicine, Centre for Health Services Research, Brisbane, QLD, AUS, Australia
| | - Natasha Reid
- The University of Queensland Faculty of Medicine, Centre for Health Services Research, Brisbane, QLD, AUS, Australia
| | - Ruth E Hubbard
- The University of Queensland Faculty of Medicine, Centre for Health Services Research, Brisbane, QLD, AUS, Australia
| | - Nancye May Peel
- The University of Queensland Faculty of Medicine, Centre for Health Services Research, Brisbane, QLD, AUS, Australia
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Patel BG, Luo S, Wildes TM, Sanfilippo KM. Frailty in Older Adults With Multiple Myeloma: A Study of US Veterans. JCO Clin Cancer Inform 2021; 4:117-127. [PMID: 32083955 DOI: 10.1200/cci.19.00094] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Age-associated cumulative decline across physiologic systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in administrative data can allow for assessment of prognosis and facilitate control for confounding variables. The purpose of this study was to assess frailty from claims-based data using the accumulation of deficits approach in veterans with multiple myeloma (MM). METHODS From the Veterans Administration Central Cancer Registry, we identified patients who were diagnosed with MM between 1999 and 2014. Using the accumulation of deficits approach, we calculated a Frailty Index (FI) using 31 health-associated deficits and categorized scores into five groups: nonfrail (FI, 0 to 0.1), prefrail (FI, 0.11 to 0.20), mild frailty (FI, 0.21 to 0.30), moderate frailty (FI, 0.31 to 0.40), and severe frailty (FI, > 0.4). We used Cox proportional hazards regression analysis to assess association between FI score and mortality while adjusting for potential confounders. RESULTS We calculated an FI for 3,807 veterans age 65 years or older. Among the cohort, 28.7% were classified as nonfrail, 41.3% prefrail, 21.6% mildly frail, 6.6% moderately frail, and 1.7% severely frail. Frailty was strongly associated with mortality independent of age, race, MM treatment, body mass index, or statin use. Higher FI score was associated with higher mortality with hazard ratios of 1.33 (95% CI, 1.21 to 1.47), 1.97 (95% CI, 1.70 to 2.20), 2.86 (95% CI, 2.45 to 3.34), and 3.22 (95% CI, 2.46 to 4.22) for prefrail, mildly frail, moderately frail, and severely frail, respectively. CONCLUSION Frailty status is a significant predictor of mortality in older veterans with MM. Assessment of frailty status using the readily available electronic medical records data in administrative data allows for assessment of prognosis.
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Affiliation(s)
| | - Suhong Luo
- Washington University School of Medicine, St Louis, MO.,St Louis VA Medical Center, St Louis, MO
| | | | - Kristen M Sanfilippo
- Washington University School of Medicine, St Louis, MO.,St Louis VA Medical Center, St Louis, MO
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Busnel C, Vallet F, Ludwig C. Tooling nurses to assess complexity in routine home care practice: Derivation of a complexity index from the interRAI-HC. Nurs Open 2021; 8:815-823. [PMID: 33570265 PMCID: PMC7877136 DOI: 10.1002/nop2.686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
AIM Home care nurses often use the Resident Assessment Instrument-Home Care (interRAI-HC) to assess health needs. However, this tool does not assess complexity. This study proposes to derive a complexity index (CI) from the interRAI-HC using the operational definition of the dedicated COMID checklist (COmplexité Multidimensionnelle des prises en soins Infirmières à Domicile). DESIGN Data were collected at the baseline assessment of the fraXity study (N = 231, aged ≥ 65), which relied on an observational longitudinal design. METHODS Measures were the interRAI-HC, from which the CI binary variables were computed and the COMID, used as a reference. RESULTS Twenty-six CI variables were computed from the interRAI-HC, and all but three correlations were significant. The correlation between the CI score and the COMID score was ρ = 0.730 (p < .001). CONCLUSIONS The study demonstrates that complexity can be assessed directly from the interRAI-HC by deriving a CI.
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Affiliation(s)
- Catherine Busnel
- Research and Development UnitGeneva Institution for Homecare and Assistance (imad)CarougeSwitzerland
| | - Fanny Vallet
- Research and Development UnitGeneva Institution for Homecare and Assistance (imad)CarougeSwitzerland
| | - Catherine Ludwig
- Geneva School of Health Sciences, HES‐SOUniversity of Applied Sciences and Arts Western SwitzerlandGenevaSwitzerland
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Blodgett JM, Rockwood K, Theou O. Changes in the severity and lethality of age-related health deficit accumulation in the USA between 1999 and 2018: a population-based cohort study. LANCET HEALTHY LONGEVITY 2021; 2:e96-e104. [DOI: 10.1016/s2666-7568(20)30059-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
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Moldovan M, Khadka J, Visvanathan R, Wesselingh S, Inacio MC. Using elastic nets to estimate frailty burden from routinely collected national aged care data. J Am Med Inform Assoc 2021; 27:419-428. [PMID: 31951002 DOI: 10.1093/jamia/ocz210] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/31/2019] [Accepted: 11/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To (1) use an elastic net (EN) algorithm to derive a frailty measure from a national aged care eligibility assessment program; (2) compare the ability of EN-based and a traditional cumulative deficit (CD) based frailty measures to predict mortality and entry into permanent residential care; (3) assess if the predictive ability can be improved by using weighted frailty measures. MATERIALS AND METHODS A Cox proportional hazard model based EN algorithm was applied to the 2003-2013 cohort of 903 996 participants for selecting items to enter an EN based frailty measure. The out-of-sample predictive accuracy was measured by the area under the curve (AUC) from Cox models fitted to 80% training and validated on 20% testing samples. RESULTS The EN approach resulted in a 178-item frailty measure including items excluded from the 44-item CD-based measure. The EN based measure was not statistically significantly different from the CD-based approach in terms of predicting mortality (AUC 0.641, 95% CI: 0.637-0.644 vs AUC 0.637, 95% CI: 0.634-0.641) and permanent care entry (AUC 0.626, 95% CI: 0.624-0.629 vs AUC 0.627, 95% CI: 0.625-0.63). However, the weighted EN based measure statistically outperforms the weighted CD measure for predicting mortality (AUC 0.774, 95% CI: 0.771-0.777 vs AUC 0.757, 95% CI: 0.754-0.760) and permanent care entry (AUC 0.676, 95% CI: 0.673-0.678 vs AUC 0.671, 95% CI: 0.668-0.674). CONCLUSIONS The weighted EN and CD-based measures demonstrated similar prediction performance. The CD-based measure items are relevant to frailty measurement and easier to interpret. We recommend using the weighted and unweighted CD-based frailty measures.
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Affiliation(s)
- Max Moldovan
- South Australian Health and Medical Research Institute (SAHMRI), Registry of Senior Australians (ROSA), Adelaide, Australia
| | - Jyoti Khadka
- Healthy Ageing Research Consortium and Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Health and Social Care Economics Group, College of Nursing and Health Science, Flinders University, Adelaide, Australia.,School of Business, University of South Australia, Adelaide, Australia
| | - Renuka Visvanathan
- University of Adelaide, The Queen Elizabeth Hospital, National Health and Medical Research Council of Australia Centre of Research Excellence in Frailty and Healthy Ageing, Registry of Senior Australians (ROSA), Adelaide, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute (SAHMRI), Registry of Senior Australians (ROSA), Adelaide, Australia
| | - Maria C Inacio
- South Australian Health and Medical Research Institute (SAHMRI), Registry of Senior Australians (ROSA), Adelaide, Australia
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Lo SY, Zhang M, Hubbard RE, Gnjidic D, Redston MR, Hilmer SN. Development and validation of a frailty index based on data routinely collected across multiple domains in NSW hospitals. Australas J Ageing 2020; 40:184-194. [PMID: 33340206 DOI: 10.1111/ajag.12888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/18/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE(S) To develop and validate a frailty index (FI) that covers multiple domains, using routine hospital data. To investigate the FI's validity, after excluding medication-related items (FI-ExMeds), for studies of frailty and polypharmacy. METHODS A FI was derived from routine NSW hospital data following standard published guidance. In a development cohort (151 inpatients ≥ 70 years), the FI was correlated with the Reported Edmonton Frail Scale (REFS) using Pearson's R. Validity and distribution of FI and FI-ExMeds, and correlation with each other, were evaluated in a validation cohort (999 inpatients ≥ 75 years). RESULTS The mean FI for the development cohort was 0.27 (SD 0.09). The FI showed moderate linear correlation with the REFS (n = 148, R = 0.52, P < .001). In the validation cohort, mean FI (n = 993) and FI-ExMeds (n = 990) were both 0.28 (SD 0.11). FI-ExMeds showed high linear correlation with the FI (n = 990, R = 0.99, P < .001). CONCLUSION This multi-domain FI is comparable to REFS, with adequate redundancy to exclude deficits for specific analyses.
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Affiliation(s)
- Sarita Y Lo
- Laboratory of Ageing and Pharmacology, Faculty of Medicine and Health, Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Meggie Zhang
- Laboratory of Ageing and Pharmacology, Faculty of Medicine and Health, Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Discipline of Pharmacology, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, Centre for Health Services Research, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health and Charles Perkins Centre, Sydney School of Pharmacy, University of Sydney, NSW, Australia
| | - Mitchell R Redston
- Laboratory of Ageing and Pharmacology, Faculty of Medicine and Health, Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine, University of Notre Dame, Darlinghurst, NSW, Australia
| | - Sarah N Hilmer
- Laboratory of Ageing and Pharmacology, Faculty of Medicine and Health, Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia
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Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
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Bloomfield K, Wu Z, Tatton A, Calvert C, Peel N, Hubbard R, Jamieson H, Hikaka J, Boyd M, Bramley D, Connolly MJ. An interRAI-derived frailty index is associated with prior hospitalisations in older adults residing in retirement villages. Australas J Ageing 2020; 40:66-71. [PMID: 33118304 DOI: 10.1111/ajag.12863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To develop and validate a frailty index (FI) from interRAI-Community Health Assessments (CHA) on older adults in retirement villages (RVs). METHODS This is a cross-sectional analysis of a current RV research study. A FI was generated using the cumulative deficit model. Health-care utilisation measures were acute, and all, hospitalisations 12 months before baseline assessment. Associations between FI and hospitalisations were explored using multivariable logistic regression to estimate odds ratio (OR). RESULTS Of 577 included residents, mean (SD) age was 81 (7) and 419 (73%) were female. Mean (SD) FI was 0.16 (0.09); 260 (45%) were mildly frail, and 108 (19%) moderate-severely frail. In multivariate-adjusted analysis, odds of acute hospitalisation for mild (OR = 3.3, P < .001) and moderate-severely frail (OR = 6.4, P < .001) were significantly higher than fit residents. Higher odds were also observed for all hospitalisations. CONCLUSION A considerable proportion of RV residents were moderately-severely frail. FI was associated with acute and all hospitalisations.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Waitematā District Health Board, Auckland, New Zealand
| | | | - Nancye Peel
- University of Queensland, Brisbane, Queensland, Australia
| | - Ruth Hubbard
- University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
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Khadka J, Visvanathan R, Theou O, Moldovan M, Amare AT, Lang C, Ratcliffe J, Wesselingh SL, Inacio MC. Development and validation of a frailty index based on Australian Aged Care Assessment Program data. Med J Aust 2020; 213:321-326. [DOI: 10.5694/mja2.50720] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/16/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Jyoti Khadka
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide SA
- UniSA Business School University of South Australia Adelaide SA
- Caring Future Institute Flinders University Adelaide SA
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (G‐TRAC) Centre University of Adelaide Adelaide SA
- NHMRC Centre of Research Excellence in Frailty and Healthy Ageing Adelaide SA
- Basil Hetzel Institute Central Adelaide Local Health Network Adelaide SA
| | - Olga Theou
- Basil Hetzel Institute Central Adelaide Local Health Network Adelaide SA
- Dalhousie University Halifax Nova Scotia Canada
| | - Max Moldovan
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide SA
| | - Azmeraw T Amare
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide SA
| | - Catherine Lang
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide SA
| | - Julie Ratcliffe
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide SA
- Caring Future Institute Flinders University Adelaide SA
| | - Steven L Wesselingh
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide SA
| | - Maria C Inacio
- Registry of Senior Australians South Australian Health and Medical Research Institute Adelaide SA
- Sansom Institute for Health Research University of South Australia Adelaide SA
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Frailty Index Status of Canadian Home Care Clients Improves With Exercise Therapy and Declines in the Presence of Polypharmacy. J Am Med Dir Assoc 2020; 21:766-771.e1. [DOI: 10.1016/j.jamda.2020.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 11/30/2022]
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Kerminen H, Huhtala H, Jäntti P, Valvanne J, Jämsen E. Frailty Index and functional level upon admission predict hospital outcomes: an interRAI-based cohort study of older patients in post-acute care hospitals. BMC Geriatr 2020; 20:160. [PMID: 32370740 PMCID: PMC7201739 DOI: 10.1186/s12877-020-01550-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 12/18/2022] Open
Abstract
BACKGROUND Geriatric assessment upon admission may reveal factors that contribute to adverse outcomes in hospitalized older patients. The purposes of this study were to derive a Frailty Index (FI-PAC) from the interRAI Post-Acute Care instrument (interRAI-PAC) and to analyse the predictive ability of the FI-PAC and interRAI scales for hospital outcomes. METHODS This retrospective cohort study was conducted by combining patient data from interRAI-PAC with discharge records from two post-acute care hospitals. The FI-PAC was derived from 57 variables that fulfilled the Frailty Index criteria. Associations of the FI-PAC and interRAI-PAC scales (ADLH for activities of daily living, CPS for cognition, DRS for mood, and CHESS for stability of health status) with hospital outcomes (prolonged hospital stay ≥90 days, emergency department admission during the stay, and in-hospital mortality) were analysed using logistic regression and ROC curves. RESULTS The cohort included 2188 patients (mean age (SD) 84.7 (6.3) years) who were hospitalized in two post-acute care hospitals. Most patients (n = 1691, 77%) were discharged and sent home. Their median length of stay was 35 days (interquartile range 18-87 days), and 409 patients (24%) had a prolonged hospital stay. During their stay, 204 patients (9%) were admitted to the emergency department and 231 patients (11%) died. The FI-PAC was normally distributed (mean (SD) 0.34 (0.15)). Each increase of 0.1 point in the FI-PAC increased the likelihood of prolonged hospital stay (odds ratio [95% CI] 1.91 [1.73─2.09]), emergency admission (1.24 [1.11─1.37]), and in-hospital death (1.82 [1.63─2.03]). The best instruments for predicting prolonged hospital stay and in-hospital mortality were the FI-PAC and the ADLH scale (AUC 0.75 vs 0.72 and 0.73 vs 0.73, respectively). There were no differences in the predictive abilities of interRAI scales and the FI-PAC for emergency department admission. CONCLUSIONS The Frailty Index derived from interRAI-PAC predicts adverse hospital outcomes. Its predictive ability was similar to that of the ADLH scale, whereas other interRAI-PAC scales had less predictive value. In clinical practice, assessment of functional ability is a simple way to assess a patient's prognosis.
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Affiliation(s)
- Hanna Kerminen
- Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), Tampere University, P.O. Box 100, 33014, Tampere, Finland. .,Centre of Geriatrics, Tampere University Hospital, Central Hospital, P.O. Box 2000, 33521, Tampere, Finland.
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland
| | - Pirkko Jäntti
- Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), Tampere University, P.O. Box 100, 33014, Tampere, Finland
| | - Jaakko Valvanne
- Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), Tampere University, P.O. Box 100, 33014, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), Tampere University, P.O. Box 100, 33014, Tampere, Finland.,Centre of Geriatrics, Tampere University Hospital, Central Hospital, P.O. Box 2000, 33521, Tampere, Finland
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Informative frailty indices from binarized biomarkers. Biogerontology 2020; 21:345-355. [DOI: 10.1007/s10522-020-09863-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022]
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Shafiee Hanjani L, Hubbard RE, Freeman CR, Gray LC, Scott IA, Peel NM. Medication use and cognitive impairment among residents of aged care facilities. Intern Med J 2020; 51:520-532. [PMID: 32092243 DOI: 10.1111/imj.14804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Potentially inappropriate polypharmacy is common in residential aged care facilities (RACF). This is of particular concern among people with cognitive impairment who, compared with cognitively intact residents, are potentially more sensitive to the adverse effects of medications. AIM To compare the patterns of medication prescribing of RACF residents based on cognitive status. METHODS De-identified data collected during telehealth-mediated geriatric consultations with 720 permanent RACF residents were analysed. Residents were categorised into cognitively intact, mild to moderate impairment and severe impairment groups using the interRAI Cognitive Performance Scale. The number of all regular and when-required medications used in the past 3 days, the level of exposure to anti-cholinergic/sedative medications and potentially inappropriate medications and the use of preventive and symptom control medications were compared across the groups. RESULTS The median number of medications was 10 (interquartile range (IQR) 8-14). Cognitively intact residents were receiving significantly more medications (median (IQR) 13 (10-16)) than those with mild to moderate (10 (7-13)) or severe (9 (7-12)) cognitive impairment (P < 0.001). Overall, 82% of residents received at least one anti-cholinergic/sedative medication and 26.9% were exposed to one or more potentially inappropriate medications, although the proportions of those receiving such medications were not significantly different across the groups. Of 7658 medications residents were taking daily, 21.3% and 11.7% were classified as symptom control and preventive medications respectively with no significant difference among the groups in their use. CONCLUSION Our findings highlight the need for optimising prescribing in RACF residents, with particular attention to medications with anti-cholinergic effects.
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Affiliation(s)
- Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,PA-Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher R Freeman
- Centre for Optimising Pharmacy Practice-based Excellence in Research, School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian A Scott
- PA-Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nancye M Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Cunha AIL, Veronese N, de Melo Borges S, Ricci NA. Frailty as a predictor of adverse outcomes in hospitalized older adults: A systematic review and meta-analysis. Ageing Res Rev 2019; 56:100960. [PMID: 31518686 DOI: 10.1016/j.arr.2019.100960] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/25/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Abstract
Frailty syndrome is prevalent among hospitalized older adults as are the occurrence of adverse outcomes. This systematic review and meta-analysis investigated whether frailty in older adults at hospital admission predicts adverse outcomes. Manual (ProQuest, conferences annals and references) and electronic searches (PUBMED, EMBASE, Web of Science, Lilacs, CINAHL, PsycINFO and Google Scholar) were performed. We included prospective studies of hospitalized older adults. Primary outcomes were functional decline at hospital discharge and mortality after discharge. Other data were considered secondary outcomes. Methodological quality was evaluated by the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twenty-eight papers were included, corresponding to 19 cohorts (5 cohorts for functional decline and 16 for mortality), with moderate to good methodological quality. Being frail [RR: 1.32 (95%CI: 1.04; 1.67)] and pre-frail [RR: 1.51 (95%CI: 1.05; 2.17)] are risk factors for functional decline compared with being nonfrail. Frail individuals had a relative risk for in-hospital mortality and mortality in medium- and long-term compared to nonfrail (in-hospital RR: 8.20, medium RR: 9.49 and long RR: 7.94) and pre-frail (in-hospital RR: 3.19, medium RR: 3.31 and long RR: 3.72). The overall mortality risk in frail individuals is 3.49 and 2.14 times compared to nonfrail and pre-frail, respectively. Length of hospital stay was higher for frail older adults (13.5 days) compared with pre-frail (10.5 days) and nonfrail (8.3 days). Therefore, being frail at hospital admission is a risk factor for in-hospital mortality, long hospital stay, functional decline at hospital discharge, and mortality in the medium- and long-term.
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Gee SB, Cheung G, Bergler U, Jamieson H. "There's More to Frail than That": Older New Zealanders and Health Professionals Talk about Frailty. J Aging Res 2019; 2019:2573239. [PMID: 31915552 PMCID: PMC6930781 DOI: 10.1155/2019/2573239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/15/2019] [Accepted: 10/26/2019] [Indexed: 11/17/2022] Open
Abstract
There is general agreement that frailty is common and important in later life, but there is less agreement about what frailty is. Little is known about the extent to which practicing health professionals and older people hold a mutual understanding of frailty. Focus groups were held to engage older people and health professionals in discussion about what made them think that someone was frail. Eighteen older people took part across three focus groups, and se'venteen health professionals took part across another three focus groups. Both the health professionals and the older people talked about the experience of frailty as an interplay of physical, psychological, and social dimensions. Older people with frailty were seen as needing help and being vulnerable to adverse outcomes, but accepting help was positioned by older people as an adaptive choice. The experience of frailty was described as being mediated by the individual's psychological mindset, highlighting the importance of approaches that recognise strengths and resilience. A broader and more balanced understanding of frailty may help create more rounded and appropriate approaches to assessment and management.
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Affiliation(s)
- Susan B. Gee
- University of Otago, Christchurch New Zealand, Canterbury District Health Board, Christchurch 8083, New Zealand
| | - Gary Cheung
- University of Auckland, Auckland 1023, New Zealand
| | - Ulrich Bergler
- University of Otago, Christchurch New Zealand, Canterbury District Health Board, Christchurch 8083, New Zealand
| | - Hamish Jamieson
- University of Otago, Christchurch New Zealand, Canterbury District Health Board, Christchurch 8083, New Zealand
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Peel NM, Hornby-Turner YC, Henderson A, Hubbard RE, Gray LC. Prevalence and Impact of Functional and Psychosocial Problems in Hospitalized Adults: A Prospective Cohort Study. J Am Med Dir Assoc 2019; 20:1294-1299.e1. [DOI: 10.1016/j.jamda.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/28/2019] [Accepted: 03/17/2019] [Indexed: 10/26/2022]
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Ludwig C, Busnel C. Protocol of a case-control longitudinal study (fraXity) assessing frailty and complexity among Swiss home service recipients using interRAI-HC assessments. BMC Geriatr 2019; 19:207. [PMID: 31382880 PMCID: PMC6683486 DOI: 10.1186/s12877-019-1230-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The early screening of frail individuals and of patients with complex care needs are challenges that countries witnessing population aging face. Homecare nurses are actors of choice in meeting these challenges, yet they need means of identifying frail and complex patients in their routine practice. The fraXity study's aim is to fill this gap by (1) proposing frailty and complexity computation algorithms derived from the interRAI-HC; (2) assessing the predictive validity of the proposed indices with respect to adverse health outcomes; and (3) identifying subgroups of the aged population for whom the early screening of frailty and complexity appears to be most relevant. METHODS The study will rely on a prospective observational case-control longitudinal study. Three samples of individuals aged 65 or older living in the community will be considered: recipients of formal home care (case 1), of formal home assistance (case 2) and individuals free of formal home services (controls). All participants will receive interRAI-HC assessments at three measurement occasions, separated by six-month intervals. Baseline assessments will serve to derive frailty and complexity scores. Follow-ups will serve to assess the predictive validity of the proposed indices and to estimate the intra-individual change in frailty and complexity. Group comparisons will serve to identify subgroups of the population for whom the screening of frailty and complexity appears to be the most relevant. DISCUSSION The expected results of the fraXity study are a) reliable computation algorithms for frailty and complexity scores derived from the interRAI-HC and b) clinical assessment protocols for use by homecare nurses. These outcomes should contribute to outfitting key actors of the health system with means of enhancing their part in a collective endeavor targeting the best care and quality of life for aged citizens. TRIAL REGISTRATION ClinicalTrials.gov, NCT03883425 , registered on March 20, 2019.
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Affiliation(s)
- Catherine Ludwig
- Geneva School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Avenue de Champel 47, 1206 Geneva, Switzerland
| | - Catherine Busnel
- Geneva Institution for Homecare and Assistance (imad), Avenue du Cardinal Mermillod 36, 1227 Carouge, Switzerland
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Knoop V, Costenoble A, Vella Azzopardi R, Vermeiren S, Debain A, Jansen B, Scafoglieri A, Bautmans I, Bautmans I, Verté D, Beyer I, Petrovic M, De Donder L, Kardol T, Rossi G, Clarys P, Scafoglieri A, Cattrysse E, de Hert P, Jansen B. The operationalization of fatigue in frailty scales: a systematic review. Ageing Res Rev 2019; 53:100911. [PMID: 31136819 DOI: 10.1016/j.arr.2019.100911] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify the different fatigue items in existing frailty scales. METHODS PubMed, Web of Knowledge and PsycINFO were systematically screened for frailty scales. 133 articles were included, describing 158 frailty scales. Fatigue items were extracted and categorized in 4 fatigue constructs: "mood state related tiredness", "general feeling of tiredness", "activity based feeling of tiredness" and "resistance to physical tiredness". RESULTS 120 fatigue items were identified, of which 100 belonged to the construct "general feeling of tiredness" and only 9 to the construct "resistance to physical tiredness". 49,4% of the frailty scales included at least 1 fatigue item, representing 15 ± 9,3% of all items in these scales. Fatigue items have a significantly higher weight in single domain (dominantly physical frailty scales) versus multi domain frailty scales (21 ± 3.2 versus 10.6 ± 9.8%, p=<0,05). CONCLUSION Fatigue is prominently represented in frailty scales, covering a great diversity in fatigue constructs and underlying pathophysiological mechanisms by which fatigue relates to frailty. Although fatigue items were more prevalent and had a higher weight in physical frailty scales, the operationalization of fatigue leaned more towards psychological constructs. This review can be used as a reference for choosing a suitable frailty scale depending on the type of fatigue of interest.
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Abstract
Understanding geriatric physiology is critical for successful perioperative management of older surgical patients. The frailty syndrome is evolving as an important, potentially modifiable process capturing a patient's biologic age and is more predictive of adverse perioperative outcomes than chronologic age. Use of frailty in risk stratification and perioperative decision-making allows providers to effectively diagnose, risk stratify, and treat patients in the perioperative setting. Further study is needed to develop a universal definition of frailty, to identify comprehensive yet feasible screening tools that allow for accurate detection of frailty in the perioperative setting, and to refine treatment programs for frail surgical patients.
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Gait Speed and Frailty Status in Relation to Adverse Outcomes in Geriatric Rehabilitation. Arch Phys Med Rehabil 2019; 100:859-864. [DOI: 10.1016/j.apmr.2018.08.187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 01/14/2023]
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Shaw BH, Borrel D, Sabbaghan K, Kum C, Yang Y, Robinovitch SN, Claydon VE. Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents. BMC Geriatr 2019; 19:80. [PMID: 30866845 PMCID: PMC6415493 DOI: 10.1186/s12877-019-1082-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/21/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH; profound falls in blood pressure when upright) is a common deficit that increases in incidence with age, and may be associated with falling risk. Deficit accumulation results in frailty, regarded as enhanced vulnerability to adverse outcomes. We aimed to evaluate the relationships between OH, frailty, falling and mortality in elderly care home residents. METHODS From the Minimum Data Set (MDS) document, a frailty index (FI-MDS) was generated from a list of 58 deficits, ranging from 0 (no deficits) to 1.0 (58 deficits). OH was evaluated from beat-to-beat blood pressure and heart rate (finger plethysmography) collected during a 15-min supine-seated orthostatic stress test. Retrospective and prospective falling rates (falls/year) were extracted from facility falls incident reports. All-cause 3-year mortality was determined. Data are reported as mean ± standard error. RESULTS Data were obtained from 116 older adults (aged 84.2 ± 0.9 years; 44% males) living in two long term care facilities. The mean FI-MDS was 0.36 ± 0.01; FI-MDS was correlated with age (r = 0.277; p = 0.003). Those who were frail (FI ≥ 0.27) had larger Initial (- 17.8 ± 4.2 vs - 6.1 ± 3.3 mmHg, p = 0.03) and Consensus (- 22.7 ± 4.3 vs - 11.5 ± 3.3 mmHg, p = 0.04) orthostatic reductions in systolic arterial pressure. Frail individuals had higher prospective and retrospective falling rates and higher 3-year mortality. Receiver operating characteristic curves evaluated the ability of FI-MDS alone to predict prospective falls (sensitivity 72%, specificity 36%), Consensus OH (sensitivity 68%, specificity 60%) and 3-year mortality (sensitivity 77%, specificity 49%). Kaplan Meier survival analyses showed significantly higher 3-year mortality in those who were frail compared to the non-frail (p = 0.005). CONCLUSIONS Frailty can be captured using a frailty index based on MDS data in elderly individuals living in long term care, and is related to susceptibility to orthostatic hypotension, falling risk and 3-year mortality. Use of the MDS to generate a frailty index may represent a simple and convenient risk assessment tool for older adults living in long term care. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk.
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Affiliation(s)
- Brett H Shaw
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Dave Borrel
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Kimiya Sabbaghan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Colton Kum
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Yijian Yang
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
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Darvall JN, Braat S, Story DA, Greentree K, Bose T, Loth J, Lim WK. Protocol for a prospective observational study to develop a frailty index for use in perioperative and critical care. BMJ Open 2019; 9:e024682. [PMID: 30782738 PMCID: PMC6340067 DOI: 10.1136/bmjopen-2018-024682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Frailty is of increasing importance to perioperative and critical care medicine, as the proportion of older patients increases globally. Evidence continues to emerge of the considerable impact frailty has on adverse outcomes from both surgery and critical care, which has led to a proliferation of different frailty measurement tools in recent years. Despite this, there remains a lack of easily implemented, comprehensive frailty assessment tools specific to these complex populations. Development of a frailty index using routinely collected hospital data, able to leverage the automated aspects of an electronic medical record, would aid risk stratification and benefit clinicians and patients alike. METHODS AND ANALYSIS This is a prospective observational study. 150 intensive care unit (ICU) patients aged ≥50 years and 200 surgical patients aged ≥65 years will be enrolled. The primary objective is to develop a frailty index. Secondary objectives include assessing its ability to predict in-hospital mortality and/or discharge to a new non-home location; the performance of the frailty index in predicting postoperative and ICU complications, as well as health-related quality of life at 6 months; to compare the performance of the frailty index against existing frailty measurement and risk stratification tools; and to assess its modification by patients' health assets. ETHICS AND DISSEMINATION This study has been approved by the Melbourne Health Human Research Ethics Committee(20 January 2017, HREC/16/MH/321). Dissemination will be via international and national anaesthetic and critical care conferences, and publication in the peer-reviewed literature.
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Affiliation(s)
- Jai N Darvall
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Clinical and Translational Science Platform, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David A Story
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Greentree
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tony Bose
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joel Loth
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Wen K Lim
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Fialová D, Laffon B, Marinković V, Tasić L, Doro P, Sόos G, Mota J, Dogan S, Brkić J, Teixeira JP, Valdiglesias V, Costa S. Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies). Eur J Clin Pharmacol 2019; 75:451-466. [PMID: 30610276 DOI: 10.1007/s00228-018-2603-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the "age-blind" approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. METHODOLOGY A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). RESULTS Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. CONCLUSION Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.
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Affiliation(s)
- Daniela Fialová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic. .,Department of Geriatrics and Gerontology, 1st Faculty of Medicine in Prague, Charles University, Prague, Czech Republic.
| | - Blanca Laffon
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Valentina Marinković
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Tasić
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Peter Doro
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Gyӧngyver Sόos
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Jorge Mota
- Centro de Investigação em Actividade Fìsica, Saúde e Lazer (CIAFEL), University of Porto, Porto, Portugal
| | - Soner Dogan
- Department of Medical Biology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Jovana Brkić
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - João Paulo Teixeira
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Vanessa Valdiglesias
- DICOMOSA Group, Department of Psychology, Area of Psychobiology, Universidade da Coruña, A Coruña, Spain
| | - Solange Costa
- Department of Environmental Health, Portuguese National Institute of Health, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
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Basile G, Catalano A, Mandraffino G, Maltese G, Alibrandi A, Ciancio G, Brischetto D, Morabito N, Lasco A, Cesari M. Frailty modifications and prognostic impact in older patients admitted in acute care. Aging Clin Exp Res 2019; 31:151-155. [PMID: 29946755 DOI: 10.1007/s40520-018-0989-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/11/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frailty is a predictor of adverse outcomes in older subjects. AIMS The aims of this study are to (1) measure the frailty status and its changes occurring during the hospital stay, (2) determine the relationships among frailty and adverse outcomes. METHODS Frailty was assessed using a 46-item Frailty Index (FI) in 156 patients admitted to an Acute Geriatric Medicine Unit. The FI was calculated within 24 h from the hospital admission (aFI) and at his/her discharge (dFI). Patients were followed up to 12 months after the hospital discharge. RESULTS A statistically significant difference was reported between the aFI (0.31, IQR 0.19-0.44) and the dFI (0.29, IQR 0.19-0.40; p = 0.04). The aFI was directly associated with the risk of in-hospital death (OR = 5.9; 95% CI 2.0-17.5; p = 0.001), 1 year mortality (OR = 5.5, 95% CI 2.4-12.7, p < 0.001) and re-hospitalization (OR = 6.3, 95% CI 2.2-17.9, p = 0.03). CONCLUSION Frailty is a strong predictor of negative endpoints in hospitalized older persons. DISCUSSION Frailty assessment from routinely collected clinical data may provide important insights about the biological status of the individual and promote the personalization of care.
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