Current and Future Directions in Frailty Research

Mohandas, Anita; Reifsnyder, JoAnne; Jacobs, Mimi; Fox, Tim

doi:10.1089/pop.2010.0066

Cited by 22 publications

(20 citation statements)

References 39 publications

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“…With the aging of the population undergoing cardiac surgery, the issue of how to define frailty has assumed increasing importance. A multitude of frailty definitions and measures have been developed in recent years . Although the literature on frailty specifically in cardiac surgery patients is limited, a few studies have reported on the use of various types of scoring systems to assess operative morbidity and mortality in this population.…”

Section: Discussionmentioning

confidence: 99%

“…Frailty is widely recognized as being linked to the outcomes of surgical procedures, including cardiac surgery, and numerous instruments have been developed in an attempt to identify and quantitate its characteristics. These studies have had variable results using measurements of frailty that are cumbersome and impractical to administer in a clinical setting . Consensus on how best to measure frailty or to apply these instruments in clinical practice to predict outcomes thus remains elusive.…”

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confidence: 99%

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The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery

Holmes

Halpin

et al. 2016

J Card Surg

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Background: The Society of Thoracic Surgeons (STS) recommends using gait speed as a marker of frailty to identify cardiac surgery patients at risk for adverse outcomes. However, a single marker of frailty may not provide consistently reliable risk information. We evaluated the impact of frailty and gait speed on patient outcomes after elective cardiac surgery. Methods: This was a prospective study of 167 older (!65 years) coronary artery bypass grafting (CABG) and/or valve surgery patients. Patients were assessed using Cardiovascular Health Study (CHS) Frailty Index criteria: weight loss, exhaustion, physical activity, gait speed, and grip strength. Results: Frailty was identified in 39 patients (23%) using CHS criteria. Frail patients had longer median intensive care unit stays (54 vs. 28 h, p = 0.003), longer median length of stay (8 vs. 5 days, p < 0.001), and greater likelihood of STS-defined complications (54% vs. 32%, p = 0.011) and discharge to an intermediate-care facility (45% vs. 12%, p < 0.001) but were not different from nonfrail patients on major outcome, operative mortality, or readmissions. After multivariate adjustment, frail and nonfrail patients were similar on perioperative outcomes. Absolute gait speed and slow gait speed using a cutoff were not related to incidence of STS-defined complications or major outcome in multivariate analyses. However, higher body mass index was correlated with slower gait speed (r s = 0.30, p < 0.001). Conclusions: The CHS index did not identify ''frail'' patients at increased risk for adverse outcomes. No relationship was found between gait speed and outcome. There is a need for alternative multidimensional measures to assess frailty in cardiac surgical patients.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery

Holmes

Halpin

et al. 2016

J Card Surg

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“…For example, targeted interventions such as exercise have shown promise in reducing incident frailty in selected groups of older people (Mohandas et al 2011). Indeed, reducing frailty at the population level is a desirable goal.…”

Section: Introductionmentioning

confidence: 99%

Multidimensional predictors of physical frailty in older people: identifying how and for whom they exert their effects

2017

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Physical frailty in older people is an escalating health and social challenge. We investigate its physical, psychological, and social predictors, including how and for whom these conditions exert their effects. For 4638 respondents aged 65–89 years from wave 2 of the English Longitudinal Study of Ageing, we examine prediction of future physical frailty by physical, psychological, and social conditions using latent growth curve analysis with multiple indicators. In addition, we explore their indirect effects through disease and physiologic decline, and repeat these analyses after stratification by gender, age group, and selected conditions which are possible moderators. We find that chronic disease, allostatic load, low physical activity, depressive symptoms, cognitive impairment, and poor social support all predict future physical frailty. Furthermore, chronic disease and allostatic load mediate the effects of low physical activity, depressive symptoms, and cognitive impairment on future physical frailty. Finally, although poor social integration is not a predictor of future physical frailty, this condition moderates the indirect effect of poor social support through chronic disease by rendering it stronger. By virtue of their roles as predictor, mediator, or moderator on pathways to physical frailty, chronic disease, allostatic load, low physical activity, cognitive impairment, depressive symptoms, poor social support, and poor social integration are potentially modifiable target conditions for population-level health and social interventions to reduce future physical frailty in older people.Electronic supplementary materialThe online version of this article (doi:10.1007/s10522-017-9677-9) contains supplementary material, which is available to authorized users.

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“…Frailty in older adults is a key clinical concept characterized by dysregulation of multiple biological systems, accumulation of deficits, vulnerability to stressors and increased risk of adverse outcomes, such as falls, disability, hospitalization, institutionalization and death 1–3 . Although there is no international consensus on the definition of frailty, 4,5 two popular operationalizations are the phenotypic and one defined by accumulation of deficits 6 …”

Section: Introductionmentioning

confidence: 99%

The Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe predicts mortality similarly to a frailty index based on comprehensive geriatric assessment

Romero-Ortuño

2012

Geriatrics Gerontology Int

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Aim frailty is an emerging concept in primary care, which potentially can provide healthcare commissioners with a clinical focus for targeting resources at an ageing population. However, primary care practitioners need valid instruments that are easy to use. With that purpose in mind, we created a Frailty Instrument (FIt) for primary care based on the Survey of Health, Ageing and Retirement in Europe (SHARE). The aim of the present study was to compare the mortality prediction of the 5-item SHARE-FIt with that of a 40-item Frailty Index (FIx) based on comprehensive geriatric assessment (CGA). Methods the subjects were 15,578 women and 12,783 men from the first wave of SHARE. A correspondence analysis was used to assess the degree of agreement between phenotypic classifications. The ability of the continuous frailty measures (FIt score and FIx) to predict mortality (mean follow-up of 2.4 years) was compared using receiver operating characteristic (ROC) plots and areas under the curve (AUCs). Results in both sexes, there was significant correspondence between phenotypic categories. The two continuous measures performed equally well as mortality predictors (women: AUC-FIx = 0.79, 95% CI: 0.75 – 0.82, P < 0.001; AUC-FIt = 0.77, 95% CI: 0.73 – 0.81, P < 0.001. Men: AUC-FIx = 0.77, 95% CI: 0.74 – 0.79, P < 0.001; AUC-FIt = 0.76, 95% CI: 0.74 – 0.79, P < 0.001). Their equivalent performance was confirmed by statistical comparisons of the AUCs. Conclusions SHARE-FIt is simpler and more usable, and predicts mortality similarly to a more complex FIx index based on CGA.

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Current and Future Directions in Frailty Research

Cited by 22 publications

References 39 publications

The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery

The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery

Multidimensional predictors of physical frailty in older people: identifying how and for whom they exert their effects

The Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe predicts mortality similarly to a frailty index based on comprehensive geriatric assessment

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