The prevalence of frailty among acute stroke patients, and evaluation of method of assessment

Abstract

Objective:We aimed to determine prevalence of pre-stroke frailty in acute stroke and describe validity of a Frailty Index–based assessment.Design:Cross-sectional.Setting:Single UK urban teaching hospital.Subjects:Consecutive acute stroke unit admissions, recruited in four waves (May 2016–August 2018). We performed the assessments within first week and attempted to include all admissions.Main measures:Our primary measure was a Frailty Index, based on cumulative disorders. A proportion of participants were also assessed with the ‘Frail non-disabled’ questionnaire. We evaluated concurrent validity of Frailty Index against variables associated with frailty in non-stroke populations. We described predictive validity of Frailty Index for stroke severity and delirium. We described convergent validity, quantifying agreement between frailty assessments and a measure of pre-stroke disability (modified Rankin Scale) using kappa statistics and correlations.Results:We included 546 patients. A Frailty Index–defined frailty syndrome was observed in 427 of 545 patients (78%), of whom, 151 (28%) had frank frailty and 276 (51%) were pre-frail. Phenotypic frailty was observed in 72 of 258 patients (28%). We demonstrated concurrent validity via significant associations with all variables (all p < 0.01). We demonstrated predictive validity for stroke severity and delirium ( p < 0.01). Agreement between the frailty measures was poor (kappa = –0.06) and convergent validity was moderate (Frail non-disabled ‘Cramer’s V’ = 0.25; modified Rankin Scale ‘Cramer’s V’ = 0.47).Conclusion:Frailty is present in around one in four patients with acute stroke; if pre-frailty is included, then a frailty syndrome is seen in three out of four patients. The Frailty Index is a valid measure of frailty in stroke; however, there is little agreement between this scale and other measurements of frailty.

Association between in-hospital frailty and health-related quality of life after stroke: the Nor-COAST study

“…We found 10.4% of the study population to be frail and 58.6% pre-frail in hospital by using a modified version of the Fried phenotype model, while other studies have found higher frailty prevalence and lower pre-frail prevalence in acute stroke populations [19,20]. A possible explanation for this is that in the present study, participants with missing data on a modified Fried criteria were given 0 points indicating a robust score on that specific criterion, which could partly explain our findings.…”

“…Frailty is characterised by reduced physiologic reserve, increased vulnerability to stressors, and multisystem dysregulation [16,17] with symptoms such as fatigue, decreased strength and endurance, and weight loss [18]. Two previous studies have shown the prevalence of frailty among acute stroke patients to be 24.9% [19] and 28% [20], respectively.…”

The Association Between Frailty and All-Cause Mortality in Community-Dwelling Older Individuals: An Umbrella Review

“…Determination of frailty status is emerging as a signi cant predictor of outcomes in various medical disciplines, including cardiology (27,45), neurology (46,47), oncology (48), orthopedics (23), and surgery (49), as well as the senior population in general. Accordingly, the association between frailty and all-cause mortality has been investigated across different settings and populations.…”

Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward

“…The mRS was not developed as an index of frailty, although it correlates well with established indices of frailty. 4,7,22 Thus, this study relates closely to the work of Seamon et al 20 They took a large cohort of Medicare patients in the USA to explore the influence of frailty (using the Faurot frailty index) and stroke severity on discharge to an inpatient rehabilitation setting. Their logistic regression analysis found that non-frail and pre-frail patients, and frail patients with low stroke severity scores, were more likely to be discharged to inpatient rehabilitation.…”

“…2,3 Twenty-five to 28% of these patients are frail, while 51% are considered 'pre-frail', approximately double the incidence observed in the general inpatient population. [4][5][6] Frailty is a predictor of mortality, length of stay and functional recovery in the period following an acute stroke. 5,[7][8][9] Twelve to 15% of stroke patients will die during their presenting admission, although this number is falling in the UK.…”