Frailty and Geriatric Syndromes in Vascular Surgical Ward Patients

McRae, Prue; Walker, Philip J.; Peel, Nancye M.; Hobson, Denise; Parsonson, Fiona; Donovan, Peter; Reade, Michael C.; Marquart, Louise; Mudge, Alison

doi:10.1016/j.avsg.2016.01.033

Cited by 49 publications

(53 citation statements)

References 44 publications

(1 reference statement)

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“…Several papers on PIs reported incidence . These papers measured incidence over a variety of time periods, from 7 days to 12 months .…”

Section: Resultsmentioning

confidence: 99%

“…A summary of study characteristics for each of the 90 studies selected for inclusion is presented in Appendix S3. The studies were published from 1991 21 to 2016 [22][23][24][25][26][27] inclusive. Cohorts from all six states and two territories in Australia were included in at least one study.…”

Section: Resultsmentioning

confidence: 99%

“…74 In people in acute and non-acute health care facilities who were classified as malnourished, the prevalence of PIs was measured at 31.5%. 75 35,38,39 There was one study that included a multi-state population 89 Venous leg ulcers (VLUs) 24 9,21,[28][29][30][31][32][33][34][35][36][37]43,93,94,[101][102][103][104][105][106][107][108][109] Most studies included small local (single-site) or regional (multi-site) populations in single states; there were also studies that included state-wide cohorts 94 and two studies that included a multi-state cohort 43 There were two studies that included a multi-state cohort 43,103 Pressure injuries (PIs) 52 [23][24][25][26]30,33,[35][36][37]90,91 Most studies included small local (single-site) or regional (multi-site) populations in single states; there were a number that included state-wide or multi-state cohorts…”

Section: Pressure Injuriesmentioning

confidence: 99%

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Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters

McCosker

Tulleners

Cheng

et al. 2018

International Wound Journal

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Chronic wounds are a significant problem in Australia. The health care‐related costs of chronic wounds in Australia are considerable, equivalent to more than AUD $3.5 billion, approximately 2% of national health care expenditure. Chronic wounds can also have a significant negative impact on the health‐related quality of life of affected individuals. Studies have demonstrated that evidence‐based care for chronic wounds improves clinical outcomes. Decision analytical modelling is important in confirming and applying these findings in the Australian context. Epidemiological and clinical data on chronic wounds are required to populate decision analytical models. Although epidemiological and clinical data on chronic wounds in Australia are available, these data have yet to be systematically summarised. To address these omissions and clarify the state of existing evidence, we conducted a systematic review of the literature on key epidemiological and clinical parameters of chronic wounds in Australia. A total of 90 studies were selected for inclusion. This paper presents a synthesis of the evidence on the prevalence and incidence of chronic wounds in Australia, as well as rates of infection, hospitalisation, amputation, healing, and recurrence.

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“…Several papers on PIs reported incidence . These papers measured incidence over a variety of time periods, from 7 days to 12 months .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Pressure Injuriesmentioning

confidence: 99%

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Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters

McCosker

Tulleners

Cheng

et al. 2018

International Wound Journal

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“…Frailty syndrome, defined as “a state of increased vulnerability to poor resolution of homeostasis after a stressor event as a consequence of accumulated age-related defects in physiological systems”, is increasingly turned to as a risk stratification strategy [3]. Frailty affects approximately 11% of community-dwelling older adults and as many as 30–70% of older surgical patients [4, 5], and has been associated with adverse health-related outcomes including increased complications, impaired balance and fall, hospitalization, length of hospital stay, and mortality [6–9]. …”

Section: Introductionmentioning

confidence: 99%

Frailty assessment in older adults using upper-extremity function: index development

et al. 2017

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Background: Numerous multidimensional assessment tools have been developed to measure frailty; however, the clinical feasibility of these tools is limited. We previously developed and validated an upper-extremity function (UEF) assessment method that incorporates wearable motion sensors. The purpose of the current study was to: 1) crosssectionally validate the UEF method in a larger sample in comparison with the Fried index; 2) develop a UEF frailty index to predict frailty categories including non-frail, pre-frail, and frail based on UEF parameters and demographic information, using the Fried index as the gold standard; and 3) develop a UEF continuous score (points scores for each UEF parameter and a total frailty score) based on UEF parameters and demographic information, using the Fried index as the gold standard. Methods: We performed a cross-sectional validation and index development study within the Banner Medical Center, Tucson, and Banner Sun Health Research Institute, Sun City, Arizona. Community-dwelling and outpatient older adults (≥60 years; n = 352; 132 non-frail, 175 pre-frail, and 45 frail based on Fried criteria) were recruited. For the UEF test, each participant performed a 20-s elbow flexion, within which they repetitively and rapidly flexed and extended their dominant elbow. Using elbow motion outcomes two UEF indexes were developed (categorical and score). The Fried index was measured as the gold standard. Results: For the categorical index, speed of elbow flexion, elbow range of motion, elbow moment, number of flexion, speed variability and reduction within 20 s, as well as body mass index (BMI) were included as the pre-frailty/frailty predictor parameters. Results from 10-fold cross-validation showed receiver operator characteristic area under the curve of 0.77 ± 0.07 and 0.80 ± 0.12 for predicting Fried pre-frailty and frailty, respectively. UEF score (0.1 to 1.0) was developed using similar UEF parameters. Conclusions: We present an objective, sensor-based frailty assessment tool based on physical frailty features including slowness, weakness, exhaustion (muscle fatigue), and flexibility of upper-extremity movements. Within the current study, the method was validated cross-sectionally using the Fried index as the gold standard and the UEF categorical index and UEF frailty score were developed for research purposes and potentially for future clinical use.

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“…Hospital-associated geriatric syndromes share risk factors including functional impairment, mobility impairment, cognitive impairment and malnutrition. They frequently co-exist, and are associated with longer hospitalisations, increased dependency and greater risk of institutional care and death [2, 3, 5, 8–10]. …”

Section: Introductionmentioning

confidence: 99%

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients

et al. 2017

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BackgroundOlder inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention.MethodsA hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards.DiscussionUsing a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation.Trial registration ACTRN12615000879561 registered prospectively 21/8/2015.

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Frailty and Geriatric Syndromes in Vascular Surgical Ward Patients

Cited by 49 publications

References 44 publications

Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters

Chronic wounds in Australia: A systematic review of key epidemiological and clinical parameters

Frailty assessment in older adults using upper-extremity function: index development

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients

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