Higher Risk Of Frailty Research Articles

Frailty in a Frailty Prevention Program Participants During COVID-19 pandemic: A Cross-Sectional Japanese Study

Background: Cognitive frailty is a newly proposed clinical entity, referring to concurrent cognitive impairment and physical frailty in the absence of dementia. The clinical significance of cognitive frailty remains poorly understood. We aimed to investigate the association between cognitive frailty and functional disability in older adults. Methods: A total of 1,644 non-demented older adults aged ≥65 years (mean age: 73 ± 6 years; men: 41.8%) and without functional disability at baseline were followed-up for 4 years. Cognitive frailty was defined as the presence of both physical frailty (based on the modified Cardiovascular Health Study criteria) and cognitive impairment (Mini-Mental State Examination score of <24 points). Functional disability was identified using the database of Japan’s Long-term Care Insurance System. Association between cognitive frailty and functional disability was assessed by using the Cox proportional hazard models. Results: During the follow-up, 152 participants were identified as being functionally disabled. There was a significant interaction between physical frailty and cognitive impairment on the development of functional disability (P <0.1). Compared with being robust both physically and cognitively, the hazard ratio (95% confidence interval) of functional disability was 8.40 (4.05-17.42) for cognitively frailty, after adjustment for age, sex, education, living alone, smoking, drinking, number of comorbidities (hypertension, stroke, chronic heart disease, diabetes, chronic kidney disease, poor hearing, poor vision, osteoarthritis or rheumatism, minor trauma fracture, or cancer). Conclusion: Cognitive frailty was associated with an increased risk of functional disability in community-dwelling older adults. Cognitive frailty could be an underrecognized risk factor for functional disability.

Abstract 12686: Frailty is Associated With Perioperative Major Adverse Cardiovascular Events After Non-Cardiac Surgery

Introduction: Frailty is increasingly recognized for its association with adverse outcomes after surgery, but its excess risks have not been characterized in large representative cohorts. We investigated the prevalence of frailty and the associated incidence of major adverse cardiovascular events (MACE) among those hospitalized for non-cardiac surgery. Methods: Adults aged ≥45 years hospitalized for non-cardiac surgery between 2004-2014 were identified from the Healthcare Cost and Utilization Project’s National Inpatient Sample. A validated Hospital Frailty Risk Score (HFRS) based on International Classification of Diseases codes was used to classify patients as low (&lt;5), medium (5-15), or high (&gt;15) frailty risk. The primary outcome was MACE, defined as in-hospital mortality, myocardial infarction, and cardiac arrest. Multivariable logistic regression was used to estimate the adjusted odds of MACE by HFRS. Results: A total of 55,349,978 hospitalizations were identified, of which 81%, 18%, and 1% had low, medium, and high HFRS, respectively. Patients with higher HFRS had a greater burden of cardiovascular risk factors and comorbidities (Table). MACE occurred during 2.5% of all hospitalizations and was more common in patients with higher HFRS (high: 8.4%, medium: 7.4%, low: 1.3%, p&lt;0.001). Compared to low HFRS, medium (adjusted odds ratio [aOR] 2.34, 95% CI 2.31-2.38) and high (aOR 2.49, 95% CI 2.42-2.56) HFRS were associated with greater odds of MACE. The association between high (versus low) HFRS and MACE was consistent across age groups (aOR 4.26 [95% CI 3.96 - 4.57] for ages 45-64, aOR 2.64 [95% CI 2.51 - 2.79] for ages 65-74, and aOR 2.80 [95% CI 2.72 - 2.89] for ages ≥75). Conclusion: Higher frailty scores are associated with increased risks of MACE overall and within age subgroups. Implementation of HFRS as a standardized, electronic health record-based screening tool may identify frail surgical inpatients at risk for adverse perioperative outcomes.

Frailty and Depression in Late Life: A High-Risk Comorbidity With Distinctive Clinical Presentation and Poor Antidepressant Response.

To investigate the longitudinal relationship between physical frailty, the clinical representation of accelerated biological aging, and antidepressant medication response in older adults with depressive illness. An 8-week randomized placebo-controlled trial (escitalopram or duloxetine) followed by 10 months of open antidepressant medication treatment (augmentation, switch strategies) was conducted in an outpatient research clinic. 121 adults aged 60 years or older with major depressive disorder (MDD) or persistent depressive disorder and a 24-item Hamilton Rating Scale for Depression (HRSD) ≥16 were enrolled. Primary measures assessed serially over 12 months include response (50% reduction from baseline HRSD score), remission (HRSD score <10), and frailty (non/intermediate frail [0-2 deficits] vs frail [≥3 deficits]); latent class analysis was used to classify longitudinal frailty trajectories. A 2-class model best fit the data, identifying a consistently low frailty risk (63% of the sample) and consistently high frailty risk (37% of the sample) trajectory. Response and remission rates (ps ≤ .002) for adults in the high-risk frailty class were at least 21 percentage points worse than those in the low-risk class over 12 months. Furthermore, subsequent frailty was associated with previous frailty (ps ≤ .01) but not previous response or remission (ps ≥ .10). Antidepressant medication is poorly effective for MDD occurring in the context of frailty in older adults. Furthermore, even when an antidepressant response is achieved, this response does little to improve their frailty. These data suggest that standard psychiatric assessment of depressed older adults should include frailty measures and that novel therapeutic strategies to address comorbid frailty and depression are needed.

Red meat consumption and risk of frailty in older women.

BackgroundRed meat is a nutrient‐dense source of protein fundamental for older adults; however, red meat is also high in detrimental components, including saturated fat. It is unclear whether habitual red meat consumption is associated with risk of frailty. This study aimed to examine the prospective association between the consumption of total, unprocessed, and processed red meat and the risk of frailty in older adults.MethodsWe analysed data from 85 871 women aged ≥60 participating in the Nurses' Health Study. Consumption of total, unprocessed, and processed red meat was obtained from repeated food frequency questionnaires administered between 1980 and 2010. Frailty was defined as having at least three of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 chronic illnesses, and unintentional weight loss ≥5%. The occurrence of frailty was assessed every four years from 1992 to 2014.ResultsDuring 22 years of follow‐up (median follow‐up 14 years), we identified 13 279 incident cases of frailty. Women with a higher intake of red meat showed an increased risk of frailty after adjustment for lifestyle factors, medication use, and dietary factors. The relative risk (95% confidence interval) for one serving/day increment in consumption was 1.13 (1.08, 1.18) for total red meat, 1.08 (1.02, 1.15) for unprocessed red meat, and 1.26 (1.15, 1.39) for processed red meat. When each component of the frailty syndrome was individually examined, each of them was positively associated with total red meat consumption, except for the weight loss criterion. Replacing one serving/day of unprocessed red meat with other protein sources was associated with significantly lower risk of frailty; the risk reduction estimates were 22% for fish and 14% for nuts, while for replacement of processed red meat, the percentages were 33% for fish, 26% for nuts, 13% for legumes, and 16% for low‐fat dairy.ConclusionsHabitual consumption of unprocessed and processed red meat was associated with a higher risk of frailty. Replacement of red meat by other protein sources might reduce the risk of frailty. These findings are in line with dietary guidelines promoting diets that emphasize plant‐based sources of protein.

The correlation between nutrition and frailty and the receiver operating characteristic curve of different nutritional indexes for frailty

BackgroundFrailty is a kind of geriatric syndrome, which is very common in the elderly. Patients with malnutrition are at higher risk of frailty. This study explored the correlation between nutrition and frailty and compared the receiver operating characteristic curve of different nutritional indexes for frailty.MethodsThis cross-sectional study included 179 inpatients aged ≥65 years old. Frailty was measured using Fried Frailty Phenotype, handgrip strength was measured using JAMAR@Plus and the 4.57 m usual gait speed was measured using a stopwatch. Comprehensive nutritional assessment refers to the application of Mini Nutritional Assessment (MNA) to assess the nutritional status of patients.ResultsCompared with the non-frailty group, the upper arm circumference, calf circumference, hemoglobin, albumin, prealbumin, cholesterol and low density lipoprotein in the frailty group were lower (P < 0.05). Comprehensive nutritional assessment, whether as a categorical variable or a continuous variable, was significantly correlated with frailty (P < 0.05). Model1 showed that the risk of frailty in malnourished patients was 3.381 times higher than that in well nourished patients (P = 0.036). Model2 showed that the risk of frailty decreased by 13.8% for every 1 point increase in MNA score (P = 0.009). The area under the curves of albumin, prealbumin and hemoglobin was larger (AUC > 0.65), AUC was 0.718, 0.693 and 0.743, respectively.ConclusionsOur results suggest that malnutrition is closely related to frailty. As for single nutritional indexes, albumin, prealbumin and hemoglobin were found to be associated with frailty. Further cohort studies are needed to verify their ability to screen for frailty.

Long sleep duration is associated with cognitive frailty among older community-dwelling adults: results from West China Health and Aging Trend study

ObjectiveTo investigate the association between sleep duration and cognitive frailty among older adults dwelling in western China.MethodsWe used the baseline data from West China Health and Aging Trend (WCHAT) study. Sleep duration was classified as short sleep duration (< 6 h), normal sleep duration (6–8 h) and long sleep duration (≥ 9 h). Fried frailty criteria and Short Portable Mental Status Questionnaire were used to measure cognitive frailty. Multinomial logistic regression was conducted to estimate odds ratio (OR) and 95% confidence interval (CI).ResultsA total of 4093 older adults (age = 67.8 ± 5.9 years, 1708 males and 2385 females) were included in the analysis. The prevalence of cognitive frailty was 11.8% among older adults in western China. Approximately 11.9% participants had short sleep duration (< 6 h); 22.2% had a long sleep duration (≥ 9 h). After adjusting for covariates, only long sleep duration was significantly associated with high risk of cognitive frailty (OR = 2.07, 95%CI = 1.60–2.68, P < 0.001) in western China older adults compared to normal sleep duration.ConclusionsLong sleep duration was significantly related to cognitive frailty in older adults. Intervention for long sleep duration may be helpful to prevent cognitive frailty.Trial registrationChinese Clinical Trial Registry: ChiCTR1800018895.

Hospital readmission and mortality associations to frailty in hospitalized patients with coronary heart disease

BackgroundFrailty is associated with poor quality outcomes. ObjectiveTo examine associations between frailty and hospital readmission or mortality in Coronary Heart Disease (CHD). MethodsRetrospectively assessed the 2016 US Nationwide Readmissions Database (NRD) including adults ≥ 65 years with pre-existing CHD. A validated Hospital Frailty Risk Score (HFRS) using ICD-10-CM codes identified frailty risk. Outcomes included: Readmission (30-day and subsequent readmission after index event) and in-hospital morality (during index event, readmission, and at 30-day readmission). ResultsAmong 1.1 million eligible patients, low, intermediate, and high frailty risk accounted for 48.9%, 46.7%, and 4.4% of the sample. Compared to low frailty risk, intermediate and high frailty risk showed significantly higher overall readmission rates (40.9% vs. 31.4%, 41.7% vs. 31.4%) and 30-day readmission rates (21.9% vs. 15.7%, 23.5% vs. 15.7%), respectively. After adjustment, higher in-hospital mortality and readmission rates were associated with higher frailty risk. The associations between in-hospital mortality and frailty depended on the presence of acute coronary syndrome. ConclusionsReadmission and mortality rates increased proportionally to the level of frailty risk in older adults with CHD. CHD, frailty risk, and older age profoundly negatively impact health outcomes and increases risk of death and readmission.

Hospital Frailty Risk Score predicts adverse events in older patients with hip fractures after surgery: Analysis of a nationwide inpatient database in Japan

Background: Frailty may predict adverse events in patients with hip fractures. This study aimed to investigate the association between frailty and adverse events in patients with hip fractures after surgery using information from Japanese health insurance.Methods: This retrospective cohort study included patients with hip fractures aged ≥ 65 years using a nationwide database in Japan. We examined the relationship of the frailty risk, which was defined using the Hospital Frailty Risk Score (HFRS), with in-hospital mortality, complications such as delirium and pneumonia, and functional outcomes. We used descriptive analysis, logistic regression, and linear regression analysis to estimate the association between the HFRS and outcomes in patients with hip fracture.Results: We analysed data from 36,192 patients with hip fractures after surgery (mean age: 83.6 ± 6.7 years, female: 79.5%). The proportions of low, intermediate, and high risk of frailty were 68.4%, 28.1%, and 3.5%, respectively. The frailty risk was independently associated with in-hospital mortality (intermediate risk: odds ratio [OR] 1.385, P < 0.001; high risk: OR 1.572; P < 0.001) and the occurrence of complications. Furthermore, each frailty risk was negatively associated with the Barthel Index score at discharge (intermediate risk: coefficient –11.919, P < 0.001; high risk: coefficient –18.044; P < 0.001).Conclusions: The HFRS could predict adverse events, including in-hospital mortality, in Japanese older patients with hip fractures. This finding supports the validity of using the HFRS in clinical practice for patients with hip fractures.

Development of risk prediction models for incident frailty and their performance evaluation

There is currently no tool to predict incident frailty despite various frailty assessment tools. This study aimed to develop risk prediction models for incident frailty and evaluated their performance on discrimination, calibration, and internal validity. This 2-year follow-up study used data from 5076 non-frail older adults (51% women) living in Tokyo at baseline. We used the Kaigo-Yobo checklist, a standardised assessment instrument, to determine frailty. Twenty questionnaire-based variables that include sociodemographic, medical, behavioural, and subjective factors were entered into binary logistic regression analysis with stepwise backward elimination (p < 0.1 for retention in the model). Discrimination and calibration were assessed by area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow test, respectively. For the assessment of internal validity, we used a 5-fold cross-validation method and calculated the mean AUC. At the follow-up survey, 15.0% of men and 10.2% of women were frail. The frailty risk prediction model was composed of 10 variables for men and 11 for women. AUC of the model was 0.71 in men and 0.72 in women. The P-value for the Hosmer-Lemeshow test in both models was more than 0.05. For internal validity, the mean AUC was 0.71 in men and 0.72 in women. Probability of incident frailty rose with an increasing risk score that was calculated from the developed models. These results demonstrated that the developed models enable the identification of non-frail older adults at high risk of incident frailty, which could help to implement preventive approaches in community settings.

Association Between Chronologic Age and Geriatric Assessment-Identified Impairments: Findings From the CARE Registry.

The NCCN Guidelines for Older Adult Oncology recommend that, when possible, older adults with cancer undergo a geriatric assessment (GA) to provide a comprehensive health appraisal to guide interventions and appropriate treatment selection. However, the association of age with GA-identified impairments (GA impairments) remains understudied and the appropriate age cutoff for using the GA remains unknown. We designed a cross-sectional study using the Cancer and Aging Resilience Evaluation (CARE) registry of older adults with cancer. We included adults aged ≥60 years diagnosed with gastrointestinal malignancy who underwent a patient-reported GA prior to their initial consultation at the gastrointestinal oncology clinic. We noted the presence of GA impairments and frailty using Rockwood's deficit accumulation approach. We studied the relation between chronologic age and GA impairments/frailty using Spearman rank correlation and chi-square tests of trend. We identified 455 eligible older adults aged ≥60 years with gastrointestinal malignancies; the median age was 68 years (range, 64-74 years) and colorectal (33%) and pancreatic (24%) cancers were the most common cancer type. The correlation between chronologic age and number of geriatric impairments was weak and did not reach statistical significance (Spearman ρ, 0.07; P=.16). Furthermore, the prevalence of domain-specific impairments or frailty was comparable across the 3 age groups (60-64 years, 65-74 years, ≥75 years) with the exception of comorbidity burden. Notably, 61% of patients aged 60 to 64 years had ≥2 GA impairments and 35% had evidence of frailty, which was comparable to patients aged 65 to 74 years (66% and 36%, respectively) and ≥75 years (70% and 40%, respectively). Using chronologic age alone to identify which patients may benefit from GA is problematic. Future studies should identify screening tools that may identify patients at high risk of frailty and GA impairments.

Psychometric Properties of Frailty Syndrome Checklist 5-Items in Frail Older Adults in Iran

Psychometric Properties of Frailty Syndrome Checklist 5-Items in Frail Older Adults in Iran

Spliceosome Mutations Are Associated with Frailty in Older Patients with Myeloid Malignancies

Background: Frailty is a state of depleted physiologic reserve that is common in older patients with myeloid malignancies. While it is associated with chemotherapy-related toxicity, poor response to therapy, and higher mortality (Sherman, 2013; Fega, 2015), little is known about its causes. Moreover, there are increasing data demonstrating that clonal somatic mutations may be related to atherosclerotic disease (Jaiswal, 2017), which is an important driver of frailty. In this context, we sought to determine whether there is an association between hematopoietic DNA mutations and frailty in patients with overt myeloid neoplasms, hypothesizing that both RAS/MAPK and spliceosome mutations would be associated with the frailty phenotype.Methods: Starting in February of 2015,all patients aged 75 and older who presented for initial consultation to the DFCI Adult Leukemia Clinic were approached for evaluation by a trained research assistant. In a 15-minute interview, the assistant used two methods to characterize the patient as frail, pre-frail, or robust. The first employs a cumulative deficit approach (Rockwood, 2007) including 26 questions adapted from the Yale Precipitating Events Project (Searle, 2008), as well as the delayed recall section of the Montreal Cognitive Assessment (Nasreddine, 2005), a clock-in-the-box test (Chester, 2011), a grip strength test (Gill, 2006), and a gait speed test (Studenski, 2011). The second is a phenotype approach (Fried, 2001), which gives equal weight to performance on the gait speed and grip strength tests, as well as three questions about weight loss, energy expenditure and self-reported exhaustion. Patients were assigned frailty designations using the worse of the two scores. 85% of patients approached agreed to participate. Routine assessment of recurrent genetic alterations was performed using the Rapid Heme Panel (RHP), a gene panel sequencing test that evaluates 95 genes recurrently mutated in hematologic malignancies (Kluk, 2016). Associations between mutations and frailty were assessed via tests for trend across frailty status categories as well as a Fisher's exact test comparing the proportion of patients with robust status (versus frail/pre-frail combined).Results: As of July 2017, 93 patients with MDS (n=39), MPN (n=18), MDS/MPN (n=18), or AML (n=18) had completed frailty assessment and disease genetic characterization. Patients were majority male (n=70, 75%) with median age of 78 years (range, 75-89). Hypertension (65%) and hyperlipidemia (42%) were common. 59% (n=55) of patients in the cohort were pre-frail, 23% were frail (n=21), and 18% (n=17) were robust. There were no significant differences in frailty status between AML patients and those with chronic myeloid disorders (MDS, MPN, MDS/MPN). Gene mutations present in at least 5% of the cohort included SRSF2 (25%), SF3B1 (12%) , U2AF1 (8%), TET2 (44%), ASXL1 (26%), DNMT3A (8%), JAK2 (24%), RUNX1 (19%), TP53 (13%), STAG2 (9%), IDH2 (8%), EZH2 (8%) , and CBL (6%). 47% of patients had one of 4 non-co-occurring splicing mutations (SRSF2, SF3B1, U2AF1, ZRSR2). 18% of patients had one or more mutations that cause aberrant activation of RAS/MAPK signaling (NRAS, KRAS, CBL, PTPN11, RIT1, FLT3, KIT) and are associated with leukemic transformation of MDS (Lindsley, 2015). Patient with any splicing mutations were less likely to be robust (5% robust, 73% pre-frail, 23% frail) compared to those without (31% robust, 47% pre-frail, 22% frail; P for trend = 0.05; P -exact for robust versus pre-frail/frail = 0.001). Patients with an SF3B1 mutation specifically were also less likely to be robust then patients without an SF3B1 mutation (P for trend=0.02, Figure). The association between presence of a splicing mutation and frailty persisted within subgroups of patients with chronic myeloid malignancies and patients with AML, although the latter did not reach statistical significance (p=0.10) in that small dataset. No other single mutation, number of mutations present, or presence of a mutation in the RAS/MAPK pathway was significantly associated with frailty.Conclusion: In our cohort, patients with splicing mutations were less likely to be robust than patients without splicing mutations. These findings suggest that molecular characterization of myeloid disease may identify patients at higher risk for frailty and complications associated with treatment. [Display omitted] DisclosuresDeAngelo:Glycomimetics: Research Funding; Amgen: Consultancy, Research Funding; BMS: Consultancy; Blueprint Medicines: Honoraria, Research Funding; Immunogen: Honoraria, Research Funding; Shire: Honoraria; Takeda Pharmaceuticals U.S.A., Inc.: Honoraria; Celgene: Research Funding; Incyte: Consultancy, Honoraria; Pfizer Inc.: Consultancy, Honoraria, Research Funding; ARIAD: Consultancy, Research Funding; Novartis Pharmaceuticals Corporation: Consultancy, Honoraria, Research Funding. Steensma:Celgene: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy; Janssen: Consultancy, Research Funding; H3 Biosciences: Consultancy; Incyte: Equity Ownership; Onconova: Consultancy; Takeda: Consultancy; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees. Lane:Stemline Therapeutics: Research Funding; N-of-one: Consultancy. Lindsley:MedImmune: Research Funding; Jazz Pharmaceuticals: Consultancy; Takeda Pharmaceuticals: Consultancy.

Frailty is an outcome predictor in patients with acute ischemic stroke receiving endovascular treatment.

Frailty is a disorder of multiple physiological systems impairing the capacity of the organism to cope with insult or stress. It is associated with poor outcomes after acute illness. Our aim was to study the impact of frailty on the functional outcome of patients with acute ischemic stroke (AIS) submitted to endovascular stroke treatment (EST). We performed a retrospective study of patients with AIS of the anterior circulation submitted to EST between 2012 and 2017, based on a prospectively collected local registry of consecutive patients. The Hospital Frailty Risk Score (HFRS) at discharge was calculated for each patient. We compared groups of patients with and without favourable 3-month outcome after index AIS (modified Rankin Scale 0-2 and 3-6, respectively). A multivariable logistic regression model was used to identify variables independently associated with favourable 3-month outcome. Diagnostic test statistics were used to compare HFRS with other prognostic scores for AIS. We included 489 patients with median age 75.6years (interquartile range [IQR] = 65.3-82.3) and median NIHSS 15 (IQR = 11-19). About 29.7% presented a high frailty risk (HFRS >15 points). Patients with favourable 3-month outcome presented lower HFRS and lower prevalence of high frailty risk. High frailty risk was independently associated with decreased likelihood of favourable 3-month outcome (adjusted odds ratio = 0.48, 95% confidence interval = 0.26-0.89). Diagnostic performances of HFRS and other prognostic scores (THRIVE and PRE scores, SPAN-100 index) for outcome at 3-months were similar. Frailty is an independent predictor of outcome in AIS patients submitted to EST.

Red Meat Consumption and Risk of Frailty in Older Women

Abstract Objectives The aim of this study was to examine the prospective association between the consumption of total, unprocessed, and processed red meat and the risk of frailty in older adults. Methods We analyzed data from 85,870 women aged ≥60 participating in the Nurses’ Health Study. Consumption of red meat was obtained from repeated food frequency questionnaires administered between 1980 and 2010. Frailty was defined as having at least three of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 chronic illnesses, and weight loss ≥5%. The occurrence of frailty was assessed every four years from 1992 to 2014. Results During follow-up we identified 13,279 incident cases of frailty. Women with a higher intake of red meat showed an increased risk of frailty after adjustment for lifestyle factors, medication use, and dietary factors. The relative risk (95% confidence interval) for one serving/day increment in consumption was 1.13 (1.08, 1.18) for total red meat, 1.08 (1.02, 1.15) for unprocessed red meat, and 1.26 (1.15, 1.39) for processed red meat. Replacing one serving/day of unprocessed red meat with other protein sources was associated with significantly lower risk of frailty; the risk reduction estimates were 21% for fish and 14% for nuts, while for replacement of processed red meat the percentages were 32% for fish, 26% for nuts, 13% for legumes, and 16% for dairy. Conclusions Habitual consumption of red meat was associated with a higher risk of frailty. Replacement of red meat by other protein sources might reduce the risk of frailty. Funding Sources This work was supported by grants from the Instituto de Salud Carlos III, State Secretary of R+D+I of Spain and FEDER/FSE (FIS 16/609, 16/1512, 19/319); the European Union (JPI A Healthy Diet for a Healthy Life, SALAMANDER project); and the Nurses´ health study is supported by grant UM1 CA186107 from National Institutes of Health.

Silent Myocardial Infarction and Long-Term Risk of Frailty: The Atherosclerosis Risk in Communities Study.

BackgroundSilent myocardial infarction (SMI) accounts for more than half of all MIs, and common risk factors and pathophysiological pathways coexist between SMI and frailty. The risk of frailty among patients with SMI is not well established. This study aimed to examine the association between SMI and frailty.Methods and ResultsThis analysis included data from the Atherosclerosis Risk in Communities study. Patients without MI at baseline were eligible for inclusion. SMI was defined as electrocardiographic evidence of MI without clinical MI (CMI) after the baseline and until the fourth visit. Frailty was assessed during the fifth visit. A total of 4953 participants were included with an average age of 52.2±5.1 years. Among these participants, 2.7% (n=135) developed SMI, and 2.9% (n=146) developed CMI. After a median follow-up time of 14.7 (14.0–15.3) years, 6.7% (n=336) of the participants developed frailty. Patients with SMI and CMI were significantly more likely to become frail than those without MI (15.6% vs 6.2%, P<0.001 and 16.4% vs 6.2%, P<0.001, respectively). After adjusting for confounders, SMI and CMI were found to be independent predictors of frailty (odds ratio [OR]=2.243, 95% confidence interval [CI]=1.307–3.850, P=0.003 and OR=2.164, 95% CI=1.259–3.721, P=0.005, respectively). The association was consistent among the subgroups of age, sex, race, diabetes, and hypertension.ConclusionIn conclusion, both SMI and CMI were found to be associated with a higher risk of frailty. Future studies are needed to confirm the beneficial effects of screening for SMI as well as to implement standardized preventive treatment to reduce the risk of frailty.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT00005131.

Reexamining the Classification of Older Adults With Diabetes by Comorbidities and Exploring Relationships With Frailty, Disability, and 5-year Mortality.

Limited research has been conducted to risk stratify older adults with diabetes. Our objective was to reexamine the 2005-2006 classification systems in participants who are now 5 years older. We examined a subsample of 884 community-residing older adults with the diagnosis of diabetes from the National Social Life, Health, and Aging Project. The primary objective was to utilize a latent class analysis (LCA) to fit a model to 11 comorbidities, comparing the 2010-2011 LCA model to that of 2005-2006. The secondary objective was to evaluate the association of the identified classes with frailty, disability, and 5-year mortality. Both 2005-2006 LCA and the 2010-2011 LCA model fit 3 similar comorbidity profiles: Class 1 with the lowest rates of nearly all comorbidities, Class 2 had highest rates of obesity, hypertension, arthritis, and incontinence, and Class 3 had the higher rates of myocardial infarctions, congestive heart failure, and stroke. When compared to the healthier Class 1 (class probability = 0.67), participants with a comorbidity profile with more prevalent cardiovascular conditions (Class 3; 0.09) were at higher risk of frailty and mortality, but not disability; whereas participants with a comorbidity profile with more prevalent geriatric syndrome conditions (Class 2; 0.24) were at higher risk of frailty and disability, but not mortality. We reconfirmed 3 latent classes with distinct comorbidity profiles among older adults with diabetes. However, the complex relationships between comorbidity classes with frailty, disability, and mortality will likely require revision of the current rationale for stratified goal setting and treatment selection.

Validation of the Hospital Frailty Risk Score in older surgical patients: A population-based retrospective cohort study.

There is a need for standardized and cost-effective identification of frailty risk. The objective was to validate the Hospital Frailty Risk Score which utilizes International Classification Diagnoses in a cohort of older surgical patients, assess the score as an independent risk factor for adverse outcomes and compare discrimination properties of the frailty risk score with other risk stratification scores. Data were analysed from all patients ≥65years undergoing primary surgical procedures from 2006-2018. Patients were categorized based on the frailty risk score. The primary outcomes were 30-day mortality and 180-day risk of readmission. Of 16793 patients evaluated, 7480 (45%), 7605 (45%) and 1708 (10%) had a low, intermediate and high risk of frailty. There was a higher incidence of 30-day mortality for individuals with intermediate (2.9%) and high (8.3%) compared with low (1.4%) risk of frailty (P<.001 for both comparisons). Similarly, the hazard of readmission within the first 180days was higher for intermediate (HR 1.25; 95% CI: 1.16-1.34) and high (HR 1.84; 95% CI: 1.66-2.03) compared with low (HR 1.00, P<.001 for both comparisons) risk of frailty. The hazard of long-term mortality was higher for intermediate (HR 1.70; 95% CI: 1.61-1.80) and high (HR 4.16; 95% CI: 3.84-4.49) compared with low (HR 1.00, P<.001 for both comparisons) risk of frailty. Finally, long length of primary hospitalization occurred for 9.3%, 15.0% and 27.3% of individuals with low, intermediate and high frailty risk (P<.001 for all comparisons). A model including age and ASA classification had the best discrimination for 30-day mortality (AUC 0.862; 95% CI: 0.847-0.877). Our findings suggest that the Hospital Frailty Risk Score might be used to screen older surgical patients for risk of frailty. While only slightly improving prediction of 30-day mortality using the ASA classification, the Hospital Frailty Risk Score can be used to independently classify older patients for the risk of important outcomes using pre-existing readily available electronic data.

Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes.

Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate whether frail patients also face adverse outcomes after experiencing an endovascular treated large vessel occlusion stroke (LVOS). In this retrospective observational cohort study, we analyzed patients ≥ 65 years that were admitted during 2015–2019 with LVOS and endovascular treatment. Primary outcomes were mortality and the modified Rankin Scale (mRS) after three months. Regression models were used to determine the impact of frailty. A total of 318 patients were included in the cohort. The median HFRS was 1.6 (IQR 4.8). A total of 238 (75.1%) patients fulfilled the criteria for a low-frailty risk with a HFRS < 5.72 (22.7%) for moderate-frailty risk with an HFRS from 5–15 and 7 (2.2%) patients for a high-frailty risk. Multivariate regression analyses revealed that the HFRS was associated with an increased mortality after 90 days (CI (95%) 1.001 to 1.236; OR 1.112) and a worse mRS (CI (95%) 1.004 to 1.270; OR 1.129). We identified frailty as an impact factor on functional outcome and mortality in patients undergoing thrombectomy in LVOS.

Hospital frailty risk score and adverse health outcomes: evidence from longitudinal record linkage cardiac data

Despite recent evidence on the effect of frailty on health outcomes among those with heart failure, there is a dearth of knowledge on measuring frailty using administrative health data on a wide range of cardiovascular diseases (CVD). We conducted a retrospective record-linkage cohort study of patients with diverse CVD in Queensland, Australia. We investigated the relationship between the risk of frailty, defined using the hospital frailty risk score (HFRS), and 30-day mortality, 30-day unplanned readmission, non-home discharge, length of hospital stay (LOS) at an emergency department and inpatient units and costs of hospitalisation. Descriptive analysis, bivariate logistic regression and generalised linear models were used to estimate the association between HFRS and CVD outcomes. Smear adjustment was applied to hospital costs and the LOS for each frailty risk groups. The proportion of low, medium and high risk of frailty was 24.6%, 34.5% and 40.9%, respectively. The odds of frail patients dying or being readmitted within 30days of discharge was 1.73 and 1.18, respectively. Frail patients also faced higher odds of LOS, and non-home discharge at 3.1 and 2.25, respectively. Frail patients incurred higher hospital costs (by 42.7-55.3%) and stayed in the hospital longer (by 49%). Using the HFRS on a large CVD cohort, this study confirms that frailty was associated with worse health outcomes and higher healthcare costs. Administrative data should be more accessible to research such that the HFRS can be applied to healthcare planning and patient care.

Red blood cell distribution width is associated with frailty in older inpatients in China: Sex differences in a cross-sectional study.

Although some studies have investigated an association between inflammatory marker and frailty, little is known about the relationship of red blood cell volume distribution width (RDW) and frailty. This study aimed to determine whether there were sex-specific associations of RDW and frailty among older hospitalized patients. A cross-sectional study was conducted in a comprehensive tertiary hospital in mainland China between February 2015 and November 2017. Hospitalized patients aged 60years and above were included. Frailty was defined according to Fried's frailty phenotype. Data on patients' demographics, clinical characteristics, and inflammatory markers were collected. The association was evaluated by using the linear and logistic regression modeling. The frailty prevalence was 26.65% (89/334) in men and 28.07% (80/285) in women. After adjusting for all covariates, patients in the 4th RDW quartile exhibited an increased risk of frailty compared with those of the 1st RDW quartile [men: odds ratio (OR)=2.26; 95%CI=1.01, 5.07; women: OR=6.29; 95%CI=2.11, 18.71]. P for trend were<0.05 for all models. An increased RDW among older inpatients was more strongly associated with a corresponding increased risk of frailty in women than in men. Our findings suggest that there were sex differences in the association between elevated RDW levels and frailty among older inpatients. These results may provide support for the intervention decision-making.