The frailty syndrome

Wou, Franklin; Conroy, Simon

doi:10.1016/j.mpmed.2012.10.004

Cited by 22 publications

(24 citation statements)

References 16 publications

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“…Nonetheless, it is already known that greater frailty is related to lower educational levels, lower income, perceptions of worse health, and a larger number of comorbidities. 13 The literature 2,8 shows that the prevalence of frailty varies according to criteria, type of research method, and the instrument(s) used, in addition to the setting of data collection and the participants. Studies using the EFS have reported a prevalence of frailty ranging from 14.9% to 39.2%.…”

Section: Discussionmentioning

confidence: 99%

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Frailty and its relationship with mortality among older adults from a Brazilian community: A cohort study

2018

JCGG

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Background/Purpose: People are living longer. However, the aging process, coupled with lifestyle and health conditions, may lead to what is known as frailty syndrome. There is a consensus among researchers in the field that frailty is associated with adverse health outcomes, such as functional decline, dependency, recurrent falls, fractures, institutionalization, hospitalization and death. The aim of the present study was to analyze the relationship between frailty and mortality in a population of older people living in a Brazilian community. Methods: A prospective cohort study was conducted through two assessments in the city of Ribeirão Preto, state of São Paulo, with a mean follow-up period of 5.6 years. The sample was made up of 515 (75.37±7.28) older adults who were assessed in 2007/2008, and 262 (79.31±6.34) who were assessed in 2013. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 22.0; the Wilcoxon test, Cox regression and Kaplan-Meier survival analysis were also used. Results: We verified that most older people were considered non-frail in 2007/2008 (59.5%); 22.9% were identified as apparently vulnerable, and 17.6% were frail. In 2013, 28.7% were considered non-frail, 20.9% apparently vulnerable; and 50.4% were frail (an increase of 186%). A total of 24.7% died during the follow-up period; 45.7% were considered frail according to the Edmonton Frail Scale. The survival analysis showed that frail older people were more likely to die. Conclusion: Frailty developed during the period under study, in association with mortality: a greater proportion of non-frail older people were among the survivors. In the present study, frailty was considered an important predictor of mortality.

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Section: Discussionmentioning

confidence: 99%

“…This is an emergent geriatric syndrome, with key domains that include physical function, nutritional status, mental health and cognition. 13 Various definitions have been used to diagnose frailty, but further studies are needed to establish an operational definition.…”

Section: Discussionmentioning

confidence: 99%

Frailty and its relationship with mortality among older adults from a Brazilian community: A cohort study

2018

JCGG

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“…It is recognised in this study that frailty should be seen as a multidimensional syndrome (Wou & Conroy, 2013) affecting the physical and mental function of the persons in different ways. Cognitive (Buchman, Schneider, Leurgans, & Bennett, 2008) and emotional impairment (Buchman et al, 2014) resulting from ageing had been frequently reported in the frail older people while many of the screening tools determine only physical deficits as a proxy measures of frailty (Heuberger, 2011 We found in this study that 16.7% of people with moderate dementia were also diagnosed with severe frailty.…”

Section: Discussionmentioning

confidence: 95%

The relationship between frailty, functional dependence, and healthcare needs among community‐dwelling people with moderate to severe dementia

Abreu

Tolson

Jackson

et al. 2018

Health Soc Care Community

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This paper examines the healthcare needs of community‐dwelling older people living in Porto, Portugal, diagnosed with moderate or severe dementia, linked to functional dependency, cognitive decline, limitations in the activities of daily life, and frailty levels. A sample of 83 participants was recruited. Data were collected between 2013 and 2017. A sociodemographic questionnaire, the Clinical Dementia Rating (CDR), the Barthel Index (BI), the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, and the Edmonton Frail Scale (EFS) were used. A set of 26 healthcare needs was defined to support the assessment. The Pearson chi‐square or Fisher's exact test (as appropriate) was used to examine the association of the needs (unmet and met) with the levels of dementia and frailty. Participants were diagnosed previously with moderate or severe dementia and benefited from a structured home‐care program. There was a high number rated as “severe dementia,” “fully dependent,” “severely or fully dependent in the activities of daily living (ADL),” and “severe frailty.” There were statistically significant differences among needs identified in people with moderate or severe dementia and moderate or severe frailty. The most prevalent healthcare needs in the sample were food preparation, medication/taking pills, looking after their home, toilet use, sensory problems, communication/interaction, bladder, bowels, eating and drinking, memory, sleeping, and falls prevention. In particular, the study identifies a set of needs that are present simultaneously in both frailty and dementia stages. This study underlines that despite well‐structured home‐care programs for people with dementia, unmet health needs remain. Timely healthcare needs assessment may help professionals to avoid fragmented care and to tailor quality‐integrated interventions, including the emotional and psychological balance of the caregiver.

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“…Early phenotype models exclude dimensions subsequently proven to be linked to poor outcome(e.g. cognitive impairment) (143). The large data requirements of the frailty index model (at least 30 variables recommended) (138,144) and the necessity for specialised research apparatus(145) limit clinical usability.…”

Section: Operationalised Frailtymentioning

confidence: 99%

“…There have been international efforts to reach agreement (13,135,214) but at present there is no absolute consensus on clinical and operational definitions for frailty (143), particularly in the context of acute care. Current definitions are very research orientated.…”

Section: Introductionmentioning

confidence: 99%

Frailty Assessment in Acute Care

2015

The Gerontologist

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IntroductionFor some people, ageing is associated with the experience of increased co-morbidity, functional impairment, poor resilience and heightened vulnerability to external stressors, resulting in reduced lifespan as well as health-span. This frailty phenomenon poses challenges to health care systems in the form of increased patient complexity and resource utilisation. The acute care setting, characterised by time-pressure and high patient turn-over, is under strain and struggles to recognise and subsequently reliably intervene, to prevent, reverse or halt the decline of this vulnerable cohort. MethodsThis mixed-methods study probes existing evidence and 'real-world' processes with a systematic review of frailty assessments developed or validated in the acute care setting and a survey of contemporaneous clinical practice in London Acute Medical Units. Content validation and understanding of contextual factors for ideal frailty assessment in acute care is explored using Delphi consensus and Focus Group methodology respectively. The resultant model is developed on existing retrospective national Hospital Episode Statistics data, and prospectively tested on observational data in a local Acute Medical Unit setting. ResultsExisting frailty scores are preponderantly biophysical in nature, and have poor predictive power for adverse outcomes in the acute care setting. In clinical practice, single-dimension assessment tools predominate. Frailty syndromes and previous high resource utilisation in the form of a simple, clinically relevant tool useful to the multidisciplinary team gain consensus as optimal assessment for the setting. Retrospective testing of the frailty model displays moderate predictive powers for adverse events (inpatient mortality, emergency readmission and institutionalisation) and prospective testing provides concurrent (Frailty Index, Age, Co-Morbidity) and comparative predictive validity (Frailty Index, Co-Morbidity, 2 admission National Early Warning Score) with existing risk stratification models in this setting. ConclusionsA risk prediction model based on frailty syndromes and previous high resource utilisation is a valid, feasible and useful for the acute care setting.

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The frailty syndrome

Cited by 22 publications

References 16 publications

Frailty and its relationship with mortality among older adults from a Brazilian community: A cohort study

Frailty and its relationship with mortality among older adults from a Brazilian community: A cohort study

The relationship between frailty, functional dependence, and healthcare needs among community‐dwelling people with moderate to severe dementia

Frailty Assessment in Acute Care

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