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Lundgren M, Segernäs A, Nord M, Alwin J, Lyth J. Reasons for hospitalisation and cumulative mortality in people, 75 years or older, at high risk of hospital admission: a prospective study. BMC Geriatr 2024; 24:176. [PMID: 38378482 PMCID: PMC10877827 DOI: 10.1186/s12877-024-04771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND A small proportion of the older population accounts for a high proportion of healthcare use. For effective use of limited healthcare resources, it is important to identify the group with greatest needs. The aim of this study was to explore frequency and reason for hospitalisation and cumulative mortality, in an older population at predicted high risk of hospital admission, and to assess if a prediction model can be used to identify individuals with the greatest healthcare needs. Furthermore, discharge diagnoses were explored to investigate if they can be used as basis for specific interventions in the high-risk group. METHODS All residents, 75 years or older, living in Östergötland, Sweden, on January 1st, 2017, were included. Healthcare data from 2016 was gathered and used by a validated prediction model to create risk scores for hospital admission. The population was then divided into groups by percentiles of risk. Using healthcare data from 2017-2018, two-year cumulative incidence of hospitalisation was analysed using Gray´s test. Cumulative mortality was analysed with the Kaplan-Meier method and primary discharge diagnoses were analysed with standardised residuals. RESULTS Forty thousand six hundred eighteen individuals were identified (mean age 82 years, 57.8% women). The cumulative incidence of hospitalisation increased with increasing risk of hospital admission (24% for percentiles < 60 to 66% for percentiles 95-100). The cumulative mortality also increased with increasing risk (7% for percentiles < 60 to 43% for percentiles 95-100). The most frequent primary discharge diagnoses for the population were heart diseases, respiratory infections, and hip injuries. The incidence was significantly higher for heart diseases and respiratory infections and significantly lower for hip injuries, for the population with the highest risk of hospital admission (percentiles 85-100). CONCLUSIONS Individuals 75 years or older, with high risk of hospital admission, were demonstrated to have considerable higher cumulative mortality as well as incidence of hospitalisation. The results support the use of the prediction model to direct resources towards individuals with highest risk scores, and thus, likely the greatest care needs. There were only small differences in discharge diagnoses between the risk groups, indicating that interventions to reduce hospitalisations should be personalised. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03180606, first posted 08/06/2017.
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Affiliation(s)
- Moa Lundgren
- Primary Health Care Centre Finspång, Finspång, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anna Segernäs
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Ekholmen, Linköping, Sweden
| | - Magnus Nord
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre Valla, Linköping, Sweden
| | - Jenny Alwin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Kumar V, Barkoudah E, Jin DX, Banks P, McNabb-Baltar J. Hospital Frailty Risk Score (HFRS) Predicts Adverse Outcomes Among Hospitalized Patients with Chronic Pancreatitis. Dig Dis Sci 2023:10.1007/s10620-023-07946-w. [PMID: 37140839 DOI: 10.1007/s10620-023-07946-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The prevalence of frailty among patients with chronic pancreatitis (CP) and its impact on clinical outcomes is unclear. We report the impact of frailty on mortality, readmission rates, and healthcare utilization among patients with chronic pancreatitis in the United States. METHODS We extracted data on patients hospitalized with a primary or secondary diagnosis of CP from the Nationwide Readmissions Database 2019. We applied a previously validated hospital frailty risk scoring system to classify CP patients into frail and non-frail on index hospitalization and compared the characteristics of frail and non-frail patients. We studied the impact of frailty on mortality, readmission, and healthcare utilization. RESULTS Of 56,072 patients with CP, 40.78% of patients were classified as frail. Frail patients experienced a higher rate of unplanned and preventable hospitalizations. Almost two-thirds of frail patients were younger than 65, and one-third had no or only single comorbidity. On multivariate analysis, frailty was independently associated with two times higher mortality risk (adjusted hazard ratio [aHR], 2.05; 95% CI 1.7-2.5). Frailty was also associated with a higher risk of all-cause readmission with an aHR of 1.07; (95% CI 1.03-1.1). Frail patients experienced a longer length of stay, higher hospitalization costs, and hospitalization charges. Infectious causes were the most common cause of readmission among frail patients compared to acute pancreatitis among non-frail patients. CONCLUSIONS Frailty is independently associated with higher mortality, readmission rates, and healthcare utilization among patients with chronic pancreatitis in the US.
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Affiliation(s)
- Vivek Kumar
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ebrahim Barkoudah
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - David X Jin
- Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Peter Banks
- Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Julia McNabb-Baltar
- Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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Chan HCN, Fei X, Leung ELY, Langston K, Marshall S, van der Meij BS. Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review. Clin Nutr ESPEN 2023; 54:382-397. [PMID: 36963884 DOI: 10.1016/j.clnesp.2023.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND & AIMS Malnutrition, sarcopenia, and frailty are three prevalent wasting conditions among older rehabilitation patients that lead to multiple health-related negative outcomes. This systematic review and meta-analysis aimed to determine the post-discharge consequences of malnutrition, sarcopenia, and frailty in older adults admitted to inpatient rehabilitation. METHODS MEDLINE, Embase, Web of Science, and CINAHL databases were searched on 20 April, 2021 for longitudinal studies in older adults (≥65 years) admitted for inpatient rehabilitation. This systematic review included and synthesised studies that 1) measured malnutrition, sarcopenia, and/or frailty using a validated assessment tool or guideline; and 2) reported the association with post-discharge mortality, physical function, quality of life, or discharge location. The Academy of Nutrition & Dietetics Quality Criteria Checklist and GRADE criteria were used to assess risk of bias and evidence certainty. Where possible, data were pooled using Revman. RESULTS Twenty-six observational studies (n = 9709 participants in total) with similarly aged populations were included. Eight, seven, and eleven studies assessed malnutrition, sarcopenia, and frailty, respectively. Follow-up periods ranged from immediate to 7 years post-rehabilitation. Malnutrition was associated with discharge to a higher level of care (GRADE: very low), and worse quality of life (GRADE: very low) and physical function (GRADE: very low). Sarcopenia was associated with worse physical function (GRADE: very low) and lower rate of home discharge (OR: 0.14; 95%CI: 0.09-0.20; I2:30%; GRADE: low). Frailty was associated with increased mortality (GRADE: very low), hospital readmission (GRADE: very low), and decreased home discharge (GRADE: very low). CONCLUSION Wasting conditions in older adults during rehabilitation admission may be associated with poorer quality of life, lower rates of home discharge, and higher rates of health service use, physical dysfunction, and mortality following discharge. Further research is needed to investigate the comparative and combined impacts, as well as the overlap of malnutrition, sarcopenia, and frailty during and after rehabilitation to guide priority screening and intervention.
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Affiliation(s)
- Hei Chun Nicholas Chan
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Xinzhu Fei
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Eden Long Yin Leung
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Keanne Langston
- Department of Nutrition and Dietetics, Robina Hospital, Gold Coast, Queensland, Australia
| | - Skye Marshall
- Research Institute for Future Health, Gold Coast, Queensland, Australia
| | - Barbara Suzanne van der Meij
- Dietetics and Foodservices, Mater Health, Brisbane, Queensland, Australia; Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands.
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Cowley A, Goldberg SE, Gordon AL, Logan PA. A non-randomised feasibility study of the Rehabilitation Potential Assessment Tool (RePAT) in frail older people in the acute healthcare setting. BMC Geriatr 2022; 22:785. [PMID: 36207681 PMCID: PMC9541000 DOI: 10.1186/s12877-022-03420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rehabilitation potential involves predicting who will benefit from rehabilitation. Decisions about rehabilitation potential must take into account personal, clinical and contextual factors, a process which is complicated in the presence of acute ill-health and frailty. This study aimed to evaluate the feasibility and acceptability of the Rehabilitation Potential Assessment Tool (RePAT) - a 15 item holistic, person-centred assessment tool and training package - in the acute hospital setting. METHODS A non-randomised feasibility study with nested semi-structured interviews explored whether RePAT was feasible and acceptable. Feasibility was tested by recruiting physiotherapy and occupational therapy participants delivering the RePAT intervention to patients alongside usual clinical care. Acceptability was tested by conducting semi-structured interviews with staff, patient and carer participants. Staff and patient characteristics were analysed using descriptive statistics. Interview data were analysed thematically. Fidelity of completed RePAT items was assessed against a priori criteria on how closely they matched tool guidance by two researchers. Mean values of the two scores were calculated. RePAT content was analysed and supported with verbatim quotes. RESULTS Six staff participants were recruited and trained. They assessed 26 patient participants using RePAT. Mean (SD) patient age was 86.16 (±6.39) years. 32% were vulnerable or mildly frail, 42% moderately frail and 26% severely or very severely frail using the Clinical Frailty Scale. Mean (SD) time to complete RePAT was 32.7 (±9.6) minutes. RePAT fidelity was good where 13 out of 15 items achieved a priori fidelity. RePAT was acceptable and tolerated by staff and patients. Staff participants reported RePAT enabled them to consider rehabilitation decisions in a more structured and consistent way. Patients and carer participants, although unable to comment directly on RePAT, reported being satisfied with their rehabilitation assessments which were found to embrace a person-centred approach. CONCLUSIONS RePAT was found to be acceptable and feasible by staff, carers and patients. It allowed clinicians to make explicit their reasoning behind rehabilitation assessments and encouraged them to become more cognisant of factors which affected their clinical decision-making. TRIAL REGISTRATION ID ISRCTN31938453 . Registered 05/10/2021.
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Affiliation(s)
- Alison Cowley
- Research and Innovation, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK.
- Academic Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- Academic Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Pip A Logan
- Academic Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
- Nottingham CityCare Partnership CIC, Nottingham, UK
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Andersen K, Hewitt L, Davis KJ. Impact of Frailty on Acute Rehabilitation Outcomes: An Observational Study in a Regional Australian Context. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2021.2008087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kate Andersen
- Occupational Therapy Department, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Nowra, New South Wales, Australia
| | - Lyndel Hewitt
- Research Central, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Kimberley J. Davis
- Research Central, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia
- Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Frailty predicts failure to discharge patients home from a subacute-care unit: a 3-year Italian experience. Aging Clin Exp Res 2022; 34:95-103. [PMID: 34291406 PMCID: PMC8795051 DOI: 10.1007/s40520-021-01908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/05/2021] [Indexed: 12/02/2022]
Abstract
Background The primary purpose of Subacute Care Units (SCU) is to decongest acute hospital wards and facilitate the return of older patients to home. Aims We analyzed the clinical characteristics and outcomes of patients admitted to an Italian SCU, and we explored factors associated with discharge to locations other than home (outcome). Methods This retrospective observational cohort study was conducted at a medium-sized suburban hospital, enrolling all patients consecutively admitted to one SCU from October 2017 to February 2020. We collected demographics, cause of admission, comorbidities, cognition, Barthel Index (BI), nutritional status, Clinical Frailty Scale (CFS), length of stay, and discharge destination. Delirium was screened with the 4AT score. We adopted a multivariable conditional logistic regression model to identify the factors associated with the outcome. Results Frail subjects accounted for 58.6% of 406 patients (mean age 78.2 years, SD 11.6), while 61% were classified as functionally dependent. More than half of patients had relevant comorbidity, approximately 80% had a poor nutritional status, and 25% had pre-existing dementia. The overall prevalence of delirium was 14.5%. Most patients came from a hospital setting; recurrent reasons for admission were infections (70.5%) and heart failure (12.7%). Having a urinary bladder catheter at discharge, being overtly frail (CFS > 8), and low BI score were factors independently associated with not being discharged home. Discussion and conclusion The routine assessment of frailty, as expressed by the CFS, may help redirecting the patients eligible for SCU admission.
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Cowley A, Goldberg SE, Gordon AL, Logan PA. Rehabilitation potential in older people living with frailty: a systematic mapping review. BMC Geriatr 2021; 21:533. [PMID: 34620112 PMCID: PMC8496021 DOI: 10.1186/s12877-021-02498-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Following periods of acute ill-health and injury, older people are frequently assessed and provided with rehabilitation services. Healthcare practitioners are required to make nuanced decisions about which patients are likely to benefit from and respond to rehabilitation. The clinical currency in which these decisions are transacted is through the term “rehabilitation potential”. The aim of this study was to explore information about rehabilitation potential in older people to inform the development of an evidence-based assessment tool. Methods A systematic mapping review was completed to describe the extent of research and the concepts underpinning rehabilitation potential. We searched Medline, CINHAL, EMBASE, AMED, PsycINFO, PEDro, Cochrane Library, Web of Science, ProQuest, Trip and EThOS from inception to December 2020. We included studies which focused on rehabilitation potential and/or assessing for rehabilitation interventions for older people with comorbidities in the hospital and community setting. Reviewer pairs independently screened articles and extracted data against the inclusion criteria. A descriptive narrative approach to analysis was taken. Results 13,484 papers were identified and 49 included in the review. Rehabilitation potential was found to encompass two different but interrelated concepts of prognostication and outcome measurement. 1. Rehabilitation potential for prognostication involved the prediction of what could be achieved in programmes of rehabilitation. 2. Rehabilitation potential as an outcome measure retrospectively considered what had been achieved as a result of rehabilitation interventions. Assessments of rehabilitation potential included key domains which were largely assessed by members of the multi-disciplinary team at single time points. Limited evidence was identified which specifically considered rehabilitation potential amongst older people living with frailty. Conclusions Current approaches to rehabilitation potential provide a snapshot of an individual’s abilities and conditions which fail to capture the dynamic nature and fluctuations associated with frailty and rehabilitation. New approaches to measures and abilities over time are required which allow for the prognostication of outcomes and potential benefits of rehabilitation interventions for older people living with frailty. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02498-y.
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Affiliation(s)
- Alison Cowley
- Institute of Care Excellence, Derwent House, City Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK. .,School of Medicine, University of Nottingham, Nottingham, UK.
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK.,University Hospitals of Derby and Burton NHS Foundation Trust, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Pip A Logan
- School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK.,Nottingham CityCare Partnership CIC, Nottingham, UK
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Sutton JL, Gould RL, Coulson MC, Ward EV, Butler AM, Smith M, Lavelle G, Rosa A, Langridge M, Howard RJ. Multicomponent Frailty Assessment Tools for Older People with Psychiatric Disorders: A Systematic Review. J Am Geriatr Soc 2018; 67:1085-1095. [PMID: 30589075 DOI: 10.1111/jgs.15710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review evidence evaluating the use of multicomponent frailty assessment tools in assessing frailty in older adults with psychiatric disorders. METHODS A systematic literature review was conducted to identify all multicomponent frailty assessment tools (ie, a tool that assesses two or more indicators of frailty). The items of each frailty assessment tool were compared with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria for psychiatric disorders to assess construct overlap. Studies conducted in community, inpatient, and outpatient clinical settings were considered for inclusion. PARTICIPANTS Adults aged 60 years or older. RESULTS A total of 5639 records were identified following the removal of duplicates, from which 95 studies were included for review. Of the 48 multicomponent frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with a psychiatric disorder. Overall, 20 of 48 frailty assessment tools contained a psychological assessment domain, with 17 of 48 tools citing the presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM-5 diagnostic criteria included weight loss (29 of 48) and fatigue (21 of 48). CONCLUSIONS Significant construct overlap exists between the indicators of frailty as conceptualized in existing frailty assessment tools and DSM-5 diagnostic criteria for common psychiatric disorders including major depressive episode and generalized anxiety disorder that has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population. J Am Geriatr Soc 67:1085-1095, 2019.
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Affiliation(s)
- Jennifer L Sutton
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rebecca L Gould
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
| | - Mark C Coulson
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | - Emma V Ward
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | | | - Megan Smith
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Grace Lavelle
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Amy Rosa
- Division of Psychiatry, University College London, London, UK
| | - Margaret Langridge
- Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Howard
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
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Roberts PS, Goud M, Aronow HU, Riggs RV. Frailty in a Post-Acute Care Population: A Scoping Review. PM R 2018; 10:1211-1220. [PMID: 29550407 DOI: 10.1016/j.pmrj.2018.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/03/2018] [Accepted: 03/09/2018] [Indexed: 12/25/2022]
Abstract
Frailty is a complex and growing phenomenon facing health care providers throughout the continuum of care. Frailty is not well understood in post-acute care (PAC) settings. The purpose of this scoping review was to summarize current evidence of frailty impact on outcomes and frailty mitigation initiatives in PAC. Three major publication databases were searched from January 2000 to June 2017 that identified 18 articles specifically addressing frailty in PAC. Three themes were identified: scales used to measure frailty, factors that led to an adverse outcome or diagnosis of frailty, and interventions to address frailty in PAC. Scales used to measure frailty were dominated by physical factors and scarce on nutrition and social support. Functional decline, grip strength, gait speed, polypharmacy, and nutrition were identified in the studies as factors that identify frailty and are associated with poor outcomes. All these frailty characteristics compromise patients' ability to benefit from rehabilitation, which further establishes the importance of PAC providers to identify, prevent, and treat frailty. Intervention studies had mixed outcomes, suggesting a need for further development in this area. The findings of this scoping review highlight the need for a comprehensive multidimensional assessment of frailty risks in PAC. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Pamela S Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, 6500 Wilshire Blvd. Suite 1511, Los Angeles, CA 90048(∗).
| | - Manoj Goud
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA(†)
| | - Harriet Udin Aronow
- Department of Nursing Research and Development, Cedars-Sinai, Los Angeles, CA(‡)
| | - Richard V Riggs
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA(§)
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Black S, Nicholas C, Cotton S, Brock K. Determining discharge destination in geriatric evaluation and management units: Is progressive goal attainment a better early indicator of discharge destination than improvement in functional independence measure scores? Geriatr Gerontol Int 2018; 18:1058-1063. [PMID: 29573155 DOI: 10.1111/ggi.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 11/30/2022]
Abstract
AIM To determine whether progress in goal attainment is a more responsive measure of functional improvement than the Functional Independence Measure, and whether it is a more accurate predictor of discharge destination in the early phase of a Geriatric Evaluation and Management episode. METHODS The present study was a prospective audit of goal achievement, functional ability and discharge destination. A total of 83 patients were included in this study. Logistic regression was carried out with the outcome variable discharge destination (home vs residential care), and the predictors being goal attainment, age at admission and change in the Functional Independence Measure motor function scale from admission to 2 weeks. RESULTS Of the predictors, goal attainment was the only significant predictor. The overall amount of variability in the discharge destination explained by the predictors was 25% (Nagelkerke pseudo R2 ). CONCLUSIONS Progressive goal attainment might be a better predictor of improvement in function and discharge destination than change in the Functional Independence Measure. Geriatr Gerontol Int 2018; 18: 1058-1063.
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Affiliation(s)
- Susan Black
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Caitlin Nicholas
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Susan Cotton
- Health Services and Outcomes Research, Center for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Brock
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
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Freire JCG, Nóbrega IRAPD, Dutra MC, Silva LMD, Duarte HA. Fatores associados à fragilidade em idosos hospitalizados: uma revisão integrativa. SAÚDE EM DEBATE 2017. [DOI: 10.1590/0103-1104201711517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivou-se sintetizar e avaliar a produção do conhecimento sobre os fatores significativamente associados à fragilidade em idosos hospitalizados. Para isso, foram consultadas as bases de dados Medical Literature and Retrieval System Online (Medline), Literatura Latino-Americana em Ciências da Saúde (Lilacs) e Índice Bibliográfico Español em Ciencias de la Salud (Ibecs), de 2012 a 2016, cuja análise de 20 artigos identificou fatores associados à fragilidade: maior mortalidade hospitalar e após alta, longa hospitalização, reinternação, transferências, idade avançada, sexo feminino e viuvez, além de fatores psicossociais, físicos e/ou funcionais. Espera-se que os resultados da revisão facilitem o aprimoramento de práticas e a tomada de decisão das equipes multiprofissionais que prestam assistência ao idoso no ambiente hospitalar.
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Wickerson L, Rozenberg D, Janaudis-Ferreira T, Deliva R, Lo V, Beauchamp G, Helm D, Gottesman C, Mendes P, Vieira L, Herridge M, Singer LG, Mathur S. Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach. World J Transplant 2016; 6:517-31. [PMID: 27683630 PMCID: PMC5036121 DOI: 10.5500/wjt.v6.i3.517] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/31/2016] [Accepted: 08/17/2016] [Indexed: 02/06/2023] Open
Abstract
Physical rehabilitation of lung transplant candidates and recipients plays an important in optimizing physical function prior to transplant and facilitating recovery of function post-transplant. As medical and surgical interventions in lung transplantation have evolved over time, there has been a demographic shift of individuals undergoing lung transplantation including older individuals, those with multiple co-morbidites, and candidates with respiratory failure requiring bridging to transplantation. These changes have an impact on the rehabilitation needs of lung transplant candidates and recipients. This review provides a practical approach to rehabilitation based on research and clinical practice at our transplant centre. It focuses on functional assessment and exercise prescription during an uncomplicated and complicated clinical course in the pre-transplant, early and late post-transplant periods. The target audience includes clinicians involved in pre- and post-transplant patient care and rehabilitation researchers.
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Stoicea N, Baddigam R, Wajahn J, Sipes AC, Arias-Morales CE, Gastaldo N, Bergese SD. The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings. Front Public Health 2016; 4:150. [PMID: 27493935 PMCID: PMC4954808 DOI: 10.3389/fpubh.2016.00150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/06/2016] [Indexed: 11/13/2022] Open
Abstract
The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.
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Affiliation(s)
- Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Ramya Baddigam
- Medical School, The Ohio State University College of Medicine , Columbus, OH , USA
| | - Jennifer Wajahn
- Medical School, The Ohio State University College of Medicine , Columbus, OH , USA
| | - Angela C Sipes
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Carlos E Arias-Morales
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Nicholas Gastaldo
- Medical School, Ohio University Heritage College of Osteopathic Medicine , Dublin, OH , USA
| | - Sergio D Bergese
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Hartley P, Adamson J, Cunningham C, Embleton G, Romero-Ortuno R. Clinical frailty and functional trajectories in hospitalized older adults: A retrospective observational study. Geriatr Gerontol Int 2016; 17:1063-1068. [PMID: 27426434 DOI: 10.1111/ggi.12827] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/02/2016] [Accepted: 04/10/2016] [Indexed: 11/29/2022]
Abstract
AIM Frailty predicts inpatient mortality and length of stay, but its link to functional trajectories is under-researched. Addenbrooke's Hospital, Cambridge, UK, collects the Clinical Frailty Scale (CFS) within 72 h of admission for those aged ≥75 years. We studied whether the CFS links to functional trajectories in hospitalized older adults. METHODS This was a retrospective observational study in an English university hospital. We analyzed all first episodes of county residents aged ≥75 years admitted to the Department of Medicine for the Elderly wards between December 2014 and May 2015. Data were extracted from the hospital's information systems. Patients were classified as non-frail (CFS 1-4), moderately frail (CFS 5-6) and severely frail (CFS 7-8). Function was retrospectively measured with the modified Rankin Scale (mRS) at preadmission, admission and discharge. RESULTS Of 539 eligible patients, 46 died during admission (mortality rates: 2% in CFS 1-4, 5% in CFS 5-6, 19% in CFS 7-8). Among the 493 survivors, 121 were non-frail, 235 moderately and 137 severely frail. The mean mRS of the non-frail was 1.8 (95% CI 1.7-2.0) at baseline, 3.3 (95% CI 3.1-3.5) on admission and 2.2 (95% CI 2.0-2.3) on discharge (mean length of stay 9 days). The moderately frail had a mean mRS of 2.9 (95% CI 2.8-3.0) at baseline, 4.0 (95% CI 3.8-4.1) on admission and 3.2 (95% CI 3.1-3.3) on discharge (mean length of stay 15 days). The severely frail had mean mRS of 3.5 (95% CI 3.3-3.6) at baseline, 4.3 (95% CI 4.1-4.4) on admission and 3.7 (95% CI 3.6-3.9) on discharge, respectively (mean length of stay 17 days). CONCLUSIONS In older inpatients, frailty might be linked to lower and slower functional recovery. Prospective work is required to confirm these trajectories and understand how to influence them. Geriatr Gerontol Int 2017; 17: 1063-1068.
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Affiliation(s)
- Peter Hartley
- Department of Physiotherapy, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jennifer Adamson
- Department of Physiotherapy, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Carol Cunningham
- Department of Physiotherapy, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Georgina Embleton
- Department of Physiotherapy, Luton and Dunstable Hospital, Luton, United Kingdom
| | - Roman Romero-Ortuno
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, United Kingdom.,Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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15
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Juma S, Taabazuing MM, Montero-Odasso M. Clinical Frailty Scale in an Acute Medicine Unit: a Simple Tool That Predicts Length of Stay. Can Geriatr J 2016; 19:34-9. [PMID: 27403211 PMCID: PMC4922366 DOI: 10.5770/cgj.19.196] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Frailty is characterized by increased vulnerability to external stressors. When frail older adults are admitted to hospital, they are at increased risk of adverse events including falls, delirium, and disability. The Clinical Frailty Scale (CFS) is a practical and efficient tool for assessing frailty; however, its ability to predict outcomes has not been well studied within the acute medical service. Objective To examine the CFS in elderly patients admitted to the acute medical ward and its association with length of stay. Design Prospective cohort study in an acute care university hospital in London, Ontario, Canada, involving 75 patients over age 65, admitted to the general internal medicine clinical teaching units (CTU). Measurements Patient demographics were collected through chart review, and CFS score was assigned to each patient after brief clinician assessment. The CFS ranges from 1 (very fit) to 9 (terminally ill) based on descriptors and pictographs of activity and functional status. The CFS was collapsed into three categories: non-frail (CFS 1–4), mild-to-moderately frail (CFS 5–6), and severely frail (CFS 7–8). Outcomes of length of stay and 90-day readmission were gathered through the LHSC electronic patient record. Results Severe frailty was associated with longer lengths of stay (Mean = 12.6 ± 12.7 days) compared to mild-to-moderate frailty (mean = 11.2 ± 10.8 days), and non-frailty (mean = 4.1 ± 2.1 days, p = .014). This finding was significant after adjusting for age, sex, and number of medications. Participants with higher frailty scores showed higher readmission rates when compared with those with no frailty (31.2% for severely frail, vs. 34.2% for mild-to-moderately frail vs. 19% for non-frail) although there was no significant difference in the adjusted analysis. Conclusion The CFS helped identify patients that are more likely to have prolonged hospital stays on the acute medical ward. The CFS is an easy to use tool which can detect older adults at high risk of complicated course and longer stay. Objective early identification of seniors with frailty in acute care units can help to target interventions to prevent complications and to implement effective discharge planning in high risk older adults.
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Affiliation(s)
- Salina Juma
- Department of Medicine, Internal Medicine, London Health Sciences Centre, The University of Western Ontario, London, ON
| | - Mary-Margaret Taabazuing
- Department of Medicine, Division of Geriatric Medicine, The University of Western Ontario, London, ON
| | - Manuel Montero-Odasso
- Department of Medicine, Internal Medicine, London Health Sciences Centre, The University of Western Ontario, London, ON;; Department of Medicine, Division of Geriatric Medicine, The University of Western Ontario, London, ON;; Gait and Brain Lab, Lawson Health Research Institute, Parkwood Hospital, London, ON
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16
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Sutton JL, Gould RL, Daley S, Coulson MC, Ward EV, Butler AM, Nunn SP, Howard RJ. Psychometric properties of multicomponent tools designed to assess frailty in older adults: A systematic review. BMC Geriatr 2016; 16:55. [PMID: 26927924 PMCID: PMC4772336 DOI: 10.1186/s12877-016-0225-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/12/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability. The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidenced. There is currently no gold standard frailty assessment tool; optimizing the assessment of frailty in older people therefore remains a research priority. The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged ≥60 years old and to systematically and critically evaluate the reliability and validity of these tools. METHODS A systematic literature review was conducted using the standardised COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist to assess the methodological quality of included studies. RESULTS Five thousand sixty-three studies were identified in total: 73 of which were included for review. 38 multi-component frailty assessment tools were identified: Reliability and validity data were available for 21 % (8/38) of tools. Only 5 % (2/38) of the frailty assessment tools had evidence of reliability and validity that was within statistically significant parameters and of fair-excellent methodological quality (the Frailty Index-Comprehensive Geriatric Assessment [FI-CGA] and the Tilburg Frailty Indicator [TFI]). CONCLUSIONS The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties. However, there is insufficient evidence at present to determine the best tool for use in research and clinical practice. Further in-depth evaluation of the psychometric properties of these tools is required before they can fulfil the criteria for a gold standard assessment tool.
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Affiliation(s)
- Jennifer L Sutton
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO70, De Crespigny Park, London, SE5 8AF, UK.
| | - Rebecca L Gould
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO70, De Crespigny Park, London, SE5 8AF, UK
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, East Sussex, UK
| | - Mark C Coulson
- Department of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - Emma V Ward
- Department of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - Aine M Butler
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO70, De Crespigny Park, London, SE5 8AF, UK
| | - Stephen P Nunn
- Department of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - Robert J Howard
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO70, De Crespigny Park, London, SE5 8AF, UK.,Division of Psychiatry, University College London, London, UK
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17
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Nolan M, Power D, Long J, Horgan F. Frailty and its association with rehabilitation outcomes in a post-acute older setting. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.1.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary Nolan
- Senior physiotherapist, Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | - Dermot Power
- Consultant geriatrician, Mater Misericordiae and Cappagh National Orthopaedic Hospitals, Dublin, Ireland
| | - Jill Long
- Physiotherapy manager, Cappagh National Orthopaedic Hospital, Dublin, Ireland
| | - Frances Horgan
- Senior lecturer, School of Physiotherapy, Royal College of Surgeons in Ireland
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Dent E, Hoogendijk EO. Psychosocial factors modify the association of frailty with adverse outcomes: a prospective study of hospitalised older people. BMC Geriatr 2014; 14:108. [PMID: 25262425 PMCID: PMC4190287 DOI: 10.1186/1471-2318-14-108] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 09/23/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Frailty increases the risk of adverse outcomes in older people. The impact of psychosocial factors on frailty and adverse clinical outcomes associated with frailty has not yet been examined in the hospital setting. The aims of this study were to: i) investigate the association between psychosocial factors and frailty, and ii) to establish whether psychosocial factors impact on the association between frailty and adverse outcomes. METHODS Data was collected from a Geriatric Evaluation and Management Unit (GEMU) in Australia. Frailty was identified using Fried's frailty criteria. Psychosocial factors included wellbeing, sense of control (mastery), social activities, home/neighbourhood satisfaction, social relationships, anxiety and depression. Outcome measures were: mortality at 12 months, long length of GEMU stay (LOS), 1-month emergency rehospitalisation, and a higher level of care needed on discharge. Covariates adjusted for were age, gender and comorbidity. RESULTS The mean (SD) age of participants (n = 172) at admission was 85.2 (6.4) years, with 129 (75%) female patients. 96 (56%) patients were classified as frail, with 64 (37%) pre-frail and 12 (7%) robust. Frail patients had an increased likelihood of 12-month mortality (HR, 95% CI = 3.16, 1.36-7.33), discharge to a higher level of care (OR, 95% CI = 2.40, 1.21-4.78), long LOS (OR, 95% CI = 2.04, 1.07-3.88) and 1-month emergency rehospitalisation (OR, 95% CI = 2.53, 1.10-5.82). Psychosocial factors associated with frailty included poor wellbeing, anxiety, depression, and a low sense of control. Several psychosocial factors increased the likelihood of adverse outcomes associated with frailty, including anxiety and low ratings for: wellbeing, sense of control, social activities and home/neighbourhood satisfaction. CONCLUSIONS Our results indicate that frail older adults with low psychosocial resources had an elevated risk of mortality, discharge to higher level care, long LOS and rehospitalisation. Consideration of psychosocial factors in comprehensive geriatric assessments will assist in patient care planning.
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Affiliation(s)
- Elsa Dent
- Discipline of Public Health, School of Population Health, The University of Adelaide, 178 North Terrace-Terrace Towers, Adelaide, Australia.
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