Effects of hospital-wide interventions to improve care for frail older inpatients: a systematic review

Bakker, Franka C.; Robben, Sarah H M; Rikkert, Olde

doi:10.1136/bmjqs.2010.047183

Cited by 73 publications

(66 citation statements)

References 52 publications

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“…These results were found by other scientific evidence, especially as we verified a prevalence ranging from 50% to 80% of frailty among hospitalized elderly [23][24][25] . The greater number and length of hospitalizations found in our research is also evidenced in other studies.…”

Section: Discussionsupporting

confidence: 76%

Impacts of frailty on the negative health outcomes of elderly Brazilians

Barbosa¹,

Mansur

Colugnati

2017

Rev. bras. geriatr. gerontol.

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Objective: to verify the association between frailty and the occurrence of falls, hospitalization and death among Brazilian elderly persons. Methods: a representative sample of elderly persons from the city of Juiz de Fora, Minas Gerais, Brazil, who had been evaluated with regard to frailty, socio-demographic conditions and health in 2009, were reevaluated in terms of negative health outcomes between 2014 and 2015 (n=304). Results: The results revealed a greater incidence of falls, hospitalization, and death among frail elderly persons. The frail group also had an increased risk (1.5, crude estimate) of death during the follow-up period than the robust individuals. The pre-frail elderly had a 55% (crude) and 58% (adjusted) greater risk of falls, and an 89% (crude) greater risk of death than robust individuals. Conclusion: frailty, as well as pre-frailty, can increase the risk of adverse events in the health of the elderly.

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Section: Discussionsupporting

confidence: 76%

Impacts of frailty on the negative health outcomes of elderly Brazilians

Barbosa¹,

Mansur

Colugnati

2017

Rev. bras. geriatr. gerontol.

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“…Interventions such as cardiac rehabilitation, physical exercise, polypharmacy reduction (especially the reduction of unnecessary medications), nutritional recommendations, and HF self-care and treatment optimization could be particularly useful for delaying the transition from fragility to disability and for reducing mortality after discharge in frail patients 23, 24. Our study found a high prevalence of fragility in HFmrEF (48.6%); the prevalence was nearly as high as that found in HFpEF and slightly higher than that in HFrEF.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction

Gastelurrutia

Lupón

Moliner

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area.Patients and MethodsConsecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed.ResultsComorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, P<.001, and 36.5±20.7, P=.003, respectively). No statistically significant differences in fragility between HFmrEF (48.6%) and HFrEF (41.9%) (P=.09) nor HFpEF (54.3%) (P=.29) were found. In univariate analysis, the association of comorbidities, QOL, and fragility with the 3 end points was higher for HFmrEF than for HFrEF and HFpEF. In multivariate analysis, comorbidities were independently associated with the 3 end points (P≤.001), and fragility was independently associated with all-cause death and the composite end point (P<.001) in HFmrEF.ConclusionComorbidities and fragility are independent predictors of outcomes in ambulatory patients with HFmrHF and should be considered in the routine clinical assessment of HFmrEF.

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“…By using the prognosis-driven age cutoffs validated in this study, as opposed to subjective age cutoffs, clinical care pathways and research protocols have a better starting point to target the elderly patients who may benefit from preoperative comprehensive geriatric assessment and optimization. 24,25 …”

Section: Discussionmentioning

confidence: 99%

Derivation and Validation of Prognosis-Based Age Cutoffs to Define Elderly in Cardiac Surgery

Afilalo

Steele

Manning

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background-The age cutoff to define elderly is controversial in cardiac surgery, empirically ranging from ≥65 to ≥80 years. Beyond semantics, this has important implications as a starting point for clinical care pathways and inclusion in trials. We sought to characterize the relationship between age and adverse outcomes in patients undergoing cardiac surgery and to derive and validate prognosis-based age cutoffs. Methods and Results-Six thousand five hundred seventy one consecutive adult patients undergoing cardiac surgery at 3 hospitals in the United States and Canada were included in the cohort. Logistic regression models and generalized additive models with thin-plate splines were fit to the data. The age distribution was 50 to 59 years in 1244 (18.9%), 60 to 69 years in 2144 (32.6%), 70 to 79 years in 2000 (30.4%), ≥80 years in 1183 (18.0%) patients. After controlling for sex and type of operation, the relationship between age and 30-day operative mortality was found to be nonlinear. Receiver operating characteristic analysis showed that the optimal cutoffs to identify older patients at higher risk of operative mortality were greater than 74, 78, and 75 years for isolated coronary bypass, isolated valve surgery, and coronary bypass plus valve surgery, respectively. These age cutoffs were validated in an independent cohort. Conclusions-The relationship between age and operative mortality is not linear, manifesting a steeper rise after age 75 for coronary bypass and approaching octogenarian age for isolated valve surgery. Rather than using arbitrary age cutoffs to define elderly, the outcomes-based cutoff of ≥75 years should be used to identify the population of older adults that has higher risk and may benefit from preoperative geriatric evaluation and optimization. (Circ Cardiovasc Qual Outcomes. 2016;9:424-431.

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Effects of hospital-wide interventions to improve care for frail older inpatients: a systematic review

Cited by 73 publications

References 52 publications

Impacts of frailty on the negative health outcomes of elderly Brazilians

Impacts of frailty on the negative health outcomes of elderly Brazilians

Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction

Derivation and Validation of Prognosis-Based Age Cutoffs to Define Elderly in Cardiac Surgery

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