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Arnautovska U, Soole R, Wing Ling Kwan W, Reid N, Baker A, Gordon EH, Hubbard RE, Siskind D, Warren N. Outcomes of a pilot feasibility study of comprehensive geriatric assessment for younger frail patients with severe mental illness. BMC Psychiatry 2025; 25:473. [PMID: 40355820 PMCID: PMC12070768 DOI: 10.1186/s12888-025-06830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/08/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Individuals with severe mental illness (SMI) are at risk of early-onset frailty, leading to adverse outcomes. Effective interventions for reducing frailty in this population are currently lacking. AIMS To assess the feasibility, acceptability, and preliminary efficacy of Comprehensive Geriatric Assessment (CGA), delivered by an Advanced Trainee in Geriatric Medicine, as an intervention for individuals with co-occurring frailty and SMI. METHOD Participants, aged 18-64, with frailty and SMI were recruited from public community outpatient clinics between July 2022 and January 2023. Feasibility of CGA was evaluated through mixed methods. Secondary outcomes included a range of mental and physical health factors. RESULTS Out of 38 eligible individuals, 17 were enrolled and 14 completed the study; three dropped out post-baseline assessment and CGA. 86% were male, average age was 48.4, Body Mass Index 34.6, and Frailty Index 0.35. Participants expressed high acceptability and perceived benefits of CGA, including increased insight about one's health and receipt of multidisciplinary holistic care. While this study was inadequately powered to show statistically significant changes in secondary outcomes, positive trends were observed in overall psychosis symptoms and weekly physical activity engagement which increased by 56.6 min, reaching the recommended levels to achieve health benefits. CONCLUSION The findings of this study support the feasibility of CGA as an intervention in routine care of people with SMI and provide evidence for designing future trials of frailty interventions in this population. The study underscores the significance of tailored, multidisciplinary, and individualised approaches, though further research is required to substantiate its efficacy in this priority population.
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Affiliation(s)
- Urska Arnautovska
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia.
- Queensland Centre for Mental Health Research, Wacol, QLD, 4076, Australia.
| | - Rebecca Soole
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
| | | | - Natasha Reid
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Andrea Baker
- Queensland Centre for Mental Health Research, Wacol, QLD, 4076, Australia
| | - Emily H Gordon
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Dan Siskind
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, 4076, Australia
| | - Nicola Warren
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
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Åhlund K, Larsson LG, Ekerstad N, Normann M, Prytz M, Johnsson A. Experiences of participating in a preoperative comprehensive geriatric assessment and care intervention among frail older adults before colorectal cancer resection surgery. BMC Geriatr 2025; 25:310. [PMID: 40325373 PMCID: PMC12051325 DOI: 10.1186/s12877-025-05922-9] [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: 01/23/2025] [Accepted: 04/10/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) and care has shown benefits for frail older adults across various care settings. However, its integration into routine care within a surgical context remains limited. An ongoing randomised controlled multicentre study will evaluate the effects of a period of preoperative optimisation (up to eight weeks), involving interprofessional CGA and care, in addition to routine care before colorectal cancer resection surgery. If this approach proves favourable, it could potentially be incorporated into routine surgical care. To facilitate implementation, it is crucial to explore and understand participants' perceptions of taking part in a preoperative CGA and care intervention. AIM To describe how frail older adults with colorectal cancer experience participation in a preoperative CGA and care intervention. METHODS This qualitative, descriptive study was part of a randomised controlled multi-centre study. In total, 20 semi-structured interviews were conducted with frail older adults undergoing a CGA and care intervention before colorectal cancer surgery. The data were analysed using inductive qualitative content analysis. RESULTS Frail older adults with colorectal cancer experienced participation in preoperative CGA and care as an integral part of an intervention. They adopted an opportunity mindset when deciding to participate. Throughout the intervention, they observed the team working collaboratively and actively involving them in the optimisation process, enhancing their readiness for surgery by the end of the period. CONCLUSIONS The findings indicated that frail older adults with colorectal cancer viewed the preoperative CGA and care intervention as a meaningful opportunity for improvement and a chance to extend life. Their active involvement and the collaborative efforts of the care team during the intervention were crucial in enhancing their understanding, manageability, and readiness for surgery. They valued the opportunity to make active choices when appropriate and appreciated having the right to delegate decisions to healthcare professionals. From a frail older adult's perspective, team-based approaches in preoperative care, such as CGA and care, offer benefits in terms of involvement and satisfaction. However, the thorough evaluation of postoperative outcomes remains necessary. TRIAL REGISTRATION OSF registry: https://osf.io/ch49n , registered on Sep 04, 2023.
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Affiliation(s)
- Kristina Åhlund
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
- Department of Health Sciences, University West, Trollhättan, Sweden.
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lena G Larsson
- Department of Health Sciences, University West, Trollhättan, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Niklas Ekerstad
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
- Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Maria Normann
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
| | - Mattias Prytz
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
| | - Anette Johnsson
- Department of Health Sciences, University West, Trollhättan, Sweden
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Cai S, Li J, Fang Y, Feng Z, Liu H, Chen J, Yang X, Lin B, Tian Z. Frailty and pre-frailty prevalence in community-dwelling elderly with multimorbidity: A systematic review and meta-analysis. Arch Gerontol Geriatr 2025; 132:105782. [PMID: 40020460 DOI: 10.1016/j.archger.2025.105782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 02/06/2025] [Accepted: 02/08/2025] [Indexed: 03/03/2025]
Abstract
BACKGROUND The relationship between frailty/pre-frailty, and multimorbidity in the elderly is recognized, but specific prevalence among community-dwelling elderly with multimorbidity is unclear. This study aims to determine these rates, analyze subgroup, and identify sources of heterogeneity to bolster evidence-based interventions and health policies. METHODS We searched nine databases from inception to November 16, 2023, for cross-sectional and cohort studies on community-dwelling elderly with multimorbidity. Data were extracted to calculate the prevalence of frailty and pre-frailty. Study quality was assessed using AHRQ and NOS tools. RESULTS Fifteen studies encompassing 9,683 participants with multimorbidity were analyzed. The pooled prevalence of frailty and pre-frailty was 18.1 % and 48.9 %, respectively. Age-stratified analyses found 17 % frailty and 58.4 % pre-frailty in the 70-74 age group, and 16.7 % and 54.2 % in those above 75 years. Cross-sectional studies showed 18.8 % frailty and 48.1 % pre-frailty, while cohort studies showed 18.1 % and 50.5 %, respectively. Asia had higher rates (22.7 % frailty, 43.5 % pre-frailty) than the Americas (9.9 % frailty, 56.3 % pre-frailty). By sample size, frailty prevalence was 21.3 % (<500), 9.1 % (500-999), and 17.9 % (≥1000), with pre-frailty at 51.1 %, 45.6 %, and 47.7 %. The FP method yielded higher prevalence estimates (17.7 % frailty, 51.6 % pre-frailty) than the FS method (9.5 % frailty, 39.2 % pre-frailty). CONCLUSION This study provides insights into the prevalence of frailty and pre-frailty among community-dwelling elderly with multimorbidity. Variations in prevalence rates may be attributed to differences in sample size and measurement tools, which also contribute to heterogeneity observed across subgroups.
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Affiliation(s)
- Shiying Cai
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Jue Li
- Center for Nursing Research, Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Yi Fang
- School of Nursing, Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Zikai Feng
- The First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Huanjiang Liu
- School of Nursing, Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Jiaxin Chen
- College of Basic Medicine, Naval Medical University, Shanghai, 200433, China
| | - Xiali Yang
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361003, China
| | - Bin Lin
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China.
| | - Zhiyuan Tian
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, China.
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Serra-Prat M, Fortuny Borsot A, Burdoy E, Lavado Cuevas À, Muñoz Ortiz L, Cabré M. Frailty reversal and its main determinants: a population-based observational and longitudinal study. Fam Med Community Health 2025; 13:e003250. [PMID: 40295111 PMCID: PMC12039016 DOI: 10.1136/fmch-2024-003250] [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: 12/11/2024] [Accepted: 04/11/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Clinical guidelines recommend frailty screening for the aged population, given that frailty is frequently reversible. However, little is known about frailty and prefrailty reversal rates in the general population if no specific interventions have been implemented. AIM To assess real-world frailty and prefrailty reversal rates in the general population aged ≥65 years, the main contributing clinical conditions and the main risk factors for reversing frailty and prefrailty. METHODS Observational longitudinal 12-month study (2019) of all 1·5 million persons aged ≥65 years in Catalonia. Data were retrospectively collected from various health databases through the Catalan Public Data Analysis for Health Research and Innovation (PADRIS) V.2022 programme. Frailty status according to the electronic Screening Index for Frailty (e-SIF) was determined for 31 December 2018 and for 31 December 2019. RESULTS The study included 1 465 312 Catalan inhabitants (mean age 75.8 years, 57.0% women). The annual frailty and pre-frailty reversal rates were 7.1% and 4.6%, respectively. Both rates were higher in men and decreased with age. The e-SIF components with the greatest impact on frailty reversal were non-planned hospitalisations, polypharmacy, orthostatic hypotension or syncope, anaemia and visual impairment. Female sex, age, dependency, ≥2 comorbidities and polypharmacy had an independent protective effect on 12-month frailty and pre-frailty reversals. CONCLUSIONS Prefrailty and frailty are reversible, but reversal is unlikely in cases of multimorbidity, polypharmacy and functional dependency in older and severely frail individuals. Interventions that mainly target the avoidance of non-planned hospitalisations, polypharmacy and falls would have the greatest impact on reversing frailty and pre-frailty.
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Affiliation(s)
- Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Catalonia, Spain
- Networked Biomedical Research Centre for Liver and Digestive Diseases, Madrid, Spain
| | | | - Emili Burdoy
- Primary Care, Consorci Sanitari del Maresme, Mataro, Catalunya, Spain
| | | | | | - Mateu Cabré
- Internal Medicine Department, Hospital de Mataró, Mataro, Spain
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Liu S, Zhang MJ, Xiong XY, Chen L, Wu R. Exercise interventions for older patients with frailty and heart failure: A scoping review. Geriatr Nurs 2025; 63:476-485. [PMID: 40267660 DOI: 10.1016/j.gerinurse.2025.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 02/14/2025] [Accepted: 03/31/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND To provide a structured analysis of exercise interventions and outcome measures in older patients with frailty and heart failure (HF). METHODS 8 databases were searched up to May 22, 2024 to identify relevant studies. Two independent reviewers assessed and collected data according to the TIDieR checklist, CONTENT scale and COMET outcome taxonomy. RESULTS We screened 1,253 articles, resulting in 8 articles being included in the scoping review. Aerobic exercise and resistance training were fundamental elements of exercise rehabilitation, with balance training also being essential. Most exercise interventions are individualized, with the type and intensity of exercise being set and adjusted according to the patient's actual condition. However, the tailoring process of resistance training, including exercise load, sets, and repetitions, needs to be more detailed in most studies. The exercise interventions were provided by qualified therapists in most studies, and various methods were taken to ensure fidelity. None of the studies mentioned their theoretical basis. Only two exercise interventions were considered therapeutically valid. The two most commonly reported outcomes were physical function and quality of life. CONCLUSIONS It is necessary to focus on addressing research heterogeneity and report transparency to better implement exercise interventions in older frail adults with HF.
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Affiliation(s)
- Si Liu
- Nursing Department, The Second Affiliated Hospital, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China; School of Nursing, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China
| | - Mei-Jun Zhang
- Nursing Department, The Second Affiliated Hospital, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China; School of Nursing, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China
| | - Xiao-Yun Xiong
- Nursing Department, The Second Affiliated Hospital, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China.
| | - Lu Chen
- Nursing Department, The Second Affiliated Hospital, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China; School of Nursing, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China
| | - Rui Wu
- Nursing Department, The Second Affiliated Hospital, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China; School of Nursing, Jiangxi Medical College, Nan Chang University, Nan Chang, Jiang Xi, People's Republic of China
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Wiedermann CJ, Barbieri V, Ausserhofer D, Engl A, Piccoliori G, Mahlknecht A. Sex Bias in Frailty Screening: A Cross-Sectional Analysis of PRISMA-7 and the Clinical Frailty Scale in Primary Care. Diagnostics (Basel) 2025; 15:915. [PMID: 40218265 PMCID: PMC11989021 DOI: 10.3390/diagnostics15070915] [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: 02/06/2025] [Revised: 03/29/2025] [Accepted: 03/31/2025] [Indexed: 04/14/2025] Open
Abstract
Background/Objectives: Frailty screening is essential in primary care for the early identification of vulnerable older adults. PRISMA-7 is a widely used screening tool, but Item 2 ("Are you male?") introduces potential sex bias and overestimates frailty in men. PRISMA-6, a modified version that excludes Item 2, might provide a more equitable alternative. This study evaluates PRISMA-6's alignment with the Clinical Frailty Scale (CFS) and its impact on sex-specific frailty classification. Methods: A cross-sectional study was conducted in 142 general practices across South Tyrol, including 9190 general practice patients aged ≥75 years. Frailty was assessed using PRISMA-7, PRISMA-6, and the CFS. Correlations between tools were calculated using Kendall's Tau-b, whereas Fisher's z-test was used to compare differences in alignment. The frailty prevalence and odds ratios were stratified according to sex and age. Results: PRISMA-6 showed a stronger correlation with the CFS (τ = 0.492) than PRISMA-7 (τ = 0.308, z = -10.2, p < 0.001). This effect was pronounced in men (z = -9.8, p < 0.001), whereas no difference was observed in women (z = 0.00, p = 1.000). PRISMA-6 reduced the frailty detection rate in men and was more closely aligned with the CFS. Conclusions: PRISMA-6 demonstrated improved alignment with the CFS and reduced sex bias compared to PRISMA-7. However, its use as a screening tool for men requires prospective validation in diverse settings. PRISMA-6 shows promise as a reliable and equitable frailty screening tool and should be considered for use in future studies, particularly in primary care settings, while awaiting further prospective validation.
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Affiliation(s)
- Christian J. Wiedermann
- Institute of General Practice and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy (A.M.)
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Isaradech N, Sirikul W, Buawangpong N, Siviroj P, Kitro A. Machine Learning Models for Frailty Classification of Older Adults in Northern Thailand: Model Development and Validation Study. JMIR Aging 2025; 8:e62942. [PMID: 40262171 PMCID: PMC12038762 DOI: 10.2196/62942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 11/26/2024] [Accepted: 02/28/2025] [Indexed: 04/24/2025] Open
Abstract
Background Frailty is defined as a clinical state of increased vulnerability due to the age-associated decline of an individual's physical function resulting in increased morbidity and mortality when exposed to acute stressors. Early identification and management can reverse individuals with frailty to being robust once more. However, we found no integration of machine learning (ML) tools and frailty screening and surveillance studies in Thailand despite the abundance of evidence of frailty assessment using ML globally and in Asia. Objective We propose an approach for early diagnosis of frailty in community-dwelling older individuals in Thailand using an ML model generated from individual characteristics and anthropometric data. Methods Datasets including 2692 community-dwelling Thai older adults in Lampang from 2016 and 2017 were used for model development and internal validation. The derived models were externally validated with a dataset of community-dwelling older adults in Chiang Mai from 2021. The ML algorithms implemented in this study include the k-nearest neighbors algorithm, random forest ML algorithms, multilayer perceptron artificial neural network, logistic regression models, gradient boosting classifier, and linear support vector machine classifier. Results Logistic regression showed the best overall discrimination performance with a mean area under the receiver operating characteristic curve of 0.81 (95% CI 0.75-0.86) in the internal validation dataset and 0.75 (95% CI 0.71-0.78) in the external validation dataset. The model was also well-calibrated to the expected probability of the external validation dataset. Conclusions Our findings showed that our models have the potential to be utilized as a screening tool using simple, accessible demographic and explainable clinical variables in Thai community-dwelling older persons to identify individuals with frailty who require early intervention to become physically robust.
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Affiliation(s)
- Natthanaphop Isaradech
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110, Intrawarorot Road, Meaung, 50200, Thailand, 66 53935472, 66 935476
- Environmental and Occupational Medicine Excellence Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110, Intrawarorot Road, Meaung, 50200, Thailand, 66 53935472, 66 935476
- Center of Data Analytics and Knowledge Synthesis for Health Care, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Biomedical Informatics and Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110, Intrawarorot Road, Meaung, 50200, Thailand, 66 53935472, 66 935476
| | - Amornphat Kitro
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110, Intrawarorot Road, Meaung, 50200, Thailand, 66 53935472, 66 935476
- Environmental and Occupational Medicine Excellence Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Wu YC, Chen CT, Shen SF, Chen LK, Peng LN, Tung HH. Comparative analysis of frailty identification tools in community services across the Asia-Pacific: A systematic review and meta-analysis. J Nutr Health Aging 2025; 29:100496. [PMID: 39889374 DOI: 10.1016/j.jnha.2025.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/19/2025] [Accepted: 01/22/2025] [Indexed: 02/03/2025]
Abstract
OBJECTIVES This study aimed to compare various frailty screening and assessment tools with the Frailty Phenotype (FP), Frailty Index (FI), and Comprehensive Geriatric Assessment (CGA), which are considered the current gold standards, among the Asia-Pacific population in community settings. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS This review included studies evaluating frailty identification tools based on the criteria of population, index and reference tests, and diagnosis of interest. METHODS A diagnostic test accuracy review was conducted to assess frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines. Comprehensive electronic database searches and manual searches were conducted up to August 20, 2024. Study quality, including risks of bias and applicability, was assessed using the QUADAS-2 tool. Hierarchical analysis and Youden's index were employed to identify the optimal tool and cutoff points, and pooled frailty prevalence was calculated. RESULTS Fourteen studies were included: 10 for the FRAIL scale, 3 for TUG, and 2 for the SOF index (screening tools), and 2 each for the CFS and KCL, and 1 for the REFS (assessment tools). All studies demonstrated a high risk of bias. The pooled sensitivity and specificity for screening tools were 0.63 and 0.89, respectively, whereas for assessment tools, they were 0.79 and 0.85. The pooled prevalence of frailty and pre-frailty was 19.7% and 31.7%, respectively. The pooled diagnostic odds ratios were highest for the FRAIL scale (15.72) and CFS (35.03) among the screening and assessment tools. The subgroup analysis revealed that the setting had no significant impact on screening tool performance (p = 0.58), but a borderline significant effect was observed for assessment tools (p = 0.06), although this result is limited by the small number of studies, with only one conducted in a community setting. The FRAIL scale, with a cutoff of 2, had a Youden's index of 0.60, signifying optimal screening performance. CONCLUSION Among the frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines, this meta-analysis identifies the FRAIL scale as the most robust tool for distinguishing frailty, with a cutoff of 2 significantly enhancing diagnostic accuracy. Furthermore, the estimated prevalence of frailty in the Asia-Pacific region is 19.7% across various community settings, underscoring the need for further research and the development of validated assessment tools tailored to this population.
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Affiliation(s)
- Yi-Chen Wu
- College of Nursing and Health Sciences, Da-Yeh University, No.168, University Rd., Dacun, Changhua 515006, Taiwan.
| | - Chia-Te Chen
- Graduate Institute of Clinical Nursing, College of Medicine, National Chung Hsing University, No. 145 Xingda Rd., South Dist., Taichung City 402202, Taiwan; Department of Nursing, College of Medicine, National Cheng Kung University, No.1-3, Daxue Rd., East Dist., Tainan City 70101, Taiwan.
| | - Shu-Fen Shen
- Department of Nursing, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan.
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan. No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Beitou Dist., Taipei, 112, Taiwan; Taipei Municipal Gan-Dau Hospital, No. 12, Ln. 225, Zhixing Rd., Beitou Dist., Taipei 112020, Taiwan.
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan. No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Beitou Dist., Taipei, 112, Taiwan.
| | - Heng-Hsin Tung
- College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong Street, Beitou Dist., Taipei, 112, Taiwan; Tungs' Taichung MetroHarbor Hospital, Taiwan, No.699, Section 8, Taiwan Boulevard, Wuqi District, Taichung City 435403, Taiwan.
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Ellis HL, Dunnell L, Eyres R, Whitney J, Jennings C, Wilson D, Tippett J, Stein DF, Teo J, Ibrahim Z, Rockwood K. What can we learn from 68 000 clinical frailty scale scores? Evaluating the utility of frailty assessment in emergency departments. Age Ageing 2025; 54:afaf093. [PMID: 40253684 PMCID: PMC12009543 DOI: 10.1093/ageing/afaf093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Indexed: 04/22/2025] Open
Abstract
BACKGROUND Emergency departments (EDs) in England are under significant strain, with increasing attendances and extended wait times, affecting frail older adults. The clinical frailty scale (CFS) has been implemented as a tool to assess frailty in ED settings, but its reliability and predictive accuracy as a screening tool remain debated. OBJECTIVE To evaluate the use and variability of the CFS in EDs and its association with patient outcomes, including discharge rates, length of stay, readmission and mortality. METHODS A retrospective cohort study of ED attendances at two London (UK) hospitals from 2017 to 2021. Data included CFS scores, demographics, clinical observations and outcomes. Comparative statistics, logistic regression, Cox proportional hazards models and competing risk regression were applied to examine CFS predictive validity. RESULTS In a sample of 123 324 ED visits, CFS scores strongly correlated with adverse outcomes: e.g. for long-term mortality (n = 33 475, events = 8871), each CFS single-point increase was associated with a 25% increase in mortality risk (95% CI 1.23-1.26). CFS scores varied significantly between raters and across visits, median difference two levels (interquartile range 1-3). Intraclass correlation coefficient analysis showed that 33.1% of CFS score differences was attributable to between-patient differences, 15.4% to inter-rater differences, with 51.5% residual variance from non-frailty factors, such as acute illness severity. CONCLUSION The CFS is associated with crucial patient outcomes in the ED. Inter-rater variability and potentially confounding factors can limit its consistency. Automation to enhance CFS score reliability should be explored as a means to support proactive management.
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Affiliation(s)
- Hugh Logan Ellis
- King’s College London, Department of Biostatistics & Health Informatics, Social Genetic and Developmental Psychiatry Centre, Memory Lane, Southwark, London, SE5 8AF, UK
- Dalhousie University Ringgold Standard Institution,Department of Medicine, Suite 1421-5955, Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Liam Dunnell
- University Hospital Lewisham, Lewisham, London, UK
| | - Ruth Eyres
- Princess Royal University Hospital, Department of Clinical Gerontology, Orpington, Bromley, Kent, UK
| | - Julie Whitney
- King's College London, The School of Life Course & Population Sciences, Southwark, London, UK
| | - Cara Jennings
- King's College Hospital NHS Foundation Trust, Emergency Department, Lambeth, London, UK
| | - Dan Wilson
- Kings College Hospital NHS Foundation Trust, Department of Clinical Gerontology, Lambeth, London, UK
| | - Jane Tippett
- King's College Hospital NHS Foundation Trust, Emergency Department, Lambeth, London, UK
| | - Dan F Stein
- King’s College London, Department of Biostatistics & Health Informatics, Social Genetic and Developmental Psychiatry Centre, Memory Lane, Southwark, London, SE5 8AF, UK
| | - James Teo
- King's College Hospital NHS Foundation Trust, Neurology Department, Lambeth, London, UK
| | - Zina Ibrahim
- King’s College London, Department of Biostatistics & Health Informatics, Social Genetic and Developmental Psychiatry Centre, Memory Lane, Southwark, London, SE5 8AF, UK
| | - Kenneth Rockwood
- Dalhousie University Ringgold Standard Institution,Department of Medicine, Suite 1421-5955, Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 4R2, Canada
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10
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Nguyen TN, Yu J, Perkovic V, Jardine M, Mahaffey KW, Chow CK, Arnott C, Lindley RI. The Efficacy and Safety of Canagliflozin by Frailty Status in Participants of the CANVAS and CREDENCE Trials. J Am Geriatr Soc 2025. [PMID: 40105285 DOI: 10.1111/jgs.19444] [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: 06/28/2024] [Revised: 12/29/2024] [Accepted: 02/16/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to improve renal and cardiovascular outcomes in patients with type 2 diabetes. Limited evidence exists about the efficacy and safety of SGLT2 inhibitors in patients with frailty. METHODS This was a post hoc pooled, participant-level data analysis of the CANVAS Program (CANVAS and CANVAS-R) and the CREDENCE trial. We examined the effect of canagliflozin on: (1) Major adverse cardiovascular events (MACE), (2) Cardiovascular mortality, (3) all-cause mortality, and (4) key safety outcomes. Frailty was defined by a Frailty Index (FI) based on a deficit accumulation approach (FI > 0.25: frail). Cox proportional-hazard models were used to estimate the efficacy and safety of canagliflozin overall and according to frailty status. RESULTS There were 14,543 participants (10,142 from the CANVAS Program, 4401 from the CREDENCE trial). Their mean age was 63.2 years; 35.3% were female. Frailty was present in 56% of the study participants. The benefits of canagliflozin were observed in both the frail and non-frail subgroups: HRs for MACE 0.80 (95% CI 0.70-0.90) in the frail versus 0.91 (95% CI 0.75-1.09) in the non-frail (p for interaction = 0.27); HRs for cardiovascular mortality 0.79 (95% CI 0.67-0.95) in the frail versus 0.94 (95% CI 0.70-1.27) in the non-frail (p for interaction = 0.38); HRs for all-cause mortality 0.81 (95% CI 0.70-0.94) in the frail versus 0.93 (95% CI 0.74-1.16) in the non-frail (p for interaction = 0.39). Adverse events were similar among frail and non-frail participants, except for osmotic diuresis (HRs 1.67, 95% CI 1.22-2.28 in the frail vs. 3.05, 95% CI 2.13-4.35 in the non-frail, p for interaction = 0.01). CONCLUSIONS Canagliflozin improved cardiovascular and mortality endpoints in participants with type 2 diabetes irrespective of frailty status, with a similar safety profile. Our findings, in addition to those from other recent studies, provide evidence to support the introduction of SGLT2 inhibitor therapy in patients perceived to be frail. TRIAL REGISTRATION ClinicalTrials.gov CANVAS: NCT01032629; CANVAS-R: NCT01989754; CREDENCE: NCT02065791.
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Affiliation(s)
- Tu N Nguyen
- Westmead Applied Research Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jie Yu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Meg Jardine
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California, USA
| | - Clara K Chow
- Westmead Applied Research Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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11
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Aliberti MJR, Arteaga-Vargas DF, Avelino-Silva TJ. Frailty Matters-Why Isn't It Guiding Clinical Decisions? J Am Geriatr Soc 2025. [PMID: 40105286 DOI: 10.1111/jgs.19443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 02/23/2025] [Indexed: 03/20/2025]
Affiliation(s)
- Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica Em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica Em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Division of Geriatrics, Department of Medicine, University of California san Francisco, San Francisco, California, USA
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12
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Drop PH, van Ham C, Mulder ACM, Veeken-Dijkstra PA, Daal JO, Zwart LAR. Validation of the nurse directed frailty assessment tool, to identify patients at risk of emergency department visits, hospitalisation, and 1-year all-cause mortality. Eur Geriatr Med 2025:10.1007/s41999-025-01182-3. [PMID: 40085379 DOI: 10.1007/s41999-025-01182-3] [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: 11/11/2024] [Accepted: 02/28/2025] [Indexed: 03/16/2025]
Abstract
METHODS This is a validation study of a new frailty assessment that can be administered by outpatient care nurses. The nurse directed frailty assessment (NDFA) encompasses the medical, psychological, social, and functional domain, based on standard care, and can be performed without any specialised equipment. Performance of the NDFA is compared to a comprehensive geriatric assessment (CGA)-based frailty index (FI), with generalised linear model with reporting of hazard ratios (HR) and 95% confidence intervals (95% CI). The best cutoff value for the NDFA was assessed by Youden index and the area under the receiver operator curve (ROC). RESULTS Within 1 year, 15 patients (5%) died, 57 (18%) had an unplanned hospital admission, and 83 (26%) visited the emergency department (ED). Based on the Youden index and ROC curve, the best cutoff value for the NDFA was 4 points. With a binary logistic regression model, an HR of 3.59 (95% CI 1.16-11.15, p < 0.001) was found for mortality. In the general mixed model with Poisson logistic regression, an HR of 1.78 (95% CI 1.06-2.97, p 0.028) was found for unplanned hospital and an HR of 1.87 (95% CI 1.25-2.78, p 0.002) was found for ED visits. The HR and 95% CI of the FI were similar for all three outcome measures. CONCLUSIONS The NDFA identifies patients at risk for hospitalisation, emergency department visits, and mortality within 12 months equally well as the FI. Further research is necessary to determine the effectiveness of the NDFA in other settings than the geriatric medicine outpatient population.
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Affiliation(s)
- P H Drop
- Department of Geriatric Medicine, Dijklander Hospital, Hoorn, The Netherlands
| | - C van Ham
- Department of Geriatric Medicine, Dijklander Hospital, Hoorn, The Netherlands
| | - A C M Mulder
- Department of Geriatric Medicine, Dijklander Hospital, Hoorn, The Netherlands
| | - P A Veeken-Dijkstra
- Department of Geriatric Medicine, Dijklander Hospital, Hoorn, The Netherlands
| | - J O Daal
- Department of Geriatric Medicine, Dijklander Hospital, Hoorn, The Netherlands
| | - L A R Zwart
- Department of Geriatric Medicine, Dijklander Hospital, Hoorn, The Netherlands.
- Department of Ageing and Public Health, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
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13
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Che Y, Xin H, Gu Y, Ma X, Xiang Z, He C. Associated factors of frailty among community-dwelling older adults with multimorbidity from a health ecological perspective: a cross-sectional study. BMC Geriatr 2025; 25:172. [PMID: 40087569 PMCID: PMC11907925 DOI: 10.1186/s12877-025-05777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 02/10/2025] [Indexed: 03/17/2025] Open
Abstract
BACKGROUND As the global aging process accelerates, the older population is increasing annually, with the majority suffering from one or more chronic diseases. Due to the influence of chronic disease comorbidity, frailty among the older is widespread. Therefore, early identification of frailty in older adults with comorbidities from a comprehensive perspective, along with proactive measures for prevention and timely intervention, becomes an inevitable requirement for healthy aging. This study aimed to identify the entry point of frailty management in the older with multimorbidity in the community and clarify the focus of frailty management. METHODS A national cross-sectional survey of 1056 older adults with comorbidities in 148 cities across China was conducted. Frailty was assessed using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Based on the health ecological model, the factors which may influence frailty were collected from five levels. Univariate and multivariate analysis were utilized to determine the factors influencing frailty. The STROBE checklist was used preparing the manuscript. RESULTS A total of 417 patients (39.5%) reported having frailty, while 613 patients (58.0%) were in the pre-frail state. Multivariate logistic regression analysis indicate that compared with robust patients, number of comorbidities, self-efficacy, sleep quality and perceived social support are associated with frailty in older patients with comorbidities (P < 0.05). Compared to pre-frail group, factors such as number of comorbidities, gender (female), cognitive status of diseases, anxiety, having four or more comorbidities, smoking, eating habits, taking three or more different types of medication and perceived social support are associated with frailty (P < 0.05). CONCLUSIONS The prevalence of frailty among older adults with comorbidities is exceptionally high, influenced by various dimensions from health ecology perspective. Psychological care and daily behavior management should be strengthened for the frail older with multimorbidity. Precise and individualized care interventions need to be developed to help promote healthy aging.
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Affiliation(s)
- Yunqiu Che
- School of Nursing, Jiangxi Medical College, Nanchang University, 461 Bayi Street, Nanchang, 330000, China
| | - Hanjia Xin
- School of Nursing, Jiangxi Medical College, Nanchang University, 461 Bayi Street, Nanchang, 330000, China
| | - Yingying Gu
- School of Nursing, Jiangxi Medical College, Nanchang University, 461 Bayi Street, Nanchang, 330000, China
| | - Xiuxiu Ma
- School of Nursing, Jiangxi Medical College, Nanchang University, 461 Bayi Street, Nanchang, 330000, China
| | - Ziying Xiang
- School of Nursing, Jiangxi Medical College, Nanchang University, 461 Bayi Street, Nanchang, 330000, China
| | - Chaozhu He
- School of Nursing, Jiangxi Medical College, Nanchang University, 461 Bayi Street, Nanchang, 330000, China.
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14
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Wang X, Hu W, Zhang J. Advances in pathophysiology and assessment methods of chronic obstructive pulmonary disease with frailty. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2025; 3:22-28. [PMID: 40226603 PMCID: PMC11993078 DOI: 10.1016/j.pccm.2025.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Indexed: 04/15/2025]
Abstract
Frailty, a multidimensional syndrome characterized by decreased physiological reserves and vulnerability to stressors, presents significant challenges in the management of chronic obstructive pulmonary disease (COPD). COPD and frailty share common risk factors and pathophysiological pathways, such as muscle wasting, chronic inflammation, and malnutrition. Both COPD and frailty lead to a significant reduction in patients' physical functionality and quality of life. Consequently, early screening for frailty and proactive interventions for patients with COPD are increasingly considered essential. There are several methods for screening and assessing frailty in patients with COPD, such as the Fried Frailty Phenotype and the Frailty Index, each with its own advantages and limitations. However, there is currently no unified standard, nor a method specifically tailored to the Chinese population. The treatment of patients with COPD and concurrent frailty currently favors exercise interventions, nutritional interventions, or a combination of both. Further treatment approaches, including pharmacological interventions, are still being explored. Therefore, the development of frailty screening and assessment tools tailored to the Chinese population, along with the exploration of reasonable and effective new intervention measures, represents a crucial direction in China's efforts to prevent and treat frailty.
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Affiliation(s)
- Xia Wang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Weiping Hu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai 200032, China
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15
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Kennedy F, Murray D, Ní Cheallaigh C, Romero-Ortuno R, Broderick J. Evaluation of a Low-threshold Exercise And Protein supplementation intervention for Women (LEAP-W) experiencing homelessness and addiction: Protocol for a single-arm mixed methods feasibility study. PLoS One 2025; 20:e0300412. [PMID: 39913349 PMCID: PMC11801605 DOI: 10.1371/journal.pone.0300412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 12/18/2024] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Frailty is a complex multi-dimensional state of increased vulnerability to adverse outcomes and is associated with older age but there is growing evidence of accelerated ageing and frailty in non-geriatric populations, including those experiencing socio-economic deprivation and extreme social exclusion, such as people experiencing homelessness. Addiction, as a coping mechanism for prior trauma, is common among people who are homeless and can have a gendered dimension. Women experiencing homelessness and addiction have unique needs which require a gendered approach. The aim of this study is to evaluate the feasibility and impact of an exercise intervention to target the known physical functioning deficits and frailty which this population experiences. METHODS This quantitatively driven, sequential single-arm mixed-methods feasibility study will evaluate the feasibility and impact of a low threshold trauma informed exercise intervention on physical functioning and frailty in women experiencing homelessness and addiction. Physical function (10m Walk Test, 2Min Walk Test, Single Leg Stance, Chair Stand Test, hand grip dynamometry), frailty (Clinical Frailty Scale and the SHARE-Frailty Instrument) and nutritional status (Mini-Nutritional Status), pain (Numerical Rating Scale) and quality of life (SF 12-V2) will be evaluated. The 10-week intervention will involve a 3-times weekly exercise programme with protein supplementation. Following this, qualitative interviews, which will be thematically analysed using Braun & Clarke methodology, will be conducted. This study will be conducted in Dublin from February to July 2024. DISCUSSION Little is known about frailty-focussed interventions in women experiencing homelessness and addiction. This proposed study will help to increase the knowledge base regarding the physical health burden and frailty experienced by this vulnerable population and will deliver a targeted intervention with a gendered dimension to mitigate its affects. The findings of this research will help narrow the research gap and will guide clinicians and policy makers to implement unique gender-based treatment strategies for this population. (300). CLINICAL TRIALS.GOV NUMBER NCT05700305.
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Affiliation(s)
- Fiona Kennedy
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Murray
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Clíona Ní Cheallaigh
- St James’s Hospital, Dublin, Ireland
- Trinity Centre for Health Sciences, Department of Clinical Medicine, School of Medicine, St. James’s Hospital, Trinity College Dublin, Dublin, Ireland
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
- Global Brain Institute, Trinity College Dublin, Dublin, Ireland
| | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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16
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Lau LK, Lun P, Gao J, Tan E, Ding YY. Application and implementation of brief geriatric assessment in primary care and community settings: a scoping review. BMC Geriatr 2025; 25:2. [PMID: 39748279 PMCID: PMC11697857 DOI: 10.1186/s12877-024-05615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 12/05/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Comprehensive Geriatric Assessment is the gold standard of clinical care for older patients but its application in the primary care setting is limited, possibly due to its time-consuming process. Hence, a brief geriatric assessment could be a feasible alternative. We conducted a scoping review to identify which brief geriatric assessment tools have been evaluated or implemented in primary and community care settings and to identify the domains assessed including their reported outcomes. METHODS CENTRAL, PubMed and Embase were searched using specific text words and MeSH for articles published from inception that studied evaluation or implementation of brief geriatric assessments in primary care or community setting. RESULTS Twenty-five articles were included in the review, of which 11 described brief geriatric assessments implemented in community, nine in primary care and five in mixed settings. Physical health, functional, mobility/balance and psychological/mental emerged as four domains that are most assessed in brief geriatric assessments. Self-reported questionnaire is the key approach, but uncertainty remains on the validity of subjective cognitive assessments. Brief geriatric assessments have been administered by non-healthcare professionals. The duration taken to complete ranged from five to 20 min. Studies did not report significant change in the clinical outcomes of older adults except for better identification of those with higher needs. CONCLUSION The studies reported that brief geriatric assessments could identify older adults with unmet needs or geriatric syndromes, but they did not report improved health outcomes when combined with clinical intervention pathways. Clarity of brief geriatric assessments' questions is important to ensure the feasibility of using self-administered questionnaire by older adults. Future studies should determine which groups of older adults benefit the most from the brief assessments when these are paired with additional evaluations and interventions.
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Affiliation(s)
- Lay Khoon Lau
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Singapore, 768024, Singapore.
| | - Penny Lun
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Singapore, 768024, Singapore
| | - Jonathan Gao
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Singapore, 768024, Singapore
| | - Edward Tan
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Singapore, 768024, Singapore
| | - Yew Yoong Ding
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Singapore, 768024, Singapore
- Department of Geriatric Medicine & Institute of Geriatric and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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17
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Logan B, Pascoe EM, Viecelli AK, Johnson DW, Comans T, Hawley CM, Hickey LE, Janda M, Jaure A, Kalaw E, Kiriwandeniya C, Matsuyama M, Mihala G, Nguyen KH, Pole JD, Polkinghorne KR, Pond D, Raj R, Reidlinger DM, Scholes-Robertson N, Valks A, Wong G, Hubbard RE. Baseline Characteristics of Frailty and Disease Stage in Older People Living With CKD. Kidney Int Rep 2025; 10:120-133. [PMID: 39810773 PMCID: PMC11725818 DOI: 10.1016/j.ekir.2024.10.009] [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: 06/15/2024] [Revised: 10/02/2024] [Accepted: 10/07/2024] [Indexed: 01/16/2025] Open
Abstract
Introduction The GOAL trial, a cluster randomized controlled trial, investigated the effect of comprehensive geriatric assessment (CGA) on frail older people with chronic kidney disease (CKD). This paper describes the following: (i) participant baseline characteristics, and (ii) their relationship with CKD stage and frailty severity. Methods Sixteen kidney outpatient clinics (clusters) were randomly allocated 1:1 to CGA or usual care. Enrolled frail older people with CKD (Frailty Index [FI] > 0.25; aged ≥65 years or ≥55 if First Nations people) received the intervention allocated to their cluster. CKD was defined as moderate (stages 3 or 4) or severe (stage 5 or 5D), and frailty categorized as moderate (>0.25-<0.36), severe (0.36-<0.45) or very severe (≥0.45). Participant characteristics were analyzed using descriptive statistics. Statistical methods appropriate for type of outcome were used to describe the association of frailty and CKD categories with participant characteristics. Results Over a 27-month period, 240 people were recruited (55.7% male, 82.9% White/European). Mean age was 76.9 (SD: 6.6) years and median FI was 0.39 (interquartile range [IQR]: 0.32-0.47). The median EQ-5D-5L quality-of-life index score was worse in those with very severe frailty (0.57, IQR: 0.28-0.83) compared to severe frailty (0.85, IQR: 0.67-0.92) and moderate frailty (0.90, IQR: 0.82-0.93) (overall P < 0.001). Median EQ-5D-5L was also worse in those with severe CKD (0.79, IQR: 0.40-0.89), compared to moderate CKD (median 0.87, IQR: 0.73-0.92; P = 0.001). Conclusion This cohort demonstrated poorer quality-of-life scores in those with more severe frailty and more advanced CKD.
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Affiliation(s)
- Benignus Logan
- Australian Frailty Network, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Andrea K. Viecelli
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Tracy Comans
- Australian Frailty Network, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- National Ageing Research Institute, Melbourne, Australia
| | - Carmel M. Hawley
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Laura E. Hickey
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Emarene Kalaw
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Charani Kiriwandeniya
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Misa Matsuyama
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Gabor Mihala
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Kim-Huong Nguyen
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland and University of California, San Francisco, California, USA
| | - Jason D. Pole
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Kevan R. Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Dimity Pond
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
- University of New England, Armidale, Australia
| | - Rajesh Raj
- School of Medicine, University of Tasmania, Hobart, Australia
- Department of Nephrology, Launceston General Hospital, Launceston, Australia
| | - Donna M. Reidlinger
- Australian Frailty Network, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - Ruth E. Hubbard
- Australian Frailty Network, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Department of General and Geriatric Medicine, Princess Alexandra Hospital, Brisbane, Australia
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18
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Alattas A, Shuweihdi F, Best K, Nikolova S, West R. Bidirectional association between frailty and quality of life within English longitudinal study of aging. Qual Life Res 2025; 34:261-271. [PMID: 39400690 PMCID: PMC11802669 DOI: 10.1007/s11136-024-03809-7] [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] [Accepted: 10/07/2024] [Indexed: 10/15/2024]
Abstract
PURPOSE The relationship between quality of life (QoL) and frailty has previously been investigated cross-sectionally and longitudinally as unidirectional where QoL depends upon frailty and where frailty depends on QoL. Here a bidirectional relationship is examined. METHODS This work uses a latent curve model with structured residuals to address the bidirectional association between QoL and frailty in older English people considering within-person and group levels. The study measures frailty using a functional frailty measure and quality of life using CASP-12. The sample size is 17,529. RESULTS There is a strong relationship between QoL (Quality of Life) and frailty, which is almost linear and inversely proportional over time. Although the cross-lagged coefficients from QoL to frailty and vice versa showed statistical significance, the impact was found to be minimal. The time between assessments (which are two years apart) and/or the few observations available per individual may have impacted the effect of this relationship. When accounting for gender, age, net wealth, and multimorbidity, some variations in the results were observed at the group level but not at the within-person level. CONCLUSION The study provides empirical evidence that supports a bidirectional association between QoL and frailty in older individuals who reside at home. These results offer valuable insights for healthcare providers, as participants did not exhibit an advanced need for health services. Additionally, involving participants in evaluating and assessing these services enhances their effectiveness and overall benefit.
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Affiliation(s)
- Ali Alattas
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
- Basic Science Department, College of Science and Health Professions, King Saud bin Abdulaziz for Health Sciences, Jeddah, Saudi Arabia.
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Kate Best
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Silviya Nikolova
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Pérez-Rugosa V, Núñez-Castro I, Carriles-Freire WC, Rodríguez-Rodríguez A, Sarabia-Cobo C. SANTANA Cohort: Study on Frailty in Institutionalised Older Adults and Its Relationship With Gordon's Functional Health Patterns. J Adv Nurs 2024. [PMID: 39740079 DOI: 10.1111/jan.16710] [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: 06/05/2024] [Revised: 10/24/2024] [Accepted: 12/17/2024] [Indexed: 01/02/2025]
Abstract
AIM This study investigated whether Gordon's Functional Health Patterns (FHPs) can predict frailty in older adults residing in nursing homes over 5 years. DESIGN Prospective cohort study with participants from 10 nursing homes across five countries. METHODS Researchers assessed 1245 participants at baseline and 903 at follow-up (5 years) using standardised frailty measures and FHP assessments. Statistical analyses explored the relationships between FHPs and frailty. RESULTS FHPs, particularly those related to mobility, nutrition and social interaction, significantly predicted lower frailty risk at baseline. Furthermore, FHPs showed an increased ability to predict frailty over time, explaining a substantial portion of frailty variation at both baseline and follow-up. Analyses also revealed differences in how specific FHPs impacted frailty, suggesting the importance of individual functional variations. CONCLUSION This study suggests that Gordon's FHPs are a valuable tool for predicting frailty in older adults within institutional settings. Integrating FHPs into clinical practice can promote early frailty detection and intervention. Future research should explore how FHPs change over time and their impact on frailty in broader populations. REPORTING METHOD The study followed the CONSORT guideline for cohort studies to enhance the quality and transparency of reporting the results. PATIENT OR PUBLIC CONTRIBUTION Not applicable.
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Affiliation(s)
| | - Isabel Núñez-Castro
- Residencia Santo Espiritu, Geriatric Nursing Research Group. (Spain), Lisboa, Portugal
| | | | | | - Carmen Sarabia-Cobo
- Nursing Research Group IDIVAL. Geriatric Nursing Research Group. CIBERFRAILTY, University of Cantabria, Santander, Spain
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Rashıdı M, Yıldırım G, Karaman F, Çakmak S, Durusoy E, Akgöz HF, Saygın Şahin B, Genç A. Determination of the relationship between frailty level and quality of life in elderly individuals with type 2 diabetes. Sci Rep 2024; 14:32028. [PMID: 39738443 PMCID: PMC11685459 DOI: 10.1038/s41598-024-83766-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 12/17/2024] [Indexed: 01/02/2025] Open
Abstract
The aim of the study was to examine the relationship between frailty level and quality of life in elderly individuals with Type 2 diabetes. This descriptive and correlational study was conducted with 211 patients who applied to the diabetes outpatient clinic of a private and a public hospital in Istanbul between September and November 2022. The data were obtained by using the Personal Information Form, Edmonton Frail Scale and the Quality of Life in the Elderly Scale. The mean Edmonton Frail Scale score of the participants was 7.36 ± 4.35. Their mean quality of life scale score was 19.32 ± 7.12. A low degree of negative correlation was found between Elderly Quality of Life Scale total and subscale scores and the Edmonton Frail Scale score (p < 0.05). Besides, there was a statistically significant difference between the Edmonton Frail Scale mean score and education level, history of falling in the last 1 year, using oral antidiabetic drugs, and the presence of diabetes complications (p < 0.05). It is recommended that frailty and quality of life should be evaluated regularly in elderly patients with diabetes and necessary planning should be made in diabetes management and improving quality of life in the presence of frailty.
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Affiliation(s)
- Mahruk Rashıdı
- Department of Nursing, Faculty of Health Sciences, İstanbul Gelişim University, Cihangir Dist. Şehit Jandarma Komando Er Hakan Öner Str. No:1 Avcılar, Istanbul, Turkey.
| | - Gülay Yıldırım
- Department of Nursing, Trakya University, Keşan Hakkı Yörük School of Health, Edirne, Turkey
| | - Funda Karaman
- Department of Nursing, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Sultan Çakmak
- Department of Nursing, Faculty of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey
| | - Ebru Durusoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey
| | - Hasan Fatih Akgöz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Gelisim University, Istanbul, Turkey
| | - Buse Saygın Şahin
- Mental Health and Diseases Nursing PhD Program, Istanbul University - Cerrahpasa, Institute of Graduate Studies, Istanbul, Turkey
| | - Aslı Genç
- Department of Nursing, School of Nursing, Ufuk University, Ankara, Turkey
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21
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Yuan G, Yang Y, Lin Y, Lin J, Wu Y. Current status and development trends in CKD with frailty research from 2000 to 2021: a bibliometric analysis. Ren Fail 2024; 46:2292142. [PMID: 38178378 PMCID: PMC10773684 DOI: 10.1080/0886022x.2023.2292142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The prevalence of chronic kidney disease (CKD) is gradually increasing in the elderly population. At the same time, frailty has become one of the research hotspots in the field of geriatrics. Bibliometric analyses help to understand the direction of a field. Therefore, this study aimed to analyze the status and emerging trends of frailty in CKD patients. DATA AND METHODS The Web of Science Core Collection (WoSCC) database was screened for relevant literature published between 1 January 2000 and 31 December 2021. Next, publications were analyzed for information including authors, journals, cited references, citing journals, institutions, countries and regions, high-frequency keywords and co-citations using VOSviewer, Microsoft Excel, and R software. RESULTS A total of 2223 articles were obtained, from which 613 relevant articles were selected based on title and abstract screening. There was an upward trend in the number of annual publications and Johansen KL was considered the most contributing author in the field. The Clinical Journal of the American Society of Nephrology was the most productive research journal. Johns Hopkins University is the most published organization. The United States is the global leader in the field and contributes the most to research. Research hotspots focus on epidemiological studies of frailty and frailty intervention. CONCLUSIONS This study presents a comprehensive bibliometric analysis of CKD and frailty research. Key findings highlight the current focus on early screening and assessment of frailty in CKD patients, as well as physical function interventions in frail patients.
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Affiliation(s)
- Guowei Yuan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yaqin Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yujie Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiarong Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yuchi Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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22
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Waefler N, Abid I, Montaut V, Donzé J, Zender H, John G. Neurological diagnostic tests for patients with and without delirium: a prospective observational study. GeroScience 2024; 46:6383-6393. [PMID: 38916662 PMCID: PMC11494000 DOI: 10.1007/s11357-024-01246-5] [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: 01/22/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024] Open
Abstract
Since most of the precipitating factors of delirium are not due to neurological disorders, neurological diagnostic tests (NDTs) may be of limited value. We hypothesized that delirium has a high burden of NDTs with a low diagnostic yield. All patients admitted to the internal medicine wards of a single secondary teaching hospital between November 2019 and January 2020 were eligible. Within the first 48 h of their admission, they had a formal evaluation by a neuropsychologist to screen for presence of delirium. NDTs (brain MRI, brain CT, electroencephalography (EEG), and lumbar puncture) performed during the hospital stay were compared between patients with and without delirium using a logistic regression model stratified by a propensity score. The proportions of diagnostic yield (acute anomalies that changed the treatment management) provided by each type of examination were compared. Of 217 patients included, 19/32 patients (61%) with delirium had one or more NDTs, compared to 48/185 (26%) without delirium (adjusted OR 2.7; 95%CI 1.1-6.7; p = 0.027). The proportions of NDT results affecting management for patients with and without delirium were 13 and 20% for brain CT scans (p = 0.71), 29 and 38% for brain MRI (p = 0.99), and 20 and 10% for EEGs (p = 0.99), respectively. The higher proportion of NDTs performed on patients with delirium was associated with a low diagnostic yield, although not statistically different from those performed among inpatients without delirium. There is a need for restrictive, evidence-based guidelines to help with the work-up for patients with delirium.
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Affiliation(s)
- Noémie Waefler
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
| | - Imen Abid
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
| | - Victor Montaut
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
| | - Jacques Donzé
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland
- Division of Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Medicine, University Hospital of Lausanne, Rue de Bugnon 21, CH-1011, Lausanne, Switzerland
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hervé Zender
- Department of Medicine, Neuchâtel Hospital Network, Rue du Chasseral 20, CH-2300, La Chaux-de-Fonds, Switzerland
- Department of Acute Medicine, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland
| | - Gregor John
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000, Neuchâtel, Switzerland.
- Department of Internal Medicine, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland.
- University of Geneva, Rue Michel Servet 1, CH-1211, Geneva, Switzerland.
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Serra-Prat M, Moreno-Carmona MR, Fortuny A, Lavado À, Papiol M, Muñoz L, Martínez-Cerdá JF, Serra-Colomer J, Burdoy E, Cabré M. Frailty trends in Catalonia 2017-2021: An epidemiological study with 1.5 million people aged ≥65 years. Public Health 2024; 237:14-21. [PMID: 39316851 DOI: 10.1016/j.puhe.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/27/2024] [Accepted: 09/17/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVES Knowledge of frailty prevalence and incidence trends over time is essential for planning the necessary health and social resources. The objective of this study was to assess frailty prevalence, incidence, reversibility and mortality rates, and trends for the population aged ≥65 years in Catalonia over the period 2017-2021. STUDY DESIGN Longitudinal epidemiological study. METHODS An observational longitudinal 5-year study (1 January 2017 to 31 December 2021) of the population aged ≥65 years in Catalonia (approximately 1.5 million individuals) was performed using retrospectively collected data from different health databases. Frailty status was evaluated using the electronic Screening Index of Frailty (e-SIF) and categorised as robust, pre-frail, moderately frail or severely frail. RESULTS Standardised frailty prevalence rates were 10.5 % (2017), 11.8 % (2018), 13.1 % (2019), 12.9 % (2020) and 14.3 % (2021) [p-value for trend = 0.010]. Standardised frailty incidence rates per 1000 non-frail persons/year were 35 (2018), 36 (2019), 28 (2020) and 33 (2021) [p-value for trend = 0.492]. Both prevalence and incidence were higher in women and increased with age. Standardised frailty reversibility rates per 1000 frail persons/year were 123 (2018), 108 (2019) and 121 (2020) [p-value for trend = 0.406], and decreased with age. Standardised mortality rates for frail individuals per 1000 frail persons/year were 93 (2018), 84 (2019) and 110 (2020) [p-value for trend = 0.555], and increased with frailty severity. CONCLUSIONS Frailty prevalence in Catalonia increased by 36 % between 2017 and 2021; however, no clear trend was evident for frailty incidence and reversibility, while results for mortality were likely to have been influenced by the COVID-19 pandemic.
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Affiliation(s)
- Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain; Networked Biomedical Research Centre for Liver and Digestive Diseases (CIBEREHD), Madrid, Spain; Germans Trias i Pujol Research Institute, Badalona, Barcelona, Spain.
| | | | - Aida Fortuny
- Primary Care Department, Institut Català de la Salut, Barcelona, Spain
| | - Àngel Lavado
- Information Management Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Mònica Papiol
- Primary Care Department, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | | | - Juan Francisco Martínez-Cerdá
- Agency for Health Quality and Assessment of Catalonia (AQUAS), Department of Health, Catalan Government, Barcelona, Spain
| | - Júlia Serra-Colomer
- Department of Universities and Research, Catalan Government, Barcelona, Spain
| | - Emili Burdoy
- Primary Care Department, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Mateu Cabré
- Internal Medicine Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
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Cui Y, Meng C, Xiang L, Luo Y, Song X, Cheng D, Ye J, Zhang X. Association between patient-reported frailty and nonhome discharge among older patients with acute stroke: A prospective study. Clin Rehabil 2024; 38:1691-1702. [PMID: 39397433 DOI: 10.1177/02692155241290258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
OBJECTIVE To investigate the association between prestroke frailty and nonhome discharge, prolonged length of stay as well as functional outcomes. DESIGN Prospective observational study. SETTING Single urban teaching hospital in Guangzhou, China. PARTICIPANTS Consecutive sample of 271 older patients admitted with acute stroke. INTERVENTION N/A. MAIN MEASURES A five-item FRAIL scale (0∼5 points) and the stroke severity at onset were measured. The primary outcome of interest was nonhome discharge, with secondary outcomes including prolonged length of stay and worse short-term prognosis. Multivariable logistic regression adjusting for confounding factors was used to determine the association between patient-reported frailty and nonhome discharge, prolonged length of stay, worse short-term prognosis. RESULTS The population had a median age of 68 [interquartile range (IQR), 64∼74)]years, with 50 individuals (18.5%) identified as frail. After adjusting for age, sex, Barthel index, National Institutes of Health Stroke Scale, and Mini-Mental Status Exam score at admission, patients with self-reported frailty were significantly likely to experience nonhome discharge (Odds Ratio [OR] = 4.788; 95% confidence interval [CI] = 1.272∼18.017; p = .021), prolonged length of stay (OR = 4.76; 95% CI = 1.80∼12.56; p = .002), mRS scores at 30 days (OR = 6.72;95% CI = 1.79∼25.20; p = .005) and three months postdischarge and three-month (OR = 8.94; 95% CI = 2.10∼38.08; p = .003). CONCLUSIONS In older adults with stroke, frailty is associated with nonhome discharge, prolonged length of stay, and worse short-term prognosis, regardless of the stroke severity, cognition, and Barthel index score at admission. FRAIL scale can be used as a practical screening tool in acute care setting by multidisciplinary team in supporting discharge process.
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Affiliation(s)
- Yanli Cui
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Anesthesia and Perioperative and Pain Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cao Meng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lijun Xiang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yansi Luo
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuemei Song
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Daihong Cheng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiawei Ye
- Department of Neurology, Nanfang Hospital Baiyun Branch, Guangzhou, China
| | - Xiaomei Zhang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Lieber SB, Wysham KD, Sattui SE, Yung R, Misra D. Frailty and rheumatic diseases: evidence to date and lessons learned. THE LANCET. RHEUMATOLOGY 2024; 6:e881-e891. [PMID: 39542001 DOI: 10.1016/s2665-9913(24)00191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/31/2023] [Accepted: 06/27/2024] [Indexed: 11/17/2024]
Abstract
Frailty represents a dynamic multisystem state of reduced physiological reserve that increases vulnerability to adverse health outcomes. Frailty occurs prematurely in adults with immune-mediated rheumatic diseases and is emerging as an important risk factor for adverse outcomes in these conditions. In this Series paper, we present a conceptual overview of frailty and its prevalence among patients with immune-mediated rheumatic diseases. We discuss putative mechanisms of frailty relevant to these diseases, tools for frailty measurement, and potential implications of frailty assessment for clinical care. We also explore the complex inter-relationship between frailty, inflammation, and disease activity in immune-mediated rheumatic diseases. As insight is gained into the epidemiology and mechanisms of frailty among patients with immune-mediated inflammatory rheumatic diseases, the possibility of targeting frailty with an intervention that could complement standard disease-modifying therapies to prevent adverse outcomes and improve health-related quality of life becomes closer to reality.
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Affiliation(s)
- Sarah B Lieber
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA; Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Katherine D Wysham
- Department of Veteran Affairs, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Raymond Yung
- Geriatrics Center and Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Ann Arbor Geriatrics Research, Education and Clinical Center, Ann Arbor, MI, USA
| | - Devyani Misra
- Division of Rheumatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Division of Geriatrics, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Canevelli M, Jackson-Tarlton C, Rockwood K. Frailty for neurologists: perspectives on how frailty influences care planning. Lancet Neurol 2024; 23:1147-1157. [PMID: 39276779 DOI: 10.1016/s1474-4422(24)00291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 06/20/2024] [Accepted: 07/03/2024] [Indexed: 09/17/2024]
Abstract
The concept of frailty, now being adopted in most medical disciplines, is attracting growing interest in neurology. Every day, most neurologists care for patients with varying degrees of frailty, from very mild to very severe. Frailty exacerbates patients' health needs, complicates clinical decision making, and negatively affects their health outcomes. Increasing evidence suggests that frailty affects the risk, clinical presentation, and course of common age-related neurological disorders, including dementia, Parkinson's disease, stroke, and multiple sclerosis. Most neurologists should become familiar with assessing and measuring frailty. Doing so can provide information that is crucial for diagnosis, prognostication, and care planning. Consideration of frailty can help to elucidate the pathophysiological underpinnings of age-related neurological disorders, clarify the clinical validity and utility of candidate biomarkers, and identify novel therapeutic targets. Randomised controlled trials investigating late-life neurological diseases that address frailty have the potential to provide insight into these complex disorders.
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Affiliation(s)
- Marco Canevelli
- Department of Human Neuroscience, Sapienza University, Rome, Italy; National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Caitlin Jackson-Tarlton
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, Canada; Nova Scotia Health, Halifax, NS, Canada
| | - Kenneth Rockwood
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, Canada; Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada; Frailty and Elder Care Network, Halifax, NS, Canada.
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Hershkowitz Sikron F, Schenker R, Koom Y, Segal G, Shahar O, Wolf I, Mazengya B, Lewis M, Laxer I, Albukrek D. Development and validation of an electronic frailty index in a national health maintenance organization. Aging (Albany NY) 2024; 16:13025-13038. [PMID: 39448091 PMCID: PMC11552639 DOI: 10.18632/aging.206141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/02/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND Frailty constitutes a major factor that puts the elderly at risk of health and functional deterioration. OBJECTIVES To develop and validate an Electronic Frailty Index based on electronic data routinely collected in the HMO. STUDY DESIGN AND SETTING A retrospective cohort of the HMO members. PARTICIPANTS 120,986 patients, aged 65 years and over at the beginning of 2023. PREDICTORS A cumulative frailty index including 36 medical, functional, and social deficits. OUTCOMES One-year all-cause mortality or hospitalization. STATISTICAL ANALYSIS One-year hazard ratios were estimated for composite outcome of mortality or hospitalization using multivariable hierarchical Cox regression. RESULTS The mean EFI score increased with the Social Security Nursing Benefit. Compared to fit patients, mild, moderate, and severe frailty patients had 2.07, 3.35, and 4.4-fold increased risks of mortality or hospitalization, after controlling for covariates. CONCLUSIONS The findings showed that the Electronic Frailty Index version we created is valid in predicting mortality or hospitalization. In addition, the Electronic Frailty Index converged with an independent measurement produced by National Social Security.
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Affiliation(s)
| | | | - Yishay Koom
- Meuhedet Health Maintenance Organization (HMO), Tel-Aviv, Israel
| | - Galit Segal
- Meuhedet Health Maintenance Organization (HMO), Tel-Aviv, Israel
| | - Orit Shahar
- The Joint-Eshel Organization, Jerusalem, Israel
| | - Idit Wolf
- Meuhedet Health Maintenance Organization (HMO), Tel-Aviv, Israel
| | - Bawkat Mazengya
- Meuhedet Health Maintenance Organization (HMO), Tel-Aviv, Israel
| | - Maor Lewis
- Meuhedet Health Maintenance Organization (HMO), Tel-Aviv, Israel
| | - Irit Laxer
- Department of Geriatrics, Israeli Ministry of Health, Jerusalem, Israel
| | - Dov Albukrek
- Meuhedet Health Maintenance Organization (HMO), Tel-Aviv, Israel
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Baynouna Alketbi LM, Afandi B, Nagelkerke N, Abdubaqi H, Al Nuaimi RA, Al Saedi MR, Al Blooshi FI, Al Blooshi NS, Al Aryani AM, Al Marzooqi NM, Al Khouri AA, Al Mansoori SA, Hassanein M. Frailty assessment and outcomes in primary care for patients with diabetes during Ramadan: implications for risk evaluation and care plans. Front Med (Lausanne) 2024; 11:1426140. [PMID: 39411191 PMCID: PMC11475290 DOI: 10.3389/fmed.2024.1426140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/30/2024] [Indexed: 10/19/2024] Open
Abstract
Background Frailty is a critical concern for older adults, impacting their susceptibility to adverse events and overall quality of life. This study aimed to determine the frailty status of patients 60 years or older in Abu Dhabi Ambulatory Healthcare Services (AHS) and assess its relation to the stress exerted by Ramadan fasting and the occurrence of any adverse outcomes. Methods In this prospective observational study, participants were included if the attending physicians used the IDF-DAR risk stratification assessment tool. A tele-interview was conducted to complete the FRAIL score within 6 weeks before Ramadan 1,444 (CE 2022). The outcome was assessed through another tele-interview and an electronic medical record review after Ramadan. Results According to the FRAIL assessment tool, among the 204 patients aged 60 years or older included in the study, 109 (53.4%) were classified as either frail or pre-frail. In total, 20 (9.8%) patients were frail, that is, 1 out of 10, and 89 (43.6%) were pre-frail. The remaining 95 (46.6%) patients were robust. Using logistic regression to assess the occurrence of adverse outcomes after Ramadan fasting, a higher frailty score was identified as the third independent risk factor [B = 0.4, OR = 1.5 (1-2.02-1.86), and p = 0.039] for experiencing an adverse event. The identified factors associated with frailty were age, increased albumin-to-creatinine ratio (ACR), chronic kidney diseases (CKDs), and ischemic heart diseases (beta = 0.27, p = 0.003; beta = 0.24, p = 0.004; beta = 0.2, p = 0.039; and beta = 0.18, p = 0.041, respectively). One-third of the frail patients had an event, while the incidence in pre-frail patients was 11.2%, and among the robust patients, the incidence was 6.3%. Physicians' global assessment of frailty did not align well with the structured FRAIL scoring. Only five (25%) out of the 20 patients identified as frail by the FRAIL assessment tool were also judged as frail or having cognitive function impairment by the physicians' global assessment tool. Conclusion Frailty is prevalent among elderly patients with diabetes. Disparity exists between subjective and objective frailty assessments, emphasizing the need for standardized evaluation methods. Using the FRAIL tool is recommended for patients aged 60 or older with diabetes in Abu Dhabi.
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Affiliation(s)
| | | | - Nico Nagelkerke
- College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, United Arab Emirates
| | - Hanan Abdubaqi
- Ambulatory Healthcare Services, Abu Dhabi, United Arab Emirates
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29
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Man S, Wu X, Huang H, Yu J, Xia L. Frailty in middle-aged and older adult postoperative patients with gynecological malignancies structural equation modeling. Front Public Health 2024; 12:1431048. [PMID: 39391154 PMCID: PMC11464329 DOI: 10.3389/fpubh.2024.1431048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 09/13/2024] [Indexed: 10/12/2024] Open
Abstract
Background Frailty and self-management are important determinants of quality of life in cancer patients. However, their synergistic effects and potential mechanisms on quality of life in middle-aged and older adult postoperative gynecologic malignancy patients have not been adequately studied. Objective This cross-sectional study aimed to explore the relationship between frailty, self-management, and quality of life in middle-aged and older adult postoperative gynecologic malignancy patients. Methods A cross-sectional study was conducted from January 2024 to April 2024 in three gynecological wards of a tertiary hospital in Wuxi. The study recruited 177 patients aged 45 years or older who underwent surgery for gynecologic malignancies (cervical, ovarian, and endometrial cancer). Data were collected using demographic and clinical characteristics, the Edmonton Frailty Scale, the Self-Management Competence Scale, and the EORTC Core Quality of Life Questionnaire. Structural equation modeling was used to explore the interactions between frailty, self-management, and quality of life. Results The prevalence of frailty in middle-aged and older adult postoperative gynecologic malignancy patients was 39.5%, with a mean total self-management score of 125.81 ± 13.21 and a mean total quality of life score of 69.26 ± 10.88. The fit indices of the model indicated a good fit, and that frailty had multiple effects on quality of life; specifically, frailty could affect the quality of life directly or through self-management, i.e., self-management partially mediated frailty and quality of life. Conclusion Self-management is a mediating variable between frailty and quality of life, suggesting that clinical workers can intervene in self-management skills to improve patient's quality of life and physical and mental health.
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Affiliation(s)
- Shuo Man
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
- Jiangnan University, Wuxi, Jiangsu, China
| | - Xiaofang Wu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - HaoWen Huang
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jinjin Yu
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Ling Xia
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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Cantrell A, Chambers D, Booth A. Interventions to minimise hospital winter pressures related to discharge planning and integrated care: a rapid mapping review of UK evidence. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-116. [PMID: 39267416 DOI: 10.3310/krwh4301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Background Winter pressures are a familiar phenomenon within the National Health Service and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review focuses on interventions or initiatives in relation to hospital winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care. Methods We conducted a mapping review of United Kingdom evidence published 2018-22. Initially, we searched MEDLINE, Health Management Information Consortium, Social Care Online, Social Sciences Citation Index and the King's Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and a draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar (Google Inc., Mountain View, CA, USA). For each taxonomy heading, we produced a table with definitions, findings from research studies, local initiatives and systematic reviews and evidence gaps. Results The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These headings were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified. Conclusions Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and hospital at home interventions are heavily used and well supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole-system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting. Limitations Time limitations for completing the review constrained the period available for additional searches. This may carry implications for the completeness of the evidence base identified. Future work Further research to consider a realist review that views approaches across the different sectors within a whole system evaluation frame. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130588) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 31. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Jain S, Ghosh Moulic A. Neuropsychiatric and Cardiac Complications in Post-operative Antibiotic Therapy in Elderly Patients Undergoing Otorhinolaryngological Surgeries: A Review of Frailty Risk Indices. Cureus 2024; 16:e69765. [PMID: 39429271 PMCID: PMC11490751 DOI: 10.7759/cureus.69765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 09/19/2024] [Indexed: 10/22/2024] Open
Abstract
With the increase in life expectancy and awareness, more otorhinolaryngologic surgeries are being performed in the elderly population. Otorhinolaryngologic surgeries like septoplasty, tympanoplasty, and dacryocystorhinostomy (DCR) surgeries are elective surgeries for improving the quality of life. However, post-operative medication can entail a risk to life or serious side effects in elderly patients. It is seen that before any surgery, the patients have undergone various tests and investigations to monitor the nephrotoxicity and hepatotoxicity primarily to gauge medication clearance and organ damage. However, the effects of various post-operative medications on the central nervous system and cardiovascular system are less well-discussed. Harmful effects of various drugs especially antibiotics given post-operatively in otorhinolaryngology on the central nervous and cardiovascular system are not frequently reported, and the underlying mechanisms may be unclear or conflicting. Older individuals have a greater chance of experiencing serious drug reactions due to physiologic changes affecting pharmacokinetic processes. Some frailty risk indices can be used to determine the cognitive and physiological conditions in geriatric patients so that the outcome of using antibiotics in the post-operative period on the neuropsychiatric and cardiovascular systems can be predicted. This review aims to summarise the research on the neurotoxic and cardiac effects of antibiotics used in otorhinolaryngology practice in the post-operative period in elderly patients, with a focus on signs of psychosis, delirium, cognitive impairment, syncope, cardiac arrest, angina-like symptoms, etc. This review also studies some frailty risk indices that can be used to predict the neuropsychiatric and cardiac side effects due to polypharmacy, especially antibiotics. Hence, post-operative risks can be predetermined and a protocol for further management can be established.
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Affiliation(s)
- Shraddha Jain
- Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ayushi Ghosh Moulic
- Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Liu X, Yang X. Research Progress on Frailty in Elderly People. Clin Interv Aging 2024; 19:1493-1505. [PMID: 39224708 PMCID: PMC11368114 DOI: 10.2147/cia.s474547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
Global aging is rapidly accelerating, which significantly influences the health systems worldwide. Frailty emerges as the most conspicuous hallmark of aging, imposing novel global health challenges. Characterized by a multifaceted decline across physiological system, frailty diminishes an individual's capacity to maintain equilibrium in the presence of stressors, which leads to adverse outcomes such as falls, delirium, and disability. Several screening tools and interventions have been developed to mitigate the harm caused by frailty to human health, but research on frailty in mainland China commences belatedly with scant studies conducted. Therefore, it is imperative to explore screening methods and treatment modalities tailored to the Chinese context, thereby enhancing the older adults' quality of life and advancing social medicine. This review aims to elucidate the evolution, diagnosis, and management of frailty, alongside the challenges it poses, with the overarching goal of guiding future diagnostic and therapeutic endeavors. Specifically, we summarized the mechanisms of frailty and intervention strategies in elderly people, and meanwhile, we evaluated the advantages and disadvantages of different measurement tools.
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Affiliation(s)
- Xiaoming Liu
- Department of Geriatric Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Xiaoni Yang
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People’s Republic of China
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Fox ST, Hubbard R, Valks A, Matsuyama M, Kalaw E, Viecelli A, Aquino EM, Johnson D, Janda M. Protocol for the process evaluation of the GOAL trial: investigating how comprehensive geriatric assessment (CGA) improves patient-centred goal attainment in older adults with chronic kidney disease in the outpatient setting. BMJ Open 2024; 14:e076328. [PMID: 39097313 PMCID: PMC11298742 DOI: 10.1136/bmjopen-2023-076328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION The GOAL Cluster Randomised Controlled Trial (NCT04538157) is now underway, investigating the impact of comprehensive geriatric assessment (CGA) for frail older people with chronic kidney disease (CKD). The primary outcome is the attainment of patient-identified goals at 3 months, assessed using the goal attainment scaling process. The protocol requires a dedicated process evaluation that will occur alongside the main trial, to investigate issues of implementation, mechanisms of impact and contextual factors that may influence intervention success. This process evaluation will offer novel insights into how and why CGA might be beneficial for frail older adults with CKD and provide guidance when considering how to implement this complex intervention into clinical practice. METHODS AND ANALYSIS This process evaluation protocol follows guidance from the Medical Research Council and published guidance specific for the evaluation of cluster-randomised trials. A mixed methodological approach will be taken using data collected as part of the main trial and data collected specifically for the process evaluation. Recruitment and process data will include site feasibility surveys, screening logs and site issues registers from all sites, and minutes of meetings with intervention and control sites. Redacted CGA letters will be analysed both descriptively and qualitatively. Approximately 60 semistructured interviews will be analysed with a qualitative approach using a reflexive thematic analysis, with both inductive and deductive approaches underpinned by an interpretivist perspective. Qualitative analyses will be reported according to the Consolidated criteria for Reporting Qualitative research guidelines. The Standards for Quality Improvement Reporting Excellence guidelines will also be followed. ETHICS AND DISSEMINATION Ethics approval has been granted through Metro South Human Research Ethics Committee (HREC/2020/QMS/62883). Dissemination will occur through peer-reviewed journals and feedback to trial participants will be facilitated through the central coordinating centre. TRIAL REGISTRATION NUMBER NCT04538157.
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Affiliation(s)
- Sarah Therese Fox
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
- Internal Medicine Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Misa Matsuyama
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Emarene Kalaw
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea Viecelli
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Eunise Martha Aquino
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
| | - David Johnson
- Australasian Kidney Trials Network, The University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
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Jackwert K, Holmér M, Hallongren M, Asmar T, Wretenberg P, Andersson ÅG. Agreement between Clinical Frailty Scale-scores based on information from patient interviews and Clinical Frailty Scale-scores based on information from medical records - a cross sectional study. BMC Geriatr 2024; 24:570. [PMID: 38956490 PMCID: PMC11218100 DOI: 10.1186/s12877-024-05160-5] [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: 09/28/2023] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Frailty is an age-related condition with increased risk for adverse health outcomes. Assessing frailty according to the Clinical Frailty Scale (CFS) based on data from medical records is useful for previously unassessed patients, but the validity of such scores in exclusively geriatric populations and in patients with dementia is relatively unknown. METHODS Patients admitted for the first time to one of two geriatric wards at Örebro University hospital between January 1st - December 31st, 2021, were included in this study if they had been appointed a CFS-score by anamnestic interview (CFSI) at admission. CFS scores based on medical records (CFSR) were appointed by a single medical student, who was blinded to the CFSI score. Score-agreement was evaluated with quadratic weighted Cohen's kappa (κ). RESULTS In total, 145 patients between the age of 55-101 were included in the study. The CFSR and CFSI scores agreed perfectly in 102 cases (0.7, 95% CI 0.65-0.77). There was no significant difference regarding age, sex, comorbidity, or number of patients diagnosed with dementia between the patients with complete agreement and the patients whose scores did not agree. Agreement between the scores was substantial, κ = 0.66, 95% CI 0.53-0.80. CONCLUSIONS CFS scores based on information from medical records can be generated with substantial agreement to CFS scores based on in-person anamnestic interviews. A dementia diagnosis does not influence the agreement between the scores. Therefore, these scores are a useful tool for assessing frailty in geriatric patients who previously lack a frailty assessment, both in clinical practice and future research. The results support previous findings, but larger studies are warranted.
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Affiliation(s)
- Kim Jackwert
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
| | - Michael Holmér
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
- Department of Geriatrics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Matilda Hallongren
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
| | - Todel Asmar
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
| | - Per Wretenberg
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden
- Department of Orthopaedics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Åsa G Andersson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, SE70182, Sweden.
- Department of Geriatrics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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Muscedere J, Bagshaw SM, Kho M, Mehta S, Cook DJ, Boyd JG, Sibley S, Wang HT, Archambault PM, Albert M, Rewa OG, Ball I, Norman PA, Day AG, Hunt M, Loubani O, Mele T, Sarti AJ, Shahin J. Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study. Intensive Care Med 2024; 50:1064-1074. [PMID: 38748266 PMCID: PMC11245420 DOI: 10.1007/s00134-024-07404-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/19/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE Frailty is common in critically ill patients but the timing and optimal method of frailty ascertainment, trajectory and relationship with care processes remain uncertain. We sought to elucidate the trajectory and care processes of frailty in critically ill patients as measured by the Clinical Frailty Scale (CFS) and Frailty Index (FI). METHODS This is a multi-centre prospective cohort study enrolling patients ≥ 50 years old receiving life support > 24 h. Frailty severity was assessed with a CFS, and a FI based on the elements of a comprehensive geriatric assessment (CGA) at intensive care unit (ICU) admission, hospital discharge and 6 months. For the primary outcome of frailty prevalence, it was a priori dichotomously defined as a CFS ≥ 5 or FI ≥ 0.2. Processes of care, adverse events were collected during ICU and ward stays while outcomes were determined for ICU, hospital, and 6 months. RESULTS In 687 patients, whose age (mean ± standard deviation) was 68.8 ± 9.2 years, frailty prevalence was higher when measured with the FI (CFS, FI %): ICU admission (29.8, 44.8), hospital discharge (54.6, 67.9), 6 months (34.1, 42.6). Compared to ICU admission, aggregate frailty severity increased to hospital discharge but improved by 6 months; individually, CFS and FI were higher in 45.3% and 50.6% patients, respectively at 6 months. Compared to hospital discharge, 18.7% (CFS) and 20% (FI) were higher at 6 months. Mortality was higher in frail patients. Processes of care and adverse events were similar except for worse ICU/ward mobility and more frequent delirium in frail patients. CONCLUSIONS Frailty severity was dynamic, can be measured during recovery from critical illness using the CFS and FI which were both associated with worse outcomes. Although the CFS is a global measure, a CGA FI based may have advantages of being able to measure frailty levels, identify deficits, and potential targets for intervention.
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Affiliation(s)
- John Muscedere
- Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | - Michelle Kho
- School of Rehabilitation Science, Faculty of Health Science, Physiotherapy Department, McMaster University, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Deborah J Cook
- Departments of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - J Gordon Boyd
- Department of Medicine (Neurology) and Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Stephanie Sibley
- Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Han T Wang
- Division of Critical Care Medicine, Department of Medicine, Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Martin Albert
- Division of Critical Care Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal Research Center and Université de Montréal, Montreal, QC, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | - Ian Ball
- Department of Medicine and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Patrick A Norman
- Kingston General Health Research Institute and Kingston Health Sciences Centre, Kingston, Canada
| | - Andrew G Day
- Kingston General Health Research Institute and Kingston Health Sciences Centre, Kingston, Canada
| | - Miranda Hunt
- Department of Critical Care Medicine, Kingston Health Sciences Center, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Osama Loubani
- Department of Critical Care, Dalhousie University, Halifax, ON, Canada
| | - Tina Mele
- Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jason Shahin
- Department of Medicine, McGill University, Montreal, Qc, Canada
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Ferrante LE, Szczeklik W. Frailty is crucial in FORECASTing outcomes in critical care. Intensive Care Med 2024; 50:1119-1122. [PMID: 38953928 PMCID: PMC11556853 DOI: 10.1007/s00134-024-07518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/08/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
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Brighton LJ, Evans CJ, Farquhar M, Bristowe K, Kata A, Higman J, Ogden M, Nolan C, Yi D, Gao W, Koulopoulou M, Hasan S, Ingram K, Clarke S, Parmar KR, Baldwin E, Steves CJ, Man WDC, Maddocks M. Comprehensive geriatric assessment for people with both COPD and frailty starting pulmonary rehabilitation: a mixed-methods feasibility trial. ERJ Open Res 2024; 10:00774-2023. [PMID: 39076524 PMCID: PMC11284595 DOI: 10.1183/23120541.00774-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/26/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Many people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated. The aim of the present study was to determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation. Methods A multicentre mixed-methods randomised controlled feasibility trial ("Breathe Plus"; ISRCTN13051922) was carried out. People with COPD, aged ≥50 years, Clinical Frailty Scale ≥5 and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during COVID-19 restrictions. Outcomes (physical, psychosocial, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews. Results Recruitment stopped at 31 participants (mean±sd age 72.4±10.1 years, 68% Medical Research Council Dyspnoea Scale 4-5), due to COVID-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8-129) and prompted 46 individual care recommendations (median 3 per participant, range 0-12), 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it. Conclusion Integrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.
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Affiliation(s)
- Lisa Jane Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- King's College London, Department of Psychology, London, UK
| | - Catherine J. Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | - Morag Farquhar
- University of East Anglia, School of Health Sciences, Norwich, UK
| | - Katherine Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | | | - Jade Higman
- King's College London, Clinical Trials Unit, London, UK
| | - Margaret Ogden
- King's College London, Cicely Saunders Institute Public Involvement Group, London, UK
| | - Claire Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Brunel University London, College of Health, Medicine and Life Sciences, London, UK
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Maria Koulopoulou
- King's College Hospital NHS Foundation Trust, Pulmonary Rehabilitation, London, UK
| | - Sharmeen Hasan
- King's College Hospital NHS Foundation Trust, Department of Clinical Gerontology, London, UK
| | - Karen Ingram
- Harefield Pulmonary Rehabilitation, Heart Lung and Critical Care Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Stuart Clarke
- Harefield Pulmonary Rehabilitation, Heart Lung and Critical Care Group, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Kishan R. Parmar
- Department of Geriatric Medicine, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Eleni Baldwin
- Department of Geriatric Medicine, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Claire J. Steves
- King's College London, Department of Twin Research and Genetic Epidemiology, London, UK
- Guys and St. Thomas’ NHS Foundation Trust, Department of Ageing and Health, London, UK
| | - William D-C. Man
- Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Imperial College, National Heart and Lung Institute, London, UK
- King's College London, Faculty of Life Sciences and Medicine, London, UK
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
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Hussien H, Siriteanu L, Nistor I, Kanbay M, Covic A, Voroneanu L, Covic A. The Impact of Frailty and Severe Cognitive Impairment on Survival Time and Time to Initiate Dialysis in Older Adults With Advanced Chronic Kidney Disease: A Prospective Observational Cohort Study. Cureus 2024; 16:e64303. [PMID: 39130911 PMCID: PMC11316242 DOI: 10.7759/cureus.64303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Background and objectives Frailty and cognitive impairment significantly impact survival time and time to initiate dialysis in older adults with advanced chronic kidney disease (CKD). This study aims to evaluate the effects of frailty and cognitive impairment on these outcomes and determine the most effective assessment tool for predicting early dialysis initiation and short survival time. Materials and methods This prospective observational cohort study involved 240 patients aged ≥65 years with stage 4 or 5 CKD, recruited from a nephrology outpatient department (ambulatory care) between March 2020 and March 2021. Frailty was assessed using the Physical Frailty Phenotype (PFP), PRISMA-7, Clinical Frailty Scale (CFS), and FRAIL scale. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). The primary outcomes were time to initiate dialysis and survival time, with secondary outcomes including hospitalization rates, length of stay, and mortality after dialysis initiation. Results Frail patients only showed significantly shorter time to dialysis initiation when identified by the PFP and FRAIL scale (28.3 months for frail vs. 31.2 months for non-frail, p = 0.028; 26.9 months for frail vs. 30.9 months for non-frail, p = 0.038). The PFP, FRAIL, and CFS tools indicated significantly shorter survival times for frail patients compared to non-frail patients (26.8 months for frail vs. 30.6 months for non-frail, p = 0.003). Frailty is strongly correlated with severe cognitive impairment, as 45.5% of frail patients (according to the FRAIL scale) have dementia compared to 15.1% of non-frail patients (p<0.001). However, cognitive impairment did not significantly affect the time to dialysis initiation or survival time. Hospitalization rates and length of stay in the hospital were significantly higher only for frail patients identified by PRISMA-7, with a median hospital length of stay of 9.15 days for frail patients vs 6.37 days for non-frail patients (p = 0.044). Overall, 37.5% of the patients did not survive during the study follow-up, with frail patients having a higher mortality rate. Conclusion Frailty, mainly when assessed by PFP and FRAIL, is a significant predictor of early dialysis initiation and reduced survival time in older adults with advanced CKD. Cognitive impairment, while prevalent, did not independently predict these outcomes. Regular frailty screening should be incorporated into CKD management to tailor interventions and improve patient outcomes.
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Affiliation(s)
- Hani Hussien
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Lucian Siriteanu
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Ionut Nistor
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Mehmet Kanbay
- Department of Internal Medicine, Koc University School of Medicine, Istanbul, TUR
| | - Andreea Covic
- Department of Nephrology, "Dr. C.I. Parhon" University Hospital, Iasi, ROU
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Luminita Voroneanu
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | - Adrian Covic
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
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Tran TH, Ta TTH, Nguyen LTN, Vu HTT, Van Nguyen H. Adaptation of the comprehensive rheumatologic assessment of frailty (CRAF) as a multidimensional frailty screening tool in patients with rheumatoid arthritis in Vietnam. BMC Rheumatol 2024; 8:24. [PMID: 38849947 PMCID: PMC11161963 DOI: 10.1186/s41927-024-00394-7] [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: 01/31/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND In recent times, there has been acknowledgment of the prevalence of frailty and pre-frailty among individuals with rheumatoid arthritis (RA). Comprehensive Rheumatologic Assessment of Frailty (CRAF) stands out as a dependable tool grounded in synthesis and clinical judgment. Despite this, a validated Vietnamese rendition of the CRAF is currently unavailable. This study seeks to assess the reliability and validity of the CRAF in a patient with RA in Vietnam. METHODS A cross-sectional investigation was carried out with 402 patients diagnosed with rheumatoid arthritis, encompassing both inpatients and outpatients at the Centre for Rheumatology at Bach Mai Hospital in Hanoi, Vietnam. CRAF was employed to gauge the extent of frailty. To establish convergent validity, the scores from the CRAF were correlated with those from the Fried phenotype. Discriminant validity was ascertained through the utilization of receiver operating characteristic (ROC) curve analysis. Additionally, a multivariate logistic regression model was applied to evaluate the individual determinants' relative impact on the CRAF. RESULTS In testing for convergent validity, a significant correlation was found between CRAF and Fried phenotype (p < 0.001). The discriminatory power of CRAF was higher than those of the Fried phenotype (difference between areas under the ROC curves = 0.947 (95% CI: 0.927-0.967). Variables associated with frailty at the multivariate analysis were comorbitidy, medication intake, BMI, DAS28-CRP, and age (all at p < 0.01). CONCLUSION CRAF exhibited strong validity and accurate discrimination. Incorporating frailty assessment into regular rheumatological practices could signify a significant advancement in the care of rheumatoid arthritis.
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Affiliation(s)
- Trang Huyen Tran
- Department of Internal Medicine, Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam.
- Centre for Rheumatology, Bach Mai Hospital, Hanoi, Vietnam.
| | - Trang Thi Huong Ta
- Department of Internal Medicine, Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam
- Centre for Rheumatology, Bach Mai Hospital, Hanoi, Vietnam
| | - Lan Thi Ngoc Nguyen
- Department of Internal Medicine, Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- National Geriatric Hospital, Hanoi, Vietnam
| | - Hung Van Nguyen
- Department of Internal Medicine, Hanoi Medical University, 01 Ton That Tung, Hanoi, Vietnam
- Centre for Rheumatology, Bach Mai Hospital, Hanoi, Vietnam
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Azevedo PS, de Melo RC, de Souza JT, Frost R, Gavin JP, Robinson K, Boas PJFV, Minicucci MF, Aprahamian I, Wachholz PA, Hinslif-Smith K, Gordon AL. Frailty identification and management among Brazilian healthcare professionals: a survey. BMC Geriatr 2024; 24:486. [PMID: 38831274 PMCID: PMC11149253 DOI: 10.1186/s12877-024-05020-2] [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: 12/18/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND National and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice. METHODS An anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil. RESULTS Most of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011). CONCLUSION Frailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people.
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Affiliation(s)
- Paula Schmidt Azevedo
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | | | - Juli Thomaz de Souza
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - James P Gavin
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Katie Robinson
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK
| | - Paulo José Fortes Villas Boas
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Marcos Ferreira Minicucci
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | | | - Patrick Alexander Wachholz
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Kathryn Hinslif-Smith
- Leicester School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Adam Lee Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK.
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Nottingham, UK.
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Alves J, Prendki V, Chedid M, Yahav D, Bosetti D, Rello J. Challenges of antimicrobial stewardship among older adults. Eur J Intern Med 2024; 124:5-13. [PMID: 38360513 DOI: 10.1016/j.ejim.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Older adults hospitalized in internal medicine wards or long-term care facilities (LTCF) are progressively increasing. Older adults with multimorbidity are more susceptible to infections, as well as to more vulnerable to adverse effects (and interactions) of antibiotics, resulting in a need for effective and safer strategies for antimicrobial stewardship (ASM), both in hospitalization wards and long-term care facilities. Studies on antimicrobial stewardship in older patients are scarce and guidelines are required. Given the peculiarities of the optimization of antimicrobial prescription in individual older adults for common infections, tactics to overcome barriers need an update. The use of rapid diagnosis tests, biomarkers, de-escalation and switching from intravenous to oral/subcutaneous therapy strategies are examples of successful AMS interventions. AMS interventions are associated with reduced side effects, lower mortality, shorter hospital stays, and reduced costs. The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness. Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.
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Affiliation(s)
- Joana Alves
- Infectious Diseases Specialist, Head of Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance, Hospital de Braga, Portugal.
| | - Virginie Prendki
- Department of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland; Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Marie Chedid
- Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - Davide Bosetti
- Department of Infectious Disease, Geneva University Hospital, Switzerland; Infection Control Programme and WHO Collaborating Centre for Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jordi Rello
- Medicine Department, Universitat Internacional de Catalunya, Spain; Clinical Research Pneumonia and Sepsis (CRIPS) Research Group-Vall d'Hebrón Institute Research (VHIR), Barcelona, Spain; Formation, Recherche, Evaluation (FOREVA), CHU Nîmes, Nîmes, France
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Shafiee Hanjani L, Fox S, Hubbard RE, Gordon E, Reid N, Hilmer SN, Saunders R, Gnjidic D, Young A. Frailty knowledge, training and barriers to frailty management: A national cross-sectional survey of health professionals in Australia. Australas J Ageing 2024; 43:271-280. [PMID: 37563782 DOI: 10.1111/ajag.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE(S) To understand Australian health professionals' perceptions of their knowledge and previous training about frailty, as well as barriers to frailty assessment and management in their practice. METHODS A cross-sectional online survey was developed and distributed to health professionals (medical, nursing and allied health) engaged in clinical practice in Australia through convenience and snowball sampling techniques from March to May 2022. The survey consisted of five sections: frailty training and knowledge; confidence in recognising and managing adults with frailty; the importance and relevance of frailty; barriers to assessing and managing frailty in practice; and interest in further frailty training. Responses were analysed using descriptive statistics. RESULTS The survey was taken by 736 health professionals. Less than half of respondents (44%, 321/733) reported receiving any training on frailty, with 14% (105/733) receiving training specifically focussed on frailty. Most respondents (78%, 556/712) reported 'good' or 'fair' understanding of frailty. The majority (64%, 448/694) reported being 'fairly' or 'somewhat' confident with identifying frailty. Almost all respondents (>90%) recognised frailty as having an important impact on outcomes and believed that there are beneficial interventions for frailty. Commonly reported barriers to frailty assessment in practice included 'lack of defined protocol for managing frailty' and 'lack of consensus about which frailty assessment tool to use'. Most respondents (88%, 521/595) were interested in receiving further education on frailty, with a high preference for online training. CONCLUSIONS The findings suggest frailty is important to health professionals in Australia, and there is a need for and interest in further frailty education.
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Affiliation(s)
- Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Fox
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Emily Gordon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Reid
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Young
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Greeley B, Chung SS, Graves L, Song X. Combating Barriers to the Development of a Patient-Oriented Frailty Website. JMIR Aging 2024; 7:e53098. [PMID: 38807317 DOI: 10.2196/53098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/02/2024] [Accepted: 03/07/2024] [Indexed: 05/30/2024] Open
Abstract
Unlabelled This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users' responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care.
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Yau DKW, Griffith JF, Underwood MJ, Joynt GM, Lee A. Preoperative rectus femoris muscle ultrasound, its relationship with frailty scores, and the ability to predict recovery after cardiac surgery: a prospective cohort study. Perioper Med (Lond) 2024; 13:45. [PMID: 38783315 PMCID: PMC11112902 DOI: 10.1186/s13741-024-00401-y] [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: 04/25/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Frailty is common in patients undergoing cardiac surgery and is associated with poorer postoperative outcomes. Ultrasound examination of skeletal muscle morphology may serve as an objective assessment tool as lean muscle mass reduction is a key feature of frailty. METHODS This study investigated the association of ultrasound-derived muscle thickness, cross-sectional area, and echogenicity of the rectus femoris muscle (RFM) with preoperative frailty and predicted subsequent poor recovery after surgery. Eighty-five patients received preoperative RFM ultrasound examination and frailty-related assessments: Clinical Frailty Scale (CFS) and 5-m gait speed test (GST5m). Association of each ultrasound measurement with frailty assessments was examined. Area under receiver-operating characteristic curve (AUROC) was used to assess the discriminative ability of each ultrasound measurement to predict days at home within 30 days of surgery (DAH30). RESULTS By CFS and GST5m criteria, 13% and 34% respectively of participants were frail. RFM cross-sectional area alone demonstrated moderate predictive association for frailty by CFS criterion (AUROC: 0.76, 95% CI: 0.66-0.85). Specificity improved to 98.7% (95% CI: 93.6%-100.0%) by utilising RFM cross-sectional area as an 'add-on' test to a positive gait speed test, and thus a combined muscle size and function test demonstrated higher predictive performance (positive likelihood ratio: 40.4, 95% CI: 5.3-304.3) for frailty by CFS criterion than either test alone (p < 0.001). The combined 'add-on' test predictive performance for DAH30 (AUROC: 0.90, 95% CI: 0.81-0.95) may also be superior to either CFS or gait speed test alone. CONCLUSIONS Preoperative RFM ultrasound examination, especially when integrated with the gait speed test, may be useful to identify patients at high risk of frailty and those with poor outcomes after cardiac surgery. TRIAL REGISTRATION The study was registered on the Chinese Clinical Trials Registry (ChiCTR2000031098) on 22 March 2020.
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Affiliation(s)
- Derek King Wai Yau
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR.
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, G/F Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Malcolm John Underwood
- Cardiovascular Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
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Vankova H, Schmalz M, Andel R, Rajnochova Bloudickova S. Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians. BMC Geriatr 2024; 24:423. [PMID: 38741066 DOI: 10.1186/s12877-024-04972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). METHODS This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. RESULTS The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01-1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39-2.89). CONCLUSION There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.
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Affiliation(s)
- Hana Vankova
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic.
| | - Michal Schmalz
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Sandrucci S. Frailty: How to assess, prognostic role. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106862. [PMID: 36922252 DOI: 10.1016/j.ejso.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
Despite the clear clinical significance of frailty in surgical populations, there is no consensus on how best to define or measure frailty, even within the geriatric literature. A diversity of measures exists to measure some or all these domains, but only research-focused tools have been validated in surgical populations. These tools are too resource-intensive for rapid, cost-effective, preoperative screening of entire populations considering elective surgery. This narrative review deals with the definition of frailty and the different assessment methods of the phenotypic definition and the accumulation of deficits definition. Moreover, as in the area of surgery frailty seems to be an independent risk factor for mortality, morbidity, length of stay, and postoperative complication, different studies reporting the association of preoperative frailty with postoperative outcomes after cancer surgery and the association with postoperative mortality within 30 days are considered. Preoperative care should include a focus on the goals of treatment and care options. Patient-oriented functional and cognitive outcomes as well as the development and implementation of interventions that could potentially improve adverse postoperative effects must be further investigated.
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Affiliation(s)
- Sergio Sandrucci
- General Surgery Department, CDSS University of Turin, Torino, Italy.
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Voorend CG, Berkhout-Byrne NC, van Bodegom-Vos L, Diepenbroek A, Franssen CF, Joosten H, Mooijaart SP, Bos WJW, van Buren M. Geriatric Assessment in CKD Care: An Implementation Study. Kidney Med 2024; 6:100809. [PMID: 38660344 PMCID: PMC11039322 DOI: 10.1016/j.xkme.2024.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Rationale & Objective Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care. Study Design Mixed methods implementation study. Setting & Participants Dutch nephrology centers were approached for implementation of geriatric assessment in patients aged ≥70 years and with an estimated glomerular filtration rate of ≤20 mL/min/1.73 m2. Quality Improvement Activities/Exposure We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures. Outcomes We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population. Analytical Approach Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions. Results Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments. Limitations Selection bias of interventions' early adopters may limit generalizability. Conclusions Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.
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Affiliation(s)
- Carlijn G.N. Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Noeleen C. Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F.M. Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
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Coca-Martinez M, Carli F. Prehabilitation: Who can benefit? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106979. [PMID: 37451924 DOI: 10.1016/j.ejso.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 05/29/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Prehabilitation is an intervention that occurs between cancer diagnosis and the start of an acute treatment. It involves physical, nutritional, and psychological assessments to establish a baseline functional level and provide targeted interventions to improve a person's health and prevent future impairments. Prehabilitation has been applied to surgical oncology and has shown positive results at improving functional capacity, reducing hospital stay, decreasing complications, and enhancing health-related quality of life. The importance of collaboration between various healthcare professionals and the implementation of multimodal interventions, including exercise training, nutrition optimization, and emotional support is discussed in this manuscript. The need for screening and assessment of conditions such as sarcopenia, frailty, or low functional status in order to identify patients who would benefit the most from prehabilitation is vital and should be a part of all prehabilitation programs. Exercise and nutrition play complementary roles in prehabilitation, enhancing anabolism and performance. However, in the presence of malnutrition and sarcopenia, exercise-related energy expenditure without sufficient protein intake can lead to muscle wasting and further deterioration of functional capacity, thus special emphasis on nutrition and protein intake should be made in these cases. Finally, the challenges and the need for a paradigm shift in perioperative care are discussed to effectively implement personalized prehabilitation programs.
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Affiliation(s)
- Miquel Coca-Martinez
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada; Department of Anesthesia and Intensive Care, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
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Hernández-Aguiar Y, Becerra-Bolaños Á, Rodríguez-Pérez A. Preoperative diagnosis of frailty. J Int Med Res 2024; 52:3000605241251705. [PMID: 38818532 PMCID: PMC11143825 DOI: 10.1177/03000605241251705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 06/01/2024] Open
Abstract
The aging world population obliges physicians to establish measures to optimize and estimate the outcomes of increasingly frail patients. Thus, in the last few years there has been an increase in the application of frailty indices. Multiple scales have emerged that can be applied in the perioperative setting. Each one has demonstrated some utility, either by way of establishing postoperative prognosis or as a method for the clinical optimization of patient care. Anaesthesiologists are offered a wide choice of scales, the characteristics and appropriate management of which they are often unaware. This narrative review aims to clarify the concept of frailty, describe its importance in the perioperative setting and evaluate the different scales that are most applicable to the perioperative setting. It will also establish paths for the future optimization of patient care.
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Affiliation(s)
- Yanira Hernández-Aguiar
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ángel Becerra-Bolaños
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Aurelio Rodríguez-Pérez
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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50
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Xie R, Jing X, Yang C. The prevalence and characteristics of frailty in cirrhosis patients: a meta-analysis and systematic review. Front Med (Lausanne) 2024; 11:1353406. [PMID: 38745743 PMCID: PMC11092890 DOI: 10.3389/fmed.2024.1353406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/08/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives This study aimed to assess the prevalence of frailty in cirrhosis patients and the distribution of age, sex, and body mass index (BMI) in cirrhotic patients with frailty. Methods We performed a thorough literature search using PubMed, Embase, Web of Science, and the Cochrane Library from inception to 29 February 2024. The estimated prevalence with a 95% confidence interval (CI) was calculated with a random effect model. Subgroup analysis and sensitivity analysis were performed to assess the heterogeneity and characterize the distribution of age, sex, and body mass index (BMI) in cirrhotic patients. Publication bias was assessed by the funnel plot, Begg's test, and Egger's test. Results The 16 included studies, which were all observational, reported a prevalence of frailty in 8,406 cirrhosis patients ranging from 9 to 65%, and the overall estimated prevalence was 27% (95% CI: 21-33%; I2 = 97.7%, P < 0.001). This meta-analysis indicated that the estimated prevalence of frailty in cirrhosis patients was high, and compared to the non-frail cohort, the frail cohort tended to have a higher mean age, with a mean age of 63.3 (95% CI: 59.9, 66.7; Z = 36.48; P < 0.001), and a larger proportion of male patients with worse liver function, with a mean of 73.5% (95% CI: 71.4, 75.5%; Z = 7.65; P < 0.001), ND in the frail cohort, 54.8% (95% CI: 43.1, 66.5%; P < 0.001) and 23.4% (95% CI: 13.2, 33.7%; P < 0.001) were classified into Child-Pugh B and C, respectively. Meanwhile, the patients in the non-frail cohort are more likely to have a higher BMI, with a mean of 28.4 (95% CI: 24.1, 32.7; Z = 13.07; P < 0.001). Conclusion The current study suggests that cirrhosis patients have a high prevalence of frailty. Compared with the non-frail cohort, the frail patients tend to be male, older, and have a lower BMI with worse liver function.
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Affiliation(s)
- Ruiyu Xie
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang, Hebei, China
| | - Xiaotong Jing
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chuanjie Yang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang, Hebei, China
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