Development of a comprehensive, multidisciplinary program of care for frailty in an emergency department

Puig, Mireia; Romeu, Josep Ris; Andión, Marta Blázquez; Vales, S. Benito

doi:10.1007/s41999-018-0151-2

Cited by 18 publications

(20 citation statements)

References 29 publications

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“…Delirium is characterized by fluctuating disturbances in arousal, a sudden and rapid onset, trouble concentrating, and cognition secondary to an acute medical condition; it is common and affects 8–17% of older patients attending ED and 51% of patients in postacute care [21]. This syndrome has some important common consequences compared with frailty, such as a loss of executive function leading to falls, increased rehospitalizations, institutionalizations, and premature death [22, 23, 24, 25, 26, 27].…”

Section: Introductionmentioning

confidence: 99%

“…The rapid detection of geriatric syndromes in the ED, such as frailty and delirium, is related to awareness and risks of an increased length of stay, more adverse effects, increased admissions and readmissions, and increased mortality [21]. Frailty and delirium would appear to be two clinically distinct geriatric syndromes; however, their simultaneous onset has often been documented in the scientific literature [20, 24, 25].…”

Section: Introductionmentioning

confidence: 99%

“…Highlighting an association between frailty and delirium could lead to a better understanding of both these geriatric syndromes and their interdependence, to prevent and detect them more consequently in the ED [33, 35]. Nevertheless, few authors have sought to evidence any relationship between frailty and the initiation of other geriatric syndromes in the ED [20, 21].…”

Section: Introductionmentioning

confidence: 99%

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Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Choutko-Joaquim

Tacchini-Jacquier²,

D'Alessio

et al. 2019

Dement Geriatr Cogn Disord Extra

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Background: Switzerland’s demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium. Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland. Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants’ cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant’s most significant informal caregiver. Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference. Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Choutko-Joaquim

Tacchini-Jacquier²,

D'Alessio

et al. 2019

Dement Geriatr Cogn Disord Extra

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“…Most of the 34 included studies were developed within the scope of secondary care (n = 23 articles). In this case, 13 articles focused only on a hospital department, namely, (i) Emergency Department, seven articles [27][28][29][30][31][32][33]; (ii) Surgery Department, two articles [34,35]; (iii) Acute Care Service, two articles [36,37]; (iv) Outpatient Department, one article [38]; and (v) Internal Medicine Department, one article [39]. The remaining ten articles analyze the entire hospital [5,[40][41][42][43][44][45][46][47][48].…”

Section: Nature Of Carementioning

confidence: 99%

“…On the one hand, there are studies in which an assessment of the current services provided to older adults is carried out, aiming to a future implementation of age-friendly health care [5,27,29,34,38,39], or in an attempt to formulate strategies that allow this implementation [30,33,42,45]. On the other hand, there are studies that have already implemented agefriendly health care and are concerned with measuring the results achieved [28,35,36,52].…”

Section: Level Of Conformancementioning

confidence: 99%

Age-Friendly Health Care: A Systematic Review

2021

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Background: Health care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide. Methods: A systematic review was conducted to synthesize the literature on age-friendly health care in accordance with the PRISMA recommendations in the PubMed, Web of Science, and Scopus databases. Results: The research identified 34 articles, with only seven recognizing the WHO Principles and only four using the implementation toolkit. In addition, in the context of primary care, three studies recognize the WHO Principles, but only two use the toolkit. Conclusions: The WHO Principles are being implemented in health care, but in a smaller scale than desired, which reveals possible flaws in their dissemination and standardization. Thus, a greater scientific investment in age-friendly health care should be considered, which represents a greater operationalization of the Principles and an evaluation of their effectiveness and impacts.

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The implications of frailty in older adults with epilepsy

Hashmi,

Sachdeva,

Sindhu

et al. 2024

Epilepsia Open

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Older adults constitute a large proportion of people with epilepsy (PWE) due to the changing demographics worldwide and epilepsy's natural history. Aging‐related pathophysiological changes lower the tolerance and increase our vulnerability to stressors, which manifests as frailty. Frailty is closely associated with adverse health outcomes. This narrative review examines the interplay between frailty and epilepsy, especially in older adults, emphasizing its clinical implications, including its role in managing PWE. Mechanistically, frailty develops through complex interactions among molecular and cellular damage, including genomic instability, mitochondrial dysfunction, and hormonal changes. These contribute to systemic muscle mass, bone density, and organ function decline. The concept of frailty has evolved from a primarily physical syndrome to include social, psychological, and cognitive dimensions. The “phenotypic frailty” model, which focuses on physical performance, and the “deficit accumulation” model, which quantifies health deficits, provide frameworks for understanding and assessing frailty. PWE are potentially more prone to developing frailty due to a higher prevalence of risk factors predisposing to frailty. These include, but are not limited to, polypharmacy, higher comorbidity, low exercise level, social isolation, low vitamin D, and osteoporosis. We lack commercial biomarkers to measure frailty but can diagnose it using self‐ or healthcare provider‐administered frailty scales. Recent attempts to develop a PWE‐specific frailty scale are promising. Unlike chronological age, frailty is reversible, so its management using multidisciplinary care teams should be strongly considered. Frailty can affect antiseizure medication (ASM) tolerance secondary to its impact on pharmacokinetics and pharmacodynamics. While frailty's effect on seizure control efficacy of ASM is poorly understood, its undoubted association with overall poor outcomes, including epilepsy surgery, behooves us to consider its presence and implication while treating older PWE. Incorporation of frailty measures in future research is essential to improve our understanding of frailty's role in PWE health.Plain Language SummaryFrailty is the declining state of the human body. People with epilepsy are more prone to it. It should be factored into their management.

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Development of a comprehensive, multidisciplinary program of care for frailty in an emergency department

Cited by 18 publications

References 29 publications

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Age-Friendly Health Care: A Systematic Review

The implications of frailty in older adults with epilepsy

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