Frailty assessment, hip fracture and long‐term clinical outcomes in older adults

Abstract

Background The primary aim of the study was determining the validation of the modified 19‐item Frailty Index (mFI‐19), based on the standard procedure for creating a frailty index scoring in the accumulation deficit theory of Rockwood and comparing it with the gold standard comprehensive geriatric assessment (CGA) in old age patients with hip fracture. As a secondary aim, we compared prognostic accuracies of mFI‐19 and CGA in predicting long‐term mortality after surgery. Materials and Methods A total of 364 older patients with hip fractures, each a candidate for surgery, were consecutively enrolled. All were subjected to CGA and mFI‐19 at baseline and time to death (years from hip surgery) were collected prospectively. Results Mean patient age was 86.5 (SD: 5.65) years. The most common clinical phenotype (77%) was frail. Both CGA and mFI‐19 performed similarly in predicting long‐term mortality (Harrell's C‐index: 0.66 and 0.68, respectively). Conclusions The mFI‐19 was validated, compared to the gold standard CGA, based on a systematic process for creating a frailty index in relation to the accumulation deficit. This is one of few prospective studies addressing long‐term mortality in older adults with hip fractures, invoking a methodologically robust frailty screening assessment.

Patient-specific risk factors for adverse outcomes following geriatric proximal femur fractures

“…When patients with PFF present with an mFI of 4 or greater, the odds ratio for 1-year mortality is 4.97, as described by Patel et al [ 27 ]. This correlation of the mFI with mortality after PFF has been confirmed by others [ 28 , 29 ]. Inoue et al also demonstrated a correlation of an elevated mFI with the occurrence of postoperative complications such as delirium, deep thrombophlebitis, pneumonia, urinary tract infection and pressure sores, lower rates of functional recovery and the new need for institutional care taking [ 30 ].…”

The Impact of Frailty on Adverse Outcomes in Geriatric Hip Fracture Patients: A Systematic Review and Meta-Analysis

“…In 11 included studies, 4 were prospective cohort studies ( 6 , 16 , 18 , 19 ) and the remaining 7 were retrospective cohort studies ( 15 , 17 , 20 – 24 ). The studies were implemented in the Netherlands ( 19 ), America ( 15 ), Singapore ( 16 ), Canada ( 17 ), China ( 18 ), Korea ( 20 , 22 ), Australia ( 21 ), Italy ( 6 ), Japan ( 24 ) and England ( 23 ). The average age ranged from 78 to 86.5 years old (More details in Table 1 ).…”

“…Two reviewers (YS and ZW) independently assessed the quality using the Newcastle-Ottawa Scale (NOS) (More details in Supplementary File 2). In 11 included studies, 4 were prospective cohort studies (6,16,18,19) and the remaining 7 were retrospective cohort studies (15,17,(20)(21)(22)(23)(24). The studies were implemented in the Netherlands (19), America (15), Singapore (16), Canada (17), China (18), Korea (20,22), Australia (21), Italy (6), Japan (24) and England (23).…”

“…Osteoporosis, muscle atrophy, and many other reasons have put the older persons at high risk for fractures ( 4 , 5 ). Hip fractures have become a worldwide public health threat, with data indicating that the 1-year mortality rate after hip fracture surgery may exceed 20% ( 6 ). It is estimated that by 2050, the population of hip fractures is predicted to reach 4.5 million worldwide, and nearly 30% will occur in China ( 7 ).…”

Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes

“…The frailty index is easy to use in clinical practice because it consists mainly of medical conditions [69] and can be evaluated from the medical record. Patel et al [70], Inoue et al [78], Vasu et al [76], and Pizzonia M et al [82] adopted 19 items and Krishnan et al [71] adopted 51 items to develop the modified frailty index for hip fracture patients. These models suggest that frailty is a continuous score that considers disability, comorbidity, and symptoms.…”