Frailty, Hospitalization, and Mortality in Residential Aged Care

Theou, Olga; Sluggett, Janet K.; Bell, John; Lalic, Samanta; Cooper, Tina; Robson, Leonie; Morley, John E.; Rockwood, Kenneth; Visvanathan, Renuka

doi:10.1093/gerona/glx185

Cited by 64 publications

(55 citation statements)

References 35 publications

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“…Along with the lack of a universal definition, there is no single method of quantifying frailty . The two most widely used clinical methods are the “frailty phenotype” and the “frailty index” and both approaches are predictive of adverse health outcomes, such as mortality . The frailty phenotype views frailty as a syndrome caused by a downward spiral of energy reserves .…”

Section: Introductionmentioning

confidence: 99%

The biology of frailty in humans and animals: Understanding frailty and promoting translation

Bisset

Howlett

2019

Aging Medicine

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Frailty is a state of high vulnerability to adverse health outcomes. This concept is used to explain the heterogeneity in rates of aging in people of the same age. Frailty has important clinical implications, because even minor stressors can lead to adverse outcomes, including death, in frail individuals. Although frailty mechanisms are not well understood, advances in our ability to qualify frailty have encouraged efforts in this area. Quantification of frailty with both “frailty phenotype” and “frailty index” approaches has begun to highlight putative frailty mechanisms and new animal models of frailty are inspiring preclinical research. These models either adapt frailty phenotype and frailty index tools for use in animals or they use genetically manipulated mice that mimic conditions seen in frailty (eg, inflammation, sarcopenia, weakness). This review: describes commonly used tools to quantify frailty clinically, discusses potential frailty mechanisms, and describes animal models of frailty. It also highlights how these models have been used to explore frailty mechanisms and potential frailty interventions, including pharmacological treatments, diet, and exercise. These exciting new developments in the field have the potential to facilitate translational research, improve our understanding of mechanisms of frailty, and help develop new interventions to mitigate frailty in our aging population.

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Section: Introductionmentioning

confidence: 99%

The biology of frailty in humans and animals: Understanding frailty and promoting translation

Bisset

Howlett

2019

Aging Medicine

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“…Numerous studies have conclusively demonstrated that frailty is a predictor for many adverse health outcomes, including disability, falls, delirium, hospitalization, and mortality up to 12 years follow up period 6,9–14 . However, the majority of these previous studies have focused on the association between frailty and mortality among community-dwelling older persons 9–11 or residents in long-term care settings 12,15 , rather than on those in acute care settings.…”

Section: Introductionmentioning

confidence: 99%

The role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective study

Qin

Zhou

Dong

et al. 2019

Sci Rep

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Few studies have focused on frailty as a predictor of mortality and readmission among inpatients in the acute care setting, especially over long follow-up periods. We conducted this study to determine the impact of the frailty on subsequent mortality and readmission in this setting. This study was a prospective observational study conducted in the acute geriatric wards, with a three-year follow-up duration. We assessed frailty via the 36-item Frailty Index (FI), and a cut-off value of 0.25 was used to identify the presence or absence of frailty. We collected survival and readmission information through telephone interviews at 12, 24, and 36 months. We used the Cox regression model to examine the association between frailty and outcomes interested (death and readmission). The present study included 271 patients (mean age: 81.1 years old; 20.3% females), of whom 21.4% died during the 3-year follow-up period. One hundred and thirty-three patients (49.1%) were identified as being frail. The prevalence of frailty was similar in men and women (46.8% vs.58.2%, P = 0.130). Compared with non-frail patients, death and hospital readmission rates of frail patients were increased. Frailty was an independent predictor of 3-year death (adjusted hazard ratio (HR): 2.09; 95% confidence interval (CI): 1.20 to 3.63) and readmission (adjusted HR: 1.40; 95% CI: 1.04 to 1.88) after adjusting for several potential confounders. Frailty is prevalent among older inpatients and is a valuable predictor of 3-year mortality and hospital readmission in an acute care setting.

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“…Many older people have several coexisting comorbidities/geriatric syndromes, including cardiovascular disease, renal disease, sensory impairments, lower limb pathology, cognitive changes/dementia, some forms of cancer and frailty that individually and collectively affect life expectancy [6][7][8][9]. Frailty predicts admission to a care home and mortality and increases the risk of death [10,11]. Frailty is assessed in various ways, including phenotype and accumulation of deficits.…”

Section: Introductionmentioning

confidence: 99%

Diabetes and Palliative Care: A Framework to Help Clinicians Proactively Plan for Personalized care

Dunning¹,

Martin²

2019

Palliative Care

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The aim of the chapter is to provide a brief overview of diabetes and the associated morbidities that affect life expectancy to highlight why proactively planning for palliative and end-of-life care is essential to quality personalized diabetes care. Life expectancy may not be significantly reduced if blood glucose, lipids and blood pressure are well controlled; but several diabetes-related complications and long duration of diabetes affect life expectancy. Significantly, complications and related organ and tissue damage can be present 10-15 years before type 2 diabetes is diagnosed. The challenge of prognostication is discussed as recommendations for when to consider changing the focus of care from preventing diabetes complications to palliation and comfort care. Life-limiting illness and palliative and end-of-life care are defined. A framework for integrating diabetes and palliative care is proposed. The framework could help clinicians and people with diabetes prevent/manage complications and plan care to maintain quality of life, dignity and autonomy and ameliorate suffering as their life trajectory changes. The framework aims to facilitate care transitions and help clinicians proactively initiate management and have timely meaningful conversations about palliative and end-of-life care with older people with diabetes and their families.

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Frailty, Hospitalization, and Mortality in Residential Aged Care

Abstract: Residents with mild/moderate frailty had higher risk of hospitalization and death than nonfrail residents. Residents who were most frail had higher risk of death but lower risk of hospitalization than nonfrail residents.

Cited by 64 publications

References 35 publications

The biology of frailty in humans and animals: Understanding frailty and promoting translation

The biology of frailty in humans and animals: Understanding frailty and promoting translation

The role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective study

Diabetes and Palliative Care: A Framework to Help Clinicians Proactively Plan for Personalized care

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