The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment

Evans, Stephen; Sayers, Margaret; Mitnitski, Arnold; Rockwood, Kenneth

doi:10.1093/ageing/aft156

Cited by 195 publications

(183 citation statements)

References 29 publications

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“…Additionally, support for this assertion comes from comparing the results of this study with the work of Evans et al [37].…”

Section: Patient Factorssupporting

confidence: 74%

“…Evans et al [37] tested the prognostic capacity of the frailty index in an acute care setting in relation to the risk of death, length of stay and discharge destination. Patients discharged home had the lowest admitting mean frailty index at 0.38, compared to those who died (Frailty Index=0.51) and those discharged to a nursing home (Frailty Index=0.49).…”

Section: Patient Factorsmentioning

confidence: 99%

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The Effectiveness of a Care Transitions and Rapid Response Nurse Intervention at Reducing Readmissions and Emergency Department Use for High Risk Patients

McNeil¹,

Strasser²,

Lightfoot³

et al. 2017

J Nurs Care

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The transition from hospital to home is a vulnerable period for the elderly patient with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the postdischarge period.This article presents the results of a randomized control trial evaluating the effectiveness of an intervention involving a care transitions nurse and a rapid response nurse at lengthening the time to first readmission, emergency department use and total hospital bed days during the 30 days, 60 days and 90 days post-discharge periods for patients at high risk of readmission. The intervening impact of social isolation and patient frailty was also evaluated.No statistically significant differences were found between the intervention and control groups on the time to first readmission or in the post-discharge emergency department or inpatient bed use. Social isolation and frailty were not shown to significantly influence these outcomes.

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“…Additionally, support for this assertion comes from comparing the results of this study with the work of Evans et al [37].…”

Section: Patient Factorssupporting

confidence: 74%

Section: Patient Factorsmentioning

confidence: 99%

The Effectiveness of a Care Transitions and Rapid Response Nurse Intervention at Reducing Readmissions and Emergency Department Use for High Risk Patients

McNeil¹,

Strasser²,

Lightfoot³

et al. 2017

J Nurs Care

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show abstract

“…Frailty is a term first used in the medical literature in the1970's which is receiving increasing focus in research and clinical practice due to its ability to predict poor outcomes in older people of relevance to society such as falls, disability, functional decline, hospitalization, institutionalisation and mortality [3][4][5][6][7][8][9][10][11]. While linked to theories of aging, it has come to be thought of as a separate condition indicating abnormal aging and poor health and therefore a potential target for interventions and therapies to slow or reverse its progression [12].…”

Section: Musculoskeletal Health Frailty and Functional Declinementioning

confidence: 99%

Musculoskeletal health, frailty and functional decline

Milte

Crotty

2014

Best Practice & Research Clinical Rheumatology

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Frailty in older people is associated with a vulnerability to adverse events. While ageing is associated with a loss of physiological reserves identifying those with the syndrome of frailty has the potential to assist clinicians tailor treatments to those at risk of future decline into disability with increased risk of complications, morbidity and mortality. Sarcopenia is a key component of the frailty syndrome and on its own puts older people at risk of fragility fractures however the clinical syndrome of frailty affects musculoskeletal and non musculoskeletal systems. Hip fractures are becoming a prototype condition in the study of frailty. Following a hip fracture many of the interventions are focused on limiting mobility disability and restoring independence with activities of daily living but there are multiple factors to be addressed including osteoporosis, sarcopenia, delirium, weight loss. Established techniques of geriatric evaluation and management allow systematic assessment and intervention on multiple components by multidisciplinary teams and deliver the best outcomes. Using the concept of frailty to identify older people with musculoskeletal problems as at risk of a poor outcome assists in treatment planning and is likely to become more important as effective pharmacological treatments for sarcopenia emerge. This review will focus on the concept of frailty and its relationship with functional decline, as well as describing its causes, prevalence, risk factors and potential clinical applications and treatment strategies. Key wordsFragility fracture, frailty, functional decline, screening, older adult, exercise therapy, dietary therapy Word count 9,401 words (word limit=9,400)

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“…The studies were geographically distributed worldwide: 4 in the North America (41,163,166,167), Canada (36,(168)(169)(170)(171) There was variation in sample size, with the 3 large outliers unsurprisingly utilising secondary analysis of previous data (43,172,178) as methodology within single secondary care centres in the general internal medicine and elderly care setting. The observational studies were of relatively modest size ( Figure 3).…”

Section: General Features and Quality Assessmentmentioning

confidence: 99%

“…Some studies excluded patients with significant cognitive impairment (36,160,166,168,169,171), critically unwell patients (41,177,180,181) or patients residing in a long term care facility (163,171,174). 3 studies based in the Emergency Department setting excluded patients who were subsequently admitted to hospital during the assessment episode (166,168,169).…”

Section: Na Not Applicablementioning

confidence: 99%

Frailty Assessment in Acute Care

2015

The Gerontologist

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IntroductionFor some people, ageing is associated with the experience of increased co-morbidity, functional impairment, poor resilience and heightened vulnerability to external stressors, resulting in reduced lifespan as well as health-span. This frailty phenomenon poses challenges to health care systems in the form of increased patient complexity and resource utilisation. The acute care setting, characterised by time-pressure and high patient turn-over, is under strain and struggles to recognise and subsequently reliably intervene, to prevent, reverse or halt the decline of this vulnerable cohort. MethodsThis mixed-methods study probes existing evidence and 'real-world' processes with a systematic review of frailty assessments developed or validated in the acute care setting and a survey of contemporaneous clinical practice in London Acute Medical Units. Content validation and understanding of contextual factors for ideal frailty assessment in acute care is explored using Delphi consensus and Focus Group methodology respectively. The resultant model is developed on existing retrospective national Hospital Episode Statistics data, and prospectively tested on observational data in a local Acute Medical Unit setting. ResultsExisting frailty scores are preponderantly biophysical in nature, and have poor predictive power for adverse outcomes in the acute care setting. In clinical practice, single-dimension assessment tools predominate. Frailty syndromes and previous high resource utilisation in the form of a simple, clinically relevant tool useful to the multidisciplinary team gain consensus as optimal assessment for the setting. Retrospective testing of the frailty model displays moderate predictive powers for adverse events (inpatient mortality, emergency readmission and institutionalisation) and prospective testing provides concurrent (Frailty Index, Age, Co-Morbidity) and comparative predictive validity (Frailty Index, Co-Morbidity, 2 admission National Early Warning Score) with existing risk stratification models in this setting. ConclusionsA risk prediction model based on frailty syndromes and previous high resource utilisation is a valid, feasible and useful for the acute care setting.

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The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment

Abstract: frailty, measured by the FI-CGA, was independently associated with a higher risk of death and other adverse outcomes in older people admitted to an acute care hospital.

Cited by 195 publications

References 29 publications

The Effectiveness of a Care Transitions and Rapid Response Nurse Intervention at Reducing Readmissions and Emergency Department Use for High Risk Patients

The Effectiveness of a Care Transitions and Rapid Response Nurse Intervention at Reducing Readmissions and Emergency Department Use for High Risk Patients

Musculoskeletal health, frailty and functional decline

Frailty Assessment in Acute Care

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