The impact of frailty and delirium on mortality in older inpatients

Eeles, Eamonn; White, Susan V.; O'Mahony, Sinead; Bayer, Antony James; Hubbard, Ruth E.

doi:10.1093/ageing/afs021

Cited by 195 publications

(143 citation statements)

References 20 publications

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“…Frailty is associated with an increased risk of delirium 45 , cognitive impairment 46 , and dementia 47 . The frail person who presents with one of these conditions is a particular challenge for appropriate pain assessment.…”

Section: Discussionmentioning

confidence: 99%

Pain in older people with frailty

Brown

Young

Clegg

et al. 2015

Rev. Clin. Gerontol.

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In this review we identified cohort and cross-sectional studies which assessed pain in community-dwelling older people (> 65 years) reliably characterised as frail. Secondly, we considered biologically plausible mechanisms which may alter pain perception, or contribute to, or exacerbate pain in an older person with frailty. Thirdly, we considered specific implications of pain management for this group of people. From the limited data from the seven included studies, it would appear that the presence of pain is higher in older people with frailty compared to people characterised as pre-frail or not frail. Thus, older people reporting pain are more likely to be frail. However, a lack of prospective data precludes inferences about the direction of the relationship: that is whether pain or frailty is the antecedent. Further research is needed to understand the direction of the relationship, and to identify appropriate pain management strategies for older people with frailty.

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Section: Discussionmentioning

confidence: 99%

Pain in older people with frailty

Brown

Young

Clegg

et al. 2015

Rev. Clin. Gerontol.

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“…Unfortunately, this physiological condition become clinically relevant in more than 25% of people older than 85 years [2] and is referred to as "frailty. " This condition has been defined as a state of increased vulnerability to poor resolution of homoeostasis after a stressor event, which increases the risk of adverse outcomes [3][4][5]. In other words, an apparently small insult, such as a minor infection or surgery, results in disproportionate changes in the health state.…”

Section: Introductionmentioning

confidence: 99%

The Pleiotropic Effect of Physical Exercise on Mitochondrial Dynamics in Aging Skeletal Muscle

Barbieri¹,

Agostini²,

Polidori³

et al. 2016

Clinical Nutrition and Aging

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Decline in human muscle mass and strength (sarcopenia) is one of the principal hallmarks of the aging process. Regular physical exercise and training programs are certain powerful stimuli to attenuate the physiological skeletal muscle alterations occurring during aging and contribute to promote health and well-being. Although the series of events that led to these muscle adaptations are poorly understood, the mechanisms that regulate these processes involve the "quality" of skeletal muscle mitochondria. Aerobic/endurance exercise helps to maintain and improve cardiovascular fitness and respiratory function, whereas strength/resistance-exercise programs increase muscle strength, power development, and function. Due to the different effect of both exercises in improving mitochondrial content and quality, in terms of biogenesis, dynamics, turnover, and genotype, combined physical activity programs should be individually prescribed to maximize the antiaging effects of exercise.

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“…The identified prevalence of frailty in most studies of surgical inpatients is lower than that of most medical inpatient studies, estimates of which range from 41-80%. 14,20,21 Similarly, the frailty prevalence of 33% identified in this study is just over half the previous 64% estimate of a similar demographic of mixed medical and surgical inpatients, in which the REFS was also used. 15 This could reflect the necessary level of robustness required to be considered a candidate for surgery.…”

Section: Discussionmentioning

confidence: 56%

A prospective cohort study of older surgical inpatients examining the prevalence and implications of frailty

2017

JCGG

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Background:Older inpatients who are frail have complex medical issues and are likely to benefit from geriatric medicine services, but currently there are limited studies of frailty in the surgical inpatient population. The aims of this prospective cohort study were to identify the prevalence of frailty in a cohort of older surgical inpatients, and the association of frailty with adverse outcomes and provision of geriatric medicine assessment. Methods: Surgical inpatients aged ≥65 years admitted to a Sydney tertiary referral hospital were assessed for frailty using the Reported Edmonton Frail Scale. Outcomes in hospital and geriatrician involvement in inpatient care were identified by medical record review, and outcomes three months post-recruitment were assessed via telephone interview. Results: Of 100 participants, 33 were classified as frail. Frailty was associated with a higher risk of falls (P=0.01), disability in activities of daily living (P<0.001), polypharmacy (P<0.001) and new discharge to a nursing home (P=0.04). Prevalence of specialist geriatric assessment was not significantly greater in frail (36%) compared to non-frail (22%) participants. Conclusions: A significant proportion of frail surgical inpatients are vulnerable to adverse outcomes, but do not receive geriatric medicine services in the hospital setting. Preoperative frailty assessments have the potential to inform the management of these patients.

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The impact of frailty and delirium on mortality in older inpatients

Abstract: delirium was associated with higher levels of frailty: the identification of frail patients may help to target those at a greatest risk of delirium. Survival following delirium was poor with the combination of frailty and delirium conferring a particularly bleak prognosis.

Cited by 195 publications

References 20 publications

Pain in older people with frailty

Pain in older people with frailty

The Pleiotropic Effect of Physical Exercise on Mitochondrial Dynamics in Aging Skeletal Muscle

A prospective cohort study of older surgical inpatients examining the prevalence and implications of frailty

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