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Wolf LA, Delao A, Clark PR, Malsch AJ, Eagles D, Oiyemhonlan B, Callihan M, Stone EL. Frailty means falling between the cracks: A qualitative study exploring emergency nurses' understanding of frailty and its use in informing clinical decision-making related to acuity, care, and disposition. Geriatr Nurs 2024; 59:203-207. [PMID: 39043047 DOI: 10.1016/j.gerinurse.2024.07.015] [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: 03/14/2024] [Revised: 06/26/2024] [Accepted: 07/14/2024] [Indexed: 07/25/2024]
Abstract
THE PURPOSE Of this study was to understand emergency nurses' use of frailty to inform care, disposition decision-making, and further assessment. METHODS A qualitative, descriptive, exploratory approach was used. Field notes from group discussions held during a conference presession on frailty and post-session evaluation data were analyzed. RESULTS Two common ideas threaded these discussions: frailty as vulnerability to "falling through the cracks" and that of an iceberg. Participants stressed the broad and expansive ramifications of frailty, and lack of structure/process to accurately describe, quantify, and utilize the concept. Participants described issues of physical and emotional/social fragility, including being unable to complete activities of daily living independently; also of concern were the patients' social determinants of health and financial challenges. CONCLUSION The conceptual understanding of frailty encompassed physical, social, cognitive, and access deficits. Emergency nurses are aware of this concept and would conduct formal frailty screening if provided with training, time, and resources.
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Affiliation(s)
- Lisa Adams Wolf
- Emergency Nursing Research, Emergency Nurses Association, Schaumburg, IL, USA.
| | - Altair Delao
- Emergency Nursing Research, Emergency Nurses Association, Schaumburg, IL, USA
| | | | | | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ontario, Canada
| | - Brenda Oiyemhonlan
- The Permanente Medical Group, Department of Emergency Medicine, Oakland and Richmond, CA, USA
| | - Michael Callihan
- University of North Carolina at Greensboro, School of Nursing, Greensboro, NC, USA
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Blayney MC, Reed MJ, Masterson JA, Anand A, Bouamrane MM, Fleuriot J, Luz S, Lyall MJ, Mercer S, Mills NL, Shenkin SD, Walsh TS, Wild SH, Wu H, McLachlan S, Guthrie B, Lone NI. Multimorbidity and adverse outcomes following emergency department attendance: population based cohort study. BMJ MEDICINE 2024; 3:e000731. [PMID: 39184567 PMCID: PMC11344864 DOI: 10.1136/bmjmed-2023-000731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 05/22/2024] [Indexed: 08/27/2024]
Abstract
ABSTRACT Objectives To describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department. Design Population based cohort study. Setting Emergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019. Participants Adults (≥18 years) attending emergency departments. Data sources Linked data from emergency departments, hospital discharges, and cancer registries, and national mortality data. Main outcome measures Multimorbidity was defined as at least two conditions from the Elixhauser comorbidity index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30 day mortality (primary outcome), hospital admission, reattendance at the emergency department within seven days, and time spent in emergency department (secondary outcomes). Primary analysis was stratified by age (<65 v ≥65 years). Results 451 291 people had 1 273 937 attendances to emergency departments during the study period. 43 504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 v 43 years), more likely to arrive by emergency ambulance (57.8% v 23.7%), and more likely to be triaged as very urgent (23.5% v 9.2%) than people who do not have multimorbidity. After adjusting for other prognostic covariates, multimorbidity, compared with no multimorbidity, was associated with higher 30 day mortality (8.2% v 1.2%, adjusted odds ratio 1.81 (95% confidence interval (CI) 1.72 to 1.91)), higher rate of hospital admission (60.1% v 20.5%, 1.81 (1.76 to 1.86)), higher reattendance to an emergency department within seven days (7.8% v 3.5%, 1.41 (1.32 to 1.50)), and longer time spent in the department (adjusted coefficient 0.27 h (95% CI 0.26 to 0.27)). The size of associations between multimorbidity and all outcomes were larger in younger patients: for example, the adjusted odds ratio of 30 day mortality was 3.03 (95% CI 2.68 to 3.42) in people younger than 65 years versus 1.61 (95% CI 1.53 to 1.71) in those 65 years or older. Conclusions Almost one in ten patients presenting to emergency department had multimorbidity using Elixhauser index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand.
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Affiliation(s)
- Michael C Blayney
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Matthew J Reed
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John A Masterson
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Atul Anand
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Matt M Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Jacques Fleuriot
- Artificial Intelligence and its Applications, University of Edinburgh School of Informatics, Edinburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Saturnino Luz
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | | | - Stewart Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Susan D Shenkin
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Timothy S Walsh
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Honghan Wu
- Institute of Health Informatics, University College London, London, UK
- The Alan Turing Institute, British Library, London, UK
| | - Stela McLachlan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Edinburgh, UK
| | - Nazir I Lone
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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Kamwa V, Knight T, Atkin C, Cooksley T, Subbe C, Holland M, Lasserson D, Sapey E. Acute frailty services: results of a national day of care survey. BMC Geriatr 2024; 24:608. [PMID: 39014306 PMCID: PMC11251303 DOI: 10.1186/s12877-024-05075-1] [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: 06/02/2023] [Accepted: 05/14/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Older people living with frailty are at high risk of emergency hospital admission and often have complex care needs which may not be adequately met by conventional models of acute care. This has driven the introduction of adaptations to acute care pathways designed to improve outcomes in this patient group. The identification of differences in the organisational approach to frailty may highlight opportunities for quality improvement. METHODS The Society for Acute Medicine Benchmarking audit is a national service evaluation which uses a single day-of-care methodology to record patient and organisational level data. All acute hospitals in the United Kingdom are eligible to participate. Emergency admissions referred to acute medical services between 00:00 and 23:59 on Thursday 23rd June 2022 were recorded. Information on the structure and operational design of acute frailty services was collected. The use of a validated frailty assessment tool, clinical frailty scale within the first 24 h of admission, assessment by an acute frailty service and clinical outcomes were reported in patients aged 70 year and above. A mixed effect generalised linear model was used to determine factors associated same-day discharge without overnight stay in patients with frailty. RESULTS A total of 152 hospitals participated. There was significant heterogeneity in the operational design and staffing model of acute frailty services. The presence of an acute frailty unit was reported in 57 (42.2%) hospitals. The use of validated frailty assessment tools was reported in 117 (90.0%) hospitals, of which 107 (91.5%) used the clinical frailty scale. Patient-level data were recorded for 3604 patients aged 70 years and above. At the patient level, 1626 (45.1%) were assessed using a validated tool during the admission process. Assessment by acute frailty services was associated with an increased likelihood of same-day discharge (adjusted OR 1.55, 95%CI 1.03- 2.39). CONCLUSION There is significant variation in the provision of acute frailty services. Frailty-related policies and services are common at the organisational level but implemented inconsistently at the patient level. Older people with frailty or geriatric syndromes assessed by acute frailty services were more likely to be discharged without the need for overnight bed-based admission.
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Affiliation(s)
- Vicky Kamwa
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England
| | - Thomas Knight
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England.
| | - Catherine Atkin
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England
| | - Tim Cooksley
- The Christie NHS Foundation Trust, Manchester, England
| | - Chris Subbe
- School of Medical and Health Sciences, Bangor University, Bangor, Wales
| | - Mark Holland
- School of Clinical and Biomedical Sciences, University of Bolton, Bolton, England
| | - Daniel Lasserson
- Warwick Medical School, University of Warwick, Coventry, England
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England
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Frost R, Robinson K, Gordon A, Caldeira de Melo R, Villas Boas PJF, Azevedo PS, Hinsliff-Smith K, Gavin JP. Identifying and Managing Frailty: A Survey of UK Healthcare Professionals. J Appl Gerontol 2024; 43:402-412. [PMID: 37861268 PMCID: PMC10875903 DOI: 10.1177/07334648231206321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/17/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Frailty is a common condition that leads to multiple adverse outcomes. Frailty should be identified and managed in a holistic, evidence-based and patient-centered way. We aimed to understand how UK healthcare professionals (HCPs) identify and manage frailty in comparison with UK Fit for Frailty guidelines, their frailty training, their confidence in providing support and organizational pathways for this. An online mixed-methods survey was distributed to UK HCPs supporting older people through professional bodies, special interest groups, key contacts, and social media. From 137 responses, HCPs valued frailty assessment but used a mixture of tools that varied by profession. HCPs felt confident managing frailty and referred older people to a wide range of supportive services, but acknowledged a lack of formalized training opportunities, systems, and pathways for frailty management. Clearer pathways, more training, and stronger interprofessional communication, appropriate to each setting, may further support HCPs in frailty management.
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Affiliation(s)
- Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Katie Robinson
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - Adam Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Paula S. Azevedo
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | - Kathryn Hinsliff-Smith
- Leicester School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - James P. Gavin
- School of Health Sciences, University of Southampton, Southampton, UK
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Elias TCN, Jacklin C, Bowen J, Lasserson DS, Pendlebury ST. Care pathways in older patients seen in a multidisciplinary same day emergency care (SDEC) unit. Age Ageing 2024; 53:afad257. [PMID: 38275098 PMCID: PMC10811520 DOI: 10.1093/ageing/afad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Same day emergency care (SDEC) services are being advocated in the UK for frail, older patients in whom hospitalisation may be associated with harm but there are few data on the 'ambulatory pathway'. We therefore determined the patient pathways pre- and post-first assessment in a SDEC unit focussed on older people. METHODS In consecutive patients, we prospectively recorded follow-up SDEC service reviews (face-to-face, telephone, Hospital-at-Home domiciliary visits), outpatient referrals (e.g. to specialist clinics, imaging, and community/voluntary/social services), and hospital admissions <30 days. In the first 67 patients, we also recorded healthcare interactions (except GP attendances) in the 180 days pre- and post-first assessment. RESULTS Among 533 patients (mean/SD age = 75.0/17.5 years, 246, 46% deemed frail) assessed in an SDEC unit, 210 were admitted within 30 days (152 immediately). In the 381(71%) remaining initially ambulatory, there were 587 SDEC follow-up reviews and 747 other outpatient referrals (mean = 3.5 per patient) with only 34 (9%) patients being discharged with no further follow-up. In the subset (n = 67), the number of 'healthcare days' was greater in the 180 days post- versus pre-SDEC assessment (mean/SD = 26/27 versus 13/22 days, P = 0.003) even after excluding hospital admission days, with greater healthcare days in frail versus non-frail patients. DISCUSSION AND CONCLUSION SDEC assessment in older, frail patients was associated with a 2-fold increase in frequency of healthcare interactions with complex care pathways involving multiple services. Our findings have implications for the development of admission-avoidance models including cost-effectiveness and optimal delivery of the multi-dimensional aspects of acute geriatric care in the ambulatory setting.
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Affiliation(s)
- Tania C N Elias
- Departments of Acute Internal Medicine and Older Persons' Services, Great Western Hospital NHS Foundation Trust, Swindon SN3 6BB, UK
| | - Chloe Jacklin
- Departments of Care of the Elderly and Stroke Medicine, North Middlesex University Hospital NHS Trust, Sterling Way, London N18 1QX, UK
| | - Jordan Bowen
- Department of Acute Internal Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Daniel S Lasserson
- Department of Acute Internal Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, Warwick Medical School, University of Warwick, Coventry, Warwickshire CV4 3AL, UK
- Department of Acute Medicine, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Sarah T Pendlebury
- Department of Acute Internal Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, and the University of Oxford, Oxford, UK
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6
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Knight T, Atkin C, Kamwa V, Cooksley T, Subbe C, Holland M, Sapey E, Lasserson D. The impact of frailty and geriatric syndromes on metrics of acute care performance: results of a national day of care survey. EClinicalMedicine 2023; 66:102278. [PMID: 38192597 PMCID: PMC10772156 DOI: 10.1016/j.eclinm.2023.102278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 01/10/2024] Open
Abstract
Background Frailty is associated with a range of adverse clinical outcomes in the acute hospital setting. We sought to determine whether frailty and related factors affected clinical processes such as time to assessment during emergency hospital admission within the National Health Service (NHS) in the UK. Methods The Society for Acute Medicine Benchmarking Audit (SAMBA) is an annual cross-sectional day of care survey. SAMBA 2022 was conducted on Thursday 23rd June 2022. We assessed whether the Clinical Frailty Scale (CFS) and presence of a geriatric syndrome affected performance against nationally recognised clinical quality indicators based on time to initial assessment and time to consultant review. CFS was graded into robust (CFS1-3), mild (CFS 4-5), moderate (CFS 6), severe (CFS7-8) and terminal illness (CFS 9). Plausible values were created for missing variables using multi-level multiple imputation. The association was described using mixed effect generalised linear models adjusting for initial National Early Warning Score 2 (NEWS2) and time of arrival. Findings A total of 152 hospitals provided patient level data relating to 7248 emergency medical admissions. Patients with mild, moderate and severe frailty were less likely to be assessed within 4 h of arrival (adjusted OR, mild 0.79, 95% CI 0.68-0.96, moderate 0.67 95% CI 0.53-0.84, severe, 0.75 95% CI 0.58-0.96, terminally ill 0.59 95% CI 0.23-1.43) and less likely to be achieve the clinical quality indicator for consultant review (adjusted OR, mild 0.69 95% CI 0.58-0.83, moderate 0.55 95% CI 0.44-0.70, severe 0.54 95% CI 0.41-0.69, terminally ill 0.76 95% CI 0.42-1.5). Patients with geriatric syndromes were also less likely to be assessed within 4 h of arrival (adjusted OR 0.66 95% CI 0.56-0.76) or by a consultant within the recommended time frame (adjusted OR 0.45 95% CI 0.39-0.51). The difference was partially explained by differential use of SDEC pathways. Sub-group analysis of 5148 patients assessed outside of SDEC areas demonstrated patients with geriatric syndromes (adjusted OR 0.71, 95% CI 0.60-0.83), but not frailty defined by CFS were less likely to be assessed within 4 h of arrival. Moderate and severe frailty and the presence of a geriatric syndrome were associated with a decreased likelihood of achieving the consultant review standard (moderate, adjusted OR 0.75, 95% CI 0.59-0.94, severe adjusted OR 0.75 95% CI 0.58-0.96, geriatric syndrome adjusted OR 0.59, 95% CI 0.50-0.69). Interpretation Frailty is associated with delayed clinical assessment. This association may suggest a systemic issue with clinical prioritisation, with important implications for acute care policy. Funding The database for SAMBA is funded by the Society for Acute Medicine.
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Affiliation(s)
- Thomas Knight
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, UK
| | - Catherine Atkin
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, UK
| | - Vicky Kamwa
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, UK
| | - Tim Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - Chris Subbe
- School of Medical and Health Sciences, Bangor University, UK
| | - Mark Holland
- School of Clinical and Biomedical Sciences, University of Bolton, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, UK
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Hörlin E, Munir Ehrlington S, Toll John R, Henricson J, Wilhelms D. Is the clinical frailty scale feasible to use in an emergency department setting? A mixed methods study. BMC Emerg Med 2023; 23:124. [PMID: 37880591 PMCID: PMC10601295 DOI: 10.1186/s12873-023-00894-8] [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: 08/07/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is a frailty assessment tool used to identify frailty in older patients visiting the emergency department (ED). However, the current understanding of how it is used and accepted in ED clinical practice is limited. This study aimed to assess the feasibility of CFS in an ED setting. METHODS This was a prospective, mixed methods study conducted in three Swedish EDs where CFS had recently been introduced. We examined the completion rate of CFS assessments in relation to patient- and organisational factors. A survey on staff experience of using CFS was also conducted. All quantitative data were analysed descriptively, while free text comments underwent a qualitative content analysis. RESULTS A total of 4235 visits were analysed, and CFS assessments were performed in 47%. The completion rate exceeded 50% for patients over the age of 80. Patients with low triage priority were assessed to a low degree (24%). There was a diurnal variation with the highest completion rates seen for arrivals between 6 and 12 a.m. (58%). The survey response rate was 48%. The respondents rated the perceived relevance and the ease of use of the CFS with a median of 5 (IQR 2) on a scale with 7 being the highest. High workload, forgetfulness and critical illness were ranked as the top three barriers to assessment. The qualitative analysis showed that CFS assessments benefit from a clear routine and a sense of apparent relevance to emergency care. CONCLUSION Most emergency staff perceived CFS as relevant and easy to use, yet far from all older ED patients were assessed. The most common barrier to assessment was high workload. Measures to facilitate use may include clarifying the purpose of the assessment with explicit follow-up actions, as well as formulating a clear routine for the assessment. REGISTRATION The study was registered on ClinicalTrials.gov 2021-06-18 (identifier: NCT04931472).
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Affiliation(s)
- Erika Hörlin
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Samia Munir Ehrlington
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rani Toll John
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Joakim Henricson
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Daniel Wilhelms
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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da Costa Pereira JP, Diniz ADS, de Lemos MCC, Pinho Ramiro CPS, Cabral PC. Frailty but not low muscle quality nor sarcopenia is independently associated with mortality among previously hospitalized older adults: A prospective study. Geriatr Gerontol Int 2023; 23:736-743. [PMID: 37691481 DOI: 10.1111/ggi.14660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Abstract
AIM There are few studies comparing the effects of geriatric syndromes and abnormalities in nutritional status and body composition on outcomes among older individuals who have been previously hospitalized. Our study aimed to evaluate the frequency and diagnosis of geriatric syndromes, low muscle quality, and nutritional status in hospitalized older individuals, and to examine their impact on both short- and long-term outcomes. METHODS This was a prospective study involving older adults (≥60 years). We assessed nutritional status, muscle quality, sarcopenia, and frailty. The outcomes were functional dependence, length of hospital stay, transfer to the Intensive Care Unit, number of readmissions, and mortality. Multivariate analysis was conducted to identify independent risk factors. RESULTS Even after adjustment for age and sex, increased risk of death was associated with possible undernourishment, sarcopenia, low muscle quality, and frailty (P < 0.05), but not the length of hospital stay (P > 0.05). Our multivariate analysis showed that frailty was independently associated with mortality and functional dependence. Low muscle quality was independently associated with functional dependence. CONCLUSIONS Geriatric syndromes, abnormalities in body composition, and the overall nutritional status of older patients are important risk factors for adverse outcomes, including functional dependence and mortality. These findings emphasize the need for interventions to improve muscle quality, prevent and treat malnutrition and sarcopenia, and address frailty in hospitalized patients. Geriatr Gerontol Int 2023; 23: 736-743.
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9
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McAdams-DeMarco MA, Thind AK, Nixon AC, Woywodt A. Frailty assessment as part of transplant listing: yes, no or maybe? Clin Kidney J 2023; 16:809-816. [PMID: 37151416 PMCID: PMC10157764 DOI: 10.1093/ckj/sfac277] [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: 10/04/2022] [Indexed: 12/31/2022] Open
Abstract
Frailty, characterized by a decreased physiological reserve and an increased vulnerability to stressors, is common among kidney transplant (KT) candidates and recipients. In this review, we present and summarize the key arguments for and against the assessment of frailty as part of KT evaluation. The key arguments for including frailty were: (i) sheer prevalence and far-reaching consequences of frailty on KT, and (ii) the ability to conduct a more holistic and objective evaluation of candidates, removing the inaccuracy associated with 'eye-ball' assessments of transplant fitness. The key argument against were: (i) lack of agreement on the definition of frailty and which tools should be used in renal populations, (ii) a lack of clarity on how, by whom and how often frailty assessments should be performed, and (iii) a poor understanding of how acute stressors affect frailty. However, it is the overwhelming opinion that the time has come for frailty assessments to be incorporated into KT listing. Although ongoing areas of uncertainty exist and further evidence development is needed, the well-established impact of frailty on clinical and experiential outcomes, the invaluable information obtained from frailty assessments, and the potential for intervention outweigh these limitations. Proactive and early identification of frailty allows for individualized and improved risk assessment, communication and optimization of candidates.
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Affiliation(s)
- Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Amarpreet K Thind
- Division of Immunology and Inflammation, Department of Medicine, Centre for Inflammatory Disease, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Manchester, UK
| | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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10
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Bart NK, Powell A, Macdonald PS. The role of frailty in advanced HF and cardiac transplantation. Front Cardiovasc Med 2023; 10:1082371. [PMID: 37077743 PMCID: PMC10106718 DOI: 10.3389/fcvm.2023.1082371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Frailty is a complex, multi-system condition often associated with multimorbidity. It has become an important prognostic maker across a range of conditions and is particularly relevant in patients with cardiovascular disease. Frailty encompasses a range of domains including, physical, psychological, and social. There are currently a range of validated tools available to measure frailty. It is an especially important measurement in advanced HF, because frailty occurs in up to 50% of HF patients and is potentially reversible with therapies such as mechanical circulatory support and transplantation. Moreover, frailty is dynamic, and therefore serial measurements are important. This review delves into the measurement of frailty, mechanisms, and its role in different cardiovascular cohorts. Understanding frailty will help determine patients that will benefit from therapies, as well as prognosticate outcomes.
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Affiliation(s)
- Nicole K. Bart
- Heart Transplant Program, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Infiltrative Cardiomyopathy Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- Correspondence: Nicole K. Bart
| | - Alice Powell
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Peter S. Macdonald
- Heart Transplant Program, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Infiltrative Cardiomyopathy Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Dean J, Jones M, Dyer P, Moulton C, Price V, Lasserson D. Possible futures of acute medical care in the NHS: a multispecialty approach. Future Healthc J 2022; 9:125-132. [DOI: 10.7861/fhj.2022-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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