Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study

Espaulella-Ferrer, Mariona; Espaulella-Panicot, Joan; Noell-Boix, Rosa; Casals-Zorita, Marta; Ferrer-Sola, Marta; Puigoriol-Juvanteny, Emma; Cullell-Dalmau, Marta; Otero-Viñas, Marta

doi:10.1186/s12877-021-02676-y

Cited by 12 publications

(8 citation statements)

References 54 publications

(57 reference statements)

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“…Thirdly, the presence of frailty may cause delayed healing (f.e. immobility) and permanent loss of function and independency 12,32 . Given the high prevalence of frailty in leg ulcer patients described in this study, we hypothesize that by giving more attention to frailty screening patient outcomes may be improved.…”

Section: Discussionmentioning

confidence: 85%

A prospective, multicentre study to assess frailty in elderly patients with leg ulcers (GERASstudy)

Zorge

Scheerders

Dudink

et al. 2022

Acad Dermatol Venereol

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Background: Although leg ulcers are a burdensome disease most common in those aged 65 years and older, frailty in this population has not yet been well established. Objectives:The aim of this study was to prospectively explore and compare the presence of frailty in elderly patients with chronic leg or foot ulcers by applying different validated frailty screening methods in three healthcare settings and to assess the feasibility of frailty screening. Methods:We compared frailty of leg ulcer patients referred to an academic hospital with a non-academic hospital, leg ulcer patients receiving (primary) homecare, and a dermato-oncology patient population (control group). Frailty and quality of life were assessed using four validated questionnaires: the Groninger Frailty Indicator, Geriatric-8, Mini-Cog and Wound Quality of Life. To analyse data multiple (non)parametric tests were performed.Results: Fifty of 60 included leg ulcer patients (83%) scored "frail" on at least one frailty questionnaire (GFI, G8 or Mini-Cog). The number of patients scoring "frail" on two or three out of three applied frailty questionnaires were significantly higher in the academic and homecare ulcer population compared with the non-academic ulcer population and control group (p = 0.002). In the academic ulcer population mean Wound Quality of Life scores were 30.2 (SD 17.6), compared with 17.7 (SD 13.1) in the non-academic and 15.0 (SD 10.4) in the homecare ulcer population (p = 0.002). Conclusion:The majority of patients suffering from leg ulcers in this study was frail.The highest frailty prevalence was observed in the academic and homecare ulcer populations. The largest impaired quality of life was reported in the academic ulcer population. In dermatology practice, implementing frailty screening and initiating appropriate (paramedical) supportive care should be considered to improve patient outcomes.

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Section: Discussionmentioning

confidence: 85%

A prospective, multicentre study to assess frailty in elderly patients with leg ulcers (GERASstudy)

Zorge

Scheerders

Dudink

et al. 2022

Acad Dermatol Venereol

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“… 34 Further, slower healing increases the risk of infection and the likelihood of chronicity, 35 also leading to more complex wound management in older adults. 31 This, coupled with older adults’ reluctance to use ICT in healthcare, could lead to a preference for face-to-face dressing sessions over the TMS.…”

Section: Discussionmentioning

confidence: 99%

“…Current literature found that age-related skin changes impair wound healing, 34 and concurrent comorbidities contribute most to the development of nonhealing wounds in the older adult 34 . Further, slower healing increases the risk of infection and the likelihood of chronicity, 35 also leading to more complex wound management in older adults 31 . This, coupled with older adults’ reluctance to use ICT in healthcare, could lead to a preference for face-to-face dressing sessions over the TMS.…”

Section: Discussionmentioning

confidence: 99%

“…30 Further, changing wound dressings at home requires patients to understand the nature of their wounds and to recognize when further follow up at the clinic is necessary. This may be a struggle for older adults because they tend to be frail, 31 face challenges such as difficulty using technology, have hearing problems, struggle with hands-on self-examinations, 32 or lack access to a caregiver to assist them with technology, 33 reducing the success of wound self-management.…”

Section: Figure Telewound Monitoring Service Processmentioning

confidence: 99%

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Description and Utilization of Telewound Monitoring Services in Primary Care Patients with Acute Wounds in Singapore: A Retrospective Study

Zhu

Ren

Lim

et al. 2022

Adv Skin Wound Care

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OBJECTIVE To describe an inaugural telewound monitoring service (TMS) designed for the remote monitoring of acute wounds to empower primary care patients, and identify factors associated with the utilization of the TMS. METHODS Retrospective data were collected from 204 patients who participated in the TMS between June 19, 2016 and August 31, 2017 and analyzed using both descriptive and multiple regression analysis. RESULTS The mean patient age was 27.9 years (SD, 12.4); wound area was 7.8 cm 2 (SD, 21.2); and duration of healing was 11.7 days (SD, 6.9). A multiple regression model based on patients’ demographics and wound factors predicted which patients were likely to have more telewound sessions than face-to-face sessions. The model was statistically significant (F = 2.093 (11, 124), P = .025) with 15.7% of variance explained by the variables. An increase in age ( P = .043) and increased days to healing ( P = .043) were associated with a reduction in the number of telewound sessions. CONCLUSIONS The TMS is a valuable alternative to face-to-face wound care that enables patients with acute wounds to assume the roles of both patient and carer simultaneously. Age and healing duration are predictors for utilization of this service. Prompt attention to these predictors may improve service allocation and utilization.

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“…The world population is aging, and the numbers of very old people are increasing even faster. Aging is associated with the onset of frailty, which is a biological syndrome involving decreased reserves and resistance to stressors resulting from cumulative declines across multiple physiologic systems and causing vulnerability to adverse outcomes [ 1 , 2 ]. In addition, aging is often related to increases in comorbidities, which produce changes in overall health status.…”

Section: Introductionmentioning

confidence: 99%

Medication Assessment in an Older Population during Acute Care Hospitalization and Its Effect on the Anticholinergic Burden: A Prospective Cohort Study

Espaulella-Ferrer

Molist-Brunet

Espaulella-Panicot

et al. 2023

IJERPH

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(1) Background: Anticholinergic and sedative drugs (ASDs) contribute to negative health outcomes, especially in the frail population. In this study, we aimed to assess whether frailty increases with anticholinergic burden and to evaluate the effects of medication reviews (MRs) on ASD regimens among patients attending an acute care for the elderly (ACE) unit. (2) Methods: A cohort study was conducted between June 2019 and October 2020 with 150 consecutive patients admitted to our ACE unit. Demographic, clinical, and pharmacological data were assessed. Frailty score was determined using the Frail-VIG index (FI-VIG), and ASD burden was quantified using the drug burden index (DBI). In addition, the MR was performed using the patient-centered prescription (PCP) model. We used a paired T-test to compare the DBI pre- and post-MR and univariate and multivariate regression to identify the factors associated with frailty. (3) Results: Overall, 85.6% (n = 128) of participants showed some degree of frailty (FI-VIG > 0.20) and 84% (n = 126) of patients received treatment with ASDs upon admission (pre-MR). As the degree of frailty increased, so did the DBI (p < 0.001). After the implementation of the MR through the application of the PCP model, a reduction in the DBI was noted (1.06 ± 0.8 versus 0.95 ± 0.7) (p < 0.001). After adjusting for covariates, the association between frailty and the DBI was apparent (OR: 11.42, 95% (CI: 2.77–47.15)). (4) Conclusions: A higher DBI was positively associated with frailty. The DBI decreased significantly in frail patients after a personalized MR. Thus, MRs focusing on ASDs are crucial for frail older patients.

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Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study

Cited by 12 publications

References 54 publications

A prospective, multicentre study to assess frailty in elderly patients with leg ulcers (GERASstudy)

A prospective, multicentre study to assess frailty in elderly patients with leg ulcers (GERASstudy)

Description and Utilization of Telewound Monitoring Services in Primary Care Patients with Acute Wounds in Singapore: A Retrospective Study

Medication Assessment in an Older Population during Acute Care Hospitalization and Its Effect on the Anticholinergic Burden: A Prospective Cohort Study

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