Canadian Study Of Health And Aging Research Articles

Abstract 18211: Does Frailty Matter in High Risk PCI

Background: There are limited data depicting the relationship between frailty and in-hospital outcomes for high-risk PCI. Methods: The Cath-PCI registry (2018 - 2020) was used to examine the association of frailty as defined by the Canadian Study of Health and Aging (CSHA) frailty index and in-hospital complications for patients undergoing PCI. We conducted a logistic regression analysis for in-hospital mortality. Results: The sample size was 1,316,390 individuals aged ≥ 65 years undergoing PCI. The frailty distribution was: 78,921 not frail (6.0%), 892,695 pre-frail (67.8%), 284,444 frail (21.6%), and 60,330 severely frail (2.2%). The median age of patients who were frail was 76 years, 39.4% were female, and 87.2% were white. In-hospital rates for any bleeding stratified by frailty status were: not frail: 1.0%, pre-frail: 1.5%, frail 3.3%, severely frail 8.9%. The adjusted odds ratio (aOR) regarding in-hospital mortality among PCI patients at high bedside mortality risk for pre-frail, 2.58 (95% CI: 1.42 - 1.80) for frail, and 5.14 (95% CI: 4.56 - 5.80) for severely frail. The adjusted association for in-hospital mortality across sub-groups stratified by frailty status was: left main PCI ~ pre-frail aOR 1.44 (95% CI: 1.01 - 2.05), frail aOR 2.18 (95% CI: 1.53 - 3.11) and severely frail aOR 3.98 (95% CI: 2.79 - 5.70). While the aORs for chronic total occlusion were ~ pre-frail 1.57 (95% CI: 0.97 - 2.52), frail 2.31 (95% CI: 1.43 - 3.75) and severely frail 6.04 (5.40 - 6.75) and cardiogenic shock ~ pre-frail 1.33 (95% CI: 1.08 - 1.64), frail 1.54 (95% CI: 1.25 - 1.90) and severely frail 2.44 (1.99 - 3.00). Conclusions: Contemporary PCI is commonly performed on frail patients. Frailty is associated with higher risk of mortality across high-risk PCI categories; however, severe frailty depicts a distinct and exceptionally high-risk cohort.

Prediction of cognitive status and 5‐year survival for elderly with diabetes by using the Neurocognitive Frailty Index (NFI)

AbstractBackgroundType 2 diabetes mellitus has been shown to be associated to cognitive decline and an increased risk of mild cognitive impairment and dementia in elderly persons (Biessels et al., 2014). The aim of this research was to determine whether the Neurocognitive Frailty Index (NFI, Pakzad et al., 2017) could help to predict cognitive changes in elderly people with diabetes.MethodParticipants in this study were drawn from waves 1 (1991 to 1992) and 2 (1996 to 1997) of the Canadian Study of Health and Aging (CSHA) for prediction of 5‐year cognitive changes in those who received a consensus diagnosis of no cognitive impairment (NCI) or cognitive impairment but not dementia (CIND) in wave 1 (n = 997). The CIND category was contained to individuals whose level of cognitive impairment was measured to be greater than the NCI group but less than the dementia group. NFI was defined as a combined score of 41 physical and mental components (in 8 cognitive domains) as they were available in the dataset (NFI has 42 components but we withdraw diabetes). Cognitive score (measured by 3MS) at follow‐up, and mortality were outcome.ResultMean NFI and standard deviation was 9.7±6.22 in people without diabetes, 11.71±5.42 in people with diabetes and 9.36±5.30 in people with diabetes but are using treatment. Multiple linear regression indicated that NFI score is significantly associated to cognitive status (3MS at follow‐up, p<0.05), however, diabetes did not show any significant association to predict this outcome. CHAID decision tree analysis stratified NFI scores into five categories, while proportional hazards analysis adjusted for age, gender and education indicated that NFI was more correlated to survival than age and had a dose‐response effect in relation to survival. Those with diabetes had a higher probability of death compared to those without (p<0.05).ConclusionNFI was significantly associated with cognitive changes for the elderly in those with and without diabetes. Given that the NFI is proving to be a valuable tool to assess the risk of developing dementia, further investigation is needed to clarify which modifiable risk factors may help reduce the risk of cognitive decline.

The role of frailty score in early surgical treatment of elderly cholecystitis patients

Objectives: The average life expectancy is increasing all over the world, and as a result, the number of elderly patients is increasing. Acute cholecystitis is one of the most common diseases requiring emergency surgical treatment in the elderly. In the literature, it has been reported that in the treatment of elderly patients with acute cholecystitis, physicians do not fully comply with the current literature recommendations due to some concerns and do not apply surgical treatment in the early period. The concept of frailty, which has come to the fore in geriatric assessment today, provides objective information about the general health status of the patient. In our study, the role of frailty assessment in the decision made regarding the early surgery in elderly patients with acute cholecystitis treated in our hospital was investigated. Methods: In our study, the clinical features, comorbidities, American Society of Anesthesiologists (ASA) scores, Canadian Study of Health and Aging (CSHA) frailty scale, treatment modalities and prognosis of patients over the age of 65 who were treated with the diagnosis of acute cholecystitis between January 2018 and January 2021 were evaluated retrospectively. Results: Of the 182 patients included in the study, 24 (13.2%) were found to be frail. It was observed that the mean age and multi-morbidity were higher in the frail group (p < 0.001). It was observed that the mean C-reactive protein and leukocyte values, which are inflammatory mediators, increased in both groups, both fragile and non-fragile, and complicated cholecystitis accompanied by cholangitis or pancreatitis was observed in a total of 64 (35.16%) patients. There were 57 (31.3%) patients using anticoagulant or antiaggregant agents. The patients were most frequently treated with medical treatment (n = 108; 59.3%), the other treatment methods were early surgery ( (n = 46; 25.3%), endoscopic retrograde cholangiopancreatography (n = 22; 12.1%) and percutaneous cholecystostomy (n = 11; 6.0%). Surgical treatment was more common in ASA I and II patients, and percutaneous cholecystostomy was more common in frail patients (p < 0.001). There were 20 (14.70%) patients who were re-admitted to the hospital and 6 (3.29%) patients ended up with mortality. No statistical relationship could be demonstrated between these conditions and frailty (p > 0.05). Conclusions: In the treatment of the elderly cholecystitis patients, early surgical treatment is the most favorable treatment method in order to reduce re-admission and prevent possible complications. However, we think that a detailed geriatric evaluation should be made in a multidisciplinary manner for the decision making regarding the of surgical treatment of elderly patients, and frailty evaluation should also be made in this context.

Assessing Frailty Risk in Clinical Practice

Assessing Frailty Risk in Clinical Practice

MP31-10 SYSTEMATIC REVIEW AND META-ANALYSIS OF FRAILTY INDICES IN UROLOGIC SURGERY: RISK PREDICTION OF POSTOPERATIVE COMPLICATIONS

You have accessJournal of UrologyCME1 May 2022MP31-10 SYSTEMATIC REVIEW AND META-ANALYSIS OF FRAILTY INDICES IN UROLOGIC SURGERY: RISK PREDICTION OF POSTOPERATIVE COMPLICATIONS Jane Kurtzman, Preston Kerr, Rashed Kosber, and Steven Brandes Jane KurtzmanJane Kurtzman More articles by this author , Preston KerrPreston Kerr More articles by this author , Rashed KosberRashed Kosber More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002580.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Contemporary surgical planning rarely involves formally assessing patient frailty, especially among urology (GU) patients. Our aim was to systematically review the literature to assess the ability of frailty indices to predict the risk of postoperative complications after GU surgery. METHODS: We systematically reviewed EMBASE, PubMed and SCOPUS according to PRISMA criteria in June 2021. Studies that utilized a validated frailty index (FI) to assess risk of major postoperative complication (Clavien-Dindo ≥3), following GU surgery were eligible for inclusion. Charlson Comorbity Index and Eastern Cooperative Oncology Group were not considered FIs. Administrative studies, those without odds ratios (OR) and/or raw data were excluded. The pooled effect size was calculated as OR and corresponding 95% CI through a random effect model using inverse variance weighing. RESULTS: Of 1,265 unique articles initially identified, 9 studies - from 6 different countries, published from 2019-2021, were eligible for inclusion (4 prospective; 5 retrospective). 8/9 studies assessed only GU oncologic surgery. The Modified Frailty Index (mFI) was the most commonly used index (n=3), followed by the Fried Phenotype Criteria (n=2), the Canadian Study of Health and Aging (CSHA) Index (n=2) and the Rockwood Frailty Index (n=2). Data from a total of 2,153 patients was included. Based on pooled OR from both univariable and multivariable analyses, frailty was associated with a significantly higher odds of postoperative complication at 30 days (OR 2.7, 95% CI: 1.8-4.0, p <0.001 and OR 2.1, 95% CI: 1.5-3.0, p <0.001, Fig 1A-B), but may not be at 90 days (OR 2.0, p=0.11 and OR 1.6, p=0.35, Fig 1C-D). Stratified by FI, higher Rockwood and CSHA scores were associated with an increased odds of 30 d complication (OR 1.8, p <0.001 and OR 2.6, p=0.002), but mFI ≥2 was not (OR 5.0, p=0.11). CONCLUSIONS: Frailty indices are a relatively new addition to the urologist’s toolkit. Preoperative assessment of frailty can help predict risk of early (30 d) major postoperative complications but may be less useful for later complications, though significant additional studies are needed. Further work is also needed to evaluate the impact of frailty on non-oncologic urology patients who undergo major GU surgery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e525 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Preston Kerr More articles by this author Rashed Kosber More articles by this author Steven Brandes More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of frailty on early and mid-term outcomes of hybrid aortic arch repair.

The purpose of this study was to investigate the impact of frailty on the clinical outcomes of hybrid aortic arch repair with debranching of the supra-aortic arteries. Consecutive patients ≥ 75years old who underwent hybrid aortic arch repair from January 2010 to December 2019 were retrospectively analyzed. Using the Canadian Study of Health and Aging (CSHA) scale, all patients with a CSHA scale score > 4 were defined as frail. The frail patients (FP) group and the non-frail patients (NFP) group were compared regarding the early and mid-term outcomes of hybrid aortic arch repair. A total of 84 patients were included. The early postoperative results were not markedly different between the groups, except that the rate of transfer to a rehabilitation hospital was higher in the FP group than in the NFP group. The survival at 5years was significantly lower in the FP group at 43.0% than in the NFP group at 67.7% (P = 0.015). However, the freedom from aorta-related death was not significantly different between the two groups. Frailty did not affect the short-term outcomes of hybrid aortic arch repair; however, the mid-term outcomes, including the survival, of the frail patients were significantly worse than those of the non-frail patients, mostly because of non-aorta-related causes.

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.

A 10-item frailty index based on a comprehensive geriatric assessment (FI-CGA-10) in older adults with cancer: Development and construct validation.

e24011 Background: A frailty index based on domain-level deficits in a comprehensive geriatric assessment (FI-CGA) has been previously developed and validated in general geriatric patients (Jones D, Aging Clin Exp Res 2005). Our objectives were to construct an FI-CGA and to assess its construct validity in geriatric oncology setting. Methods: Consecutive older adults with cancer who underwent a CGA on a geriatric oncology service were included. 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 score of each domain by 10, and categorized as fit ( &lt; 0.2), pre-frail (0.2–0.35), and frail ( &gt; 0.35). Construct validity was tested by comparing the FI-CGA-10 with the following established frailty measures: the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS), CSHA rules-based frailty definition and CSHA Function Scale. To evaluate the ability to predict mortality, we tested association between the FI-CGA-10 and validated prognostic indices for mortality: the Lee index and Schonberg index (higher scores reflect a higher risk of mortality). We also examined associations between the FI-CGA-10 and several features commonly seen in frail older adults such as function (Timed Up &amp; Go (TUG) test), cognitive impairment (Mini-Cog), and high comorbidity burden (Charlson Comorbidity Index (CCI)). Results: Of 540 patients (median age 80 years, range 66–96 years), common cancer types were gastrointestinal tract in 37%, hepatobiliary and pancreatic in 22%, and head and neck in 12%. 406 (75%) patients had ECOG PS 0 to 1. The FI-CGA-10 had a right-skewed distribution and was well approximated by the gamma distribution. Overall, 20% of patients were fit, 41% were pre-frail, and 39% were frail. The FI-CGA-10 was highly correlated with CSHA CFS (Pearson's r = 0.83), CSHA rules-based frailty definition (r = 0.67) and CSHA Function Score (r = 0.77). People who were more frail had higher scores on the Lee index (fit: 7.3, prefrail: 8.8, frail: 12.0; p &lt; .0001) and Schonberg index (fit: 10.1, prefrail: 13.1, frail: 15.7; p &lt; .0001), suggesting an increased probability of death. Increasing levels of frailty were significantly associated with a longer TUG (seconds), fit: 11.3, prefrail: 13.0, frail: 26.3; p &lt; .0001, poorer cognitive function (Mini-Cog score, fit: 4.7, prefrail: 4.0, frail: 3.1; p &lt; .0001), and higher comorbidity burden (CCI, fit: 0.8, prefrail: 1.4, frail: 1.9; p &lt; .0001). Conclusions: The FI-CGA-10 is a clinically sensible and construct-validated measure of quantifying frailty from a CGA.

Frailty and Autonomy among the Oldest Old: Evidence from the Multicenter Prospective AgeCoDe-AgeQualiDe Study

Introduction: There is a lack of studies examining the link between perceived autonomy and frailty among the oldest old. Therefore, our objective was to fill this gap. Methods: Data were used from the multicenter prospective cohort study “Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe; follow-up [FU] wave 9; n = 510 observations in the analytical sample). The average age was 90.3 years (SD: 2.7 years). The Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to assess frailty. Socioeconomic and health-related covariates were included in our regression model. The autonomy scale developed by Schwarzer was used to assess perceived autonomy in old age. Results: Adjusting for various confounders, multiple linear regressions showed that lower perceived autonomy was associated with increased levels of frailty (total sample: β = −0.13, p < 0.001; women: β = −0.14, p < 0.001; and men: β = −0.12, p < 0.001). Furthermore, lower perceived autonomy was associated with more depressive symptoms, higher cognitive impairment, and being institutionalized (except for men) in the total sample and in both sexes, but it was not significantly associated with age, sex, marital status, educational level, and social support. Conclusion: Findings indicate that frailty is associated with lower autonomy among the oldest old. More generally, while health-related factors were consistently associated with autonomy, sociodemographic factors (except for being institutionalized) were not associated with autonomy among the oldest old. We should be aware of the strong association between autonomy and physical as well as mental health in very old age.

Can a biomarker for oxidative stress and antioxidant reserves identify frailty in geriatric trauma patients?

ObjectiveFrailty is a state of systematic physiologic decline and reduced ability to recover from illness. There are no rapid quantitative biological measures to assess frailty. The study objective was to determine whether oxidation-reduction potential (ORP) is correlated with frailty score. MethodsThis prospective, observational cohort study was performed using plasma samples of geriatric trauma patients (≥65 years) admitted to a level I trauma center. Frailty was measured with the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (7-point scale; 1 = robust health and 7 = severely frail). Plasma ORP was determined using the RedoxSYS™ system to measure static ORP (aggregate measure of oxidative stress) and capacity ORP (antioxidant reserves; log transformed). Spearman rank correlation (presented as rs) and ordinal logistic regression (presented as adjusted odds ratios, AOR) were used to examine the unadjusted and adjusted relationship between frailty score and ORP values. ResultsThere were 93 geriatric trauma patients in our study. The majority (86%) had frailty scores 1-5, 11% were moderately frail and 3% were severely frail. There was a u-shaped relationship between ORP and frailty scale that became monotonic for scores 1-5. Each increase in frailty score demonstrated significant decreases in antioxidant reserves (log cORP rs = -0.26, p = 0.02) and nonsignificant increases in oxidative stress (sORP rs = 0.17, p = 0.15). After adjustment, variables significantly associated with frailty included log cORP (e.g., fewer antioxidant reserves, AOR: 0.70), age (AOR: 1.82), injury severity score (AOR: 0.50), admission lactate ≥2.5 mMol (AOR: 4.31), and alcohol use (AOR: 0.34). ConclusionsThe amount of antioxidant reserves (cORP) appears to be a quantitative marker to differentiate the degree of frailty ranging from robust health to mild frailty in geriatric trauma patients. We propose that direct quantification of frailty by way of a biomarker for oxidative reserves could have application in emergent trauma situations.

The Quantile Frailty Index: A Cutpoint-Free Approach to Biomarker-Based Health Assessment

We develop a frailty index (FI) from continuous valued biomarker measurements that does not use thresholds to binarize deficits. In this work we construct a quantile frailty index (FI-Q) directly from risk quantiles, without binarizing the deficits. FI-Q is the average risk quantile for an individual in the population with respect to the set of measured biomarkers. We show that FI-Q predicts adverse health outcomes better than either a quantile-based cutpoint approach or an FI-Lab method used in previous studies. We also address practical questions such as how to use longitudinal data. We use data from the English Longitudinal Study of Ageing (ELSA) for longitudinal analysis and data from the National Health and Nutrition Examination Survey (NHANES) and the Canadian Study of Health and Aging (CSHA) to compare predictive value of FI-QM with previous FI-Lab studies.

Depressive Symptoms and Frailty Among the Oldest Old: Evidence From a Multicenter Prospective Study

ObjectiveThere is a lack of studies disentangling whether changes in frailty are associated with subsequent changes in depressive symptoms or vice versa among the oldest old. Consequently, we aimed to disentangle this link. DesignThree waves [follow-up (FU) wave 7 to FU wave 9; n = 423 individuals in the analytical sample] were used from the multicenter prospective cohort study “Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)” (AgeQualiDe). Setting and ParticipantsPrimary care patients aged 85 years and older. MethodsThe Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS) was used to quantify frailty, and the Geriatric Depression Scale was used to measure depressive symptoms. It was adjusted for several covariates (sociodemographic and health-related factors) in regression analysis. ResultsMultiple linear regressions with first differences showed that initial increases in depressive symptoms (from FU wave 7 to FU wave 8) were associated with subsequent increases in frailty (from FU wave 8 to FU wave 9; β = 0.06, P < .05), whereas initial increases in frailty (from FU wave 7 to FU wave 8) were not associated with subsequent increases in depressive symptoms (from FU wave 8 to FU wave 9). Conclusions and ImplicationsThe study findings suggest the relevance of increases in depressive symptoms for subsequent increases in frailty. Treatment of depressive symptoms may also be beneficial to postpone frailty.

Fatigue, However Measured, Continues to Refine Prognosis in Higher Risk MDS: An MDS-CAN Study

Fatigue, However Measured, Continues to Refine Prognosis in Higher Risk MDS: An MDS-CAN Study

Next-day discharge after transcatheter aortic valve implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is being used increasingly in patients with severe symptomatic aortic stenosis. Few studies focused on hospital length of stay (LOS) and feasibility of next-day discharge. Purpose This study aims to evaluate the feasibility and factors associated with next-day discharge post TAVI, which can be used to help selecting suitable patients for a “fast-track” TAVI admission. Methods Data from all TAVI procedures conducted at our centre from January 2014 to March 2019 were collected in our local TAVI registry, and analysed retrospectively. Patients discharged within 1 day of TAVI (early discharge group) were compared with consecutive patients discharged after 24 h (late discharge group). Degree of frailty was assessed by the Canadian Study of Health and Aging (CSHA) frailty scale, and baseline functional status was assessed by Katz index of independence in activities of daily living. Results Of 502 patients, 274 (54.6%) were male, mean age 83.2±7.3 years, and 87 (17.7%) patients were considered frail by CSHA frailty scale. Median Katz index was 6 (i.e. functionally independent, interquartile range [IQR] 1), and mean logistic Euroscore 17.4±10.7. Percutaneous transfemoral access was performed in 468 (95.5%), and general anaesthesia was used in 64 (14.4%) patients. Early complications before discharge were comparable to national standards: death in 11 (2.3%), myocardial infarction (MI) in 1 (0.2%), permanent pacemaker (PPM) in 20 (4.3%), gastrointestinal bleed in 3 (0.6%), and tamponade in 5 (1.1%) patients. Median LOS post procedure was 2 (IQR 3), median length of total hospital stay was 3 (IQR 5). Early discharge was achieved in 213 (44.7%) patients. Multivariate logistic regression analysis showed that male gender (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.68 to 4.7; p&amp;lt;0.001), baseline New York Heart Association (NYHA) class below III (OR: 2.04, 95% CI 1.19 to 3.51; p=0.01) were associated with early discharge after TAVI. Furthermore, advancing age (OR: 0.96, 95% CI 0.93–0.99; p=0.02), and presence of extensive ascending aorta calcification (OR: 0.38, 95% CI 0.16–0.88; p=0.025) were associated with less probability of early discharge (i.e. presence of these features were associated with delayed discharge). Conclusions Next-day discharge after TAVI can be achieved in nearly half of all patients. Male younger patients with minimal symptoms at baseline (NYHA &amp;lt; III), without feature of extensive ascending aorta calcification (porcelain aorta) are a potential suitable group to be considered for a “fast-track” next-day TAVI discharge. Funding Acknowledgement Type of funding source: None

Can a Frailty Index Score Aid in the Decision to Stop Abdominal Aortic Aneurysm (AAA) Surveillance or Turn Down a Patient for Elective Infrarenal AAA Repair?

Background: In an era where intensive medical imaging is the norm, there is an increase in abdominal aortic aneurysms (AAAs) in the older, frail patient. The decision to electively repair an AAA in these patients can be difficult. Furthermore, surveillance of an AAA < 5.5 cm is often continued even when the patient is unfit for surgery. This has implications for resource management. The aim of this study was to evaluate a formal, objective frailty scoring system to aid in decision making. Methods: The modified Frailty Index (Canadian Study of Health and Aging (CSHA) mFI) is a verified, practical system consisting of 11 items. Three hundred and eighty-four patients referred to the vascular clinics with a diagnosis of AAA over the past three years were included. Of those unfit for surgery and/or continued surveillance, records for positive mFI features were retrospectively reviewed. Results: A total of 63 patients fit the criteria. 39 patients were <5.5cm; seven (11.1%) were small (<4cm), seven (11.1%) declined surveillance and 25 (39.7%) were withdrawn from surveillance due to co-morbidities. These 25 patients had an average of 2.9 mFI items. 24 patients had an AAA >5.5cm. Of these, six (9.5%) declined intervention, 18 (28.6%) were turned down for surgical intervention due to comorbidities. Those turned down for surgery had an average of 3.5 mFI items. Elective AAA repair patients for the same period had an average of 1.4 mFI items. Conclusion: The study shows that a Standardised Frailty Index Scoring System correlated closely with senior clinician decision making. While there is no substitute for clinical experience, such an objective scoring system could aid a surgeon’s decision and also provide medico-legal protection.

Which Factors Contribute to Frailty among the Oldest Old? Results of the Multicentre Prospective AgeCoDe and AgeQualiDe Study

Introduction: There is a lack of studies investigating the link between time-varying factors associated with changes in frailty scores in very old age longitudinally. This is important because the level of frailty is associated with subsequent morbidity and mortality. Objective: To examine time-dependent predictors of frailty among the oldest old using a longitudinal approach. Methods: Longitudinal data were drawn from the multicentre prospective cohort study “Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe), covering primary care patients aged 85 years and over. Three waves were used (from follow-up, FU, wave 7 to FU wave 9 [with 10 months between each wave]; 1,301 observations in the analytical sample). Frailty was assessed using the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS). As explanatory variables, we included sociodemographic factors (marital status and age), social isolation as well as health-related variables (depression, dementia, and chronic diseases) in a regression analysis. Results: In total, 18.9% of the individuals were mildly frail, 12.4% of the individuals were moderately frail, and 0.4% of the individuals were severely frail at FU wave 7. Fixed effects regressions revealed that increases in frailty were associated with increases in age (β = 0.23, p < 0.001), and dementia (β = 0.84, p < 0.01), as well as increases in chronic conditions (β = 0.03, p = 0.058). Conclusion: The study findings particularly emphasize the importance of changes in age, probably chronic conditions as well as dementia for frailty. Future research is required to elucidate the underlying mechanisms. Furthermore, future longitudinal studies based on panel regression models are required to confirm our findings.

Association between aluminum in drinking water and incident Alzheimer’s disease in the Canadian Study of Health and Aging cohort

Epidemiological evidence linking aluminum in drinking water and Alzheimer’s disease (AD) has been inconsistent, with previous studies often limited by small sample sizes. The present study addresses this issue using data from the Canadian Study of Health and Aging (CSHA), a prospective cohort of 10,263 subjects followed-up from 1991-1992 through 2001–2002. Participants’ residential histories were linked to municipal drinking water sources in 35 Canadian municipalities to obtain ecologic pH, aluminum, fluoride, iron and silica concentrations in drinking water. Cox proportional hazards models were used to examine associations between aluminum and incident AD [Hazard Ratios (HRs), 95% confidence intervals (CIs)], adjusting for age, gender, history of stroke, education, and high blood pressure.A total of 240 incident AD cases were identified during follow-up of 3, 638 subjects derived from the CSHA cohort with complete data on all covariates. With categorical aluminum measurements, there was an increasing, but not statistically significant, exposure-response relationship (HR = 1.34, 95% CI 0.88−2.04, in the highest aluminum exposure category; p = 0.13 for linear trend). Similar results were observed using continuous aluminum measurements (HR=1.21, 95% CI 0.97−1.52, at the interquartile range of 333.8 μg/L; p = 0.09 for linear trend). In a subsample genotyped for ApoE-ε4, there was some evidence of an association between aluminum and AD (p = 0.03 for linear trend).Although a clear association between aluminum in drinking water and AD was not found, the linear trend observed in ApoE-ε4 subsample warrants further examination.

Comparison of two frailty indexes in hip fractures

Modified-Krishnan's frailty index (FI) is an FI calculation method developed by Krishnan et al. in 2014. This study aimed to compare the effectiveness and correlation of the FIs from Krishnan and the Canadian study of health and aging (CSHA) in predicting postoperative outcomes of elderly patients with hip fracture. Based on clinical follow-up and observation, we utilized these two instruments to predict 3-month mortality, hip function, and recovery of daily activities. The area under the curve (AUC) and the Pearson correlation coefficient were used to compare the two scales' predictive validities for postoperative outcomes. A total of 130 patients were included; 67% female and mean age 77.5 ± 8.5 years. The AUCs of modified-Krishnan's FI (AUC = 0.856; 95% confidence interval (CI) = 0.767-0.945) and the CSHA-FI (AUC = 0.793; 95% CI = 0.652-0.934) were used to compare the effectiveness in predicting patient mortality. The optimal predictive scores were 0.335 and 0.28, respectively. The Pearson correlation analysis showed that the modified-Krishnan's FI correlated with the Japanese Orthopaedic Association hip score (pain, activity, walking ability, and ability for daily living; R = -0.249, p = 0.005), while the CSHA-FI was not correlated (R = -0.125, p = 0.170). The modified-Krishnan's FI (R = -0.415, p < 0.001) and the CSHA-FI (R = -0.332, p < 0.001) were both significantly correlated with the functional recovery scale score. The modified-Krishnan's FI and the CSHA-FI were effective in the prediction of postoperative mortality. But the modified-Krishnan's FI was more consistently associated with the recovery of hip function and daily activities at 3 months after the operation than that of the CSHA-FI. The modified-Krishnan's FI was more suitable to utilize for risk stratification, identifying deficits, and predicting recovery capacity in hip fracture patients.

Prediction of Cognitive Status and 5-Year Survival Rate for Elderly with Cardiovascular Diseases: A Canadian Study of Health and Aging Secondary Data Analysis

BackgroundGiven the important association between cardiovascular disease and cognitive decline, and their significant implications on frailty status, the contribution of neurocognitive frailty measure helping with the assessment of patient outcomes is dearly needed.ObjectivesThe present study examines the prognostic value of the Neurocognitive Frailty Index (NFI) in the elderly with cardiovascular disease.DesignSecondary analysis of the Canadian Study of Health and Aging (CSHA) dataset was used for prediction of 5-year cognitive changes.SettingCommunity and institutional sample.ParticipantsCanadians aged 65 and over [Mean age: 80.4 years (SD=6.9; Range of 66–100)].MeasurementNeurocognitive Frailty Index (NFI) and Modified Mini-Mental State (3MS) scores for cognitive functioning of all subjects at follow-up and mortality rate were measured.ResultsThe NFI mean score was 9.63 (SD = 6.04) and ranged from 0 to 33. This study demonstrated that the NFI was significantly associated with cognitive changes for subjects with heart disease and this correlation was a stronger predictor than age.ConclusionThe clinical relevance of this study is that our result supports the prognostic utility of the NFI tool in treatment planning for those with modifiable cardiovascular disease risk factors in the development of dementia.

Frailty Significantly Associated with a Risk for Mid-term Outcomes in Elderly Chronic Coronary Syndrome Patients: a Prospective Study.

IntroductionFrailty is a condition of elderly characterized by increased vulnerability to stressful events. Frail patients are more likely to have adverse events. The purposes of this study were to define frailty in patients aged ≥ 70 years with chronic coronary syndrome (CCS) and to evaluate mortality and prognostic significance of frailty in these patients.MethodsWe included 99 patients, ≥ 70 years old (mean age 74±5.3 years), with diagnosis of CCS. They were followed-up for up to 12 months. The frailty score was evaluated according to the Canadian Study of Health and Aging (CSHA). All patients were divided as frail or non-frail. The groups were compared for their characteristics and clinical outcomes.ResultsFifty patients were classified as frail, and 49 patients as non-frail. The 12-month Major Adverse Cardiac Events (MACE) rate was 69.4% in frail patients and 20% in non-frail patients. Frailty increases the risk for MACE as much as 3.48 times. Two patients died in the non-frail group and 11 patients died in the frail group. Frailty increases the risk for death as much as 6.05 times. When we compared the aforementioned risk factors by multivariate analysis, higher CSHA frailty score was associated with increased MACE and death (relative risk [RR] = 22.94, 95% confidence interval [CI] 3.33-158.19, P=0.001, for MACE; RR = 7.41, 95% CI 1.44-38.03, P=0.016, for death).ConclusionBeing a frail elderly CCS patient is associated with worse outcomes. Therefore, frailty score should be evaluated for elderly CCS patients as a prognostic marker.