Predictors of adverse outcomes on an acute geriatric rehabilitation ward

Singh, Inderpal; Gallacher, John; Davis, Karl R; Johansen, Antony; Eeles, Eamonn; Hubbard, Ruth E.

doi:10.1093/ageing/afr179

Cited by 102 publications

(109 citation statements)

References 23 publications

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“…33 Frail older adults, for example, will show less recovery Evaluative Frailty Index for Physical Activity in rehabilitation than non-frail older adults. 34 On the other hand, it is important to know to what extent the level of frailty can be reduced by an intervention. Numerous factors determine the level of frailty in interaction.…”

Section: Discussionmentioning

confidence: 99%

Evaluative Frailty Index for Physical Activity (EFIP): A Reliable and Valid Instrument to Measure Changes in Level of Frailty

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Evaluative Frailty Index for Physical Activity (EFIP): A Reliable and Valid Instrument to Measure Changes in Level of Frailty

et al. 2013

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“…It also includes two clinical performance items interrogating cognition (clock test) and functional performance (timed up and go -TUG test). Tools based on the deficit accumulation model, such as the 40-item FI adopted by Singh et al 98 adopted in elderly patients in acute geriatric rehabilitation wards, could be used to assess prognosis or guide intervention planning, or for evaluating frailty changes with time; however, in the busy CR world tools based on the deficit accumulation model may be cumbersome to apply. Therefore, an easy-to-use tool based on a standardised subjective evaluation of frailty would be more easily accepted and adopted, such as the Canadian Study on Health and Ageing clinical frailty scale 22 ( Table 6).…”

Section: Future Directionsmentioning

confidence: 99%

Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section

Vigorito

Abreu

Ambrosetti³

et al. 2016

Eur J Prev Cardiolog

165

133

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Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation. The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients. Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients.

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“…someone with six deficits out of 40 counted has a FI of 0.15) [15]. The FI approach is feasible in older inpatients [11] and also predicts a patient's capacity to recover from acute illness [16] and potential for rehabilitation [17]. However, it has yet to be implemented in routine clinical practice.…”

Section: Definition and Assessment Of Frailtymentioning

confidence: 99%

Prescribing appropriately in frail older people

2015

Healthy Aging Res

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Frailty is one of the most important aspects associated with the elderly. It is defined as a state of increased vulnerability to poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes such as falls, institutionalization and death. Frail older adults are more likely to have several concurrent disorders, requiring multiple treatments and hence, considerable medication consumption. The functional reserve of multiple organs deteriorates with ageing and this often leads to changes in drug pharmacokinetics and metabolism. As a result, prescribing medications for frail older people is often complex and challenging. Furthermore, there is a paucity of evidence from clinical trials on the effects of multiple drug consumption in patients aged above 80 years since people from this age group tend to be excluded from such studies. Because of the changes in the pharmacokinetics and pharmacodynamics of drugs in older people, especially in those who are frail, there is an increased risk of adverse drug events for these patients, which can result in hospitalization, increased morbidity and mortality. In this review, appropriate prescribing for frail older people is explored. Consideration will be given to the impact of frailty on medication prescribing and how individualized prescribing could reduce the risk of adverse drug events in at-risk older patients. Tools used to enhance prescribing practice are examined, including those aimed at reducing polypharmacy, underprescribing and inappropriate prescribing. These tools use either explicit (criterion-based) or implicit (judgment-based) criteria. However, most of the current therapeutic guidelines are applicable mainly for the fit older population and cannot be directly applied where frail individuals are concerned. Approaches to improving appropriate prescribing among frail elderly patients, including those with limited life expectancy, are also reviewed.

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Predictors of adverse outcomes on an acute geriatric rehabilitation ward

Abstract: frailty is associated with adverse rehabilitation outcomes. The FI may have clinical utility, augmenting clinical judgement in the management of older inpatients.

Cited by 102 publications

References 23 publications

Evaluative Frailty Index for Physical Activity (EFIP): A Reliable and Valid Instrument to Measure Changes in Level of Frailty

Evaluative Frailty Index for Physical Activity (EFIP): A Reliable and Valid Instrument to Measure Changes in Level of Frailty

Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section

Prescribing appropriately in frail older people

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