Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes

Chong, Edward; Ho, Eu Chin; Baldevarona-Llego, Jewel; Chan, Mark; Wu, Lynn; Tay, Laura; Ding, Yew Yoong; Lim, Wee Shiong

doi:10.1016/j.jamda.2017.10.006

Cited by 92 publications

(86 citation statements)

References 33 publications

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“…Frailty is known to be related to institutionalization or short- and long-term outcomes in hospitalized older adults. 24 Our study also found that frailty was associated with healthcare setting transitions to institutions from home after adjustment for age, comorbidities, and pneumonia severity. Even though patients’ age, comorbidities, and pneumonia severity are important clinical factors to determine whether elderly pneumonia patients need intensive or conservative treatment, assessment of physiologic vulnerabilities unique to the elderly, such as frailty, should also be considered to determine the discharge site because function to maintain independent living of frailty elderly could deteriorate after pneumonia treatment.…”

Section: Discussionsupporting

confidence: 67%

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Choi¹,

Kim²,

Yoon³

et al. 2018

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PurposePneumonia poses a significant health risk in aging societies. We aimed to elucidate the determinative value of frailty for do-not-resuscitate (DNR) orders in pneumonia patients.Patients and methodsThis was a retrospective cohort study conducted at the Seoul National University Bundang Hospital (SNUBH) in Korea. Medical records of 431 pneumonia patients, aged 65 years and older, who were admitted between June 2014 and May 2015 were analyzed. Patients were categorized into DNR and no-DNR groups.ResultsAmong the 65 patients (15.1% of pneumonia patients) who completed DNR documents, 24 patients were survived, and 21 patients decided imminent to death (<24 hours before death), with all decisions determined by surrogates. The DNR group tended to be older and frail, with higher rates of renal impairment and malnutrition, and had a lower microbiology detection effort than the no-DNR group. The DNR group used a high number of broad-spectrum antibiotics, experienced high levels of in-hospital (63.1% vs 5.7%, P<0.001) and 30-day (64.6% vs 9.6%, P<0.001) mortality rates, and had prolonged hospital stays (median length of hospital stay, 12 vs 9 days, P=0.020). Frailty was independently associated with DNR status even after adjustment for sepsis, septic shock, and the pneumonia severity index (PSI) score. Frailty also significantly influenced healthcare setting transitions after adjustment for sepsis, septic shock, and the PSI.ConclusionWe identified the factors associated with DNR orders and their prognoses among elderly Koreans with pneumonia. Frailty was significantly associated with DNR decision and healthcare setting transitions in pneumonia patients.

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Section: Discussionsupporting

confidence: 67%

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Choi¹,

Kim²,

Yoon³

et al. 2018

CIA

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“…The increased risk experienced by frail older adults who are acutely ill comes not just from their frailty, but from the severity of their illness [ 7 , 13 , 14 ]. Both frailty and illness acuity can add information about risk [ 5 , 6 , 13 ]. Screening and assessment measures include formal acuity-based measures (e.g.…”

Section: Introductionmentioning

confidence: 99%

The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine

et al. 2020

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Background we investigated whether two frailty tools predicted mortality among emergency department (ED) patients referred to internal medicine and how the level of illness acuity influenced any association between frailty and mortality. Methods two tools, embedded in a Comprehensive Geriatric Assessment (CGA), were the clinical frailty scale (CFS) and a 57-item deficit accumulation frailty index (FI-CGA). Illness acuity was assessed using the Canadian Triage and Acuity Scale (CTAS). We examined all-cause 30-day and 6-month mortality and time to death. Results in 808 ED patients (mean age ± SD 80.8 ± 8.8, 54.4% female), the mean FI-CGA score was 0.44 ± 0.14, and the CFS was 5.6 ± 1.6. A minority (307; 38%) were classified as having low acuity (CTAS: 1–2). The 30-day mortality rate was 17%; this increased to 34% at 6 months. Compared to well patients with low acuity, the risk of 30-day mortality was 22.5 times (95% CI: 9.35–62.12) higher for severely frail patients with high acuity; 53% of people with very severe frailty (CFS = 8) and high acuity died within 30 days. When acuity was low, the risk for 30-day mortality was significantly higher only among those with very high levels of frailty (CFS 7–9, FI-CGA > 0.5). When acuity was high, even lower levels of frailty (CFS 5–6, FI-CGA 0.4–0.5) were associated with higher 30-day mortality. Conclusions across levels of frailty, higher acuity increased mortality risk. When acuity was low, the risk was significant only when the degree of frailty was high, whereas when acuity was high, even lower levels of frailty were associated with greater mortality risk.

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“…Previous studies also showed that different tools for the same cohort of patients would have different results of frailty prevalence. [32][33][34][35][36] We used the combined index as the gold standard to evaluate the sensitivity and specificity of two frailty screening tools and three assessment tools. We found CFS as a screening tool has better sensitivity (94.1% for all patients, range from 91.8% to 98.5% for different wards) than FRAIL (only 63.0% for all patients, range from 58.0% to 65.7% for different wards), meanwhile CFS also has an acceptable specificity, ranging from 81.5% to 87.2%.…”

Section: Evaluation Of Frailty By Different Toolsmentioning

confidence: 99%

<p>Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China</p>

Liang¹,

Zhang²,

Liu³

et al. 2019

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Objectives: To survey the difference of frailty prevalence in elderly inpatients amongdifferent wards; to compare the diagnostic performance of five frailty measurements (Clinical Frailty Scale [CFS], FRAIL, Fried, Edmonton, Frailty Index [FI]) in identifying frailty; and to explore the risk factors of frailty in elderly inpatients. Participants and methods: This was a cross-sectional study including 1000 inpatients (mean age 75.2±6.7 years, 51.5% male; 542, 229, and 229 patients from cardiology, nonsurgical, and surgical wards, respectively) in a tertiary hospital from September 2018 to February 2019. We applied the combined index to integrate the five frailty measurements mentioned above as the gold standard of frailty diagnosis. Multivariate logistic regression models were used to determine the independent risk factors of frailty. Results: Frailty prevalence was 32.3% (Fried), 36.2% (CFS), 19.2% (FRAIL), 25.2% (Edmonton), 35.1% (FI) in all patients. The frailty was more common in non-surgical wards, regardless of the frailty assessment tools used (non-surgical wards: 27.5% to 51.5%; cardiology ward: 14.9% to 29.3%; surgical wards: 18.8% to 41.9%). CFS≥5 showed a sensitivity of 94.1% and a specificity of 85.2% for all patients. FI≥0.25 showed a sensitivity of 94.8% and a specificity of 87.0% for all patients. Age [odds ratio (OR) = 1.089, P<0.001], education level (OR = 0.782, P=0.001), heart rate (OR = 1.025, P<0.001), albumin (OR = 0.911, P=0.002), log D-dimer (OR = 2.940, P<0.001), ≥5 comorbidities (OR = 2.164, P=0.002), and ≥5 medications (OR = 2.819, P<0.001) were independently associated with frailty in all participants. Conclusion: Frailty is common among elderly inpatients, especially in non-surgical wards. CFS is a preferred screening tool and FI may be an optimal assessment tool. Old age, low educational level, fast heart rate, low albumin, high D-dimer, ≥5 comorbidities, and polypharmacy are independent risk factors of frailty in elderly hospitalized patients.

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Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes

Cited by 92 publications

References 33 publications

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

Impact of frailty on do-not-resuscitate orders and healthcare transitions among elderly Koreans with pneumonia

The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine

<p>Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China</p>

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