Rockwood Clinical Frailty Scale Research Articles

1989 Improving accuracy of Clinical Frailty Scale (CFS) scoring on geriatric and oncology wards in Hull University Teaching Hospitals

Abstract Introduction The Rockwood Clinical Frailty Scale (CFS) is a tool that assesses global frailty, validated for use in people aged over 65. It assesses an individual’s functional status to assign a number from 1 (very fit) to 9 (terminally ill). Hull University Teaching Hospitals has integrated mandatory CFS assessment on admission for inpatients aged over 65. This project aimed to improve the accuracy of CFS scoring in an oncology and a geriatric ward by empowering ward nurses to better recognise frailty. Methods Phase 1. Baseline data was collected from admission CFS scores from inpatients on one geriatrics ward and one oncology ward. We then individually reviewed admission CFS scores for the same patients. We recorded concordance if the same score was assigned. Phase 2. We surveyed nursing teams on both wards, as they assign the initial CFS score during a patient admission. This revealed unanimous recognition of the pivotal role accurate frailty recognition plays in targeting individualised frailty intervention and called for more staff training in frailty/CFS. Following this, we introduced a pictographic version of the Rockwood CFS scale to nursing stations where admission documentation takes place and re-assessed CFS score concordance. Results A substantial improvement in CFS score concordance was demonstrated within the geriatric ward, from 41% at baseline to 56%. However, only minimal change was observed within the oncology ward remaining static at 11.1% from baseline 8.3%. Conclusions We have worked with the two wards to disseminate knowledge and use of the NHS CFS app. Through collaboration with the trust’s frailty leads, the CFS app is now being incorporated into the electronic recording system, encouraging routine use of the app when calculating CFS scores. Once this change is implemented, we will recollect data again.

1743 Frailty is associated with poor cardiopulmonary resuscitation outcomes in the COVID-19 pandemic

Abstract Background This study aims to investigate the relationship between frailty and in-hospital cardiopulmonary resuscitation (CPR) outcomes in the COVID-19 pandemic. Methods The study was carried out in a tertiary hospital in Scotland and included all patients over the age of 18 who had an in-hospital CPR attempt between April 2020 and March 2022. Patients were identified via the pre-existing National Cardiac Arrest Audit Database which was collected prospectively. Data collected from this included age, sex, initial arrest rhythm, return of spontaneous circulation (ROSC) and in-hospital mortality. The electronic and paper patient notes were retrospectively reviewed to calculate a Rockwood clinical frailty scale (CFS) and Charlson comorbidity index (CCI). The data was stratified in to frail (CFS ≥5) and non-frail (CFS <5) groups. Results 65 patients were included in the study. In univariate analysis, there was a significant difference between the frail and non-frail groups in age (p=0.006), ROSC (p=0.02) and survival to discharge (p=0.004). Only 10 out of 34 (29.4%) frail patients had ROSC and of those only 3 (8.8%) survived to discharge compared to 12 out of 31 (35.3%) of non-frail patients. In a binary logistic regression, there was a significant association between frailty and both ROSC (adjusted OR 3.31 [95% CI: 1.12-9.78}) and survival to discharge (adjusted OR 6.33 [95% CI: 1.48-27.13]) and no significant association with age, CCI or sex. Conclusion The findings support the relationship between frailty and poor CPR outcomes independent of age and co-morbidity during the COVID-19 pandemic.

Who benefits from MRI in memory clinics? A clinical and research perspective from the Oxford Brain Health Clinic

AbstractBackgroundWith the advent of disease modifying treatments for dementia, it is essential to restructure memory clinic services to provide accurate and early diagnosis to enable precision therapies and recruitment to clinical trials. The Oxford Brain Health Clinic (BHC) offers a comprehensive clinical and embedded research assessment in the patient pathway, including a research‐quality brain MRI scan (using the UK Biobank protocol), well‐tolerated by patients (Griffanti et al., 2022, Neuroimage:Clinical). In this study we investigated whether the images obtained from BHC patients were of sufficient quality for clinical/diagnostic purposes (i.e. to provide a radiology report) and research purposes (i.e. suitable to extract quantitative measures with automated software) and whether the scan quality was related to patients’ characteristics (capacity, frailty, anxiety, cognitive impairment ‐ CI), to inform future triage to Brain Health Clinics.MethodT1 and FLAIR scans from 138 BHC patients were reported by a radiologist and independently rated as high, medium or low quality for research purposes (consensus between 2 raters). The following patients’ characteristics were evaluated: capacity (yes/no), Rockwood Clinical Frailty Scale (more frail if 5 or more), anxiety before/during the scan (low/not‐low), Addenbrooke’s Cognitive Examination III (ACE‐III, score above or below 82). A two‐sided Fisher‐Freeman‐Halton test was run to test the association between scan quality (3 classes) and patients characteristics (2 classes for each independent variable). Bonferroni‐adjusted post‐hoc comparisons were performed between scan quality classes using 2×2 Fisher’s Exact Tests.ResultThe radiologist was able to provide a clinical report for all scans. Over 90% of scans were rated high or medium quality for research purposes (Fig.1). No significant associations were observed between patients’ characteristics and FLAIR quality. T1 quality was significantly associated with patients’ capacity (p = 0.001, more low‐quality images from patients lacking capacity, Fig.2) and frailty (p = 0.014, more low‐quality images from frailer patients, Fig.3).ConclusionResearch‐quality MRI scans in memory clinic are useful for both clinical and research purposes. For research comprised of high‐quality MRI, relatively generous thresholds relating to frailty and capacity could be considered to balance the trade‐off between inclusivity (i.e. increasing representativeness) and adherence to protocols.

Frailty Assessment in Vascular OUtpatients Review (FAVOUR) protocol: single-centre prospective cohort study comparing feasibility and prognostic value of commonly used frailty assessment tools

IntroductionFrailty has consistently demonstrated associations with poorer healthcare outcomes. Vascular guidelines have recognised the importance of frailty assessment. However, an abundance of frailty tools and a lack of prospective studies...

Who benefits from MRI in memory clinics? A clinical and research perspective from the Oxford Brain Health Clinic

AbstractBackgroundWith the advent of disease modifying treatments for dementia, it is essential to restructure memory clinic services to provide accurate and early diagnosis to enable precision therapies and recruitment to clinical trials. The Oxford Brain Health Clinic (BHC) offers a comprehensive clinical and embedded research assessment in the patient pathway, including a research‐quality brain MRI scan (using the UK Biobank protocol), well‐tolerated by patients (Griffanti et al., 2022, Neuroimage:Clinical). In this study we investigated whether the images obtained from BHC patients were of sufficient quality for clinical/diagnostic purposes (i.e. to provide a radiology report) and research purposes (i.e. suitable to extract quantitative measures with automated software) and whether the scan quality was related to patients’ characteristics (capacity, frailty, anxiety, cognitive impairment ‐ CI), to inform future triage to Brain Health Clinics.MethodT1 and FLAIR scans from 138 BHC patients were reported by a radiologist and independently rated as high, medium or low quality for research purposes (consensus between 2 raters). The following patients’ characteristics were evaluated: capacity (yes/no), Rockwood Clinical Frailty Scale (more frail if 5 or more), anxiety before/during the scan (low/not‐low), Addenbrooke’s Cognitive Examination III (ACE‐III, score above or below 82). A two‐sided Fisher‐Freeman‐Halton test was run to test the association between scan quality (3 classes) and patients characteristics (2 classes for each independent variable). Bonferroni‐adjusted post‐hoc comparisons were performed between scan quality classes using 2×2 Fisher’s Exact Tests.ResultThe radiologist was able to provide a clinical report for all scans. Over 90% of scans were rated high or medium quality for research purposes (Fig.1). No significant associations were observed between patients’ characteristics and FLAIR quality. T1 quality was significantly associated with patients’ capacity (p = 0.001, more low‐quality images from patients lacking capacity, Fig.2) and frailty (p = 0.014, more low‐quality images from frailer patients, Fig.3).ConclusionResearch‐quality MRI scans in memory clinic are useful for both clinical and research purposes. For research comprised of high‐quality MRI, relatively generous thresholds relating to frailty and capacity could be considered to balance the trade‐off between inclusivity (i.e. increasing representativeness) and adherence to protocols.

The relationships between sarcopenia, frailty, bioelectrical impedance analysis, and anthropometry in patients with type two intestinal failure

IntroductionSARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs and Falls) is a validated screening questionnaire for rapidly assessing sarcopenia in older adults with a variety of diseases while the Rockwood clinical frailty scale (RCFS) is a commonly used tool for assessing frailty in older adults. However, there are no data regarding the use of these tools in patients with type two intestinal failure (T2IF). We aimed to compare SARC-F and RCFS to bioimpedance analysis (BIA) and anthropometry in patients with T2IF. MethodsIn this cross-sectional study, patients with T2IF admitted to a national U.K. reference centre had SARC-F, RCFS, BIAs and anthropometry performed. A SARC-F score ≥4 indicated potential sarcopenia while a RCFS ≥5 indicated frailty. Statistical analyses were conducted to assess correlation, concordance and differences between measurements. ResultsThe study comprised 76 patients, of whom 59.2% were female, with a mean age of 56.5 years ± 16. Seventy percent of patients had short bowel syndrome as an underlying cause of IF. Thirty eight percent of patients had a SARC-F ≥4 and 20% had a RCFS ≥5. SARC-F was correlated with RCFS (rs 0.43, p <0.001), phase angle (PA) (rs -0.55, p <0.001) and hand grip strength (HGS) (rs -0.34, p 0.004). RCFS was correlated with HGS (rs -0.31, p 0.009). Significant differences emerged between PA (p 0.002) and HGS (p 0.003) values in patients with SARC-F scores ≥4 and <4 and with HGS for patients with RCFS ≥5 and <5 (p 0.01). Patients with SARC-F scores ≥4 had longer lengths of stays than those with scores <4 (p 0.002). Compared to PA and HGS, SARC-F had sensitivities of 39% and 37% and specificities of 92% and 73% respectively. ConclusionWe demonstrated SARC-F is correlated with PA and HGS with comparable sensitivity and specificity to its original use in older individuals. There is a role for SARC-F as a means of rapidly assessing muscle quality and function in hospitalised patients with IF with RCFS providing some useful information about muscle function.

Introducing a multidisciplinary approach to medication optimization for geriatric oncology inpatients.

455 Background: Drug-related complications have been associated with adverse outcomes in older adults with cancer. This pilot interventional study aimed to assess the feasibility of introducing an inpatient multidisciplinary (MDT) comprehensive medication assessment focussing on the specific needs of older adults with cancer, in addition to standard hospital medication review and reconciliation. Methods: Patients≥70 years with a solid tumour diagnosis, admitted under the medical oncology service, were discussed at a weekly MDT meeting involving geriatric oncology physicians, nurses and pharmacists. Relevant data including age, cancer type and stage, Rockwood clinical frailty scale, comorbidities, medications on admission and initiated during hospitalisation, systemic anti-cancer therapy (SACT), falls history, cognitive screening, and laboratory parameters were prospectively collected. An MDT medication review was conducted including SACT toxicity assessment, drug-drug interactions (DDI), potentially inappropriate medication (PIM) assessment using STOPP/START criteria, and anticholinergic burden (ACB) scoring. A summary of medication review findings and recommendations was provided to the primary inpatient team to support medication optimisation. Results: Sixty patients were included over a 4 month period, with a median age of 76.5 years (range 65-88). Most patients had lung cancer (36.7%), 80% had stage IV disease. Twenty-five patients (42%) were moderately or severely frail. Most patients (61.7%) were on systemic anti-cancer therapy (SACT). Seven patients (11.7%) had a fall in the previous 3 months and 15 patients (25%) experienced acute confusion during the hospitalisation. ADEs were identified in 26 patients (43%), PIMs in 33 (55%), excessive ACB in 43 (72%) and DDIs in 53 (88%). MDT medication optimisation recommendations were made in 59 patients (98%) in addition to standard of care review. Based on review findings, medication interventions included recommendations to deprescribe, start drug, amend drug dose, route or frequency, perform additional laboratory monitoring, and SACT-specific recommendations (Table 1). Conclusions: Implementing an interprofessional geriatric oncology MDT approach to medication review in hospitalised older adults with cancer can result in additional medication recommendations alongside standard of care.[Table: see text]

198 How comprehensive is our Comprehensive Geriatric Assessment in clinical practice?

Abstract Background No gold standard exists for what should be included within a Comprehensive Geriatric Assessment (CGA). Consensus is that a CGA assessment should assess physical, functional, psychological and social well-being. We sought to examine the specific content of CGA that are being delivered across integrated care teams in Ireland. Methods We completed a cross sectional study of what domains are included in different integrated care CGA proformas. All operational leads for each integrated care hub were contacted and invited to share their local CGA. We examined what components across the domains of physical, psychological, functional and social assessment were included. Results We examined 16 different CGAs. The median length of a CGA was 14 pages (range: 4–28 pages). Common areas in all CGAs included assessments of frailty, cognition, mobility, falls, continence and social assessment, but there was variability in how these assessments were carried out. The Rockwood Clinical frailty scale the most common diagnostic tool for frailty (15/16 CGAs) with sarcopenia assessed in 75% of CGAs. The 4AT tool was used in 56% of CGAs, with a more detailed tool (e.g MMSE or MOCA) used in 56% of CGAs. Mood was assessed in 15 CGAs, sleep assessed in 10 CGAs and pain assessed in 7 CGAs. The widest variability was in the social assessment section with inconsistent assessments of caregiver strain (completed in 50%) and assessments of formal advanced care supports such as enduring power of attorney included in 44% of CGAs. Sexual health was not explicitly addressed in any CGA. Conclusion While there is considerable overlap with the core components of a CGA across integrated care sites there is significant variability across individual sites. Our results highlight the opportunity for consensus building across different integrated care teams to harmonise the delivery of CGA.

172 Using the early identification and management of delirium to optimise memory pathway referrals and resources

Abstract Background Priority actions within the National Dementia Strategy are to ensure early diagnosis of dementia and to develop appropriate referral pathways and interventions to support patients. One element is the consideration of referral to memory services for patients who develop delirium within the acute hospital setting, which may suggest possible underlying cognitive impairment. We examined the effect of early identification and diagnosis of delirium via an inpatient frailty service on this process. Methods Over a 9-month period (September 2022–May 2023), patients &amp;gt;75 years admitted to the acute medical floor were screened with the Rockwood Clinical Frailty Scale (CFS) by a multi-disciplinary in-patient frailty team. Those with a CFS score of 5–6 (mild to moderate frailty) were prioritised for Comprehensive Geriatric Assessment (CGA), which included the 4AT delirium screening tool. Patients presenting with a 4AT of 1–3 indicating cognitive vulnerability and those with a 4AT of &amp;gt;4 suggesting a probable delirium with possible dementia were identified for assessment. Results 3,200 patients &amp;gt;75 years were admitted to the medical floor during the 9 months. Over 2,100 patients were screened for mild to moderate frailty and 495 CGA’s were completed. 105 patients presented with a 4AT of &amp;gt;4 with 44% not having a formal diagnosis of cognitive impairment. 74% of this cohort were referred onward to memory streams. 143 patients presented with a 4AT of 1–3. 66% did not have a formal diagnosis of cognitive impairment, of which 61% were referred onward to memory services. Conclusion The development of delirium in the acute hospital setting is an important opportunity to assess for the presence of an underlying neurodegenerative process. Early identification and management pathways for delirium can allow timely initiation of referral to specialist memory streams to aid prompt diagnosis of dementia, facilitating optimisation of care, supports, and advanced planning.

173 The development and early experience of a multidisciplinary acute in-patient frailty team

Abstract Background Frail older adults represent a growing proportion of the acute in-patient population. A point-prevalence audit in our hospital revealed 40% of adult in-patients were frail (median age: 74). Following a patient-mapping exercise and review of service-user requirements, a consensus was reached among stakeholders that a multidisciplinary in-patient frailty team would be the most effective approach to supporting this group. The Rapid Assistance with Frailty Team (RAFT) work closely with Emergency Department (ED) and ward-based colleagues to optimise their care. Methods Newly admitted patients &amp;gt;75 years are screened daily for mild to moderate frailty (Rockwood Clinical Frailty Scale 5–6) and a Comprehensive Geriatric Assessment (CGA) is completed within 72 hours of admission. Hospital-associated complications e.g. deconditioning, delirium, weight loss, constipation, falls, cognitive and functional decline, are addressed through CGA-led recommendations. Physical and functional status are optimised through supplementary ward-based therapy and Geriatric Medicine support, with a view to facilitating earlier discharge. Results 609 CGAs were completed over a one-year period. Patients were primarily identified through daily screening (77.51%). Other referral sources included the ED Therapy Team, Primary Teams, therapies and nurses. In 50% of patients reviewed, new onset of confusion, decline in memory, or delirium was noted, with only half of those having a prior history of cognitive impairment. 80% presented with a decline in general function and approximately 35% were admitted with a fall as their main presentation. Polypharmacy was identified in 80% of this patient population. Conclusion The initial steps in implementing an inpatient frailty service, i.e. developing a system of patient identification, documentation to support CGA, and an integrated approach to working in a busy clinical environment, have been achieved. The focus is now on prospective data collection, continuous monitoring of key performance indicators, and feedback from service-users and staff, to further streamline this approach.

187 Prospective study of patients admitted to a model 2 hospital

Abstract Background Model 2 hospitals provide in-patient and out-patient care for differentiated, low-risk medical patients, who are not likely to require full resuscitation. Smaller hospitals are generally very well regarded by the local population and general practitioners. Methods This is a prospective descriptive study. Data were collected from all patients admitted via the Medical Assessment Unit (MAU) or stepped-down from a model 4 hospital for six consecutive weeks. Data points included: route of admission, age, Rockwood Clinical Frailty Scale (CFS) on presentation, length of stay (LOS), long term care/community resident, if delirium was present, known cognitive impairment, number of medications, hospital admissions in the past year and discharge destination. Results 144 patients were recruited to the study—79 via the MAU, 64 stepped down from a model 4 hospital and 1 via outpatient clinic, 95 of whom had a hospital admission within the previous year. The average age of patients was 72 years with a mean CFS of 4. 38% of patients were felt to be delirious on presentation to hospital, with 14% having a formal diagnosis of cognitive impairment prior to admission. Over 80% of patients were prescribed 5 or more medications in the community. Average overall LOS at the module 2 hospital was 9 days; 8 days for patients admitted via the MAU and 12 days for those stepped down from a model 4 hospital. The mean LOS at module 4 hospital prior to transfer was 6 days. 92% were living in the community prior to admission, 82% of which returned home. Conclusion Model 2 hospitals are a vital resource, particularly catering for the geriatric population. Patients are often multimorbid and admissions are often complicated with polypharmacy, delirium and discharge planning. Further exploration is required to assess how best to appropriately staff and resource them.

315 Financial planning as part of an integrated care comprehensive geriatric assessment

Abstract Background Evaluation of a social support network, including the need for support in managing finances independently is an essential component of Comprehensive Geriatric Assessment (CGA). Safeguarding of finances (e.g. third party authorities, enduring power of attorney, will) should be encouraged in all order adults, particularly those with cognitive decline to provide security and protection of their wishes should they lose capacity to manage financial decisions. We sought to evaluate financial competency and preparedness in a population attending our Integrated Care for Older Persons (ICPOP) service. Methods Participants included were new patients referred to ICPOP between January and May 2023 with completed CGAs. A retrospective analysis was conducted of patient demographics, ability to independently manage finances, dependency on personal and instrumental activities of daily living. Results Of our analytic cohort (n = 85), 56% (n = 48) were female, median age was 81. The most common reason for referral was new change in cognition which accounted for 48% (n = 41/85) of patients. Median Rockwood Clinical Frailty Scale was 5. Median Barthel score was 17. Median Lawton-Brody score was 4/8 with 80% (n = 68) patients scoring 1 in the financial section which indicates their ability to manage their finances partially or completely. 60% (n = 51) of patients collected their own pensions and on specific questioning reported managing their finances independently. No patient had an advanced care directive, 90% (n = 77/85) did not have EPoA and 41% (n = 35/85) did not have a will. Conclusion We identified that in those attending our service, very few had EPoA in place with no person having a documented advanced care directive. Over half required some if not total assistance with financial matters. Supported decision making is essential to uphold the right of the older person to make choices on their welfare, property and affairs and CGA provides opportunity for intervention in this remit.

Vulnerability to environmental and climatic health provocations among women and men hospitalized with chronic heart disease: insights from the RESILIENCE TRIAL cohort.

We aimed to recruit a representative cohort of women and men with multi-morbid chronic heart disease as part of a trial testing an innovative, nurse-co-ordinated, multi-faceted intervention to lower rehospitalization and death by addressing areas of vulnerability to external challenges to their health. The prospective, randomized open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure, and/or atrial fibrillation. Levels of concurrent multi-morbidity were high (mean Charlson Index of Comorbidity Score 6.5 ± 2.7), and 8.9% had at least mild frailty according to the Rockwood Clinical Frailty Scale. Including the index admission, 19-20% of women and men had a pre-existing pattern of seasonally linked hospitalization (seasonality). Detailed phenotyping revealed that 48% of women and 40% of men had ≥3 physiological factors, and 15% of women and 16% of men had ≥3 behavioural factors likely to increase their vulnerability to external provocations to their health. Overall, 61-62% of women and men had ≥4 combined factors indicative of such vulnerability. Additional factors such as reliance on the public health system (63 vs. 49%), lower education (30 vs. 14%), and living alone (48 vs. 29%) were more prevalent in women. We successfully recruited women and men with multi-morbid chronic heart disease and bio-behavioural indicators of vulnerability to external provocations to their health. Once completed, the RESILIENCE TRIAL will provide important insights on the impact of addressing such vulnerability (promoting resilience) on subsequent health outcomes. ClinicalTrials.org: NCT04614428.

Frailty and heart failure: State-of-the-art review.

At least half of all patients with heart failure (HF) are affected by frailty, a syndrome that limits an individual ability to recover from acute stressors. While frailty affects up to 90% of patients with HF with preserved ejection fraction, it is also seen in ~30-60% of patients with HF with reduced ejection fraction, with ~26% higher prevalence in women compared with men. The relationship between frailty and HF is bidirectional, with both conditions exacerbating the other. Frailty is further complicated by a higher prevalence of sarcopenia (by ~20%) in HF patients compared with patients without HF, which negatively affects outcomes. Several frailty assessment methods have been employed historically including the Fried frailty phenotype and Rockwood Clinical Frailty Scale to classify HF patients based on the severity of frailty; however, a validated HF-specific frailty assessment tool does not currently exist. Frailty in HF is associated with a poor prognosis with a 1.5-fold to 2-fold higher risk of all-cause death and hospitalizations compared to non-frail patients. Frailty is also highly prevalent in patients with worsening HF, affecting >50% of patients hospitalized for HF. Such patients with multiple readmissions for decompensated HF have markedly poor outcomes compared to younger, non-frail cohorts, and it is hypothesized that it may be due to major physical and functional limitations that limit recovery from an acute episode of worsening HF, a care aspect that has not been addressed in HF guidelines. Frail patients are thought to confer less benefit from therapeutic interventions due to an increased risk of perceived harm, resulting in lower adherence to HF interventions, which may worsen outcomes. Multiple studies report that <40% of frail patients are on guideline-directed medical therapy for HF, of which most are on suboptimal doses of these medications. There is a lack of evidence generated from randomized trials in this incredibly vulnerable population, and most current practice is governed by post hoc analyses of trials, observational registry-based data and providers' clinical judgement. The current body of evidence suggests that the treatment effect of most guideline-based interventions, including medications, cardiac rehabilitation and device therapy, is consistent across all age groups and frailty subgroups and, in some cases, may be amplified in the older, more frail population. In this review, we discuss the characteristics, assessment tools, impact on prognosis and impact on therapeutic interventions of frailty in patients with HF.

Is Transcatheter Aortic Valve Replacement Futile in Patients Over Ninety Years of Age?

BackgroundClinical outcomes and quality of life (QoL) indices are not well described after transcatheter aortic valve replacement (TAVR) in patients aged ≥ 90 years. MethodsWe conducted a retrospective cohort study of TAVR among nonagenarian patients between 2008 and 2020. The survival of TAVR patients among nonagenarians was compared to the provincial estimated survival for an age- and sex-matched general population. QoL was assessed up to 1 year postintervention, using standardized questionnaires. ResultsDuring the study period, n = 268 patients aged ≥ 90 years were evaluated for severe aortic stenosis. TAVR was performed in n = 171 (48% female; median [IQR] Rockwood Clinical Frailty Scale score: 4 [3-4]); n = 84 underwent medical therapy; and n = 13 underwent surgical aortic valve replacement. Survival was significantly better following TAVR, compared to that after MT (adjusted hazard ratio [95% CI]: 1.99 [1.37-2.88], P < 0.001). TAVR patients demonstrated a survival advantage compared with the general population, with an estimated relative mortality of 0.86 (0.75-0.87). TAVR patients showed sustained improvements in functional status and QoL up to 1 year compared to baseline (all P < 0.05): the 6-minute walk test results improved from 192 to 252 m; the Kansas City Cardiomyopathy Questionnaire score improved from 64 to 81; the Duke Activity Status Index score improved from 13 to 16; and the health state scale result of the Euro Quality of life - 5 Dimensions improved from 63% to 74%. ConclusionsNonagenarians undergoing TAVR experience a slightly better survival rate, compared to that of an age- and sex-matched general population, and they have significant improvements in functional status and several QoL indices following the procedure.

Investigation of frailty markers including a novel biomarker panel in emergency laparotomy: protocol of a prospective cohort study

BackgroundEmergency laparotomy (EmLAP) is one of the commonest emergency operations performed in the United Kingdom (approximately 30, 000 laparotomies annually). These potentially high-risk procedures can be life changing with frail patients and/ or older adults (≥ 65 years) having the poorest outcomes, including mortality. There is no gold standard of frailty assessment and no clinical chemical biomarkers existing in practice. Early detection of subclinical changes or deficits at the molecular level are essential in improving our understanding of the biology of frailty and ultimately improving patient outcomes. This study aims primarily to compare preoperative frailty markers, including a blood-based biomarker panel, in their ability to predict 30 and 90-day mortality post-EmLAP. The secondary aim is to analyse the influence of perioperative frailty on morbidity and quality of life post-EmLAP.MethodsA prospective single centred observational study will be conducted on 150 patients ≥ 40 years of age that undergo EmLAP. Patients will be included according to the established NELA (National Emergency Laparotomy Audit) criteria. The variables collected include demographics, co-morbidities, polypharmacy, place of residence, indication and type of surgery (as per NELA criteria) and prognostic NELA score. Frailty will be assessed using: a blood sample for ultra-high performance liquid chromatography mass spectrometry analysis; preoperative CT abdomen pelvis (sarcopenia) and Rockwood Clinical Frailty Scale (CFS). Patients will be followed up for 90 days. Variables collected include blood samples (at post operative day 1, 7, 30 and 90), place of residence on discharge, morbidity, mortality and quality of life (EQ-5D-5 L). The frailty markers will be compared between groups of frail (CFS ≥ 4) and non-frail using statistical methods such as regression model and adjusted for appropriate confounding factors.DiscussionThis study hypothesises that frailty level changes following EmLAP in frail and non- frail patients, irrespective of age. We propose that non- frail patients will have better survival rates and report better quality of life compared to the frail. By studying the changes in metabolites/ biomarkers in these patients and correlate them to frailty status pre-surgery, this highly novel approach will develop new knowledge of frailty and define a new area of clinical biomolecular research.Trial registrationClinicalTrials.gov: NCT05416047. Registered on 13/06/2022 (retrospectively registered).

122-OR: What Are the Barriers and Facilitators of Resistance Training in Mildly Frail Older Adults with Insulin-Treated Diabetes? A Qualitative Analysis Using the Capability, Opportunity, Motivation, and Behaviour (COM-B) Behavioural Science Model

Background: Resistance exercise offers many benefits for those with frailty and sarcopenia and may carry less risk of exercise induced hypoglycaemia. However most older adults do not meet recommended levels of exercise. Little is known about why, especially for mildly frail older adults with insulin treated diabetes. Our aim was to investigate behavioural related influences to undertaking resistance exercise in this vulnerable group. Methods: A phenomenological qualitative study using semi structured interviews with mildly frail adults aged ≥60 with insulin-treated diabetes (Type 1 (n=12); Type 2 (n=3)) recruited via online advert, in the UK. Frailty was assessed using the Rockwood Clinical Frailty Scale. Those with a history of myocardial infarction, stroke, renal failure, severe hypertension or liver disease in the last 12 months were excluded. Data were analysed inductively using thematic analysis, then aligned to the COM-B. Results: Barriers to exercise centred on the physical capability, opportunity, and reflective motivation COM-B domains. Primary barriers included exacerbating existing fatigue or diabetes-related complications, exercise induced hypoglycaemia and injury, and inability to use resistance equipment. Most were unaware of the benefits of exercise on diabetes and muscle health. Many with a decades-long diagnosis were initially told that exercise was unsafe. Facilitators included an informative and flexible training environment, clarity on potential diabetes specific benefits, and having a supportive partner ideally also capable of exercise. Conclusion: Older, mildly frail adults with insulin-treated diabetes are a vulnerable group whose beliefs may prevent them from undertaking regular exercise. They may benefit from a specific programme of awareness raising and a tailored, flexible exercise environment. Disclosure R.Stocker: None. J.A.Shaw: Advisory Panel; Betalin Therapeutics, Provention Bio, Inc., Consultant; Mogrify. M.D.Witham: None. G.Taylor: None. D.J.West: None. Funding UK Wellcome Trust

1242 CO-MORBIDITY, FRAILTY AND EJECTION FRACTION IN OLDER HEART FAILURE INPATIENTS

Abstract Introduction Co-morbidities and frailty are common in older heart failure patients. The aim of this study is to explore the relationship between co-morbidity, frailty and ejection fraction (EF) in older heart failure inpatients Methods A cross-sectional, observational, retrospective analysis of consecutive patients aged 60 years and over who were admitted with heart failure in a UK hospital. Patients with incomplete data were excluded. The Carlson’s comorbidity index (CCI) was used to compute comorbidity and the Rockwood Clinical Frailty Scale (CFS) was used to measure frailty. The EF was calculated as the midpoint of the ranges measured by echocardiography. IBM SPSS 28 software was used for statistical analysis. Descriptive statistics were used to measure baseline characteristics and Pearson’s correlation coefficient and linear regression were used to calculate correlation. Results and discussion 101 patients were analysed; 48 males and 53 females. Mean age was 81.2 years(SD 9.98). Mean CCI was 6.97(SD 1.63) and mean CFS was 5.09(SD 1.14). There was statistically significant positive correlation between CCI and CFS (r= 0.232; p= .01). There was statistically significant inverse correlation between CCI and EF (r= -.277; p=. 005). When taking into account the level of frailty the correlation between CCI and EF was much stronger in non-frail than in frail patients (r= -.612; p=. 035 and r= -.216; p= .047 respectively). There was no correlation between CFS and EF (r= .095; p=.26). This was not surprising as HFpEF is the most common type of HF in the elderly. HFpEF patients are more likely to have more comorbidities and to be more frail compared to HFrEF patients. Conclusion There was a positive correlation between multi-morbidity and frailty in older inpatients admitted with heart failure. There was statistically significant inverse correlation between CCI and ejection fraction but there was no correlation between frailty and ejection.

1251 FRAILTY PREVALENCE AND RISK OF SARCOPENIA IN OLDER HEART FAILURE (HF) INPATIENTS

Abstract Introduction Both frailty and HF are common in the elderly population. Elderly HF patients have an increased risk of frailty and elderly frail patients are at a higher risk of developing HF. Frailty is an independent predictor of mortality in cardiovascular disease. Sarcopenia (defined as decreased muscle mass and muscle strength and/or performance) is also prevalent in HF patients and may progress to cardiac cachexia. HF may induce sarcopenia and sarcopenia may contribute to the poor prognosis of HF. Aims Methods A cross-sectional, retrospective analysis of consecutive patients, 60 years and over, admitted with HF to a UK hospital. Data was manually extracted from anonymized electronic records. The Rockwood Clinical Frailty Scale (CFS) was used for assessment for frailty and the SARC-F tool was used for screening for sarcopenia. Patients with medical history of HF but did not present with decompensated HF were excluded. Also, patients with incomplete data were excluded. The IBM SPSS 28 statistical package was used for statistical analysis. Descriptive statistics and risk estimates were calculated. Results 163 patients were analysed; 82 males and 81 females. The mean age was 81.4 years (SD 9.69). 71.5 % of patients were frail while 28.5 % were non-frail. The risk of sarcopenia was 10.9 times greater in the frail than in the non-frail patients (OR = 10.9; 95% C.I 4.85 – 24.67). There was a lower risk of sarcopenia in male patients than in the female patients (OR =0.45; 95% C.I 0.22 – 0.94). Conclusions Frailty is prevalent in older heart failure inpatients. It significantly increases the risk of sarcopenia in these patients. Women are at higher risk of sarcopenia than men. More research is needed into frailty and sarcopenia in.

Evaluation of the risk factors for falls in the geriatric population presenting to the emergency department.

We evaluated risk factors and frailty assessments to identify fall-prone geriatric patients in the emergency department (ED). This prospective study included 264 consecutive patients aged ≥65 years who presented to the ED. The participants were divided into those who had fallen or not. The patient groups were compared in terms of age, sex, presenting complaints (falls vs. others), comorbidities, medications, frailty assessment tools, and orthostatic hypotension (OH). In total, 264 patients were included: 129 (48.8%) patients who had fallen and 135 (51.2%) who hadn't fallen. The mean ages of patients who had fallen and those who had not fallen were 80.48±8.38 and 79.42±7.94 years, respectively. In addition, 62.01% (n=80) and 51.85% (n=70) of patients were females. There were no statistically significant differences between the groups in terms of age or sex (P=0.290 and P=0.096, respectively). In total, 89.92% (n=116) of patients who had fallen had at least one chronic medical condition. There was a significant difference in the proportion of patients with OH between the groups. Frailty scores such as the Edmonton Frail Scale, Frail Non-Disabled Questionnaire, PRISMA-7 questionnaire, Identification of Seniors at Risk test, and Rockwood Clinical Frailty Scale scores were also significantly different between the groups. A higher PRISMA-7 score at admission was found to be an independent predictor of fall risk. Falls occur more frequently in the older population and in females. In addition, the frailty assessment scores, except for the FRESH Frailty Scale, were associated with falls in geriatric patients. After elimination of non-significant variables in multivariate analysis, a high PRISMA-7 questionnaire score at admission was identified as an independent predictor of fall risk.