Frail Elderly Research Articles

The impact of a cardio-geriatric integrated care on mortality and readmissions in older patients with Heart Failure. Results of a quasi-experimental study

Abstract Background Despite advancements in heart failure (HF) management, older adults still experience adverse outcomes. Post-discharge care for frail elders is often complicated by non-cardiac events and Hospital-Acquired Deconditioning Syndrome. While an integrated multidisciplinary approach combining cardiological and geriatric expertise appears highly beneficial, it remains underutilized. Purpose To evaluate the effectiveness of an integrated Cardio-Geriatric approach in improving one-year mortality, reducing HF readmissions and increasing days-alive-out-of-hospital (DAOH) among older patients discharged from acute care hospitals. Methods The study utilized a before-and-after design. The study enrolled two groups of patients: the first consisted of individuals aged ≥ 65 years hospitalized for acute HF between January 2018 and December 2019, receiving usual care (UC) post-discharge follow-up (referral to a cardiologist and general practitioner); the second group evaluated outpatients in the Cardio-Geriatric ambulatory clinic (CG) within three weeks after discharge for acute HF between January 2020 and December 2022. Primary outcomes included one-year all-cause mortality, HF readmissions and DOAH. Cox Regression analysis adjusted for age, sex, frailty status, and main comorbidities assessed CG effectiveness. Results Among 606 patients (mean age 86 years, 56% females), 477 received US, the remaining 175 were referred to the CG. At 1-year follow-up we observed a significant reduction in re-hospitalizations between CG and UC (36.5% vs. 53.6%; respectively, p < 0.001) and mortality (20% vs. 44.8%; respectively, p < 0.001). CG patients had more than double DAOH (300 ± 100 vs 156 ± 145 days, p <0.001). Cox regression analysis confirmed CG integrated approach as a protective factor for mortality or re-hospitalization even after adjustment for confounders [aHR 0.50; 95% CI (0.28-0.89)]. Respiratory diseases, neurological conditions, and infections were common causes of readmission, emphasizing the need for comprehensive post-discharge care. Conclusion The Cardio-Geriatric integrated approach significantly improved outcomes, highlighting the potential of integrated care in addressing the multifaceted needs of older adults with heart failure

Frailty: A Familiar Challenge or an Unknown Question for Anesthesiologist – Results of an Indian Survey

Abstract Background: Frailty is a public health issue, and with increased life expectancy, more elderly patients are coming for surgical interventions. It is a multidimensional condition, characterized by loss of functional reserve which leads to adverse perioperative outcomes. This novel survey in the Indian scenario not only identifies the knowledge and orientation of the Indian anesthesiologists but also their day-to-day practice of frailty assessment. Methods: This 22-question survey was distributed to mostly Indian anesthesiologists practicing in various cities through electronic media. The first section included the electronic addresses and the informed consent. The second section contains the academic background and demography of the respondents. The third section includes their awareness about frailty and how they perceive it as a clinical entity. The last section focuses on the actual practice of frailty assessment by the participants. Results: We received 306 responses, among them 295 doctors practice anesthesia. Ninety-four percent of respondents agreed that the concept of frailty should be known to all anesthesiologists, 89% of the responses concurred that frailty affects postoperative outcomes. Only 54% respondents were properly trained in this topic during their training days and 45% of all were only confident to diagnose frailty in the preanesthetic check (PAC) clinic. Thirty seven percent of respondents lacked basic knowledge about different frailty tools. Forty-three percent of respondents revealed that they do not report the presence of frailty in patient files during PAC. Only 10% of the respondents have ever used any point-of-care ultrasound for frailty assessment. In 73% of cases, there was no geriatric team available in the hospitals, and 71% said that there is no well-implemented preoperative approach in their hospital for elderly frail patients for elective surgery. Conclusions: Despite the awareness of the importance of frailty in preoperative assessment, there is a huge void in the identification and assessment of frail patients in hospitals. There is an absolute need for a uniform and standardized national guideline.

SP9.1 - Enhancing Personalised Care by Introducing Frailty Management On Lower GI 2ww Pathway

Abstract Introduction/Aim Increasing number of patients with suspected lower GI cancer are being sent Straight-To-Test to achieve the 28Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have piloted a frailty pathway incorporated into the protocol for management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes. Methods A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-November2023 was analysed. Patients age>75 with a frailty score>=5 or performance status>=3, dementia, poly-pharmacy or from care home were referred straight to the frailty-unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard pathway. Results Over 22 months-period, 228 patients with suspected cancer were seen on the frailty pathway. The average number of investigations per referral was0.5 for frail patients compared to 1 for other patients on the standard pathway. 49.5% (113 patients) were found to be unfit for further investigations or declined/self-discharged. 5 patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer. The 2ww standard was met in 80% of frail patients compared to 55% in >75s who were sent straight-to-test on the standard pathway. The 28-day FDS standard was met in 50% of frail patients compared with 18% in >75s. Conclusion The frailty pathway is an effective initiative in reducing unnecessary invasive investigations. Frail patients benefit from holistic geriatric assessment prior to invasive investigations, ensuring suitability and appropriateness.

SP9.3 - Introducing Frailty Assessment into The Suspected Lower GI Cancer Pathway – Results of a 2 Year Pilot

Abstract Introduction & Aim An Increasing number of patients with suspected lowerGI cancer are being sent Straight-To-Test to achieve the 28 Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have been piloting a frailty pathway incorporated into the protocol for secondary care management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes. Methods A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-January2024 was analysed. Patients aged>75 with a frailty score of >=5 or performance status>=3, dementia, poly-pharmacy or from care home were referred straight to the frailty unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard-pathway. Results Over a 24-month period, 228patients with suspected cancer were seen on the frailty pathway. 49.5%(113patients) were found to be unfit for further investigations or declined/self-discharged. The 2ww standard was met in80%of frail patients compared to55% in>75s who were sent straight-to-test on the standard pathway. The 28day-FDS standard was met in50%of frail patients compared with18%in the other>75s.The average number of investigations per referral was0.5for frail patients compared to 1 for patients on the standard-pathway. 5patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer. Conclusion The frailty pathway is an effective initiative in reducing unnecessary invasive investigations, whilst providing timely investigations on the suspected cancer pathway.

Impact of Frailty on Outcome of Older Patients With Non-ST Elevation Acute Myocardial Infarction Who Undergo Percutaneous Coronary Intervention

IntroductionFrailty status is linked with a poorer clinical outcome and frail patients are often less revascularized even with percutaneous coronary intervention (PCI). We therefore sought to assess the impact of frailty on clinical outcome of elderly patients with non ST-elevation acute-myocardial-infarction (NSTEMI) undergoing PCI. MethodsWe prospectively enrolled 141 consecutive elderly (>75 years) patients admitted for NSTEMI. 104 patients underwent PCI (35 frail, 69 non-frail), 37 were not revascularized (22 frail, 15 non frail). ResultsFrail patients were older, less frequently male, more affected by dementia and severe left ventricular dysfunction, less treated with PCI; patients treated with PCI were younger and less affected by dementia.Thirty-day mortality rates were proportionally higher from 3% in non-frail patients treated with PCI, to 7% in non-frail not treated with PCI, 17% in frail treated with PCI, 48% in frail patients not treated with PCI (p <0.05). Similarly 6-month mortality rates were proportionally higher (12%, 29%, 37%, 71%).At multivariable analysis frail status was associated to a 6-fold increased risk of mortality at 30-days; at 6 months, frail status was associated to a 3.4-fold risk of death (p<0.01) but also PCI was associated to a lower risk of mortality (OR 0.2, p<0.01). ConclusionsIn an observational study on elderly NSTEMI patients, frail status is associated to a poorer outcome, while PCI is associated to a better long term outcome. A careful selection of patient suitable for revascularization by PCI may be useful in improving outcome of elderly frail patients with NSTEMI.

The conveyor belt for older people nearing the end of life.

The current fallback position for the elderly frail nearing the end of life (less than 12 months to live) is hospitalisation. There is a reluctance to use the term 'terminally ill' for this population, resulting in overtreatment, overdiagnosis and management that is not consistent with the wishes of people. This is the major contributor to the so-called hospital crisis, including decreased capacity of hospitals, reduced ability to conduct elective surgery, increased attendances at emergency departments and ambulance ramping. The authors recently conducted the largest randomised study, to their knowledge, attempting to inform specialist hospital medical teams about the terminally ill status of their admitted patients. This information did not influence their clinical decisions in any way. The authors discuss the reasons why this may have occurred, such as the current avoidance of discussing death and dying by society and the concentration of healthcare workers on actively managing the acute presenting problem and ignoring the underlying prognosis in the elderly frail. The authors discuss ways of improving the management of the elderly nearing the end of life, such as more detailed goals of care discussions using the concept of shared decision-making rather than simply completing Advanced Care Decision documents. Empowering people in this way could become the most important driver of people's health care.

Strategies to Reduce Alternate Level of Care

What Is the Issue? Alternate level of care (ALC) is when a patient is occupying a bed in a hospital and does not require the intensity of resources or services provided in that hospital. ALC is a persistent barrier to providing efficient health care in Canada, as it is in most health systems worldwide (where ALC is referred to as delayed discharge). Older adults (aged 65 years or older) who require placement in residential care are the largest subgroup of the ALC patient population. Analyzing ALC use data can inform decision-makers about data trends and which jurisdictions have reduced ALC times. By understanding the strategies, policies, or other interventions that have been used to reduce ALC in Canada, and which have been successful at minimizing ALC, decision-makers can consider which strategies to implement in their health jurisdictions. What Did We Do? We analyzed Canadian Institute for Health Information data related to ALC and average length of ALC in older adults in the provinces and territories of Canada. We conducted an environmental scan of the academic and grey literature to: identify strategies to address ALC in older adults in Canada identify strategies that have been effective in reducing ALC in older adults in Canada. What Did We Find? In 2022 to 2023, Canada (excluding Quebec) had 15 ALC hospitalizations per 1,000 population, 369 total ALC days per 1,000 population, and a mean of 25 ALC days per hospitalization in patients aged 65 and older awaiting admission to residential care or elsewhere. While there were variations across jurisdictions, the trends in ALC over time for adults aged 55 years and older were relatively consistent. Patients with more ALC days were aged 75 years and older, had lower incomes, and were admitted to the hospital as urgent. We identified 19 strategies that addressed ALC in older adults in Canada. These included input, throughput, and system-level interventions, which we categorized as live information sharing, recommended initiatives, tools and guidelines, practice changes, and infrastructure and finance. We identified 4 studies that reported a favourable effect of a throughput or system-level strategy compared to no strategy or standard care on ALC hospitalizations, length of stay, or discharge to home. Two throughput strategies may be effective: The Subacute Care for the Frail Elderly (SAFE) Unit improved ALC length of stay (LOS), hospital LOS, and discharge to home. The Transitional Care Unit improved discharge to home. Two system-level strategies may be effective: Home First improved ALC hospitalizations, ALC LOS, and discharge to home. Behavioural Supports Ontario improved ALC hospitalizations and ALC LOS. What Does This Mean? We found common themes in our environmental scan that decision-makers may incorporate into strategies for addressing ALC in older adults waiting for residential care, including the provision of integrated care, promotion of age-friendly care, early identification of patients at risk of ALC, sharing of tools and resources, transitional care, and inclusion of families and caregivers in care planning. This report may serve as the first step for future systematic reviews or other evidence syntheses with a broader scope. Future research might investigate the factors that contribute to ALC and interventions to address those factors.

Adherence to the Mediterranean Diet Mitigates Inflammation and Hospital Stay in Frail Elderly Patients: A Moderation Analysis.

We conducted two-way ANOVA and multiple regression analysis to evaluate the effects of nutritional status and MD adherence on the CRP levels and LOS in a cohort of 117 frail elderly patients aged 65 years or older. Patients with cancer or acute infection were excluded. Adherence to the MD was assessed using the 14-item PREDIMED questionnaire. Significant interactions were found between nutritional status and MD adherence for both the CRP and LOS. The patients with low-level MD adherence and a poor nutritional status exhibited higher CRP levels and longer hospital stays compared to those with high MD adherence. Specifically, a statistically significant interaction was observed for the CRP (F (1, 113) = 7.36, p = 0.008) and LOS (F (1, 113) = 15.4, p < 0.001), indicating the protective effect of high-level MD adherence. Moderation analysis confirmed that high-level MD adherence mitigates the adverse effects of malnutrition on both the inflammatory response and LOS. These findings highlight the importance of promoting the MD, particularly in malnourished elderly patients, to improve health outcomes and reduce hospitalization duration. Further longitudinal studies are warranted to establish causality and explore the underlying mechanisms.

An uncommon orthogeriatric syndrome: a case of Ogilvie’s syndrome

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is an uncommon postoperative complication of major orthopedic surgery that is characterized by massive colonic dilatation and the potential for substantial morbidity and mortality. Most patients who had Ogilvie’s syndrome had risk factors that could be identified preoperatively, such as immobility, elevated comorbidity, and polypharmacy, prefiguring the frail elderly patient. In modern terms, it is considered a typical orthogeriatric syndrome. In these kinds of patients, we need to be vigilant for its development and judicious in the use of epidural anesthesia. We present an ACPO case in an elderly frail patient with a hip fracture, and we review the available literature to outline clinical characteristics and outcomes. Our patient presented numerous risk factors for developing the syndrome in the preoperative period: nonautonomy in basic and daily living activities, polypharmacotherapy, spinal trauma, and hyposodiemia. In this patient, epidural anesthesia was an additional risk factor. The purpose of this case report is to emphasize the presence of this rare syndrome (1.5% of orthogeriatric patients) in orthogeriatric departments and to identify not only pharmacological, traumatic, and electrolytic risk factors but also those that can be identified even through geriatric evaluation to avoid the use of anesthesiologic techniques and drugs that may have an impact on the prognosis of these patients.

Integrating Palliative Medicine into Medical Education: Creating a More Compassionate Generation of Physicians

How should Palliative Medicine competencies be taught to medical students? In the United States and other countries, there is a consensus that teaching Palliative Medicine competencies to medical students is essential. Health agencies have also identified teaching Palliative Medicine competencies as crucial. According to Sanchez-Reilly and Ross, medical students reported that they feel better prepared to care for the elderly, patients with severe illness, and dying patients after completing formal training. The authors hypothesized that a one-week rotation with Palliative Medicine during the Medicine Clerkship would improve the medical students’ skills to care for these populations of patients. The one-week inpatient rotation was designed to equip all fifty medical students at Mayo Medical School with a knowledge base of Palliative Care, communication skills, care for elderly frail and dying patients, and basic pain management for patients with severe illness. Each of the fifty students rotated with a Palliative Care consulting team with patient interaction, lectures, online teaching, and interdisciplinary team activities. Hands-on learning proved more effective than using just the classroom teaching classical model, with 70% of students responding positively to the hands-on approach. Learning how to apply Palliative Care skills while visiting patients with complex diseases, showed to be better received as an education module. Out of the fifty medical students surveyed, thirty-five responded (70%), and all responses were positive. This method of teaching could be expanded to teach other advanced hospice and palliative care skills.

Impaired oral health: a required companion of bacterial aspiration pneumonia.

Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.

Correlation between depression and adherence to respiratory function exercise in elderly frail patients with tuberculosis: A cross-sectional survey.

We investigated the current state of frailty in elderly patients with tuberculosis and analyzed the factors that influence it. Using a convenience sampling method, 120 elderly patients with tuberculosis were selected from the Department of Infectious Diseases at Lishui Hospital of Traditional Chinese Medicine in Zhejiang Province. A cross-sectional survey was conducted using general demographic questionnaires, the FRAIL (fatigue, resistance, aerobic capacity, illnesses, and loss of weight) screening scale, the self-rating depression scale (SDS), and a questionnaire on respiratory function exercise adherence. The influencing factors for depression were analyzed using logistic regression. The average depression score of the 120 elderly patients with frailty and tuberculosis was 54.88 ± 5.61, indicating a mild level of depression. The correlation between this score and respiratory function exercise adherence was negative. According to a logistic regression analysis, marital status and payment methods were influencing factors for depression in these elderly patients with frailty and tuberculosis. There is a need to increase respiratory function exercise adherence among elderly patients with frailty and tuberculosis who have a high incidence of depression. Medical staff should assess adverse emotions in patients and their adherence to respiratory function exercises on a periodic basis.

Timing to surgery in elderly patients with small bowel obstruction: An insight on frailty.

Small bowel obstruction (SBO) frequently necessitates emergency surgical intervention. The impact of frailty and age on operative outcomes is uncertain. This study evaluated postoperative outcomes of SBO surgery based on patient's age and frailty and explore the optimal timing to operation in elderly and/or frail patients. Patients who underwent SBO surgery were identified in American College of Surgeons National Surgical Quality Improvement Program database 2005 to 2021. Patients aged ≥65 years were defined as elderly. Patients with 5-Factor Modified Frailty Index≥2 were defined as frail. Multivariable logistic regression was used to compare 30-day postoperative outcomes between elderly frail versus nonfrail patients, as well as between nonfrail young versus elderly patients. There were 49,344 patients who had SBO surgery, with 7,089 (14.37%) patients classified as elderly frail, 17,821 (36.12%) as elderly nonfrail, and 21,849 (44.28%) as young nonfrail. Elderly frail patients had higher mortality (adjusted odds ratio, 1.541; p < 0.01) and postoperative complications compared with their elderly nonfrail counterparts; these patients also had longer wait until definitive operation ( p < 0.01). Among nonfrail patients, when compared with young patients, the elderly had higher mortality (adjusted odds ratio, 2.388; p < 0.01) and complications, and longer time to operation ( p < 0.01). In elderly nonfrail patients, a higher mortality was observed when surgery was postponed after 2 days. Mortality risk for frail elderly patients is heightened from their already higher baseline when surgery is delayed after 4 days. When SBO surgery is postponed for more than 2 days, elderly nonfrail patients have an increased mortality risk. Consequently, upon admission, these patients should be placed under a nasogastric tube and undergo an initial gastrograffin challenge. If there is no contrast in colon, they should be operated on within 2 days. Conversely, elderly frail patients with SBO have a higher mortality risk when surgery is delayed beyond 4 days. Thus, following the same scheme, they should be operated on before 4 days if gastrograffin challenge fails. Therapeutic/Care Management; Level III.

Determination of Frail Elderly Status in a Home Healthcare Population

Determination of Frail Elderly Status in a Home Healthcare Population

Barriers and facilitators to the implementation of prehabilitation for elderly frail patients prior to elective surgery: a qualitative study with healthcare professionals

BackgroundPrehabilitation aims to enhance functional capacity before surgery, minimise complications and achieve a better postoperative outcome. This can be particularly useful for older, frail patients to better tolerate surgery. The aim of this study was to identify what barriers and facilitators healthcare professionals in Germany experienced in the implementation and delivery of the multimodal prehabilitation programme “PRAEP-GO” for (pre-)frail adults aged 70 years and older to inform the implementation of prehabilitation into standard care.MethodsA nested descriptive qualitative study was conducted using semi-structured face-to-face interviews with healthcare professionals involved in the PRAEP-GO trial from the Berlin and Brandenburg region in Germany. Transcripts were analysed using Kuckartz’ qualitative content analysis. Results were interpreted and synthesised using the Consolidated Framework for Implementation Research, a theoretical framework to allow their application to a more general context.ResultsA total of 14 interviews were conducted. Seven therapists (physio-, ergo-, sports therapy), five physicians and two employees from other professions with mainly administrative and organisational tasks in the project. All identified barriers and facilitating factors could be assigned to the themes of organisation, prehabilitation, cooperation and communication between healthcare professionals and with patients. Much optimisation potential was found regarding organisational aspects, e.g. addressing perceived staff shortages and optimising the patient pathway. Furthermore, it became apparent that communication and cooperation between professionals but also with patients need to be improved. More evidence regarding prehabilitation should be provided to convince professionals more. Prehabilitation should be multimodal and individualised, including the programme duration. Officially introducing prehabilitation into standard care would facilitate its delivery.DiscussionThese findings underscore the fact that successful implementation of prehabilitation programmes, such as PRAEP-GO, requires sufficient organisational infrastructure, human resources, access to knowledge, an adaptable and individualised programme design as well as good communication among professionals and with patients. The transferability of the findings is limited by the absence of nutritionists and resulting overrepresentation of other therapists in the sample. To further convince professionals and patients of the concept of prehabilitation, more research is needed to build a solid evidence base that will ensure greater awareness and, thus, more motivation and cooperation among professionals and patients.Trial registrationOpen Science Framework (osf.io/ksfgj).

Issues in Performing Actual Ways of Salah (Islamic Prayer) among Physically Frail Elderly Muslim

This study addresses the escalating challenges posed by Malaysia's rapidly ageing population, with projections indicating a surge in the elderly demographic. The geriatric giant, encompassing issues like immobility and memory impairment, has expanded to include frailty and sarcopenia. Notably, the impact of these conditions on daily activities, notably the crucial spiritual practice of Salah (Islamic prayer) among elderly Muslims, is underexplored. This research aims to bridge this gap by identifying and exploring the intricacies of performing Salah among frail elderly Muslims, shedding light on the often-neglected spiritual needs within the ageing population in Malaysia.

Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

BackgroundPrehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation for frail elderly patients before elective surgery compared to standard care (PRAEP-GO RCT). The aim is to determine the cost-effectiveness and cost-utility of prehabilitation for frail elderly before an elective surgery.MethodsThe planned health economic evaluation comprises cost-effectiveness, and cost-utility analyses. Analyses are conducted in the German context from different perspectives including the payer perspective, i.e. the statutory health insurance, the societal perspective and the health care provider perspective. Data on outcomes and costs, are collected alongside the ongoing PRAEP-GO RCT. The trial population includes frail or pre-frail patients aged ≥70 years with planned elective surgery. The intervention consists of frailty screening (Fried phenotype), a shared decision-making conference determining modality (physiotherapy and unsupervised physical exercises, nutrition counselling, etc.) and setting (inpatient, day care, outpatient etc.) of a 3-week individual multimodal prehabilitation prior to surgery. The control group receives standard preoperative care.Costs include the intervention costs, the costs of the index hospital stay for surgery, and health care resources consumed during a 12-month follow-up. Clinical effectiveness outcomes included in the economic evaluation are the level of care dependency, the degree of disability as measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), quality-adjusted life years (QALY) derived from the EQ-5D-5L and the German utility set, and complications occurring during the index hospital stay. Each adopted perspective considers different types of costs and outcomes as outlined in the protocol. All analyses will feature Intention-To-Treat analysis. To explore methodological and parametric uncertainties, we will conduct probabilistic and deterministic sensitivity analyses. Subgroup analyses will be performed as secondary analyses.DiscussionThe health economic evaluation will provide insights into the cost-effectiveness of prehabilitation in older frail populations, informing decision-making processes and contributing to the evidence base in this field. Potential limitation includes a highly heterogeneous trial population.Trial registrationPRAEP-GO RCT: NCT04418271; economic evaluation: OSF (https://osf.io/ecm74).

Factors contributing to subjective well-being and supporting successful aging among rural Japanese community-dwelling older adults: A cross-sectional and longitudinal study.

We aimed to identify the factors contributing to subjective well-being in community-dwelling older adults in rural Japan. This study explored the relationship among physical and mental health, socioeconomic status, and activity levels with regard to the subjective well-being of older adults. In the Frail Elderly in the Sasayama-Tamba Area study, a cohort investigation of independent older adults in a rural Japanese community, 541 of 844 participants completed a 2-year follow-up survey. Subjective well-being was assessed as a binary based on three factors - "happiness," "satisfaction with life" and "meaning in life" - using a subset of the World Health Organization's Quality of Life questionnaire. The improvement group transitioned from not having subjective well-being during the baseline survey to having subjective well-being during the follow-up survey. Furthermore, we used multivariable log-Poisson regression models to calculate the prevalence ratios of subjective well-being. The cross-sectional study showed that sleep satisfaction, health services access satisfaction and having a higher-level functional capacity were positively associated with having "happiness" and "satisfaction with life." Furthermore, being aged 80 years and having financial leeway were positively associated with having "meaning in life." The longitudinal study showed that having a higher-level functional capacity was positively associated with improving "happiness" and "satisfaction with life." Being female was positively associated with improving "happiness" and "meaning in life," and health services access satisfaction and alcohol drinking were positively associated with improving "satisfaction with life" and "meaning in life," respectively. These findings offer promising avenues for enhancing the subjective well-being of older adults. Geriatr Gerontol Int 2024; 24: 311-319.

Serum Creatinine-Cystatin C Based Screening of Sarcopenia in Community Dwelling Older Adults: A Cross-Sectional Analysis.

To compare the discriminative capabilities for the manifestation of sarcopenia or physical frailty between serum creatinine- and cystatin C-derived indices among community-dwelling older adults. Cross-sectional study. Primary Care and Community. We utilized a subset of data from the Frail Elderly in the Sasayama-Tamba Area (FESTA) study, which was initiated in 2015 to gather comprehensive information on various health-related parameters among community-dwelling older individuals (age ≥65 years). Five serum creatinine-cystatin C based indices including the Sarcopenia Index, the serum creatinine/cystatin C ratio, the disparity between serum cystatin-C-based and creatinine-based estimated GFR, the total body muscle mass index (TBMM), and the prediction equation for skeletal muscle mass index (pSMI) were employed. Sarcopenia and physical frailty were identified based on the Asian Working Group for Sarcopenia criteria and the revised Japanese version of the Cardiovascular Health Study criteria, respectively. The receiver operating characteristic (ROC) and logistic regression analyses were performed to assess the discriminative abilities of these tools. In the analysis of 954 participants, 52 (5.5%) were identified with sarcopenia and 35 (3.7%) with physical frailty. Regarding sarcopenia discrimination, TBMM and pSMI both exhibited area under the curve (AUC) values exceeding 0.8 for both men and women. Concerning the identification of physical frailty, AUC values ranged from 0.61 to 0.77 for males and 0.50 to 0.69 for females. In the multivariate logistic regression analyses, only TBMM and pSMI consistently displayed associations with sarcopenia, irrespective of sex (P<0.001, respectively). On the other hand, no consistent associations were observed between the indices and physical frailty. This study provides a robust association of a serum creatinine- and cystatin C-derived indices, especially TBMM and pSMI, with sarcopenia among community-dwelling older adults. Conversely, the application of these indices for the screening of physical frailty has its constraints, necessitating further investigation.

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.