Frailty: An Emerging Public Health Priority

Cesari, Matteo; Prince, Martin; Thiyagarajan, Jotheeswaran Amuthavalli; Carvalho, Islène Araujo de; Bernabei, Roberto; Chan, Piu; Robledo, Luis Miguel Gutiérrez; Michel, Jean Pierre; Morley, John E.; Ong, Paul M.; Mañas, Leocadio Rodríguez; Sinclair, Alan J.; Won, Chang Won; Beard, John; Vellas, Bruno

doi:10.1016/j.jamda.2015.12.016

Cited by 554 publications

(411 citation statements)

References 42 publications

Supporting

Mentioning

375

Contrasting

Unclassified

Order By: Relevance

“…The meta‐regression showed that age per se did not increase the risk of major postoperative morbidity and short‐term mortality. This supports frailty as a marker of ‘biological age’ with more value than chronological age13. Conversely, ageing modulated the effect size of long‐term mortality in meta‐regression, suggesting that other factors contribute to long‐term mortality.…”

Section: Discussionmentioning

confidence: 59%

See 1 more Smart Citation

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

View full text Add to dashboard Cite

BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

show abstract

Section: Discussionmentioning

confidence: 59%

“…On the contrary, frailty may reflect a more accurate and individualized parameter of ‘biological age’13. Thus, frailty should not be considered as an exclusive state of ageing and may be detected in any person with limited functional reserve for several different reasons.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Similarly, untreated pain may diminish the effectiveness of traditional frailty interventions aimed at building strength or ensuring adequate nutrition (31). Few interventions to address frailty have incorporated pain treatment as a central element or vice versa (31,32); however, given the mutually reinforcing nature of these deficits, such programs are warranted.…”

Section: Discussionmentioning

confidence: 99%

Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes

Lohman

Whiteman

Greenberg

et al. 2016

GERONA

View full text Add to dashboard Cite

Background: Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement. Methods: Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component. Results:In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95% CI = 1.71-2.59 (excluding pain). Conclusions: Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes.

show abstract

“…Public health authorities must become familiar with the increasing burdens that disability will impose on these systems, and become more proactive in the planning and implementation of care models that priorities multidisciplinary and integrated services (39).…”

Section: Discussionmentioning

confidence: 99%