Edmonton Frail Scale Score Research Articles

Inferior vena cava collapsibility index and trauma severity in elderly fall injuries.

Falls are a serious cause of morbidity and mortality among older people. One of the underlying causes of falls is dehydration. Therefore, ultrasonography has become an essential tool for evaluating volume status in the emergency department. However, the effect of volume status on falls in older people has not been evaluated before. The aim of this study was to determine the relationship between the inferior vena cava collapsibility index and the injury severity score in older patients who presented with fall-related injuries to the emergency department. A total of 66 patients were included in the study. The injury severity score was used as the trauma severity score, and the Edmonton Frail Scale was used as the frailty scale. Volume status was evaluated with inferior vena cava collapsibility index. The primary outcome measure was defined as the correlation between inferior vena cava collapsibility index and injury severity score. Secondary outcome measures were defined as the effect of inferior vena cava collapsibility index and injury severity score on hospitalization and mortality. There was no significant correlation between injury severity score and inferior vena cava collapsibility index (p=0.342). Neither inferior vena cava collapsibility index nor injury severity score was an indicator of the mortality of these patients. However, injury severity score was an indicator of hospitalization. The mean Edmonton Frail Scale score was an indicator of mortality among older people who experienced falls (p=0.002). Inferior vena cava collapsibility index cannot be used to predict trauma severity in older patients who have experienced falls admitted to the emergency department.

The Edmonton Frail Scale as a screening score for frailty in oncogeriatrics.

The comprehensive geriatric assessment (CGA) is recommended for assessing frailty in older cancer patients but is time-consuming. The G8 screening tool was developed to select frail patients requiring CGA to optimize resources. The Edmonton Frail Scale (EFS) is another frailty scale validated for preoperative frailty screening, but scarcely studied in the field of oncogeriatrics. In this study, we examined the added value of the EFS in older cancer patients already considered as frail by the G8, by analyzing the association of EFS with CGA adjusted for age, gender, metastatic stage and comorbidity. We also analyzed the association of EFS with the one-year mortality rate after adjusting for cancer type and metastatic stage. This retrospective study included patients aged over 70 years old with a new diagnosis of cancer, considered as potentially frail according to the G8 and who had had a CGA (N = 380). The EFS identified 329 (86.58%) patients as frail and having a statistically significant predicted number of pathological components on the CGA (r = 0.64, p < 0.001). When adjusted for age, sex, comorbidity, and metastatic stage, the EFS was independently associated with the CGA (p < 0001), as well as with comorbidity (p = 0.004). The patients who died in the first year (43%) had a significantly higher mean EFS score (8/17) than living patients (6/17) (p < 0.0001). After adjustment for cancer type and stage, EFS independently predicted one-year mortality (OR 1.17; 95% CI 1.08-1.28; pseudo R 2 = 0.228, p < 0.001). The EFS is a reliable tool for predicting frailty identified by the CGA in an older cancer population pre-selected as frail by the G8. EFS is an independent predictor of one-year mortality after adjustment for confounding factors. Validation of the EFS as a screening tool for frailty in cancer requires further studies to assess its performance in patients with normal G8 scores.

Geriatric assessment with management for older patients with cancer receiving radiotherapy: a cluster-randomised controlled pilot study

BackgroundGeriatric assessment and management (GAM) improve outcomes in older patients with cancer treated with surgery or chemotherapy. It is unclear whether GAM may provide better function and quality of life (QoL), or be cost-effective, in a radiotherapy (RT) setting.MethodsIn this Norwegian cluster-randomised controlled pilot study, we assessed the impact of a GAM intervention involving specialist and primary health services. It was initiated in-hospital at the start of RT by assessing somatic and mental health, function, and social situation, followed by individually adapted management plans and systematic follow-up in the municipalities until 8 weeks after the end of RT, managed by municipal nurses as patients’ care coordinators. Thirty-two municipal/city districts were 1:1 randomised to intervention or conventional care. Patients with cancer ≥ 65 years, referred for RT, were enrolled irrespective of cancer type, treatment intent, and frailty status, and followed the allocation of their residential district. The primary outcome was physical function measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Secondary outcomes were overall quality of life (QoL), physical performance, use and costs of health services. Analyses followed the intention-to-treat principle. Study registration at ClinicalTrials.gov ID NCT03881137.ResultsWe included 178 patients, 89 in each group with comparable age (mean 74.1), sex (female 38.2%), and Edmonton Frail Scale scores (mean 3.4 [scale 0–17], scores 0–3 [fit] in 57%). More intervention patients received curative RT (76.4 vs 61.8%), had higher irradiation doses (mean 54.1 vs 45.5 Gy), and longer lasting RT (mean 4.4 vs 3.6 weeks). The primary outcome was completed by 91% (intervention) vs 88% (control) of patients. No significant differences between groups on predefined outcomes were observed. GAM costs represented 3% of health service costs for the intervention group during the study period.ConclusionsIn this heterogeneous cohort of older patients receiving RT, the majority was fit. We found no impact of the intervention on patient-centred outcomes or the cost of health services. Targeting a more homogeneous group of only pre-frail and frail patients is strongly recommended in future studies needed to clarify the role and organisation of GAM in RT settings.

Effects of Baduanjin exercise on cognitive frailty, oxidative stress, and chronic inflammation in older adults with cognitive frailty: a randomized controlled trial.

Oxidative stress and chronic inflammation play an important role in the pathogenesis process of cognitive frailty (CF). Regular Baduanjin exercise could improve cognitive frailty in older adults, but it is unclear whether the effect of Baduanjin exercise on improving CF is mediated by modulating circulating oxidative stress and inflammatory process. A total of 102 community-dwelling older adults with CF were recruited and randomly allocated into a 24-week Baduanjin exercise training group or no specific exercise intervention control group at an equal rate. Cognitive function and physical frailty index were assessed using the Montreal Cognitive Assessment (MoCA) and the Edmonton Frail Scale (EFS), as well as the oxidative stress and inflammatory cytokines were measured at baseline and after intervention. After 24 weeks of intervention, the increased MoCA score (2.51 ± 0.32 points, p < 0.001) and the decreased EFS scores (1.94 ± 0.20 points, p = 0.012) in the Baduanjin group were significantly higher than those in the control group. Serum antioxidant SOD levels were increased by 10.03 ± 4.73 U/mL (p < 0.001), and the prooxidative MDA and 8-iso-PGF2α levels were decreased by -1.08 ± 0.80 nmol/mL (p = 0.030) and -86.61 ± 15.03 ng/L (p < 0.001) in the Baduanjin training group; while inflammatory cytokines IFN-γ, IL-2 and IL-4 levels were increased (1.08 ± 0.33 pg./mL, p = 0.034, 2.74 ± 0.75 pg./mL, p = 0.04 and 1.48 ± 0.35 pg./mL, p = 0.042). In addition, a mediation effect that Baduanjin training improved cognitive ability mediated by an increase of circulating IFN-γ and IL-2 levels were observed in this study. Regular Baduanjin exercise training could improve the cognitive frailty of the community-dwelling older adults with CF, and modulate oxidative stress and inflammatory processes by reducing circulating pro-oxidative MDA and 8-iso-PGF2α levels and increasing anti-oxidative SOD levels, as well as impacting inflammatory cytokines IFN-γ, IL-2, and IL-4 levels. Nevertheless, the mechanism of Baduanjin exercise mediating oxidative stress and inflammatory processes should be cautious to be explained. http://www.chictr.org.cn/index.aspx, ChiCTR1800020341.

Comparison of Clinical Frailty Scale and Edmonton Frail Scale in older adults presenting to the emergency department

Introduction: This study aimed to compare the prognostic values of Edmonton Frail Scale and Clinical Frailty Scale in the emergency department and determine their suitability for patient management. Materials and Method: This study was conducted as a single-center prospective observational study. Patients aged 65 and older who presented to the emergency department were included. Clinical Frailty Scale and Edmonton Frail Scale scores, the emergency department outcomes, length of stay in the emergency department, 30-day mortality, and 30-day readmission data of the patients were recorded. ROC analysis was performed to examine the predictive values on outcomes. DeLong Test was used to compare the predictive values. Results: This study included 400 patients. Intensive care unit admission was significantly more frequent in the frail group according to both Edmonton Frail Scale and Clinical Frailty Scale. The length of stay in the emergency department was significantly longer in the frail group in both classifications. The mortality rate was significantly higher in the frail group in both classifications. The optimal cut off value for predicting mortality was found to be 9 for Edmonton Frail Scale and 7 for Clinical Frailty Scale. There was no significant difference between the predictive values of two scales. Conclusion: We found that two frail scales have good predictive values for adverse outcomes, such as mortality and the need for Intensive care unit admission in the emergency department. We believe that both scores would be valuable in guiding decisions for the emergency department usage due to their similar predictive values. Keywords: Geriatrics; Emergency Service; Hospital; Frailty; Frail Elderly; Mortality.

Effect of Baduanjin exercise on executive function in older adults with cognitive frailty: A randomized controlled trial

Objective To investigate the effectiveness of Baduanjin exercise on executive function in community-dwelling older adults with cognitive frailty. Design Randomized controlled trial. Setting Community residential centers. Subjects 120 eligible older adults. Interventions Baduanjin training group received supervised Baduanjin training, 60 min sessions three times per week for 24 weeks. The control group did not receive any exercise intervention. Main measures Primary outcome was executive function, assessed using Clock Drawing Test. Secondary outcomes included the subcomponents of executive function (working memory, inhibitory control and cognitive flexibility), attention and cognitive frailty (global cognitive function, physical frailty) assessed using Verbal Fluency Test, Trail Making Test-A/B, Stroop Test, Montreal Cognitive Assessment and Edmonton Frailty Scale, respectively, at baseline and 24 weeks after intervention. Results After the 24-week intervention, the scores of Clock Drawing Test and Verbal Fluency Test, the Trail Making Test-B time and the Card correct numbers of Stroop Test in Baduanjin training group showed significant improvement compared with control group (all P < 0.05) with small to moderate effect sizes and the significant interaction effect of group by time in the Clock Drawing Test and Trail Making Test-B test (P = 0.003 and P = 0.043); cognitive frailty variables, including Montreal Cognitive Assessment and Edmonton Frail Scale scores, also showed significant improvement (P = 0.002 and P = 0.004) with a moderate effect sizes and a significant interaction effect (P < 0.001, P = 0.013). No adverse events were reported. Conclusion Regular Baduanjin training may be an effective and safe intervention to improve cognitive frailty and executive function in community-dwelling older adults with cognitive frailty. Trial registration Chinese Clinical Trial Registry, ChiCTR2100050857. Data of registration: 8/5/2020, https://www.chictr.org.cn/showproj.html?proj = 133037.

Epigenetic age biomarkers and risk assessment in adult spinal deformity: a novel association of biological age with frailty and disability.

Surgery for spinal deformity has the potential to improve pain, disability, function, self-image, and mental health. These surgical procedures carry significant risk and require careful selection, optimization, and risk assessment. Epigenetic clocks are age estimation tools derived by measuring the methylation patterns of specific DNA regions. The study of biological age in the adult deformity population has the potential to shed insight onto the molecular basis of frailty and to improve current risk assessment tools. Adult patients who underwent deformity surgery were prospectively enrolled. Preoperative whole blood samples were used to assess epigenetic age and telomere length. DNA methylation patterns were quantified and processed to extract 4 principal component (PC)-based epigenetic age clocks (PC Horvath, PC Hannum, PC PhenoAge, and PC GrimAge) and the instantaneous pace of aging (DunedinPACE). Telomere length was assessed using both quantitative polymerase chain reaction (telomere to single gene [T/S] ratio) and a methylation-based telomere estimator (PC DNAmTL). Patient demographic and surgical data included age, BMI, American Society of Anesthesiologists Physical Status Classification System class, and scores on the Charlson Comorbidity Index, adult spinal deformity frailty index (ASD-FI), Edmonton Frail Scale (EFS), Oswestry Disability Index, and Scoliosis Research Society-22r questionnaire (SRS-22r). Medical or surgical complications within 90 days of surgery were collected. Spearman correlations and beta coefficients (β) from linear regression, adjusted for BMI and sex, were calculated. Eighty-three patients were enrolled with a mean age of 65 years, and 45 were women (54%). All patients underwent posterior fusion with a mean of 11 levels fused and 33 (40%) 3-column osteotomies were performed. Among the epigenetic clocks adjusted for BMI and sex, DunedinPACE showed a significant association with ASD-FI (β = 0.041, p = 0.002), EFS (β = 0.696, p = 0.026), and SRS-22r (β = 0.174, p = 0.013) scores. PC PhenoAge showed associations with ASD-FI (β = 0.029, p = 0.028) and SRS-22r (β = 0.159, p = 0.018) scores. PC GrimAge showed associations with ASD-FI (β = 0.029, p = 0.037) and SRS-22r (β = 0.161, p = 0.025) scores. Patients with postoperative complications were noted to have shorter telomere length (T/S 0.790 vs 0.858, p = 0.049), even when the analysis controlled for BMI and sex (OR = 1.71, 95% CI 1.07-2.87, p = 0.031). Epigenetic clocks showed significant associations with markers of frailty and disability, while patients with postoperative complications had shorter telomere length. These data suggest a potential role for aging biomarkers as components of surgical risk assessment. Integrating biological age into current risk calculators may improve their accuracy and provide valuable information for patients, surgeons, and payers.

Assessing frailty in urogynecology patients: a comparative analysis of the Edmonton frail scale and pelvic floor symptom severity

This study aimed to measure frailty using the Edmonton frail scale (EFS) and examine whether frailty is associated with presenting complaints or worse pelvic floor symptom severity in older urogynecology outpatients. We conducted a cross-sectional study of new urogynecology patients aged 50 and older at 2 urban academic centers between November 2018 and January 2020. Pelvic floor symptom severity was assessed using surveys [overactive bladder validated 8-question screener (OAB-V8), pelvic floor distress inventory, and 6-item female sexual function index]. Multivariable linear and logistic regression analyses were performed to compare chief complaint and questionnaire scores by EFS score, frailty status, and EFS component. A total of 138 women were recruited, with a mean age of 65 years (standard deviation 9.3). 11.6% met the criteria for frailty. Frail women had 6.2 greater adjusted odds of endorsing urinary incontinence symptoms as their presenting complaint, and women with higher EFS scores had worse OAB-V8 scores (adjusted ß=0.04, p=0.03). Depression/sadness were associated with worse urinary and prolapse symptoms. Frailty is common in older urogynecology outpatients, especially those presenting with urinary incontinence. Individual components of the EFS associated with symptomatic pelvic floor dysfunction included depressed mood, lack of reliable help, and incontinence.

Validation And Reliability Of Edmonton Frail Scale In Turkish Community-Dwelling Older Adults

Objectives: This study aimed to demonstrate the validity and reliability of the Edmonton Frail Scale (EFS) among community-dwelling older adults in Türkiye. Methods: Participants who applied to the geriatrics outpatient clinic of a university hospital were included. The validity of the EFS was tested by its concordance with the Clinical Frailty Scale (CFS). Results: The median EFS score was 4.0 (IQR: 2.0-7.0), and the median CFS score was 3.0 (IQR: 3.0-4.0). There was substantial concordance between EFS and CFS (Cohen's kappa: 0.715, p

Edmonton Frail Scale predicts mortality in older patients with cancer undergoing radiotherapy-A prospective observational study.

Several screening tools are developed to identify frailty in the increasing number of older patients with cancer. Edmonton Frail Scale (EFS) performs well in geriatric settings but is less studied in oncology. We aimed to investigate if EFS score (continuous and categorical) predicts survival in patients referred for radiotherapy, and to assess the concurrent validity of EFS compared with a modified geriatric assessment (mGA). Prospective observational, single-center study including patients ≥65 years, referred for curative or palliative radiotherapy for confirmed cancer. Patients underwent mGA (assessment of cognition, mobility, falls, comorbidity, polypharmacy, depression, nutrition, and activities of daily living) and screening with EFS prior to radiotherapy. The predictive value of EFS score of two-year overall survival (OS) was assessed by Kaplan-Meier plots and compared by log-rank test. Cox proportional hazards regression model was estimated to adjust the associations for major cancer-related factors. Concurrent validity of EFS in relation to mGA was estimated by Spearman`s correlation coefficient and ordinal regression. Sensitivity and specificity for different cut-offs was assessed. Patients' (n = 301) mean age was 73.6 (SD 6.3) years, 159 (52.8%) were men, 54% received curative-intent treatment, breast cancer (32%) was the most prevalent diagnosis. According to EFS≥6, 101 (33.7%) were classified as frail. EFS score was predictive of OS [hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10-1.30)], as was increasing severity assessed by categorical EFS (p<0.001). There was a strong correlation between EFS score and number of geriatric impairments (Spearman`s correlation coefficient 0.77). EFS cut-off ≥6 had a sensitivity of 0.97 and specificity of 0.57 for identifying patients with minimum two geriatric impairments. EFS predicts mortality in older patients with cancer receiving radiotherapy, and it is a quick (<5 minutes) and sensitive screening tool to identify patients who may benefit from a geriatric assessment.

Association of frailty with chemotherapy toxicity in chemotherapy-naive older patients with cancer.

The purpose of this study is to assess the relationship between chemotherapy toxicity and frailty as determined using the Edmonton Frail Scale (EFS). Older adults (≥ 65years old) newly diagnosed with cancer were evaluated for frailty with EFS prior to chemotherapy. Participants evaluated on 17 points were grouped as "No Frailty" (0-4), "Apparently Vulnerable" (5-6), "Mild Frailty" (7-8), "Moderate Frailty" (9-10), and "Severe Frailty" (11 or more). Before the second and third chemotherapy cycles, patients were reassessed for toxicity. Of the 44 participants, 12 (27.4%) were rated as "frail" (EFS score ≥ 7). The median Charlson Age-Comorbidity Index score was 3 (IQR: 1), and the median EFS score was 5 (IQR: 3). There was no significant difference between the "frail" and "robust" groups in terms of the toxicity. There was no correlation between age, gender, chemotherapy intent, chemotherapy dosing, ECOG performance score, or other parameters with grade 3 or higher toxicity development. The Edmonton Frail Scale is not successful in predicting the toxicity risk of chemotherapy. However, it may be used as a tool to determine the need for comprehensive geriatric assessment and it may lead to increased alertness to adverse events during treatment of frail patients.

403. FRAILTY AS A PREDICTOR OF POSTOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING ESOPHAGECTOMY

Abstract Careful selection and optimization of esophageal cancer patients for esophagectomy is necessary and has been shown to improve outcomes. Preoperative frailty measures, both objective and subjective, may predict postoperative outcomes after minimally invasive esophagectomy (MIE) and be applied to surgical decision-making and patient selection. We hypothesize that measures of increased frailty are associated with major complications after MIE for esophageal cancer. This is a prospective cohort study of patients undergoing MIE for esophageal cancer in a US academic tertiary hospital over one year (2021). We tested preoperative frailty by measuring two-flight stair climb times, pulse change during stair climb, grip strength, and Edmonton Frail Scale (EFS) score. Postoperative complications in the first 30 days were classified based on Clavien-Dindo, with Grade III or above defined as a major complication (primary outcome). We calculated Spearman correlations among the four different frailty measures. We performed t-tests to compare frailty measures in patients with and without major complications. Thirty-four patients were enrolled with a mean age of 64 (SD 11) and 79.4% male. EFS score, grip strength, and stair climb time were significantly correlated (p &amp;lt; 0.05), as shown in Figure 1. There was a significant difference in EFS scores between groups with or without major complications (4.7 vs 3.0, p = 0.04, respectively), with a higher score representing increased frailty. Other frailty measures did not meet significance between groups for major complication, including stair climb time (difference of 11.0 s, 95% CI: −0.38-22.4) and grip strength (difference of 7.7 kg, 95% CI: −0.94-16.3). No difference was seen in pulse change by complication status. A higher Edmonton Frail Scale score is associated with major postoperative complications following MIE. Patients with higher EFS score should be counseled on increased surgical risk of morbidity and prehabilitation should be considered. Other measures such as stair climb time and grip strength may support the preoperative frailty assessment in esophageal cancer patients, as they were highly correlative with each other.

Domains of Frailty Predict Loss of Independence in Older Adults After Noncardiac Surgery.

Preoperative frailty has been consistently associated with death, severe complications, and loss of independence (LOI) after surgery. LOI is an important patient-centered outcome, but it is unclear which domains of frailty are most strongly associated with LOI. Such information would be important to target individual geriatric domains for optimization. To assess whether impairment in individual domains of the Edmonton Frail Scale (EFS) can predict LOI in older adults after noncardiac surgery. Retrospective Cohort Study. One Academic Hospital. Patients aged 65 or older who were living independently and evaluated with the EFS during a preoperative visit to the Center for Preoperative Optimization at the Johns Hopkins Hospital between June 2018 and January 2020. LOI defined as discharge to increased level of care outside of the home with new mobility deficit or functional dependence. New mobility deficit and functional dependence were extracted from chart review of the standardized occupational therapy and physical therapy assessment performed before discharge. A total of 3497 patients were analyzed. Age (mean±SD) was 73.4±6.2 years, and 1579 (45.2%) were female. The median total EFS score was 3 (range 0-16), and 725/3497 (27%) were considered frail (EFS≥6). The frequencies of impairment in each EFS domain were functional performance (33.5% moderately impaired, 11% severely impaired), history of hospital readmission (42%), poor self-described health status (37%), and abnormal cognition (17.1% moderately impaired, 13.8% severely impaired). Overall, 235/3497 (6.7%) patients experienced LOI. Total EFS score was associated with LOI (odds ratio: 1.37, 95% CI, 1.30-1.45, P <0.001) in a model adjusted for age, sex, body mass index, American Society of Anesthesiologists rating, congestive heart failure, valvular heart disease, hypertension diagnosis, chronic lung disease, diabetes, renal failure, liver disease, weight loss, anemia, and depression. Using a nested log likelihood approach, the domains of functional performance, functional dependence, social support, health status, and urinary incontinence improved the base multivariable model. In cross-validation, total EFS improved the prediction of LOI with the final model achieving an area under the curve of 0.840. Functional performance was the single domain that most improved outcome prediction, but together with functional dependence, social support, and urinary incontinence, the model resulted in an area under the curve of 0.838. Among domains measured by the EFS before a wide range of noncardiac surgeries in older adults, functional performance, functional dependence, social support, and urinary incontinence were independently associated with and improved the prediction of LOI. Clinical initiatives to mitigate LOI may consider screening with the EFS and targeting abnormalities within these domains.

Potentially Inappropriate Medication Administration Is Associated With Adverse Postoperative Outcomes in Older Surgical Patients: A Retrospective Cohort Study.

The American Geriatrics Society (AGS) Beers Criteria is an explicit list of potentially inappropriate medications (PIMs) best avoided in adults ≥65 years of age. Cognitively impaired and frail surgical patients often experience poor outcomes after surgery, but the impacts of PIMs on these patients are unclear. Our objective was to assess whether perioperative PIM administration was associated with poor outcomes in geriatric surgical patients. We then evaluated the association between PIM administration and postoperative outcomes in subgroups of patients who were frail or cognitively impaired. We performed a retrospective cohort study of patients ≥65 years of age who underwent elective inpatient surgery at a large academic medical center from February 2018 to January 2020. Edmonton Frail Scale and Mini-Cog screening tools were administered to all patients at their preoperative clinic visit. A Mini-Cog score of 0 to 2 was considered cognitive impairment, and frailty was defined by an Edmonton Frail Scale score of ≥8. Patients were divided into 2 groups depending on whether they received at least 1 PIM (PIM+), based on the 2019 AGS Beers Criteria, in the perioperative period or none (PIM-). We assessed the association of preoperative frailty, cognitive impairment, and perioperative PIM administration with the length of hospital stay and discharge disposition using multiple regression analyses adjusted for age, sex, ASA physical status, and intensive care unit (ICU) admission. Of the 1627 included patients (mean age, 73.7 years), 69.3% (n = 1128) received at least 1 PIM. A total of 12.7% of patients were frail, and 11.1% of patients were cognitively impaired; 64% of the frail patients and 58% of the cognitively impaired patients received at least 1 PIM. Perioperative PIM administration was associated with longer hospital stay after surgery (PIM-, 3.56 ± 5.2 vs PIM+, 4.93 ± 5.66 days; P < .001; 95% confidence interval [CI], 0.360-0.546). Frail patients who received PIMs had an average length of stay (LOS) that was nearly 2 days longer than frail patients who did not receive PIMs (PIM-, 4.48 ± 5.04 vs PIM+, 6.33 ± 5.89 days; P = .02). Multiple regression analysis revealed no significant association between PIM administration and proportion of patients discharged to a care facility (PIM+, 26.3% vs PIM-, 28.7%; P = .87; 95% CI, -0.046 to 0.054). Perioperative PIM administration was common in older surgical patients, including cognitively impaired and frail patients. PIM administration was associated with an increased hospital LOS, particularly in frail patients. There was no association found between PIM administration and discharge disposition.

Determining the frailty status in patients who apply for home health care

Background To examine the relationship between an institutionally prepared standardized patient evaluation form and the Edmonton Frail Scale (EFS) in patients receiving home health care.&#x0D; Material and Methods Our prospective, observational study included 200 patients over the age of 18 who requested home health care, regardless of gender. The EFS and institutional data collection forms were applied consecutively on the same day to all patients included in the study. &#x0D; Results Among the 200 individuals recruited for the study, 59% were female and 41% were male; the overall average age was 80 years. According to the EFS results, 4.5% of the patients were classified as non-frail, 6% were vulnerable, and 89.5% had varying degrees of frailty (mild, moderate and severe). There was a significant positive correlation between EFS score and age (p

Frailty in Diabetic Subjects during COVID-19 and Its Association with HbA1c, Mean Platelet Volume and Monocyte/Lymphocyte Ratio

Background: Frailty is associated with increased risk of hospitalization in diabetic patients. Both SARS-CoV-2 pandemic and type 2 diabetes mellitus contribute to the frailty. In this study we aimed to observe clinical and laboratory indices of the diabetic subjects during COVID-19 pandemic who were either frail or not according to Edmonton frail score. Material and methods: During the pandemic era, 100 consecutive patients with type 2 diabetes mellitus divided into two groups either as frail or non-frail according to the Edmonton Frail Scale scores. Laboratory and clinical features of the frail and non-frail subjects were compared. Results: Frail patients were older than the non-frail diabetics. Blood urea, serum creatinine, eGFR, plasma albumin, total cholesterol, triglyceride, HbA1c, mean platelet volume (MPV), and monocyte lymphocyte ratio (MLR) levels of the frail and non-frail groups were significantly different. Moreover, Edmonton frail score was significantly and positively correlated with blood urea, serum creatinine, MLR, MPV, HbA1c and inversely correlated with eGFR and plasma albumin levels. Conclusions: We think that HbA1c, MPV and MLR could be surrogate markers of frailty in diabetic elderly during COVID-19 outbreak. Strategies to keep them in normal range do not only improve diabetes control but also reduce the risk of frailty in this population.

Validity of the Malnutrition Universal Screening Tool for Evaluation of Frailty Status in Older Hospitalised Patients.

The malnutrition-universal-screening-tool (MUST) is commonly used for screening malnutrition in hospitalised patients but its utility in the detection of frailty is unknown. This study determined the utility of MUST in detection of frailty in older hospitalised patients. This prospective-study enrolled 243 patients ⩾65 years in a tertiary-teaching hospital in Australia. Patients with a MUST score of ⩾1 were classified as at-risk of malnutrition. Frailty status was determined by the Edmonton-Frail-Scale (EFS) and patients with an EFS score of >8 were classified as frail. We validated the MUST against the EFS by plotting a receiver-operating-characteristic-curve (ROC) curve and area-under-the-curve (AUC) was determined. The mean (SD) age was 83.9 (6.5) years and 126 (51.8%) were females. The EFS determined 149 (61.3%) patients as frail, while 107 (44.1%) patients were at-risk of malnutrition according to the MUST. There was a positive linear but weak association between the MUST and the EFS scores (Pearson’s correlation coefficient= .22, 95% CI .12– .36, p < .001). The sensitivity, specificity, positive and negative predictive value of MUST in the detection of frailty was 51%, 67%, 78.5% and 37%, respectively and the AUC was .59 (95% CI .53–.65, p < .001). The MUST is moderately sensitive in detection of frailty in older-hospitalised patients.

Pre-Existing Frailty is Unrelated to Progression of Diffuse Subcortical Damage of Vascular Origin: A Longitudinal Prospective Study in Community-Dwelling Older Adults

Background:Both frailty and white matter hyperintensities (WMH) of presumed vascular origin are associated with enhanced expression of inflammatory biomarkers. Therefore, it is possible that pre-existing frailty predisposes to WMH progression. However, this relationship has not been explored. This population-based longitudinal prospective study aimed to assess the impact of frailty on subsequent progression of WMH in community-dwelling older adults living in rural Ecuador.Methods:Participants of the Atahualpa Project Cohort received baseline frailty assessment and brain MRIs. Frailty was evaluated by means of the Edmonton Frail Scale (EFS). WMH were graded according to the modified Fazekas scale. Individuals who received a follow-up brain MRI were included. Poisson regression models were fitted to assess the differential rate of WMH progression according to EFS score, after adjusting for demographics, level of education, and cardiovascular risk factors.Results:The study included 263 individuals aged ≥60 years (mean age: 65.7 ± 6.2 years; 57% women). The mean EFS score at baseline was 4 ± 2.3 points. Follow-up MRIs after a median follow-up of 6.5 years showed WMH progression in 103 (39%) individuals. The EFS score at baseline was associated with WMH progression in unadjusted analysis (P = .006). However, significance was not achieved in a multivariate Poisson regression model adjusted for relevant covariates (IRR: 1.07; 95% C.I.: 0.97-1.18; P = .192).Conclusions:Study results do not support an independent relationship between frailty and WMH progression, adjusting for the confounding effect of aging.

Relationship Between Frailty and Fatigue in Older Cancer Patients.

Older patients with cancer present many symptoms during treatment. One of those symptoms is fatigue, which may be caused by factors unrelated to cancer. One of those factors is frailty increased with age. Frailty and fatigue affect older patients with cancer physically, psychosocially, emotionally, and spiritually. This study investigated the relationship between frailty and fatigue in older patients with cancer. This descriptive study was conducted between July 15, 2019, and February 15, 2020, in the medical oncology polyclinic and the medical oncology outpatient treatment unit of a university hospital. The sample consisted of voluntary 288 patients who met inclusion criteria. Data were collected using a demographic questionnaire and the Edmonton Frail Scale (EFS), and the Cancer Fatigue Scale (CFS). The mean age of participants was 71.71 ± 5.29 years. Participants had a mean EFS score of 6 ± 3.21. Of participants, 36.1% were not frail, while 20.1% were vulnerable, 19.1% moderately frail, 17.7% mildly frail, and 6.9% severely frail. Participants had a mean CFS score of 21.41 ± 12.25. There was a positive correlation between EFS and CFS scores (P = .000, r = 0.734). Of participants, 63.8% were frail with physical and cognitive fatigue. The higher the frailty, the higher the fatigue. Elderly patients with cancer appear to be fragile, with frailty causing fatigue and many other conditions. It is important to determine the frailty and fatigue of elderly patients with cancer. It is essential understand the relationship between the frailty and fatigue for effective and correct management of nursing care.

Prevalence of Hypovitaminosis C and its Relationship with Frailty in Older Hospitalised Patients: A Cross-Sectional Study.

Frailty is common in older hospitalised patients and may be associated with micronutrient malnutrition. Only limited studies have explored the relationship between frailty and vitamin C deficiency. This study investigated the prevalence of vitamin C deficiency and its association with frailty severity in patients ≥75 years admitted under a geriatric unit. Patients (n = 160) with a mean age of 84.4 ± 6.4 years were recruited and underwent frailty assessment by use of the Edmonton Frail Scale (EFS). Patients with an EFS score <10 were classified as non-frail/vulnerable/mildly frail and those with ≥10 as moderate–severely frail. Patients with vitamin C levels between 11–28 μmol/L were classified as vitamin C depleted while those with levels <11 μmol/L were classified as vitamin C deficient. A multivariate logistic regression model determined the relationship between vitamin C deficiency and frailty severity after adjustment for various co-variates. Fifty-seven (35.6%) patients were vitamin C depleted, while 42 (26.3%) had vitamin C deficiency. Vitamin C levels were significantly lower among patients who were moderate–severely frail when compared to those who were non-frail/vulnerable/mildly frail (p < 0.05). After adjusted analysis, vitamin C deficiency was 4.3-fold more likely to be associated with moderate–severe frailty (aOR 4.30, 95% CI 1.33-13.86, p = 0.015). Vitamin C deficiency is common and is associated with a greater severity of frailty in older hospitalised patients.