Assessment Of Frailty In Patients Research Articles

P100 Prospective mid-term assessment of frailty in patients implanted with left ventricular assist devices- any reversibility within different domains?

Abstract Background The coalescence of the frailty phenotype and advanced heart failure (HF) presents a unique opportunity to assess any LVAD mediated improvement of cardiac output that may potentially improve the slowness, weakness, fatigue, weight loss and physical inactivity that comprise the frailty phenotype. We sought to determine whether implantation of LVAD could improve frailty in Chinese population. Methods From March 2015 to May 2018, 24 patients (pts) with advanced HF underwent LVAD implantation and 16 pts who remained on LVAD support for 18 months were assessed serially every six months. A new multi-disciplinary objective assessment of frailty with relevance to local Chinese population was designed to enable serial reassessment of patient’s clinical progress. The total maximum scores ranged from 0-7 [1. Physical score 0-5 namely exhaustion, poor appetite, weak hand grip, 6 minute hall walk test <400m and reduced physical activity; 2. Cognitive (Montreal Cognitive Assessment-Hong Kong) <22= 1; 3. Depression (Hospital Anxiety and Depression Scale) > = 1]. Results During the period studied, 5 pts received heart transplantation and 3 pts died. Mean age of remaining 16 pts (94% men) was 53 ± 13 years old. There was significant reduction in total frailty score mainly driven by significant reduction in physical domain. However, frailty was only completely reversible in 8 pts (50%). Improvement in frailty post LVAD were not associated with significant differences in measures of mood or cognition. (Figure 1) Conclusions The components of the frailty phenotype in pts with post LVAD surgery all have significant improvements. Absences of any association between improvements in the frailty phenotype and mood or cognition warranted further focused attention in the rehabilitation program for LVAD pts. Abstract P100 Figure.

Heart Failure Association/European Society ofCardiology position paper on frailty in patients with heart failure.

Heart failure (HF) and frailty are two distinct yet commonly associated conditions. The interplay between the two conditions is complex, due to overlaps in underlying mechanisms, symptoms and prognosis. The assessment of frailty in patients with HF is crucial, as it is associated with both unfavourable outcomes and reduced access and tolerance to treatments. However, to date a consensus definition of frailty in patients with HF remains lacking and the need for a validated assessment score, for identifying those HF patients with frailty, is high and timely. This position paper proposes a new definition of frailty for use by healthcare professionals in the setting of HF and creates a foundation for the design of a tailored and validated score for this common condition.

Frailty Assessment in Patients with Liver Cirrhosis.

Frailty Assessment in Patients with Liver Cirrhosis.

Assessment of frailty in Alzheimer's: a literature review

As the UK's older population continues to rise, the more likely it is for practice nurses to encounter patients living with Alzheimer's and frailty. Kirsty Smith and Sophie Wallington explore the definitions and models of frailty available in medical literature As a consequence of an ageing global population, it is likely that encounters between health professionals and frail patients will rise. Patients with both suspected frailty and Alzheimer's disease are frequently encountered in primary care. There are links and overlaps between these disease states; however, the key theories and models of frailty propose some contradictions. This review of the definition, theories and models of frailty, and relevance to patients with Alzheimer's disease will add a quality, evidence-based approach to the assessment of frailty in patients in primary care living with Alzheimer's disease.

Abstract 17274: Timed up and Go Test Predicts One-Year Mortality Among Patients Cardiovascular Events After Percutaneous Coronary Intervention

Timed Up and Go test predicts one-year mortality among patients cardiovascular events after percutaneous coronary intervention Nadeem A. Khan, R. Jay Widmer, Amrit Kanwar, Mohammed A. Al-Hijji, Abdallah El Sabbagh, Ryan J. Lennon, Rajiv Gulati, Amir Lerman, Arashk Motiei, Mandeep Singh Background: Frailty is frequently seen in older adults and among patients with cardiovascular disease (CVD). Timed Up and Go Test (TUG) is a reliable and validated measure of frailty. We aim to assess 1-year mortality and stratify patients based on the performance on the test. Methods: Patients ≥55 years and referred to the cardiac catheterization laboratory underwent the TUG, a simple test to measure static and dynamic balance. We timed the patients while they were instructed to rise from the chair, walk 3 meters (or 10 feet), turn around, and walk back to the chair and sit down. Timing was divided in four categories [<7 sec (controls), 8-10 sec, 11-14 sec, and > 15 sec]. Mortality at one year was evaluated using a Cox proportional hazards model. Results: Those with TUG >15s were older (75.8 ±9.1years vs. 71.2±9.2 years in controls; P<0.001) and more women (42% vs. 29%) had TUG >15s, P=0.002. Patients with TUG >15 s had a significantly increased risk of mortality on follow-up (HR 3.88, 95% CI 1.97-7.66; P<0.001, Figure) which remained significant after adjusting for age and sex (HR 1.86, 95% CI 1.05, 3.30). Conclusions: The TUG test predicts one year mortality among patients referred to the cardiac catheterization laboratory. These data underscore the importance of frailty assessment in patients with CVD.

Frailty assessment in older adults with chronic obstructive respiratory diseases.

The number of patients with chronic obstructive pulmonary disease (COPD) has been rising with continued exposure to environmental risk factors and aging of populations around the world. Frailty is a geriatric syndrome with a decline in physiological reserve and often coexists with chronic diseases such as COPD. Frailty is an independent risk factor for the development and progression of COPD, and COPD can lead to frailty; treating one might improve the other. Thus, there is an increasing interest in the assessment of frailty in patients with COPD. Furthermore, early identification and assessment of frailty in patients with COPD may affect the choice of intervention and improve its effectiveness. Based on the current literature, the intent of this review was to summarize and discuss frailty assessment tools used for COPD patients and the relevant clinical practices for predicting outcomes. We ascertain that using suitable frailty assessment tools could facilitate physicians to screen and stratify physically frail patients with COPD. Screening appropriately targeted population can achieve better intervention outcomes and pulmonary rehabilitation among frail COPD patients.

23. Frailty assessment in patients with cirrhosis: a pilot study

Background and Aims: Patients with cirrhosis are vulnerable to an increased risk of functional decline. Frailty is a validated geriatric construct that objectively measures progressive functional decline. In this prospective study, we aimed to determine the prevalence and degree of frailty in patients with cirrhosis. Methods: Consecutive adult patients (>18 years) with cirrhosis were included in the study. Four measure frailty testing using Fried Frailty Instrument, Short Physical Performance Battery (SPPB) and Instrumental Activities of Daily Living Scale (IADL) were administered at a single time point. Furthermore, Karnofsky's performance status and Eastern Cooperative Oncology Group (ECOG) performance status was calculated. Results: Thirty-three adults were included in the study (27 males, 6 females; age 54.03 ± 11.68 years). Etiology of cirrhosis was Non-alcoholic steato-hepatitis in 12, ethanol in 10, Hepatitis B in 5 and Hepatitis C, cryptogenic and autoimmune in 2 patients each. Nine patients belonged to Child-Turcotte-Pugh (CTP) class A, 18 to class B and 6 to class C. The average Model for End Stage Liver Disease-sodium (MELDNa) score was 12.2 ± 4.8. Twenty-three patients were frail and 10 were intermediate frail. Frail patients had more prevalence of ascites (18 vs. 4 patients; p = 0.049), weight loss (p = 0.001) and lower physical energy (p = 0.039). They also had a higher MELDNa score (12.9 ± 5.3 vs. 10.2 ± 2.2; p = 0.05) and higher CTP score (p = 0.082). Additionally, frail patients had lower grip strength (10.78 ± 8.71 kg vs. 22.08 ± 13.94 kg; p = 0.035), lower balance test score (p = 0.007), lower gait speed score for 4-meter walk (p = 0.001), lower chair stand score (p = 0.001) and lower total SPPB score (p = 0.001). Total IADL score (p = 0.0001), Karnofsky Performance status (p = 0.0010) and ECOG performance score (p = 0.0001) was lower in frail patients. Conclusions: Frailty is an important problem amongst patients with cirrhosis. Frailty assessment and interventions directed towards improving performance status should be an essential part of management of patients with cirrhosis. The authors have none to declare.

Grip strength measurement for frailty assessment in patients with vascular disease and associations with comorbidity, cardiac risk, and sarcopenia

ObjectiveFrailty is associated with adverse events, length of stay, and nonhome discharge after vascular surgery. Frailty measures based on walking-based tests may be impractical or invalid for patients with walking impairment from symptoms or sequelae of vascular disease. We hypothesized that grip strength is associated with frailty, comorbidity, and cardiac risk among patients with vascular disease. MethodsDominant hand grip strength was measured during ambulatory clinic visits among patients with vascular disease (abdominal aortic aneurysm [AAA], carotid stenosis, and peripheral artery disease [PAD]). Frailty prevalence was defined on the basis of the 20th percentile of community-dwelling population estimates adjusted for age, gender, and body mass index. Associations between grip strength, Charlson Comorbidity Index (CCI), Revised Cardiac Risk Index (RCRI), and sarcopenia (based on total psoas area for patients with cross-sectional abdominal imaging) were evaluated using linear and logistic regression. ResultsGrip strength was measured in 311 participants; all had sufficient data for CCI calculation, 217 (69.8%) had sufficient data for RCRI, and 88 (28.3%) had cross-sectional imaging permitting psoas measurement. Eighty-six participants (27.7%) were categorized as frail on the basis of grip strength. Frailty was associated with CCI (odds ratio, 1.86; 95% confidence interval, 1.34-2.57; P = .0002) in the multivariable model. Frail participants also had a higher average number of RCRI components vs nonfrail patients (mean ± standard deviation, 1.8 ± 0.8 for frail vs 1.5 ± 0.7 for nonfrail; P = .018); frailty was also associated with RCRI in the adjusted multivariable model (odds ratio, 1.75; 95% confidence interval, 1.16-2.64; P = .008). Total psoas area was lower among patients categorized as frail vs nonfrail on the basis of grip strength (21.0 ± 6.6 vs 25.4 ± 7.4; P = .010). Each 10 cm2 increase in psoas area was associated with a 5.7 kg increase in grip strength in a multivariable model adjusting for age and gender (P < .0001). Adjusted least squares mean psoas diameter estimates were 25.5 ± 1.1 cm2 for participants with AAA, 26.7 ± 2.0 cm2 for participants with carotid stenosis, and 22.7 ± 0.8 cm2 for participants with PAD (P = .053 for PAD vs AAA; P = .057 for PAD vs carotid stenosis; and P = .564 for AAA vs carotid stenosis). ConclusionsGrip strength is useful for identifying frailty among patients with vascular disease. Frail status based on grip strength is associated with comorbidity, cardiac risk, and sarcopenia in this population. These findings suggest that grip strength may have utility as a simple and inexpensive risk screening tool that is easily implemented in ambulatory clinics, avoids the need for imaging, and overcomes possible limitations of walking-based measures. Lower mean psoas diameters among patients with PAD vs other diagnoses may warrant consideration of specific approaches to morphomic analysis.

Frailty Assessments in Surgical Practice: What is Frailty and How Can It Be Used in Prosthetic Health?

Surgical frailty is a previously unrecognized clinical entity that objectifies a multiorgan decrease in physiologic reserve in those undergoing surgery. Although penile implantation has been demonstrated to be an effective means of restoring erectile function in patients whose previous conservative measures have failed, there are limited data regarding the assessment of frailty in patients undergoing penile implantation. To review the various objective methods used to describe surgical frailty in medical and surgical disciplines, report on methodologies of frailty assessment, and discuss the relevance of surgical frailty in the preoperative evaluation of patients undergoing implantation of an inflatable penile prosthesis. A literature review was performed through PubMed regarding surgical frailty in the disciplines of medicine, surgery, and urology. Key words and phrases included frailty, elderly, aging, erectile dysfunction, penile implantation, and penile prosthesis. Critical assessment of frailty in medicine and its application to male prosthetic health. Frailty has been assessed by different metrics in multiple fields. Validated modalities to determine physiologic reserve include an accumulation of deficits and phenotypic objective assessments that are reviewed in detail. Frail patients experience longer length of stay, postoperative complications, unplanned returns to the operating room, and readmissions and are less likely to be discharged to home. Novel frailty assessments objectified through grip strength measurements from our institution demonstrate that a considerable number of patients, young and old, undergoing penile implantation exhibit surgical frailty. There is a growing need to incorporate frailty assessment in the preoperative risk stratification of patients undergoing penile implantation. Grip strength evaluation seems to be an obvious standard because it is likely the easiest to measure and is clinically relevant given the user's dependence on manual dexterity to use the device. Screening for frailty does not create a substantial time, financial, or resource burden for the urologist. Brennan MS, Barlotta RM, Simhan J. Frailty Assessments in Surgical Practice: What is Frailty and How Can It Be Used in Prosthetic Health? Sex Med Rev 2018;6:302-309.

ORTHOSTATIC HYPOTENSION AND ITS RELATIONSHIP WITH FRAILTY

AbstractOrthostatic hypotension (OH) is the most common disorder of blood pressure regulation after essential hypertension, with prevalences increasing with age. Biologically, it is plausible that OH, reflecting disordered haemodynamic equilibrium, could be a manifestation of a wider process of multisystem dysregulation of frailty. Despite suggestions in the literature that OH may be a sign of frailty, few studies have been able to validate this hypothesis. In this cross-sectional observational study, we recruited 150 subjects from three different settings (apparently healthy, outpatient and inpatient). OH was defined as a drop of ≥20 mmHg in systolic blood pressure or a drop of ≥10 mmHg diastolic pressure and frailty was assessed using both the phenotypic (FP) and frailty index (FI) models. The frequency and correlates of OH in the three different settings were identified. OH was significantly related to the both FP and FI models.This study suggests that OH may be a marker of the system dysregulation seen in frailty and further assessment of frailty in patients of OH can be a potential opportunity for early intervention to delay functional decline.

A study of clinical assessment of frailty in patients on maintenance hemodialysis supported by cashless government scheme.

This is a prospective cohort study to assess the prevalence of frailty in patients undergoing maintenance hemodialysis (HD) under the government-funded scheme at our center and to assess the relationship between frailty and falls, hospitalizations, and mortality. This was done at our center which is completely supported by the government, which provides HD to all the patients under poverty line. Epidemiological data, anthropometric measurements, comorbidities assessment, frailty assessment using Fried criteria, subsequent hospitalizations, falls, and mortality were recorded in our prevalent dialysis population at our center between October 2014 and October 2015. Two hundred and twenty-six patients were enrolled during this period. Twenty-one patients were excluded as they did not satisfy the inclusion criteria. Two hundred and five prospective patients were studied for the predictors of frailty. Frailty was present in 82% of the study population. Mean age of our study population was 44.95 ± 13.27 years. On univariate analysis, diabetes mellitus, hypertension (HTN), cerebrovascular accident (CVA), left ventricular dysfunction (LVD), peripheral vascular disease (PVD), smoking, hepatitis C, inadequate dialysis, intradialytic hypotension (IDH), interdialytic weight gain, low serum creatinine <4 mg/dL, and anemia (Hb <10 g/dL) were found to be statistically significantly different between frail and nonfrail groups On multivariate regression analysis, only HTN, PVD, CVA, anemia, smoking, and IDH were found to be significant. Frailty is highly prevalent among dialysis population. Factors predicting frailty include HTN, smoking, LVD, PVD, CVA, smoking, anemia, and IDH. Frailty is a significant risk factor for falls and hospitalizations.

Frailty Assessment in Patients Utilizing a Free Clinic.

Frailty is most commonly associated with older adults; however, it has also been identified in vulnerable populations, including homeless adults. Patients who seek health care services in a free clinic often report physical exhaustion, difficulty coping with stressors, chronic disease states, environmental limitations, and a lack of social support, which may contribute to a state of frailty. This pilot study (N = 38) was conducted in adults ages 40-64 years who utilized a free clinic to determine if factors suggestive of frailty were present. The Comprehensive Frailty Assessment Instrument (CFAI) was the primary data collection instrument. Anthropometrics and physical performance data were also collected. Physical indicators of frailty were present in 60% of the sample. Psychological, social, and environmental factors affecting health were identified. Sixty-three percent of the participants scored frail or very frail on the CFAI. A larger study is needed to confirm these findings.

Frailty scoring in transcatheter aortic valve replacement patients.

Transcatheter aortic valve replacement (TAVR) is a less invasive treatment option for patients that are deemed too high a risk for surgical aortic valve replacement (SAVR). The aim of this review is to evaluate the frailty tools currently being used in patients referred for TAVR. Using a literature search involving database search engines from CINAHL, PubMed, SAGE publications and European Society of Cardiology conducted from 2010 to the present, a critical evaluation of studies dealing with frailty assessment in patients referred for TAVR/SAVR is discussed. Eight studies met the criteria using frailty assessment in TAVR/SAVR patients. In all reviewed studies the impact of frailty on clinical outcome has been proved. Different instruments for measurements of frailty were used that have not been robustly evaluated. Frailty was defined differently and results may not be comparable. All reviewed studies used different cutoffs and scales and some a composite scoring system, although validity was limited. For frailty assessment implementation of validated standardized test protocols based on well-established assessment tools, covering all domains of frailty among TAVR centers is crucial for patient selection. Secondly, validated cutoffs and scoring systems are essential.

Orthostatic hypotension, orthostatic intolerance and frailty: The Irish Longitudinal Study on Aging-TILDA

Because frailty may represent impaired response to physiological stress we explored the associations between frailty and orthostatic hypotension (OH), and orthostatic intolerance (OI). This study was based on a cross-sectional analysis of 5692 community dwelling adults aged 50 years and older included in wave 1 of the Irish Longitudinal Study on Aging. Frailty was assessed using both the phenotypic (FP) and frailty index (FI) models. OH was defined as a drop of ≥20mmHg in systolic blood pressure or a drop of ≥10mmHg diastolic pressure on standing from a seated position. OI was defined as reporting feeling dizzy, light headed or unsteady during this test. 346 (6.1%) participants had OH and 381 (6.7%) participants had OI. The prevalence OH in frail participants was 8.9%, compared to 5% in robust. Similarly the prevalence of OI was 14.3% in frail and 5.7% in robust participants. After adjustment for age and gender, OH was not significantly related to the FP (OR=1.10 95% CI=0.67, 1.81). Conversely OI was (OR=1.80 95% CI=1.13, 2.87), even after adjustment for age, gender, cardiovascular factors and mental health. In fully adjusted models OI remained related to slowness and low muscle strength and to higher FI scores. These data suggest OI symptoms in older adults may reflect various important underlying health deficits, indicative of increasing levels of frailty. Further assessment of frailty in patients experiencing OI is a potential opportunity for early intervention to delay functional decline.

Role of frailty assessment in patients undergoing cardiac interventions

Average life expectancy is increasing in the western world resulting in a growing number of frail individuals with coronary heart disease, often associated with comorbidities. Decisions to proceed to invasive...

E5-1 Modular organization of the insect memory center: Common structure with mammalia. N cerebral cortex

Because frailty may represent impaired response to physiological stress we explored the associations between frailty and orthostatic hypotension (OH), and orthostatic intolerance (OI). This study was based on a cross-sectional analysis of 5692 community dwelling adults aged 50 years and older included in wave 1 of the Irish Longitudinal Study on Aging. Frailty was assessed using both the phenotypic (FP) and frailty index (FI) models. OH was defined as a drop of ≥20 mmHg in systolic blood pressure or a drop of ≥10 mmHg diastolic pressure on standing from a seated position. OI was defined as reporting feeling dizzy, light headed or unsteady during this test. 346 (6.1%) participants had OH and 381 (6.7%) participants had OI. The prevalence OH in frail participants was 8.9%, compared to 5% in robust. Similarly the prevalence of OI was 14.3% in frail and 5.7% in robust participants. After adjustment for age and gender, OH was not significantly related to the FP (OR = 1.10 95% CI = 0.67, 1.81). Conversely OI was (OR = 1.80 95% CI = 1.13, 2.87), even after adjustment for age, gender, cardiovascular factors and mental health. In fully adjusted models OI remained related to slowness and low muscle strength and to higher FI scores. These data suggest OI symptoms in older adults may reflect various important underlying health deficits, indicative of increasing levels of frailty. Further assessment of frailty in patients experiencing OI is a potential opportunity for early intervention to delay functional decline.