The Timed Up and Go Test as a Measure of Frailty in Urologic Practice

Abstract

Objectives To evaluate the prevalence of frailty, a known predictor of poor outcomes, among patients presenting to an academic non-oncologic urology practice and to examine whether frailty differs among patients who did and did not undergo urologic surgery. Methods The Timed up and Go Test (TUGT), a parsimonious measure of frailty, was administered to patients ages ≥ 65. The TUGT, demographic data, urologic diagnoses and procedural history were abstracted from the medical record into a prospective database. TUGT times were categorized as nonfrail (≤10 sec), prefrail (11–14 sec) and frail (≥15 sec). These times were evaluated across age and urologic diagnoses and compared between patients who did and did not undergo urologic surgery using chi-square and t-tests. Results The TUGT was recorded for 78.9% of patient visits from December 2015 to May 2016. For 1089 patients, average age was 73.3 ± 6.3 years; average TUGT time was 11.6 ± 6.0 sec; 30.0% were categorized as prefrail and 15.2% as frail. TUGT times increased with age, with 56.9% of patients age 86 and over categorized as frail. Times varied across diagnoses (highest average TUGT was 14.3 ± 11.9 sec for patients with urinary tract infections), however no difference existed between patients who did and did not undergo surgery (p = 0.94). Conclusions Among our population, prefrailty and frailty were common, TUGT times increased with age and varied by urologic diagnosis, but did not differ between patients who did and did not undergo urologic surgery, presenting an opportunity to consider frailty in preoperative surgical decision making.

The association between frailty and detrusor overactivity in older adults

“…However, there is a relative paucity of research examining the role of frailty with regard to OAB. Findings from this study build upon our prior work in a similar population demonstrating that older individuals with a diagnosis of OAB are more frail compared with older individuals with other benign urologic conditions 20,24 . These results add to a growing body of evidence that a significant relationship between frailty, DO, and OAB exists in older adults and highlights the possibility of frailty among patients with OAB as a potential avenue for future intervention.…”

“…Findings from this study build upon our prior work in a similar population demonstrating that older individuals with a diagnosis of OAB are more frail compared with older individuals with other benign urologic conditions. 20,24 These results add to a growing body of evidence that a significant relationship between frailty, DO, and OAB exists in older adults and highlights the possibility of frailty among patients with OAB as a potential avenue for future intervention. However, our results simply show only an association between frailty and DO; more studies should be done to better delineate the direct causal relationship between the two, if there is one.…”

“…However, there is evidence in the literature to suggest that in addition to age‐related physiologic changes, age‐related cognitive changes in the planning and coordination of movement may also contribute to the decrease in physical aptitude as well, 36 with significant differences in the subtle movement kinematics between young and frail individuals during sit‐to‐stand and back‐to‐sit during the TUGT 37 . Furthermore, TUGT was chosen over other frailty measures due to its cost‐effectiveness, simplicity, and ease of administration, making it easily usable and adaptable to other practices as a screening tool for frailty 24 . Prior literature also demonstrates that TUGT is an established measure of frailty in the perioperative setting, 18,20,23‐25 making it an optimal measure to use in surgical clinical practice.…”

“…Study subjects were categorized as fast (≤10 seconds), intermediate (11‐14 seconds) and slow (≥15 seconds), with corresponding implications for frailty as “not frail”, “pre‐frail,” and “frail,” respectively. A slower walking time has been demonstrated in the literature as a sensitive and specific measure of frailty 22 and found to be associated with increased postoperative complications across surgical subspecialties 18,23‐25 …”

The Impact of Frailty on Artificial Urinary Sphincter Placement and Removal Procedures

“…We have previously published on our use of the Timed Up and Go Tests (TUGT) as a parsimonious measure for frailty in an academic nononcologic urology practice. 22 Other measurement tools include the Fried frailty phenotype, consisting of 5 domains (unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity), 23 and the Edmonton Frail Scale consisting of 9 domains (cognition, general health status, functional independence, social support, medication use, nutrition, mood, continence, and functional performance). 24 Once it is determined that a patient is frail, this information is useful both for risk stratification and risk optimization.…”