Aspects Of Frailty Research Articles

Mental Health Issues and Frailty

As the population continues to age, it becomes pertinent to consider the experience and quality of life of older adults. With the advancement of age, older adults experience many physical challenges (e.g., mental health issues and aspects of frailty) and changes in their everyday lives. Frailty can be an outcome of decreased movement, stimulation, and confidence. Mental health issues like anxiety and depression can occur from changes in self-perception, abilities, and relationships. Socialization is affected by changes seen with aging, even though a social support system is an integral part of successful aging. For health care professionals working with older adults, it is important to provide education about mental and physical health changes to assist older adults maintaining their well-being and thrive as they age. Encouraging older adults to seek timely and necessary help to handle challenges and changes as needed is also a productive way to foster successful aging. This paper aims to discuss existing knowledge mental health and frailty with the hope that health care professionals may find it useful to stabilize and diversify the care older adults receive, thereby improving quality of life and reducing mental health and frailty issues.

Evaluation of the geriatric 8 (G8) screening tool in a multi-ethnic Asian population of older adults with cancer: Results from Geriatric Oncology Longitudinal End to eNd (GOLDEN) Study.

e24029 Background: The Geriatric 8 (G8) questionnaire has been validated predominantly in Western populations as a screening tool to identify vulnerable older adults with cancer who would benefit from comprehensive geriatric assessment (CGA). Given the paucity of evidence of the performance of this tool in a multi-ethnic Asian population, there is a need to determine whether the established cut-off score of 14 should be adjusted for improved performance in this population of older adults. Methods: Prospective cross-sectional study was done in older adults aged ≥ 65 years in the outpatient setting of an academic tertiary cancer center, the National University Cancer Institute, Singapore (NCIS). G8 questionnaire and CGA were conducted for eligible patients. The performance of the G8 screening tool in identifying patients who would benefit from a CGA was evaluated using receiver operating characteristic (ROC) curve analysis: area under the curve (AUC), sensitivity (Sn), and specificity (Sp). Results: 180 participants (mean age 74 years) were included in the study. 40.5% were female. 90% were Chinese, 7% were Malay, 2% were Indian. 57.8% were pre-frail and 12.8% were frail. The top five cancers in our study population were colorectal (30%), lung (25%), head and neck (12%), upper gastrointestinal (10%) and gynecological (7.0%). ROC analysis showed an AUC of 0.73 (95% CI 0.65 – 0.80) with an optimal cut-off score of 13 (Sn 71.7%, Sp 74.0%). Conclusions: G8 performed well in identifying older adults with cancer who would benefit from a CGA, in a multi-ethnic Asian population. In our cohort, we found that a slightly lower cut-off score of 13 performed better, and should be taken into consideration as part of daily oncology practice in Asia. Future research efforts should go into examining the biological aspects of frailty in this population.

Understanding and Measuring Frailty: Insights From the Canadian NuAge and CLSA Cohorts

Frailty is one of the most central concepts in geriatrics; nonetheless, multiple definitions and operationalizations abound, and the underlying biology remains a topic of much discussion. Here, we bring together four talks that join questions of understanding with questions of measurement, in order to explore how answering each is necessary to make progress on the other. We cannot measure frailty if we have not understood and defined it, but we cannot understand if we cannot measure it and study it. Turcot et al. present work on operationalizing frailty in the NuAge cohort. Mayo et al. establish a scale to test the extent to which frailty can be operationalized as a ladder rather than a condition, again using the NuAge cohort. Mendo et al. use mediation analyses to understand how grip strength and other aspects of frailty may play a role in the relationship between diabetes and atherosclerosis. Ghachem et al. test the relationship between physiological dysregulation of different systems and different criteria of the Fried model, in order to assess the evidence for frailty as an emergent physiological state. Together, these talks will push the boundaries of how we think about frailty at levels ranging from biological to clinical to operational.

Development and validation of a prediction model for actionable aspects of frailty in the text of clinicians' encounter notes.

Frailty is a prevalent risk factor for adverse outcomes among patients with chronic lung disease. However, identifying frail patients who may benefit from interventions is challenging using standard data sources. We therefore sought to identify phrases in clinical notes in the electronic health record (EHR) that describe actionable frailty syndromes. We used an active learning strategy to select notes from the EHR and annotated each sentence for 4 actionable aspects of frailty: respiratory impairment, musculoskeletal problems, fall risk, and nutritional deficiencies. We compared the performance of regression, tree-based, and neural network models to predict the labels for each sentence. We evaluated performance with the scaled Brier score (SBS), where 1 is perfect and 0 is uninformative, and the positive predictive value (PPV). We manually annotated 155952 sentences from 326 patients. Elastic net regression had the best performance across all 4 frailty aspects (SBS 0.52, 95% confidence interval [CI] 0.49-0.54) followed by random forests (SBS 0.49, 95% CI 0.47-0.51), and multi-task neural networks (SBS 0.39, 95% CI 0.37-0.42). For the elastic net model, the PPV for identifying the presence of respiratory impairment was 54.8% (95% CI 53.3%-56.6%) at a sensitivity of 80%. Classification models using EHR notes can effectively identify actionable aspects of frailty among patients living with chronic lung disease. Regression performed better than random forest and neural network models. NLP-based models offer promising support to population health management programs that seek to identify and refer community-dwelling patients with frailty for evidence-based interventions.

1841P Retrospective review of frailty in lung cancer patients

Lung Cancer is most diagnosed over the age of 70 years. This population have an increasing risk of frailty and these impact cancer treatment tolerance, quality of life and survival. We performed a retrospective study to look at whether aspects of frailty were being assessed.

A pragmatic tool to identify aspects of frailty.

A pragmatic tool to identify aspects of frailty.

Care Professionals Manage the Future, Frail Older Persons the Past. Explaining Why Frailty Management in Primary Care Doesn't Always Work.

Frailty management focuses on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention in primary care. Such care programs demand a joint effort by primary care professionals and older persons, one in which professionals are expected to promote or facilitate self-management practices and older persons are expected to adhere to the professional advice. It is known that patients and professionals hold different perspectives on frailty, but we know little about how this may affect their cooperation in frailty management. In this article, we therefore study how different perspectives of older persons and their primary care professionals play a role frailty management in practice. Nine cases of frailty management were reconstructed through semi-structured interviews with older persons, their family doctor and practice nurse. Drawing from literature on managing complex problems, we analyzed how “factual” and “normative” orientations played a role in their perspectives. We observe that the perspectives of care professionals and older persons on frailty management were substantially different. Both actors “manage” frailty, but they focus on different aspects of frailty and interestingly, care professionals' rationale is future-oriented whereas older person's rationale past-oriented. Primary care professionals employed practices to manage the medical and social factors of frailty in order to prevent future loss. Older persons employed practices to deal with the psychological, emotional and social aspects of the different types of loss they already experienced, in order to reconcile with loss from the past in the present. These findings raise fundamental questions regarding the different perceptions of and priorities around not only care for frail older people in general, but also implied professional-patient relations and the value of a risk-management approach to care for older people with frail health. The distinction between these perspectives could help care professionals to better respond to older patients' preferences and it could empower older persons to voice preferences and priorities that might not fit within the proposed care program.

Estimation of homeostatic dysregulation and frailty using biomarker variability: a principal component analysis of hemodialysis patients

Increased intraindividual variability in several biological parameters is associated with aspects of frailty and may reflect impaired physiological regulation. As frailty involves a cumulative decline in multiple physiological systems, we aimed to estimate the overall regulatory capacity by applying a principal component analysis to such variability. The variability of 20 blood-based parameters was evaluated as the log-transformed coefficient of variation (LCV) for one year’s worth of data from 580 hemodialysis patients. All the LCVs were positively correlated with each other and shared common characteristics. In a principal component analysis of 19 LCVs, the first principal component (PC1) explained 27.7% of the total variance, and the PC1 score exhibited consistent correlations with diverse negative health indicators, including diabetes, hypoalbuminemia, hyponatremia, and relative hypocreatininemia. The relationship between the PC1 score and frailty was subsequently examined in a subset of the subjects. The PC1 score was associated with the prevalence of frailty and was an independent predictor for frailty (odds ratio per SD: 2.31, P = 0.01) using a multivariate logistic regression model, which showed good discrimination (c-statistic: 0.85). Therefore, the PC1 score represents principal information shared by biomarker variabilities and is a reasonable measure of homeostatic dysregulation and frailty.

FRAILTY AND PRECARITY: UNTANGLING THE CONCEPTUAL PATHWAYS OF NEED AND DISADVANTAGE IN LATE LIFE

The concepts of frailty and precarity circulate in social gerontology and studies of aging, with the former a dominant construct, and the latter emerging as a way of linking experiences, insecurities and risks. Although these concepts are used inter-changeably by some authors, their roots, key areas of focus and meanings differ. This paper considers the state of knowledge on frailty, and sets this against the uses of precarity. A After outlining a recent scoping review on precarity that revealed a high number of articles cross-referencing concepts of frailty and vulnerability. the paper distinguishes key aspects of frailty, vulnerability, and precarity. Situating qualitative experiences of each serves as a means to further explore similarities and differences. The paper concludes with reflections on what (if anything) each of these allied concepts may offer understandings of late life, and in particular, the study of disadvantage across the life course and into late life.

269 Early Identification of Frailty: Developing an International Delphi Consensus for a Definition of Pre-frailty

Abstract Background Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent condition before frailty becomes established. Despite this, there is no widely accepted definition of pre-frailty to support its early identification and management. This study applied an international consensus approach to define and better understand pre-frailty. Methods A modified electronic two-round Delphi Consensus study was conducted. In all, 23 experts from 12 countries with different backgrounds participated. The questionnaire was developed following a systematic literature review. An online consensus meeting was conducted with eight Delphi participants and two external experts. Qualitative and quantitative methods were employed for data analysis. An agreement level of 70% was applied for accepting statements. Results A total of 71 statements were circulated in Round 1. Of these, 52.8% were accepted. Fifty-one statements were re-circulated in Round 2, of which 92.1% were accepted. The online consensus meeting produced a consensus statement describing the concept, multi-factorial nature, and mechanism of pre-frailty as well as assessment, prevention and management approaches. All experts agreed that physical and non-physical factors such as psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life outcomes. Practitioners should regard pre-frailty as a multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It might be reversed or attenuated by targeted interventions. Brief, feasible and validated tools are recommended for opportunistic screening or case-finding followed by confirmation with multi-dimensional assessment. Conclusion It is difficult to establish consensus on one compact definition of pre-frailty, which is a multi-dimensional concept not only associated with physical impairment, but also with cognitive, nutritional, socioeconomic and other aspects of frailty. However, it may be too early to agree on an operational definition of pre-frailty since none yet exists for frailty.

Safety and Effectiveness of Ninjin'yoeito: A Utilization Study in Elderly Patients.

Post-marketing surveillance studies of traditional Japanese medicine in Japan are limited, and currently there are no data for Ninjin'yoeito, which is often used for the elderly because of its efficacy. In this study, we aimed to investigate the post-marketing safety and efficacy of Ninjin'yoeito in elderly patients over 65 years of age in clinical practice in Japan. This survey was an open-label, non-comparative, prospective, multicenter, post-marketing survey conducted at 383 centers between February 2016 and March 2017. In the safety analysis of 808 patients, adverse reactions were reported in 25 patients (3.1%), most of whom had gastrointestinal disorders (2.1%). In the efficacy analysis, Ninjin'yoeito was found to significantly improve visual analog scale scores in fatigue/malaise and anorexia at weeks 8, 16, and 24, and weeks 8 and 24 after commencement of treatment, respectively. In addition, the Basic Checklist created by the Ministry of Health, Labor and Welfare of Japan was used as a secondary survey item. The proportion of patients expected to require nursing care significantly decreased after 24 weeks compared with the baseline in four domains (activities of daily living, motor function, oral function, and depression). On the basis of physician assessment, Ninjin'yoeito was rated as “effective” or “moderately effective” in 486 (90.5%) of 537 cases. As the checklist contains many aspects of frailty, Ninjin'yoeito might be beneficial in preventing frailty. The findings of the present study indicate the safety of Ninjin'yoeito in aged patients, although further integrated clinical trials are necessary to examine its efficacy.

Waitlisted Patients and Serious Fall

Waitlisted Patients and Serious Fall

Influence of ischemic stroke on the frailty process of older adults

Introducción. Los ancianos pueden tornarse frágiles por diferentes mecanismos que influencian la homeostasis, como por ejemplo el accidente cerebrovascular (ACV).Objetivo. Investigar la relación del ACV con el proceso de fragilización en correlación con el índice de masa corporal, la funcionalidad y los déficits resultantes.Materiales y métodos. Se realizó un estudio de caso-control. Se incluyeron pacientes con 60 años o más que sufrieron ACV isquémico y evaluados con Kihon Checklist (KCL), Escala de Rankin Modificada y Evaluación Neurológica del National Institutes of Health Stroke Scale. Se recogieron datos de baseline de información pre-ACV y de follow-up un mes después del alta hospitalaria. El análisis estadístico se realizó mediante prueba t pareada y prueba non paramétrica de Friedman.Resultados. Se incluyeran 16 ancianos (720.19±7.20 años) y se observó la influencia del ACV en la fragilización (p<0.005). Aumentaron las puntuaciones de los dominios: KCL total (p=0.001); actividades instrumentales de la vida diária (p=0.001); físico (p=0.002); socialización (p=0.006); humor (p=0.004).Conclusiones. Se observó empeoramiento de la fragilidad después del ACV. El KCL se presentó como una evaluación satisfactoria para medir la fragilidad pre y post ACV debido a su aplicabilidad y cobertura de los aspectos principales de la fragilidad en ancianos.

M-Health: Lessons Learned by m-Experiences.

m-Health is an emerging area that is transforming how people take part in the control of their wellness condition. This vision is changing traditional health processes by discharging hospitals from the care of people. Important advantages of continuous monitoring can be reached but, in order to transform this vision into a reality, some factors need to be addressed. m-Health applications should be shared by patients and hospital staff to perform proper supervised health monitoring. Furthermore, the uses of smartphones for health purposes should be transformed to achieve the objectives of this vision. In this work, we analyze the m-Health features and lessons learned by the experiences of systems developed by MAmI Research Lab. We have focused on three main aspects: m-interaction, use of frameworks, and physical activity recognition. For the analysis of the previous aspects, we have developed some approaches to: (1) efficiently manage patient medical records for nursing and healthcare environments by introducing the NFC technology; (2) a framework to monitor vital signs, obesity and overweight levels, rehabilitation and frailty aspects by means of accelerometer-enabled smartphones and, finally; (3) a solution to analyze daily gait activity in the elderly, carrying a single inertial wearable close to the first thoracic vertebra.

Abstract 207: Assessing the Clinical Value of Frailty as a Prognostic Indicator to Aid Decision-Making in Cardiac Surgery

Background: In North America, octogenarians are the fastest growing demographic. Chronological age of a patient is not always the same as their biological age, and their biological status can vary from robust to frail. Frail patients are predisposed to falls, institutionalization, hospitalization, and mortality. In the realm of cardiac surgery, there is little research examining frailty as a prognostic factor for cardiac surgical intervention. Purpose: The objective of the current study is to explore whether frailty provides additional information as a risk factor regarding patient prognosis over and above that of the comprehensive risk analysis scale, EuroSCORE II, used to determine suitability for cardiac surgery. Methods: This non-interventional study uses hospital patient files and questionnaire interviews, which assesses the patient’s frailty using the Frailty Assessment for Care-Planning Tool (FACT). From the documented EuroSCORE II from patient files, predictive modeling was used to consider frailty as a prognostic indicator for three adverse outcomes, discharge to an institution, major adverse cardiac events (MACE), and all-cause mortality + MACE. Furthermore, the sensitivity and specificity of the FACT will be evaluated using the area under the ROC curve for significant models. Results: Prognostic models determined that AUROC values provide improved prediction for two adverse outcomes, MACE and all-cause mortality + MACE. Using a cumulative score that involves all four domains (usual mobility, daily tasks, social function, and memory), higher discrimination with good calibration is achieved. Conclusions: Certain aspects of frailty, as measured by the FACT, have clinical value as prognostic indicators. These models are the first, to our knowledge, to investigate the relationship between the EuroSCORE II and MACE +/- all-cause mortality using the FACT. Traditional risk assessment scores such as the EuroSCORE II will benefit from having frailty included as a risk factor. Implications: This study will assist in educating future heart surgery patients about their possible risks by predicting adverse outcomes with better predictive ability. It is hoped that patients who possess more knowledge about their personal risks will be able to make more informed decisions about their surgery. Strategies to address and reduce frailty by increasing mobility and cognitive function and reducing nutritional deficiencies could use this information to inform future work.

ASSESSMENT OF MORTALITY RISK IN FRAIL PATIENTS WITH CRITICAL LIMB ISCHEMIA UNDERGOING REVASCULARIZATION

Frailty is recognized as a major prognostic risk factor in patients with critical limb ischemia (CLI). However, a frail CLI population is heterogeneous. The aim of the current study was to reveal which aspects of frailty were associated with mortality risk in a frail CLI patients undergoing

Frailty in aging and its influence on perceived stress exposure and stress-related symptoms: evidence from the Swiss Vivre/Leben/Vivere study.

Frailty is a core concept in understanding vulnerability and adjustment to stress in older adults. Adopting the perspective provided by the transactional model of stress and coping (Lazarus and Folkman in Stress, appraisal, and coping, Springer, New York, 1984), the present study examined three aspects of frailty in older adults: (1) the link between frailty and perceived stress exposure (PSE); (2) the link between frailty and stress-related symptoms (SRS); and (3) the role of frailty in the link between PSE and SRS. Participants were 2711 adults aged between 64 and 101years who were taking part in the Swiss Vivre/Leben/Vivere study. As well as assessing frailty, we measured PSE and SRS during the 4 weeks preceding the administration of the questionnaires, together with the covariates age, sex, educational attainment, language of the canton, and type of canton (urban vs. rural). Regression analyses revealed higher levels of PSE in frail older adults than in non-frail older adults. In addition, frail older adults reported more SRS than non-frail older adults. As expected, the association between PSE and SRS differed as a function of the frailty status: The positive relation between PSE and SRS being stronger for frail older adults than for non-frail older adults. These results suggest that frailty is related to perceived discrepancy between resources and demands, and to ability to cope with PSE. Our findings have implications for interventions to help frail older adults manage stress.

Blood transfusion in elderly patients with chronic anemia: a qualitative analysis of the general practitioners\u2019 attitudes

BackgroundBlood transfusion in chronic anemia is not covered by guidelines specific to older adults. When they consider that this treatment is necessary in elderly patients, French general practitioners (GPs) contact a hospital specialist to plan a transfusion.MethodsTwenty French GPs were questioned individually regarding their approach to blood transfusion using semi-structured interviews. Each interview was recorded, typed up verbatim and then coded using an inductive procedure by theme, in a cross-over design (two researchers) in two phases: analysis and summary, followed by grouping of the recorded comments.ResultsThe criteria for transfusion were hemoglobin level < 8 g/dL and cardiac comorbidities. Some geriatric issues, such as cognitive disorder or dependence, were considered, either as aspects of frailty favoring transfusion or as markers of reduced life expectancy that limit care. Falls and fear of an unpleasant death from anemia prompted GPs to order blood transfusion. The patient’s family provided guidance, but the patient was not routinely consulted. The specialists were rarely asked to participate in decision making. GPs’ perceptions were ambivalent: they considered transfusion to be extraordinary and magical, but also pointless since its effects are transient.ConclusionThe decision to give a transfusion to an elderly patient with chronic anemia is deemed complex, but GPs seem to take it alone, sometimes guided by the patient’s family. The drawing up of an advance care plan could help involve the patient in decision making.

Systematic review of the Kihon Checklist: Is it a reliable assessment of frailty?

To investigate whether the Kihon Checklist (KCL) can predict frailty and disability. The studies analyzed for the present review were retrieved by searching electronic databases and other sources using the keywords "Kihon Checklist" and "Basic Checklist." The articles were restricted to those written in English and published in health sciences journals from the year 2006 until the end of April 2015. To be included in the full analysis, the study had to be primary research and use the KCL as a dependent or independent variable. A total of 62 articles were identified in the initial search, and after screening, 13 articles were included in this review. The KCL was found to be closely correlated with validated assessments of frailty phenotypes. The complete version of the KCL and specific domains have been used as research outcomes to verify frailty in cross-sectional and longitudinal studies. KCL domains were applied to evaluate different outcomes, such as depressive mood, functional disability and instrumental activities of daily living limitations. The KCL is a reliable tool for predicting general frailty and frailty aspects in older adults. The KCL was shown to be adequate for cross-cultural studies and to be suitable for addressing frailty demands among elderly in multiple cohorts. The KCL is a short questionnaire, which makes its administration by health promoters easy; thus, it has been used to evaluate the effectiveness of frailty interventions. We strongly recommend use of the KCL in community and clinical practice to assess frailty status. Geriatr Gerontol Int 2016; 16: 893-902.

Community-dwelling frail elderly people's experience of daily life: a qualitative systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify and synthesize the best available knowledge on how community-dwelling frail elderly people experience daily life and what they find meaningful in daily life. Specifically the review questions are: • How do community-dwelling frail elderly people experience daily life? • What do community-dwelling frail elderly people find meaningful in daily life? INCLUSION CRITERIA Types of participants: The review will consider studies that include frail elderly community-dwelling people, aged 65 years or more, of either gender. For the purpose of this review the definition of frailty will be based on a multidimensional integrated approach including the physical, psychological and social aspects of frailty. Studies will be included in the systematic review if inclusion criteria such as a screening tool for frailty or known risk factors for frailty are used to identify and describe the participants, who were included in the studies. Known risk factors are, amongst others, being aged 75 years or more, comorbidity, living alone, low income and low educational levels. Phenomena of interest: This review will consider studies investigating the experiences of daily life for community-dwelling frail elderly and the themes they find meaningful in daily life. Context: This review will consider studies involving community-dwelling frail elderly people, living alone or with a spouse in their own home.