Burden Of Frailty Research Articles

Frailty transition and burden on mortality risk in middle-aged and older population: a prospective cohort study

The effect of frailty transition and burden on the risk of all-cause mortality in South Korea remains unclear. This study aimed to investigate the risk of all-cause mortality using the most recent frailty index (FI), changes in FI, and frailty burden. We analyzed data from the Korean Genome and Epidemiology Study (2013–2020). A total of 3,134 participants aged 53–87 years with a computable FI based on the osteoporotic fracture index during their initial visit. The FI was updated biennially during re-examinations and changes between the initial and last visits were categorized into four groups: (1) improved or maintained to non-frail, (2) worsened to pre-frail, (3) improved or maintained to pre-frail, and (4) worsened or maintained to frail. We used the Cox proportional hazards model, adjusted for age, sex, education, lifestyle factors, and diseases. During the follow-up, 218 participants died. Compared to those who were robust at the last visit, pre-frailty and frailty were associated with an increased risk of all-cause death. Of those who visited > 2 times, 62.3% improved or remained robust, and had a decreased risk of all-cause death. Those with > 63% of pre-frailty or frailty burden significantly higher risk of death, with > 60% increase compared to their non-frail counterparts. Maintaining or achieving robustness is associated with a decreased risk of mortality. To prevent premature death and extend healthy life expectancy, identifying biological aging through surrogate measures and implementing interventions to maintain or achieve a robust health status are needed.

Independent association between radial secondary access and stroke in patients undergoing transcatheter aortic valve implantation

Abstract Background Radial access has become the primary approach for invasive coronary angiography due to its lower complication rate than femoral access. Transcatheter aortic valve implantation (TAVI) frequently requires a secondary access, which has traditionally been femoral access. However, radial access for TAVI is feasible and gaining popularity, but data on its safety and complication rates is still limited. Purpose To evaluate the occurrence of stroke rate in patients undergoing a TAVI procedure with femoral or radial secondary access. Methods A prospective single-center TAVI registry of 2327 patients who received a TAVI procedure between 2019 and 2022 was conducted. All procedures had the primary access over the femoral route. 337 (14.5%) patients had a secondary access over the radial route, whereas 1990 (85.5%) received a femoral secondary access. The primary endpoint was the occurrence of stroke within the hospital stay. Both groups were compared using the t-test or the Mann-Whitney U test according to the distribution of the data. In a second step, a multivariable model was created in which parameters were included that were associated with the endpoint in the previous analysis, as well as parameters that are known to be associated with stroke. Results: Patients were 81.1 ± 6.3 years old, with a Euroscore II of 5.3 ± 6. A total of 610 (26.2%) patients received a balloon-expandable valve. The primary endpoint (stroke within 30 days of the TAVI procedure) was met by 94 (4%) of all patients. Stroke occurred more often in the group with radial secondary access (6.6% (22) vs. 3.6%(72), p = 0.012). Other significant differences between the two groups included (radial vs. femoral access): burden of atrial fibrillation (36.8% vs. 44.6%, p = 0.007), arterial hypertension (87.4% vs. 92%, p = 0.007), Euroscore II (4.6 vs. 5.5, p = 0.006), and frailty (25.2% vs. 40%, p < 0.001). There were no significant differences between the two groups in terms of secondary diagnosis of diabetes or coronary artery disease, age, occurrence of NYHA class III/IV, gender, or cerebral artery disease. In the multivariate analysis including Age, Euroscore II, NYHA class, gender, secondary diagnosis of arterial Hypertension, diabetes or cerebral artery disease, arterial fibrillation, Frailty and radial secondary access, only radial secondary access was independently associated with in-hospital stroke (p = 0.01). Conclusion Radial secondary access was significantly associated with an increased risk of in-hospital stroke following transcatheter aortic valve implantation (TAVI) in our study population. Intense manipulation of the guidewire and catheter to reach the ascending aorta at the beginning of the procedure and to reach the descending aorta for the final angiogram of the primary access vessel may be causative and should be minimized.

The 5-Item Modified Frailty Index (mFI-5) for risk stratification of patients with infective endocarditis undergoing cardiac surgery

Abstract Background population aging has led to an increased burden of frailty as an emerging global health issue, and variables for its quantification in patients with infective endocarditis (IE) are lacking in current surgical risks scores. The 5-item modified frailty index (mFI-5) score has shown to be effective in the prediction of surgical outcomes in other medical scenarios. Purpose this study aimed to assess the role of the mFI-5 in the prediction of surgical outcomes in patients with left-sided IE undergoing cardiac surgery. Methods a total of 112 cases of confirmed left-sided IE undergoing surgery, were consecutively collected and followed during one year after diagnosis in two tertiary hospitals between 2016 and 2021. The mFI-5 score included 5 baseline patient-specific comorbidities: diabetes, congestive heart failure, non-independent functional status (Barthel index <80), hypertension and chronic obstructive pulmonary disease (range 0-5), and patients were categorised as mFI-low (<2, n=65), and mFI-high (>=2, n=47). Results mean age was 66 [SD 15] years, 67% were men and community-acquired infections were 75%. As shown in Table 1, mFI-high patients were older and, aside from the specific comorbidities included in the score, with more chronic kidney disease. The most isolated pathogen was S. viridans (n=32), predominantly in mFI-low, in contrast to enterococcal and polymicrobial IEs, which were more frequent in mFI-high. Larger vegetations were reported in mFI-high [16 (10) vs 13 (9) mm, p 0.03], with no differences regarding infection site or periannular complications. Acute kidney injury, decompensated heart failure and higher natriuretic peptides were more common in mFI-high. Regarding mortality, in-hospital deaths were more frequent in mFI-high group. When analyzing mFI-score as a discrete variable, in-hospital mortality was associated with higher median scores values [2 (2) vs 1(1) points, p 0.02], being 2 points the optimal cutoff point for prediction [AUC 0.64 (95% CI 0.54-0.73), Fig.1A]. Among survivors who completed follow-up (n=82), rehospitalization and all-cause mortality rates in mFI-high exceeded those from mFI-low. Predictors of in-hospital and 1-year mortality were assessed by logistic regression (Fig. 1B), confirming the independent prognostic association of mFI-5-score in patients with IE undergoing surgery. Conclusions patients with IE undergoing cardiac surgery with higher mFI-5 scores were older, more predisposed to enterococcal and polymicrobial infections, and had a greater comorbidity burden with a more complicated clinical course. The mFI-score was independently associated with in-hospital mortality as well as rehospitalizations and 1-year mortality, positioning itself as an additional tool for risk stratification in this cluster of patients.Table 1Figure 1

The association between dietary flavonoid intake and frailty risk among middle-aged and elderly US adults: A nationally representative study

Given the global ageing population, exploring potential dietary prevention strategies to reduce the public health burden of frailty is critically important. Dietary flavonoids offer multiple health benefits; however, there is a scarcity of research evidence regarding their association with the risk of frailty in middle-aged and older adults. This study aimed to assess the association between dietary flavonoid intake and frailty risk among middle-aged and older U.S. adults and to analyse the potential roles of different flavonoid subclasses. This study involved 9063 participants aged ≥40 years. Frailty was evaluated using a frailty index, and flavonoid intake was estimated through two 24-h dietary recalls. Analyses were carried out via multivariable logistic regression, restricted cubic spline models, weighted quantile sum regression, and quantile g-computation models. Additionally, subgroup analyses and interaction tests were conducted for age and gender. The results indicated that higher intakes of total flavonoids and subclasses (anthocyanidins, flavan-3-ols, flavanones, flavones, flavonols) were significantly associated with a lower prevalence of frailty, but isoflavone intake was not associated with frailty. A nonlinear, L-shaped dose-response relationship was observed between total flavonoids and frailty risk. Flavonols and flavanones were identified as the main contributors to the overall effect. Age influenced the association between dietary flavonoids and frailty, with middle-aged adults benefiting more than older adults. This study provides new evidence supporting an inverse association between dietary flavonoid intake and frailty risk, especially for foods rich in flavonols and flavanones.

Frailty, age, and treatment effect of surgical coronary revascularization in ischemic cardiomyopathy: a post hoc analysis of the STICHES trial.

Frailty is common among older patients with heart failure (HF). The efficacy of coronary artery bypass grafting (CABG) on the risk of mortality amongfrailpatients with ischemic cardiomyopathy and HF is uncertain, and whether frailty burden modifies the treatment benefits of CABG among these patients is unknown. We performed a post hoc analysis of the STICHES trial, a randomized trial of CABG with medical therapy vs medical therapy alone among participants with ischemic cardiomyopathy with ejection fraction ≤ 35%. Baseline frailty was assessed through a Rockwood Frailty Index (FI), and based on FI cut-offs from prior HF studies, participants with FI ≥ 0.311 were classified as more frail, and those with FI < 0.311 were classified as less frail. A multivariable Cox proportional hazard model with multiplicative interaction terms was constructed to evaluate whether frailty status modified the treatment effect of CABG on mortalityin the overall trial cohort and among those < 60 vs ≥ 60 years of age. Of 1187 participants (12.4% female, 2.6% Black, median FI = 0.33 [IQR 0.27-0.39]), 678 were characterized as more frail. Frailty burden did not modify the efficacy of CABG on the risk of all-cause death in the overall cohort (Pint CABG × frailty = 0.2). In age stratified analysis,Baseline frailty status did not modify the treatment effect of CABG on the risk of all-cause mortality among younger (< 60years, Pint CABG × frailty = 0.2) as well as older participants (≥60years, Pint CABG × frailty = 0.6). In this post hoc analysis of the STICHES trial, baseline frailty status did not modify the efficacy of CABG in the overall cohort as well asamong younger or older participants. Frailty alone should not be used as a criterion to determine the utilization of CABG among patients with ischemic cardiomyopathy.

Early geriatric assessment and management in older patients with Clostridioides difficile infection in Denmark (CLODIfrail): a randomised trial

Clostridioides difficile infection causes diarrhoea and colitis. Older patients with Cdifficile infection are often frail and have comorbidities, leading to high mortality rates. The frailty burden in older people might restrict access to treatments, such as Cdifficile infection-specific antibiotics and faecal microbiota transplantation. We aimed to investigate the clinical effects of early comprehensive geriatric assessment (CGA) and frailty evaluation, including home visits and assessment for faecal microbiota transplantation, in older patients with Cdifficile infection. In this randomised, quality improvement trial with a pragmatic design, patients from the Central Denmark Region aged 70years or older with a positive PCR test for Cdifficile toxin were randomly assigned (1:1) to CGA or standard care, both with equal access to faecal microbiota transplantation. Patients and investigators were unmasked to treatment. The primary outcome was 90-day mortality, and was compared in the study groups according to the intention-to-treat principle. The study is registered with ClinicalTrials.gov, NCT05447533. Between Sept 1, 2022, and May 3, 2023, we randomly assigned 217patients to CGA (n=109) or standard care (n=108). The median patient age was 78years (IQR 74-84). 116 (53%) of 217patients were female and 101 (47%) were male. 16 (15%; 95% CI 9-23) of 109patients in the CGA group and 22 (20%; 14-29) of 108patients in the standard-care group died within 90days (odds ratio 0·66, 95% CI 0·32-1·38. No serious adverse events or deaths related to patient assessment or faecal microbiota transplantation were recorded in either group. Deaths directly attributable to Cdifficile infection were lower in the CGA group (seven [44%] of 16deaths vs 18 [82%] of 22deaths in the standard-care group; p=0·020). Older patients who received CGA had a 90-day mortality rate similar to that of patients who received standard care, but with fewer deaths directly attributable to Cdifficile infection. Innovation Fund Denmark, Novo Nordisk Foundation, and Helsefonden.

Understanding the Role of Oxidative Stress in Platelet Alterations and Thrombosis Risk among Frail Older Adults.

Frailty and cardiovascular diseases are increasingly prevalent in aging populations, sharing common pathological mechanisms, such as oxidative stress. The evidence shows that these factors predispose frail individuals to cardiovascular diseases but also increase the risk of thrombosis. Considering this background, this review aims to explore advances regarding the relationship between oxidative stress, platelet alterations, and cardiovascular diseases in frailty, examining the role of reactive oxygen species overproduction in platelet activation and thrombosis. The current evidence shows a bidirectional relationship between frailty and cardiovascular diseases, emphasizing how frailty not only predisposes individuals to cardiovascular diseases but also accelerates disease progression through oxidative damage and increased platelet function. Thus, oxidative stress is the central axis in the increase in platelet activation and secretion and the inadequate response to acetylsalicylic acid observed in frail people by mitochondrial mechanisms. Also, key biomarkers of oxidative stress, such as isoprostanes and derivate reactive oxygen metabolites, can be optimal predictors of cardiovascular risk and potential targets for therapeutic intervention. The potential of antioxidant therapies in mitigating oxidative stress and improving cardiovascular clinical outcomes such as platelet function is promising in frailty, although further research is necessary to establish the efficacy of these therapies. Understanding these mechanisms could prove essential in improving the health and quality of life of an aging population faced with the dual burden of frailty and cardiovascular diseases.

Economic burden of frailty in older adults accessing community-based aged care services in Australia.

To explore the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality for frail compared with non-frail individuals following their first assessment by an aged care assessment team (ACAT) for a government-funded home care package. The study involved people aged 65 years and over who completed their first ACAT assessment in 2013 and were followed for up to 36 months. Frail and non-frail study participants were matched through caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression estimated the impact of frailty on PRAC admission and mortality rates. Healthcare costs, encompassing hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use, from ACAT assessment to end of follow-up, PRAC entry or death were summarized monthly by frailty status. 13 315 non-frail controls were matched with up to three frail individuals (52 678 total). Frail individuals experienced higher mortality (incidence rate ratio [IRR] = 1.76; 95% confidence interval [CI] 1.70-1.83) and greater likelihood of entering PRAC (IRR = 1.73; 95% CI 1.67-1.79) compared with non-frail individuals. Total healthcare costs over the 3-year post-assessment period for 39 363 frail individuals were $1 277 659 900, compared with expected costs of $885 322 522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual (mean = $457, SD = 3192) was hospital admissions ($345; 75%). Frailty is associated with higher rates of mortality and of entering PRAC, and excess costs of frailty are substantial and sustained over time. These findings emphasize the potential economic value of providing home care for older people before they become frail. Geriatr Gerontol Int 2024; ••: ••-••.

Use of chronic care management service among Medicare beneficiaries in 2015-2019.

The Centers for Medicare and Medicaid Services (CMS) introduced chronic care management (CCM) services in 2015 for patients with multiple chronic diseases. Few studies examine the utilization of CCM services by geographic region, sociodemographic, and clinical characteristics. We used 2014-2019 Medicare claims data from a 5% random sample of fee-for-service beneficiaries aged 65 years or over. We included beneficiaries potentially eligible for CCM services because they had multiple chronic conditions (1,073,729 in 2015 and 1,130,523 in 2019). We calculated the proportion of potentially eligible beneficiaries receiving CCM service each year for the total population and by geographic region, sociodemographic, and clinical characteristics. The proportion of beneficiaries with two or more chronic conditions receiving CCM services increased from 1.1% in 2015 to 3.4% in 2019. The increase in CCM use was higher in the southern region, among dually eligible beneficiaries and beneficiaries with a greater burden of chronic conditions (2-5 conditions vs ≥10 conditions: 0.7% vs 2.0% in 2015; 2.1% vs 7.0% in 2019) and frailty (robust vs severely frail: 0.6% vs 3.3% in 2015; 1.9% vs 9.4% in 2019). Nearly one out of five recipients did not continue CCM service after the initial service. We found that CCM service is being used by a very small fraction of eligible patients. Barriers and facilitators to more effective CCM adoption should be identified and incorporated into strategies that encourage more widespread use of this Medicare benefit.

#2838 Dialysis regret is associated with level of information about health status but not with frailty

Abstract Background and Aims Elderly patients (&amp;gt;75 years of age) are the fastest growing group on dialysis with a high burden of multi-morbidity, functional dependence and frailty. Treatment decisions about End-Stage Renal Disease (ESRD) in this group are complex and quality of life, development of functional status and independence are often given higher priority than prolongation of life. Studies from the U.S., Canada and the Netherlands have shown varying degrees of dialysis regret (7–61%) [1–3]. As frailty is common among patients on dialysis and associated with poor clinical outcomes, the aim of this study was to determine the prevalence of regret in having started dialysis and associated risk factors. Method This cross-sectional, multicenter, prospective study in southern Germany included 123 adult patients on maintenance dialysis. Dialysis regret was assessed by a single question as part of a 6-item questionnaire. Frailty status was assessed based on modified Fried criteria and by self-assessment using a 5-point visual analogue scale (VAS). Statistical analysis was performed using Fisher's exact test and Chi-square test. Results The median age was 68 years, 71% were male, 40% of the participants were considered frail using the Fried criteria. Only 7/123 (5.7%) patients reported regretting the decision to have started dialysis (Table 1). 85% of patients reported sufficient information about their own health status. We found a significant correlation between the level of information regarding own health status and dialysis regret. There was no correlation of dialysis regret with age, sex, frailty or dialysis vintage. Even though frailty status was not correlated with dialysis regret, frail patients were significantly less informed about their own health status. Of note, 82% of patients reported that the decision to initiate dialysis was driven mainly by the health care team or their family (Fig. 1). The main reasons for starting dialysis were prolongation of life and the feeling of having no other choice (Fig. 2). Conclusion Dialysis regret was uncommon in our cohort of elderly dialysis patients and was associated with the level of information about health status but not with age, sex, frailty status, comorbid conditions or dialysis vintage. This underscores the importance of patient-education and the process of shared-decision making.

Physical activity to reduce the burden of frailty after menopause: effectiveness and adherence rate of a resource saving exercise plan.

Frailty may be increased by menopause. Physical activity has been proposed to reduce frailty, but poor adherence and cost limit effectiveness. We aimed to investigate both the effectiveness against the frailty burden and the adherence rate of a multicomponent physical activity scheme partially managed by the participating women themselves. Prospective controlled study consisting of a twice-weekly group physical activity scheme divided into two consecutive periods, one supervised by a health professional (12 wk) and the other supervised by the women themselves (36 wk). Group cohesion and mutual support during the patient-only period were aided by social networking via smartphones. Community-dwelling postmenopausal women were divided into a physical activity group (PAG = 126) and a usual activity control group (UAG = 126), both assessed at baseline and at the end of the study. Participants self-assigned to one of the two study arms. Overall, women in the PAG were more likely to improve their frailty status (60.2% vs 42.6%, P < 0.05). The frailty reversal rate from prefrail to robust was significantly higher in the PAG than in the UAG (34.04 vs 8.00%, P < 0.05). Logistic regression confirmed that women in the PAG were more likely to improve their frailty phenotype (odds ratio [OR], 9.12; 95% confidence interval [CI], 3.45-31.52; P < 0.001). Adherence, defined by participants attending 75% of sessions, was attained by 56.35% of women at 48 wk. A physical activity scheme implemented to improve frailty proved effective and attained acceptable adherence. Conditions in the peer-supervised 36-wk phase may increase sustainability.

The double burden of hypertension and frailty in the aging population: Does lowering blood pressure improve outcomes?

The double burden of hypertension and frailty in the aging population: Does lowering blood pressure improve outcomes?

Burden of frailty and its correlates among the elderly: a cross-sectional study in a rural community of West Bengal.

With the ageing of Indian society, providing a healthy life among older people is a public health precedence. Therefore, beforehand discovery and possible forestalment of frailty may help promote healthy ageing and dwindle the social, mental and financial burden of their families and caregivers. The study aimed to assess the proportion of frailty and its associated factors among the elderly aged 65 years and above in a rural community of West Bengal. A community-based cross-sectional study was conducted among 270 elderlies selected from 15 villages out of a total 64 villages of Singur under the Hooghly District of West Bengal from January 2019 to February 2020. Cluster sampling technique was used. Data was collected using a pre-designed, pre-tested structured schedule including Fried frailty phenotype (FFP), geriatric depression scale short form (GDS 15) and mini nutritional assessment (MNA) tool. Associated factors of frailty were assessed by univariate and multivariable logistic regression using SPSS version 16 software and MS Excel 2019. The proportion of frailty was observed to be 23.7% and that of prefrailty 40.7%. Frailty was significantly associated with increasing age [AOR(CI) 1.2(1.1-1.3)], decreasing years of schooling [AOR(CI) 1.3(1.1-1.5)], loss of spouse [AOR(CI) 4.2(1.2-15.2)], financial dependency [AOR(CI) 19.3(2.7-139.0)], staying at home [AOR(CI) 16.3(2.7-98.2)], presence of anaemia [AOR(CI) 3.6(1.3-9.5)], at risk of malnutrition [AOR(CI) 6.5(1.9-22.3)], increasing number of falls in the last 1 year [AOR(CI) 4.3(1.2-15.6)], presence of 3 or more chronic diseases [AOR(CI) 154.7(12.1-1981.9)] and depression [AOR(CI) 8.3(2.5-27.0)]. The burden of frailty among the study population is relatively high. It's an intimidating situation that needs bettered screening provisions for early discovery with special stress on nutritive upliftment. Screening for depression should also be done regularly.

D-41 | Assessing the Burden of Frailty in Chronic Total Occlusion Interventions: In-Hospital Mortality and Readmission Outcomes Post-PCI

D-41 | Assessing the Burden of Frailty in Chronic Total Occlusion Interventions: In-Hospital Mortality and Readmission Outcomes Post-PCI

Assessment indexes of cognitive status, anxiety and depression in senior women with diff erent severity of frailty

Frailty is a key geriatric syndrome characterized by an age-associated diminution of the physiological reserve and functions of many body systems leading to increased vulnerability of the elderly people to the eff ects of endo- and exogenous factors. The combination of frailty, cognitive impairment, anxiety and depression is a signifi cant clinical predictor for an unfavorable prognosis.Purpose. Identifi cation and study of the relationship of cognitive impairment, anxiety, depression and frailty assessment indexes in female patients over 60 years old, observed on an outpatient basis.Material and methods. The study included 80 women over 60 years old. All participants were divided into 4 groups: non-frail (10 women), pre-frail (44 women), mildly frail (20 women), more-frail (6 women). A comprehensive clinical examination was carried out: Montreal cognitive assessment (MoCA), Mini-Mental State Examination (MMSE), frontal assessment battery (FAB), phonetic association test, semantic association test, Beck anxiety inventory, geriatric depression scale–15 (GDS-15), questionnaire “Age is no barrier”, Frailty index (FI, Hoover et al., 2013).Results. All women in 4 groups did not signifi cantly diff er in age. There was no statistically signifi cant diff erence in the MMSE, FAB data and mild cognitive impairment (MCI) prevalence among the groups. Lower rates of MoCA scale were associated with higher probability of frailty (odds ratio (OR) = 0.78; 95 confi dence interval (CI) CI: 0.63–0.96, p = 0.016). The cut-off level of 26 and lower according MoCA has sensitivity 69% and specifi city 50% to detect of high frailty risk (according FI). Questionnaire “Age is no barrier” has a sensitivity of 86% and a specifi city of 53% to detect prefrailty (score 1–2) and a sensitivity of 69% and a specifi city of 87% to detect the presence of frailty (score ≥ 3) regarding FI. Combined sensitivity of MoCA (≤ 26 score) and questionnaire “Age is no barrier” (≥ 3 score) of 78%, combined specifi city of 69%. Higher rates of Beck anxiety inventory and GDS-15 were associated with frailty (OR = 1.12; 95 CI: 1.02–1.22, p = 0.0134 and OR = 1.39; 95 CI: 1.05–1.84, p = 0.0201, respectively). A higher index of the Beck anxiety inventory was also associated with mild cognitive impairment according MoCA (OR = 1.12; 95% CI: 1.04–1.2, p = 0.003). Arterial hypertension was signifi cantly more common for women with FS (χ2 = 4.23, p = 0.04).Conclusion. There was no signifi cant association between MMSE, FAB, MCI prevalence and the severity of frailty in senior women due to the insuffi cient study power (&lt; 80%). MoCA cut-off ≤ 26 score is associated with higher burden of frailty. The questionnaire «Age is no barrier» is an acceptable screening method for determining the necessity of additional geriatric examination of independently living women over 60 years old. Higher rates of the Beck anxiety inventory, GDS-15, BMI, lower rates of MoCA scale and arterial hypertension are associated with high rates of FS and may be predictors for the frailty progression.

Effect of pre-morbid frailty status on in hospital mortality in critically ill patients.

Objective: To determine the pre-morbid frailty and its association with in-hospital mortality among critically ill patients admitted in intensive care unit (ICU) of a tertiary care hospital. Study Design: Cross-sectional study. Setting: ICU of Sindh Institute of Urology and Transplantation, Karachi, Pakistan. Period: December 2022 to July 2023. Material &amp; Methods: Patients of age 18 years or older, admitted to the ICU were included. Frailty was defined as per Clinical Frailty Scale (CFS). Detailed history was taken to assess frailty status two weeks prior to hospital admission. Patients were classified as pre-morbid frail if their score was higher than 4. Results: Total 151 patients were analyzed with median age of 47 (IQR= 33-59) years. There were 106 (70.2%) male patients, whereas and 92 (60.9%) were having comorbidities. Median CFS score was 4 (IQR=3-5). Out of 151 patients admitted to ICU, 56 (37.1%) had frail. Odds of frailty were increasing with increasing age and among those who had comorbidity. Mechanical ventilation (MV) days (p=0.234), hemodynamic support days (p=0.216) and LOS (p=0.903) were not significantly different among frail and non-frail patients. Nearly half of the patients had died (49%). Mortality was noted in 74 (49.0%) patients. Need of MV, hemodynamic support, APACHEII and SOFA score were associated with mortality (p&lt;0.05). Conclusion: There was considerable burden of frailty among critically ill patients admitted in ICU. However, in-hospital outcomes including mechanical ventilation, hemodynamic support and mortality were not associated with frailty status.

The association of degree of polypharmacy before and after among hospitalised internal medicine patients and clinical outcomes: a retrospective, population-based cohort study

ObjectivesTo determine the prevalence and incidence of polypharmacy/hyperpolypharmacy and which medications are most prescribed to patients with varying burden of polypharmacy.DesignRetrospective, population-based cohort study.SettingIceland.ParticipantsIncluding patients (≥18 years) admitted to internal...

Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania

BackgroundPopulations are ageing globally and Low- and Middle-Income Countries (LMICs) are experiencing the fastest rates of demographic change. Few studies have explored the burden of frailty amongst older people in hospital in LMICs, where healthcare services are having to rapidly adapt to align with the needs of older people. This study aimed to measure the prevalence of frailty amongst older people admitted to hospital in Tanzania and to explore their demographic and clinical characteristics.MethodsThis study had a prospective observational design. Over a six-month period, all adults ≥ 60 years old admitted to medical wards in four hospitals in northern Tanzania were invited to participate. They were screened for frailty using the Clinical Frailty Scale (CFS) and the Frailty Phenotype (FP). Demographic and clinical characteristics of interest were recorded in a structured questionnaire. These included the Barthel Index, the Identification of Elderly Africans Instrumental Activities of Daily Living (IADEA-IADL) and Cognitive (IDEA-Cog) screens, the EURO-D depression scale and Confusion Assessment Method.Results540 adults aged ≥ 60 were admitted, and 308 completed assessment. Frailty was present in 66.6% using the CFS and participants with frailty were significantly older, with lower levels of education and literacy, greater disability, greater comorbidity, poorer cognition and higher levels of delirium. Using the FP, 57.0% of participants were classed as frail though a majority of participants (n = 159, 51.6%) could not be classified due to a high proportion of missing data.ConclusionsThis study indicates that the prevalence of frailty on medical wards in northern Tanzania is high according to the CFS. However, the challenges in operationalising the FP in this setting highlight the need for future work to adapt frailty screening tools for an African context. Future investigations should also seek to correlate frailty status with long-term clinical outcomes after admission in this setting.

The “Get Moving Trial”: A phase I/II RCT of home-based (P)rehabilitation ((P)REHAB) with ExerciseRx in muscle-invasive bladder cancer (MIBC)—Study protocol for a randomized controlled trial.

TPS706 Background: Patients with MIBC often have a high burden of frailty, sarcopenia, mobility impairment, and multimorbidity, each of which is associated with reduced treatment tolerability. Prehabilitation programs are designed to improve functional capability prior to treatment to mitigate functional decline and optimize outcomes. Barriers to widespread adoption include cost, time, intensity of in-person interventions, and overly restrictive inclusion criteria which would exclude most patients with MIBC. Here, we describe a randomized controlled trial to evaluate the feasibility, usability, and impact of a pragmatic (P)REHAB exercise intervention delivered via the ExerciseRx app in participants with MIBC undergoing neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). The primary objectives are to evaluate the (P)REHAB intervention vs. standard care (SC) to quantify the efficacy of the intervention to 1) improve or maintain physical function in patients with MIBC undergoing NAC followed by RC, and 2) globally characterize the impact of the (P)REHAB intervention with respect to patient-reported feasibility and acceptability, health-related quality of life, body-composition, frailty, treatment-associated and clinical outcomes. Methods: We will recruit and randomize 102 patients in a 1:1 ratio to the (P)REHAB or SC arms. The (P)REHAB arm will be prescribed a personalized, home exercise program (~20-minutes, 4x weekly) via the ExerciseRx app, during NAC, prior to RC and for 90-days post-RC as well as graded progression in step count. SC participants will receive printed guideline-based recommendations for physical activity during standard perioperative care. ExerciseRx comprises of 1) a provider dashboard integrated into the electronic health record for prescribing exercises and monitoring patient progress, and 2) a patient app, that administers exercise plans and tracks exercise repetitions using sensors in commodity smart devices. Step count in the (P)REHAB and SC arm will be tracked with Fitbit trackers. In the (P)REHAB arm, step count data from the Fitbit will be reviewable in the ExerciseRx provider dashboard and patient app. Eligibility criteria: English-speaking adults (&gt;18 years) with AJCC pT2-4 N0-1 M0 MIBC planning to undergo NAC followed by RC who are willing and able to participate in the trial. Primary outcome: Change in the Short Physical Performance Battery. Secondary outcomes: FitBit-assessed step count and sedentary time, ExerciseRx adherence and usability, patient-reported quality of life (EORTC-QLQ-C30, -BLM30), change in body composition (fat-mass, fat-free mass), frailty (Cancer and Aging Resilience Evaluation), treatment-associated adverse events between baseline and following NAC, and 3 months following RC. Trial enrollment will commence 10/2023. Clinical trial information: NCT06040762 .

The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications.

Frailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on health utilization, use of HF-related medications and adverse clinical outcomes (all-cause mortality, all-cause readmissions and HF readmissions) among older HF patients. A total of 38843 newly admitted HF patients were identified from Taiwan's National Health Insurance Research Database and categorized into three frailty subgroups (fit, mild frailty and severe frailty) based on the multimorbidity frailty index. Cox regression models and Fine and Gray subdistribution hazard models were used to estimate the impacts of frailty on clinical outcomes at 1 and 2years of follow-up. Generalized estimating equation models were further conducted to evaluate the associations between longitudinal and time-varying use of HF-related medications and clinical outcomes among distinct frailty subgroups. Of 38843 older HF patients (mean age 80.4±8.5years, 52.3% females) identified, 68.3% were categorized as frail (47.5% of mild frailty and 20.8% of severe frailty). The median number of readmissions (fit: 1 [inter-quartile range-IQR 2], mild frailty: 1 [IQR 2] and severe frailty: 2 [IQR 3]) increased with the severity of frailty. Only 27.3% of HF patients died of cardiovascular diseases regardless of their frailty status. Compared with the fit group, the severe frailty group was associated with increased risk of all-cause mortality (adjusted hazard ratio 1.16, 95% confidence interval [CI] 1.11-1.21), all-cause readmissions (subdistributional hazard ratio (sHR) 1.21, 95% CI 1.16-1.25) and HF-related readmissions (sHR 1.14, 95% CI 1.09-1.20) at 2years of follow-up. Those who used triple or more HF-related medications were at lower risk for all-cause readmissions (adjusted odds ratio [aOR] 0.49, 95% CI 0.44-0.54) and HF-related readmissions (aOR 0.42, 95% CI 0.37-0.47) at 2years of follow-up even in the severe frailty group. Frailty is highly prevalent and associated with increased risk of all-cause mortality, all-cause readmissions and HF readmissions among older HF patients. Those who were using triple or more HF-related medications were at lower risk of adverse clinical outcomes across distinct frailty subgroups. Further studies are needed to optimize the treatment strategies for older HF patients with distinct frailty status.