Management Of Frailty Research Articles

Improving Surgical Outcomes for Older Adults with Adoption of Technological Advances in Comprehensive Geriatric Assessment

Frailty is a well-recognized predictor of poor surgical outcomes for older adults, yet effective measurements and interventions remain limited. Technological advances offer an opportunity to address this gap and improve surgical care for older adults. This paper reviews the background of frailty and comprehensive geriatric assessments in surgery, and how technological innovations can advance frailty measurement and intervention in surgical settings. We review two broad areas of technological advancement as applied to frailty in surgery: 1) Innovation in the use of electronic health records (EHR) using Artificial Intelligence (AI) and Machine Learning (ML), and 2) Novel uses for wearable sensors and mobile health (mHealth) applications. We explore the integration of AI and ML with EHR systems, which can surpass traditional comorbidity indices by providing comprehensive health assessments and enhancing prediction models. Innovations like the electronic Frailty Index (eFI) show promise in expanding the reach of frailty assessments and facilitating real-time screening. Additionally, wearable devices and mobile health (mHealth) applications offer new ways to monitor and improve physical activity, nutrition, and psychological well-being, supporting perioperative rehabilitation. While these technologies present challenges, such as the need for infrastructure, training, and data interoperability, they offer promising strategies to facilitate the assessment and management of frailty among surgical patients. Continued research and tailored implementation strategies will be essential to fully realize the potential of these advancements in improving surgical outcomes for frail older adults.

Longitudinal trajectories of frailty and cognitive decline among older Korean cancer survivors

This study aimed to identify frailty trajectories among older adults diagnosed with cancer, as well as the impacts of frailty trajectories on cognitive decline at an eight-year follow-up. We used longitudinal data from the Korean Longitudinal Study of Aging. A total of 173 older Korean cancer survivors were included in our analysis. Frailty and cognitive function were assessed using the multi-domain frailty index and the Korean version of the mini mental state examination, respectively. Latent class growth modeling and multivariate logistic regression were employed. Two distinct frailty trajectories were identified: “low and stable” (75.1%) and “moderate and increasing” (24.9%). Older cancer survivors in the “moderate and increasing” frailty group were 4.89 times more likely to experience cognitive decline at the eight-year follow-up than their counterparts in the “low and stable” frailty group. Periodic evaluation and timely management of frailty could contribute to preventing cognitive decline among older cancer survivors.

Sarcopenia, dysphagia, and frailty in community-dwelling older adults: An analysis of mediation and moderated mediation models.

Sarcopenia, dysphagia, and frailty are geriatric syndromes that commonly occur with age and are associated with various adverse health consequences. Nevertheless, the complex associations among them require further study to be clarified. The objectives of this study were to investigate (1) the potential role of dysphagia as a mediator in the association between sarcopenia and frailty and (2) the potential role of taste and smell dysfunction as a moderator of this mediator effect in community-dwelling older adults. A total of 352 older adults (mean age = 70.48 ± 5.31 years; 57.67% female) enrolled in this cross-sectional study. The SARC-F, Eating Assessment Tool-10 (EAT-10), and Edmonton Frailty Scale (EFS) were used to assess sarcopenia, dysphagia, and frailty, respectively. The Taste and Smell Dysfunction Questionnaire (TSDQ) was employed to assess taste and smell dysfunction. Frailty was present in 21.86%, sarcopenia risk in 39.77%, and dysphagia in 26.99% of the participants. The mediation analysis showed that the SARC-F had a significant effect on the EAT-10 (B = 1.001; p < 0.001), which in turn had a significant effect on the EFS (B = 0.129; p < 0.001). The direct (B = 0.659; p < 0.001), indirect (B = 0.129), and total (B = 0.778; p < 0.001) effects of SARC-F on EFS were significant. Of the association between sarcopenia and frailty, 16.6% was explained by dysphagia. The moderated mediation analysis showed that the TSDQ (B = 0.127; p < 0.001) moderated the association between SARC-F and EAT-10 and that the EAT-10 mediated the association between SARC-F and EFS only in older adults who scored moderate and high on the TSDQ (B = 0.049 and B = 0.114, respectively). The EAT-10 partially mediates the association between the SARC-F and the EFS, implying that sarcopenia affects frailty indirectly via dysphagia. Furthermore, taste and smell dysfunction moderates this mediator effect, with sarcopenia functioning as a mediator in older adults who scored moderate and high on the TSDQ. Therefore, it is plausible to anticipate that if someone has taste and smell dysfunction in addition to sarcopenia, they are more likely to have dysphagia and, ultimately, frailty. These findings emphasize the importance of addressing sarcopenia, taste and smell dysfunction, and dysphagia concurrently in frailty management in older adults.

A prehabilitation programme is feasible and acceptable for mild-to-moderately frail patients undergoing cardiac surgeries

Abstract Background Preoperative frailty is a strong prognostication in cardiac surgical patients to predict poorer health outcomes. Intervening at the preoperative stage through prehabilitation is gaining increasing research attention. Previous studies tested a single frailty-reversing strategy, either nutritional or exercise, the exercise protocols were mainly aerobic-focused, which deviates from the exercise prescription principles suggested for frailty management, rendering an effective prehabilitation intervention is yet to be developed in cardiac surgical patients. Purpose This study aimed to examine the preliminary effects and explore the feasibility of a multi-component frailty-specific prehabilitation programme for mild-to-moderately frail patients undergoing cardiac surgeries/procedures. We hypothesised that compared with patients who receive usual care, patients awaiting cardiac surgeries who participate in the prehabilitation programme would have improved functional capacity, frailty status, quality of life and psychological outcomes, increased serum albumin and reduced C-reactive protein. Methods This study adopted a mixed-method design comprising a pilot randomised controlled trial and a qualitative study. Adult patients with a Clinical Frailty Scale score between 4 and 6, waiting for coronary artery bypass grafting surgery and/or valve repair/replacement, with at least 5 weeks of procedural waiting time and without contraindications for exercise were recruited. They were randomized in a 1:1 ratio to receive the prehabilitation programme or usual care. The programme comprised a structured preoperative education, nutritional optimization, stress management; and a multi-component exercise training with 3 sessions/week and 60 minutes/session. The exercise training lasted at least 4 weeks and maintained throughout the preoperative period. Results Twenty participants were randomized into the intervention (n = 11) or control (n = 9) group. The programme was feasible, acceptable and no severe adverse events were recorded. The lost to follow-up rate was 7.9%, and the overall attendance was 96%. The intervention group showed significantly greater improvement in functional capacity, frailty status and psychological outcomes than the control group at post-intervention. Participants gave positive comments about the programme and its delivery mode. They expressed that the one-on-one home-based practice enabled them greater confidence to overcome kinesiophobia. Two participants voiced out the preference for exclusive home-based training, rather than having hospital-based training in the first two weeks. Conclusion(s) The prehabilitation programme is feasible and acceptable for patients waiting for cardiac surgeries. It improves the functional performance, frailty status and psychological outcomes in these patients. A full-scale randomised controlled trial is warranted to investigate its longer-term and clinical effects.

Association of frailty and serum neurofilament light chain levels: the mediating role of estimated glomerular filtration rate.

Both frailty and elevated serum neurofilament light chain (sNfL) levels are linked to cognitive impairment. However, evidence of their relationship is lacking, and whether it was mediated by renal function was unknown. This study aimed to investigate the association between frailty and sNfL levels in a representative U.S. population, and to explore the potential mediating role of estimated glomerular filtration rate (eGFR) in this relationship. Data from 1,782 participants aged 20-75 years in the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were analyzed. Frailty was assessed using a 49-item frailty index, and participants were categorized as non-frail, pre-frail, or frail. sNfL levels were measured using acoustic emission technology. Multivariable linear regression models and restricted cubic spline analyses were employed to examine the associations between frailty, eGFR, and sNfL levels. Mediation analysis was conducted to evaluate the role of eGFR in the frailty-sNfL relationship. The prevalence of pre-frailty and frailty was 45.39 and 11.60%, respectively. A significant positive association was observed between frailty score and sNfL levels (adjusted β: 39.97, SE: 11.07, p = 0.003), with a linear relationship confirmed by restricted cubic spline analysis. Frail individuals had significantly higher sNfL levels compared to non-frail participants (adjusted β: 11.86, SE: 5.42, p = 0.04). eGFR was negatively associated with sNfL levels (adjusted β: -0.23, SE: 0.05, p < 0.001). Mediation analysis revealed that eGFR accounted for 12.52% of the total effect of frailty on sNfL levels (p < 0.0001). This study demonstrates a significant association between frailty and elevated sNfL levels in a representative U.S. population, with eGFR partially mediating this relationship. These findings suggest that sNfL may serve as a potential biomarker for frailty-related neuronal damage and highlight the importance of kidney function in this association. Further research is warranted to explore the clinical implications of these findings in frailty assessment and management strategies.

Proactive frailty in primary care: A primary care system fit for frailty.

Older adults with frailty are at increased risk of premature death, and numerous negative sequalae including falls, disability, and dementia alongside increased healthcare costs. Most healthcare interactions for older people with frailty take place in primary care, and there is increasing interface working between primary and secondary care to manage this patient group including virtual wards, frailty management programmes and Hospital @ Home. This commentary aims to place proactive frailty into recent policy perspective, alongside highlighting some of the current challenges around the implementation of proactive frailty programmes.

Moderate physical activity and higher frequency are inversely associated with incidence of frailty in middle-aged and older population: a 4-year longitudinal study in Europe.

Global aging is leading to an increase in frailty patients, and physical activity (PA) may have an impact on frail in middle-aged and older population. This study aimed to explore the relationship between the frequency of different PA intensities and the incidence and prevalence of frailty in middle-aged and older adults based on the Survey of Health, Ageing, and Retirement in Europe (SHARE). Self-reported questionnaires were used to obtain information on demographics and PA, and frailty was assessed using the SHARE Frailty Instrument (SHARE-FI). Cox regression and logistic regression models were used to explore the association between PA and frailty and stratified according to middle or old age. Among 6315 baseline non-frail participants aged 44-96years, 16.1% developed frailty over 4years, with higher incidence and prevalence in women (P < 0.05). Women accounting for 55.80% of the sample. The frequency of participants participating in sports decreased over 4years (P < 0.05). Compared with participants who engaged in PA more than once a week, participants who engaged in moderated PA less frequently had a higher risk of new-onset frailty (HR: 3.174-6.115), and participants who engaged in vigorous PA 1-3 times a month had a higher risk of new-onset frailty (HR: 1.335). Participation in low-frequency moderate PA and vigorous PA 1-3 times per month were positively associated with the prevalence of frailty (P < 0.05). Physical activity frequency decreases with age in middle-aged and older adults. Those adults who engage in moderate PA more than once a week have a lower risk of incidence of frailty, compared to those with more sedentary life-styles. Additionally, women need to pay more attention to frailty management.

Association Between Disease Severity and Frailty in Patients with Aortic Stenosis.

Frailty is highly prevalent among patients with aortic stenosis (AS). Nonetheless, the impact of AS severity on frailty remains unclear. This study aimed to clarify the association between AS severity and frailty in this population.This retrospective study included consecutive patients with AS who were hospitalized as candidates for transcatheter aortic valve implantation (TAVI). The prevalence of frailty, N-terminal pro B-type natriuretic peptide (NT-proBNP) level, gait speed, and geriatric nutritional risk index (GNRI) were compared between patients with severe and those with very severe AS. We employed multiple logistic regression analysis to examine the association between AS severity and frailty.A total of 137 patients were included. The prevalence of frailty was not significantly different between the severe and very severe AS groups (31% versus 30%). Similarly, no significant differences between the groups were observed for gait speed and GNRI, whereas the NT-proBNP level was significantly higher in the very severe group than in the severe AS group (P < 0.01). In the multiple logistic regression analysis, AS severity was not associated with frailty; however, gait speed and GNRI showed significant association with frailty independently of age, sex, and heart failure (very severe AS: odds ratio [OR] 1.051, 95% confidence interval [CI] 0.439-2.517; low gait speed: OR 5.109, 95% CI 1.556-16.775; malnutrition: OR 2.841, 95% CI 1.145-7.049).These findings suggest that low-intensity exercise training and nutritional therapy may be necessary in addition to AS treatment for the management of frailty in this population.

Frailty Assessment and Management: A Qualitative Study of the Educational and Training Experiences of Postgraduate Doctors

Abstract Background Understanding and addressing frailty, a complex syndrome commonly found in older adults, demands a deep understanding and proficiency across various health domains. Existing research indicates a disparity between medical education and the hands-on management of frailty in practice. There is a scarcity of research on the educational requirements of postgraduate doctors in caring for frail patients. Methods Qualitative semi-structured interviews were conducted with post-internship doctors working in an AMU, using transcripts to analyse themes. The focus was on frailty conceptualisation, educational training, and clinical experience. Results Several themes were noted, particularly the lack of focus and variation on frailty teaching in undergraduate curriculums. This, coupled with limited hands-on experience, an emphasis on acute care over chronic management, inadequate multidisciplinary training, and a need for more structured education on frailty assessment tools, underscores the need for ongoing education and support. Many interviewees shared their experiences of being well-equipped to handle acute medical emergencies, demonstrating the effectiveness of their current medical education. However, they also pointed out that this preparation did not adequately equip them for the ongoing, multidimensional care that frail patients require. Several interviewees stressed the role of continued education and support for healthcare professionals managing frailty, suggesting ongoing professional development opportunities could effectively bridge the gap between initial medical education and the evolving demands of clinical practice. The potential of mentorship from experienced geriatricians adds invaluable guidance for early career doctors. Conclusion This qualitative study underscores a significant gap between medical education and the practical management of frailty. Addressing this gap requires a multifaceted approach that integrates frailty-focused content into undergraduate curricula, provides hands-on experience, fosters multidisciplinary collaboration, and offers ongoing professional development. By enhancing frailty education and training, healthcare systems can improve the quality of care for this vulnerable population, leading to better patient outcomes and more efficient use of resources.

The Establishment of Geriatric Multidisciplinary Service (GEMS) for the Identification and Management of Frailty and Delirium in Emergency Care

Abstract Background In Ireland the number of people aged 75 and over has grown by greater than 20% in recent years, as a consequence increasing numbers of older adults are presenting to emergency departments. Frailty is a multi-factorial syndrome that diminishes body reserves and impacts on the person's ability to respond to stressors, such as illness or trauma. In October 2023, a Consultant Geriatrician lead GEMS was launched to identify, assess and manage frailty and associated syndromes, this study concentrated on delirium. Methods All patients 75 and older are triaged by GEMS using an electronic IPM System against prioritisation inclusion and exclusion criteria, utilising a case management approach and Rockwood Clinical Frailty Scale to screen for frailty. CFS score 1 to 3 is fit and managing well, alternatively a CFS of 4 or greater initiates a Comprehensive Geriatric Assessment. A 4AT assessment identifies patients at risk and screening for delirium. Results The results demonstrate a total of 744 patients were reviewed by GEMS from Jan - April 2024, 67% (n=503) had a CGA completed and 72% (n=537) of the population sample are living with frailty. A CFS7 (n=121), CFS8 (n=15) and CFS9 (n=3) are severely frail 26% and moderate frailty CFS6 (n=149) 28%. The 4AT results identified 10% of patients had a positive delirium score (n=60). In addition, a total of (n=61) patients had a formal diagnosis of dementia of which (n=12) patients had a positive 4AT. Conclusion The data confirms the prevalence of frailty in emergency care is approximately 70% and the incidence of acute delirium is approximately 10%. These indicators significantly impact on outcomes of care and treatment plans. Therefore, substantiates the need for early identification of frailty and delirium and the requirement for a highly specialised Consultant Geriatrician Lead (GEM) Service to ensure patients are on the right journey.

Optimising Outcomes For Those With Chronic Respiratory Disease: Detecting Frailty In The Respiratory OPD

Abstract Background Frailty is a treatable trait of relevance to people with various chronic respiratory diseases, especially those with severe COPD and/or lung transplantation. This has been recognised in the 2024 GOLD (Global initiative for chronic Obstructive Lung Disease) report and within recent European Respiratory Society guidelines. Central to optimisation of frailty management in those with chronic respiratory conditions is the identification of frail patients in the respiratory OPD (outpatients department) setting. This study aims to assess the prevalence of frailty among patients attending the respiratory OPD in our hospital. Methods A cross-sectional study was conducted over two respiratory clinics over a two-week period. Patients aged 65 and above were screened for frailty using the Clinical Frailty Scale (CFS). A CFS score was assigned to each patient by an assessing NCHD/consultant on the respiratory team. Statistical analysis was then performed to determine the prevalence of frailty amongst such patients. Frailty was defined as those having a CFS score of &amp;gt;5. Results A total of 25 patients were included in the study. Frailty (CFS score of &amp;gt;5) was identified in 56% of patients assessed, with 12% of patients being identified as having a CFS score of 7 (severely frail) or higher. Frailty had not previously been diagnosed by the respiratory team in those patients. Conclusion This study highlights a high prevalence of frailty among patients aged 65 or over in the respiratory OPD. Implementing systematic frailty screening in the respiratory OPD using the CFS can improve early identification of such patients, potentially enhancing management and clinical outcomes. The CFS is a quick and effective tool in identifying frailty. Integrating frailty assessments into routine clinical practice may help to ensure comprehensive care for this vulnerable population. We are currently looking at options for referral pathways to develop to improve management of frailty in this population.

Níos Fearr Le Chéile/Together is Better: ICPOP Case Review of Intervention for an Older Carer of a Referred Patient

Abstract Background The Integrated Care Programme for Older Persons (ICPOP) aims to implement integrated services and care pathways for older adults with complex health and social care needs. The aim is to place patients at the center of their healthcare decision making and to support them to live well in their homes and communities. A Comprehensive Geriatric Assessment (CGA), which is the gold standard for the management of frailty in older persons, is carried out on all referred patients at the initial home visit. It is often as an ICPOP assessor delves deeply into the family unit that frailty makers such as decreased mobility, declining cognition, poor appetite, polypharmacy is identified in the non-referred cohabitating person who is also over 65 years of age (Potier et al., 2018). Methods The purpose of this poster is to demonstrate how a holistic approach to care within a household led to the incidental finding of frailty in a family carer who was also an older adult. This case review will illustrate how the referral of one half of a married couple led to opportunistic multi-disciplinary intervention for the second person. Following discussion, at MDT level, of both the referred patient and their spouse, a request for a formal referral to ICPOP for the second person was made to the GP, as it is a referral criteria for ICPOP referrals. Results ICPOP intervention ultimately led to home supports being put in place for both parties along with medical reviews, rationalisation of medications and assistive technology supports, this enabled both patients to live well and safely at home. Conclusion A comprehensive geriatric assessment using a holistic approach resulted in intervention for both parties with a positive outcome for the entire family.

Integrating frailty management into cardiac intensive care unit nursing practice: A qualitative study

BackgroundFrailty is prevalent among older patients in intensive care units (ICUs) and poses significant challenges to recovery. Despite its importance, there is limited research on effective nurse-led frailty management strategies in this context. ObjectiveThe purpose of this qualitative study was to explore nurses' perceptions of frailty management in cardiac ICUs through the lens of the Wuli-Shili-Renli (WSR) system approach. MethodsSixteen nurses from two tertiary hospitals in Shandong province, China, participated in semi-structured interviews. Participants were selected based on their involvement in frailty training, educational background, and cardiac ICU work experience. Thematic analysis was conducted to identify key themes and sub-themes. ResultsAnalysis in three categories revealed the need for foundational support, including the need for appropriate screening tools, updated evidence-based practices, and institutional support. Closed-loop management involved frailty screening, personalized program implementation, information management, and follow-up assessment. Personnel training and coordination emphasized enhancing nurses' professionalism, multidisciplinary teamwork, and cooperation from patients and their caregivers. ConclusionThe insights gained can inform evidence-based practices and improve the quality of care provided to frail patients in cardiac ICUs. There is a need for future research to empirically investigate these strategies.

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&amp;gt;75 with a frailty score&amp;gt;=5 or performance status&amp;gt;=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 &amp;gt;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 &amp;gt;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.

Role of FIRE-MADE FI for diagnosing frailty in central rural India and its comparison with LASA FI.

An aging population ultimately has deprived physiological stores making them vulnerable for development of a syndrome called frailty, which presents with a cumulative decrease in tolerance, immunity, vision, balance, organ functions, health, and independent living. All these result in rising prevalence of frailty and its components, along with burden of disease, dependence, and health care cost. Thus, early estimation and assessment and interventions to correct it mark the mile stone in geriatric medicine. The present study was conducted with an aim to compare and correlate FIRE-MADE (Frailty Index in Rural Elderly - Mental status, Activities of daily living, Depression, and Events) FI (frailty index) with LASA (Longitudinal Aging Study Amsterdam) FI in central rural India's geriatric population. A cross-sectional study for assessment of frailty in the geriatric population of central rural India, reporting to the medicine department of a tertiary hospital, situated at Wardha district, by using FIRE-MADE and LASA FI was undertaken. Their scores were compared. The efficiency of FIRE-MADE FI in comparison with LASA FI was calculated. A frailty threshold of ≥ 0.25 is considered for diagnosing frailty. Standard descriptive and inferential statistics were used to evaluate all parametric and non-parametric data. Out of 250 geriatric people, 224 (89.6%) were frail according to LASA FI and 204 (81.6%) were frail according to FIRE-MADE FI. As compared to LASA FI, FIRE-MADE FI was 91.07% sensitive and 73.08% specific, with a positive predictive value of 96.68% and a diagnostic accuracy of 89.20%. The Indian rural population of central India has high prevalence of frailty. FIRE-MADE FI can be used as a potential, effective, and validated tool for early diagnosing and management of frailty. Among the parameters of FIRE-MADE FI, IHD was the most important contributing factor for development of frailty, followed by cognitive impairment, polypharmacy, and remaining factors mentioned in FIRE-MADE FI.

Relationship between glycaemic control and frailty in older Chinese patients: The mediating role of diabetes distress.

This study aimed to investigate the effects of glycaemic control and diabetes distress on frailty in older Chinese patients with diabetes, and to explore the mediating role of diabetes distress between glycaemic control and frailty. This is a descriptive, cross-sectional study. A total of 209 older patients with diabetes were recruited from a teaching hospital in Zhejiang Province. Data were collected from February to September 2022. A self-designed questionnaire was used to collect demographic and disease-related data. The Fried Scale and Diabetes Distress Scale were employed to assess frailty and diabetes distress, respectively The bootstrap method was used to examine the mediating effects of diabetes distress on glycaemic control and frailty. The STROBE checklist was adhered to in the reporting of this study (see details in File S1). The findings indicated a positive correlation between the level of glycaemic control and frailty, as well as between diabetes distress and frailty. Furthermore, diabetes distress was found to play a complete mediating role between glycaemic control and frailty. The study findings highlight the relationship between glycaemic control, diabetes distress and frailty offering a valuable reference for enhancing the management of frailty in older patients with diabetes. This study emphasizes the significance of managing glycaemic control and diabetes distress in older patients with diabetes to prevent frailty, and may contribute for healthcare professionals to developing effective measures to improve the frailty of older diabetic patients in clinical settings. This study was conducted with the participation of older patients with diabetes who contributed data by completing study questionnaires and undergoing physical assessments.

A predictive nomogram among hypertension old population from the community: A cross-sectional study

BackgroundFrailty presents a significant challenge for aging adults, with a multitude of factors needing consideration. Despite this, there is a lack of research on predicting frailty in the old population with hypertension. AimThis study aims to create and validate a nomogram model for the old population with hypertension, to predict frailty and gain valuable insights into its prevalence and determinants. MethodData for this study were extracted from the "Psychology and Behavior Investigation of Chinese Residents (PBICR) in 2022 (PBICR-2022)", with information on frailty and related factors obtained through self-reported questionnaires. Frailty was assessed using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale. The independent variables encompassed sociodemographic, physiological, psychological, and family health factors. A total of 1135 participants aged over 60 with hypertension were included in the study. Univariate and stepwise binary logistic regression analyses were conducted to identify the relationship between frailty and multiple risk factors and to establish the frailty risk prediction nomogram. ResultsThe prevalence of social frailty was found to be 30.91%. The final model included the degree of hypertension, history of falling in the past 3 months, Brief Illness Perception Questionnaire score, depression levels, and Family Health Scale score. The model exhibited good accuracy in the testing set, with an area under the ROC curve of 0.984 (95% CI: 0.978, 0.990). ConclusionThese findings suggest that the prediction model effectively estimated the prevalence of frailty in the older population with hypertension from community and identified associated factors. The model demonstrated good performance and holds potential for further study on the management of frailty.

Frailty in Oncology: Updated Recommendations for Clinical Practice

Frailty is a clinical condition associated with aging and resulting in increased risk of adverse outcomes upon exogenous or endogenous stressors. In oncology, cancer treatment itself can be a stressor event. In older cancer patients, frailty therefore not only enhances the probability of age-related health events such as institutionalization or falls, but also of treatment complications such as toxicity and interruption or discontinuation of therapy. As demonstrated by recent randomized-controlled trials conducted in older cancer patients receiving systemic treatment, the evaluation of frailty by geriatric assessment (GA) followed by an adjustment of the oncological therapy as well as targeted frailty interventions help to improve cancer treatment tolerability and feasibility. Based on these data, the American Society of Clinical Oncology (ASCO) updated the clinical practice guidelines for the assessment and management of vulnerabilities in older adults receiving systemic cancer therapy. The guideline recommends the use of a new GA-tool named 'practical geriatric assessment' (PGA) to foster the implementation of GA-based frailty assessment and management in routine cancer care. This article describes the background and key aspects of these recent advances.

Frailty response in patients with aortic stenosis undergoing transcatheter aortic valve implantation: protocol for a pilot, cluster randomised controlled trial (FRAIL-AS Response Trial)

Abstract Background Three in ten severe aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI) are frail. Frailty correlates with adverse post-procedure patient outcomes, such as higher 1-year mortality, increased adverse events, prolonged hospital stays, and diminished quality of life. Despite the urgency for evidence-based frailty management in this population, research in this area is limited. Methods A pilot, cluster randomised controlled trial to assess the feasibility of implementing a Frailty Response Program intervention in 10 hospital TAVI programs for frail patients with aortic stenosis undergoing valve replacement. The intervention includes an implementation strategy and a Frailty Response Clinical Protocol, focused on malnutrition identification, patient education, general practitioner notification, comprehensive geriatric assessment, and cardiac rehabilitation. Eligible hospitals will be randomised (1:1) to either the intervention or control (standard care). Primary outcome: proportion of patients receiving nutritional assessment upon frailty identification. Secondary outcomes include mortality and hospital admissions, frailty improvement, quality of life, and evidence-based frailty management. Implementation outcomes will be evaluated through a process assessment. Discussion The trial aims to bridge the gap between the recognition of frailty in patients with aortic stenosis undergoing TAVI and the implementation of evidence-based frailty management practices to improve patient outcomes and care quality.

Frailty trajectories and determinants in Chinese older adults: A longitudinal study

ObjectivesThis study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese. Methods2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors. ResultsFour FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed. ConclusionsFrailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.