Adverse Outcomes In Older Patients Research Articles

Hospital admission of older patients with mild traumatic brain injury and traumatic intracranial hemorrhage: is it always necessary?

Background and importanceTraumatic intracranial hemorrhage (tICH) after mild traumatic brain injury (mTBI) is not uncommon in the elderly. Often, these patients are admitted to the hospital for observation. The necessity of admission in the absence of clinically important intracranial injuries is however unclear.ObjectivesThe objective of this study is to identify which factors additional to tICH affect the risk of this outcome and to evaluate the differences in the risk of adverse outcome in younger and older mTBI patients with tICH.Design, setting, and participantsThis retrospective study assessed adult (≥ 16 years) mTBI patients with tICH admitted to a Level 1 trauma center between January 2017 and October 2020.Outcome measures and analysisPatients were stratified into two groups, age < 65 years and age ≥ 65 years. Adverse outcome due to tICH was assessed using a composite adverse outcome which comprised either, a drop in GCS by more than 1 point, progression of or new neurological deficits, seizure activity, progression of tICH on repeated neuroimaging after clinical deterioration, a neurosurgical intervention, a readmission within three months of injury related to TBI, or death. Logistic regression analysis was used to identify independent predictors of the composite adverse outcome.Main resultsIn total, 332 mTBI patients with tICH were enrolled in our study. Older mTBI patients with tICH met the criteria for the composite adverse outcome significantly more often than younger patients (12.6% 95% CI 8.0–17.0% vs. 4.9%, 95% CI 1.0–9.0%, p = 0.033). The univariate analysis showed that a neurological deficit (OR 6.55, 95% CI 2.37–18.08) or a SDH on admission (OR 3.13, 95% CI 1.40–6.99) was positively associated with the composite adverse outcome in older patients. The presence of isolated traumatic SAH (tSAH) was associated with a decreased risk of the composite adverse outcome (OR 0.10, 95% CI 0.01–0.71). Multivariate analysis was not possible.ConclusionSerious adverse outcomes are frequently observed in older mTBI patients with tICH. Nonetheless, our findings suggest that older patients with an isolated tSAH are at low-risk for deterioration and may be directly discharged from the ED after a short period of observation.

Association between geriatric nutritional risk index and adverse outcomes in critical ill patients with chronic obstructive pulmonary disease: a cohort study of 2824 older adults

ObjectivesChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, particularly among the elderly, resulting in high rates of intensive care unit (ICU) admissions. Malnutrition is common in elderly patients and has been associated with poor prognosis in patients with COPD. However, its impact in the ICU setting remains incompletely defined. The objective of this study is to examine the association between malnutrition, as measured by the Geriatric Nutritional Risk Index (GNRI), and adverse outcomes in older patients with COPD in the ICU.MethodsA cohort study of 2,824 older COPD patients admitted to the ICU from 2008 to 2019 was conducted. The association between GNRI scores and outcomes including in-hospital mortality, risk of pressure injuries, and length of ICU stay was evaluated. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. A causal mediation analysis was employed to identify potential mediating variables and to calculate the proportion mediated.ResultsThe median age of study participants was approximately 75 years, with 1,281 (45.4%) being female. Lower GNRI scores (GNRI ≤ 98) were significantly associated with increased in-hospital mortality (OR: 1.48, 95% CI: 1.08–2.05, p = 0.015), higher incidence of pressure injuries (OR: 1.97, 95% CI: 1.54–2.54, p < 0.001), and longer ICU stays (OR: 1.51, 95% CI: 1.18–1.94, p = 0.001). Mediation analysis indicated that pressure injury accounted for approximately 22.9% of the association between malnutrition and in-hospital mortality.ConclusionsLower GNRI scores, indicative of malnutrition, are associated with adverse outcomes in elderly ICU patients with COPD. The findings highlight the importance of early nutritional assessment and intervention in this high-risk group to improve survival and reduce complications.

Association of preoperative cognitive frailty with postoperative complications in older patients under general anesthesia: a prospective cohort study

BackgroundCognitive frailty (CF) is characterized by the coexistence of physical frailty and cognitive impairment, and it is associated with adverse health outcomes. Older adults are particularly vulnerable to CF due to factors such as age-related brain changes and the presence of comorbidities.ObjectiveTo investigate the effect of preoperative CF on postoperative complications in older patients.MethodsThis prospective cohort study was conducted among 253 patients aged 60–85 years, who underwent elective orthopedic and abdominal surgery (with a postoperative hospital stay of ≥ 3 days) at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2023 to November 2023. CF was assessed using the Montreal Cognitive Assessment (MoCA) for the cognitive status and the Fried criteria for five frailty scales. Participants were split into four groups: Group A (neither frailty nor cognitive impairment), Group B (frailty without cognitive impairment), Group C (cognitive impairment without frailty), and Group D (cognitive frailty). The primary outcome was postoperative complications, while secondary outcomes included mobility disability, prolonged hospital stay (PLOS), re-operation and 90-day readmission.ResultsThe median age (interquartile range) of participants was 69 (65–73) years, of which 40.3% were male. The prevalence of CF was 17.8%. The incidence of postoperative complications was 18.2% in Group A, 50.0% in Group B, 37.4% in Group C, and 75.6% in Group D. Multivariate analysis revealed that, compared to the control group (without cognitive impairment or frailty), patients with CF had a significantly higher risk of postoperative complications (OR, 12.86; 95%CI, 4.23–39.08). “Patients with frailty without cognitive impairment” had an increased risk (OR, 6.53; 95%CI, 2.04–20.9), while “those with cognitive impairment without frailty” also showed a higher risk (OR, 3.46; 95%CI, 1.57–7.64).ConclusionsCognitive frailty is significantly associated with an increased risk of postoperative adverse outcomes in older patients undergoing orthopedic and abdominal surgeries with general anesthesia. It indicates that clinicians should pay much attention to these older adults with CF.

Usefulness of the SARC-F questionnaire and the measurement of the hand grip strength in predicting short-term mortality in older patients hospitalized for acute heart failure.

Sarcopenia is a potentially reversible syndrome that increases the risk of cardiogenic cachexia and adverse outcomes in older patients with heart failure (HF). Despite its clinical significance, sarcopenia remains underdiagnosed due to the complexities of comprehensive assessment in patients with acute HF. This study aimed to evaluate whether the SARC-F questionnaire, its inviduals components,and the handgrip strength test (HGS) can predict short-term prognostic risk in very old patients recently discharged after acute HF. We consecutively enrolled patients aged 75years or older hospitalized with acute HF in the Geriatrics Unit of a tertiary care hospital. All patients underwent physical examination, complete blood tests, point-of-care ultrasound, and a comprehensive geriatric assessment, including physical performance through SARC-F and HGS. The thirty-day post-discharge mortality rate was assessed by phone interview. Out of 184 patients hospitalized with acute HF who were enrolled in the study (mean [SD], 86.8 [5.9] years, 60.3% female), 47 died within 30days after discharge. By multivariate logistic analysis, HGS (β = -0.73 ± 0.03, p = 0.008) and SARC-F [adjusted OR = 1.18 (CI 95% 1.03-1.33), p = 0.003] resulted independently associated with mortality. Furthermore, two SARC-F sub-items, namely, limitation in rising from a chair and history of falls [aOR: 3.26 (CI95% 1.27-8.34), p = 0.008; aOR: 3.30 (CI 95% 1.28-8.49), p = 0.01; respectively] emerged as determinants of 30-days mortality. SARC-F and HGS test independently predict 30-day post-discharge mortality in oldest-old patients hospitalized for acute HF.

Frailty predicts adverse outcomes in older patients with pulmonary embolism.

This study aims to evaluate the impact of frailty on the outcomes of older patients with pulmonary embolism (PE). Using the National Inpatient Sample database, we identified 288 070 patients aged 65 or older who were admitted with a primary diagnosis of PE from 2017 to 2019. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), and patients were categorized into low-, intermediate-, and high-frailty-risk groups. Multivariate logistic regression was used to calculate adjusted odds ratios for all outcomes. These patients were categorized into low-risk (57.6%, 161 420), medium-risk (39.9%, 111 805), and high-risk (2.5%, 7075) groups. High-risk patients, predominantly females with multiple comorbidities, exhibited significantly higher mortality rates and adverse outcomes. The HFRS showed a good discriminating ability in predicting mortality (area under the receiver operating characteristic curve = 0.7796). Frailty was associated with increased use of advanced therapeutic interventions and critical care resources such as thrombolysis, catheter-directed therapies, inferior vena cava filter placement, mechanical ventilation, vasopressor use, and intensive care unit admission. Frailty markedly affects outcomes in older PE patients. The HFRS offers a valuable prognostic tool in this population, suggesting that integrating frailty assessments into clinical practice could enhance care strategies and improve patient outcomes. Our findings underscore the need for further research to refine frailty-based care paradigms. Geriatr Gerontol Int 2024; 24: 924-929.

Association of Dementia with Adverse Outcomes in Older Patients with Acute Myocardial Infarction in the ICU.

Dementia limits timely revascularization in individuals with acute myocardial infarction (AMI). However, it remains unclear whether dementia affects prognosis negatively in older individuals with AMI in the intensive care unit (ICU). This research aimed to evaluate the dementia effect on the outcomes in individuals with AMI in ICU.Data from 3,582 patients aged ≥ 65 years with AMI in ICU from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were evaluated. The independent variable was dementia at baseline, and the primary finding was death from any cause during follow-up. A 1:1 propensity score matching (PSM) showed 208 participants with and without dementia. The correlation between dementia and poor prognosis of AMI was verified using a double-robust estimation method.In the PSM cohort, the 30-day all-cause mortality was 37.50% and 33.17% in the dementia and non-dementia groups (P = 0.356), respectively, and the 1-year all-cause mortality was 61.06% and 51.44%, respectively (P = 0.048). Cox regression analysis showed no association between dementia and elevated 30-day (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84, 1.60) and 1-year (HR 1.28, 95% CI 0.99, 1.66) all-cause mortality after AMI. Similarly, dementia was not connected with in-hospital mortality, bleeding, or stroke after AMI. Interaction analysis showed that 1-year all-cause mortality was 48.00% higher in individuals with dementia and diabetic complications than in those without diabetic complications.Dementia is not an independent risk factor for adverse outcomes in AMI. Thus, it may be inappropriate to include dementia as a contraindication for invasive AMI therapy.

The hospital frailty risk score effectively predicts adverse outcomes in patients with atrial fibrillation in the intensive care unit.

Atrial fibrillation (AF) and frailty are significant global public health problems associated with advancing age. However, the relationship between frailty and older patients with AF in the intensive care unit (ICU) has not been thoroughly investigated. This study aimed to investigate whether the hospital frailty risk score (HFRS) is associated with adverse outcomes in older patients with AF in the ICU. This was the first retrospective analysis of older patients with AF admitted to the ICU between 2008 and 2019 at a tertiary academic medical center in Boston. The HFRS was used to measure frailty severity. The outcomes of interest were in-hospital and 30-day mortality and the incidence of sepsis and ischemic stroke. There were 7,792 participants aged approximately 80 years, almost half (44.9%) of whom were female. Among this group, 2,876 individuals were identified as non-frail, while 4,916 were classified as frail. The analysis revealed a significantly greater incidence of in-hospital (18.8% compared to 7.6%) and 30-day mortality (24.5% versus 12.3%) in the frail group. After accounting for potential confounding factors, a multivariate Cox proportional hazards regression analysis revealed that frail participants had a 1.56-fold greater risk of mortality within 30 days (95% CI = 1.38-1.76, p < 0.001). Frailty is an independent risk factor for adverse outcomes in older patients with AF admitted to the ICU. Therefore, prioritizing frailty assessment and implementing specific intervention strategies to improve prognostic outcomes are recommended.

A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age.

There is currently no consensus on the most appropriate blood transfusion strategy for older adults undergoing cardiovascular surgery. We aimed to investigate the potential benefits of the patient blood management (PBM) program specifically for advanced age patients, and to evaluate the relationship of age and PBM in cardiovascular surgery. We collected data from patients over 60 years old who underwent on-pump cardiovascular surgery. We compared transfusion and clinical outcomes between the pre-PBM and post-PBM groups using a propensity score matching method. Then, we conducted a subgroup analysis within the original cohort, specifically focusing on patients aged of 75 and above with multivariable adjusted models. Data of 9703 older adults were analyzed. Red blood cell (RBC) transfusion rates during cardiopulmonary bypass (CPB) (31.6% vs 13.1%, P<0.001), during the operation (50.8% vs 39.0%, P<0.001) and after the operation (5.6% vs 3.1%, P<0.001) were significantly reduced, and mortality and the risk of some adverse events were also reduced after the PBM. Subgroup analysis showed that there was no interaction between age and PBM, and advanced age (over age 75) did not modify the effect of PBM program in reducing RBC transfusion (Pinteraction=0.245), on mortality (Pinteration=0.829) and on certain complications. The comprehensive PBM program could reduce RBC transfusion without adverse outcomes in older patients undergoing CPB. Even patients over age 75 may benefit from a more stringent transfusion indication. Comprehensive blood conservation measures should be applied to optimize the blood management for older patients.

Predictors of adverse outcomes in elders hospitalised for isolated orthopaedic trauma: a multicentre cohort study

BackgroundPatients >64 years of age now represent more than 51% of injury hospitalisations in Canada. The tools used to identify older patients who could benefit the most from an interdisciplinary...

P250 Geriatric impairments associate with mortality and hospitalisations during follow-up in older IBD outpatients

Abstract Background We aimed evaluate the association between impairments found in a geriatric assessment and the risk for adverse outcomes in older patients with Inflammatory Bowel Disease (IBD). Methods In a prospective multicenter cohort study, a geriatric assessment was performed at baseline in 405 older (≥ 65 years) patients with IBD. Linear-and cox regression analyses were used to study the association between impairment in five geriatric domains measured in the geriatric assessment (somatic-, functional-, mental-, and social domain, physical capacity) and adverse outcomes occurring during 18 months of follow-up. Adverse outcomes were defined as all-cause-, acute-, and IBD-related hospitalisations and all-cause mortality. All analyses were adjusted for age, sex and biochemical disease activity (C-reactive protein ≥10 mg/L and/or fecal calprotectin ≥250 μg/g). Results Of 405 patients at baseline (median age: 70 years), 11 patients (2.7%) died and follow-up was conducted in 356 patients (87.9%). During 18 months, 136 all-cause hospitalizations occurred in 96 patients (23.7%), of which 103 (75.7%) were acute, occurring in 74 patients (18.3%). Forty-one hospitalizations (30.1%) in 28 patients (6.9%) were IBD-related. The number of impaired domains at baseline was independently associated with mortality (p=0.001, B=2.76), all-cause hospitalisation (p=0.016, B=1.28) and acute hospitalisation (p=0.02, B=1.3), but not with IBD-related hospitalisation (p=0.06, B=1.37). On domain level, mortality was associated with impaired mental- (p=0.002, B=8.9) and physical domains (p=0.006, B=9.5), all-cause hospitalisation with an impaired somatic domain (p=0.002, B=2.13), and acute hospitalisation with an impaired somatic domain (p=0.02, B=2.49). Conclusion Geriatric impairments in geriatric assessment are independently associated with adverse outcomes in older patients with IBD, including an increased risk of mortality, all-cause and acute hospitalizations. Therefore, this study provides the first prospective evidence for the predictive value of the geriatric assessment, enhancing risk stratification in older patients with IBD.

Association between SARC-F scores and risk of adverse outcomes in older patients with cardiovascular disease: a prospective study at a tertiary hospital in the south of Vietnam.

Older patients typically face elevated mortality rates and greater medical resource utilization during hospitalizations compared to their younger counterparts. Sarcopenia, serving as a prognostic indicator, is related to disability, diminished quality of life, and increased mortality. The SARC-F questionnaire, known for its cost-effectiveness, offers a valuable means of assessing sarcopenia. This study aims to explore the association between SARC-F scores and risk of adverse outcomes in elderly patients with cardiovascular disease at a Ho Chi Minh City hospital. Participants aged 60 and above, admitted to the Department of Cardiology - Interventional and Cardiovascular Emergency of Thong Nhat Hospital in Ho Chi Minh City from November 2021 to June 2022, were recruited for the prospective, single-center study. The prognostic outcomes included all-cause death and the initial occurrence of emergency re-hospitalization within 6 months' post-discharge. The Kaplan-Meier analysis compared the overall survival rates between different SARC-F score groups. The study enrolled 285 patients with a median age of 74 (67, 81). During a 6-month follow-up period, there were 14 cases of mortality. A SARC-F score of 4 or higher was significantly associated with an increased risk of all-cause mortality, with HR of 2.02 (95% CI: 1.39-2.92, p < 0.001), and higher incidence of re-hospitalization events with RR of 1.66 (95% CI: 1.06 to 2.59, p = 0.026). Kaplan-Meier survival analysis indicated a notably higher mortality rate in the patients with high SARC-F scores (p < 0.001). In elderly patients with cardiovascular disease, the SARC-F questionnaire could serve as a simple and cost-effective method for detecting mortality and the risk of re-hospitalization.

Acute muscle wasting is associated with poor prognosis in older adults with severe community-acquired pneumonia.

To investigate the impact of acute muscle wasting on 90-day mortality in older patients with severe pneumonia using ultrasound and chest computed tomography (CT). Quadriceps muscle layer thickness was measured via ultrasound on days 1, 7, and 14, and cross-sectional area of the erector spinae muscle was assessed using chest CT on days 1 and 14 in patients aged ≥ 65years old. The primary outcome was all-cause 90-day mortality. Receiver operating characteristic curves were conducted for muscle loss to predict 90-day mortality. Cox proportional hazard models and Kaplan-Meier survival curves were employed to evaluate the association between muscle loss and 90-day mortality. Sixty-two patients were enrolled with median age of 80.2years, 29 (46.8%) were men and 28 (45.2%) patients died. Muscle mass measured using ultrasound and CT decreased significantly from baseline to day 14 in the non-survivor group. Muscle loss assessed by ultrasound (with minimum and maximum pressure) and CT independently predicted all-cause 90-day mortality (adjusted hazard ratios = 1.497, 1.400 and 1.082; P < 0.001, P = 0.002, and P = 0.004; respectively), and cutoff values of muscle loss were 0.34cm, 0.11cm and 4.92cm2, correspondingly. A higher muscle loss had an increased risk of 90-day mortality. Acute muscle wasting assessed by ultrasound and chest CT persisted for 14days and was an independent predictor of adverse outcomes in older patients with severe pneumonia. A greater decline in muscle mass was associated with a higher 90-day mortality risk.

Impacto de la fragilidad en la supervivencia intrahospitalaria en pacientes mayores con infección por COVID-19: la importancia de su identificación temprana. Registro Nacional SEMI-COVID

BackgroundEmerging evidence suggests that frailty may be a significant predictor of poor outcomes in older individuals hospitalized due to COVID-19. This study aims to determine the prognostic value of frailty on intrahospital patient survival. MethodsThis observational, multicenter, nationwide study included patients aged 70 years and older who were hospitalized due to COVID-19 in Spain between March 1 and December 31, 2020. Patient data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine. Frailty was assessed using the Clinical Frailty Scale. The primary outcome was hospital survival. Cox proportional hazards models were used to assess predictors of survival. ResultsA total of 1878 participants (52% men and 48% women) were included, with 1351 (71.9%) survivors and 527 (28.1%) non-survivors. The non-survivor group had higher mean age (83.5 vs. 81 years), comorbidities (6.3 vs. 5.3 points on the Charlson index), degree of dependency (26.8% vs. 12.4% severely dependent patients), and frailty (34.5% vs. 14.7% severely frail patients) compared to survivors. However, there were no differences in terms of sex. Our results demonstrate that a moderate–severe degree of frailty is the primary factor independently associated with shorter survival (HR 2.344; 1.437-3.823; p < 0.001 for CFS 5-6 and 3.694; 2.155–6.330; p < 0.001 for CFS 7-9). ConclusionFrailty is the main predictor of adverse outcomes in older patients with COVID-19. The utilization of tools such as the Clinical Frailty Scale is crucial for early detection in this population.

The impact of frailty on intra-hospital survival in older patients with COVID-19 infection: the importance of early identification. SEMI-COVID National Registry

BackgroundEmerging evidence suggests that frailty may be a significant predictor of poor outcomes in older individuals hospitalized due to COVID-19. This study aims to determine the prognostic value of frailty on intrahospital patient survival. MethodsThis observational, multicenter, nationwide study included patients aged 70 years and older who were hospitalized due to COVID-19 in Spain between March 1 and December 31, 2020. Patient data were obtained from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine. Frailty was assessed using the Clinical Frailty Scale. The primary outcome was hospital survival. Cox proportional hazards models were used to assess predictors of survival. ResultsA total of 1,878 participants (52% men and 48% women) were included, with 1,351 (71.9%) survivors and 527 (28.1%) non-survivors. The non-survivor group had higher mean age (83.5 vs. 81 years), comorbidities (6.3 vs. 5.3 points on the Charlson index), degree of dependency (26.8% vs. 12.4% severely dependent patients), and frailty (34.5% vs. 14.7% severely frail patients) compared to survivors. However, there were no differences in terms of sex. Our results demonstrate that a moderate-severe degree of frailty is the primary factor independently associated with shorter survival [HR 2.344 (1.437−3.823; p<0.001) for CFS 5−6 and 3.694 (2.155−6.330; p<0.001) for CFS 7−9]. ConclusionFrailty is the main predictor of adverse outcomes in older patients with COVID-19. The utilization of tools such as the Clinical Frailty Scale is crucial for early detection in this population.

Geriatric-8 Assessment is Predictive of Hospitalization in Patients with Glioblastoma (P7-13.005)

<h3>Objective:</h3> To describe predictors of adverse outcomes in older patients with glioblastoma (GBM). <h3>Background:</h3> Older adults with GBM have poor survival and are vulnerable to treatment toxicities. Optimal therapy is not defined and decision making depends on identifying risk factors associated with poor outcomes. <h3>Design/Methods:</h3> We prospectively enrolled patients over age 65 with newly-diagnosed GBM to undergo a comprehensive geriatric assessment (CGA) and geriatric-8 (G8) prior to disease-directed therapy. The G8 is a brief, valid and feasible tool that consists of eight items assessing age, food intake, weight loss, mobility, neuropsychology, body mass index, prescription drug, and self-perception of health. CGA consisted of several tests including Short Physical Performance Battery (SPPB), Geriatric depression scale (GDS-15), and Montreal Cognitive Assessment (MoCA). Patients were followed for adverse events, hospitalizations, and survival. Logistic regression modeled contributions of MGMT methylation status, extent of resection (EOR), G8 score and elements of CGA. Cox regression was also used to model impact of these factors on survival time. <h3>Results:</h3> 27 patients were enrolled with median age of 73.5. 20 patients were male and 11 were methylated. 21 patients are deceased (median survival=11.6 months). 44% of patients (n=12) had unplanned hospitalizations. Most common causes were for seizures (n=3), focal weakness (n=5), and cognitive decline (n=3). Poor G8 score (low) predicted unplanned hospitalizations (OR=3.38, p=0.0386). Age, EOR, MGMT methylation, GDS-15, and CGA elements were not significantly associated with hospitalization. Only MoCA score was significantly associated with improved survival (HR=0.7, p=0.02). <h3>Conclusions:</h3> Nearly half of older patients with GBM had unplanned hospitalizations. Poor G8 score predicted hospitalizations, suggesting that G8 may reveal underlying vulnerability to treatment toxicity and should be studied prospectively to validate these findings. Future studies should evaluate if treatment decisions based on G8 can reduce hospitalizations, improve patient quality of life, and decrease healthcare cost. <b>Disclosure:</b> Mr. Whitt has nothing to disclose. Dr. Hemminger has nothing to disclose. Miss Cawley has nothing to disclose. Dr. Mohile has nothing to disclose. Dr. Wasilewski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novocure. Dr. Hardy has received research support from Del Monte Institute for Neuroscience.

Frailty and subsequent adverse outcomes in older patients with atrial fibrillation treated with oral anticoagulants: The Shizuoka study

BackgroundIn older patients with atrial fibrillation (AF), frailty is frequently prevalent. However, the prognostic value of frailty for adverse events after initiation of oral anticoagulants (OACs) is unclear. ObjectivesWe assessed whether frailty at the time of OAC initiation is associated with subsequent bleeding or embolic events. MethodsWe extracted patients aged ≥65 years with nonvalvular AF in whom OACs were initiated from a universal administrative claims database incorporating primary and hospital care records in Shizuoka, Japan, between 2012 and 2018. Frailty was assessed using the electronic frailty index (eFI). The association of frailty with bleeding events and ischemic stroke/transient ischemic attack were evaluated using the Fine-Gray model and restricted cubic spline model. ResultsAmong 12,585 patients with AF, 7.8% were categorized as fit, 31.5% as mildly frail, 34.8% as moderately frail, and 25.9% as severely frail. The risk of bleeding was associated with a higher eFI (adjusted subdistribution hazard ratio [95% CI] for fit or mild frailty: 1.15 [1.02-1.30]; moderate frailty: 1.42 [1.24-1.61]; and severe frailty: 1.86 [1.61-2.15]), whereas the association was weaker for ischemic stroke/transient ischemic attack. The spline models demonstrated that the relative hazard for bleeding increased steeply with increasing eFI. ConclusionPatients with frailty in whom OAC therapy is initiated have higher risk of bleeding, highlighting the importance of discussing this increased risk with patients with AF who have frailty and assessing frailty at the time of OAC initiation.

Frailty is a stronger predictor of death in younger intensive care patients than in older patients: a prospective observational study

BackgroundWhile frailty is a known predictor of adverse outcomes in older patients, its effect in younger populations is unknown. This prospective observational study was conducted in a tertiary-level mixed ICU to assess the impact of frailty on long-term survival in intensive care patients of different ages.MethodsData on premorbid frailty (Clinical Frailty Score; CFS), severity of illness (the Simplified Acute Physiology Score, third version; SAPS3), limitations of care and outcome were collected in 817 adult ICU patients. Hazard ratios (HR) for death within 180 days after ICU admission were calculated. Unadjusted and adjusted analyses were used to evaluate the association of frailty with outcome in different age groups.ResultsPatients were classified into predefined age groups (18–49 years (n = 241), 50–64 (n = 188), 65–79 (n = 311) and 80 years or older (n = 77)). The proportion of frail (CFS ≥ 5) patients was 41% (n = 333) in the overall population and increased with each age strata (n = 46 (19%) vs. n = 67 (36%) vs. n = 174 (56%) vs. n = 46 (60%), P < 0.05). Frail patients had higher SAPS3, more treatment restrictions and higher ICU mortality. Frailty was associated with an increased risk of 180-day mortality in all age groups (HR 5.7 (95% CI 2.8–11.4), P < 0.05; 8.0 (4.0–16.2), P < 0.05; 4.1 (2.2–6.6), P < 0.05; 2.4 (1.1–5.0), P = 0.02). The effect remained significant after adjustment for SAPS3, comorbidity and limitations of treatment only in patients aged 50–64 (2.1 (1.1–3.1), P < 0.05).ConclusionsPremorbid frailty is common in ICU patients of all ages and was found in 55% of patients aged under 64 years. Frailty was independently associated with mortality only among middle-aged patients, where the risk of death was increased twofold. Our study supports the use of frailty assessment in identifying younger ICU patients at a higher risk of death.

Prognostic significance of frailty in older patients with hip fracture: a systematic review and meta-analysis.

Hip fracture (HF) has become a major healthcare concern associated with higher mortality in older patients. Frailty is one of the most important problems in aging population but its prognostic value in HF remains susceptible. This systematic review and meta-analysis aimed to evaluate the association between frailty and adverse outcomes in older patients with HF. We systematically searched electrical databases including PubMed and Embase to find eligible literature with end-search restriction of February 20, 2021. The main endpoints were all-cause mortality, peri-operative complications, abnormal discharge, and length of stay (LOS). Pooled effect size was calculated by random-effects or fixed-effect model according to study heterogeneity. Three subgroup analyses based on follow-up times, study design, and frailty criteria were conducted. We screened 22 studies out of 1599 identified studies in our analysis. Compared with normal patients, frail ones had a higher risk of mortality both before (OR = 3.48, 95% CI: 2.50-4.85, I2 = 87.2%, P < 0.001) and after (OR = 1.87, 95% CI: 1.44-2.44, I2 = 85.5%, P < 0.001) adjustment. The incidence of peri-operative complications, abnormal discharge, and prolonged LOS also significantly increased in frail subjects. There was no publication bias observed and the pooled results were stable based on sensitivity analysis. Overall, more attention needs to be paid to the prognostic effects caused by frailty in seniors with HF. Better understanding of the association between frailty and adverse outcomes in HF could help doctors perform co-management across orthopaedic and geriatric departments.

Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management.

AimFrailty is associated with adverse outcomes in older patients with acute coronary syndrome (ACS). The impact of frailty on long-term clinical outcomes following invasive management of non-ST elevation ACS (NSTEACS) is unknown.Methods and resultsThe multi-centre Improve Clinical Outcomes in high-risk patieNts with ACS 1 (ICON-1) prospective cohort study consisted of patients aged >75 years undergoing coronary angiography following NSTEACS. Patients were categorized by frailty assessed by Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) and Fried criteria. The primary composite endpoint was all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding. Of 263 patients, 33 (12.5%) were frail, 152 (57.8%) were pre-frail, and 78 (29.7%) were robust according to CFS. By Fried criteria, 70 patients (26.6%, mean age 82.1 years) were frail, 147 (55.9%, mean age 81.3 years) were pre-frail, and 46 (17.5%, mean age 79.9 years) were robust. The composite endpoint was more common at 5 years among patients with frailty according to CFS (frail: 22, 66.7%; pre-frail: 81, 53.3%; robust: 27, 34.6%, P = 0.003), with a similar trend when using Fried criteria (frail: 39, 55.7%; pre-frail: 72, 49.0%; robust: 16, 34.8%, P = 0.085). Frailty measured with both CFS and Fried criteria was associated with the primary endpoint [age and sex-adjusted hazard ratio (HR) compared with robust groups. CFS: 2.22, 95% confidence interval (CI) 1.23–4.02, P = 0.008; Fried: HR 1.81, 95% CI 1.00–3.27, P = 0.048].ConclusionIn older patients who underwent angiography following NSTEACS, frailty is associated with an increased risk of the primary composite endpoint at 5 years.Registration:Clinicaltrials.gov NCT01933581

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer