Frailty Could Predict Death in Older Adults after Admission at Emergency Department? A 6-month Prospective Study from a Middle-Income Country

Aprahamian, Ivan; Almeida, Goretti; Romanin, C. F. de Vasconcellos; Caldas, T. Gomes; Yoshitake, Norikazu; Bataglini, L.; Lin, Sumika Mori; Pereira, Alexandre Alves; Longhi, L. Nara Alegrini; Mamoni, Ronei Luciano; Martinelli, José Eduardo

doi:10.1007/s12603-019-1207-9

Cited by 10 publications

(14 citation statements)

References 30 publications

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“…Some recent studies suggest that frailty provides better risk stratification for post-operative complications than chronological age [26,27]. Therefore, it has been suggested that screening of frailty may be suitable for detecting older persons at increased risk of adverse outcomes [28][29][30]. De Silva et al reported a positive association between frailty and mortality among nursing home residents [31].…”

Section: Discussionmentioning

confidence: 99%

The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

Hou

Yang

et al. 2020

BMC Med

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Background The coronavirus disease 2019 (COVID-19) has been a pandemic worldwide. Old age and underlying illnesses are associated with poor prognosis among COVID-19 patients. However, whether frailty, a common geriatric syndrome of reduced reserve to stressors, is associated with poor prognosis among older COVID-19 patients is unknown. The aim of our study is to investigate the association between frailty and severe disease among COVID-19 patients aged ≥ 60 years. Methods A prospective cohort study of 114 hospitalized older patients (≥ 60 years) with confirmed COVID-19 pneumonia was conducted between 7 February 2020 and 6 April 2020. Epidemiological, demographic, clinical, laboratory, and outcome data on admission were extracted from electronic medical records. All patients were assessed for frailty on admission using the FRAIL scale, in which five components are included: fatigue, resistance, ambulation, illnesses, and loss of weight. The outcome was the development of the severe disease within 60 days. We used the Cox proportional hazards models to identify the unadjusted and adjusted associations between frailty and severe illness. The significant variables in univariable analysis were included in the adjusted model. Results Of 114 patients, (median age, 67 years; interquartile range = 64–75 years; 57 [50%] men), 39 (34.2%), 39 (34.2%), and 36 (31.6%) were non-frail, pre-frail, and frail, respectively. During the 60 days of follow-up, 43 severe diseases occurred including eight deaths. Four of 39 (10.3%) non-frail patients, 15 of 39 (38.5%) pre-frail patients, and 24 of 36 (66.7%) frail patients progressed to severe disease. After adjustment of age, sex, body mass index, haemoglobin, white blood count, lymphocyte count, albumin, CD8+ count, D-dimer, and C-reactive protein, frailty (HR = 7.47, 95% CI 1.73–32.34, P = 0.007) and pre-frailty (HR = 5.01, 95% CI 1.16–21.61, P = 0.03) were associated with a higher hazard of severe disease than the non-frail. Conclusions Frailty, assessed by the FRAIL scale, was associated with a higher risk of developing severe disease among older COVID-19 patients. Our findings suggested that the use of a clinician friendly assessment of frailty could help in early warning of older patients at high-risk with severe COVID-19 pneumonia.

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Section: Discussionmentioning

confidence: 99%

The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

Hou

Yang

et al. 2020

BMC Med

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“…Persons with comorbidity are at an increased risk. It is suggested that the FRAIL screen is used to detect persons at increased risk (6,7,8). Persons with hypertension and diabetes mellitus are at increased risk possibly due to alterations in the angiotensin converting enzyme 2 (ACE 2) receptor produced by ACE 1 inhibitors.…”

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confidence: 99%

COVID-19 and Older Adult

Morley

Vellas

2020

The Journal of nutrition, health and aging

163

130

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“…The FRAIL scale has been translated into different languages, including Chinese languages [29], and has been used in several studies [30,31]. Evidence demonstrates that the FRAIL scale is a valid tool for frailty screening, and it is considered to be effective in predicting poor outcomes [18,19,24,25]. Scores range from 1 to 5 points and are divided into 3 levels: robust (0), pre-frail (1-2), and frail (3)(4)(5).…”

Section: Frailty Assessmentsmentioning

confidence: 99%

“…Owing to decreased physiological reserves in the muscles, bones, circulation, and hormonal and immune systems [14], patients with frailty tend to have worse outcomes than patients without frailty. It was reported that patients with frailty have an increased risk of falls [15] and readmission [16] and experience longer lengths of hospital stay than those without frailty [3,[17][18][19]. Furthermore, frailty is associated with short-(30 days), medium-(90-180 days), and long-term mortality [6,10,20,21].…”

Section: Introductionmentioning

confidence: 99%

Association between Frailty and 90-Day Outcomes amongst the Chinese Population: A Hospital-Based Multicentre Cohort Study

et al. 2021

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Introduction: Frailty has gained increasing attention as it is by far the most prevalent geriatric condition amongst older patients which heavily impacts chronic health status. However, the relationship between frailty and adverse health outcomes in China is far from clear. This study explored the relation between frailty and a panel of adverse health outcomes. Methods: We performed a multicentre cohort study of older inpatients at 6 large hospitals in China, with two-stage cluster sampling, from October 2018 to April 2019. Frailty was measured according to the FRAIL scale and categorized into robust, pre-frail, and frail. A multivariable logistic regression model and multilevel multivariable negative binomial regression model were used to analyse the relationship between frailty and adverse outcomes. Outcomes were length of hospitalization, as well as falls, readmission, and mortality at 30 and 90 days after enrolment. All regression models were adjusted for age, sex, BMI, surgery, and hospital ward. Results: We included 9,996 inpatients (median age 72 years and 57.8% male). The overall mortality at 30 and 90 days was 1.23 and 1.88%, respectively. At 30 days, frailty was an independent predictor of falls (odds ratio [OR] 3.19; 95% CI 1.59–6.38), readmission (OR 1.45; 95% CI 1.25–1.67), and mortality (OR 3.54; 95% confidence interval [CI] 2.10–5.96), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. At 90 days, frailty had a strong predictive effect on falls (OR 2.10; 95% CI 1.09–4.01), readmission (OR 1.38; 95% CI 1.21–1.57), and mortality (OR 6.50; 95% CI 4.00–7.97), adjusted for age, sex, BMI, surgery, and hospital ward clustering effect. There seemed to be a dose-response association between frailty categories and fall or mortality, except for readmission. Conclusions: Frailty is closely related to falls, readmission, and mortality at 30 or 90 days. Early identification and intervention for frailty amongst older inpatients should be conducted to prevent adverse outcomes.

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Frailty Could Predict Death in Older Adults after Admission at Emergency Department? A 6-month Prospective Study from a Middle-Income Country

Cited by 10 publications

References 30 publications

The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

COVID-19 and Older Adult

Association between Frailty and 90-Day Outcomes amongst the Chinese Population: A Hospital-Based Multicentre Cohort Study

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