Identification Of Frailty Research Articles

Mapping the landscape of front door frailty in the United Kingdom: Lessons for further afield.

The ageing global population is posing a significant challenge to healthcare systems worldwide. Healthcare needs have become more complex and the demand for services is ever increasing. Identification of frailty at the front door of hospitals can prompt comprehensive geriatric assessment and streamline patients to the most suitable clinical area. The United Kingdom has set a priority to develop front door services given the pressure on the National Health Service. A British Geriatrics Society survey has demonstrated that the majority of frailty assessments occur in the emergency department using the Clinical Frailty Scale. This survey prompted the creation of the setting up services guide and its key principles using a collaboration of experience from across the country. Understanding the systems that already exist and creating a network to enable a flow of care towards community teams is crucial to the successful provision of modern frailty attuned care.

Frailty and quality of life in italian older adults: implications for public health interventions

Abstract Background The increasing focus on frailty in older adults underscores the significance of a timely multidimensional assessments and early detection to avert adverse outcomes. The primary aim is to integrate digital technologies, specifically online assessment tools, for the identification of frailty and the assessment of Quality of Life (QoL) in elderly individuals. Methods A nationwide multicentric study was conducted. Seven Italian centers and regions evaluated frailty in older adults residing in the community, through a prospective observational cohort study. The chosen questionnaires, Sunfrail+ and SF-12, were implemented through an easily accessible online tool, swiftly generating final scores for each test. The cross-sectional analysis included 503 older adults. The cut off to define a person “frail” is 3 positive alerts in Sunfrail baseline items, according to the literature. Results In this sample an average of 2.31 positive alerts were generated. Significant associations were established between the number of positive warnings and SF-12 physical and mental indexes, indicated by X2=53.1 (p < 0.001) and X2=25.1 (p < 0.001), respectively. The difference between two groups (frail and not frail) in relation to QoL is statistical significantly (U di Mann Whithney p < 0.001). Mean QoL mental and physical indexes are 46.3 and 39.3 in frailty group, versus 51.7 and 46.5 in non frailty group, respectively. The correlation is conceptually consistent: as frailty increases, QoL decreases. Conclusions The frailty assessment associated with the QoL assessment provides relevant information to monitor the impact of prevention interventions at community level. The assessment of frailty leads the prevention intervention whose impact could be assessed also through QoL tools. This study underlines a meaningful association between assessment tools, substantiated by conceptual correlations. Key messages • Sunfrail and SF-12 are easily accessible online tool useful for identification of frailty and the assessment of Quality of Life (QoL) in elderly individuals. • The older population in Europe is increasing a timely assessment of frailty must be a public health priority.

Using Existing Clinical Data to Measure Older Adult Inpatients' Frailty at Admission and Discharge: Hospital Patient Register Study.

Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs. We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge. A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed. Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH's 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (rs=-0.844; P<.001). An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admission and discharge. The mean e-Frail-CH score was higher at discharge than at admission. The routine calculation of e-Frail-CH scores during hospitalization could provide very useful clinical alerts on the health trajectories of older adults and help select interventions for preventing or mitigating frailty.

Selection determines therapeutic effects: a retrospective analysis of the application of different frailty tools in elderly patients with multiple myeloma

ObjectiveThe aim was to explore the effectiveness of the International Myeloma Working Group Frailty Index (IMWG-FI), Mayo Score, UK Myeloma Research Alliance Risk Profile (MRP), and Intergroupe Francophone du Myélome (IFM) simplified frailty scale for classifying frailty in elderly multiple myeloma (MM) patients and compare the validity of different frailty tools.MethodsEighty-four newly diagnosed MM patients aged ≥ 60 years in HeBei University Hospital were evaluated by the IMWG-FI, Mayo score, MRP score and IFM scale, and consistency and survival analyses were performed using Cohen's kappa coefficients and the Kaplan‒Meier method, respectively.ResultsA total of 64 patients (76.2%) were identified as frail by at least one frailty tool; 14 (21.9%) were identified as frail by all four tools, and although moderate concordance was achieved between the IMWG-FI and MRP and the Mayo Score (0.432–0.474, P < 0.001), the concordance among the four assessment tools was relatively low (Cohen's kappa 0.218–0.474). The median overall survival (OS, P = 0.006, 0.025, and 0.028) and progression-free survival (PFS, P = 0.002, 0.006, and 0.03) of patients in the frail group and the nonfrail group identified by the IMWG-FI, Mayo score, and MRP were significantly different, while the median OS (P = 0.139) and PFS (P = 0.167) were not significantly different for the frail patients identified by the different frailty assessment tools.ConclusionIn this study, the consistency of the different frailty assessment tools was low, whereas that between the MRP and IMWG-FI was high. Therefore, combining IMWG-FI and MRP may reduce assessment subjectivity and improve frailty identification.

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.

Introduction of Geriatric Medicine Multidisciplinary Service to Emergency Department

Abstract Background Ireland has an ageing demographic with a significant community dwelling population living with frailty. Identification of frailty at the hospital front door via a Geriatric Emergency Multidisciplinary Service (GEMS) was expanded in October 2023 with the aim to trigger early comprehensive geriatric assessment (CGA) in the Emergency Department (ED)and to ensure that older people with frailty are diverted to the most appropriate services as quickly as possible and, where appropriate, discharged home on the same day. Methods Using Plan Do Study Act (PDSA) cycle framework a screening pathway for all over 75-year-olds who present to ED was established. The service provides screening for frailty and delirium (using 4AT) in the ED with high clinical frailty scores (CFS) or requiring specialist input were selected for CGA. Information was collected on all patients on admission and data was also collected on discharge destination and readmission rates. Results 1308 patients were reviewed since introduction with average age 82.3 years (68-101). 63.6% (832) patients had CGA and 36.4% (476) were screened. Of those who did not have a CGA, 46.1% (185) were not frail with CFS 3 or less. Average CFS was 4.84 and average 4AT score was 2. 46.7% (611) of patients reviewed were discharged from ED with discharge rates increasing from 40.9% (93) in November 2023 to 49.5% (104) in April 2024 and 28-day readmission rates decreasing from 6.87% in April 2023 to 5.98% in March 2024. Conclusion This quality improvement project highlights the impact of GEMS in the ED in reducing admission rates and readmissions. Ongoing areas for improvement include expanding the service to review all patients identified with frailty where possible, and in the future establishing pathways for improved access to community services/supports to further reduce readmission rates and to capture the impact on length of stay.

Flagging Frailty in the Emergency Department: A System to Identify and Visualise Frailty

Abstract Background Older adults with frailty who present to the Emergency Department (ED) are at increased risk of hospitalisation, prolonged length of stay, deconditioning and loss of independence.1 Early identification of frailty using a validated tool, such as the Clinical Frailty Scale (CFS), is widely recommended to inform clinical decisions, identify the best pathway of care for older adults with frailty, and for potential use as a predictor or an outcome.2 We aimed to develop and implement a system of frailty identification which is highly visible, digitised and integrated with routine ED processes. Methods In the ED of a large teaching hospital, an expanded interdisciplinary Acute Frailty Team (AFT) commenced work in the ED in February 2024. The AFT aimed to screen all over 70s presenting within working hours for frailty using CFS. ED consultants collaborated with software developers through iterative design stages to create a ‘Frailty Flag’ for the ED Whiteboard with the requirements that it is highly visible, easy to use and highlights patients with higher frailty scores. Results In April 2024, a ‘Frailty Flag’ was launched on the ED Whiteboard, prominently displaying the CFS and using traffic light colouring to highlight those with higher CFS scores. As part of standard work, the AFT populate the CFS on the ED Whiteboard, which is viewed by all staff in ED on large wall-mounted screens. Feedback from ED and inpatient staff indicate that a highly visible frailty score is a valuable addition to the ED Whiteboard which allows them to prioritise care and supports decision making regarding suitability for geriatric care pathways. Conclusion A Frailty Flag on the ED Whiteboard allows for easy, accessible communication of frailty scores to the ED multi-disciplinary team. Next steps involve integrating the Frailty Flag with in-patient systems and developing standard work for out of hours use of the system.

Frailty and Loneliness in Older Adults: A Narrative Review.

(1) Background: In a society with an advancing aging rate, medical systems are coming under pressure due to an increasing flow of older patients with multiple somatic diseases, exacerbated by their psychological and sociological backgrounds. We aimed to investigate the relationship between frailty and loneliness in older adults and to provide a holistic perspective on these concepts. Our research question was "Is there a link between the loneliness and frailty in older people?" (2) Methods: To assess the link between loneliness and frailty, we conducted a search accessing Index Medicus and PubMed; the timeframe of our research was from 2013 until 2023. Data regarding the study population, as well as loneliness and frailty assessments and approaches, were extracted. (3) Results: A positive relationship between loneliness and the appearance and progression of frailty in older adults is argued for. (4) Conclusions: Frailty and loneliness in older adults are often interconnected and can have a significant impact on their overall well-being. Early identification of frailty by assessing risk factors (including loneliness and/or social isolation) should become a standard of care for older patients. Appropriate combined interventions that effectively address both frailty and loneliness (physical exercises, psychological support, and social engagement) can promote healthier aging, prevent health deterioration, maintain independence, and reduce healthcare costs.

Frailty as a sequela of burn injury: a post hoc analysis of the “RE-ENERGIZE” multicenter randomized-controlled trial and the National Health Interview Survey

BackgroundWith advancements in burn treatment and intensive care leading to decreased mortality rates, a growing cohort of burn survivors is emerging. These individuals may be susceptible to frailty, characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging, which significantly complicates their recovery process. To date, no study has investigated burns as a potential risk factor for frailty. This study aimed to determine the short-term prevalence of frailty among burn survivors’ months after injury and compare it with that of the general population.MethodsA post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury (RE-ENERGIZE) trial, an international randomized-controlled trial involving 1200 burn injury patients with partial- or full-thickness burns. Participants who did not complete the 36-Item Short Form Health Survey (SF-36) questionnaire were excluded. Data for the general population were obtained from the 2022 National Health Interview Survey (NHIS). Frailty was assessed using the FRAIL (Fatigue, Resistance, Ambulation, Illness, Loss of weight) scale. Due to lack of data on loss of weight, for the purposes of this study, malnutrition was used as the fifth variable. Illness and malnutrition were based on admission data, while fatigue, resistance, and ambulation were determined from post-discharge responses to the SF-36. The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status. Within the burn group, patients were divided into different subgroups based on their frailty status, and the differences in their (instrumental) activities of daily living (iADL and ADL) were compared. A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.ResultsOut of the 1200 burn patients involved in the study, 600 completed the required questionnaires [follow-up time: (5.5 ± 2.3) months] and were matched to 1200 adults from the general population in the U.S. In comparison to the general population, burn patients exhibited a significantly higher likelihood of being pre-frail (42.3% vs. 19.8%, P < 0.0001), or frail (13.0% vs. 1.0%, P < 0.0001). When focusing on specific components, burn patients were more prone to experiencing fatigue (25.8% vs. 13.5%, P < 0.0001), limited resistance (34.0% vs. 2.7%, P < 0.0001), and restricted ambulation (41.8% vs. 3.8%, P < 0.0001). Conversely, the incidence rate of illness was observed to be higher in the general population (1.2% vs. 2.8%, P = 0.03), while no significant difference was detected regarding malnutrition (2.3% vs. 2.6%, P = 0.75). Furthermore, in comparison with robust burn patients, it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL. The frail cohort reported the most pronounced limitation.ConclusionsOur findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury. Burn survivors experience compromised fatigue, resistance, and ambulation, while rates of illness and malnutrition were lower or unchanged, respectively. These results underscore the critical need for early identification of frailty after a burn injury, with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists, community physicians, physiotherapists, nutritionists, and social workers. This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.

WP7.2 - The Role of a Frailty Team to improve Perioperative Care for ELLSA Patients

Abstract Aim Frailty assessment amongst emergency laparotomy patients is essential. The 8th NELA report highlighted that only 31.8% of patients who were frail and over 65 years received geriatrician input. Within our organisation, patients who undergo emergency laparotomy are included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). The consultant geriatrician led Surgical Acute Frailty Team (SAFT) works collaboratively with the emergency general surgery team and ELLSA specialist nurse to review ELLSA patients within our hospital. Our aim was to establish outcomes of ELLSA patients reviewed by SAFT. Methods Data collected routinely via Redcap as part of our organisation’s ELLSA was reviewed. All ELLSA patients aged ≥65 years admitted between November 2022 and November 2023 were included. Data included frailty assessment, discharge destination and 30 day mortality. Results 152 patients aged ≥ 65 years underwent operative intervention as defined by ELLSA. 100% of patients had a documented Clinical Frailty Scale (CFS) score. 72 patients (47.4%) had a pre-operative frailty review. 68.4% of patients had their initial frailty assessment by a consultant geriatrician. 19.7% of patients were reviewed by frailty ANPs or clinical fellow. Only 7.9% of patients required care support on discharge. 30 day mortality was 17.1%. Conclusions Embedding a dedicated frailty team within our general surgery wards has been incredibly successful; frailty assessment is significantly above that of the 8th NELA report. The majority of ELLSA patients aged ≥65 years are discharged home independently. Collaborative working and early identification of frailty in ELLSA patients is essential to improve patient outcomes.

Identification and prediction of frailty among community-dwelling older Japanese adults based on Bayesian network analysis: a cross-sectional and longitudinal study

BackgroundFrailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults.MethodsWe conducted a cross-sectional and longitudinal study using data from the “Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC),” which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs).ResultsAt baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model’s AUC was 0.943 (95%CI 0.913–0.974), indicating good discrimination, with Hosmer–Lemeshow (H–L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model’s AUC was 0.722 (95%CI 0.656–0.788), indicating moderate discrimination, with H–L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%.ConclusionFrailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social relationships. BNs facilitate the identification of interrelationships among these variables, quantify the influence of key factors. However, further research is required to validate the proposed model.

Service provision for Frailty in European Emergency Departments (FEED): a survey of operational characteristics

BackgroundThe observational Frailty in European Emergency Departments (FEED) study found 40% of older people attending for care to be living with frailty. Older people with frailty have poorer outcomes from emergency care. Current best practice calls for early identification of frailty and holistic multidisciplinary assessment. This survey of FEED sites explores variations in frailty-attuned service definitions and provision.MethodsThis cross-sectional survey included study sites across Europe identified through snowball recruitment. Site co-ordinators (healthcare professionals in emergency and geriatric care) were surveyed online using Microsoft Forms. Items covered department and hospital capacity, frailty and delirium identification methods, staffing, and frailty-focused healthcare services in the ED. Descriptive statistics were reported.ResultsA total of 68 sites from 17 countries participated. Emergency departments had median 30 (IQR 21–53) trolley spaces. Most defined "older people" by age 65+ (64%) or 75+ (25%). Frailty screening was used at 69% of sites and mandated at 38%. Night-time staffing was lower compared to day-time for nursing (10 [IQR 8–14] vs. 14 [IQR 10–18]) and physicians (5 [IQR 3–8] vs. 10 [IQR 7–15]). Most sites had provision for ED frailty specialist services by day, but these services were rarely available at night. Sites mostly had accessible facilities; however, hot meals were rarely available at night (18%).ConclusionThis survey demonstrated variability in case definitions, screening practices, and frailty-attuned service provision. There is no unanimous definition for older age, and while the Clinical Frailty Scale was commonly used, this was rarely mandated or captured in electronic records. Frailty services were often unavailable overnight. Appreciation of the variation in frailty service models could inform operational configuration and workforce development.

Combining the clinical frailty scale with grip strength for the identification of frailty among end-stage kidney disease patients.

Combining the clinical frailty scale with grip strength for the identification of frailty among end-stage kidney disease patients.

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.

Beyond sarcopenia: frailty in chronic haemodialysis patients.

Frailty, characterized by vulnerability, reduced reserves and increased susceptibility to severe events, is a significant concern in chronic haemodialysis (HD) patients. Sarcopenia, corresponding to the progressive loss of muscle mass and strength, may contribute to frailty by reducing functional capacity, mobility and autonomy. However, consensus lacks on the optimal bedside frailty index for chronic HD patients. This study investigated the influence of frailty on chronic HD patient survival and explored the associated factors. A total of 135 patients were enrolled from January to April 2019 and then followed up prospectively until April 2022. At inclusion, frailty was assessed by the Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) tests including gait speed, standing balance and lower limb muscle strength. From a total of 114 prevalent chronic HD patients (66% men, age 67.6±15.1years), 30 died during the follow-up period of 23.7months (range 16.8-34.3). Deceased patients were older, had more comorbidities and a higher sarcopenia prevalence (P<.05). The TUG and SPPB test scores were significantly reduced in patients who had died [SPPB total score: 7.2±3.3 versus 9.4±2.5; TUG time 8.7±5.8 versus 13.8±10.5 (P<.05)]. Multivariate analysis showed that a higher SPPB score (total value >9) was associated with a lower mortality risk [hazard ratio 0.83 (95% confidence interval 0.74-0.92); P<.03). Each component of the SPPB test was also associated with mortality in univariate analysis, but only the SPPB balance test remained protective against mortality in multivariate analysis. Older age, lower handgrip strength and lower protein catabolic rate were associated with SPPB total scores <9, SPPB balance score and TUG time >10s. Screening for frailty is crucial in chronic HD patients, and incorporating SPPB, especially the balance test, provides valuable insights. Diminished muscle strength and inadequate protein intake negatively influence the SPPB score and balance in chronic HD patients. Effective identification and management of frailty can therefore improve outcomes. NCT03845452.

Status and influencing factors of frailty in hospitalized patients with chronic heart failure: A cross-sectional study.

To investigate the frailty status of inpatients with chronic heart failure (CHF) and analyse its influencing factors, so as to provide evidence for the early identification of high-risk groups and frailty management. Early identification of frailty can guide the development and implementation of holistic and individualized treatment plans. However, at present, the frailty of patients with CHF has not attracted enough attention. A cross-sectional study. From June 2022 to June 2023, a convenience sample of 256 participants were recruited at a hospital in China. Multivariate logistic regression analysis was used to explore the influencing factors of frailty in patients with CHF, and an ROC curve was drawn to determine the cut-off values for each influencing factor. STROBE checklist guides the reporting of the manuscript. A total of 270 questionnaires were sent out during the survey, and 256 valid questionnaires were ultimately recovered, resulting in an effective recovery rate of 94.8%. The incidence of frailty in hospitalized patients with CHF was 68.75%. Multivariable logistic regression analysis showed that age, self-care ability, nutritional risk, Kinesiophobia and NT-proBNP were risk factors for frailty, while albumin and LVEF were protective factors. Multidimensional frailty was prevalent in hospitalized patients with CHF. Medical staff should take measures as early as possible from the aspects of exercise, nutrition, psychology and disease to delay the occurrence and development of frailty and reduce the occurrence of clinical adverse events caused by frailty. This study emphasizes the importance of the early identification of multidimensional frailty and measures can be taken to delay the occurrence and development of frailty through exercise, nutrition, psychology and disease treatment. Patients contributed through sharing their information required for the case report form and filling out questionnaires.

Frailty identification and management among Brazilian healthcare professionals: a survey

BackgroundNational and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice.MethodsAn anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil.ResultsMost of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011).ConclusionFrailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people.

Impact of frailty on patients hospitalized with myelodysplastic syndrome: A nationwide analysis.

6569 Background: Myelodysplastic Syndrome (MDS) is a complex group of neoplasms that arises from abnormalities in the bone marrow's hematopoietic stem cells, leading to ineffective blood cell production. Frailty signifies increased vulnerability to internal and external stressors, with its impact on survival in MDS gaining recognition. We conducted a retrospective analysis to explore the impact of frailty on hospitalized MDS patients and its association with unfavorable hospital outcomes. Methods: National Inpatient Sample (NIS) 2019 and 2020 was utilized to identify the patients admitted with a primary diagnosis of MDS and had a concurrent diagnosis of Frailty. The Primary outcome was Mortality, and secondary outcomes included length of stay, total cost of hospitalization, and other adverse in-hospital outcomes. Multivariate logistic regression analysis was used to calculate the outcomes after adjusting for baseline sociodemographic characteristics. Results: A total of 17,000 patients were admitted with a primary diagnosis of MDS, among whom 4,285 (25.20%) patients had a concurrent diagnosis of Frailty. The mean age of patients with and without Frailty was 75.75 (+/-14.01) and 71.54 (+/-14.68), respectively, p&lt;0.001. After adjusting for confounding variables, Frailty was considered an independent predictor of mortality in MDS patients (OR=1.80 (1.22-2.64); p=0.003). Patients with Frailty had a prolonged length of stay in the hospital (8.62 days(3.2-9.6) without and 11.56 days (4.6-12.1) with Frailty, P&lt;0.001), as well as an increased total cost of hospitalization ($ 132159 (3256-23651) without and $173898 (5317-389146) with Frailty, p&lt;0.001). Additionally, Frailty was associated with an increased likelihood of sepsis (OR=2.02 (1.33-3.06); p=0.001), acute kidney injury (OR=1.22 (1.02-1.50); p=0.04), major depressive disorder (OR=1.51 (1.19-1.91); p=0.001), and a higher association with chemotherapy (OR=3.46 (1.21-9.91); p=0.021) and palliative care (OR=2.23 (1.72-2.90); p&lt;0.001). However, frail patients were less likely to receive blood transfusions (OR=0.73 (0.61-0.88); p=0.001), and no difference was noted in the risk of platelet transfusions (OR=0.95 (0.73-1.25); p=0.763). Conclusions: Frailty is considered an independent predictor of mortality and is associated with increased healthcare resource utilization along with other adverse in-hospital outcomes. Careful and thorough identification of frailty and its effective management is crucial for improving outcomes, reducing mortality, and enhancing the quality of life for patients with debilitating MDS. [Table: see text]

Does proactive care in care homes improve survival? A quality improvement project

BackgroundNHS England’s ‘Enhanced Health in Care Homes’ specification aims to make the healthcare of care home residents more proactive. Primary care networks (PCNs) are contracted to provide this, but approaches...

Association of frailty status with overall survival in elderly hypertensive patients: based on the Chinese Longitudinal Healthy Longevity Survey

BackgroundHypertension and frailty often coexist in older people. The present study aimed to evaluate the association of frailty status with overall survival in elderly hypertensive patients, using data from the Chinese Longitudinal Healthy Longevity Survey.MethodsA total of 10,493 elderly hypertensive patients were included in the present study (median age 87.0 years, 58.3% male). Frailty status was assessed according to a 36-item frailty index (FI), which divides elderly individuals into four groups: robustness (FI ≤ 0.10), pre-frailty (0.10 < FI ≤ 0.20), mild-frailty (0.20 < FI ≤ 0.30), and moderate-severe frailty (FI > 0.30). The study outcome was overall survival time. Accelerated failure time model was used to evaluate the association of frailty status with overall survival.ResultsDuring a period of 44,616.6 person-years of follow-up, 7327 (69.8%) participants died. The overall survival time was decreased with the deterioration of frailty status. With the robust group as reference, adjusted time ratios (TRs) were 0.84 (95% confidence interval [CI]: 0.80–0.87) for the pre-frailty group, 0.68 (95% CI: 0.64–0.72) for the mild frailty group, and 0.52 (95% CI: 0.48–0.56) for the moderate-severe frailty group, respectively. In addition, restricted cubic spline analysis revealed a nearly linear relationship between FI and overall survival (p for non-linearity = 0.041), which indicated the overall survival time decreased by 17% with per standard deviation increase in FI (TR = 0.83, 95% CI: 0.82–0.85). Stratified and sensitivity analyses suggested the robustness of the results.ConclusionsThe overall survival time of elderly hypertensive patients decreased with the deterioration of frailty status. Given that frailty is a dynamic and even reversible process, early identification of frailty and active intervention may improve the prognosis of elderly hypertensive patients.