Identifying frailty in primary care

Hamilton, William; Round, Jack

doi:10.1136/bmj.j4478

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…Making frailty integral to primary care, however, has important challenges, including the acceptability to primary care professionals and patients of frailty as a relevant concept; robust and efficient assessment of patient frailty; effective use of that information to improve care planning and patient outcomes; and convincing already overstretched14 primary care professionals that this approach will ultimately reduce, or at least not increase, their workloads.…”

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confidence: 99%

The challenge of ageing populations and patient frailty: can primary care adapt?

Reeves

Pye

Ashcroft

et al. 2018

BMJ

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confidence: 99%

The challenge of ageing populations and patient frailty: can primary care adapt?

Reeves

Pye

Ashcroft

et al. 2018

BMJ

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“…The identification of essential modifiable risk and protective factors is very important for frailty prevention (1,3,42). a Estimated effects were adjusted on the fully adjusted model 3 (see footnote in Table 2).…”

Section: Discussionmentioning

confidence: 99%

Associations Between Intellectual and Social Activities With Frailty Among Community-Dwelling Older Adults in China: A Prospective Cohort Study

Huang

Guo

et al. 2021

Front. Med.

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Background: Frailty is one of the most important global health challenges. We aimed to examine the associations between frequency of intellectual and social activities and frailty among community-dwelling older adults in China.Methods: This is a prospective analysis of older adults (aged ≥60 years) who had intellectual and social activity data and were free of frailty from the national representative China Health and Retirement Longitudinal Study (CHARLS). The exposure was frequency of intellectual and social activities. Frailty was measured by the frailty index (FI) and defined as FI ≥ 0.25. Frailty incidents were followed up for 2 years. We estimated the relative risks (RRs) with 95% confidence intervals (CIs) using log-linear binominal regression adjusting for potential confounders.Results: We documented 655 frailty cases over the past 2 years. Participants who had frequent intellectual activities had a lower frailty risk compared with participants who did not have intellectual activity (adjusted RR = 0.65, 95%CI = 0.47–0.90). The adjusted RRs were 0.51 (95%CI = 0.33–0.77) for participants who did not have a slip or a fall accident and 1.06 (95%CI = 0.65–1.75) for participants who had experienced slip and fall accidents (P = 0.01 for interaction). Having frequent social activities was not associated with a significant decrease in frailty risk compared with participants who did not have social activity (adjusted RR = 0.93, 95%CI = 0.78–1.12).Conclusions: This observational study showed that having frequent intellectual activities was associated with a decreased frailty risk. The association was likely to be stronger in participants without a slip or a fall accident. Randomized controlled trials are needed to confirm this observational finding.

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“…There is debate over the utility of predicting mortality, 23 given the lack of evidence-based interventions. We would not recommend that clinicians test inflammatory markers purely for the purpose of mortality prediction, particularly given that false positives have been shown to lead to cascades of follow on tests, appointments and referrals.…”

Section: Discussionmentioning

confidence: 99%

Raised inflammatory markers as a predictor of one-year mortality: a cohort study in primary care in the UK using electronic health record data

et al. 2020

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ObjectivesIdentification of patients at increased mortality risk is important in the context of increasing multimorbidity and an ageing population, to help facilitate the planning and delivery of services. The aim of this study was to examine 1-year all-cause mortality in a cohort of primary care patients in whom inflammatory markers including C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and plasma viscosity (PV), had been tested.DesignObservational cohort study using general practitioner Electronic Health Records from the Clinical Practice Research Datalink, with linkage to Office for National Statistics (ONS) Death Registry.SettingUK Primary Care.Participants159 325 patients with inflammatory marker tests done in 2014 and 39 928 age, sex and practice-matched controls without inflammatory marker testing. ONS Death registry data were available for 109 966 participants.Primary and secondary outcome measuresOne-year mortality in those with raised inflammatory markers compared with normal inflammatory markers and untested controls. Subanalyses stratified 1-year mortality by age group, gender and cause of death.ResultsPatients with a raised inflammatory marker (n=47 797) had an overall 1-year all-cause mortality of 6.89%, compared with 1.41% in those with normal inflammatory markers (p<0.001) and 1.62% in untested controls. A raised CRP is associated with the highest mortality rate at 8.76% compared with 4.99% for ESR and 4.66% for PV. One-year mortality is higher in men with a raised inflammatory marker compared with women (9.78% vs 5.29%). The C-statistic of a simple mortality prediction model containing age, sex and CRP test result is 0.89.ConclusionsInflammatory markers are a strong predictor of all-cause mortality in primary care, with a C-statistic comparable to several previously developed frailty indices. Future research should consider the added value of CRP testing, in combination with other risk factors, to improve prediction of mortality in primary care. Evidence- based interventions for frailty are needed alongside predictive tools.

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Identifying frailty in primary care

Abstract: Identifying a problem is acceptable only if there’s an effective solution

Cited by 7 publications

References 7 publications

The challenge of ageing populations and patient frailty: can primary care adapt?

The challenge of ageing populations and patient frailty: can primary care adapt?

Associations Between Intellectual and Social Activities With Frailty Among Community-Dwelling Older Adults in China: A Prospective Cohort Study

Raised inflammatory markers as a predictor of one-year mortality: a cohort study in primary care in the UK using electronic health record data

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