Therapeutic Interventions for Frail Elderly Patients: Part II. Ongoing and Unpublished Randomized Trials

There is general agreement that frailty is a state of heightened vulnerability to stressors arising from impairments in multiple systems leading to declines in homeostatic reserve and resiliency, but unresolved issues persist about its detection, underlying pathophysiology, and relationship with aging, disability, and multimorbidity. A particularly challenging area is the relationship between frailty and hospitalization. Based on the deliberations of a 2014 Canadian expert consultation meeting and a scoping review of the relevant literature between 2005 and 2015, this discussion paper presents a review of the current state of knowledge on frailty in the acute care setting, including its prevalence and ability to both predict the occurrence and outcomes of hospitalization. The examination of the available evidence highlighted a number of specific clinical and research topics requiring additional study. We conclude with a series of consensus recommendations regarding future research priorities in this important area.

show abstract

“…Unfortunately few interventions for frailty have been or are being rigorously studied at this time. (179,180) …”

Section: Discussionmentioning

confidence: 99%

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…58, 59 Furthermore, the trials assess improvement in frailty markers rather than cancer- or surgery-specific outcomes. Addressing weakness through resistance and strength interventions has most consistently improved frailty measures.…”

Section: Management Of Frailty In Cancer Patientsmentioning

confidence: 99%

“…59 On-going trials will test additional pharmacotherapies including ghrelin, allopurinol, vitamin D, and omega-3 fatty acids. 58 None of these agents have had enough data to recommend routine use.…”

Section: Management Of Frailty In Cancer Patientsmentioning

confidence: 99%

How should older adults with cancer be evaluated for frailty?

Huisingh-Scheetz

Walston

2017

Journal of Geriatric Oncology

View full text Add to dashboard Cite

Traditionally used as a descriptive term, frailty is now a recognized medical syndrome identifying individuals with decreased physiologic reserve. Frailty is characterized by diminished strength, endurance, and reduced physiologic function. Several valid frailty screening tools exist in the literature, and these measures have been used to relate frailty to outcomes important to the older patient with cancer. Frail adults are at increased risk of adverse surgical outcomes and early findings suggest that frailty predicts poor chemotherapy tolerance. While much research is needed to explore the biologic relationships between frailty and cancer, there is an urgent need to implement frailty screening and management into the care of the older patient with cancer in order to improve outcomes in this vulnerable subset. The purpose of this paper is to provide an introduction of frailty to oncologists including a review of the definition, frailty screening tools, its clinical relevance to older patients with cancer, and a brief guide to frailty management.

show abstract

“…Trials of interventions to improve frailty and physical functioning in HF are currently underway [49] as summarized in Table 2. Pragmatic randomized trials [50] that enlist frail patients are needed to determine the effects of guideline-based HF therapy on survival, hospitalizations, adverse drug events, and equally important-on patient-centered outcomes pertaining to physical functioning and quality of life.…”

Section: Future Directionsmentioning

confidence: 99%

Prognostic and Therapeutic Implications of Frailty in Older Adults with Heart Failure

2015

Self Cite

View full text Add to dashboard Cite

Frailty is increasingly recognized in older adults with cardiovascular disease, particularly in those with heart failure (HF). A growing body of evidence has shown that frailty has a negative effect on survival, hospitalizations, disability, and quality of life. Beyond frailty, additional domains captured by a comprehensive geriatric assessment contribute incremental value in predicting outcomes and identifying treatment targets. Exercise training is ideally suited to this setting as it can concomitantly improve physical frailty and HF symptoms. Multidisciplinary disease management programs offer a number of benefits for frail HF patients; invasive procedures carry a higher risk of morbidity than in non-frail counterparts, and evidence-based drugs and devices have an uncertain value and warrant further research. While more data accrues, difficult therapeutic decisions should be individualized using a shared patient-centered decision making approach.

show abstract

Therapeutic Interventions for Frail Elderly Patients: Part II. Ongoing and Unpublished Randomized Trials

Cited by 55 publications

References 14 publications

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

A Scoping Review of Frailty and Acute Care in Middle-Aged and Older Individuals with Recommendations for Future Research

How should older adults with cancer be evaluated for frailty?

Prognostic and Therapeutic Implications of Frailty in Older Adults with Heart Failure

Contact Info

Product

Resources

About