From research to bedside: Incorporation of a <scp>CGA</scp>‐based frailty index among multiple comanagement services

Cooper, Lisa; Loewenthal, Julia; Frain, Laura; Tulebaev, Samir; Cardin, Kristin; Hshieh, Tammy T.; DuMontier, Clark; Streiter, Shoshana; Joseph, Carly; Hilt, Austin; Theou, Olga; Rockwood, Kenneth; Orkaby, Ariela R.; Javedan, Houman

doi:10.1111/jgs.17446

Cited by 20 publications

(19 citation statements)

References 30 publications

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“…We analyzed a cohort of older adults undergoing thoracic surgery who were evaluated and collaboratively managed by a geriatricthoracic team. Frailty, as measured using a rigorous FI-CGA 26 , was prevalent in our cohort (38%). Notably, most of these individuals (82%) had degrees of frailty that often are undetected by nongeriatric teams, which we defined as "occult frailty."…”

Section: Discussionmentioning

confidence: 87%

“…We analyzed a cohort of older adults undergoing thoracic surgery who were evaluated and collaboratively managed by a geriatric‐thoracic team. Frailty, as measured using a rigorous FI‐CGA 26 , was prevalent in our cohort (38%). Notably, most of these individuals (82%) had degrees of frailty that often are undetected by nongeriatric teams, which we defined as “occult frailty.” We identified multiple geriatric‐specific interventions incorporated by the multidisciplinary team, and despite the high prevalence of frailty, these patients had similar postoperative outcomes compared to those without frailty with no evidence of higher rates of complications or longer hospital stay.…”

Section: Discussionmentioning

confidence: 87%

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Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Cooper

Gong

Dezube

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: We assessed frailty, measured by a comprehensive geriatric assessment-based frailty index (FI-CGA), and its association with postoperative outcomes among older thoracic surgical patients.Methods: Patients aged ≥65 years evaluated in the geriatric-thoracic clinic between June 2016 through May 2020 who underwent lung surgery were included. Frailty was defined as FI-CGA > 0.2, and "occult frailty", a level not often recognized by surgical teams, as 0.2 < FI-CGA < 0.4. A qualitative analysis of geriatric interventions was performed.Results: Seventy-three patients were included, of which 45 (62%) were nonfrail and 28 (38%) were frail. "Occult frailty" was present in 23/28 (82%). Sixty-one (84%) had lung malignancy. Geriatric interventions included delirium management, geriatricspecific pain and bowel regimens, and frailty optimization. More sublobar resections versus lobectomies (61% vs. 25%) were performed among frail patients. Frailty was not significantly associated with overall complications (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 0.88-6.44; p = 0.087), major complications (OR: 2.33; 95% CI: 0.48-12.69; p = 0.293), discharge disposition (OR: 2.8; 95% CI: 0.71-11.95; p = 0.141), or longer hospital stay (1.3 more days; p = 0.18). Conclusion:Frailty and "occult frailty" are prevalent in patients undergoing lung surgery. However, with integrated geriatric management, these patients can safely undergo surgery.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 87%

Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Cooper

Gong

Dezube

et al. 2022

Journal of Surgical Oncology

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“…Despite its importance, assessing and interpreting frailty has long been regarded as a barrier in incorporating this condition into real-world clinical practice (14). However, the Clinical Frailty scale (CFS), a simplified measure including pictographs and brief descriptions on global fitness and functional capabilities, has been suggested as a viable approach (15,16).…”

Section: Introductionmentioning

confidence: 99%

Operationalization of the Clinical Frailty Scale in Korean Community-Dwelling Older People

et al. 2022

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BackgroundThe Clinical Frailty Scale (CFS) is a simple measure of global fitness validated in various populations in real-world settings. In this study, we aimed to assess the characteristics and validities of the CFS in community-dwelling older people in Korea, with the original classification tree (oCFS) and a culturally modified tree (mCFS).MethodsThe comprehensive geriatric assessment records of 1,064 individuals of the Aging Study of the Pyeongchang Rural Area were used for this study. For mCFS, we considered the dependency of the food preparations and household chores not to be deficits in the male population. The frailty index was used as a reference for construct validity. We used a composite outcome of death and institutionalization for outcome validity.ResultsThe correlation coefficients with frailty index were higher in mCFS (.535) than in oCFS (.468). The mean frailty index was lower in individuals reclassified by mCFS (5 to 4) than people who stayed in mCFS 5. The classification coefficient of mCFS was significantly higher than that of oCFS (p <0.001) in determining people with frailty (frailty index.25 or higher). Trends of a higher incidence of the composite outcome were observed in both higher oCFS and mCFS, in which oCFS and mCFS did not differ significantly in predicting the risk of the outcome.ConclusionThe classification tree of CFS could be culturally adopted in a community-dwelling population of Korea and considered valid in detecting the vulnerable population.

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“…In recent decades, health care systems have been faced with an increasing number of older multimorbid patients, requiring continuous structural adjustment. Among other things, this has prompted the emergence of comprehensive geriatric care (CGC), a multidisciplinary intervention strategy developed to satisfy medical care requirements but also focusing on patients’ functional abilities in order to improve and/or maintain their independence [ 1 , 2 , 3 ]. Many investigations have indicated that patients might benefit from this approach [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Electroencephalography Findings in Older Adults Undergoing Geriatric Treatment: A Surrogate for the Outcome?

et al. 2022

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Background: Comprehensive geriatric care (CGC) is a multidisciplinary approach developed to meet the needs of older patients. Electroencephalography (EEG) provides valuable information for monitoring the cerebral function. As a surrogate, EEG findings may help to estimate the course of diseases as well as the treatment outcomes. Objectives: Therefore, the aim of the present study is to investigate EEG findings in older patients receiving CGC. Methods: Patients with an initial EEG in a geriatric unit between May 2019 and April 2020 and treated using the CGC approach were analyzed. EEG abnormalities were defined as generalized (diffuse) background slowing and/or intermittent/persistent focal slowing and/or epileptiform discharges. Assessment results for the Barthel index (BI), Tinetti Balance and Gait test (TBGT), and Timed Up and Go test (TUG) were analyzed in relation to the presence of EEG abnormalities. Results: The study included 398 patients (mean age: 83.0 ± 6.57 years, 69.3% were female). Abnormal EEG patterns were found in 94 (23.6%) patients. Patients with EEG abnormalities had a mean age of 83.4 years versus a mean of 82.8 years in those without (p = 0.451). Based on all calculated scores, the majority of the patients improved after CGC, with a tendency to higher-grade improvements in those without EEG abnormalities (BI: 86.2% vs. 75.5%, p = 0.024; TUG: 53.3% vs. 31.9%, p < 0.001); for TBGT, only a gradual difference was detected (TBGT prior CGC: 79.9% vs. TBGT after CGC: 71.3%, p = 0.088). The presence of EEG abnormalities was associated with the parameters dementia (36.2% vs. 22.4%, p = 0.010), known epilepsy/seizure (19.1% vs. 5.9%, p < 0.001), structural brain lesion (47.9% vs. 19.7%, p < 0.001), and delirium (9.6% vs. 3.6%, p = 0.030) during hospitalization. Conclusions: We found EEG abnormalities in almost a quarter of the patients treated in the geriatric unit. In older patients, the presence of EEG abnormalities is associated with lower improvements after CGC.

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From research to bedside: Incorporation of a CGA‐based frailty index among multiple comanagement services

Cited by 20 publications

References 30 publications

Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Thoracic surgery with geriatric assessment and collaboration can prepare frail older adults for lung cancer surgery

Operationalization of the Clinical Frailty Scale in Korean Community-Dwelling Older People

Electroencephalography Findings in Older Adults Undergoing Geriatric Treatment: A Surrogate for the Outcome?

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