Evaluation of a Self-Report Screening Instrument to Predict Frailty Outcomes in Aging Populations

Brody, Kathleen K.; Johnson, Richard E.; Ried, L. Douglas

doi:10.1093/geront/37.2.182

Cited by 94 publications

(64 citation statements)

References 13 publications

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“…In addition, the majority of the instruments utilized a dichotomous scoring system (i.e. frail vs not-frail), which gives minimal relevance for measuring change in populations over time [57,58,[61][62][63][64][65][66][67][68][69]. Other instruments utilize either multiple levels of frailty [10,59,60,70,71] or use continuous or ordinal scoring scales [25,[72][73][74][75] which may be more relevant to clinicians wanting to determine the level of frailty in one patient compared to another, or change in the level of frailty over time.…”

Section: How Is Frailty Identified or Diagnosed?mentioning

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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Section: How Is Frailty Identified or Diagnosed?mentioning

confidence: 99%

Musculoskeletal health, frailty and functional decline

Milte

Crotty

2014

Best Practice & Research Clinical Rheumatology

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“…All new KP members 65 years of age and older are asked to complete a mailed questionnaire, the Senior Health Status Questionnaire, which includes questions that assess health risk and predict frailty. 19 The most recent results show that overall, 65.5% of senior KP members are "robust" (low risk), 29.7% are at moderate risk, and 4.9% are frail. 20 After screening, appropriate interventions are implemented.…”

Section: Identifying At-risk Patientsmentioning

confidence: 99%

Future of End-of-Life Care: The Managed Care Organization Perspective

Brumley

2002

Journal of Palliative Medicine

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INTRODUCTION T HE VA ST MAJORITY OF AMERICANS who die eachyear are elderly patients with a median age of 77 years, typically suffering from slowly progressive, chronic diseases. 1 Most Americans will have lived with an average of 2.2 chronic conditions for 17 years by the time of their death. 2 The effects of chronic conditions such as cardiovascular disease and diabetes are felt physically, emotionally, and financially and place the patient at greater risk of serious health complications and disability. 3,4 Our society's ability to afford health care depends heavily on our ability to control long-term care costs incurred at the end of life. In turn, cost control depends on our ability to manage chronically ill patients effectively. This paper discusses the unique advantages of managed care organizations (MCOs) in developing and financing innovative systems for managing long-term and end-of-life care, presents an innovative model of end-of-life care pioneered by one MCO, and suggests future recommendations. UNMANAGED CARE: A NO-WIN SITUATIONCurrently, patients with a chronic disease experience fragmented care, with multiple specialists often separately managing care at various times and sites, typically with little communication among themselves. Patients and their families manage the transitions among various providers, disease specialists, financial systems, and care settings on their own. 5Of the roughly 2.4 million Americans who die each year, 75% are insured by Medicare at the time of their death. 6 Among these patients, approximately 50% of last-year medical costs are incurred in the last 60 days of life, and 40% in the last 30 days of life. 7 Despite older persons' preference to receive end-of-life care at home, 8 only 20% of deaths occur at home; most other deaths occur in hospitals (57%) and nursing homes (17%). 9Our current system for managing end-of-life care is dysfunctional. If we started anew, what would characterize "good" end-of-life care? Lynn and Schuster 10 and Cassel and Foley 11 have generated separate lists of key principles of care that reflect a reassuring degree of consensus. They strongly imply that a coordinated, interdisciplinary team approach is a prerequisite to achieving good end-of-life care. Such an approach is a hallmark of MCOs, and one reason they are now at the forefront of developing and financing improved models of end-of-life care. MCOS: COORDINATING CARE ACROSS THE CONTINUUMThe fiscal structure of MCOs offers unique opportunities to develop and test innovative methods for managing end-of-life care. As capitated systems, MCOs have the financial and organizational flexibility to integrate all elements of health care-from physicians to financing-into a coherent whole. As Lynn et al. 5 note, "Advantages derived from managed care systems providing quality end-of-life care include coordinated care across delivery sites, interdisciplinary teams, in-

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“…Most studies so far were not population based; many were performed in institutions [6,17,18] or used a small sample size [11,19]. In the recent population-based study of Fried et al [9], frailty was established when three or more criteria out of five were present.…”

Section: Introductionmentioning

confidence: 99%

“…A frail person can become disabled if multiple systems decline or as a consequence of one or more chronic diseases. Furthermore, frailty is presumed to be an unsteady state involving a high risk of decline in physical functioning [17]. Therefore, it is surprising that empirical studies so far have not examined change in frailty in relation to adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%