Frail elderly people: Detection and management in primary care

Martín-Lesende, Iñaki; Iturbe, Ana Gorroñogoitia; Olivas, Marta Molina; Soler, Pedro Abizanda

doi:10.1016/j.eurger.2015.05.014

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…This pattern links this group of patients to the concept of frailty in older people, underlining the need to detect persons with no perceived or incipient levels of functional impairment who are at risk of progressing to a more severe disability. 24 This is important in that the chain of events implies a worsening in the patients’ health status and an upward spiral in their care needs but is potentially modifiable, predictable and manageable. 25 …”

Section: Discussionmentioning

confidence: 99%

“…Although several studies have reported an association between functional decline over time with the number and severity of concomitant diseases, 8 21 or with underlying diseases such as heart failure, 27 other authors 18 indicate poor discrimination between comorbidity or multiple medications and the outcome of functional decline. In this study, only the association of functional decline with the number of chronic diseases/conditions and Charlson Index has been analysed, however not with specific conditions as done in other studies, 24 due to a limited sample for each of them.…”

Section: Discussionmentioning

confidence: 99%

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Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study

Lesende

Crespo²,

Manzanares

et al. 2018

BMJ Open

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ObjectiveTo analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity.Design and settingProspective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals.ParticipantsOf the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by ‘Adjusted Clinical Groups’) and 86 were newly included (patients who met Ollero’s criteria and with ≥1 hospital admission the previous year). Patients who were institutionalised, unable to complete follow-up or receiving dialysis were excluded.Outcomes and variablesThe primary outcome was the decrease in functional status category (Barthel Index or Lawton Scale). Other variables considered were sociodemographic characteristics, comorbidity, medications, number of admissions and functional status on discharge.ResultsPatients had a median age of 82 years (P75 86) and of five selected chronic conditions (IQR 4–6), and took 11 (IQR 9–14) regular medications; 46.9% were women; 38.2% had impaired function at baseline.Overall, 200 persons completed the follow-up; 10.4% (n=25) of the initial sample died within the 8 months. In 20.5% (95% CI 15.5% to 26.6%) of them we recorded a decrease in functionality, associated with older age (OR 1.1, 95% CI 1.0 to 1.2) and with having ≥1 admission during the follow-up (OR 3.6, 95% CI 1.6 to 7.7). There were 133 hospital admissions in total during the follow-up considering all the patients included, and a functional decline was observed in 35.5% (95% CI 25.7% to 46.7%) of the 76 discharges in which functional status was assessed.ConclusionsA fifth of patients showed functional decline or loss of independence in just 8 months. These findings are important as functional decline and the increasing care needs are potentially predictable and modifiable. Age and hospitalisation were closely associated with this decline

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study

Lesende

Crespo²,

Manzanares

et al. 2018

BMJ Open

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“…Therefore, following the WHO recommendations, it seems that the prevention of disease and the maintenance of functionality should become the main goals, in order to provide adequate health services to a patient [ 20 ]. Further, the TUG test could be considered an adequate tool to be used in consultations with primary care professionals [ 3 , 4 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous authors have suggested that comprehensive functional assessments in older people are significantly better predictors of survival and other health outcomes, compared to the presence of individual diseases or the amount of comorbidities [ 2 ]. The measurement of functional performance is recommended by the World Health Organization [ 1 ] and it could be easily implemented in primary health care settings [ 3 , 4 ]. Thus, from a clinical perspective, approaches based on functional performance could be useful in framing public health responses and strategies towards a healthy ageing.…”

Section: Introductionmentioning

confidence: 99%

Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models

Mateo-Abad

Vrotsou²,

Padilla-Ruiz³

et al. 2022

PLoS ONE

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Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults.

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“…), deterioration in their physical function and functionality, and greater risk of progressing toward dependency and death. 1,2 Functionality and frailty are two closely related concepts.…”

Section: Introductionmentioning

confidence: 99%

Frailty and Related Factors Based On A Multidimensional Assessment In People 70 Years Old Or Over

Lesende¹

2017

MOJGG

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Introduction: The Healthcare Plan for the Elderly (PAM) of the Basque Public Health Service (Osakidetza) determines different typologies of people ≥70 years of age based on a multidimensional assessment. The objective is to learn about the prevalence of frailty and its relationship with other variables of the assessment. Material and methods:Cross-sectional study with a sample of 666 people (569 with a certain typology determined)≥70 years of age from 7 healthcare centres, selected by random sampling. Different typologies were determined based on functionality (Instrumental Activities of Daily Living -IADL, Lawton-Brody Index; Basic Activities of Daily Living -BADL, Barthel Index), existence of chronic diseases, and life expectancy < 6 months: 'healthy older person', 'with a chronic disease but no relevant alteration of functionality', 'FRAIL' (alteration of IADL, Barthel>59, life expectancy>6 months), 'dependent', and 'at the end of life'.Results: The 19.2% (95% CI 16.1-22.6%) were frail. Frailty was significantly related (p<0.001) to age (66.1% > 80 years old versus 27.2% non-frail), physical inactivity (57.1 versus 15.4%), previous falls (58.4% versus 34.2%) and number of chronic medications (median 13 versus 8). It was also related to certain pathologies (cardiovascular, osteoarticular) and visual deficit. Detection through the assessment of IADL is closely related to the Timed Up and Go Test (p<0.001). Conclusions:In order to detect frailty, it is important to consider older age, physical inactivity, certain comorbidity (cardiovascular, osteoarticular, sensory) and polypharmacy. IADL and performance-based tests show very good correlation.Keywords: frail elderly, geriatric assessment, activities of daily living, primary care. The objective of this study is to determine the prevalence of frail people ≥ 70 years old, according to PAM criteria based on functionality (alteration in the Lawton-Brody Index, Barthel Index ≥ 60 points), and life expectancy > 6 months; and assess the relationship of frailty with other variables of the multidimensional assessment. MOJ Gerontology & Geriatrics Material and methods Study design and locationThis is a cross-sectional study based on the PAM multidimensional clinical assessment, encompassed in the pilot period of this programme prior to its extension. It was carried out in 7 healthcare centres of the Basque Autonomous Community in Spain, 4 in urban areas, 1 in a semi-urban area and 2 in rural areas. The assessments were conducted from 11 January to 15 April 2016. Study population and samplePeople ≥ 70 years old were included through random sampling stratified by healthcare centre, excluding those institutionalised in residences with their own healthcare professionals caring for them there. A minimum sample size of 377 subjects was estimated, considering the most unfavourable of the situations to determine the percentages of appearance of an event-variable in the assessment (50%), for a reference population > 20,000 people in the Basque Autonomous Community (higher t...

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Frail elderly people: Detection and management in primary care

Cited by 8 publications

References 27 publications

Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study

Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study

Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models

Frailty and Related Factors Based On A Multidimensional Assessment In People 70 Years Old Or Over

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