1
|
Deng P, Liu C, Chen M, Si L. Knowledge domain and emerging trends in multimorbidity and frailty research from 2003 to 2023: a scientometric study using citespace and VOSviewer. Health Econ Rev 2023; 13:46. [PMID: 37815722 PMCID: PMC10563353 DOI: 10.1186/s13561-023-00460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Multimorbidity and frailty represent emerging global health burdens that have garnered increased attention from researchers over the past two decades. We conducted a scientometric analysis of the scientific literature on the coexistence of multimorbidity and frailty to assess major research domains, trends, and inform future lines of research. METHODS We systematically retrieved scientific publications on multimorbidity and frailty from the Web of Science Core Collection, spanning from 2003 to 2023. Scientometric analysis was performed using CiteSpace and VOSviewer, enabling the visualization and evaluation of networks comprising co-citation references, co-occurring keywords, countries, institutions, authors, and journals. RESULTS A total of 584 eligible publications were included in the analysis. An exponential rise in research interest in multimorbidity and frailty was observed, with an average annual growth rate of 47.92% in publications between 2003 and 2022. Three major research trends were identified: standardized definition and measurement of multimorbidity and frailty, comprehensive geriatric assessment utilizing multimorbidity and frailty instruments for older adults, and the multifaceted associations between these two conditions. The United States of America, Johns Hopkins University, Fried LP, and the Journal of the American Geriatrics Society were identified as the most influential entities within this field, representing the leading country, institution, author, and journal, respectively. CONCLUSIONS Scientometric analysis provides invaluable insights to clinicians and researchers involved in multimorbidity and frailty research by identifying intellectual bases and research trends. While the instruments and assessments of multimorbidity and frailty with scientific validity and reliability are of undeniable importance, further investigations are also warranted to unravel the underlying biological mechanisms of interactions between multimorbidity and frailty, explore the mental health aspects among older individuals with multimorbidity and frailty, and refine strategies to reduce prescriptions in this specific population.
Collapse
Affiliation(s)
- Penghong Deng
- School of Health Policy & Management, Nanjing Medical University, Jiangning District, Nanjing, 211166, China
| | - Chang Liu
- School of Health Policy & Management, Nanjing Medical University, Jiangning District, Nanjing, 211166, China
| | - Mingsheng Chen
- School of Health Policy & Management, Nanjing Medical University, Jiangning District, Nanjing, 211166, China.
- Center for Global Health, Nanjing Medical University, Nanjing, China.
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| |
Collapse
|
2
|
Montgomery CL, Hopkin G, Bagshaw SM, Hessey E, Rolfson DB. Frailty inclusive care in acute and community-based settings: a systematic review protocol. Syst Rev 2021; 10:83. [PMID: 33771224 DOI: 10.1186/s13643-021-01638-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/12/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Frailty is a known risk factor for an array of adverse outcomes including more frequent and prolonged health services use and high health care costs. Aging of the population has implications for care provision across the care continuum, particularly for people living with frailty. Despite known risks associated with frailty, there has been limited research on care pathways that address the needs of persons living with frailty. Our study aims to review and examine, in a rigorous way, the quality of evidence for multi-component interventions and care pathways focused on frailty. METHODS A comprehensive electronic search strategy will be used to identify studies that evaluate multi-component interventions or care pathways for persons living with frailty. The search strategy will include terms for frailty, multi-component interventions, effectiveness, and cost effectiveness applied to the following databases: MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews. An adapted search for Google Scholar and gray literature databases will also be used. References of included studies will be hand-searched for additional citations of frailty-inclusive care. Known experts and corresponding authors of identified articles will be contacted by email to identify further eligible studies. Risk of bias will be assessed using the Effective Public Health Practice Project Quality Assessment tool. Data will be extracted from eligible studies and it is anticipated that narrative analysis will be used. If studies with sufficient homogeneity are found, then pooled effects will be reported using meta-analysis. DISCUSSION This review will appraise the evidence currently available on multi-component frailty interventions. Results will inform on clinical pathway development for people living with frailty across the care continuum and will guide future research to address gaps in the literature and areas in need of further development. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020166733.
Collapse
|
3
|
Dearing ME, Bowles SK, Isenor JE, Theou O, Reeve E. Medication-related criteria in frailty assessment tools: A narrative review. Australas J Ageing 2020; 39:e460-e465. [PMID: 32107831 DOI: 10.1111/ajag.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To review medication-related criteria within validated frailty tools. METHODS Narrative review of validated frailty assessment tools. Frailty tools were identified from recently published reviews; each tool was reviewed to determine whether any medication-related criteria were included and how these criteria contributed to the scoring/assessment of frailty. RESULTS Eight out of 16 validated frailty tools included medication-related criteria. The majority of criteria were a numerical cut-off of number of medications taken; however, the specific cut-off was not consistent. CONCLUSION Inclusion of medication-related criteria in frailty tools is highly variable. Future research is required to determine whether incorporation of medication use into frailty assessment can impact outcomes in terms of frailty prevention and treatment.
Collapse
Affiliation(s)
- Marci E Dearing
- Geriatric Medicine Research, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Pharmacy, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Susan K Bowles
- Geriatric Medicine Research, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Pharmacy, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer E Isenor
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Geriatric Medicine Research, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Reeve
- Geriatric Medicine Research, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada.,Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
4
|
Sutton JL, Gould RL, Coulson MC, Ward EV, Butler AM, Smith M, Lavelle G, Rosa A, Langridge M, Howard RJ. Multicomponent Frailty Assessment Tools for Older People with Psychiatric Disorders: A Systematic Review. J Am Geriatr Soc 2018; 67:1085-1095. [PMID: 30589075 DOI: 10.1111/jgs.15710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review evidence evaluating the use of multicomponent frailty assessment tools in assessing frailty in older adults with psychiatric disorders. METHODS A systematic literature review was conducted to identify all multicomponent frailty assessment tools (ie, a tool that assesses two or more indicators of frailty). The items of each frailty assessment tool were compared with Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria for psychiatric disorders to assess construct overlap. Studies conducted in community, inpatient, and outpatient clinical settings were considered for inclusion. PARTICIPANTS Adults aged 60 years or older. RESULTS A total of 5639 records were identified following the removal of duplicates, from which 95 studies were included for review. Of the 48 multicomponent frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with a psychiatric disorder. Overall, 20 of 48 frailty assessment tools contained a psychological assessment domain, with 17 of 48 tools citing the presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM-5 diagnostic criteria included weight loss (29 of 48) and fatigue (21 of 48). CONCLUSIONS Significant construct overlap exists between the indicators of frailty as conceptualized in existing frailty assessment tools and DSM-5 diagnostic criteria for common psychiatric disorders including major depressive episode and generalized anxiety disorder that has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population. J Am Geriatr Soc 67:1085-1095, 2019.
Collapse
Affiliation(s)
- Jennifer L Sutton
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rebecca L Gould
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
| | - Mark C Coulson
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | - Emma V Ward
- Department of Psychology, Faculty of Science and Technology, Middlesex University, London, UK
| | | | - Megan Smith
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Grace Lavelle
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Amy Rosa
- Division of Psychiatry, University College London, London, UK
| | - Margaret Langridge
- Mental Health of Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Howard
- King's College London, Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,Division of Psychiatry, University College London, London, UK
| |
Collapse
|
5
|
Gonzalez-Colaço Harmand M, Meillon C, Bergua V, Tabue Teguo M, Dartigues JF, Avila-Funes JA, Amieva H. Comparing the predictive value of three definitions of frailty: Results from the Three-City study. Arch Gerontol Geriatr 2017; 72:153-63. [PMID: 28666213 DOI: 10.1016/j.archger.2017.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite several attempts to reach a single definition of frailty, no consensus has been reached. The definitions previously published have tried to prove its utility in predicting negative health outcomes. The objective of the present study is to compare the predictive value of 3 different frailty instruments, for selected outcomes. METHODS The study sample includes 1278 participants of the Three-City study, a French prospective population-based study, assessed for frailty using Fried's phenotype criteria, Rockwood's Frailty Index and Tilburg Frailty Indicator. To assess the risk of mortality, incident disability, falls, institutionalization and hospitalization for a follow up period of 12 years, Cox proportional hazard models with delayed entry have been used. The area under the time-dependent ROC curve has been used to estimate and compare the ability of the three instruments of frailty to predict the previous adverse outcomes at 12 years. RESULTS Five hundred ninety four participants were identified as non-robust with Fried's criteria; 169 with Rockwood's FI and 303 with TFI. The three scales consistently identified 91 participants as non-robust and 574 as robust. Rockwood's FI was a statistically significant predictor of mortality, incident disability and falls, and a strong predictor of hospitalization. CONCLUSION In the absence of a "gold standard" definition of frailty, a debate on what measures and how to include them is open. A clue may be that one should select the appropriate definition according to the to-be predicted outcome, the setting and the underlying etiology of frailty.
Collapse
|
6
|
Sutton JL, Gould RL, Daley S, Coulson MC, Ward EV, Butler AM, Nunn SP, Howard RJ. Psychometric properties of multicomponent tools designed to assess frailty in older adults: A systematic review. BMC Geriatr 2016; 16:55. [PMID: 26927924 PMCID: PMC4772336 DOI: 10.1186/s12877-016-0225-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/12/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Frailty is widely recognised as a distinct multifactorial clinical syndrome that implies vulnerability. The links between frailty and adverse outcomes such as death and institutionalisation have been widely evidenced. There is currently no gold standard frailty assessment tool; optimizing the assessment of frailty in older people therefore remains a research priority. The objective of this systematic review is to identify existing multi-component frailty assessment tools that were specifically developed to assess frailty in adults aged ≥60 years old and to systematically and critically evaluate the reliability and validity of these tools. METHODS A systematic literature review was conducted using the standardised COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist to assess the methodological quality of included studies. RESULTS Five thousand sixty-three studies were identified in total: 73 of which were included for review. 38 multi-component frailty assessment tools were identified: Reliability and validity data were available for 21 % (8/38) of tools. Only 5 % (2/38) of the frailty assessment tools had evidence of reliability and validity that was within statistically significant parameters and of fair-excellent methodological quality (the Frailty Index-Comprehensive Geriatric Assessment [FI-CGA] and the Tilburg Frailty Indicator [TFI]). CONCLUSIONS The TFI has the most robust evidence of reliability and validity and has been the most extensively examined in terms of psychometric properties. However, there is insufficient evidence at present to determine the best tool for use in research and clinical practice. Further in-depth evaluation of the psychometric properties of these tools is required before they can fulfil the criteria for a gold standard assessment tool.
Collapse
Affiliation(s)
- Jennifer L Sutton
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO70, De Crespigny Park, London, SE5 8AF, UK.
| | - Rebecca L Gould
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO70, De Crespigny Park, London, SE5 8AF, UK
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, East Sussex, UK
| | - Mark C Coulson
- Department of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - Emma V Ward
- Department of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - Aine M Butler
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO70, De Crespigny Park, London, SE5 8AF, UK
| | - Stephen P Nunn
- Department of Psychology, School of Science and Technology, Middlesex University, London, UK
| | - Robert J Howard
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Box PO70, De Crespigny Park, London, SE5 8AF, UK.,Division of Psychiatry, University College London, London, UK
| |
Collapse
|
7
|
Díez-Manglano J, Cabrerizo García JL, García-Arilla Calvo E, Jimeno Saínz A, Calvo Beguería E, Martínez-Álvarez RM, Bejarano Tello E, Caudevilla Martínez A. External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón. Intern Emerg Med 2015; 10:915-26. [PMID: 25986479 DOI: 10.1007/s11739-015-1252-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
Abstract
The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.
Collapse
Affiliation(s)
- Jesús Díez-Manglano
- Internal Medicine Department, Hospital Royo Villanova, Avda San Gregorio no 30, 50015, Saragossa, Spain.
- Research Group on Comorbidity and Polypathology in Aragón, Aragón Health Sciences Institute, Saragossa, Spain.
- Department of Medicine, Dermatology and Psychiatry, University of Zaragoza School of Medicine, Saragossa, Spain.
| | | | | | - Araceli Jimeno Saínz
- Research Group on Comorbidity and Polypathology in Aragón, Aragón Health Sciences Institute, Saragossa, Spain
- Internal Medicine Department, Hospital Ernest Lluch, Calatayud, Spain
| | | | - Rosa M Martínez-Álvarez
- Internal Medicine Department, Hospital Royo Villanova, Avda San Gregorio no 30, 50015, Saragossa, Spain
- Department of Medicine, Dermatology and Psychiatry, University of Zaragoza School of Medicine, Saragossa, Spain
| | - Esperanza Bejarano Tello
- Internal Medicine Department, Hospital Royo Villanova, Avda San Gregorio no 30, 50015, Saragossa, Spain
| | - Aránzazu Caudevilla Martínez
- Research Group on Comorbidity and Polypathology in Aragón, Aragón Health Sciences Institute, Saragossa, Spain
- Internal Medicine Department, Hospital Ernest Lluch, Calatayud, Spain
| |
Collapse
|
8
|
|
9
|
Bouillon K, Kivimaki M, Hamer M, Sabia S, Fransson EI, Singh-Manoux A, Gale CR, Batty GD. Measures of frailty in population-based studies: an overview. BMC Geriatr 2013; 13:64. [PMID: 23786540 PMCID: PMC3710231 DOI: 10.1186/1471-2318-13-64] [Citation(s) in RCA: 291] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/06/2013] [Indexed: 12/12/2022] Open
Abstract
Background Although research productivity in the field of frailty has risen exponentially in recent years, there remains a lack of consensus regarding the measurement of this syndrome. This overview offers three services: first, we provide a comprehensive catalogue of current frailty measures; second, we evaluate their reliability and validity; third, we report on their popularity of use. Methods In order to identify relevant publications, we searched MEDLINE (from its inception in 1948 to May 2011); scrutinized the reference sections of the retrieved articles; and consulted our own files. An indicator of the frequency of use of each frailty instrument was based on the number of times it had been utilized by investigators other than the originators. Results Of the initially retrieved 2,166 papers, 27 original articles described separate frailty scales. The number (range: 1 to 38) and type of items (range of domains: physical functioning, disability, disease, sensory impairment, cognition, nutrition, mood, and social support) included in the frailty instruments varied widely. Reliability and validity had been examined in only 26% (7/27) of the instruments. The predictive validity of these scales for mortality varied: for instance, hazard ratios/odds ratios (95% confidence interval) for mortality risk for frail relative to non-frail people ranged from 1.21 (0.78; 1.87) to 6.03 (3.00; 12.08) for the Phenotype of Frailty and 1.57 (1.41; 1.74) to 10.53 (7.06; 15.70) for the Frailty Index. Among the 150 papers which we found to have used at least one of the 27 frailty instruments, 69% (n = 104) reported on the Phenotype of Frailty, 12% (n = 18) on the Frailty Index, and 19% (n = 28) on one of the remaining 25 instruments. Conclusions Although there are numerous frailty scales currently in use, reliability and validity have rarely been examined. The most evaluated and frequently used measure is the Phenotype of Frailty.
Collapse
Affiliation(s)
- Kim Bouillon
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Martocchia A, Frugoni P, Indiano I, Tafaro L, Comite F, Amici A, Cacciafesta M, Marigliano V, Falaschi P. Screening of frailty in elderly patients with disability by the means of Marigliano-Cacciafesta polypathology scale (MCPS) and Canadian Study of Health and Aging (CSHA) scales. Arch Gerontol Geriatr 2013; 56:339-42. [PMID: 23246500 DOI: 10.1016/j.archger.2012.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 11/02/2012] [Accepted: 11/08/2012] [Indexed: 11/21/2022]
Abstract
Frailty is an age-related condition, characterized by a decreased homeostatic reserve and increased vulnerability to stressful events, with high risk of adverse outcomes. The aim of this study was to compare the evaluation of the frailty by the means of the MCPS and the Rockwood criteria. We enrolled 98 patients (mean age ± standard deviation, m ± SD, 80.7 ± 7.0 years) and 20 controls (82.7 ± 3.4 ys), who attended our outpatient clinic for the evaluation of disability and the renewal of driving license, respectively. The multidisciplinary geriatric assessment (MGA) was performed including the administration of the following scales for frailty: MCPS scale (range 0-245), CSHA-Rules-Based Definition of Frailty (CSHA-RBDF) (range 0-3) and CSHA-Clinical Frailty Scale (CSHA-CFS) (range 0-7). The patients and controls showed MCPS=52.39 ± 11.36 and 4.6 ± 3.28, CSHA-RBDF=2.27 ± 0.62 and 0.10 ± 0.44, CSHA-CFS=6.22 ± 0.75 and 2.95 ± 0.51, respectively (p<0.000001). Frailty scores were higher in female than in male (p=0.065 for CSHA-RDBF and p<0.05 for CSHA-CFS). The MCPS scores were significantly related to both CSHA-RDBF (r=0.753, p<0.001) and CSHA-CFS scores (r=0.793, p<0.001). The frailty scales were significantly related to disability, cognitive impairment and polypathology. In conclusion, the frail patient may be a carrier of multiple chronic pathologies and/or of physical/cognitive decline. The frail patient has to be considered the elective geriatric patient, characterized by a continuous multidimensional care requirement. MCPS is an useful tool for the frailty screening and to set up a tailored program of geriatric rehabilitation, in order to prevent or reduce the development of frailty-related complications.
Collapse
|
11
|
Abstract
The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.
Collapse
Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA). RECENT FINDINGS Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving. SUMMARY The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost-effectiveness of interventions based on its scoring deserves investigation.
Collapse
Affiliation(s)
- Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| |
Collapse
|
13
|
Affiliation(s)
| | | | - Sathya Karunananthan
- Solidage Research Group on Frailty and Aging: McGill University and Université de Montréal; Montreal; Canada
| | | | | |
Collapse
|
14
|
Affiliation(s)
- G Abellan Van Kan
- Gerontopole de Toulouse, Department of Geriatric medicine, Toulouse University Hospital, Toulouse, France
| | | |
Collapse
|
15
|
Amici A, Pecci M, Linguanti A, Passador P, Ponzanetti A, De Angelis R, Martinelli V, Zaccone M, Marigliano V, Cacciafesta M. Self-administrated test based on the Marigliano-Cacciafesta Polypathological Scale (MCPS), as a screening tool for early identification of frailty in the elderly: A cohort study. Arch Gerontol Geriatr 2011; 52:e60-5. [DOI: 10.1016/j.archger.2010.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 03/07/2010] [Accepted: 03/12/2010] [Indexed: 11/30/2022]
|
16
|
Abstract
No clear consensual definition regarding frailty seems to emerge from the literature after 30 years of research in the topic, and a large array of models and criteria has been proposed to define the syndrome. Controversy continues to exist on the choice of the components to be included in the frailty definition. Two main definitions based on clusters of components are found in literature: a physical phenotype of frailty, operationalized in 2001 by providing a list of 5 measurable items of functional impairments, which coexists with a multidomain phenotype, based on a frailty index constructed on the accumulation of identified deficits based on comprehensive geriatric assessment. The physical phenotype considers disability and comorbidities such as dementia as distinct entities and therefore outcomes of the frailty syndrome, whereas comorbidity and disability can be components of the multidomain phenotype. Expanded models of physical frailty (models that included clusters other than the original 5 items such as dementia) increased considerably the predicting capacity of poor clinical outcomes when compared with the predictive capacity of the physical phenotype. The unresolved controversy of the components shapes the clusters of original frailty syndrome, and the components depend very much on how frailty is defined. This update also highlights the growing evidence on gait speed to be considered as a single-item frailty screening tool. The evaluation of gait speed over a short distance emerges from the literature as a tool with the capacity to identify frail older adults, and slow gait speed has been proven to be a strong predictor for frailty-adverse outcomes.
Collapse
Affiliation(s)
- Gabor Abellan van Kan
- Gérontopôle de Toulouse, Department of Geriatric Medicine, Pavillon JP Junod, University Hospital Toulouse, CHU Toulouse, 170 Avenue de Casselardit, TSA 40031, 31059 Toulouse Cedex 9, France.
| | | | | | | | | | | |
Collapse
|
17
|
Lucicesare A, Hubbard RE, Fallah N, Forti P, Searle SD, Mitnitski A, Ravaglia G, Rockwood K. Comparison of two frailty measures in the Conselice Study of Brain Ageing. J Nutr Health Aging 2010; 14:278-81. [PMID: 20305994 DOI: 10.1007/s12603-010-0061-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Uncertainty about the definition of frailty is reflected by the development of many ways to identify frail people. We aimed to compare the validity of two frailty measures in participants of the Conselice Study of Brain Aging. DESIGN Prospective population-based study with 4 year follow up. PARTICIPANTS/SETTING 1,016 subjects aged 65 and over in a rural Italian population. METHODS For each participant, a Frailty Index (FI) and a Conselice Study of Brain Aging Score (CSBAS) were determined. The FI was created from 43 deficits according to a standardized methodology; 7 variables derived from a previously validated Easy Prognostic Score comprised the CSBAS. RESULTS The FI had characteristic properties described in other population samples, with a gamma distribution, a 99% limit of about 0.64 and higher values in women than men. CSBAS and FI were strongly correlated with each other (r = 0.72) and both correlated with age (r = 0.32, r = 0.27, respectively). Each was independently predictive of death in a multivariate model, with greater specificity and sensitivity than age alone. CONCLUSIONS Frailty can be measured by different tools and facilitates a more direct quantification of individual vulnerability than chronological age alone. Though the Frailty Index and the Conselice Study of Brain Aging Score are underpinned by different rationales, clinical utility will continue to motivate their development.
Collapse
Affiliation(s)
- A Lucicesare
- Department of Internal Medicine, Cardioangiology, and Hepatology, University Hospital Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Martocchia A, Indiano I, Tafaro L, Frugoni P, Amici A, Cacciafesta M, Marigliano V, Falaschi P. The evaluation of the presence of comorbidity by the Marigliano–Cacciafesta polypathology scale (MCPS) and the cumulative illness rating scale (CIRS) in elderly subjects with disability. Arch Gerontol Geriatr 2009; 49:150-2. [DOI: 10.1016/j.archger.2008.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 11/21/2022]
|
19
|
Amici A, Cicconetti P, Baratta A, Linguanti A, Scalise C, Giudice G, Piccirillo G, Marigliano V, Cacciafesta M. The Marigliano–Cacciafesta polypathology scale (MCPS): A tool for predicting the risk of developing disability. Arch Gerontol Geriatr 2008; 47:201-6. [DOI: 10.1016/j.archger.2007.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 08/02/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
|