Aging Clinical Frailty Scale Research Articles

Is Frailty Discouraging Surgeons from Performing Thoracolumbar Fusion? A Retrospective Study.

Retrospective cohort study. To evaluate whether frailty scoring is associated with adverse outcomes and management of thoracolumbar fractures (TLF) patients. Trauma patients with TLF often face longer recovery. The Canadian Study of Health and Aging clinical frailty scale (CSHA-CFS) predicts outcomes in older trauma patients. Adult trauma patients admitted from 2017 to 2021 who presented with TLF were included. Frailty was scored using CSHA-CFS. Endpoints were in-hospital mortality, hospital length of stay, surgery, complications, and discharge disposition. Multivariate analyses adjusting for baseline characteristics were performed. P<0.05 was considered significant. Overall, 1456 patients were included; 1013 fit, 240 pre-frail, and 203 frail. Frail patients underwent fewer surgeries (OR=0.5 [0.32-0.77], P=0.002). TL fusion was associated with lower mortality (OR=0.31 [0.11-0.85], P=0.024). Pre-frailty and frailty were associated with increased risk of pneumonia (OR=2.522 [1.428-4.456], P=0.001; OR=2.93 [1.32-6.54], P=0.008, respectively) and death (OR=3.581 [1.853-6.921], P<0.001; OR=2.46 [1.07-5.67], P=0.035). Pre-frail and frail patients were more likely to discharge to skilled nursing facilities (OR=1.687 [1.024-2.780], P=0.04; OR=4.89 [2.66-9.0]), P<0.001). Pre-frailty and frailty were associated with poor outcomes and higher level of care at discharge. Frail patients were less likely to undergo TL fusion, despite its association with improved survival. This suggests frailty should not discourage surgeons from performing thoracolumbar fusion. Frailty scoring upon admission may help guide management and set realistic expectations for patients and their families.

The relationship between fragility scores and intraoperative body temperature changes in geriatric patients: Prospective observational research.

Today, to evaluate morbidity and mortality in elderly surgical patients, fragility scores, which reflect the patient's current condition rather than increasing age, are used as a basis. Our research examines the association between fragility groups, body temperature changes, and inadvertent perioperative hypothermia (IPH) in major orthopedic surgery patients. Patients over the age of 65 who underwent major orthopedic surgery were evaluated. Body temperature measurements were taken tympanically preoperatively and every 5 minutes during surgery. Temperature changes (Δn) were calculated. Patients whose body temperature was below 36 °C were recorded as IPH. The Canadian Study of Health and Aging-Clinical Frailty Scale scoring system, consisting of 9 categories, was used for fragility scores. As the category number increases, the level of fragility increases. These categories are classified into 3 subgroups: Group F1 (Level 1-3), Group F2 (Level 4-7), and Group F3 (Level 8-9). Age groups: it is defined as Group A1 (66-74 years), Group A2 (75-84 years), and Group A3 (85<). The median (min-max) of surgery time was determined as 75 (35-131). For Δ35 (ºC), the differences between both fragility groups (P = .054) and the age groups (P = .145) were not significant. IPH frequency is 44.0% (n = 149). No difference was detected between hypothermia frequencies in the fragility groups (P = .546) and the age groups (P = .065). Nearly half of major surgery patients developed IPH. We did not find a relationship between both fragility groups and age groups and the frequency of IPH.

Profiles of Met and Unmet Care Needs in the Oldest Old Primary Care Patients with Cognitive Disorders and Dementia: Results of the AgeCoDe and AgeQualiDe Study.

The prevalence of mild cognitive impairment (MCI) and dementia is increasing as the oldest old population grows, requiring a nuanced understanding of their care needs. Few studies have examined need profiles of oldest old patients with MCI or dementia. Therefore, this study aimed to identify patients' need profiles. The data analysis included cross-sectional baseline data from N = 716 primary care patients without cognitive impairment (n = 575), with MCI (n = 97), and with dementia (n = 44) aged 85+ years from the multicenter cohort AgeQualiDe study "needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients [85+]". Patients' needs were assessed using the Camberwell Assessment of Needs for the Elderly (CANE), and latent class analysis identified need profiles. Multinomial logistic regression analyzed the association of MCI and dementia with need profiles, adjusting for sociodemographic factors, social network (Lubben Social Network Scale [LSNS-6]), and frailty (Canadian Study of Health and Aging-Clinical Frailty Scale [CSHA-CFS]). Results indicated three profiles: "no needs," "met physical and environmental needs," and "unmet physical and environmental needs." MCI was associated with the met and unmet physical and environmental needs profiles; dementia was associated with the unmet physical and environmental needs profile. Patients without MCI or dementia had larger social networks (LSNS-6). Frailty was associated with dementia. Integrated care should address the needs of the oldest old and support social networks for people with MCI or dementia. Assessing frailty can help clinicians to identify the most vulnerable patients and develop beneficial interventions for cognitive disorders.

Value of a multidisciplinary geriatric oncology committee on patient care in a community-based, academic cancer center.

e13771 Background: The heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management and recommendations for older patients. This study aimed to assess the benefits of the implementation of such a program at a community- based academic cancer center. Materials and Methods: We retrospectively analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between January 2017 and July 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/ or hospice care. ANOVA, chi-square, and Kaplan-Meier analyses were used to assess patient outcomes. Results: Among 233 patients included, 76 (32.6%) received SOC (Group 1), 43 (18.5%) were optimized (Group 2), and 114 (49.0%) received supportive care or hospice referral (Group 3). There was no significant difference in sex, race, or age among all three groups. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n=90). Patients receiving supportive/ hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p=&lt; .001). SOC patients had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p= &lt;0.001). 69.8% of optimized patients were deemed fit for SOC upon re-evaluation following optimization services. For all patients that underwent surgical interventions, post- operatively, 23 patients (85%) were discharged home and 4 (15%) were discharged to a rehab facility. The average survival after surgery for all patients was 3.16 years, while patients who were optimized prior to surgery had an average survival after surgery of 3.21 years. Conclusions: The present study demonstrates the need for specialized consideration of the heterogeneity that cancer diagnoses present in older individuals. The Geriatric Oncology Program at BWMC is able to maximize treatment outcomes for geriatric patients through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.

Value of a multidisciplinary geriatric oncology committee on patient care in a community-based, academic cancer center

IntroductionThe heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management for older patients. This study aimed to assess the benefits of the implementation of such a program at a community-based academic cancer center. Materials and MethodsWe analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between 2017 and 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/or hospice care. ResultsThe study cohort consisted of 233 patients, of which 76 (32.6%) received SOC, 43 (18.5%) were optimized, and 114 (49.0%) received supportive care or hospice referral. Among the optimized patients, 69.8% were deemed fit for SOC upon re-evaluation following their respective optimization services. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n = 90). Patients receiving supportive/hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p ≤0.001). Patients receiving SOC had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p ≤0.001). For all patients that underwent surgical interventions post-operatively, 23 patients (85%) were discharged home and four (15%) were discharged to a rehabilitation facility. DiscussionThe present study demonstrates the profound impact that the complexities in health status and frailty among older individuals can have during cancer management. The Geriatric Oncology Program at BWMC maximized treatment outcomes for older adults through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.

Risk factors of dementia cognitive symptoms among older patients in Vietnam: A cross-sectional study

Background. Dementia has emerged as a significant contributor to declining quality of life and stands as a prominent factor in the increase of disability and dependency among elderly populations globally. This study aimed to explore the relationship between cognitive symptoms of dementia and their risk factors in individuals aged 60 years and older among Vietnamese outpatients who visited Geriatrics Clinic at University Medical Center of Ho Chi Minh city, Vietnam. Methods. 387 participants who were aged ≥ 60 years old were included in the cross-sectional study. Cognitive impairment was assessed by using the Mini Mental State Evaluation (MMSE) questionnaire. The functional limitations in activities of daily living (ADL) and Instrumental Activities of Daily Living (IADL), multimorbidity, and polypharmacy were also evaluated. Frailty was determined by The Canadian Study of Health and Aging Clinical Frailty Scale. Suffering dementia was determined when MMSE score was below 24 and IADL score less than 8. Results. People with dementia cognitive symptoms accounted for 22.74 % of the cohort. The percentage increased with age, and was higher in women than in men. Factors that increased the odds of having dementia symptoms were of older age, female, multimorbidity, Frailty Scale &gt; Grade 4 and ADL dependency. Conclusions. Age, female gender, multimorbidity, frailty and ADL dependency were considered as risk factors of dementia cognitive symptoms among the Vietnamese people aged 60 years and older.

Association of preoperative clinical frailty and clinical outcomes in elderly patients with stable coronary artery disease after percutaneous coronary intervention.

There are few reports on the long-term clinical outcome after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) complicated with frailty. This novel study investigated the association between pre-PCI frailty and long-term clinical outcomes in elderly patients aged 65years or older with stable CAD who underwent elective PCI. We assessed 239 consecutive patients aged 65years or older with stable CAD who underwent successful elective PCI at Kagoshima City Hospital between January 1st, 2017 and December 31st, 2020. Frailty was retrospectively assessed using the Canadian Study and Aging Clinical Frailty Scale (CFS). Based on the pre-PCI CFS, patients were divided into two groups: the non-frail (CFS < 5) and the frail (CFS ≥ 5) group. We investigated the association between pre-PCI CFS and major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization. Additionally, we assessed the association between pre-PCI CFS and major bleeding events defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The mean age was 74.8 ± 7.0years, and 73.6% were men. According to the pre-PCI frailty assessment, 38 (15.9%) and 201 (84.1%) were classified as frail and non-frail groups, respectively. During a median follow-up of 962 (607-1284) days, 46 patients developed MACEs and 10 patients developed major bleeding events. Kaplan-Meier curves showed a significantly higher incidence of MACE in the frail group compared to those in the non-frail group (Log-rank p < 0.001). Even in multivariate analysis, pre-PCI frailty (CFS ≥ 5) was independently associated with MACE (HR 4.27, 95% CI 1.86-9.80, p-value: < 0.001). Additionally, the cumulative incidence of major bleeding events was significantly higher in the frail group than in the non-frail group (Log-rank p = 0.001). Pre-PCI frailty was an independent risk factor for MACE and bleeding events in elderly patients with stable CAD who underwent elective PCI.

Reliability and validity of a frailty assessment tool in specialized burn care, a retrospective multicentre cohort study

BackgroundFrailty is a predictor of adverse outcomes in elderly patients. The Canadian Study of Health and Aging Clinical Frailty Scale (CFS) is an often-used frailty assessment instrument. However, the CFS’s reliability and validity in patients with burn injuries are unknown. This study aimed to assess the CFS’s inter-rater reliability and validity (predictive validity, known group validity and convergent validity) in patients with burn injuries treated to specialized burn care. MethodsA retrospective multicentre cohort study was conducted in all three Dutch burn centres. Patients aged ≥ 50 years with burn injuries, with a primary admission in 2015–2018, were included. Based on information in the electronic patient files, a research team member scored the CFS retrospectively. Inter-rater reliability was calculated using Krippendorff’s α. Validity was assessed using logistic regression analysis. Patients with a CFS ≥ 5 were considered frail. ResultsIn total, 540 patients were included, with a mean age of 65.8 years (SD 11.5) and a Total Body Surface Area (TBSA) burned of 8.5%. The CFS was used to assess frailty in 540 patients and the reliability of the CFS was scored for 212 patients. Mean CFS was 3.4(SD 2.0). Inter-rater reliability was adequate, Krippendorff’s α 0.69 (95%CI 0.62–0.74). A positive frailty screening was predictive of a non-home discharge location (OR 3.57, 95%CI 2.16–5.93), a higher in-hospital mortality rate (OR 1.06–8.77), and a higher mortality rate within 12 months after discharge (OR 4.61, 95%CI 1.99–10.65) after adjustment for age, TBSA, and inhalation injury. Frail patients were more likely to be older (for<70 vs. ≥70 years odds ratio 2.88, 95%CI 1.95–4.25) and their comorbidities were more severe (ASA ≥3 vs 1–2 OR 6.43, 95%CI 4.26–9.70) (known group validity). The CFS was significantly related (rSpearman=0.55) to the Dutch Safety Management System (DSMS) frailty screening, reflecting a fair-good correlation between the CFS and DSMS frailty screening outcomes. ConclusionThe Clinical Frailty scale is reliable and has shown its validity, including its association with adverse outcomes in patients with burn injury admitted to specialized burn care. Early frailty assessment with the CFS must be considered, to optimize early recognition and treatment of frailty.

Frailty predicts mortality in patients with upper gastrointestinal bleed: a prospective cohort study.

Evidence on the impact of frailty in patients with upper gastrointestinal bleed (UGIB) is limited. This study aims to define the role of frailty as defined by Canadian Study of Health and Aging clinical frailty scale (CSHA-CFS) in predicting mortality in UGIB. A prospective single-center cohort study was conducted over 21months on all consecutive patients with UGIB. Data on demographics, lab parameters, Glasgow Blatchford score, CSHA-CFS, Charlson Comorbidity Index, and AIMS65 score was recorded. The primary outcome was all-cause inpatient mortality. The secondary outcomes were all-cause 30-day mortality, 30-day rebleeding, 30-day readmission, hospital length of stay (LoS), intensive care unit (ICU) admission, need for repeat endoscopy, and need for blood transfusion. The data were evaluated using univariate and multivariate analysis. There were 298 eligible patients, of which 63% were males, median age was 68years, 44% were from non-English-speaking background, and 72% had major comorbidities. The all-cause inpatient and 30-day mortality were 9.4% and 10.7%, respectively. In the multivariate analysis, CHSA-CFS was the independent predictor of all-cause inpatient mortality (OR 1.66; 95% CI 1.13-2.143; P=0.010) and all-cause 30-day mortality (OR 1.83; 95% CI 1.26-2.67; P=0.002). CHSA-CFS was not a significant predictor of 30-day rebleed, 30-day readmission, ICU admission, hospital LoS, or need for blood transfusion. Frailty is an important independent predictor of mortality in patients with UGIB. Frailty assessment can guide clinical decision making and allow targeting of health-care resource (Australia/New Zealand Clinical Trial Registry number: ACTRN12622000821796).

Poverty and Frailty Are Not Related to Each Other With Regard to Outcomes in Middle-Aged and Older Patients with Burn Injuries.

The purpose of this study was to determine the relationship between frailty and poverty in burn patients ≥50 years old, and their association with patient outcomes. This was a single-center retrospective chart review from 2009 to 2018 of patients ≥50 years old admitted with acute burn injuries. Frailty was assigned using the Canadian Study of Health and Aging Clinical Frailty Scale. Poverty was defined as a patient from a zip code that had >20% of people living in poverty. The relationship between frailty and poverty, as well as each variable independently on mortality, length of stay (LOS), and disposition location, was examined. Of 953 patients, the median age was 61 years, 70.8% were male, and the median total body surface area burn was 6.6%. Upon admission, 26.4% and 35.2% of patients were frail and from impoverished neighborhoods, respectively. The mortality rate was 8.8%. Univariate analysis demonstrated that nonsurvivors had significantly higher chances of living in poverty (P = .02) and were more likely to be frail compared to survivors. There was no significant correlation between poverty and frailty (P = .08). Multivariate logistic regression confirmed the relationship between lack of poverty and mortality (OR .47, 95% CI 0.25-0.89) and frailty and mortality (OR 1.62, 95% CI 1.24-2.12). Neither poverty (P = .26) nor frailty (P = .52) was associated with LOS. Both poverty and frailty were associated with a patient's discharge location (P = .03; P < .0001). Poverty and frailty each independently predict mortality and discharge destination in burn patients ≥50, but they are not associated with LOS nor each other.

Population Pharmacokinetics of Piperacillin/Tazobactam Across the Adult Lifespan.

Piperacillin/tazobactam is one of the most frequently used antimicrobials in older adults. Using an opportunistic study design, we evaluated the pharmacokinetics of piperacillin/tazobactam as a probe drug to evaluate changes in antibacterial drug exposure and dosing requirements, including in older adults. A total of 121 adult patients were included. The population pharmacokinetic models that best characterized the observed plasma concentrations of piperacillin and tazobactam were one-compartment structural models with zero-order input and linear elimination. Among all potential covariates, estimated creatinine clearance had the most substantial impact on the elimination clearance for both piperacillin and tazobactam. After accounting for renal function and body size, there was no remaining impact of frailty on the pharmacokinetics of piperacillin and tazobactam. Monte Carlo simulations indicated that renal function had a greater impact on the therapeutic target attainment than age, although these covariates were highly correlated. Frailty, using the Canadian Study of Health and Aging Clinical Frailty Scale, was assessed in 60 patients who were ≥65 years of age. The simulations suggested that adults ≤50 years of age infected with organisms with higher minimum inhibitory concentrations may benefit from continuous piperacillin/tazobactam infusions (12 g/day of piperacillin component) or extended infusions of 4 g every 8 hours. However, for a target of 50% fT + minimum inhibitory concentration, dosing based on renal function is generally preferable to dosing by age, and simulations suggested that patients with creatinine clearance ≥120 mL/min may benefit from infusions of 4 g every 8 hours for organisms with higher minimum inhibitory concentrations.

Frailty in mid-life predicts outcome following trauma.

Midlife adults (50-64 y) are at risk for falls and subsequent injury; yet current guidance on fall screening only pertains to older adults (> 65 y). Herein, we evaluated whether frailty was predictive of readmission for falls in midlife trauma patients. This was a retrospective cohort study of trauma midlife patients admitted for traumatic injuries from 2010 to 2015. Demographics, injury data, fall history, and post-index readmission for falls were collected from medical records. Frailty scores were calculated retrospectively using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS). The association between frailty and outcomes was assessed. p < 0.05 was considered significant. A total of 326 midlife patients were included, 54% were considered fit, 33.7% pre-frail, and 12.3% frail. Compared to their fit and pre-frail counterparts, frail patients were more likely to be female (67.5% vs. 46.3% vs. 36.3%, p < 0.001), have a history of fall (22.5% vs. 15.5% vs. 6.2%, p < 0.001), and to have suffered a ground level fall on index admission (52.5% vs. 20% vs. 5.7%, p < 0.001). Controlling for age, BMI, gender, race, and fall history, frailty was associated with readmission of midlife adults for falls (OR = 1.82 [1.23-2.69]; p = 0.003) and discharge to skilled nursing facilities (OR = 26.86 [8.03-89.81], p < 0.001). Pre-injury frailty may be an effective tool to predict risk of readmission for fall and discharge disposition in midlife trauma patients.

Frailty as a predictor of negative outcomes in trauma patients with rib fractures

BackgroundIn patients with rib fractures, adverse outcomes are associated with number of rib fractures; however, studies suggest an association with frailty. We assessed whether frailty, measured using the Canadian Study of Health and Aging clinical frailty scale, was associated with adverse outcomes in this population. MethodsPatients ≥50 years admitted for rib fractures from July 2015 to June 2020 were retrospectively scored for frailty. Demographics, comorbidities, injury information, hospital course, and complications were collected. Univariate analyses were performed to assess significant differences between the fit, prefrail, and frail groups. The association between number of rib fractures and frailty with outcomes was determined. ResultsControlling for age, sex, Injury Severity Score, preadmission anticoagulant, injury mechanism, and comorbidities and nonchest Abbreviated Injury Scores showing significant differences, the number of rib fractures was associated with developing pneumonia (odds ratio = 1.197 [1.076–1.332]; P = .001), hospital length of stay (odds ratio = 1.066 [1.033–1.100], P < .001), mortality (odds ratio = 1.157 [1.048–1.278], P = .004), and discharge to long-term acute care facilities (odds ratio = 1.295 [1.084–1.546], P = .004). Frailty was associated with hospital length of stay (odds ratio = 1.659 [1.059–2.598], P = .027) and discharge to skilled nursing facilities (odds ratio = 5.282 [1.567–17.802], P = .007). ConclusionIn our population, the number of rib fractures was associated with respiratory complications and mortality. Frailty was associated with longer hospitalization and discharge to higher level of care.

Admission Frailty Score Are Associated With Increased Risk of Acute Respiratory Failure and Mortality in Burn Patients 50 and Older.

Herein, we assessed the utility of the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) to predict burn-specific outcomes. We hypothesized that frail patients are at greater risk for burn-related complications and require increased healthcare support at discharge. Patients 50 years and older admitted to our institution for burn injuries between July 2009 and June 2019 were included. Demographics, comorbidities, pre-injury functional status, injury and hospitalization information, complications (graft loss, acute respiratory failure, and acute kidney disease [AKI]), mortality, and discharge disposition were collected. Multivariate analyses were performed to assess the association between admission frailty scored using the CSHA-CFS and outcomes. P < .05 was considered significant. Eight-hundred fifty-one patients were included, 697 were not frail and 154 were frail. Controlling for Baux scores, sex, race, mechanism of injury, 2nd and 3rd degree burn surface, and inhalation injury, frailty was associated with acute respiratory failure (OR = 2.599 [1.460-4.628], P = .001) and with mortality (OR = 6.080 [2.316-15.958]; P < .001). Frailty was also associated with discharge to skilled nursing facility, rehabilitation, or long-term acute care facilities (OR = 3.135 [1.784-5.508], P < .001), and to hospice (OR = 8.694 [1.646-45.938], P = .011) when compared to home without healthcare services. Frailty is associated with increased risk of acute respiratory failure, mortality, and requiring increased healthcare support post-discharge. Our data suggest that frailty can be used as a tool to predict morbidity and mortality and for goals of care discussions for the burn patient.

Preexisting frailty and outcomes in older patients with acute myocardial infarction

Little is known about the prevalence and prognostic impact of preexisting frailty on acute care and in-hospital outcomes in older adults in the setting of acute myocardial infarction (AMI). Preexisting frailty was assessed at baseline in consecutive AMI patients ≥65 years of age treated at 778 hospitals participating in the NCDR ACTION Registry between January 1, 2015 to December 31, 2016. Three domains of preexisting frailty (cognition, ambulation, and functional independence) were abstracted from chart review and summed in 2 ways: an ACTION Frailty Scale based on responses to 6 groups adapted from the Canadian Study of Health and Aging Clinical Frailty Scale and an ACTION Frailty Score derived by summing a rank score of 0-2 assigned for each grade (total ranged between 0 to 6). Multivariable logistic regression examined the association between assigned frailty by score or scale and in-hospital mortality. Among 143,722 older AMI patients, 108,059 (75.2%) were fit and/or well and 6,484 (4.5%) were vulnerable to frailty, while 7,527 (5.2%) had mild, 3,913 (2.7%) had moderate, 2,715 had (1.9%) severe, and 632 (0.4%) had very severe frailty according to the ACTION Frailty Scale, while 14,392 (10.0%) could not be categorized due to incomplete ascertainment. Frail patients were older, more frequently female, of non-white race and/or ethnicity, and less likely to be treated with guideline-recommended therapies. Increasing severity of frailty by this scale was associated with a step-wise higher risk for in-hospital mortality (P-trend < .001). Patient categories of the ACTION Frailty Score provided similar results. After adjustment, each 1-unit increase in Frailty Score was associated with a 12% higher mortality risk (OR 1.12, 95% CI 1.10-1.15). Among older patients with acute myocardial infarction, frailty is common and independently associated with in-hospital mortality. These findings show the importance of pragmatic evaluation of frailty in hospital-level quality scores, guideline recommendations, and incorporation into other registry data collection efforts.

5 Admission Frailty Is Associated with Acute Respiratory Failure and Mortality in Burn Patients &amp;gt; 50

IntroductionPre-injury frailty has been shown to predict mortality of older burn patients. Herein, we assessed the utility of the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) to predict burn-specific outcomes. We hypothesize that frail patients are at greater risk for complications such as graft loss, acute respiratory failure, and acute kidney injury and will require increased healthcare support at discharge.MethodsThis is a retrospective cohort study. Patients 50 years and older admitted to our Institution for burn injuries between July 2009 and June 2019 were included. Patients with inhalation injury only, no data on total burn surface area, or for whom medical history was incomplete were excluded. Demographics; comorbidities; pre-injury functional status; admission, injury, and hospitalization information; complications (graft loss, acute respiratory failure, and acute kidney disease (AKI)); mortality, and discharge disposition were collected. Patients were scored on the CSHA-CFS based on pre-admission health and functional status. The frail and non-frail groups were compared. Multivariate analyses were performed to assess the association between admission frailty and outcomes. P < 0.05 was considered significant.ResultsWe included 851 patients, 697 were not frail and 154 were frail. Frail patients were significantly older (66.1 ± 10.8 vs. 63.5 ± 10.9, p = 0.002), more likely Caucasian (98.1% vs. 91%, p = 0.027) and to have suffered flame burn injuries (68.8% vs. 59.8%, p < 0.001). Frail patients had a lower %TBSA (4.4 ± 8.1% vs. 10.1 ± 13.1, p < 0.001) but were more likely to stay longer in hospital relative to %TBSA (3.6 ± 6.7 vs. 1.9 ± 3.1, p < 0.001). Frail patients were less likely to have had skin graft procedures (27.3% vs. 57.4, p < 0.001). On multivariate analysis, controlling for age, sex, race, mechanism of injury, %TBSA, 2nd degree and 3rd degree burn surface, inhalation injury, frailty was associated with acute respiratory failure (OR = 2.599 [1.460-4.628], p = 0.001). Frailty was also associated with mortality (OR = 6.915 [2.455-19.980]; p < 0.001) when controlling for the same variables as well as acute respiratory failure and AKI. Frailty was also associated with discharge to home with healthcare services (OR = 2.678 [1.491-4.809], p = 0.001), to SNF, rehabilitation, or long-term acute care facilities (OR = 3.572 [1.933-6.602], p < 0.001), and to hospice (OR = 5.759 [1.519-21.827], p = 0.010) when compared to home without healthcare services.ConclusionsFrailty is associated with increased risk of acute respiratory failure, mortality, and requiring increased healthcare support post-discharge. Our data suggest frailty as a tool to predict morbidity and mortality as well as for goals of care discussions for the burn patient.

15 Poverty and Frailty in Patients with Burn Injuries: Important but Unrelated

IntroductionPrevious work has demonstrated that frailty predicts mortality and patient disposition in burn patients >50 years old. It is unknown to what extent poverty contributes to these outcomes. There has been no work demonstrating the interplay of these two variables on patients with burn injuries. The purpose of this study was to determine the relationship of frailty and poverty in burn patients over the age of 50, and their association with patient outcomes.MethodsA 9-year retrospective chart review from 2009-2018 of patients >50 years old admitted to an ABA verified burn center with acute burn injuries was completed. Patient demographics, burn characteristics, frailty scores and poverty levels were collected. Frailty scores were assigned using the Canadian Study of Health and Aging Clinical Frailty Scale (scored 1-7). Frailty was dichotomized with scores >5 being frail. Poverty data were obtained using zip code and US census data. Poverty level was categorized according to whether a patient came from a zip code that had >20% of people living in poverty. Descriptive statistics, univariate analysis, and multivariate analysis were completed to examine the relationship between frailty and poverty, as well as each variable independently on mortality and length of stay (LOS).ResultsA total of 953 patients were included. Mean age was 63.5 + 10.4 years and 675 (70.8%) were male. Mean %TBSA was 11.4%+14.2% and mean frailty score was 3.8 + 1.2. Upon admission, mean poverty score was 17.3+ 8.7. The overall mortality rate was 8.8%. Univariate analysis demonstrated that non-survivors had significantly higher chances of living in poverty (p=0.02). Similarly, univariate analysis showed that non-survivors were more likely to have frailty scores of 5 or greater compared to survivors. Multivariate logistic regression confirmed relationship between poverty and mortality (<20% vs >20%, OR 0.47 95% CI 0.25-0.89) and frailty and mortality ( >5 vs 1-4, OR 2.9 95%CI 1.4-5.8). It also demonstrated that the combined variable of frailty and poverty was not significantly associated with mortality (Wald χ2 2.0, p=0.15). Neither poverty (< 20% vs >20%, p=0.26) nor frailty (1-4 vs >5, p=0.52) were associated with LOS. Both poverty and frailty were associated with a patient’s disposition destination (p=0.03; p< 0.0001). Univariate analysis did not show a significant correlation between poverty and frailty (p=0.08), though there was a trend towards significance.ConclusionsPoverty and frailty each independently predict mortality and discharge destination in burn patients >50, but they are not associated with LOS, and do not show a significant association with each other, nor a combined effect on mortality.

The relationship between frailty, nutritional status, co-morbidity, CT-body composition and systemic inflammation in patients with COVID-19

BackgroundFrailty, determined by the Canadian Study of Health and Aging-Clinical Frailty Scale (CFS), is strongly associated with clinical outcomes including mortality in patients with COVID-19. However, the relationship between frailty and other recognised prognostic factors including age, nutritional status, obesity, sarcopenia and systemic inflammation is poorly understood. Therefore, the aim of this study was to examine the relationship between frailty and other prognostic domains, in patients admitted with COVID-19.MethodsPatients who presented to our institutions between 1st April 2020–6th July 2020 with confirmed COVID-19 were assessed for inclusion. Data collected included general demographic details, clinicopathological variables, CFS admission assessment, Malnutrition Universal Screening Tool (MUST), CT-BC measurements and markers of systemic inflammation.Results106 patients met the study inclusion criteria. The majority of patients were aged ≥ 70 years (67%), male (53%) and frail (scoring > 3 on the CFS, 72%). The majority of patients were not malnourished (MUST 0, 58%), had ≥ 1 co-morbidity (87%), were sarcopenic (low SMI, 80%) and had systemic inflammation (mGPS ≥ 1, 81%, NLR > 5, 55%). On multivariate binary logistics regression analysis, age (p < 0.01), COPD (p < 0.05) and NLR (p < 0.05) remained independently associated with frailty. On univariate binary logistics regression, NLR (p < 0.05) was significantly associated with 30-day mortality.ConclusionFrailty was independently associated with age, co-morbidity, and systemic inflammation. The basis of the relationship between frailty and clinical outcomes in COVID-19 requires further study.Trial registration Registered with clinicaltrials.gov (NCT04484545)

Abstract 11825: The Association Between Frailty and Vascular Endothelial Growth Factor Families in Patients With Heart Failure: The PREHOSP-CHF Study

Background: Frailty is a complex clinical syndrome associated with ageing and chronic illness, and is common in heart failure (HF). Vascular endothelial dysfunction including maladaptive angiogenesis and lymphangiogenesis is involved in the pathogenesis of HF, and is also considered to be the causes of frailty. We investigated the association of vascular endothelial growth factor (VEGF) families, central regulators of angiogenesis and lymphangiogenesis, with frailty, and prognostic role of these cytokines in frail HF patients. Methods: We performed a multicenter prospective cohort study to determine the predictive value of VEGF families for prognosis among patients with HF. A total of 1,024 patients (mean age, 75.5 years, 58.7% male) were included in the analyses. Serum levels of VEGF, VEGF-C, VEGF-D, and soluble VEGF receptor-2 (sVEGFR-2) were measured. Frailty was assessed by Canadian Study of Health and Aging Clinical Frailty Scale (CFS). Results: A total of 256 (25.1%) patients had frailty (CFS≥5) at baseline. Frail patients were older, more likely female, and had lower body mass index, higher NYHA class, and higher rates of prior hospitalization for HF, HF with preserved ejection fraction, anemia, cerebrovascular disease, and dementia. N-terminal pro brain natriuretic peptide, high sensitivity troponin I, and high sensitivity C-reactive protein levels were higher in frail patients. During the 2-year follow-up, 211 all cause death occurred. In Kaplan-Maier analysis, frail patients showed significantly higher incidence of all-cause (hazard ratio [HR], 4.12; 95% confidence interval [CI], 3.14-5.42). Regarding VEGF families, frail patients had significantly lower levels of sVEGFR-2 and VEGF-C, and higher levels of VEGF-D. Multiple regression analysis revealed that VEGF-C had inverse correlation with CFS (P, 0.03). After adjusting for clinical confounders, a low VEGF-C level was independently associated with all-cause death in frail patients (HR, 0.74; 95%CI, 0.58-0.94 for 1-SD increase), but was not in non-frail patients (HR, 0.87; 95%CI, 0.64-1.14 for 1-SD increase) (P for interaction, 0.09). Conclusions: In HF patients, a low VEGF-C value was associated with frailty and was independent risk for all-cause death in frail patients.

A 10-Item Frailty Index Based on a Comprehensive Geriatric Assessment (FI-CGA-10) in Older Adults with Cancer: Development and Construct Validation.

A frailty index (FI) based on domain-level deficits identified through a comprehensive geriatric assessment (CGA) has been previously developed and validated in general geriatric patients. Our objectives were to construct an FI-CGA and to assess its construct validity in the geriatric oncology setting. Five hundred forty consecutive Japanese patients with cancer who underwent a CGA on a geriatric oncology service were included (median age 80 years, range 66-96 years). We developed a 10-item frailty index based on deficits in 10 domains (FI-CGA-10): cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support, and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem), and 1.0 (major problem). Scores were calculated by dividing the sum of the scores for each domain by 10 and then categorized as fit (<0.2), pre-frail (0.2-0.35), and frail (>0.35). Construct validity was tested by correlating the FI-CGA-10 with other established frailty measures. FI-CGA-10 was well approximated by the gamma distribution. Overall, 20% of patients were fit, 41% were pre-frail, and 39% were frail. FI-CGA-10 was correlated with Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (r=0.83), CSHA rules-based frailty definition (r=0.67), and CSHA Function Score (r=0.77). Increasing levels of frailty were significantly associated with functional and cognitive impairments, high comorbidity burden, poor self-rated health, and low estimated survival probabilities. The FI-CGA-10 is a user-friendly and construct-validated measure for quantifying frailty from a CGA. This article describes the construction of a user-friendly 10-item frailty index based on a comprehensive geriatric assessment (FI-CGA-10) for older adults with cancer: cognition, mood, communication, mobility, balance, nutrition, basic and instrumental activities of daily living, social support, and comorbidity. The FI-CGA-10 simplifies the original FI-CGA used in the general geriatric setting while maintaining its content validity. The index's construct validity was demonstrated in a cohort of older adults with various cancer types. The advantage of the FI-CGA-10 is that a frailty score can be calculated more readily and interpreted in a more clinically sensible manner than the original FI-CGA.