The Association of Frailty and Neighborhood Disadvantage with Emergency Department Visits and Hospitalizations in Older Adults

An Electronic Frailty Index Based on Deficit Accumulation May Predict Glaucomatous Visual Field Progression

Purpose

To investigate whether an electronic frailty index (eFI) is associated with visual field loss in glaucoma.

Patients and Methods

We identified 1163 subjects ≥65 years old with glaucoma (1082 right eyes and 1042 left eyes) who had a calculable baseline eFI, and who had reliable visual fields at baseline and final follow-up. Multivariable linear regression models adjusting for demographic and clinical variables were used to assess the association between eFI and mean deviation at baseline and the change in mean deviation over time in each eye.

Results

Being pre-frail or frail was not associated with baseline MD, except in the right eye where being pre-frail was associated with a higher baseline MD. Increasing level of eFI was negatively correlated with change in MD (p<0.05 both eyes), but not baseline MD. Moreover, being frail was significantly associated with a more significant decline in MD in both eyes (Right eye: Beta -0.89, 95% CI (-1.71, -0.063), p=0.035; Left eye: Beta -1.25, 95% CI (-2.17, -0.34), p=0.007). Notably, baseline IOP was not associated with MD at baseline or the change in MD in the multivariable models.

Conclusion

Glaucoma patients who are frail may be at higher risk of experiencing visual field decline, independent of baseline IOP. Future studies should investigate whether interventions to improve frailty can decrease risk of glaucoma progression.

New horizons in frailty identification via electronic frailty indices: early implementation lessons from experiences in England and the United States

Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health-Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives.