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Kim SE, Azarian M, Naik AD, Park C, Horstman MJ, Virani SS, Intrator O, Amos CI, Orkaby A, Razjouyan J. What is the additive value of nutritional deficiency to VA-FI in the risk assessment for heart failure patients? J Nutr Health Aging 2024; 28:100253. [PMID: 38692206 DOI: 10.1016/j.jnha.2024.100253] [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: 02/16/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To assess the impact of adding the Prognostic Nutritional Index (PNI) to the U.S. Veterans Health Administration frailty index (VA-FI) for the prediction of time-to-death and other clinical outcomes in Veterans hospitalized with Heart Failure. METHODS A retrospective cohort study of veterans hospitalized for heart failure (HF) from October 2015 to October 2018. Veterans ≥50 years with albumin and lymphocyte counts, needed to calculate the PNI, in the year prior to hospitalization were included. We defined malnutrition as PNI ≤43.6, based on the Youden index. VA-FI was calculated from the year prior to the hospitalization and identified three groups: robust (≤0.1), prefrail (0.1-0.2), and frail (>0.2). Malnutrition was added to the VA-FI (VA-FI-Nutrition) as a 32nd deficit with the total number of deficits divided by 32. Frailty levels used the same cut-offs as the VA-FI. We compared categories based on VA-FI to those based on VA-FI-Nutrition and estimated the hazard ratio (HR) for post-discharge all-cause mortality over the study period as the primary outcome and other adverse events as secondary outcomes among patients with reduced or preserved ejection fraction in each VA-FI and VA-FI-Nutrition frailty groups. RESULTS We identified 37,601 Veterans hospitalized for HF (mean age: 73.4 ± 10.3 years, BMI: 31.3 ± 7.4 kg/m2). In general, VA-FI-Nutrition reclassified 1959 (18.6%) Veterans to a higher frailty level. The VA-FI identified 1,880 (5%) as robust, 8,644 (23%) as prefrail, and 27,077 (72%) as frail. The VA-FI-Nutrition reclassified 382 (20.3%) from robust to prefrail and 1577 (18.2%) from prefrail to frail creating the modified-prefrail and modified-frail categories based on the VA-FI-Nutrition. We observed shorter time-to-death among Veterans reclassified to a higher frailty status vs. those who remained in their original group (Median of 2.8 years (IQR:0.5,6.8) in modified-prefrail vs. 6.3 (IQR:1.8,6.8) years in robust, and 2.2 (IQR:0.7,5.7) years in modified-frail vs. 3.9 (IQR:1.4,6.8) years in prefrail). The adjusted HR in the reclassified groups was also significantly higher in the VA-FI-Nutrition frailty categories with a 38% increase in overall all-cause mortality among modified-prefrail and a 50% increase among modified-frails. Similar trends of increasing adverse events were also observed among reclassified groups for other clinical outcomes. CONCLUSION Adding PNI to VA-FI provides a more accurate and comprehensive assessment among Veterans hospitalized for HF. Clinicians should consider adding a specific nutrition algorithm to automated frailty tools to improve the validity of risk prediction in patients hospitalized with HF.
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Affiliation(s)
- Seulgi Erica Kim
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA.
| | - Mehrnaz Azarian
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA.
| | - Aanand D Naik
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA; University of Texas School of Public Health and UTHealth Consortium on Aging, Houston, TX, USA.
| | - Catherine Park
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA; Division of Digital Healthcare, Yonsei University, Wonju, 26493, South Korea.
| | - Molly J Horstman
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA.
| | - Salim S Virani
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA
| | - Orna Intrator
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, NY, USA; Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, USA.
| | | | - Ariela Orkaby
- New England Geriatrics Research, Education, and Clinical Center, Boston VA Health Care System, Boston, MA, USA; Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Javad Razjouyan
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA.
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Orkaby AR, Thomson A, MacFadyen J, Besdine R, Forman DE, Travison TG, Ridker PM. Effect of canakinumab on frailty: A post hoc analysis of the CANTOS trial. Aging Cell 2024; 23:e14029. [PMID: 37927208 PMCID: PMC10776110 DOI: 10.1111/acel.14029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Although inflammation is strongly associated with frailty, whether medications that lower inflammation decrease frailty is unclear and randomized trial evidence is scant. We sought to test whether canakinumab, a therapeutic monoclonal antibody that inhibits IL-1β and reduces C-reactive protein (CRP), can lower frailty risk. This was a post hoc analysis of the Canakinumab ANti-inflammatory Thrombosis Outcome Study (CANTOS), a randomized double-blind placebo-controlled trial of 10,061 stable postmyocardial infarction patients randomized to subcutaneous canakinumab once every 3 months. Incident frailty was measured using a 34-item cumulative-deficit Frailty Index (FI). Time-to-event analysis using intent to treat. A total of 9942 CANTOS participants had data to calculate a baseline FI. Median age was 61 (IQR 54-68); 74% were male, 12% Asian, 3% Black, 80% White, and 16% Hispanic/Latino. At baseline, mean FI score was 0.12 and 13% were frail using a cutoff of 0.2. Over 5 years, 1080 participants (12.5%) became frail and mean FI scores increased to 0.14. There was no effect on frailty incidence according to randomization to any canakinumab dose versus placebo over time, HR 1.03 (0.91-1.17), p = 0.63. Results were similar using phenotypic frailty. Additionally, the primary findings of CANTOS in terms of canakinumab-associated cardiovascular event reduction were unchanged in analyses stratified by baseline frailty. In conclusion, among stable adult patients with atherosclerosis, random allocation to interleukin-1b inhibition with canakinumab versus placebo did not lower risk of incident frailty over 5 years. More randomized data are needed to understand the role of targeted anti-inflammatory medications for frailty prevention in older adults.
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Affiliation(s)
- Ariela R. Orkaby
- New England GRECC (Geriatric Research, Education, and Clinical Center)VA Boston Healthcare SystemBostonMassachusettsUSA
- Division of Aging, Brigham & Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Aerin Thomson
- Center for Cardiovascular Disease Prevention and Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Jean MacFadyen
- Center for Cardiovascular Disease Prevention and Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Richard Besdine
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Daniel E. Forman
- Section of Geriatric Cardiology, Department of Medicine (Divisions of Geriatrics and Cardiology)University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Geriatric Research, Education, and Clinical CenterVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Thomas G. Travison
- Marcus Institute for Aging Research, Hebrew SeniorLifeHarvard Medical SchoolBostonMassachusettsUSA
| | - Paul M. Ridker
- Center for Cardiovascular Disease Prevention and Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
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O’Donovan MR, Devleesschauwer B, Sezgin D, Liew A, Kabir Z, O’Caoimh R. Comparing frailty prevalence between countries: validation of the Global Burden of Disease study Frailty Index (GBD-FI) in the survey of health, ageing and retirement in Europe. Age Ageing 2023; 52:afad214. [PMID: 38029517 PMCID: PMC11004790 DOI: 10.1093/ageing/afad214] [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: 04/26/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Accurate comparable prevalence proportions are required to better understand the epidemiology of frailty. Estimates in many countries are missing or incomparable. The Global Burden of Disease Frailty Index (GBD-FI) applies the deficit accumulation model to generate frailty scores from items available in the Global Burden of Disease study. OBJECTIVE To externally validate the GBD-FI. METHODS Data were obtained from the Survey of Health Ageing and Retirement in Europe (SHARE). A 20-item modified GBD-FI was compared with established frailty measures: a 70-item frailty index (FI-70), the Clinical Frailty Scale (CFS), Frailty Phenotype (FP) and SHARE-FI. Area under receiver operating characteristic curves (AUC) were fitted to examine diagnostic accuracy for frailty and predictive validity for 2-year mortality. RESULTS In total, 31,624 participants aged ≥50 years from 15 countries were included. Frailty prevalence was 22% using the GBD-FI (ranging from 8% in Switzerland to 41% in Poland). The GBD-FI had good to excellent diagnostic accuracy for frailty, irrespective of approach; the AUC ranged from 0.86 (95% confidence interval: 0.85-0.87) measuring frailty using the CFS to 0.94 (0.93-0.94) with the FI-70. The GBD-FI had similar accuracy for 2-year mortality (AUC 0.71, 0.69-0.74) compared with the CFS (0.73; P = 0.186), FP (0.73; P = 0.392) and SHARE-FI (0.70; P = 0.255) but lower than the FI-70 (0.76; P < 0.001). CONCLUSION The GBD-FI demonstrated concurrent and predictive validity, suggesting it is a valid measure of frailty. It has the potential to be an efficient, replicable and consistent approach to comparing frailty between countries and regions across time using GBD data.
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Affiliation(s)
- Mark R O’Donovan
- Health Research Board Clinical Research Facility, University College Cork, Mercy University Hospital, Cork City, Ireland
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Duygu Sezgin
- School of Nursing and Midwifery, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Aaron Liew
- School of Nursing and Midwifery, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Ireland
| | - Zubair Kabir
- Department of Epidemiology & Public Health, School of Public Health, University College Cork, Cork City, Ireland
| | - Rónán O’Caoimh
- Health Research Board Clinical Research Facility, University College Cork, Mercy University Hospital, Cork City, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Cork City, Ireland
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Nakashima H, Nagae M, Komiya H, Fujisawa C, Watanabe K, Yamada Y, Tajima T, Miyahara S, Sakai T, Umegaki H. Combined use of the Clinical Frailty Scale and laboratory tests in acutely hospitalized older patients. Aging Clin Exp Res 2023; 35:1927-1935. [PMID: 37378813 DOI: 10.1007/s40520-023-02477-w] [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: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
AIMS To evaluate the Clinical Frailty Scale (CFS) and a Frailty Index based on laboratory tests (FI-lab) in terms of what each assesses about frailty and to determine the appropriateness of combined use of these two frailty scales. METHODS This was a prospective observational cohort study in an acute geriatric ward of a university hospital. The FI-lab is the proportion of laboratory parameters that yield abnormal results from a total of 23. The FI-lab and CFS were assessed at admission. Data on activities of daily living (ADL), cognition, geriatric syndromes, and comorbidities were also collected. Main outcomes were in-hospital mortality and 90-day mortality after admission. RESULTS In total, 378 inpatients (mean age 85.2 ± 5.8 years, 59.3% female) were enrolled. ADL and cognition correlated strongly with the CFS (Spearman's |r|> 0.60) but weakly with the FI-lab (|r|< 0.30). Both the CFS and FI-lab correlated weakly with geriatric syndromes and comorbidities (|r|< 0.40). The correlation between the CFS and FI-lab was also weak (r = 0.28). The CFS and FI-lab were independently associated with in-hospital mortality and 90-day mortality after admission. The Akaike information criterion was lower for models using both the CFS and FI-lab than for models using either tool alone. CONCLUSIONS The CFS and FI-lab each reflected only some of the aspects of frailty in acutely hospitalized older patients. The model fit was better when the two frailty scales were used together to assess the mortality risk than when either was used alone.
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Affiliation(s)
- Hirotaka Nakashima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan.
| | - Masaaki Nagae
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Hitoshi Komiya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Chisato Fujisawa
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Kazuhisa Watanabe
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Yosuke Yamada
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Tomihiko Tajima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Shuzo Miyahara
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Tomomichi Sakai
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
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Zhao H, Tu J, She Q, Li M, Wang K, Zhao W, Huang P, Chen B, Wu J. Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study. BMC Geriatr 2023; 23:308. [PMID: 37198576 DOI: 10.1186/s12877-023-04029-3] [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: 11/12/2022] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Frailty is associated with poor prognosis in a wide range of illnesses. However, its prognostic implications for older patients with community-acquired pneumonia (CAP) are not adequately addressed. METHODS In this study, patients were classified into 3 groups according to the frailty index based on standard laboratory tests (FI-Lab) score: robust (FI-Lab < 0.2), pre-frail (FI-Lab 0.2-0.35), and frail (FI-Lab ≥ 0.35). The relationships between frailty and all-cause mortality and short-term clinical outcomes (length of stay, duration of antibiotic therapy, in-hospital mortality) were examined. RESULTS Finally, 1164 patients were included, the median age was 75 years (interquartile range: 69, 82), and 438 patients (37.6%) were women. According to FI-Lab, 261(22.4%), 395(33.9%), and 508(43.6%) were robust, pre-frail, and frail. After adjustment for confounding variables, frailty was independently associated with prolonged antibiotic treatment (p = 0.037); pre-frailty and frailty were independently associated with longer inpatient days (p < 0.05 for both). The risk of in-hospital mortality was independently increased in frail patients (HR = 5.01, 95% CI = 1.51-16.57, p = 0.008) but not pre-frail patients (HR = 2.87, 95% CI = 0.86-9.63, p = 0.088) compared to robust patients. During a median follow-up of 33.9 months (interquartile range: 32.8 to 35.1 months), 408 (35.1%) patients died, of whom 29 (7.1%) were robust, 112 (27.5%) were pre-frail, and 267 (65.9%) were frail. Compared to robust patients, frail and pre-frail were significantly associated with increased risk for all-cause death (HR = 4.29, 95%CI: 1.78-10.35 and HR = 2.42 95%CI: 1.01-5.82, respectively). CONCLUSIONS Frailty is common among older patients with CAP and is strongly associated with increased mortality, longer length of stay, and duration of antibiotics. A routine frail assessment at the admission of elderly patients with CAP is necessary as the first step for appropriate multidisciplinary interventions.
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Affiliation(s)
- Hongye Zhao
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
- Department of General Practice, The First People's Hospital of Lianyungang, Lianyungang Clinical College of Nanjing Medical Unversity, Lianyungang, 222000, China
| | - Junlan Tu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Quan She
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Min Li
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Kai Wang
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Weihong Zhao
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Peng Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Bo Chen
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China.
| | - Jianqing Wu
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China.
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Hakeem FF, Maharani A, Todd C, O'Neill TW. Development, validation and performance of laboratory frailty indices: A scoping review. Arch Gerontol Geriatr 2023; 111:104995. [PMID: 36963345 DOI: 10.1016/j.archger.2023.104995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Frailty is a syndrome characterised by decline in functional ability and increasing vulnerability to disease and associated with adverse outcomes. Several established methods exist for assessing frailty. This scoping review aims to characterise the development and validation of frailty indices based on laboratory test results (FI-Lab) and to assess their utility. METHODS Studies were included in the review if they included data concerning the development and/or testing an FI-Lab using the deficit accumulation method. Studies were identified using PubMed/MEDLINE, Embase (Elsevier), OpenGrey and Google Scholar from 2010 to 2021. Two reviewers independently screened all abstracts, and those that met the inclusion criteria were reviewed in detail. Data extracted included details about the study characteristics, number, type and coding of laboratory variables included, validation, and outcomes. A narrative synthesis of the available evidence was adopted. RESULTS The search yielded 915 articles, of which 29 studies were included. In general, 89% of studies were conducted after 2016 and 51% in a hospital-based setting. The number of variables included in FI-Labs ranged from 13 to 77, and 51% included some non-laboratory variables in their indices, with pulse and blood pressure being the most frequent. The validity of FI-Lab was demonstrated through change with age, correlation with established frailty indices and association with adverse health outcomes. The most frequent outcome studied was mortality (79% of the studies), with FI-Lab associated with increased mortality in all but one. Other outcomes studied included self-reported health, institutionalisation, and activities of daily living. The effect of combining the FI-Lab with a non-laboratory-based FI was assessed in 7 studies with a marginal increase in predictive ability. CONCLUSION Frailty indices constructed based on the assessment of laboratory variables, appear to be a valid measure of frailty and robust to the choice of variables included.
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Affiliation(s)
- Faisal F Hakeem
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, AlMadinah AlMunawwarah, Saudi Arabia; Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK.
| | - Asri Maharani
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, UK; Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK
| | - Chris Todd
- School of Health Sciences, The University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK; NIHR Applied Research Collaboration- Greater Manchester, Manchester, UK
| | - Terence W O'Neill
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK
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Lekan D, McCoy TP, Jenkins M, Mohanty S, Manda P. Using EHR Data to Identify Patient Frailty and Risk for ICU Transfer. West J Nurs Res 2023; 45:242-252. [PMID: 36112762 DOI: 10.1177/01939459221123162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The predictive properties of four definitions of a frailty risk score (FRS) constructed using combinations of nursing flowsheet data, laboratory tests, and ICD-10 codes were examined for time to first intensive care unit (ICU) transfer in medical-surgical inpatients ≥50 years of age. Cox regression modeled time to first ICU transfer and Schemper-Henderson explained variance summarized predictive accuracy of FRS combinations. Modeling by age group and controlling for sex, all FRS measures significantly predicted time to first ICU transfer. Further multivariable modeling controlling for clinical characteristics substantially improved predictive accuracy. The effect of frailty on time to first ICU transfer depended on age, with highest risk in 50 to <60 years and ≥80 years age groups. Frailty prevalence ranged from 25.1% to 56.4%. Findings indicate that FRS-based frailty is a risk factor for time to first ICU transfer and should be considered in assessment and care-planning to address frailty in high-risk patients.Frailty prevalence was highest med-surg pts 60 to <70 years (56%); highest risk for time to first ICU transfer was in younger (50 to <60 years) and older (≥80 years) groups.
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Affiliation(s)
- Deborah Lekan
- Wellcare Dynamics, University of North Carolina at Greensboro, Retired, Chapel Hill, NC, USA
| | - Thomas P McCoy
- School of Nursing, University of North Carolina at Greensboro, NC, USA
| | | | - Somya Mohanty
- Department of Computer Science, University of North Carolina at Greensboro, NC, USA
| | - Prashanti Manda
- Department of Informatics and Analytics, University of North Carolina at Greensboro, NC, USA
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Welford J, Rafferty R, Short D, Dewhurst F, Greystoke A. Personalised Assessment and Rapid Intervention in Frail Patients with Lung Cancer: The Impact of an Outpatient Occupational Therapy Service. Clin Lung Cancer 2023:S1525-7304(23)00051-7. [PMID: 37068994 DOI: 10.1016/j.cllc.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Lung cancer and its treatments cause or accelerate frailty, detrimentally affecting function and quality of life. Occupational therapists (OTs) provide global assessments and interventions, but services are often available for inpatients. The impact of holistic assessment and early intervention in the outpatient setting is unknown. MATERIALS AND METHODS A tertiary cancer center in North East England piloted a Lung Cancer Outpatient OT Service for patients with thoracic malignancy and a Clinical Frailty Scale Score (CFS) ≥ 5. Service effectiveness was evaluated through calculation of admission avoidance, hospital length-of-stay reduction, completion/impact of advance care planning and patient/family feedback. Demographics, frailty level, required interventions, and onward referrals were recorded. RESULTS A total of 153 patients (median age of 71 (range 46-90) received OT assessment and intervention. 48% were in the lowest socioeconomic quintile. Median CFS score was 5 (mildly frail (range: 4-7)) at initial assessment. Total of 918 interventions were delivered (median: 5, IQR: 3-7, Range 0-22). 48% of patients engaged in future planning (national average: 10%-15% P < .0001) and 78.5% achieved preferred place of death (national average 30%). An estimated 37 hospital admissions were avoided. In admitted patients, average inpatient stay when known to the service was 6.5 days less than other frail lung cancer patients in our unit (95% CI 4-9.1 days P < .0001). Higher CFS was associated with poor survival (P < .05). CONCLUSION Outpatient OT services can avoid and shorten hospital admissions through advance care planning, management of functional disruption, onward referral to other allied health professionals and palliative care. A comprehensive multidisciplinary outpatient service may benefit patients further and should be the focus of future research.
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Falk Erhag H, Guðnadóttir G, Alfredsson J, Cederholm T, Ekerstad N, Religa D, Nellgård B, Wilhelmson K. The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings - A Systematic Review of the Literature. Clin Interv Aging 2023; 18:249-261. [PMID: 36843633 PMCID: PMC9946013 DOI: 10.2147/cia.s388160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/14/2022] [Indexed: 02/19/2023] Open
Abstract
Background Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill. Purpose To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings. Design Systematic review with narrative synthesis. Methods Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020. Results Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review. Conclusion A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.
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Affiliation(s)
- Hanna Falk Erhag
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden,Correspondence: Hanna Falk Erhag, Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Wallinsgatan 6, Gothenburg, SE 431 41, Sweden, Tel +46 760 476888, Fax +46 31 786 60 77, Email
| | - Gudny Guðnadóttir
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Ekerstad
- Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden,The Research and Development Unit, NU Hospital Group, Trollhättan, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences, and Society, Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden,Division for Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Studies, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Wilhelmson
- Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Sapp DG, Cormier BM, Rockwood K, Howlett SE, Heinze SS. The frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis. Age Ageing 2023; 52:afac309. [PMID: 36626319 PMCID: PMC9831271 DOI: 10.1093/ageing/afac309] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 01/11/2023] Open
Abstract
The frailty index (FI) quantifies frailty as deficit accumulation. It has been adapted to employ laboratory test data (FI-Lab). Our objective was to systematically review and meta-analyse the FI-Lab's ability to predict mortality. Secondary objectives were to review the FI-Lab's association with adverse health outcomes and whether FI-Lab scores differed between the sexes. A systematic literature search was carried out using six online databases to identify studies that measured the FI-Lab in humans. Hazard ratios (HRs) were combined in a meta-analysis to create a pooled risk estimate for mortality. Of the 1,201 papers identified, spanning January 2010 until 11 July 2022, 38 were included. FI-Lab scores per 0.01 unit increase predicted mortality overall (HR = 1.04; 95% confidence interval (CI) = 1.03-1.05) and for studies with a mean age of 81+ years (HR = 1.04; 95% CI = 1.03-1.05). The quality of evidence for these meta-analyses are moderate and high, respectively. Further, higher FI-Lab scores were associated with more frequent adverse health outcomes. Sex differences in FI-Lab scores varied, with no consistent indication of a sex effect. The FI-Lab is associated with mortality and with a variety of adverse health outcomes. No consistent sex differences in FI-Lab scores were observed, with several studies in disagreement. Notably, these conclusions were most relevant to older (65+ years old) individuals; further evidence in younger people is needed in both clinical and population representative studies.
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Affiliation(s)
- David G Sapp
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Brianna M Cormier
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Kenneth Rockwood
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Stefan S Heinze
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
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11
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Lin Y, Shi X, Huang L, Chen A, Zhu H. Frailty Index was Associated With Adverse Outcomes in Admitted Elderly Patients With Type 2 Diabetes Mellitus. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231201022. [PMID: 37724847 PMCID: PMC10510342 DOI: 10.1177/00469580231201022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/20/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
We aimed to investigate the role of the laboratory frailty index (LFI) in diabetic complications and incident disability in admitted older patients with type 2 diabetes mellitus (T2DM). We retrospectively collected the clinical data of older patients with T2DM from December 2018 to May 2020. Frailty was quantified using the LFI, which considers the accumulation of 27 items of abnormal laboratory outcomes. Univariate and multivariate analyses were performed to evaluate the relationship between LFI and diabetes-related adverse outcomes. In total, 293 consecutive older patients with T2DM were recruited for this study. According to the predefined LFI criteria, 110 (37.5%) participants were non-frail, 131 (44.7%) were prefrail, and 52 (17.8%) were frail. Univariate and multivariate analysis revealed that LFI was associated with the diabetic microangiopathy complications (odds ratio for prefrail [ORprefrail] 1.760, 95% confidence interval for prefrail [CIprefrail] 1.019-3.041, P = .043; ORfrail 4.667, 95% CIfrail 2.012-10.826, P < .001) and activities of daily living (ADL) disability (ORprefrail 2.323, 95% CIprefrail 1.209-4.463, P = .011; ORfrail 9.367, 95% CIfrail 4.030-21.775, P < .001), but not with the diabetic macroangiopathy complications and diabetic peripheral neuropathy. Frailty, as determined by the LFI, was proven to be an effective tool for the prediction of diabetic microangiopathy complications and ADL disability.
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Affiliation(s)
- Yi Lin
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
| | - Xiaochong Shi
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
| | - Lingling Huang
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
| | - Aixia Chen
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
| | - Haihui Zhu
- Department of Endocrinology, The Third Affiliated Hospital of Shanghai University, Wenzhou People’s Hospital, Zhejiang, China
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12
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Resendes NM, Chada A, Torres-Morales A, Fernandez M, Diaz-Quiñones A, Gomez C, Oomrigar S, Burton L, Ruiz JG. Association between a Frailty Index from Common Laboratory Values and Vital Signs (FI-LAB) and Hospital and Post-Hospital Outcomes in Veterans with COVID-19 Infection. J Nutr Health Aging 2023; 27:89-95. [PMID: 36806863 PMCID: PMC9893965 DOI: 10.1007/s12603-023-1886-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Determine the association of higher FI-LAB scores, derived from common laboratory values and vital signs, with hospital and post-hospital outcomes in Veterans hospitalized with COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter, cohort study of 7 Veterans Health Administration (VHA) medical centers in Florida and Puerto Rico. Patients aged 18 years and older hospitalized with COVID-19 and followed for up to 1 year post discharge or until death. Clinical Frailty Measure: FI-LAB. MAIN OUTCOMES AND MEASURES Hospital and post-hospital outcomes. RESULTS Of the 671 eligible patients, 615 (91.5%) patients were included (mean [SD] age, 66.1 [14.8] years; 577 men [93.8%]; median stay, 8 days [IQR:3-15]. There were sixty-one in-hospital deaths. Veterans in the moderate and high FI-LAB groups had a higher proportion of inpatient mortality (13.3% and 20.6%, respectively) than the low group (4.1%), p <0.001. Moderate and high FI-LAB scores were associated with greater inpatient mortality when compared to the low group, OR:3.22 (95%CI:1.59-6.54), p=.001 and 6.05 (95%CI:2.48-14.74), p<0.001, respectively. Compared with low FI-LAB scores, moderate and high scores were also associated with prolonged length of stay, intensive care unit (ICU) admission, and transfer. CONCLUSIONS AND RELEVANCE In this study of patients admitted to 7 VHA Hospitals during the first surge of the pandemic, higher FI-LAB scores were associated with higher in-hospital mortality and other in-hospital outcomes; FI-LAB can serve as a validated, rapid, feasible, and objective frailty tool in hospitalized adults with COVID-19 that can aid clinical care.
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Affiliation(s)
- N M Resendes
- Natasha Melo Resendes, Miami VA Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), GRECC (11GRC), Bruce W. Carter Miami VAMC, 1201 NW 16th Street, Miami, Florida 33125, USA, Telephone: (305) 575-3388 / Fax: (305) 575-3365, E-mail: , ORCID: 0000-0003-2867-7227
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13
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Welford J, Rafferty R, Hunt K, Short D, Duncan L, Ward A, Rushton C, Todd A, Nair S, Hoather T, Clarke M, Dawes L, Anderson V, Pelham A, Lowe H, Dewhurst F, Greystoke A. The Clinical Frailty Scale can indicate prognosis and care requirements on discharge in oncology and haemato-oncology inpatients: A cohort study. Eur J Cancer Care (Engl) 2022; 31:e13752. [PMID: 36286099 PMCID: PMC9788118 DOI: 10.1111/ecc.13752] [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: 03/30/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Routinely used performance status scales, assessing patients' suitability for cancer treatment, have limited ability to account for multimorbidity, frailty and cognition. The Clinical Frailty Scale (CFS) is a suggested alternative, but research detailing its use in oncology is limited. This study aims to evaluate if CFS is associated with prognosis and care needs on discharge in oncology inpatients. METHODS We evaluated a large, single-centre cohort study in this research. CFS was recorded for adult inpatients at a Regional Cancer Centre. The associations between CFS, age, tumour type, discharge destination and care requirements and survival were evaluated. RESULTS AND CONCLUSIONS A total of 676 patients were included in the study. Levels of frailty were high (Median CFS 6, 81.8% scored ≥5) and CFS correlated with performance status (R = 0.13: P = 0.047). Patients who were frail (CFS ≥ 5) were less likely to be discharged home (62.9%) compared with those who were not classed as frail (86.1%) (OR 3.6 [95%CI 2.1 to 6.3]: P < 0.001). Higher CFS was significantly associated with poorer prognosis in all ages. Solid organ malignancy (hazard ratio [HR] 2.60 [95%CI 2.05-3.32]) and CFS (HR 1.43 [95%CI 1.29-1.59]; P < 0.001) were independently associated with poorer survival. This study demonstrated that CFS may help predict prognosis in adult oncology inpatients of any age. This may aid informed shared decision-making in this setting. Future work should establish if routine CFS measurement can aid the appropriate prescription of systemic therapy and enable early conversations about discharge planning.
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Affiliation(s)
- Jenny Welford
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Raigan Rafferty
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Katherine Hunt
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - David Short
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Louise Duncan
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Ann Ward
- Department of Respiratory MedicineNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Christine Rushton
- Department of Respiratory MedicineNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Adam Todd
- Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
| | - Smeera Nair
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Thomas Hoather
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Miranda Clarke
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Lydia Dawes
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Victoria Anderson
- Department of Respiratory MedicineNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Anne Pelham
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Hannah Lowe
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Felicity Dewhurst
- Population Health SciencesNewcastle UniversityNewcastle upon TyneUK,St Oswald's HospiceNewcastle upon TyneUK
| | - Alastair Greystoke
- Northern Centre for Cancer CareNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK,Newcastle University Centre for CancerNewcastle UniversityNewcastle upon TyneUK
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14
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Ysea-Hill O, Gomez CJ, Mansour N, Wahab K, Hoang M, Labrada M, Ruiz JG. The association of a frailty index from laboratory tests and vital signs with clinical outcomes in hospitalized older adults. J Am Geriatr Soc 2022; 70:3163-3175. [PMID: 35932256 DOI: 10.1111/jgs.17977] [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: 10/30/2021] [Revised: 06/19/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty, a state of vulnerability to stressors resulting from loss of physiological reserve due to multisystemic dysfunction, is common among hospitalized older adults. Hospital clinicians need objective and practical instruments that identify older adults with frailty. The FI-LAB is based on laboratory values and vital signs and may capture biological changes of frailty that predispose hospitalized older adults to complications. The study's aim was to assess the association of the FI-LAB versus VA-FI with hospital and post-hospital clinical outcomes in older adults. METHODS Retrospective cohort study was conducted on Veterans aged ≥60 admitted to a VA hospital. We identified acute hospitalizations January 2011-December-2014 with 1-year follow-up. A 31-item FI-LAB was created from blood laboratory tests and vital signs collected within the first 48 h of admission and scores were categorized as low (<0.25), moderate (0.25-0.40), and high (>0.40). For each FI-LAB group, we obtained odds ratio (OR) and confidence intervals (CI) for hospital and post-hospital outcomes using multivariate binomial logistic regression. Additionally, we calculated hazard ratios (HR) and CI for all-cause in-hospital mortality comparing the high and moderate FI-LAB group with the low group. RESULTS Patients were 1407 Veterans, mean age 72.7 (SD = 9.0), 67.8% Caucasian, 96.1% males, 47.0% (n = 661), 41.0% (n = 577), and 12.0% (n = 169) were in the low, moderate, and high FI-LAB groups, respectively. Moderate and high scores were associated with prolonged LOS, OR:1.62 (95% CI:1.29-2.03); and 3.36 (95% CI:2.27-4.99), ICU admission, OR:1.40 (95% CI:1.03-1.90); and OR:2.00 (95% CI:1.33-3.02), nursing home placement OR:2.36 (95% CI:1.26-4.44); and 5.99 (95% CI:2.83-12.70), 30-day readmissions OR:1.74 (95% CI:1.20-2.52); and 2.20 (95% CI:1.30-3.74), 30-day mortality OR: 2.51 (95% CI:1.01-6.23); and 8.97 (95% CI:3.42-23.53), 6-month mortality OR:3.00 (95% CI:1.90-4.74); and 6.16 (95% CI:3.55-10.71), and 1-year mortality OR: 2.66 (95% CI:1.87-3.79); and 4.76 (95% CI:3.00-7.54) respectively. The high FI-LAB group showed higher risk of in-hospital mortality, HR:18.17 (95% CI:4.01-80.52) with an area-under-the-curve of 0.843 (95% CI:0.75-0.93). CONCLUSIONS High and moderate FI-LAB scores were associated with worse in-hospital and post-hospital outcomes. The FI-LAB may identify hospitalized older patients with frailty at higher risk and assist clinicians in implementing strategies to improve outcomes.
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Affiliation(s)
- Otoniel Ysea-Hill
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, USA
| | - Christian J Gomez
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, USA
| | - Natalie Mansour
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, USA
| | - Kamal Wahab
- Department of Medicine, University of Miami, Jackson Health System, Miami, Florida, USA
| | - Mihn Hoang
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.,Medical Service, Bruce W. Carter Miami VAMC, Miami, Florida, USA
| | - Mabel Labrada
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.,Medical Service, Bruce W. Carter Miami VAMC, Miami, Florida, USA
| | - Jorge G Ruiz
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, Miami, Florida, USA.,Department of Medicine, University of Miami, Jackson Health System, Miami, Florida, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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15
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Kim Y, Song K, Kang CM, Lee H. Impact of preoperative laboratory frailty index on mortality and clinical outcomes in older surgical patients with cancer. Sci Rep 2022; 12:9200. [PMID: 35654943 PMCID: PMC9163125 DOI: 10.1038/s41598-022-13426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/05/2022] [Indexed: 11/09/2022] Open
Abstract
Frailty in older patients is associated with poor postoperative outcomes. The use of uncomplicated frailty measurement tools is preferred in busy clinical settings. Therefore, we validated the frailty index using routine laboratory data and the surgical outcomes of older patients with cancer who underwent cancer resection. We retrospectively analyzed 9015 patients aged 65 years and older who underwent cancer resection at a single tertiary hospital. Based on electronic-medical-record data regarding preoperative blood test results and vital signs, Laboratory Frailty Index (FI-Lab) scores were generated to measure preoperative frailty. The associations of FI-Lab with postoperative length of stay (LOS), readmission within 30 days, intensive care unit (ICU) admission within 30 days, and mortality were evaluated. The mean FI-Lab score of the 9015 patients was 0.20 ± 0.10. Increased FI-Lab scores (0.25–0.4; > 0.4) were associated with longer LOS, increased readmission within 30 days of surgery, ICU admission, and increased mortality, compared with FI-Lab scores < 0.25. The FI-Lab score, as a frailty indicator, was able to predict the risk of poor postoperative outcomes. Therefore, the FI-Lab is a potentially useful tool for assessing preoperative frailty in older patients with cancer in acute clinical setting.
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Affiliation(s)
- Yoonjoo Kim
- Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea.,Department of Nursing, College of Healthcare Sciences, Far East University, Eumseong-gun, Chungcheongbuk-do, South Korea
| | - Kijun Song
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - Chang Moo Kang
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea
| | - Hyangkyu Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea.
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16
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Lim A, Choi M, Jang Y, Lee H. Preoperative frailty based on laboratory data and postoperative health outcomes in patients undergoing coronary artery bypass graft surgery. Heart Lung 2022; 56:1-7. [PMID: 35598421 DOI: 10.1016/j.hrtlng.2022.05.005] [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: 01/17/2022] [Revised: 04/21/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Frailty is associated with adverse surgical outcomes. Patients with cardiovascular diseases have many risk factors of frailty; thus, preoperative frailty evaluation is necessary to predict adverse outcomes after coronary artery bypass graft (CABG) surgery. Laboratory data based-frailty assessments are objective and not time-consuming, addressing the need for an accurate but simple frailty screening for patients awaiting CABG surgery. OBJECTIVES This retrospective study aimed to determine the association between laboratory based-frailty and patient health outcomes after CABG surgery. METHODS We evaluated 896 patients who underwent on-pump or off-pump CABG surgery between August 1, 2015 and July 31, 2020 at a tertiary hospital. The frailty index-laboratory (FI-LAB), which comprises 32 laboratory parameters and vital signs, was used for frailty assessment. RESULTS The patients were divided into three groups according to their preoperative FI-LAB level as low (FI-LAB <0.25, 23.0%), moderate (FI-LAB ≥0.25 to ≤0.4, 54.9%), and high (FI-LAB>0.4, 22.1%) frailty groups. In the confounder-adjusted analysis, the lengths of hospital stay and intensive care unit stay were longer by 2.20 days (p=.023) and by 0.89 days (p=.009), respectively, in the high frailty group than those in the low frailty group. The odds ratio for 30-day readmission was also 2.58 times higher in the high frailty group than that in the low frailty group. CONCLUSION A high preoperative FI-LAB score indicates increasing risks of adverse postoperative outcomes among CABG surgery patients. FI-LAB has potential strengths to capture the need for a more thorough frailty assessment for cardiac surgery patients.
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Affiliation(s)
- Arum Lim
- Department of Nursing, Graduate School, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Mona Choi
- College of Nursing, Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Yeonsoo Jang
- College of Nursing, Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Hyangkyu Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
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17
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Reid O, Ngo J, Lalic S, Su E, Elliott RA. Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight. Br J Clin Pharmacol 2022; 88:4565-4572. [PMID: 35535712 PMCID: PMC9546042 DOI: 10.1111/bcp.15394] [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: 02/07/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Aims To describe paracetamol dosing and liver function test (LFT) monitoring in older hospital inpatients who are frail or have low body weight. Methods Retrospective observational study, at a 790‐bed metropolitan public health service in Australia. Patients aged ≥70 years, with body weight <50 kg or frailty index based on laboratory data (FI‐Lab) score ≥0.3, who were administered paracetamol during an admission with length‐of‐stay >72 hours, were included. Data were extracted from electronic medical records. Paracetamol doses administered in hospital, and doses prescribed on discharge, were compared against consensus guidelines that recommended ≤60 mg/kg/d for older people weighing <50 kg, and ≤3000 mg/d for frail older people. Results In total, 240 admissions (n = 229 patients, mean age 84.7 years) were analysed. During 150 (62.5%) admissions, higher than recommended paracetamol doses were prescribed. On 138 (57.5%) occasions, patients were prescribed paracetamol on discharge, and 112/138 (81.2%) doses were higher than recommended. Most discharge prescriptions (97/138, 70.3%) were for regular administration. The median daily dose on discharge for patients <50 kg was 83.7 mg/kg (interquartile range 73.6–90.9 mg/kg). For frail patients ≥50 kg, the median daily discharge dose was 3990 mg (interquartile range 3000–4000 mg). LFTs were measured in hospital for 151/200 (75.5%) and 93/166 (56.0%) patients who received paracetamol for >48 hours and >5 days, respectively. Conclusion Majority of paracetamol doses prescribed for frail or low‐weight older patients in hospital and on discharge were higher than recommended in consensus guidelines. LFTs were not measured for 44% patients who received paracetamol regularly for >5 days. Further studies are needed to explore long‐term outcomes of this practice.
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Affiliation(s)
- Olivia Reid
- Pharmacy Department, Austin Health, Victoria, Australia
| | - Janet Ngo
- Pharmacy Department, Austin Health, Victoria, Australia
| | - Samanta Lalic
- Pharmacy Department, Austin Health, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia.,Present address: Pharmacy Department, Monash Health, Victoria, Australia
| | - Elizabeth Su
- Pharmacy Department, Austin Health, Victoria, Australia
| | - Rohan A Elliott
- Pharmacy Department, Austin Health, Victoria, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria, Australia.,Victorian Poisons Information Centre, Austin Health, Victoria, Australia
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18
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Accuracy, feasibility and predictive ability of different frailty instruments in an acute geriatric setting. Eur Geriatr Med 2022; 13:827-835. [PMID: 35460515 PMCID: PMC9034644 DOI: 10.1007/s41999-022-00645-1] [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: 12/07/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022]
Abstract
Aim To investigate the feasibility and accuracy of four frailty instruments: FRAIL, Clinical Frailty Scale (CFS), hand grip strength (HGS) and the Spanish Frailty-VIG; and to evaluate their ability to predict adverse outcomes in an acute care setting (ACS). Findings The four instruments had high feasibility but provided variable prevalence of frailty. FRAIL and CFS predicted well for three-month mortality, and FRAIL also for length of stay. However, none of the instruments predicted for the other outcomes. Message The FRAIL and CFS may be of value in diagnostic and therapeutic decision-making in an acute geriatric setting, given their prognostic ability and feasibility. Further studies are needed to identify the best frailty instrument in an ACS. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00645-1. Purpose To analyze the feasibility, accuracy and the ability of different frailty instruments to predict adverse outcomes. Methods A prospective cohort study was conducted in patients ≥ 70 years admitted to the acute care setting (ACS). Feasibility and prevalence of frailty were assessed by FRAIL, Clinical Frailty Scale (CFS), hand grip strength (HGS) and the Spanish Frailty-VIG. Receiver operator characteristic (ROC) curves and area under the curve (AUC) were performed to identify frailty according to each instrument, setting VIG as the reference. For each instrument, multiple logistic regressions were used to examine the effect of frailty on primary outcome (i.e., three-month mortality) and secondary outcomes (i.e., in-hospital mortality, length of stay, institutionalization, functional decline and 30-day readmission). Results A total of 185 patients were included, with a median age of 89 years. The feasibility of the instruments was 100%, except for HGS (67%). The prevalence of frailty varied from 65.2% (FRAIL) to 86.7% (VIG). AUCs against VIG ranged from 0.69 (95% confidence interval [CI] 0.57–0.81: FRAIL) to 0.77 (95% CI 63.5–90.2: CFS). Frail patients defined by FRAIL were 2.7times more likely to have a prolonged length of stay than non-frail patients (95% CI 1.385–5.416). Three-month mortality occurred more among frail patients, either defined by FRAIL (OR 2.5; 95% CI 1.072–5.881) or CFS (OR 3.7; 95% CI 1.255–10.812), than in non-frail patients. Conclusion The four instruments had high feasibility providing variable prevalence of frailty. FRAIL and CFS predicted well for three-month mortality, and FRAIL also for length of stay. However, none of the instruments predicted for the other secondary outcomes of the study. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00645-1.
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19
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Association of a modified laboratory frailty index with adverse outcomes in geriatric rehabilitation inpatients: RESORT. Mech Ageing Dev 2022; 203:111648. [PMID: 35219637 DOI: 10.1016/j.mad.2022.111648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
A higher number of laboratory measurements is associated with mortality in patients admitted to hospital, but is not part of the frailty index based on laboratory tests (FILab). This study aimed to modify the FI-Lab (mFI-Lab) by accounting for the number of laboratory measurements and compare its validity to predict institutionalization and mortality at three-month post-discharge with the clinical frailty scale (CFS) in geriatric rehabilitation inpatients. In 1819 patients (median age 83.3 [77.6-88.3], 56.6% female), a higher FI-Lab was not associated with institutionalization but a higher risk of mortality. A higher mFI-Lab was associated with lower odds of institutionalization but a higher risk of mortality. A higher CFS was associated with institutionalization and higher mortality. The Akaike information criterion value was lowest for the CFS, followed by the mFI-Lab and the FI-Lab. The CFS is better than the mFI-Lab predicting short-term adverse outcomes in geriatric rehabilitation inpatients. When using laboratory data to estimate frailty, the mFI-Lab rather than the FI-Lab should be used.
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20
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Goodyer E, Mah JC, Rangan A, Chitalu P, Andrew MK, Searle SD, Davis D, Tsui A. The relative impact of socioeconomic position and frailty varies by population setting. Aging Med (Milton) 2022; 5:10-16. [PMID: 35291504 PMCID: PMC8917265 DOI: 10.1002/agm2.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Frailty and socioeconomic position (SEP) are well-established determinants of health. However, we know less about the contributions of frailty and SEP in older adults, especially in acute settings. We set out to answer how frailty and SEP might influence health outcomes in older people, comparing a population sample and patients managed by a speciality acute frailty service. Methods We used the Delirium and Population Health Informatics Cohort, a population sample of 1510 individuals aged ≥70 years from the London Borough of Camden and 1750 acute frailty patients. SEP was determined using the Index of Multiple Deprivation. Linear and Cox proportional hazard regression models were conducted to assess SEP on frailty, readmission, and mortality outcomes. Results In the population sample, SEP was significantly associated with frailty and mortality with successive increases in rate of death for each IMD quintile (HR = 1.28, 95% CI 1.11 to 1.49, P < 0.005). Increasing SEP, age, and admission status among hospitalized individuals were associated with greater frailty. For individuals seen by the speciality frailty service, SEP was not associated with frailty, mortality, or readmission. Discussion When older people experience acute illness severe enough to require secondary care, particularly specialist services, this overcomes any prior advantages conferred by a higher SEP.
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Affiliation(s)
| | - Jasmine C. Mah
- Department of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Apoorva Rangan
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
- School of MedicineStanford UniversityStanfordCAUSA
| | | | - Melissa K. Andrew
- Division of Geriatric MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Samuel D. Searle
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
- Division of Geriatric MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
- Department of Medicine for the ElderlyUniversity College HospitalLondonUK
| | - Alex Tsui
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
- Department of Medicine for the ElderlyUniversity College HospitalLondonUK
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21
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Soh CH, Guan L, Reijnierse EM, Lim WK, Maier AB. Comparison of the modified Frailty-Index based on laboratory tests and the Clinical Frailty Scale in predicting mortality among geriatric rehabilitation inpatients: RESORT. Arch Gerontol Geriatr 2022; 100:104667. [PMID: 35240386 DOI: 10.1016/j.archger.2022.104667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To compare the associations of the FI-lab, modified (m)FI-lab and Clinical Frailty Scale (CFS) with one-year mortality. STUDY DESIGN An observational longitudinal inception cohort of inpatients admitted to the geriatric rehabilitation wards in the Royal Melbourne Hospital, Victoria, Australia. MAIN OUTCOME MEASURES The measured ratio was defined as the proportion of measured laboratory tests to the total number of tests (n = 77). The FI-lab is the proportion of abnormal results to the total measured laboratory tests. The mFI-lab was calculated by dividing the FI-lab by the measured ratio. The measured ratio of laboratory tests, FI-lab, mFI-lab and CFS were assessed at admission to geriatric rehabilitation. Patients' mortality data were obtained from the Registry of Births, Deaths and Marriages Victoria and medical records. RESULTS The total of 1819 inpatients had a median age of 83.3 [77.5-88.3] years and 56.5% were female. The median measured ratio, FI-lab, mFI-lab and CFS scores were 0.58 [0.47-0.70], 0.31 [0.23-0.38], 0.51 [0.38-0.69] and 6 (Abbasi et al., 2018Gill, Gahbauer, Allore & Han, 2006; Howlett et al., 2014;) respectively. The one-year mortality rate was 17.1%. The measured ratio was not associated with one-year mortality. Higher FI-lab (hazard ratio (HR)=1.180, 95%CI: 1.037-1.343), mFI-lab (HR=1.074, 95%CI: 1.030-1.119) and CFS scores (HR=1.350, 95%CI: 1.191-1.530) were associated with higher risk of one-year mortality. The area under the curve (AUC) of FI-lab, mFI-lab and CFS with one-year mortality were 0.581, 0.587 and 0.612 respectively. CONCLUSION The FI-lab, mFI-lab and CFS poorly predict mortality in geriatric rehabilitation inpatients despite the statistically significant associations shown.
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22
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Mohanty SD, Lekan D, McCoy TP, Jenkins M, Manda P. Machine learning for predicting readmission risk among the frail: Explainable AI for healthcare. PATTERNS (NEW YORK, N.Y.) 2022; 3:100395. [PMID: 35079714 PMCID: PMC8767300 DOI: 10.1016/j.patter.2021.100395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/29/2021] [Accepted: 11/02/2021] [Indexed: 01/23/2023]
Abstract
Healthcare costs due to unplanned readmissions are high and negatively affect health and wellness of patients. Hospital readmission is an undesirable outcome for elderly patients. Here, we present readmission risk prediction using five machine learning approaches for predicting 30-day unplanned readmission for elderly patients (age ≥ 50 years). We use a comprehensive and curated set of variables that include frailty, comorbidities, high-risk medications, demographics, hospital, and insurance utilization to build these models. We conduct a large-scale study with electronic health record (her) data with over 145,000 observations from 76,000 patients. Findings indicate that the category boost (CatBoost) model outperforms other models with a mean area under the curve (AUC) of 0.79. We find that prior readmissions, discharge to a rehabilitation facility, length of stay, comorbidities, and frailty indicators were all strong predictors of 30-day readmission. We present in-depth insights using Shapley additive explanations (SHAP), the state of the art in machine learning explainability.
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Affiliation(s)
- Somya D. Mohanty
- Department of Computer Science, University of North Carolina at Greensboro, Petty Building, Greensboro 27403, NC, USA
| | - Deborah Lekan
- School of Nursing, University of North Carolina at Greensboro, Petty Building, Greensboro 27403, NC, USA
| | - Thomas P. McCoy
- School of Nursing, University of North Carolina at Greensboro, Petty Building, Greensboro 27403, NC, USA
| | | | - Prashanti Manda
- Informatics and Analytics, University of North Carolina at Greensboro, 500 Forest Building, Greensboro 27403, NC, USA
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23
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Boreskie KF, Hay JL, Boreskie PE, Arora RC, Duhamel TA. Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC Geriatr 2022; 22:13. [PMID: 34979966 PMCID: PMC8722007 DOI: 10.1186/s12877-021-02722-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/15/2021] [Indexed: 12/14/2022] Open
Abstract
Healthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at increased risk for adverse health outcomes. Furthermore, frailty assessments offer an opportunity to optimize patient care in various healthcare settings. While the vast number of frailty assessment tools available can be a source of confusion for clinicians, each tool has features adaptable to the constraints and goals of different healthcare settings. This review discusses and compares barriers, facilitators, and the application of frailty assessments in primary care, the emergency department/intensive care unit and surgical care to cover a breadth of settings with different frailty assessment considerations. The implementation of frailty-aware care across healthcare settings potentiates better healthcare outcomes for older adults.
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Affiliation(s)
- Kevin F Boreskie
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada.
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Jacqueline L Hay
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Patrick E Boreskie
- Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
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24
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Lekan D, McCoy TP, Jenkins M, Mohanty S, Manda P. Frailty and In-Hospital Mortality Risk Using EHR Nursing Data. Biol Res Nurs 2021; 24:186-201. [PMID: 34967685 DOI: 10.1177/10998004211060541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study was to evaluate four definitions of a Frailty Risk Score (FRS) derived from EHR data that includes combinations of biopsychosocial risk factors using nursing flowsheet data or International Classification of Disease, 10th revision (ICD-10) codes and blood biomarkers and its predictive properties for in-hospital mortality in adults ≥50 years admitted to medical-surgical units. Methods In this retrospective observational study and secondary analysis of an EHR dataset, survival analysis and Cox regression models were performed with sociodemographic and clinical covariates. Integrated area under the ROC curve (iAUC) across follow-up time based on Cox modeling was estimated. Results The 46,645 patients averaged 1.5 hospitalizations (SD = 1.1) over the study period and 63.3% were emergent admissions. The average age was 70.4 years (SD = 11.4), 55.3% were female, 73.0% were non-Hispanic White (73.0%), mean comorbidity score was 3.9 (SD = 2.9), 80.5% were taking 1.5 high risk medications, and 42% recorded polypharmacy. The best performing FRS-NF-26-LABS included nursing flowsheet data and blood biomarkers (Adj. HR = 1.30, 95% CI [1.28, 1.33]), with good accuracy (iAUC = .794); the reduced model with age, sex, and FRS only demonstrated similar accuracy. The poorest performance was the ICD-10 code-based FRS. Conclusion The FRS captures information about the patient that increases risk for in-hospital mortality not accounted for by other factors. Identification of frailty enables providers to enhance various aspects of care, including increased monitoring, applying more intensive, individualized resources, and initiating more informed discussions about treatments and discharge planning.
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Affiliation(s)
- Deborah Lekan
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Thomas P McCoy
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Somya Mohanty
- Department of Computer Science, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Prashanti Manda
- Informatics and Analytics, University of North Carolina at Greensboro, Greensboro, NC, USA
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25
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Frailty assessment using routine clinical data: An integrative review. Arch Gerontol Geriatr 2021; 99:104612. [PMID: 34986459 DOI: 10.1016/j.archger.2021.104612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Frailty is a common but complex problem in older adults. Frailty assessment using routine clinical data has been suggested as a pragmatic approach based on electronic health records from primary care center or hospital settings. PURPOSE We aimed to explore the tools and outcome variables used in the published studies on frailty assessment using routine clinical data. METHODS An integrative literature review was conducted using the method of Whittemore and Knafl. A literature search was conducted in PubMed, EMBASE, and CINAHL from January 2010 to October 2021. RESULTS A total of 45 studies and thirteen frailty assessment tools were analyzed. The assessment items were generally biased toward frailty's risk factors rather than the mechanisms or phenotypes of frailty. Similar to using conventional tools, routine clinical data-based frailty was associated with adverse health outcomes. CONCLUSIONS Frailty assessment based on routine clinical data could efficiently evaluate frailty using electronic health records from primary care centers or hospitals. However, they need refinement to consider the risk factors, mechanisms, and frailty phenotypes.
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26
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Sarkar S, MacLeod JB, Hassan A, Dutton DJ, Brunt KR, Légaré JF. An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs. JTCVS OPEN 2021; 8:491-502. [PMID: 36004086 PMCID: PMC9390592 DOI: 10.1016/j.xjon.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/19/2021] [Indexed: 10/29/2022]
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27
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Verschoor CP, Dales RE, Duong M, Bourque C, Mian O, Ma J, Griffith LE. Respiratory Symptoms Are Associated With Frailty in Older Adults With Normal Spirometry, Independent of Smoking, in the Canadian Longitudinal Study of Aging. Respir Care 2021; 66:1848-1857. [PMID: 34610984 PMCID: PMC9993795 DOI: 10.4187/respcare.09225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recent studies have demonstrated that even in the absence of lung impairment as determined by spirometry, smoking and respiratory symptoms are associated with poor overall health and well-being. However, this relationship is not well defined; and it remains unclear the degree to which symptoms are related to poor health, independent of smoking. This is of particular importance to older adults, as they are more likely to exhibit respiratory symptoms and are, therefore, at risk of not receiving appropriate treatment if they have never smoked and have normal spirometry. METHODS We performed a cross-sectional analysis of data from the Canadian Longitudinal Study on Aging to delineate the associations of respiratory symptoms and smoking on the health of participants age 45-86 who exhibited normal spirometry. Participant health was estimated using a frailty index, a multidimensional measure of vulnerability to adverse outcomes that has been validated in numerous health settings. RESULTS Of the 21,293 participants included in our analysis, 87% exhibited a normal FEV1, FVC, and FEV1/FVC; of those, 45% reported at least one respiratory symptom, and 50% were former or current smokers. Both respiratory symptoms and smoking were independently associated with frailty (median interquartile range [IQR] = 0.11 [0.07-0.15]), the most substantial associations observed for those having at least one respiratory symptom (adjusted β 0.023, 95% CI 0.022-0.025) and current smokers with > 10 pack-year exposure (adjusted β 0.014, 95% CI [0.010-0.019). Not only was the association between symptoms and frailty evident in never smokers, a significant proportion of the total effect of smoking on frailty was observed to be mediated by symptoms. CONCLUSIONS Our data show that respiratory symptoms, regardless of smoking history, were a significant correlate of frailty in older adults with normal spirometry. Hence, they should not be simply regarded as a benign by-product of aging.
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Affiliation(s)
- Chris P Verschoor
- Health Sciences North Research Institute, Sudbury, Ontario, Canada.
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Robert E Dales
- Ottawa Hospital Research Institute, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Caitlyn Bourque
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Oxana Mian
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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28
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Martin JA, Crane-Droesch A, Lapite FC, Puhl JC, Kmiec TE, Silvestri JA, Ungar LH, Kinosian BP, Himes BE, Hubbard RA, Diamond JM, Ahya V, Sims MW, Halpern SD, Weissman GE. Development and validation of a prediction model for actionable aspects of frailty in the text of clinicians' encounter notes. J Am Med Inform Assoc 2021; 29:109-119. [PMID: 34791302 DOI: 10.1093/jamia/ocab248] [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: 06/22/2021] [Revised: 10/16/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Frailty is a prevalent risk factor for adverse outcomes among patients with chronic lung disease. However, identifying frail patients who may benefit from interventions is challenging using standard data sources. We therefore sought to identify phrases in clinical notes in the electronic health record (EHR) that describe actionable frailty syndromes. MATERIALS AND METHODS We used an active learning strategy to select notes from the EHR and annotated each sentence for 4 actionable aspects of frailty: respiratory impairment, musculoskeletal problems, fall risk, and nutritional deficiencies. We compared the performance of regression, tree-based, and neural network models to predict the labels for each sentence. We evaluated performance with the scaled Brier score (SBS), where 1 is perfect and 0 is uninformative, and the positive predictive value (PPV). RESULTS We manually annotated 155 952 sentences from 326 patients. Elastic net regression had the best performance across all 4 frailty aspects (SBS 0.52, 95% confidence interval [CI] 0.49-0.54) followed by random forests (SBS 0.49, 95% CI 0.47-0.51), and multi-task neural networks (SBS 0.39, 95% CI 0.37-0.42). For the elastic net model, the PPV for identifying the presence of respiratory impairment was 54.8% (95% CI 53.3%-56.6%) at a sensitivity of 80%. DISCUSSION Classification models using EHR notes can effectively identify actionable aspects of frailty among patients living with chronic lung disease. Regression performed better than random forest and neural network models. CONCLUSIONS NLP-based models offer promising support to population health management programs that seek to identify and refer community-dwelling patients with frailty for evidence-based interventions.
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Affiliation(s)
- Jacob A Martin
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.,Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Crane-Droesch
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Joseph C Puhl
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tyler E Kmiec
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jasmine A Silvestri
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lyle H Ungar
- Department of Computer and Information Science, University of Pennsylvania School of Engineering and Applied Science, Philadelphia, Pennsylvania, USA
| | - Bruce P Kinosian
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Geriatrics, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Geriatrics and Extended Care Data Analysis Center, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Blanca E Himes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joshua M Diamond
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Vivek Ahya
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael W Sims
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott D Halpern
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Pulmonary, Allergy, and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gary E Weissman
- Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Pulmonary, Allergy, and Critical Care Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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29
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Trent Herdman M, Seers T, Ng C, Davenport R, Sibley S, Mannion S, Balasegaram S, Redmond AD. Clinical frailty as a key characteristic of the patient population of the NHS Nightingale North West COVID-19 temporary emergency field hospital: cohort study April to June 2020. JRSM Open 2021; 12:20542704211046435. [PMID: 35154787 PMCID: PMC8832049 DOI: 10.1177/20542704211046435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives COVID-19 temporary emergency ‘field’ hospitals have been established in the
UK to support the surge capacity of the National Health Service while
protecting the community from onward infection. We described the population
of one such hospital and investigated the impact of frailty on clinical
outcomes. Design Cohort study. Setting NHS Nightingale Hospital North West, April–June 2020. Participants All in-patients with COVID-19. Main Outcome Measures Mortality and duration of admission. Methods We analysed factors associated with mortality using logistic regression and
admission duration using Cox's regression, and described trends in frailty
prevalence over time using linear regression. Results A total of 104 COVID-19 patients were admitted, 74% with moderate-to-severe
frailty (clinical frailty score, CFS > 5). A total of 84 were discharged,
14 transferred to other hospitals, and six died on site. High C-reactive
protein (CRP) > 50 mg/dL predicted 30-day mortality (adjusted odds ratio
11.9, 95%CI 3.2–51.5, p < 0.001). Patients with
CFS > 5 had a 10-day median admission, versus 7-day for CFS ≤ 5 and half
the likelihood of discharge on a given day (adjusted hazard ratio 0.51,
95%CI 0.29–0.92, p = 0.024). CRP > 50 mg/dL and
hospital-associated COVID-19 also predicted admission duration. As more
frail patients had a lower rate of discharge, prevalence of CFS > 5
increased from 64% initially to 90% in the final week (non-zero slope
p < 0.001). Conclusions: The NNW
population was characterized by high levels of frailty, which increased over
the course of the hospital's operation, with subsequent operational
implications. Identifying and responding to the needs of this population,
and acknowledging the risks of this unusual clinical context, helped the
hospital to keep patients safe.
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Affiliation(s)
- M. Trent Herdman
- NHS Nightingale Hospital North West, Manchester, UK
- South East and London Field Service, National Infection Service, Public Health England, UK
| | - Tim Seers
- NHS Nightingale Hospital North West, Manchester, UK
| | - Cassandra Ng
- NHS Nightingale Hospital North West, Manchester, UK
- Department of Geriatric Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rebecca Davenport
- NHS Nightingale Hospital North West, Manchester, UK
- Department of Geriatric Medicine, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Sibley
- NHS Nightingale Hospital North West, Manchester, UK
- Department of Respiratory Medicine, Liverpool Heart and Chest NHS Foundation Trust, Liverpool, UK
| | - Steve Mannion
- NHS Nightingale Hospital North West, Manchester, UK
- Consultant Orthopaedic and Trauma Surgeon, Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Sooria Balasegaram
- South East and London Field Service, National Infection Service, Public Health England, UK
| | - Anthony D Redmond
- NHS Nightingale Hospital North West, Manchester, UK
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
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30
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Koduri G, Gokaraju S, Darda M, Warrier V, Duta I, Hayes F, Sayed IE, Noeman-Ahmed Y. Clinical frailty score as an independent predictor of outcome in COVID-19 hospitalised patients. Eur Geriatr Med 2021; 12:1065-1073. [PMID: 34086193 PMCID: PMC8175234 DOI: 10.1007/s41999-021-00508-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/29/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF THE STUDY We explored potential predictive variables associated with outcomes using baseline clinical parameters of 500 hospitalised patients with COVID -19 in a single centre, UK. METHODS Retrospective study collecting demographic and clinical characteristics of patients admitted at Southend University Hospital from 20th February to 7th May 2020. RESULTS The mean age of the cohort admitted to hospital with Covid-19 was 69.4 and 58% were over 70. Comorbidities were more frequently observed in non-survivors, whose mean Clinical Frailty Scale was significantly higher (5 vs 3) than survivors, p < 0.001. In addition, mean C-reactive protein was significantly higher. CONCLUSION Older and frailer patients with high inflammatory markers were at risk of poor outcomes. Integrated frailty and age-based risk stratification is essential, in addition to monitoring saturation /FiO2 ratio (SFR) and inflammatory markers throughout the disease course to allow for early intervention to improve patient outcomes. A frailty-based risk-stratification approach, rather than age may prove more valuable when considering interventions in patients with multiple comorbidities.
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Affiliation(s)
- Gouri Koduri
- Rheumatology Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Sriya Gokaraju
- Respiratory Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Maria Darda
- Respiratory Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Vinod Warrier
- Department of Medicine, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Irina Duta
- Department of Medicine, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Fiona Hayes
- Rheumatology Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Yasser Noeman-Ahmed
- Respiratory Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK.
- Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Department of Respiratory Medicine, Lecturer Critical Care Medicine, Southend University Hospital, Alexandria University, Alexandria, Egypt.
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31
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Engvig A, Wyller TB, Skovlund E, Ahmed MV, Hall TS, Rockwood K, Njaastad AM, Neerland BE. Association between clinical frailty, illness severity and post-discharge survival: a prospective cohort study of older medical inpatients in Norway. Eur Geriatr Med 2021; 13:453-461. [PMID: 34417977 PMCID: PMC8379589 DOI: 10.1007/s41999-021-00555-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022]
Abstract
Aim To assess impact of frailty screening and two markers of illness severity on survival following discharge from the hospital. Findings Independently of age, ward (acute geriatric and general medical) and comorbidity, both higher degree of frailty and illness severity associated with reduced survival probability following discharge. The impact of frailty on survival was higher in those experiencing high clinical and laboratory illness severity. Message The prognostic value of frailty screening increased when performed in conjunction with two markers of illness severity. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00555-8. Purpose Study associations between frailty, illness severity and post-discharge survival in older adults admitted to medical wards with acute clinical conditions. Methods Prospective cohort study of 195 individuals (mean age 86; 63% females) admitted to two medical wards with acute illness, followed up for all-cause mortality for 20 months after discharge. Ward physicians screened for frailty and quantified its degree from one to eight using Clinical Frailty Scale (CFS), while clinical illness severity was estimated by New Early Warning Score 2 (NEWS2) and laboratory illness severity was calculated by a frailty index (FI-lab) using routine blood tests. Results CFS, NEWS2 and FI-lab scores were independently associated with post-discharge survival in an adjusted Cox proportional hazards model with age, ward category (acute geriatric and general medical) and comorbidity as covariates. Adjusted hazard ratios and 95% confidence intervals were 1.54 (1.24–1.91) for CFS, 1.12 (1.03–1.23) for NEWS2, and 1.02 (1.00–1.05) for FI-lab. A frailty × illness severity category interaction effect (p = 0.003), suggested that the impact of frailty on survival was greater in those experiencing higher levels of illness severity. Among patients with at least moderate frailty (CFS six to eight) and high illness severity according to both NEWS2 and FI-lab, two (13%) were alive at follow-up. Conclusion Frailty screening aided prognostication of survival following discharge in older acutely ill persons admitted to medical wards. The prognostic value of frailty increased when combined with readily available illness severity markers acquired during admission. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00555-8.
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Affiliation(s)
- Andreas Engvig
- Department of Internal Medicine, Oslo University Hospital (OUS), Oslo, Norway. .,Department of Nephrology, Division of Medicine, Oslo University Hospital, Ullevål Hospital, Nydalen, PO Box 4956, 0424, Oslo, Norway.
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, OUS, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo (UiO), Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Trygve Sundby Hall
- Department of Internal Medicine, Oslo University Hospital (OUS), Oslo, Norway
| | | | - Anne Mette Njaastad
- Department of Internal Medicine, Oslo University Hospital (OUS), Oslo, Norway
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32
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Howlett SE, Rutenberg AD, Rockwood K. The degree of frailty as a translational measure of health in aging. NATURE AGING 2021; 1:651-665. [PMID: 37117769 DOI: 10.1038/s43587-021-00099-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/06/2021] [Indexed: 04/30/2023]
Abstract
Frailty is a multiply determined, age-related state of increased risk for adverse health outcomes. We review how the degree of frailty conditions the development of late-life diseases and modifies their expression. The risks for frailty range from subcellular damage to social determinants. These risks are often synergistic-circumstances that favor damage also make repair less likely. We explore how age-related damage and decline in repair result in cellular and molecular deficits that scale up to tissue, organ and system levels, where they are jointly expressed as frailty. The degree of frailty can help to explain the distinction between carrying damage and expressing its usual clinical manifestations. Studying people-and animals-who live with frailty, including them in clinical trials and measuring the impact of the degree of frailty are ways to better understand the diseases of old age and to establish best practices for the care of older adults.
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Affiliation(s)
- Susan E Howlett
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew D Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada.
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33
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Chalmers LA, Searle SD, Whitby J, Tsui A, Davis D. Do specific delirium aetiologies have different associations with death? A longitudinal cohort of hospitalised patients. Eur Geriatr Med 2021; 12:787-791. [PMID: 33725336 PMCID: PMC8322002 DOI: 10.1007/s41999-021-00474-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
Aim To investigate aetiology-specific associations with mortality among older patients with delirium. Findings Delirium predicted mortality, as did inflammatory and metabolic disorders. However, there was no evidence for any interactions between these factors. Message Mortality from delirium is consistent regardless of underlying aetiology, suggesting that no aetiology carries better or worse prognosis than another. Purpose To describe aetiology-specific associations with mortality among older hospital patients with delirium. Methods Over 21 months, a cohort of 1702 patients with 2471 acute hospital admissions (median age 85, IQR 80–90, 56% women) were assessed for delirium, categorised with inflammatory and metabolic aetiologies based on available laboratory results, and followed up for all-cause mortality. Interactions between aetiology and delirium were tested. Results The total mortality for the cohort was 35.2%. While inflammation, metabolic disturbance, and delirium at time of admission all demonstrated independent associations with mortality, there was no evidence for any interactions between delirium and these laboratory-measured aetiologies. Conclusions Delirium remains an important predictor of death in older hospital patients, irrespective of underlying aetiology.
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Affiliation(s)
- Louis A Chalmers
- Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Samuel D Searle
- Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing at UCL, London, UK.,Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jon Whitby
- Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Alex Tsui
- Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Daniel Davis
- Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
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34
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Heikkilä E, Salminen M, Viljanen A, Katajamäki T, Koivula MK, Pulkki K, Isoaho R, Kivelä SL, Viitanen M, Löppönen M, Vahlberg T, Viikari L, Irjala K. A practical laboratory index to predict institutionalization and mortality - an 18-year population-based follow-up study. BMC Geriatr 2021; 21:139. [PMID: 33632124 PMCID: PMC7905906 DOI: 10.1186/s12877-021-02077-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Previously, several indexes based on a large number of clinical and laboratory tests to predict mortality and frailty have been produced. However, there is still a need for an easily applicable screening tool for every-day clinical practice. Methods A prospective study with 10- and 18-year follow-ups. Fourteen common laboratory tests were combined to an index. Cox regression model was used to analyse the association of the laboratory index with institutionalization and mortality. Results The mean age of the participants (n = 1153) was 73.6 (SD 6.8, range 64.0–100.0) years. Altogether, 151 (14.8%) and 305 (29.9%) subjects were institutionalized and 422 (36.6%) and 806 (69.9%) subjects deceased during the 10- and 18-year follow-ups, respectively. Higher LI (laboratory index) scores predicted increased mortality. Mortality rates increased as LI scores increased both in unadjusted and in age- and gender-adjusted models during both follow-ups. The LI did not significantly predict institutionalization either during the 10- or 18-year follow-ups. Conclusions A practical index based on routine laboratory tests can be used to predict mortality among older people. An LI could be automatically counted from routine laboratory results and thus an easily applicable screening instrument in clinical settings.
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Affiliation(s)
- Elisa Heikkilä
- Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland. .,Tykslab, Laboratory Division, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.
| | - Marika Salminen
- Department of Clinical Medicine, Faculty of Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,City of Turku, Welfare Division, 20101, Turku, Finland
| | - Anna Viljanen
- Municipality of Lieto, Health Care Center, 21420, Lieto, Finland.,Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, Turku City Hospital, University of Turku, 20700, Turku, Finland
| | - Taina Katajamäki
- Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland.,Tykslab, Laboratory Division, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Marja-Kaisa Koivula
- Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland.,Tykslab, Laboratory Division, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.,HUS Diagnostic Center, Helsinki University Hospital, Hospital District of Helsinki and Uusimaa (HUS), 00029, Helsinki, Finland
| | - Kari Pulkki
- Diagnostic Center, Clinical Chemistry and Hematology, Helsinki University Hospital and University of Helsinki, 00029, Helsinki, Finland
| | - Raimo Isoaho
- Department of Clinical Medicine, Faculty of Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,City of Vaasa, Social and Health Care, 65101, Vaasa, Finland
| | - Sirkka-Liisa Kivelä
- Department of Clinical Medicine, Faculty of Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, 00014, Helsinki, Finland
| | - Matti Viitanen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, Turku City Hospital, University of Turku, 20700, Turku, Finland
| | - Minna Löppönen
- City of Raisio, Social and Health Care for Elderly, 21200, Raisio, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Faculty of Medicine, Unit of Biostatistics, University of Turku, Turku, Finland
| | - Laura Viikari
- City of Turku, Welfare Division, 20101, Turku, Finland.,Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, Turku City Hospital, University of Turku, 20700, Turku, Finland
| | - Kerttu Irjala
- Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland
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35
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Abstract
The COVID-19 pandemic has seen a proposal for frailty to be used as a rationing criterion. This commentary suggests circumstances under which that is defensible: in the face of lack of capacity to treat everyone, and as an alternative to age in stratifying risk. How best to stratify risk is likely to evolve and may include information about illness severity and dynamic measures. Current research must focus on mobilizing better, COVID-19-specific prognostic information, with a goal of best discriminating which lives are most and least likely to be saved should scarcity of resources dictate that not everyone can receive critical care.
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Affiliation(s)
- Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
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36
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Bielza R, Sanz J, Zambrana F, Arias E, Malmierca E, Portillo L, Thuissard IJ, Lung A, Neira M, Moral M, Andreu-Vázquez C, Esteban A, Ramírez MI, González L, Carretero G, Moreno RV, Martínez P, López J, Esteban-Ortega M, García I, Vaquero MA, Linares A, Gómez-Santana A, Gómez Cerezo J. Clinical Characteristics, Frailty, and Mortality of Residents With COVID-19 in Nursing Homes of a Region of Madrid. J Am Med Dir Assoc 2020; 22:245-252.e2. [PMID: 33417840 PMCID: PMC7833075 DOI: 10.1016/j.jamda.2020.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/25/2020] [Accepted: 12/06/2020] [Indexed: 01/08/2023]
Abstract
Objectives To describe the clinical characteristics, 30-day mortality, and associated factors of patients living in nursing homes (NH) with COVID-19, from March 20 to June 1, 2020. Design This is a retrospective study. A geriatric hospital-based team acted as a consultant and coordinated the care of older people living in NHs from the hospital. Setting and Participants A total of 630 patients aged 70 and older with Coronavirus Disease 2019 COVID-19 living in 55 NHs. Methods A logistic regression was performed to analyze the factors associated with mortality. In addition, Kaplan-Meier curves were applied according to mortality and its associated factors using the log-rank Mantel-Cox test. Results The diagnosis of COVID-19 was mainly made by clinical compatibility (N = 430). Median age was 87 years, 64.6% were women and 45.9% were transferred to be cared for at the hospital. A total of 282 patients died (44.7%) within the 30 days of first attention by the team. A severe form of COVID-19 occurred in 473 patients, and the most frequent symptoms were dyspnea (n = 332) and altered level of consciousness (n = 301). According to multiple logistic regression, male sex (P = .019), the Clinical Frailty Score (CFS) ≥6 (P = .004), dementia (P = .012), dyspnea (P < .001), and having a severe form of COVID-19 (P = .001), were associated with mortality, whereas age and care setting were not. Conclusions and Implications Mortality of the residents living in NHs with COVID-19 was almost 45%. The altered level of consciousness as an atypical presentation of COVID-19 should be considered in this population. A severe form of the disease, present in more than three-quarters of patients, was associated with mortality, apart from the male sex, CFS ≥6, dementia, and dyspnea, whereas age and care setting were not. These findings may also help to recognize patients in which the Advance Care Planning process is especially urgent to assist in the decisions about their care.
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Affiliation(s)
- Rafael Bielza
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain.
| | - Juan Sanz
- Department of Dermatology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Francisco Zambrana
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Oncology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Estefanía Arias
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Eduardo Malmierca
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Internal Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Laura Portillo
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Pharmacy, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Israel J Thuissard
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Lung
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Marta Neira
- Department of Geriatric Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - María Moral
- Department of Palliative Care, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Cristina Andreu-Vázquez
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Ana Esteban
- Department of Rheumatology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Marcela Irma Ramírez
- Department of Endocrinology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Laura González
- Department of Neurology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Guillermo Carretero
- Department of Orthopedics, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Ricardo Vicente Moreno
- Department of Rehabilitation, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Pilar Martínez
- Department of Rehabilitation, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Javier López
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Rehabilitation, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Mar Esteban-Ortega
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Ophthalmology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Isabel García
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Ophthalmology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - María Antonia Vaquero
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of General Surgery, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Ana Linares
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Urology, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Ana Gómez-Santana
- Department of Preventive Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
| | - Jorge Gómez Cerezo
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain; Department of Internal Medicine, Hospital Universitario Infanta Sofía (San Sebastián de los Reyes), Madrid, Spain
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Pulok MH, Theou O, van der Valk AM, Rockwood K. The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine. Age Ageing 2020; 49:1071-1079. [PMID: 32392289 PMCID: PMC7583513 DOI: 10.1093/ageing/afaa089] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND we investigated whether two frailty tools predicted mortality among emergency department (ED) patients referred to internal medicine and how the level of illness acuity influenced any association between frailty and mortality. METHODS two tools, embedded in a Comprehensive Geriatric Assessment (CGA), were the clinical frailty scale (CFS) and a 57-item deficit accumulation frailty index (FI-CGA). Illness acuity was assessed using the Canadian Triage and Acuity Scale (CTAS). We examined all-cause 30-day and 6-month mortality and time to death. RESULTS in 808 ED patients (mean age ± SD 80.8 ± 8.8, 54.4% female), the mean FI-CGA score was 0.44 ± 0.14, and the CFS was 5.6 ± 1.6. A minority (307; 38%) were classified as having high acuity (CTAS: 1-2). The 30-day mortality rate was 17%; this increased to 34% at 6 months. Compared to well patients with low acuity, the risk of 30-day mortality was 22.5 times (95% CI: 9.35-62.12) higher for severely frail patients with high acuity; 53% of people with very severe frailty (CFS = 8) and high acuity died within 30 days. When acuity was low, the risk for 30-day mortality was significantly higher only among those with very high levels of frailty (CFS 7-9, FI-CGA > 0.5). When acuity was high, even lower levels of frailty (CFS 5-6, FI-CGA 0.4-0.5) were associated with higher 30-day mortality. CONCLUSIONS across levels of frailty, higher acuity increased mortality risk. When acuity was low, the risk was significant only when the degree of frailty was high, whereas when acuity was high, even lower levels of frailty were associated with greater mortality risk.
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Affiliation(s)
| | - Olga Theou
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kenneth Rockwood
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Divisions of Geriatric Medicine & Neurology, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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38
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McMillan JM, Gill MJ, Power C, Fujiwara E, Hogan DB, Rubin LH. Comorbidities in Older Persons with Controlled HIV Infection: Correlations with Frailty Index Subtypes. AIDS Patient Care STDS 2020; 34:284-294. [PMID: 32639207 DOI: 10.1089/apc.2020.0051] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Frailty is prevalent in persons with human immunodeficiency virus (PWH), but factors predisposing older PWH to frailty remain uncertain. We examined factors associated with frailty and determined whether there were multiple frailty subtypes in older adults with controlled HIV infection. This was a cross-sectional outpatient study in an urban HIV clinic. Twenty-nine clinical indicators were extracted from medical records to compute a Frailty Index (FI) for 389 older (age 50+) PWH (range = 50-93; mean = 61.1, standard deviation = 7.2; 85% men) receiving HIV treatment in Calgary, Canada. We used regressions to identify factors associated with FI values. Latent class analysis was used to identify FI subtypes. Age, employment status, and duration of known HIV infection were the strongest predictors of FI (p's < 0.05). Four FI subtypes were identified. Subtype 1 (severe metabolic dysfunction+polypharmacy) had the highest mean FI (0.30). Subtype 2 (less severe metabolic dysfunction+polypharmacy) and Subtype 3 (lung and liver dysfunction+polypharmacy) had lower but equivalent mean FIs (0.20 for each). Subtype 4 (least severe metabolic dysfunction) had the lowest mean FI (0.13; p's < 0.001). Sociodemographic and behavioral characteristics differed among the subtypes. Individuals with Subtype 1 were older and more frequently unemployed/retired, whereas those with Subtype 3 were more likely to smoke, use crack/cocaine, have heavy alcohol use, and live in temporary/unstable housing. The clinical presentation of frailty in older PWH is heterogeneous. The metabolic syndrome, hepatitis C virus coinfection, cirrhosis, lung disease, and polypharmacy were associated with frailty as were unemployment/retirement, unstable housing, and substance use.
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Affiliation(s)
- Jacqueline M. McMillan
- Section of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Canada
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael John Gill
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Power
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Esther Fujiwara
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - David B. Hogan
- Section of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Leah H. Rubin
- Department of Neurology and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Frailty and Mortality in Hospitalized Older Adults With COVID-19: Retrospective Observational Study. J Am Med Dir Assoc 2020; 21:928-932.e1. [PMID: 32674821 PMCID: PMC7280137 DOI: 10.1016/j.jamda.2020.06.008] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
Objectives To determine the association between frailty and short-term mortality in older adults hospitalized for coronavirus disease 2019 (COVID-19). Design Retrospective single-center observational study. Setting and participants Eighty-one patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of a general hospital in Belgium. Measurements Frailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical, and radiologic variables, comorbidities, symptoms, and treatment were extracted from electronic medical records. Results Participants (N = 48 women, 59%) had a median age of 85 years (range 65-97 years) and a median CFS score of 7 (range 2-9); 42 (52%) were long-term care residents. Within 6 weeks, 18 patients died. Mortality was significantly but weakly associated with age (Spearman r = 0.241, P = .03) and CFS score (r = 0.282, P = .011), baseline lactate dehydrogenase (LDH; r = 0.301, P = .009), lymphocyte count (r = −0.262, P = .02), and RT-PCR cycle threshold (Ct, r = −0.285, P = .015). Mortality was not associated with long-term care residence, dementia, delirium, or polypharmacy. In multivariable logistic regression analyses, CFS, LDH, and RT-PCR Ct (but not age) remained independently associated with mortality. Both age and frailty had poor specificity to predict survival. A multivariable model combining age, CFS, LDH, and viral load significantly predicted survival. Conclusions and Implications Although their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available.
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Affiliation(s)
| | - Kenneth Rockwood
- Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (K.R.)
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