Frailty Score Research Articles

WP7.13 - Recognising Clinical frailty in the Periooperative setting in the Acute Surgical Unit

Abstract Aim Due to an ageing population the number of elderly patients undergoing surgery is increasing. The literature and NELA guidance has highlighted frailty can lead to increased risks related to surgery, quantified by Clinical frailty scoring. With the introduction of the regions first Perioperative care for Older People undergoing Surgery (POPS) service, we aim to determine if formal documentation of clinical frailty score improved awareness of these patients and impacted on clinical outcomes. Methods A 3 week note review was completed of all patients over 65 admitted to the acute surgical emergency unit. Frailty was scored using the Rockall Score. The first cycle was a review of current documentation practice, with a subsequent cycle of documentation of frailty score following interventions included; clinical posters in clinical areas, teaching and medical and nursing staff handover. Results At baseline zero patient had a Rockall Clinical frailty score CFS documented. There has been an increase in the number of patients >65 years old who have a frailty score documented within 24 hours of admission. 15/40 patients over 65 had a CFS documented improved by 37.8%. Conclusion Overall improvement of documentation and awareness has been demonstrated highlighting higher frailty patients and those for POPS review to improve perioperative outcomes.

ThP4.7 - The outcome of a single stage Laparoendoscopic rendezvous ERCP and laparoscopic cholecystectomy for cholecystocholedocholithiasis in a DGH

Abstract Cholecystocholedocholithiasis is managed surgically by laparoscopic cholecystectomy (LC) and simultaneous common bile duct (CBD) exploration or by preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by LC. Rendezvous ERCP (RERCP) is an innovative laparoendoscopic technique combining LCs and ERCPs. As a single staged procedure, a LC is performed and selective canulisation of the CBD is aided by laparoscopic transcystic placement of a guide-wire into the duodenum. We present a case series of RERCPs within a DGH. This case series collected retrospective data (2014-2023) involving 33 patients, of which 21 underwent RERCP. Preoperative variables included age, indication, gender, ASA grade, Charlson comorbidity index (CCI), frailty score and indication. Postoperative variables analysed were operating time, complications, 30-day re-admission rates and length of stay in hospital (LOSH). Of the 21 patients who underwent a RERCP, 76% (n=16) were female. The average age was 60±17years and 59% (n=13) of all procedures were elective. The ASA range was I to III, average CCI and frailty score were 2.4±1.9 and 0.1±0.4 respectively. 52% (n=11) of patients had a previous failed ERCP. The average operating time was 152±39mins. The average LOSH was 3.5±2.8days and 2.5±2.1days following the RERCP. Biliary (including pancreatitis) and non-biliary complications were 9.5% (n=2) and 9.5% (n=2) respectively. The 30-day readmission rate was 9.5% (n=2). There was no significant difference in the operating time (p=0.16), LOSH (p=0.19) complication (p=0.13) and readmission rates (p=0.50) between emergencies and elective procedures. RERCP remains a valuable option when managing cholecystocholedocholithiasis in emergency and elective settings.

EP218 - A closed-loop audit on the assessment of the documentation of frailty at admission in emergency general surgery admission at a tertiary care hospital

Abstract Background NHS frailty guidelines advise that frailty score should be documented at the first time of contact for patients aged 65+ years. The Aim of this quality improvement project (QIP) was to assess the adequate documentation of frailty at the time of first encounter by the general surgery department for patients aged 65+ years. Method Data was collected for October 2022 for the first cycle and January and February 2023 for the second cycle. Data collection was done from an electronic database in the trust and patient notes maintained throughout the admission. Results 136 patients were included in the QIP for the first cycle. 3/136 (2.2%) patients had documented frailty at the first encounter. These findings were discussed in the clinical governance meeting, followed by a teaching session for the junior doctors. A specific section was added in the documentation as a reminder for the team to document the frailty upon the first encounter. 212 patients were included in the second cycle and documentation of frailty improved to 39/212 (18.4%). Conclusion There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.

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.

ThP7.16 - Multidisciplinary management of elderly patients undergoing emergency laparotomy: an audit at a small district general hospital

Abstract Aims The National Emergency Laparotomy Audit (NELA) suggests early involvement of the multidisciplinary geriatrician team for preoperative care of elderly patients aged over 80, or 65 and frail. Methods we audited our unit against the NELA guidelines for elderly patients. We looked at all emergency laparotomies carried out at our hospital over a 6 month period against the audit standards as set out by NELA. Results A total of 55 laparotomies were carried out in 6 months. 17 patients fit the criteria of patients needing early geriatrician involvement. Of the 34 patients aged 65 and above, 22 patients had their frailty score recorded in the notes (64%). Less than 10% of patients had early geriatrician input. Overall, six patients (11%) died within 30 days of their initial operation, and all were aged over 65. Conclusions we must take the perioperative care of elderly patients seriously and work with the Geriatric Medicine teams for early perioperative review, including accurate clinical frailty score assessments. We will initiate a project with the Geriatric Medicine department to implement an Elderly Laparotomy Perioperative Pathway for these patients.

SP9.5 - Peri-operative Comprehensive Geriatric Assessment (CGA): A new benchmark for Acute General Surgery patients

Abstract Aims More than 50% of patients undergoing emergency general surgery are over 65 years of age. NICE guidelines emphasise frailty assessment in acute surgical settings, particularly in the preoperative period. Similarly, the Emergency Laparotomy and Frailty (ELF) study showed associations between frailty (CFS ≥ 5) and 90-day mortality, increased complication and length of hospital stay in older emergency laparotomy patients. NELA best practice tariff (BPT) April 2023 heavily focuses on perioperative team involvement in frailer, older patients. This is an audit from a city teaching hospital, with a surgical liaison team against standards set by NELA. Methods Review of patients aged ≥ 65 undergoing emergency laparotomies between August and November 2023 (pre-intervention) then December and January 2024 (post-intervention). Data collected includes whether patients had a documented frailty score, a clearly documented CPR decision & treatment escalation plan (TEP), pre- or post-operative medical review, and advanced-care planning (ACP) post-operatively. Intervention included dedicated members of surgical liaison team following patients throughout admission, weekly meetings to discuss laparotomy patients, older patient template being created capturing ceilings of care, frailty score, and social history. Results Post intervention, improvement in clear documentation regarding escalation, frailty level. Greater level of MDT collaboration with regards to older patients undergoing laparotomies. Conclusion Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Even a basic surgical liaison service can achieve high levels of compliance with a few simple strategies, resulting in better outcomes for patients as well as financial benefits for Trusts.

WP3.12 - The influence between frailty, sarcopenia and physical status on mortality in patients undergoing emergency laparotomy

Abstract Aims Frailty and sarcopenia predict mortality in emergency laparotomy (EmLap) and both can be indicative of poor physical status. We aim to assess the prevalence of frailty, sarcopenia and physical status in EmLap and explore the relationship between these factors and 30-day, 90-day and 1-year mortality. Methods Retrospective analysis was performed on two Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) databases (2017-2019) which included patients ≥18years. Clinical frailty scale was used to classify frailty (score ≥4 as frail). Sarcopenia was assessed via total psoas index. Poor physical status (PPS) was defined by American Society of Anaesthesiologists physical status classification (ASA)≥4. One-way ANOVA and logistic regression were used for statistical analysis. Results 215 patients were included with 57.2% female and median age of 64years. Frailty was present in 17.2%, sarcopenia in 25.1% and 14.5% had PPS; 3.3% had all three factors. Frail patients had significantly higher risk for 30-day (p=0.003), 90-day (p=0.006) and 1-year mortality (p=0.032). Sarcopenic patients did not show significant differences in mortality risks up to 1 year. Patients with PPS had significantly higher mortality rates at 30-day (p<0.001), 90-day (p<0.001) and 1-year (p=0.001). Patients with all three factors had higher 30-day (p<0.001), 90-day (p=0.005) and 1-year mortality (p=0.049) than patients who have none of the factors. Conclusions Frailty, sarcopenia and PPS are prevalent in EmLap. Frailty and PPS were independently associated with short and long-term mortality but not sarcopenia. While overlap exists between frailty, sarcopenia and PPS, more studies are required to understand the complex interplay.

WP3.11 - Emergency laparotomies in the elderly: long term outcomes

Abstract Aims Emergency laparotomy is understood to be high risk in the elderly, but there is limited long term outcome data. This study assesses long term outcomes in the elderly including: survival and functional outcomes. Methods Patients, aged 80 and above, were identified from the prospective National Emergency Laparotomy Audit (NELA) database, who underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Surviving patients were followed up. Results 132 cases were undertaken (22% of total emergency laparotomies performed). Mean age was 85 years. Most common ASA was 3. Preoperatively, the most common clinical frailty score was 6, i.e., moderately frail and 89% were living at home without care. The most common procedure was adhesiolysis. 50% of patients were admitted to intensive care. 5 patients returned to theatre. 17% were readmitted within 30 days of discharge. The most common reason for was fall. 20% of patients did not survive to discharge. 38% did not survive to August 2023. After the procedure 46% of patients were able to return home independently; 5% had care at home; 26% were discharged to community hospital and 2% to care home. By January 2024 61% of survivors were living independently at home with no functional decline. Most commonly, patients needed support with bathing/stairs/dressing (37%). 11% of respondents were completely dependent. Conclusion Emergency laparotomy confers a significant mortality, morbidity and risk to an elderly patient’s long term functional status. We believe this information is essential for surgical decision making and the consent process.

FP7.8 - Perioperative risk prediction for Emergency Laparotomy in Adults, using the National Emergency Laparotomy Audit (NELA) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk prediction tools – an Eastern European perspective

Abstract Background Worldwide, emergency laparotomy (EL) is one of the most common procedures. Having an actual 30-day mortality (30-dm) of 10 to 15%, EL has a high mortality rate, particularly in patients >70 years old. Preoperative risk assessment and stratification can improve outcomes. The American-College-of-Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) and the National Emergency Laparotomy Audit (NELA) risk prediction tools are the most used risk calculators, but both can under or overpredict. Methods This is a single-center, retrospective, cohort study that looked at the correlation between actual and predicted 30-dm using NELA and ACS-NSQIP in adults ≥18, following EL, over 2 years, in a single-tertiary-center from Romania. The primary outcome was defined as the correlation between actual 30-dm and NELA or ACS-NSQIP predicted 30-dm. Statistical analysis was performed using GraphPad-Prism 10.1.1. and Stata18. Results 207 cases were analyzed. Male/female ratio was 1.49; age 65 years (50;77); BMI 26.25kg/m² (23.01;28.35); preoperative lactate 1.8 mmol/L (1.5;3.4); ASA grade 3 (2;4) clinical frailty score 4 (3;4); and Charlson Comorbidity Index 5 (3;8). Actual 30-dm was 31.4% with NELA and ACS-NSQIP predicted 30-dm of 5.78% (1.84;21.48) and 5.5% (1.2;24.2) respectively. NELA and ACS-NSQIP predicted 30-dm expressed a strong positive correlation, R²=0.88; p<0.0001. Both NELA and ACS-NSQIP predicted 30-dm showed a significant positive correlation with actual 30-dm: R²=0.33, p<0.0001; and R²=0.41, p<0.0001 respectively. All data is presented as Median + IQR. Conclusion In a Romanian setting both ACS-NSQIP and NELA risk calculators underpredicted 30-dm, despite expressing a strong positive correlation with actual 30-dm.

FP7.6 - Comprehensive Analysis of Emergency Laparotomy in the Geriatric Population: A Retrospective Study

Abstract Aims The British Society of Geriatrics recommends that all patients undergoing emergency laparotomy aged >= 65 who score more than 5 on Clinical Frailty Score (CFS) or >= 80 years with any CFS should receive comprehensive geriatric assessment within 72 hours of admission to a ward or step down from critical care. Despite substantial evidence outlining an improvement in postoperative outcomes, efforts to refer patients and record CFS are still insufficient. The aim of our study is to evaluate the use of CFS assessment in patients aged ≥ 65 years undergoing emergency laparotomy. Methods This was a retrospective audit of 94 patients aged ≥ 65 years old undergoing emergency laparotomy between September 2022 to October 2023. Results The mean age of the cohort was 75 years old. The average length of hospital stay was 21 days. 50% of patients were referred for an in-patient geriatrician review. The interval between surgery and geriatrician referral averaged 7 days. However, the average duration between geriatrician referral and assessment only spanned 1 day. CFS were recorded for only 11% of patients during their hospitalisation, pointing to an area for potential improvement. Conclusion Understanding the factors contributing to prolonged stays is pivotal in enhancing postoperative care. These insights not only shed light on the procedural intricacies surrounding emergency laparotomies in the elderly but also highlight opportunities for refining patient care pathways and optimising interdisciplinary care.

WP3.10 - Variability of frailty scoring during unplanned surgical admissions in older persons - why accuracy matters

Abstract Introduction The Clinical Frailty Score (CFS) is a reliable predictor of outcomes for older patients in the acute hospital setting and is used to guide management decisions. Our hospital routinely calculates the CFS for older adults on admission to the Emergency Department (ED). Patients admitted under general surgery will then be referred for a Comprehensive Geriatric Assessment (CGA) by our Perioperative Medicine for the Older Patients undergoing Surgery (POPS) team who also calculate CFS. This study aimed to compare the CFS calculated in ED and CGA for these patients. Methods We performed a single centre prospective study of emergency general surgical admissions who were reviewed as an inpatient by our POPS team between August 2022 and September 2023. CFS from ED documentation was compared to that after CGA. A two tailed, paired t test was performed to compare the CFS on admission and after CGA using GraphPad Prism version 10.0. Results A total of 293 patients were identified with a mean age of 79 years(65-102). There was a difference between the admission CFS [4.2 (3.9-4.4 95%CI)] and the CFS following POPS review [4.5 (4.3-4.7 95%CI)] which was statistically significant (p<0.0001). Univariate analysis showed that CFS was predictive of length of hospital stay. Conclusion CFS calculated in the ED can both over and underestimate the degree of frailty when compared to the CFS calculated during the CGA. As evidence suggests that CFS is predictive of outcomes in this cohort, we suggest staff are adequately trained in undertaking an accurate assessment of this score.

EP503 - A retrospective assessment of quantitative futility in emergency laparotomy using pre-operative frailty as the predictor

Abstract Background Recent literature has proposed that emergency laparotomy in the frail population may be qualitatively futile leading to negative desired morbidity and missed opportunities for palliation. The aim of this study was to appraises the futility of emergency laparotomies within a 3 month period based on the predictor of pre-operative frailty with in a large district general hospital. Method Retrospective analysis of all patients undergoing emergency laparotomy in a 3 month time period in the Dumfries Royal Infirmary. Futility was defined as all-cause mortality within 3 days of emergency laparotomy and frailty based on the characteristics set out by the Rockwood frailty score. A assessment of surgical futility in emergency laparotomy was carried out based on the pre-operative frailty. Conclusions Increased frailty demonstrates an increase in futile emergency laparotomies. It is therefore recommended that a multidisciplinary team approach with careful assessment and consent should be made prior to any surgical intervention on this patient cohort.

WP7.4 - A closed loop audit assessing adherence to NELA frailty guidelines in over 75’s undergoing Emergency Laparotomy

Abstract Background and Aims The National Emergency Laparotomy Audit (NELA) 2023 recommend patients over 65 should have clinical frailty score (CFS) recorded, and, if frail or aged 80 or over, should have Care of the Elderly (COE) input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk. This audit reviewed use of these recommendations at a large District General Hospital (DGH). Methods We performed a closed loop audit on all patients aged 75 and older who had an emergency laparotomy between September 2020 to December 2023. We collected data from their admissions, including CFS and if COE reviews had occurred. The data was analysed. Interventions included presentation at clinical governance, discussion with the COE consultant and a poster was developed for the surgical assessment unit. The data was again retrospectively collected to complete the audit cycle. Results A total of 94 patients were included. The initial audit found 0 patients had CFS recorded and 16% had COE review. The reaudit found significant improvement, with 92% of patients having CFS recorded and 46% having had COE review. Conclusion The second cycle audit has shown significant improvement at the DGH in recording CFS and organising COE reviews for patients over 75 having an emergency laparotomy. However, there remains scope for improvement. Suggested improvements include: a referral pathway to prompt COE reviews and the creation of the “general surgery geriatrician” similar to the ortho-geriatrician role. Organising COE reviews could improve patient outcomes and provide more holistic care.

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.

SP9.4 - Post-operative outcomes after emergency stoma surgery in frail older adults in the West of Scotland

Abstract Aim An emergency laparotomy (EmLap) is a common surgical procedure in the United Kingdom for older adults aged 65 and above. A significant proportion of the EmLap population is frail (20%), which is associated with increased post-operative mortality and care requirements. Stoma formation is often preferred over a bowel anastomosis in this frail population, as an anastomosis is often considered too high risk. However, there is a lack of research describing post-operative outcomes after emergency stoma surgery for this frail older adult population. Methods A retrospective review of a prospectively maintained EmLap database (ELLSA) across 3 hospitals was performed between December 2019 to 2022. Older adults undergoing emergency stoma formation per NELA criteria were included. All patients had 1-year minimum follow-up. A Rockwood frailty score of more than 4 was considered ‘frail’. Results 234 older adults were identified (Median age: 74 years (Range: 65 to 91 years); 23% frail; Median follow-up: 27 months). 30% of frail patients died within 30-days, compared with 19% of non-frail patients (p=0.04). Of the frail survivors, only 47% were managing their stoma independently (compared with 76% of those without frailty, p<0.001) and 20% were in new long-term care (compared with 6% of those without frailty, p=0.002). Conclusion Frail older adults experience unfavourable outcomes after emergency stoma surgery, indicated by higher mortality rates and a limited ability to manage their stomas independently. Therefore, in selected cases, these patients may benefit from discussion around a higher risk anastomosis rather than a stoma. This study underscores the importance of further research to identify such patients and enhance pre-operative supported decision-making processes.

ThP6.15 - 1, 3, and 5-year mortality following emergency laparotomy, can the National Emergency Laparotomy Audit (NELA) or the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) risk calculators predict it? – a retrospective, multi-center, observational, cohort study

Abstract Background Emergency laparotomy (EL) comprises a high-risk group of surgical procedures, associated with a significantly increased risk of death in the following 5 years. EL are performed on a heterogeneous population, of which at least 50% are ≥ 70 years old. Accurate preoperative risk prediction is vital for planning care, patient shared decision, and improving outcomes. To date, no prediction tool can reliably estimate long-term outcomes, including mortality, following an EL. Methods This is a multicenter, retrospective, observational, cohort study that investigated the correlation between actual mortality at 1, 3, and 5 years and predicted 30-day mortality (30-dm) using NELA and ACS-NSQIP risk prediction tools, following EL, in adults aged ≥18, over 2 years, in two UK centers. The sample size was calculated at 385 cases. GraphPad-Prism 10.1.1. was used for statistical analysis. Results 626 cases were analyzed. The male/female ratio was 0.85, age 70 years (55;78); BMI 24.94kg/m² (22;29); preoperative lactate 1.7 mmol/L (1.2;2.6), clinical frailty score 3 (2;4); and Charlson Comorbidity Index 4(2;5) (all data is expressed as median+IQR). The 1, 3, and 5-year survival were 76%, 67%, and 61%, respectively. A perfect positive correlation between NELA and ACS-NSQIP 30-dm and the 1-year actual mortality was found (R²=1). At 3 years only NELA correlated positively to actual mortality (R²=0.23, p<0.05). The 5-year mortality correlated positively with both predictors - NELA: R²=0.61, p<0.001; ACS-NSQIP: R²=0.31, p< 0.05. Conclusion Both NELA and ACS-NSQIP risk calculators can predict mortality at 1,3 and 5 years after an emergency laparotomy, with NELA expressing a stronger correlation.

Assessing Frailty, Rational Use of Medications, and Adherence to Immunosuppressive Therapy in Liver Transplant Recipients

AimThe study was conducted to determine the level of frailty, rational medication use, and adherence to immunosuppressive therapy in liver transplant patients and to examine the relationships among them. Materials and MethodsThe data of the descriptive cross-sectional study were collected between January 2023 and September 2023. Our study included 200 liver transplant recipients. In addition to demographic and medical characteristics, frailty status, rational drug use, and compliance with immunosuppressive therapy were measured in a 15–20 minute questionnaire administration period. ResultsThe frailty scores of liver transplant patients were 2.11 ± 1.34, rational drug use scores were 82.88 ± 13.11, and compliance with immunosuppressive therapy scores were 11.12 ± 1.07. The scores for rational drug use and adherence to immunosuppressive therapy were not affected by frailty status, and patients used drugs rationally and adhered to immunosuppressive therapy even when they were frail. It was found that the vulnerability status of the participants was affected by gender and occupational variables, most patients were in the vulnerable group in women and men, and those who did not work were more vulnerable than the other groups. ConclusionIt was found that liver transplant patients were frail, and frailty did not affect the level of rational drug use and compliance with immunosuppressive therapy.

Case Definition for Diagnosed Alzheimer Disease and Related Dementias in Medicare

Lack of a US dementia surveillance system hinders efforts to support and address disparities among persons living with Alzheimer disease and related dementias (ADRD). To review diagnosis and prescription drug code ADRD identification algorithms to develop and implement case definitions for national surveillance. In this cross-sectional study, a systematic literature review was conducted to identify unique International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and prescription drug codes used by researchers to identify ADRD in administrative records. Code frequency of use, characteristics of beneficiaries identified by codes, and expert and author consensus around code definitions informed code placement into categories indicating highly likely, likely, and possible ADRD. These definitions were applied cross-sectionally to 2017 to 2019 Medicare fee-for-service (FFS) claims and Medicare Advantage (MA) encounter data to classify January 2019 Medicare enrollees. Data analysis was conducted from September 2022 to March 2024. ICD-10-CM and national drug codes in FFS claims or MA encounters. The primary outcome was counts and rates of beneficiaries meeting each case definition. Category-specific age, sex, race and ethnicity, MA enrollment, dual-eligibility, long-term care utilization, mortality, and rural residence distributions, as well as frailty scores and FFS monthly expenditures were also analyzed. Beneficiary characteristics were compared across categories, and age-standardized to minimize confounding by age. Of the 60 000 869 beneficiaries included (50 853 806 aged 65 years or older [84.8%]; 32 567 891 female [54.3%]; 5 555 571 Hispanic [9.3%]; 6 318 194 non-Hispanic Black [10.5%]; 44 384 980 non-Hispanic White [74.0%]), there were 4 312 496 (7.2%) with highly likely ADRD, 1 124 080 (1.9%) with likely ADRD, and 2 572 176 (4.3%) with possible ADRD, totaling more than 8.0 million with diagnostic evidence of at least possible ADRD. These beneficiaries were older, more frail, more likely to be female, more likely to be dual-eligible, more likely to use long-term care, and more likely to die in 2019 compared with beneficiaries with no evidence of ADRD. These differences became larger when moving from the possible ADRD group to the highly likely ADRD group. Mean (SD) FFS monthly spending was $2966 ($4921) among beneficiaries with highly likely ADRD compared with $936 ($2952) for beneficiaries with no evidence of ADRD. Differences persisted after age standardization. This cross-sectional study of 2019 Medicare beneficiaries identified more than 5.4 million Medicare beneficiaries with evidence of at least likely ADRD in 2019 using the diagnostic case definition. Pending validation against clinical and other methods of ascertainment, this approach can be adopted provisionally for national surveillance.

On the Relationship Between Frailty, Nutritional Status, Depression and Quality of Life Among Older People.

Frailty is a multidimensional geriatric syndrome associated with physical, psychological and social changes. There is a paucity of research on frailty in Sub-Saharan African (SSA) countries, especially Ethiopia. To assess the initial correlations among frailty, nutritional status, depression and QOL (quality of life) in a group of older people in Ethiopia who are later enrolled in a study examining the effects of a nurse-led community intervention on frailty and related health outcomes. Data from 68 community-dwelling individuals 60 years of age, or over, were collected. Frailty was measured using the Amharic version of the Tilburg Frailty Indicator. The statistical analysis included Spearman's rank correlation coefficient for degrees of association, Mann-Whitney U-test for variables with two categories and Kruskal-Wallis for variables with three or more categories. The mean frailty score for participants was 7.3 (±1.9). Participants with higher frailty scores had lower nutritional status (rs = -0.46, p < 0.01). There was a statistically significant relationship (positive) between frailty scores and depression (rs = 0.39, p < 0.01). Depressed (Md = 9, n = 23) and non-depressed frail older people (Md = 7, n = 45) showed a significant difference in their overall frailty score, U = 330.50, z = -2.49, p = 0.01, r = 0.30. There was an inverse significant association between the level of frailty across different domains in the QOL: physical (rs = -0.44, p < 0.01), psychological (rs = -0.45, p < 0.01), social relations (rs = -0.29, p < 0.05) and environmental (rs = -0.47, p < 0.01). The findings from this study were consistent with those from across middle-income and high-income countries. This research indicates that older people living in communities who are identified as frail often suffer from a poor nutritional status, depression and reduced QOL. It suggests that healthcare professionals in Sub-Saharan countries would benefit from recognising the frailty in this population, and developing interventions aimed at enhancing nutrition, mental health and overall well-being.

266. NSQIP 5-FACTOR MODIFIED FRAILTY INDEX PREDICTS MORBIDITY BUT NOT MORTALITY AFTER ESOPHAGECTOMY

Abstract Background Frailty is a source of morbidity in esophagectomy patients. To aid clinical decision making, it is important to determine if the simplified 5-factor modified frailty index (mFI-5) retains the same associations between frailty and adverse outcomes as its 11-factor predecessor. Methods Patients undergoing esophagectomy for esophageal cancer or dysplasia from 2016-2018 were identified using National Surgical Quality Improvement Program (NSQIP). The mFI-5 was used to determine association between frailty and post-esophagectomy morbidity and mortality. Results In total, 2,567 patients were included. No patients had a mFI-5 score higher than 3/5 and the score distribution was wide: mFI0 = 1103 (43%), mFI1 = 982 (38.3%), mFI2 = 435 (16.9%), mFI3 = 47 (1.8%). Clavien-Dindo grade IV complications increased with mFI score: mFI0 (11.2%), mFI1 (15.6%), mFI2 (19.8%), mFI3 (25.5%), as did mortality: mFI0 (1.9%), mFI1 (3%), mFI2 (3.4%), mFI3 (4.3%). Multivariate logistic regression analyses controlling for age, sex, body mass index, American Society of Anesthesiology classification, operative duration, emergency surgery status, and neoadjuvant therapy status showed increasing frailty score was associated with Clavien-Dindo grade IV complications (p=0.01), but not mortality (p=0.13). Conclusions The mFI-5 is associated with morbidity but not mortality in patients who have undergone esophagectomy for esophageal cancer. Compared to the mFI-11, the mFI-5 may not be nuanced enough in the assessment of frailty specific to this patient population.