Enabling Healthy Aging to AVOID Frailty in Community Dwelling Older Canadians

Rasiah, Jananee; Prorok, Jeanette C.; Adekpedjou, Rhéda; Barrie, Carol; Basualdo, Carlota; Burns, Rachel J.; Paul, Vincent de; Donnelly, Catherine W.; Doyle, Amy; Frank, Christopher; Dolsen, Sarah; Giguère, Anik; Hsiung, Sonia; Kim, Perry; McDonald, Emily G.; O’Grady, Heather K.; Patey, Andrea M.; Puxty, John; Racey, Megan; Resin, Joyce; Sims‐Gould, Joanie; Stewart, Susan; Theou, Olga; Webster, Sarah E.; Muscedere, John

doi:10.5770/cgj.25.536

Cited by 3 publications

(3 citation statements)

References 28 publications

(28 reference statements)

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“…Adoption of a multi-faceted intervention such as the ABCDEF bundle [49] during the ICU stay may be particularly relevant to frail patients and it may more effectively improve outcomes in frail patients than in non-frail patients. Further, interventions may need to be continued throughout the ward stay and after hospital discharge in the community with a focus on rehabilitation, exercise, nutrition, medication optimization and social connection [50]. Multi-disciplinary ICU follow-up clinics could be used to facilitate this.…”

Section: Discussionmentioning

confidence: 99%

Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study

Muscedere,

Bagshaw,

Kho

et al. 2024

Intensive Care Med

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Purpose: Frailty is common in critically ill patients but the timing and optimal method of frailty ascertainment, trajectory and relationship with care processes remain uncertain. We sought to elucidate the trajectory and care processes of frailty in critically ill patients as measured by the Clinical Frailty Scale (CFS) and Frailty Index (FI).Methods: This is a multi-centre prospective cohort study enrolling patients ≥ 50 years old receiving life support > 24 h. Frailty severity was assessed with a CFS, and a FI based on the elements of a comprehensive geriatric assessment (CGA) at intensive care unit (ICU) admission, hospital discharge and 6 months. For the primary outcome of frailty prevalence, it was a priori dichotomously defined as a CFS ≥ 5 or FI ≥ 0.2. Processes of care, adverse events were collected during ICU and ward stays while outcomes were determined for ICU, hospital, and 6 months. Results:In 687 patients, whose age (mean ± standard deviation) was 68.8 ± 9.2 years, frailty prevalence was higher when measured with the FI (CFS, FI %): ICU admission (29.8, 44.8), hospital discharge (54.6, 67.9), 6 months (34.1, 42.6). Compared to ICU admission, aggregate frailty severity increased to hospital discharge but improved by 6 months; individually, CFS and FI were higher in 45.3% and 50.6% patients, respectively at 6 months. Compared to hospital discharge, 18.7% (CFS) and 20% (FI) were higher at 6 months. Mortality was higher in frail patients. Processes of care and adverse events were similar except for worse ICU/ward mobility and more frequent delirium in frail patients. Conclusions: Frailty severity was dynamic, can be measured during recovery from critical illness using the CFS and FI which were both associated with worse outcomes. Although the CFS is a global measure, a CGA FI based may have advantages of being able to measure frailty levels, identify deficits, and potential targets for intervention.

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Section: Discussionmentioning

confidence: 99%

Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study

Muscedere,

Bagshaw,

Kho

et al. 2024

Intensive Care Med

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“…In addition, more public awareness campaigns such as the Canadian AVOID (Activity, Vaccinate, Optimize medications, Interact, and Diet/nutrition) campaign by the Canadian Frailty Network are urgently needed. 109 …”

Section: Therapeutic Approaches To Frailty Post‐ Covid ...mentioning

confidence: 99%

Frailty after COVID‐19: The wave after?

2023

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The COVID‐19 pandemic poses an ongoing public health challenge, with a focus on older adults. Given the large number of older persons who have recovered from COVID‐19 and reports of long‐lasting sequelae, there is reasonable concern that the COVID‐19 pandemic may lead to a long‐term deterioration in the health of older adults, i.e., a potential “wave of frailty.” Therefore, it is critical to better understand the circumstances surrounding the development of frailty as a result of COVID‐19, as well as the underlying mechanisms and factors contributing to this development. We conducted a narrative review of the most relevant articles published on the association between COVID‐19 and frailty through January 2023. Although few studies to date have addressed the effects of COVID‐19 on the onset and progression of frailty, the available data suggest that there is indeed an increase in frailty in the elderly as a result of COVID‐19. Regarding the underlying mechanisms, a multicausal genesis can be assumed, involving both direct viral effects and indirect effects, particularly from the imposed lockdowns with devastating consequences for the elderly: decreased physical activity, altered diet, sarcopenia, fatigue, social isolation, neurological problems, inflammation, and cardiovascular morbidity are among the possible mediators. Since the COVID‐19 pandemic is leading to an increase in frailty in the elderly, there is an urgent need to raise awareness of this still little‐known problem of potentially great public health importance and to find appropriate prevention and treatment measures.

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“…Implementation of nutritional intervention is particularly urgent for those who are already malnourished or have muscle impairment ( 41 , 76 , 77 ). A Canadian initiative proved effective for avoiding development of frailty ( 78 ), while results of a recent European study demonstrated that nutritional care could prevent loss of mobility ( 79 ).…”

Section: Nutrition Matters Across the Lifespanmentioning

confidence: 99%

Good nutrition across the lifespan is foundational for healthy aging and sustainable development

et al. 2023

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Ensuring healthy lives and promoting wellbeing across the age spectrum are essential to sustainable development. Nutrition is at the heart of the World Health Organization (WHO) Sustainable Development Goals, particularly for Sustainable Development Goal 2/Subgoal 2, which is to End all forms of malnutrition by 2030. This subgoal addresses people of all ages, including targeted groups like young children and older adults. In recent decades, there have been marked advances in the tools and methods used to screen for risk of malnutrition and to conduct nutritional assessments. There have also been innovations in nutritional interventions and outcome measures related to malnutrition. What has been less common is research on how nutritional interventions can impact healthy aging. Our Perspective article thus takes a life-course approach to consider what is needed to address risk of malnutrition and why, and to examine how good nutrition across the lifespan can contribute to healthy aging. We discuss broad-ranging yet interdependent ways to improve nutritional status worldwide—development of nutritional programs and policies, incorporation of the best nutrition-care tools and methods into practice, provision of professional training for quality nutritional care, and monitoring health and economic benefits of such changes. Taken together, our Perspective aims to (i) identify current challenges to meeting these ideals of nutritional care, and to (ii) discover enabling strategies for the improvement of nutrition care across the lifespan. In harmony with the WHO goal of sustainable development, we underscore roles of nutrition to foster healthy human development and healthy aging worldwide.

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Enabling Healthy Aging to AVOID Frailty in Community Dwelling Older Canadians

Cited by 3 publications

References 28 publications

Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study

Frailty, Outcomes, Recovery and Care Steps of Critically Ill Patients (FORECAST): a prospective, multi-centre, cohort study

Frailty after COVID‐19: The wave after?

Good nutrition across the lifespan is foundational for healthy aging and sustainable development

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