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Wretborn J, Munir-Ehrlington S, Hörlin E, Wilhelms DB. Addition of the clinical frailty scale to triage tools and early warning scores improves mortality prognostication at 30 days: A prospective observational multicenter study. J Am Coll Emerg Physicians Open 2024; 5:e13244. [PMID: 39253302 PMCID: PMC11381915 DOI: 10.1002/emp2.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 09/11/2024] Open
Abstract
Objectives Frailty, assessed with clinical frailty scale (CFS), alone or in combination with aggregated vital signs, has been proposed as a measure to better predict mortality of older patients in the emergency department (ED), but the added predictive value to conventional triage is unclear. Methods This was a secondary analysis of a prospective observational study in three EDs in Sweden that evaluated the prognostic performance of the CFS alone or in combination with the national early warning score (NEWS), triage early warning score (TEWS) or the rapid emergency triage and treatment system (RETTS) triage tool using logistic regression. The primary outcome was 30-day mortality with 7- and 90-day mortality and admission as secondary outcomes reported as area under the receiver operating curve (AuROC) scores with 95% confidence intervals (CIs). The sensitivity, specificity, accuracy, predictive values, and likelihood ratios are reported for all models. Results A total of 1832 patients were included with 17 (0.9%), 57 (3.1%), and 121 (6.6%) patients dying within 7, 30, and 90 days, respectively. The admission rate was 43% (795/1832). Frailty (CFS > 4) was significantly associated with 30-day mortality (odds ratio 6, 95% CI 3‒12, p < 0.01). Prognostication of 30-day mortality was similar for all CFS-based models and better compared with models without CFS. The AuROC (95% CI) improved for RETTS from 0.67 (0.61‒0.74) to 0.83 (0.79‒0.88) (p = 0.008), for NEWS from 0.53 (0.45‒0.61) to 0.82 (0.77‒0.87) (p < 0.001), and for TEWS from 0.63 (0.55‒0.71) to 0.82 (0.77‒0.87) (p = 0.002). Conclusion Frailty measured with the CFS in combination with RETTS or structured vital sign assessment using NEWS or TEWS was better at prognosticating 30-day mortality compared to RETTS or early warnings score alone. Improved prognostication provides more realistic expectations and allows for informed discussions with patients and initiation of individualized treatment plans early in the ED process.
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Affiliation(s)
- Jens Wretborn
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Samia Munir-Ehrlington
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Erika Hörlin
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Daniel B Wilhelms
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
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Munir Ehrlington S, Hörlin E, Toll John R, Wretborn J, Wilhelms D. Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments. Emerg Med J 2024; 41:514-519. [PMID: 39053972 PMCID: PMC11347252 DOI: 10.1136/emermed-2023-213444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Older patients living with frailty have an increased risk for adverse events. The Clinical Frailty Scale (CFS) is a 9-point frailty assessment instrument that has shown promise to identify frail emergency department (ED) patients at increased risk of adverse outcomes. The aim of this study was to investigate the association between CFS scores and 30-day mortality in an ED setting when assessments are made by regular ED staff. METHOD This was a prospective multicentre observational study carried out between May and November 2021 at three EDs in Sweden, where frailty via CFS is routinely assessed by ED staff. All patients ≥65 years of age were eligible for inclusion. Mortality at 7, 30 and 90 days, admission rate, ED and hospital length of stay (LOS) were compared between patients living with frailty (CFS≥5) and robust patients. Logistic regression was used to adjust for confounders. RESULTS A total of 1840 ED visits of patients aged ≥65 years with CFS assessments done during the study period were analysed, of which 606 (32.9%) were patients living with frailty. Mortality after the index visit was higher in patients living with frailty at 7 days (2.6% vs 0.2%), 30 days (7.9% vs 0.9%) and 90 days (15.5% vs 2.4%). Adjusted ORs for mortality for those with frailty compared with more robust patients were 9.9 (95% CI 2.1 to 46.5) for 7-day, 6.0 (95% CI 3.0 to 12.2) for 30-day and 5.7 (95% CI 3.6 to 9.1) 90-day mortality. Patients living with frailty had higher admission rates, 58% versus 36%, a difference of 22% (95% CI 17% to 26%), longer ED LOS, 5 hours:08 min versus 4 hours:36 min, a difference of 31 min (95% CI 14 to 50), and longer in-hospital LOS, 4.8 days versus 2.7 days, a difference of 2.2 days (95% CI 1.2 to 3.0). CONCLUSION Patients living with frailty, had significantly higher mortality and admission rates as well as longer ED and in-hospital LOS compared with robust patients. The results confirm the capability of the CFS to risk stratify short-term mortality in older ED patients. TRIAL REGISTRATION NUMBER NCT04877028.
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Affiliation(s)
| | - Erika Hörlin
- Emergency Department, Linköping University Hospital, Linkoping, Östergötland, Sweden
| | - Rani Toll John
- Emergency Department, Linköping University Hospital, Linkoping, Östergötland, Sweden
| | - Jens Wretborn
- Emergency Department, Linköping University Hospital, Linkoping, Östergötland, Sweden
| | - Daniel Wilhelms
- Emergency Department, Linköping University Hospital, Linkoping, Östergötland, Sweden
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Chung HS, Choi Y, Lim JY, Kim K, Bae SJ, Choi YH, Lee DH. Validation of the Korean Version of the Clinical Frailty Scale-Adjusted Korean Triage and Acuity Scale for Older Patients in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:955. [PMID: 38929572 PMCID: PMC11205497 DOI: 10.3390/medicina60060955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: The Clinical Frailty Scale (CFS), used to screen for prehospital frailty in patients aged >65 years, is simple, time-efficient, and has been validated in emergency departments (EDs). In this study, we analyzed whether the Korean Triage and Acuity Scale (KTAS) classification by level in older patients determined to have frailty based on the Korean version of the CFS increases the triage performance of the current KTAS. Materials and Methods: The primary outcome was 30-day in-hospital mortality, and secondary outcomes were hospital and intensive care unit (ICU) admissions. This study retrospectively analyzed prospectively collected data from three ED centers. Patients with a CFS score ranging from five (mildly frail) to nine (terminally ill) were categorized into the frailty group. We upgraded the KTAS classification of the frailty group by one level of urgency and defined this as the CFS-KTAS. Results: The cutoff values for predicting admission were three and two for the KTAS and CFS-KTAS, respectively. A significant difference was observed in the area under the receiver operating characteristic (AUROC) curve between the KTAS and CFS-KTAS. To predict ICU admission, the cutoff score was two for both scales. A significant difference was observed in the AUROC curve between the KTAS and CFS-KTAS. For predicting in-hospital mortality, the cutoff score was two for both scales. A significant difference was observed in the AUROC curve between the KTAS and CFS-KTAS. Conclusions: This study showed that the CFS-adjusted KTAS has a more useful prognostic value than the KTAS alone for predicting hospital outcomes in older patients.
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Affiliation(s)
- Ho Sub Chung
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, 110, Deokan-ro, Gwangmyeong-si 14353, Republic of Korea; (H.S.C.); (Y.C.); (S.J.B.)
| | - Yunhyung Choi
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, 110, Deokan-ro, Gwangmyeong-si 14353, Republic of Korea; (H.S.C.); (Y.C.); (S.J.B.)
| | - Ji Yeon Lim
- Department of Emergency Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, 260, Gonghang-daero, Gangseo-gu, Seoul 07804, Republic of Korea; (J.Y.L.); (K.K.)
| | - Keon Kim
- Department of Emergency Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, 260, Gonghang-daero, Gangseo-gu, Seoul 07804, Republic of Korea; (J.Y.L.); (K.K.)
| | - Sung Jin Bae
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, 110, Deokan-ro, Gwangmyeong-si 14353, Republic of Korea; (H.S.C.); (Y.C.); (S.J.B.)
| | - Yoon Hee Choi
- Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea;
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, 110, Deokan-ro, Gwangmyeong-si 14353, Republic of Korea; (H.S.C.); (Y.C.); (S.J.B.)
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Vassallo W, Jarman H. Frailty assessment of older patients in the emergency department. Emerg Nurse 2024; 32:27-31. [PMID: 37461322 DOI: 10.7748/en.2023.e2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/06/2024]
Abstract
An ageing population is leading to an increase in patients attending emergency departments (EDs) with comorbidities and age-related syndromes such as frailty. Frailty is a clinical syndrome defined as an increased vulnerability to age-related or disease-related insults in older adults due to diminishing physiological reserves. It also places increased demands on staff and hospital services. Screening for frailty early in the care pathway ensures goal-directed and timely care. This article provides an overview of frailty and its assessment in older people presenting to the ED. It discusses the most commonly used frailty assessment tool in the ED, the Clinical Frailty Scale, and identifies that the results of frailty assessment should be used to initiate appropriate individualised care in older patients.
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Affiliation(s)
- Wendy Vassallo
- Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, England
| | - Heather Jarman
- midwifery and allied health professions, Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, England
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Wolf LA, Lo AX, Serina P, Chary A, Sri‐On J, Shankar K, Sano E, Liu SW. Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review. J Am Coll Emerg Physicians Open 2024; 5:e13084. [PMID: 38162531 PMCID: PMC10755799 DOI: 10.1002/emp2.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Objective Given the aging population and growing burden of frailty, we conducted this scoping review to describe the available literature regarding the use and impact of frailty assessment tools in the assessment and care of emergency department (ED) patients older than 60 years. Methods A search was made of the available literature using the Covidence system using various search terms. Inclusion criteria comprised peer-reviewed literature focusing on frailty screening tools used for a geriatric population (60+ years of age) presenting to EDs. An additional search of PubMed, EBSCO, and CINAHL for articles published in the last 5 years was conducted toward the end of the review process (January 2023) to search specifically for literature describing interventions for frailty, yielding additional articles for review. Exclusion criteria comprised articles focusing on an age category other than geriatric and care environments outside the emergency care setting. Results A total of 135 articles were screened for inclusion and 48 duplicates were removed. Of the 87 remaining articles, 20 were deemed irrelevant, leaving 67 articles for full-text review. Twenty-eight were excluded for not meeting inclusion criteria, leaving 39 full-text studies. Use of frailty screening tools were reported in the triage, care, and discharge decision-making phases of the ED care trajectory, with varying reports of usefulness for clinical decision-making. Conclusion The literature reports tools, scales, and instruments for identifying frailty in older patients at ED triage; multiple frailty scores or tools exist with varying levels of utilization. Interventions for frailty directed at the ED environment were scant. Further research is needed to determine the usefulness of frailty identification in the context of emergency care, the effects of care delivery interventions or educational initiatives for front-line medical professionals on patient-oriented outcomes, and to ensure these initiatives are acceptable for patients.
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Affiliation(s)
- Lisa A. Wolf
- Emergency Nurses AssociationSchaumburgIllinoisUSA
| | - Alexander X. Lo
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Peter Serina
- Department of Emergency MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Anita Chary
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Jiraporn Sri‐On
- Department of Emergency MedicineVajira HospitalBangkokThailand
| | - Kalpana Shankar
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Ellen Sano
- Department of Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Albrecht R, Espejo T, Riedel HB, Nissen SK, Banerjee J, Conroy SP, Dreher-Hummel T, Brabrand M, Bingisser R, Nickel CH. Clinical Frailty Scale at presentation to the emergency department: interrater reliability and use of algorithm-assisted assessment. Eur Geriatr Med 2024; 15:105-113. [PMID: 37971677 PMCID: PMC10876739 DOI: 10.1007/s41999-023-00890-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The Clinical Frailty Scale (CFS) allows health care providers to quickly stratify older patients, to support clinical decision-making. However, few studies have evaluated the CFS interrater reliability (IRR) in Emergency Departments (EDs), and the freely available smartphone application for CFS assessment was never tested for reliability. This study aimed to evaluate the interrater reliability of the Clinical Frailty Scale (CFS) ratings between experienced and unexperienced staff (ED clinicians and a study team (ST) of medical students supported by a smartphone application to assess the CFS), and to determine the feasibility of CFS assignment in patients aged 65 or older at triage. METHODS Cross-sectional study using consecutive sampling of ED patients aged 65 or older. We compared assessments by ED clinicians (Triage Clinicians (TC) and geriatric ED trained nurses (geriED-TN)) and a study team (ST) of medical students using a smartphone application for CFS scoring. The study is registered on Clinicaltrials.gov (NCT05400707). RESULTS We included 1349 patients aged 65 and older. Quadratic-weighted kappa values for ordinal CFS levels showed a good IRR between TC and ST (ϰ = 0.73, 95% CI 0.69-0.76), similarly to that between TC and geriED-TN (ϰ = 0.75, 95% CI 0.66-0.82) and between the ST and geriED-TN (ϰ = 0.74, 95% CI 0.63-0.81). A CFS rating was assigned to 972 (70.2%) patients at triage. CONCLUSION We found good IRR in the assessment of frailty with the CFS in different ED providers and a team using a smartphone application to support rating. A CFS assessment occurred in more than two-thirds (70.2%) of patients at triage.
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Affiliation(s)
- Rainer Albrecht
- Emergency Department, University Hospital Basel, University of Basel, Petersgraben 2, 4031, Basel, Switzerland
| | - Tanguy Espejo
- Emergency Department, University Hospital Basel, University of Basel, Petersgraben 2, 4031, Basel, Switzerland
| | - Henk B Riedel
- Emergency Department, University Hospital Basel, University of Basel, Petersgraben 2, 4031, Basel, Switzerland
| | - Søren K Nissen
- Research Unit for Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Jay Banerjee
- University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Simon P Conroy
- St Pancras Hospital, Central and North West London NHS Foundation Trust, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, University College London Hospitals, London, UK
| | - Thomas Dreher-Hummel
- Emergency Department, University Hospital Basel, University of Basel, Petersgraben 2, 4031, Basel, Switzerland
| | - Mikkel Brabrand
- Research Unit for Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Petersgraben 2, 4031, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Petersgraben 2, 4031, Basel, Switzerland.
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Sert ET, Kokulu K, Mutlu H, Yortanlı BC. Effects of Clinical Frailty Scale Score on Adverse Outcomes and Length of Emergency Department Stay Before Intensive Care Unit Admission. J Emerg Med 2024; 66:e10-e19. [PMID: 37919186 DOI: 10.1016/j.jemermed.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Older adults living with frailty who require treatment in hospitals are increasingly seen in emergency departments (EDs). OBJECTIVE This study investigated the effects of frailty severity according to the Clinical Frailty Scale (CFS) on adverse outcomes and length of stay in the ED before intensive care unit (ICU) admission. METHODS We conducted this prospective observational study with patients 65 years or older and admitted to the ICU from March 1, 2021 to December 31, 2022. We divided the patients into four groups according to their CFS scores. We determined the effects of frailty severity on length of ED stay and clinical outcomes using logistic regression analysis. RESULTS Of the 920 patients included in the study, 25.4% were nonfrail, 26.2% had mild frailty, 25.9% had moderate frailty, and 22.5% had severe frailty. In the regression analysis, compared with those who were nonfrail, the length of ED stay was significantly longer for those with moderate frailty (odds ratio [OR] 2.13; 95% confidence interval [CI] 1.63-2.90) or severe frailty (OR 3.32; 95% CI 1.92-3.87), but the result was not significant for those with mild frailty (OR 1.65; 95% CI 1.21-2.45). ICU mortality was significantly higher among patients with mild, moderate, or severe frailty than among those who were nonfrail. CONCLUSIONS We found CFS score to be a predictor of length of ED stay and adverse outcomes. Accordingly, CFS evaluation can provide an idea of the length of ED stay and the likelihood of adverse outcomes.
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Affiliation(s)
- Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
| | - Kamil Kokulu
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
| | - Hüseyin Mutlu
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
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Källberg AS, Berg LM, Skogli S, Bjurbo C, Muntlin Å, Ehrenberg A. Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments. BMC Geriatr 2023; 23:798. [PMID: 38049748 PMCID: PMC10694934 DOI: 10.1186/s12877-023-04545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited. AIM To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs. METHODS The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes. RESULTS A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care. CONCLUSION Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.
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Affiliation(s)
- Ann-Sofie Källberg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden.
- Department of Emergency Medicine, Falun Hospital and Centre for Clinical Research Dalarna, Nissers väg 3, Falun, SE-791 82, Sweden.
| | - Lena M Berg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden
| | - Sara Skogli
- Department of Internal Medicine, Falun Hospital, Falun, SE-791 82, Sweden
| | - Charlotte Bjurbo
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
| | - Åsa Muntlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, entrance 40, level 5, Uppsala, SE-751 85, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, SE-791 88, Sweden
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Blázquez-Andión M, Montiel-Dacosta JA, Rizzi-Bordigoni M, Acosta-Mejuto B, Moliné-Pareja A, Ris-Romeu J, Puig-Campmany M. Frailty and mortality: Utility of Frail-VIG index in ED short-stay units for older adults. Arch Gerontol Geriatr 2023; 115:105208. [PMID: 37774490 DOI: 10.1016/j.archger.2023.105208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Frailty assessment allows the identification of patients at risk of death. The aim here was to study the ability of Frail-VIG Index (FI-VIG) in order to discriminate frailty groups of older adults and garner its correlation with mortality in an Emergency-Department Short-Stay Unit (ED-SSU). METHODS Our observational, single-center, prospective study consecutively included patients over 65-years-old admitted between March 1, 2021, and April 30, 2021. RESULTS 302 patients were included (56 % women), mean age 83 ± 8 years, and 39.1 % of them had a functional disability whilst 16.5 % of them had dementia. A total of 174 patients (58 %) met the frailty criteria (FI-VIG ≥ 0.2): 111 (63.8 %) had mild frailty (FI-VIG 0.2-0.36), 52 (29.9 %) had moderate frailty (FI-VIG 0.36-0.55), and 11 (6.3 %) had advanced frailty (FI-VIG > 0.55). Mortality at 30 days, 6 months, and 1 year was analyzed: no frailty was 6.3 %, 10.8 %, and 12.5 %, respectively; mild frailty was 10.8 %, 22.5 %, and 22.5 %, respectively; moderate frailty was 25 %, 34.6 %, and 42.3 %, respectively; advanced frailty was 36.4 %, 54.5 %, and 3.6 %, respectively. This shows the significant differences between the groups (1-year mortality p < 0.001). Mild frailty vs. non-frail HR was 2.47 (95 %CI 1.12-5.46), moderate frailty vs. non-frail HR was 6.93 (95 %CI 3.16-15.23), and advanced frailty vs. non-frail HR was 11.29 (95 %CI 3.54-36.03). The mean test time was 7 min. CONCLUSIONS There was a strong correlation between frailty degree and mortality at 1, 6, and 12 months. FI-VIG is fast and easy-to-use in this setting. It is routine implementation in ED-SSUs could enable early risk stratification.
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Affiliation(s)
- Marta Blázquez-Andión
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Josep Anton Montiel-Dacosta
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Miguel Rizzi-Bordigoni
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Belen Acosta-Mejuto
- Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Antoni Moliné-Pareja
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain
| | - Josep Ris-Romeu
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain; Urgent Care Process Hospital de la Santa Creu i Sant Pau. Sant Quintí 87, Barcelona 08025, Spain
| | - Mireia Puig-Campmany
- Autonomous University of Barcelona, Medicine Department. Plaza Cívica, Bellaterra, Cerdanyola del Valles 08193, Spain.; Emergency Department, Hospital de la Santa Creu i Sant Pau. Sant Quinti 87, Barcelona 08025, Spain; IB Sant Pau, Research Institute. Sant Quinti 91, Barcelona 08025, Spain.
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Nickel CH, Kellett J. Assessing Physiologic Reserve and Frailty in the Older Emergency Department Patient: Should the Paradigm Change? Clin Geriatr Med 2023; 39:475-489. [PMID: 37798060 DOI: 10.1016/j.cger.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Older patients are more vulnerable to acute illness or injury because of reduced physiologic reserve associated with aging. Therefore, their assessment in the emergency department (ED) should include not only vital signs and their baseline values but also changes that reflect physiologic reserve, such as mobility, mental status, and frailty. Combining aggregated vitals sign scores and frailty might improve risk stratification in the ED. Implementing these changes in ED assessment may require the introduction of senior-friendly processes to ensure ED treatment is appropriate to the older patients' immediate discomfort, personal goals, and likely prognosis.
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Affiliation(s)
- Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Petersgraben 2, Basel CH-4031, Switzerland.
| | - John Kellett
- Department of Emergency Medicine, Odense University Hospital, University of Southern Denmark, Denmark
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11
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Abstract
Frailty affects approximately one in two patients over 70 years of age in the emergency department. These are inadequately identified as high-risk patients using conventional triage tools. Frailty screening improves the identification of high-risk patients with increased hospitalisation and readmission rates, 30-day and one-year mortality. Unspecific complaints and geriatric syndromes should be recognised as red flags, and age-specific peculiarities of vital signs should be taken into account. A holistic evaluation should already be carried out in the emergency department, as focusing on individual problems is not target-oriented. All patients identified in the screening should be evaluated geriatrically in the course. For patients with frailty, the improvement of subjective well-being is in the foreground. Inpatient admission is partly avoidable, even if this is associated with health risks. This should be discussed with the patient within the framework of participatory decision-making. In advanced frailty, the needs correspond to those of palliative patients.
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Affiliation(s)
- Jan-Niklas Krohn
- Schwerpunkt Geriatrie, Klinik für Innere Medizin 2, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg
| | - Katrin Singler
- Schwerpunkt Geriatrie, Klinik für Innere Medizin 2, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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12
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Hörlin E, Munir Ehrlington S, Toll John R, Henricson J, Wilhelms D. Is the clinical frailty scale feasible to use in an emergency department setting? A mixed methods study. BMC Emerg Med 2023; 23:124. [PMID: 37880591 PMCID: PMC10601295 DOI: 10.1186/s12873-023-00894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is a frailty assessment tool used to identify frailty in older patients visiting the emergency department (ED). However, the current understanding of how it is used and accepted in ED clinical practice is limited. This study aimed to assess the feasibility of CFS in an ED setting. METHODS This was a prospective, mixed methods study conducted in three Swedish EDs where CFS had recently been introduced. We examined the completion rate of CFS assessments in relation to patient- and organisational factors. A survey on staff experience of using CFS was also conducted. All quantitative data were analysed descriptively, while free text comments underwent a qualitative content analysis. RESULTS A total of 4235 visits were analysed, and CFS assessments were performed in 47%. The completion rate exceeded 50% for patients over the age of 80. Patients with low triage priority were assessed to a low degree (24%). There was a diurnal variation with the highest completion rates seen for arrivals between 6 and 12 a.m. (58%). The survey response rate was 48%. The respondents rated the perceived relevance and the ease of use of the CFS with a median of 5 (IQR 2) on a scale with 7 being the highest. High workload, forgetfulness and critical illness were ranked as the top three barriers to assessment. The qualitative analysis showed that CFS assessments benefit from a clear routine and a sense of apparent relevance to emergency care. CONCLUSION Most emergency staff perceived CFS as relevant and easy to use, yet far from all older ED patients were assessed. The most common barrier to assessment was high workload. Measures to facilitate use may include clarifying the purpose of the assessment with explicit follow-up actions, as well as formulating a clear routine for the assessment. REGISTRATION The study was registered on ClinicalTrials.gov 2021-06-18 (identifier: NCT04931472).
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Affiliation(s)
- Erika Hörlin
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Samia Munir Ehrlington
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rani Toll John
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Joakim Henricson
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Daniel Wilhelms
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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13
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Fehlmann CA, Stuby L, Graf C, Genoud M, Rigney R, Goldstein J, Eagles D, Suppan L. Assessment of frailty by paramedics using the clinical frailty scale - an inter-rater reliability and accuracy study. BMC Emerg Med 2023; 23:121. [PMID: 37833643 PMCID: PMC10576312 DOI: 10.1186/s12873-023-00875-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Frailty assessment by paramedics in the prehospital setting is understudied. The goals of this study were to assess the inter-rater reliability and accuracy of frailty assessment by paramedics using the Clinical Frailty Scale (CFS). METHODS This was a cross-sectional study with paramedics exposed to 30 clinical vignettes created from real-life situations. There was no teaching intervention prior to the study and paramedics were only provided with the French version of the CFS (definitions and pictograms). The primary outcome was the inter-rater reliability of the assessment. The secondary outcome was the accuracy, compared with the expert-based assessment. Reliability was determined by calculating an intraclass correlation coefficient (ICC). Accuracy was assessed through a mixed effects logistic regression model. A sensitivity analysis was carried out by considering that an assessment was still accurate if the score differed from no more than 1 level. RESULTS A total of 56 paramedics completed the assessment. The overall assessment was found to have good inter-rater reliability (ICC = 0.87 [95%CI 0.81-0.93]). The overall accuracy was moderate at 60.6% (95%CI 54.9-66.1) when considering the full scale. It was however much higher (94.8% [95%CI 92.0-96.7] when close assessments were considered as accurate. The only factor associated with accurate assessment was field experience. CONCLUSION The assessment of frailty by paramedics was reliable in this vignette-based study. However, the accuracy deserved to be improved. Future research should focus on the clinical impact of these results and on the association of prehospital frailty assessment with patient outcomes. REGISTRATION This study was registered on the Open Science Framework registries ( https://doi.org/10.17605/OSF.IO/VDUZY ).
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Affiliation(s)
- Christophe A Fehlmann
- Division of Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada.
| | - Loric Stuby
- Genève TEAM Ambulances, Emergency Medical Services, Geneva, CH-1201, Switzerland
| | - Christophe Graf
- Department of rehabilitation and geriatrics, Geneva University Hospitals, Geneva, CH-1211, Switzerland
| | - Matthieu Genoud
- Division of Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
| | | | - Judah Goldstein
- Dalhousie Department of Emergency Medicine, Division of EMS, Halifax, NS, Canada
| | - Debra Eagles
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, K1G 5Z3, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva, CH-1211, Switzerland
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14
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Cheek C, Hayba N, Richardson L, Austin EE, Francis Auton E, Safi M, Ransolin N, Vukasovic M, De Los Santos A, Murphy M, Harrison R, Churruca K, Long JC, Hibbert PD, Carrigan A, Newman B, Hutchinson K, Mitchell R, Cutler H, Holt L, Braithwaite J, Gillies D, Salmon PM, Walpola RL, Zurynski Y, Ellis LA, Smith K, Brown A, Ali R, Gwynne K, Clay-Williams R. Experience-based codesign approach to improve care in Australian emergency departments for complex consumer cohorts: the MyED project protocol, Stages 1.1-1.3. BMJ Open 2023; 13:e072908. [PMID: 37407042 DOI: 10.1136/bmjopen-2023-072908] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Emergency department (ED) care must adapt to meet current and future demands. In Australia, ED quality measures (eg, prolonged length of stay, re-presentations or patient experience) are worse for older adults with multiple comorbidities, people who have a disability, those who present with a mental health condition, Indigenous Australians, and those with a culturally and linguistically diverse (CALD) background. Strengthened ED performance relies on understanding the social and systemic barriers and preferences for care of these different cohorts, and identifying viable solutions that may result in sustained improvement by service providers. A collaborative 5-year project (MyED) aims to codesign, with ED users and providers, new or adapted models of care that improve ED performance, improve patient outcomes and improve patient experience for these five cohorts. METHODS AND ANALYSIS Experience-based codesign using mixed methods, set in three hospitals in one health district in Australia. This protocol introduces the staged and incremental approach to the whole project, and details the first research elements: ethnographic observations at the ED care interface, interviews with providers and interviews with two patient cohorts-older adults and adults with a CALD background. We aim to sample a diverse range of participants, carefully tailoring recruitment and support. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/PID02749-2022/ETH02447). Prior informed written consent will be obtained from all research participants. Findings from each stage of the project will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales, Australia.
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Affiliation(s)
- Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nema Hayba
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aaron De Los Santos
- Department of Emergency Medicine, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Margaret Murphy
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Henry Cutler
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Leanne Holt
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Donna Gillies
- NDIS Quality and Safeguards Commission, Penrith, New South Wales, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Ramesh Lahiru Walpola
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kylie Smith
- Emergency Care Institute, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Anthony Brown
- Western Sydney University, Penrith, New South Wales, Australia
| | - Reza Ali
- Department of Emergency Medicine, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Kylie Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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15
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Moloney E, O’Donovan MR, Sezgin D, Flanagan E, McGrath K, Timmons S, O’Caoimh R. Diagnostic Accuracy of Frailty Screening Instruments Validated for Use among Older Adults Attending Emergency Departments: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6280. [PMID: 37444127 PMCID: PMC10341387 DOI: 10.3390/ijerph20136280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
Early identification of frailty can prevent functional decline. Although multiple frailty screens exist for use in Emergency Departments (EDs), few are validated against diagnostic standards such as comprehensive geriatric assessment. To examine the diagnostic accuracy of ED screens for frailty, scientific databases were searched for prospective diagnostic accuracy test studies from January 2000 to September 2022. Studies were assessed for risk of bias using QUADAS-C. Psychometric properties were extracted and analysed using R. Six studies involving 1,663 participants describing seven frailty screening instruments (PRISMA-7, CFS, VIP, FRESH, BPQ, TRST, and ISAR), representing 13 unique data points, were included. The mean age of participants ranged from 76 to 86 years. The proportion that was female ranged from 45 to 60%. The pooled prevalence rate of frailty was high at 59%. The pooled estimate for sensitivity was 0.85 (95% CI: 0.76-0.91) versus 0.77 (95% CI: 0.62-0.88) for specificity. Pooled accuracy based on area under the ROC curve was 0.89 (95% CI: 0.86-0.90). Although few studies were found, limiting the ability to conduct a meta-analysis of individual instruments, available frailty screens can accurately diagnose frailty in older adults attending the ED. As specificity was comparatively low, additional assessment may be required to identify those requiring inpatient management or onward community referral. Further study is therefore required.
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Affiliation(s)
- Elizabeth Moloney
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Grenville Place, T12 WE28 Cork, Ireland; (E.M.); (M.R.O.); (E.F.)
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland; (K.M.); (S.T.)
| | - Mark R. O’Donovan
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Grenville Place, T12 WE28 Cork, Ireland; (E.M.); (M.R.O.); (E.F.)
| | - Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, H91 TK33 Galway, Ireland;
| | - Evelyn Flanagan
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Grenville Place, T12 WE28 Cork, Ireland; (E.M.); (M.R.O.); (E.F.)
| | - Keith McGrath
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland; (K.M.); (S.T.)
| | - Suzanne Timmons
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland; (K.M.); (S.T.)
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Douglas Road, T12 XH60 Cork, Ireland
| | - Rónán O’Caoimh
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Grenville Place, T12 WE28 Cork, Ireland; (E.M.); (M.R.O.); (E.F.)
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland; (K.M.); (S.T.)
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16
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Alshibani A, Alharbi M, Conroy S. Frailty Identification in Prehospital Care: A Scoping Review of the Literature. Open Access Emerg Med 2023; 15:227-239. [PMID: 37337614 PMCID: PMC10276993 DOI: 10.2147/oaem.s409083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023] Open
Abstract
The proportion of older adults is increasing worldwide. Frailty assessment in prehospital care was suggested to improve triage decisions and paramedics' judgment. This study aimed to assess the scope and nature of available evidence around frailty identification in prehospital care. A systematic search of the literature was performed using MEDLINE, SCOPUS, CINHAL, and Web of Science to identify relevant articles published from January 2022 downwards. A list of indexed terms and their associated alternatives were pre-determined. Of the 71 identified and reviewed articles after removing duplicates, six articles were included in the review. Due to the heterogeneity of the included articles, the findings were described narratively. The findings of this review showed that the available evidence is limited and heterogenic. Two themes emerged from the findings of the included articles: 1) Paramedics' Perceptions about Frailty Assessment in Prehospital Care and 2) Frailty Scores for Application in Prehospital Care. Paramedics recognised frailty assessment in pre-hospital care to be feasible and important. They highlighted the need for a simple and clear frailty score that could be used and mentioned to other healthcare professionals when handing over patients. Six frailty scores were reported to be used in prehospital care. The evidence around each frailty score is very limited. Overall, frailty assessment in prehospital care was shown to be important and feasible. Different frailty scores have been assessed for use in prehospital care. Further research investigating frailty identification in prehospital care is needed.
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Affiliation(s)
- Abdullah Alshibani
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Meshal Alharbi
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Simon Conroy
- MRC Lifelong Health & Ageing Unit, University College London, London, UK
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17
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van Dam CS, Peters MJL, Hoogendijk EO, Nanayakkara PWB, Muller M, Trappenburg MC. Older patients with nonspecific complaints at the Emergency Department are at risk of adverse health outcomes. Eur J Intern Med 2023; 112:86-92. [PMID: 37002150 DOI: 10.1016/j.ejim.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Older adults at the Emergency Department (ED) often present with nonspecific complaints (NSC) such as 'weakness' or 'feeling unwell'. Health care workers may underestimate illness in patients with NSC, leading to adverse health outcomes. This study compares characteristics and outcomes of NSC-patients versus specific complaints (SC) patients. METHODS Cohort study in patients ≥ 70 years in two Dutch EDs. NSC was classified according to the BANC-study-framework based on the medical history in the ED letter, before additional diagnostics took place. A second classification was performed at the end of the ED visit/hospital admission. Primary outcomes were functional decline, institutionalization, and mortality at 30 days. RESULTS 26% (n = 228) of a total of 888 included patients presented with NSC. Compared with SC-patients, NSC-patients were older, more frail, and more frequently female. NSC-patients had a higher risk of functional decline and institutionalization at 30 days (adjusted ORs 1.84, 95% CI 1.27 - 2.72, and 2.46, 95% CI 1.51-4.00, respectively), but not mortality (adjusted OR 1.26, 95% CI 0.58 - 2.73). Reclassification to a specific complaint after the ED visit or hospital admission occurred in 54% of NSC-patients. CONCLUSION NSC occur especially in older, frail female patients and are associated with an increased risk of functional decline and institutionalization, even after adjustment for worse baseline status. In half of the patients, a specific complaint revealed during ED or hospital stay. Physicians at the ED should consider NSC as a red flag needing appropriate observation and evaluation of underlying serious conditions and needs of this vulnerable patient group.
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Affiliation(s)
- C S van Dam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - M J L Peters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine and Vascular Medicine, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Internal Medicine and Geriatrics, UMC Utrecht, the Netherlands
| | - E O Hoogendijk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, the Netherlands
| | - P W B Nanayakkara
- Amsterdam UMC, Vrije Universiteit Amsterdam, Section General Internal Medicine, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, the Netherlands
| | - M Muller
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, De Boelelaan 1117, Amsterdam, the Netherlands
| | - M C Trappenburg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Internal Medicine and Geriatrics, Amstelland Hospital, Amstelveen, the Netherlands
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18
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Ekermo D, Ronnås M, Muntlin Å. Fundamental nursing actions for frail older people in the emergency department: A national cross-sectional survey and a qualitative analysis of practice guidelines. J Adv Nurs 2023. [PMID: 36861791 DOI: 10.1111/jan.15627] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Abstract
AIMS To map how frailty among older people is assessed at Swedish emergency departments and to describe fundamental nursing care actions for these patients. DESIGN Descriptive national survey and a qualitative analysis of text. METHODS A majority (82%, n = 54) of the Swedish hospital-based emergency departments for adults were included, representing all six healthcare regions. An online survey was used to collect data, together with submitted local practice guidelines for older people at the emergency departments. Data were collected during February-October 2021. Descriptive and comparative statistics were performed together with a deductive content analysis framed by the Fundamentals of Care framework. RESULTS Sixty-five per cent (35 of 54) of the emergency departments identified frailty, with less than half of them using an established assessment instrument. Twenty-eight (52%) of the emergency departments have practice guidelines containing fundamental nursing actions for the care of frail older people. The majority of nursing actions in the practice guidelines were related to patients' physical care needs (91%), followed by psychosocial care needs (9%). No actions could be identified as relational actions (0%) according to the Fundamentals of Care framework. CONCLUSION Many Swedish emergency departments identify frail older people, but they use a range of different assessment instruments. While practice guidelines directing fundamental nursing actions for frail older people are often in place, a holistic, person-centred view addressing the patient's physical, psychosocial and relational care needs is missing. IMPACT The population is growing older, and more people are needing more complex hospital care. Frail older people have an increased risk of negative outcomes. The use of a variety of assessment instruments for frailty may pose a challenge to equal care. To ensure a holistic, person-centred view of frail older people, the Fundamentals of Care framework can be used in developing and reviewing practice guidelines. PATIENT OR PUBLIC CONTRIBUTION Clinicians and non-health professionals were invited to review the survey to ensure face and content validity.
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Affiliation(s)
- David Ekermo
- Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Matilda Ronnås
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Muntlin
- Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden.,Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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19
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Falk Erhag H, Guðnadóttir G, Alfredsson J, Cederholm T, Ekerstad N, Religa D, Nellgård B, Wilhelmson K. The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings - A Systematic Review of the Literature. Clin Interv Aging 2023; 18:249-261. [PMID: 36843633 PMCID: PMC9946013 DOI: 10.2147/cia.s388160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/14/2022] [Indexed: 02/19/2023] Open
Abstract
Background Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill. Purpose To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings. Design Systematic review with narrative synthesis. Methods Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020. Results Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review. Conclusion A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.
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Affiliation(s)
- Hanna Falk Erhag
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden,Correspondence: Hanna Falk Erhag, Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Wallinsgatan 6, Gothenburg, SE 431 41, Sweden, Tel +46 760 476888, Fax +46 31 786 60 77, Email
| | - Gudny Guðnadóttir
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Ekerstad
- Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden,The Research and Development Unit, NU Hospital Group, Trollhättan, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences, and Society, Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden,Division for Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Studies, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Wilhelmson
- Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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O’Caoimh R, McGauran J, O’Donovan MR, Gillman C, O’Hea A, Hayes M, O’Connor K, Moloney E, Alcock M. Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:290. [PMID: 36612612 PMCID: PMC9819173 DOI: 10.3390/ijerph20010290] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Prompt recognition of frailty in the emergency department (ED) is important to identify patients at higher risk of adverse outcomes. Despite this, few studies examine the diagnostic accuracy of screening instruments for frailty, instead focusing on predictive validity. We compared three commonly used, short frailty screens to an independent comprehensive geriatric assessment (CGA) in an urban University Hospital ED. Consecutive attendees aged ≥70 years were screened by trained raters, blind to the CGA, with the Variable Indicative of Placement risk (VIP), 3 and 4-item versions, Clinical Frailty Scale (CFS) and PRISMA-7. Accuracy was measured from the area under the ROC curve (AUROC). In total, 197 patients were included, median age 79 (±10); 46% were female. Half (49%) were confirmed as frail after CGA. All instruments differentiated frail from non-frail states, although the CFS (AUROC: 0.91) and PRISMA-7 (AUROC: 0.90) had higher accuracy compared to the VIP-4 (AUROC: 0.84) and VIP-3 (AUROC: 0.84). The CFS was significantly more accurate than the VIP-3 (p = 0.026) or VIP-4 (p = 0.047). There was no significant difference between the CFS and PRISMA-7 (p = 0.90). The CFS and PRISMA-7 were more accurate and should be considered in preference to the VIP (3 or 4-item versions) to identify frailty in EDs.
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Affiliation(s)
- Rónán O’Caoimh
- Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
- Clinical Research Facility Cork, University College Cork, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - Jane McGauran
- Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
| | - Mark R. O’Donovan
- Clinical Research Facility Cork, University College Cork, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - Ciara Gillman
- Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
| | - Anne O’Hea
- Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
| | - Mary Hayes
- Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
| | - Kieran O’Connor
- Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
| | - Elizabeth Moloney
- Clinical Research Facility Cork, University College Cork, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - Megan Alcock
- Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
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21
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Kabell Nissen S, Rueegg M, Carpenter CR, Kaeppeli T, Busch J, Fournaise A, Dreher‐Hummel T, Bingisser R, Brabrand M, Nickel CH. Prognosis for older people at presentation to emergency department based on frailty and aggregated vital signs. J Am Geriatr Soc 2022; 71:1250-1258. [PMID: 36511431 DOI: 10.1111/jgs.18170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/07/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Risk stratification for older people based on aggregated vital signs lack the accuracy to predict mortality at presentation to the Emergency Department (ED). We aimed to develop and internally validate the Frailty adjusted Prognosis in ED tool (FaP-ED) for 30-day mortality combining frailty and aggregated vital signs. METHODS Single-center prospective cohort of undifferentiated ED patients aged 65 or older, consecutively sampled upon ED presentation from a tertiary Emergency Center. Vital signs were aggregated using the National Early Warning Score (NEWS) as a measure of illness or injury severity and frailty was assessed with the Clinical Frailty Scale (CFS). The FaP-ED was constructed by combining NEWS and CFS in multivariable logistic regression. The primary outcome was 30-day mortality. Measures of discrimination and calibration were assessed to evaluate predictive performance and internally validated using bootstrapping. RESULTS 2250 patients were included, 67 (1.8%) were omitted from analyses due to missing CFS, loss to follow-up, or terminal illness. Thirty-day mortality rate was 5.4% (N = 122, 95% CI = 4.5%-6.4%). Median NEWS was 1 (Inter-Quartile Range (IQR): 0-3) and median CFS was 4 (IQR: 3-5). The Area Under Receiver Operating Characteristic (AUROC) for FaP-ED was 0.86 (95% CI = 0.83-0.90). This was significantly higher than NEWS (0.81, 95% CI = 0.77-0.85, DeLong: Z = 3.5, p < 0.001) or CFS alone (0.82, 95% CI = 0.78-0.86, DeLong: Z = 4.4, p < 0.001). Bootstrapped estimates of FaP-ED AUROC, calibration slope, and intercept were 0.86, 0.95, and -0.09, respectively, suggesting internal validity. A decision-threshold of CFS 5 and NEWS 3 was proposed based on qualitative comparison of positive Likelihood Ratio at all relevant FaP-ED cutoffs. CONCLUSION Combining aggregated vital signs and frailty accurately predicted 30-day mortality at ED presentation and illustrated an important clinical interaction between frailty and illness severity. Pending external validation, the Fap-ED operationalizes the concept of such "geriatric urgency" for the ED setting.
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Affiliation(s)
- Søren Kabell Nissen
- Institute of Regional Health Research University of Southern Denmark Esbjerg Denmark
- Department of Emergency Medicine Hospital South West Jutland, University hospital of Southern Denmark Esbjerg Denmark
| | - Marco Rueegg
- Department of Emergency Medicine University Hospital Basel, University of Basel Basel Switzerland
| | - Christopher R. Carpenter
- Department of Emergency Medicine Washington University in St. Louis School of Medicine, Emergency Care Research Core St. Louis Michigan USA
| | - Tobias Kaeppeli
- Department of Emergency Medicine University Hospital Basel, University of Basel Basel Switzerland
| | - Jeanette‐Marie Busch
- Department of Emergency Medicine University Hospital Basel, University of Basel Basel Switzerland
| | - Anders Fournaise
- Department of Cross‐sectoral Collaboration Region of Southern Denmark Vejle Denmark
- Epidemiology, Biostatistics and Biodemography, Department of Public Health University of Southern Denmark Odense Denmark
- Geriatric Research Unit, Department of Geriatric Medicine Odense University Hospital Odense Denmark
| | - Thomas Dreher‐Hummel
- Department of Emergency Medicine University Hospital Basel, University of Basel Basel Switzerland
| | - Roland Bingisser
- Department of Emergency Medicine University Hospital Basel, University of Basel Basel Switzerland
| | - Mikkel Brabrand
- Institute of Regional Health Research University of Southern Denmark Esbjerg Denmark
- Department of Emergency Medicine Odense University Hospital Odense Denmark
| | - Christian H. Nickel
- Department of Emergency Medicine University Hospital Basel, University of Basel Basel Switzerland
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22
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Hörlin E, Munir Ehrlington S, Henricson J, John RT, Wilhelms D. Inter-rater reliability of the Clinical Frailty Scale by staff members in a Swedish emergency department setting. Acad Emerg Med 2022; 29:1431-1437. [PMID: 36200372 PMCID: PMC10092290 DOI: 10.1111/acem.14603] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION As frailty among the elderly is receiving increasing attention in emergency departments (EDs) around the world, the use of frailty assessment tools is growing. An often used such tool is the Clinical Frailty Scale (CFS), whose inter-rater reliability has been sparingly investigated in ED settings. No inter-rater reliability study regarding CFS has previously been performed within the Scandinavian ED context. The primary aim of this study was to evaluate the inter-rater reliability of the CFS in a Swedish ED setting. METHODS This was a prospective observational study conducted at three Swedish EDs. Patients ≥65 years were independently assessed with CFS by their responsible physician, registered nurse, and assistant nurse. Demographic information for each assessor was collected, along with frailty status (frail/not frail) on the basis of clinical judgment. Inter-rater reliability was calculated using intraclass correlation coefficient (ICC), whereas agreement of frailty assessed by CFS (dichotomized between frail/not frail, cutoff at ≥5 points) versus solely by clinical judgment was calculated by using cross-tabulation. RESULTS One-hundred patients were included. We found inter-rater reliability to be moderate to good (ICC 0.78, 95% confidence interval [CI] 0.72-0.84), regardless of whether the care team included an emergency physician (ICC 0.74, 95% CI 0.62-0.83) or an intern/resident from another specialty (ICC 0.83, 95% CI 0.74-0.89). The agreement of clinically judged frailty compared to frailty according to CFS was 84%. In the opposing cases, staff tended to assess patients as frail to a higher extent using clinical judgment than by applying CFS on the same patient. CONCLUSIONS The CFS appears to have a moderate to good inter-rater reliability when used in a clinical ED setting. When guiding clinical decisions, we advise that the CFS score should be discussed within the team. Further research needs to be performed on the accuracy of clinical judgment to identify frailty in ED patients.
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Affiliation(s)
- Erika Hörlin
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Samia Munir Ehrlington
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Joakim Henricson
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rani Toll John
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Daniel Wilhelms
- Department of Emergency Medicine and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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23
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Shaharudin MI, Abd Rahman NFN, Abd Rahman NFN. Prevalence of Frailty and Its Standardised Assessment Tools among Malaysian Older Person: A Systematic Review. Malays J Med Sci 2022; 29:34-45. [PMID: 36818895 PMCID: PMC9910367 DOI: 10.21315/mjms2022.29.6.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Abstract
Frailty is conceptually defined as a state of increased vulnerability in older persons, resulting from age-associated declines in physiological reserve and function as they cope with everyday life stressors. To date, the prevalence of frailty has been assessed in various ways. The objective of this study was to identify the prevalence of the condition and the assessment tools used to determine its occurrence among Malaysian older individuals. A systematic literature search was performed on electronic bibliographic databases, namely, Web of Science, Scopus, EBSCOHost: MEDLINE Complete and Google Scholar. Ten eligible articles were reviewed and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Newcastle-Ottawa Scale. Frailty was diagnosed using Fried's frailty phenotype and the Groningen Frailty Indicator (GFI). Assessment tools that included physical performance tests detected a lower prevalence of frailty than that determined using questionnaire-based tools. The prevalence of frailty ranged from as low as 6% to as high as 76%, and there was a higher prevalence among older persons living in aged care homes. This review suggests increasing prospective and interventional studies on frailty to establish a cause-effect relationship between standardised tools of assessing frailty and its prevalence among Malaysian older persons and provide guidelines for health professionals on promoting active lifestyles among older populations.
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Affiliation(s)
- Muhammad Iqbal Shaharudin
- Physiotherapy Programme, Faculty of Health Sciences, Universiti Teknologi MARA, Pulau Pinang, Malaysia
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24
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Lewis ET, Williamson M, Lewis LP, Ní Chróinín D, Dent E, Ticehurst M, Peters R, Macniven R, Cardona M. The Feasibility of Deriving the Electronic Frailty Index from Australian General Practice Records. Clin Interv Aging 2022; 17:1589-1598. [PMID: 36353269 PMCID: PMC9639370 DOI: 10.2147/cia.s384691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Frailty is a prevalent condition in older adults. Identification of frailty using an electronic Frailty Index (eFI) has been successfully implemented across general practices in the United Kingdom. However, in Australia, the eFI remains understudied. Therefore, we aimed to (i) examine the feasibility of deriving an eFI from Australian general practice records and (ii) describe the prevalence of frailty as measured by the eFI and the prevalence with socioeconomic status and geographic remoteness. Participants and Methods This retrospective analysis included patients (≥70 years) attending any one of >700 general practices utilizing the Australian MedicineInsight data platform, 2017–2018. A 36-item eFI was derived using standard methodology, with frailty classified as mild (scores 0.13–0.24); moderate (0.25–0.36) or severe (≥0.37). Socioeconomic status (Socio-Economic Indexes for Areas (SEIFA) index)) and geographic remoteness (Australian Statistical Geography Standard (ASGC) remoteness areas) were also examined. Results In total, 79,251 patients (56% female) were included, mean age 80.0 years (SD 6.5); 37.4% (95% CI 37.0–37.7) were mildly frail, 16.7% (95% CI 16.4–16.9) moderately frail, 4.8% (95% CI 4.7–5.0) severely frail. Median eFI score was 0.14 (IQR 0.08 to 0.22); maximum eFI score was 0.69. Across all age groups, moderate and severe frailty was significantly more prevalent in females (P < 0.001). Frailty severity increased with increasing age (P < 0.001) and was strongly associated with socioeconomic disadvantage (P < 0.001) but not with geographic remoteness. Conclusion Frailty was identifiable from routinely collected general practice data. Frailty was more prevalent in socioeconomically disadvantaged groups, women and older patients and existed in all levels of remoteness. Routine implementation of an eFI could inform interventions to prevent or reduce frailty in all older adults, regardless of location.
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Affiliation(s)
- Ebony T Lewis
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- Correspondence: Ebony T Lewis, School of Population Health, Faculty of Medicine & Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, Sydney, NSW, 2052, Australia, Tel +612 9065 2068, Email
| | - Margaret Williamson
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Lou P Lewis
- Matraville Medical Centre, Sydney, NSW, Australia
| | - Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, SA, Australia
| | - Maree Ticehurst
- Matraville Medical Centre, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruth Peters
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Rona Macniven
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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25
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Fehlmann CA, Nickel CH, Cino E, Al-Najjar Z, Langlois N, Eagles D. Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review. Intern Emerg Med 2022; 17:2407-2418. [PMID: 35864373 PMCID: PMC9302874 DOI: 10.1007/s11739-022-03042-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty is a common condition present in older Emergency Department (ED) patients that is associated with poor health outcomes. The Clinical Frailty Scale (CFS) is a tool that measures frailty on a scale from 1 (very fit) to 9 (terminally ill). The goal of this scoping review was to describe current use of the CFS in emergency medicine and to identify gaps in research. METHODS We performed a systemic literature search to identify original research that used the CFS in emergency medicine. Several databases were searched from January 2005 to July 2021. Two independent reviewers completed screening, full text review and data abstraction, with a focus on study characteristics, CFS assessment (evaluators, timing and purpose), study outcomes and statistical methods. RESULTS A total of 4818 unique citations were identified; 34 studies were included in the final analysis. Among them, 76% were published after 2018, mainly in Europe or North America (79%). Only two assessed CFS in the pre-hospital setting. The nine-point scale was used in 74% of the studies, and patient consent was required in 69% of them. The main reason to use CFS was as a main exposure (44%), a potential predictor (15%) or an outcome (15%). The most frequently studied outcomes were mortality and hospital admission. CONCLUSION The use of CFS in emergency medicine research is drastically increasing. However, the reporting is not optimal and should be more standardized. Studies evaluating the impact of frailty assessment in the ED are needed. REGISTRATION https://doi.org/10.17605/OSF.IO/W2F8N.
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Affiliation(s)
- Christophe Alain Fehlmann
- Division of Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Christian Hans Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Emily Cino
- Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | | | - Nigèle Langlois
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - Debra Eagles
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
- Ottawa Hospital Research Institute, Ottawa, ON Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON Canada
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26
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Lee JH, Park YS, Kim MJ, Shin HJ, Roh YH, Kim JH, Chung HS, Park I, Chung SP. Clinical Frailty Scale as a predictor of short-term mortality: A systematic review and meta-analysis of studies on diagnostic test accuracy. Acad Emerg Med 2022; 29:1347-1356. [PMID: 35349205 DOI: 10.1111/acem.14493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/11/2022] [Accepted: 03/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is a representative frailty assessment tool in medicine. This systematic review and meta-analysis aimed to examine whether frailty defined based on the CFS could adequately predict short-term mortality in emergency department (ED) patients. METHODS The PubMed, EMBASE, and Cochrane libraries were searched for eligible studies until December 23, 2021. We included studies in which frailty was measured by the CFS and short-term mortality was reported for ED patients. All studies were screened by two independent researchers. Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) values were calculated based on the data extracted from each study. Additionally, the diagnostic odds ratio (DOR) was calculated for effect size analysis, and the area under the curve (AUC) of summary receiver operating characteristics was calculated. Outcomes were in-hospital and 1-month mortality rate for patients with the CFS scores of ≥5, ≥6, and ≥7. RESULTS Overall, 17 studies (n = 45,022) were included. Although there was no evidence of publication bias, a high degree of heterogeneity was observed. For the CFS score of ≥5, the PLR, NLR, and DOR values for in-hospital mortality were 1.446 (95% confidence interval [CI] 1.325-1.578), 0.563 (95% CI 0.355-0.893), and 2.728 (95% CI 1.872-3.976), respectively. In addition, the pooled statistics for 1-month mortality were 1.566 (95% CI 1.241-1.976), 0.582 (95% CI 0.430-0.789), and 2.696 (95% CI 1.673-4.345), respectively. Subgroup analysis of trauma patients revealed that the CFS score of ≥5 could adequately predict in-hospital mortality (PLR 1.641, 95% CI 1.242-2.170; NLR 0.580, 95% CI 0.461-0.729; DOR 2.883, 95% CI 1.994-4.168). The AUC values represented sufficient to good diagnostic accuracy. CONCLUSIONS Evidence that is published to date suggests that the CFS is an accurate and reliable tool for predicting short-term mortality in emergency patients.
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Affiliation(s)
- Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Jung Shin
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Republic of Korea
| | - Yun Ho Roh
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Republic of Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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27
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Alshibani A, Coats T, Maynou L, Lecky F, Banerjee J, Conroy S. A comparison between the clinical frailty scale and the hospital frailty risk score to risk stratify older people with emergency care needs. BMC Emerg Med 2022; 22:171. [PMID: 36284266 PMCID: PMC9598033 DOI: 10.1186/s12873-022-00730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Older adults living with frailty who require treatment in hospitals are increasingly seen in the Emergency Departments (EDs). One quick and simple frailty assessment tool-the Clinical Frailty Scale (CFS)-has been embedded in many EDs in the United Kingdom (UK). However, it carries time/training and cost burden and has significant missing data. The Hospital Frailty Risk Score (HFRS) can be automated and has the potential to reduce costs and increase data availability, but has not been tested for predictive accuracy in the ED. The aim of this study is to assess the correlation between and the ability of the CFS at the ED and HFRS to predict hospital-related outcomes. METHODS This is a retrospective cohort study using data from Leicester Royal Infirmary hospital during the period from 01/10/2017 to 30/09/2019. We included individuals aged + 75 years as the HFRS has been only validated for this population. We assessed the correlation between the CFS and HFRS using Pearson's correlation coefficient for the continuous scores and weighted kappa scores for the categorised scores. We developed logistic regression models (unadjusted and adjusted) to estimate Odds Ratios (ORs) and Confidence Intervals (CIs), so we can assess the ability of the CFS and HFRS to predict 30-day mortality, Length of Stay (LOS) > 10 days, and 30-day readmission. RESULTS Twelve thousand two hundred thirty seven individuals met the inclusion criteria. The mean age was 84.6 years (SD 5.9) and 7,074 (57.8%) were females. Between the CFS and HFRS, the Pearson correlation coefficient was 0.36 and weighted kappa score was 0.15. When comparing the highest frailty categories to the lowest frailty category within each frailty score, the ORs for 30-day mortality, LOS > 10 days, and 30-day readmission using the CFS were 2.26, 1.36, and 1.64 and for the HFRS 2.16, 7.68, and 1.19. CONCLUSION The CFS collected at the ED and the HFRS had low/slight agreement. Both frailty scores were shown to be predictors of adverse outcomes. More research is needed to assess the use of historic HFRS in the ED.
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Affiliation(s)
- Abdullah Alshibani
- grid.9918.90000 0004 1936 8411Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, LE1 7HA UK ,grid.412149.b0000 0004 0608 0662Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia ,grid.452607.20000 0004 0580 0891King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tim Coats
- grid.269014.80000 0001 0435 9078University Hospitals of Leicester NHS Trust, Leicester, UK ,grid.9918.90000 0004 1936 8411Department of Cardiovascular Sciences, Emergency Medicine Academic Group, University of Leicester, Leicester, UK
| | - Laia Maynou
- grid.13063.370000 0001 0789 5319Department of Health Policy, London School of Economics and Political Science, London, UK ,grid.5841.80000 0004 1937 0247Department of Economics, Econometrics and Applied Economics, Universitat de Barcelona, Barcelona, Spain ,grid.5612.00000 0001 2172 2676Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Fiona Lecky
- grid.11835.3e0000 0004 1936 9262Centre for Urgent and Emergency Care Research, University of Sheffield, Sheffield, UK
| | - Jay Banerjee
- grid.9918.90000 0004 1936 8411Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, LE1 7HA UK ,grid.269014.80000 0001 0435 9078University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Simon Conroy
- grid.83440.3b0000000121901201MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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Leininger S, Davis Micco RN. The Future of Assessing Frailty in the Patient With Advanced Heart Failure: A Review of Current Literature. Crit Care Nurs Q 2022; 45:359-375. [PMID: 35980798 DOI: 10.1097/cnq.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Frailty is becoming an important component of health care outcomes in patients with a diagnosis of heart failure. A literature search was completed to determine whether a best practice guideline existed to assess frailty in patients who were considering ventricular assist device placement. The literature search revealed that best practice guidelines did not exist. A second comprehensive literature search was completed specifically for frailty including the definition, criteria, assessment, and outcomes. The studies revealed that there were challenges with defining frailty, the age of frailty, assessments tools, and study designs. Cardiologists are primarily interested in screening for frailty, but other physician specialty practices are interested in a frailty screening tool as well. This article discusses the inconsistent research studies and the need for a valid and reliable tool to assess for frailty. It is important that nurse leaders and those working with heart failure patients determine the best practice guidelines for assessing frailty.
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Shang N, Liu H, Wang N, Guo S, Ma L. Comparison of three frailty screening instruments for prediction of adverse outcomes among older adults in the emergency department. Geriatr Gerontol Int 2022; 22:851-856. [PMID: 36054799 DOI: 10.1111/ggi.14469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
AIM To compare the predictive abilities of the FRAIL scale (FS), frailty screening questionnaire (FSQ) and clinical frailty scale (CFS) for adverse outcomes in older adults in the emergency department. METHODS In total, 317 older adults aged ≥65 years attending emergency department was screened for frailty using the FS, FSQ and CFS. Outcome measures included all-cause 28-day mortality and intensive care unit readmission. Cox proportional hazards model was used for survival comparison. Logistic regression was used to analyze risk factors for readmissions. In addition, we calculated the C-statistic, net reclassification improvement and integrated discrimination improvement to evaluate the predictive value of three scales. RESULTS The prevalence of frailty was 55.2% (FS), 47.0% (FSQ) and 69.4% (CFS). Cox regression and logistic regression analysis revealed that frailty screening by FS, FSQ and CFS was an independent risk factor for all-cause 28-day mortality and 30- and 90-day readmission after adjustment. Incorporation of FS, FSQ and CFS into a basic model with other risk factors significantly improved C-statistic. For all-cause 28-day mortality, the model including FS had the highest C-statistic from 0.786 (95% confidence interval: 0.706-0.865) to 0.854 (95% confidence interval: 0.802-0.907) and the improvements in risk prediction were also confirmed by category-free net reclassification improvement and integrated discrimination improvement, suggesting FS was significantly better than CFS and FSQ. The three tools had a low predictive ability for readmission (all C-statistics <0.7). CONCLUSIONS All three frailty scales showed a predictive ability for 28-day mortality and readmission but FS may be the most valid tool in the emergency department. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; 22: 851-856.
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Affiliation(s)
- Na Shang
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, & Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, China.,Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Huizhen Liu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, & Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, China.,Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Na Wang
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Shubin Guo
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, & Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, China
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
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van Dam CS, Trappenburg MC, Ter Wee MM, Hoogendijk EO, de Vet R, Smulders YM, Nanayakkara PB, Muller M, Peters ML. The Prognostic Accuracy of Clinical Judgment Versus a Validated Frailty Screening Instrument in Older Patients at the Emergency Department: Findings of the AmsterGEM Study. Ann Emerg Med 2022; 80:422-431. [PMID: 35717270 DOI: 10.1016/j.annemergmed.2022.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To compare the prognostic accuracy of clinical judgment for frailty in older patients at the emergency department with a validated screening instrument and patient-perceived frailty. METHODS A prospective cohort study in patients 70 years of age and older in 2 Dutch EDs with a follow-up of 3 months. A dichotomous question was asked to the physician and patient: "Do you consider the patient / yourself to be frail?" The Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP) was used as a validated screening instrument. The primary composite outcome consisted of either functional decline, institutionalization, or mortality. RESULTS A total of 736 patients were included. The physician identified 59% as frail, compared with 49% by ISAR-HP and 43% by patients themselves. The level of agreement was fair (Fleiss Kappa, 0.31). After 3 months, 31% of the patients experienced at least 1 adverse health outcome. The sensitivity was 79% for the physician, 72% for ISAR-HP, 61% for the patient, and 48% for all 3 combined. The specificity was 50% for the physician, 63% for ISAR-HP, 66% for the patient, and 85% for all 3 positive. The highest positive likelihood ratio was 3.03 (physician, ISAR-HP, patient combined), and the lowest negative likelihood ratio was 0.42 (physician). The areas under the receiver operating curves were all poor: 0.68 at best for ISAR-HP. CONCLUSION Clinical judgment for frailty showed fair agreement with a validated screening instrument and patient-perceived frailty. All 3 instruments have poor prognostic accuracy, which does not improve when combined. These findings illustrate the limited prognostic value of clinical judgment as a frailty screener in older patients at the ED.
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Affiliation(s)
- Carmen S van Dam
- Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands.
| | - Marijke C Trappenburg
- Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Marieke M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Riekie de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine and Vascular Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Prabath B Nanayakkara
- Section General Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands
| | - Mike L Peters
- Department of Internal Medicine and Geriatrics, Amsterdam Cardiovascular Sciences research institute, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands; Department of Internal Medicine and Vascular Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands; Department of Internal Medicine and Geriatrics, University Medical Center Utrecht, the Netherlands
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Simon NR, Jauslin AS, Bingisser R, Nickel CH. Emergency presentations of older patients living with frailty: Presenting symptoms compared with non-frail patients. Am J Emerg Med 2022; 59:111-117. [PMID: 35834872 DOI: 10.1016/j.ajem.2022.06.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Symptoms may differ between frail and non-frail patients presenting to Emergency Departments (ED). However, the association between frailty status and type of presenting symptoms has not been investigated. We aimed to systematically analyse presenting symptoms in frail and non-frail older emergency patients and hypothesized that frailty may be associated with nonspecific complaints (NSC), such as generalised weakness. METHODS Secondary analysis of a prospective, single centre, observational all-comer cohort study conducted in the ED of a Swiss tertiary care hospital. All presentations of patients aged 65 years and older were analysed. At triage, presenting symptoms and frailty were systematically assessed using a questionnaire. Patients with a Clinical Frailty Scale (CFS) > 4 were considered frail. Presenting symptoms, stratified by frailty status, were analysed. The association between frailty and generalised weakness was tested by logistic regression. RESULTS Overall, 2'416 presentations of patients 65 years and older were analysed. Mean age was 78.9 (SD 8.4) years, 1'228 (50.8%) patients were female, and 885 (36.6%) patients were frail (CFS > 4). Generalised weakness, dyspnea, localised weakness, speech disorder, loss of consciousness and gait disturbance were recorded more often in frail patients, whereas chest pain was reported more often by non-frail patients. Generalised weakness was reported as presenting symptom in 166 (18.8%) frail patients and in 153 (10.0%) non-frail patients. Frailty was associated with generalised weakness after adjusting for age, gender and elevated National Early Warning Score 2 (NEWS) ≥ 3 (OR 1.19, CI 1.10-1.29, p < 0.001). CONCLUSION Presenting symptoms differ in frail and non-frail patients. Frailty is associated with generalised weakness at ED presentation.
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Affiliation(s)
- N R Simon
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland.
| | - A S Jauslin
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland.
| | - R Bingisser
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland.
| | - C H Nickel
- Emergency Department, University Hospital Basel, Petersgraben 2, 4031 Basel, Switzerland.
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Kellett J, Bogh SB, Ekelund U, Brabrand M. Can the ECG be used to estimate age-related survival? QJM 2022; 115:298-303. [PMID: 33970281 DOI: 10.1093/qjmed/hcab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are few reports of the relationship between electrocardiogram (ECG) findings and the age-related survival of acutely ill patients. AIM This study compared the 1-year survival curves of patients attending two Danish emergency departments (EDs) with normal and abnormal ECGs. Patients were divided into age groups from 20 to 90 years of age, and an abnormal ECG was defined as low QRS voltage (i.e. lead I + II <1.4 mV) or QTc interval prolongation >434 ms. METHODS A retrospective register-based observational study on 35 496 patients attending two Danish EDs, with 100% follow-up for 1 year. RESULTS ECG abnormality increases linearly with age, and between 30 and 70 years of age. Patients aged 20-29 years with ECG abnormalities are more than four times more likely to die within a year than patients of the same age with a normal ECG. An individual with an abnormal ECG has the same risk of dying within a year as an individual with a normal ECG who is 10 years older. After 70 years of age this tight relationship ends, but for younger individuals with an abnormal ECG the increase in mortality is even higher. CONCLUSION An ECG may be a simple practical estimate of age-related survival. For a patient under 70 years, an abnormal QRS voltage or a prolonged QTc interval may increase 1-year mortality to that of a patient ∼10 years older.
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Affiliation(s)
- J Kellett
- From the Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - S B Bogh
- Odense Patient Data Explorative Network, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - U Ekelund
- Department of Emergency and Internal Medicine, Skåne University Hospital at Lund, Lund, Sweden
| | - M Brabrand
- From the Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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Rueegg M, Nissen SK, Brabrand M, Kaeppeli T, Dreher T, Carpenter CR, Bingisser R, Nickel CH. The clinical frailty scale predicts 1-year mortality in emergency department patients aged 65 years and older. Acad Emerg Med 2022; 29:572-580. [PMID: 35138670 PMCID: PMC9320818 DOI: 10.1111/acem.14460] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To validate the Clinical Frailty Scale (CFS) for prediction of 1-year all-cause mortality in the emergency department (ED) and compare its performance to the Emergency Severity Index (ESI). METHODS Prospective cohort study at the ED of a tertiary care center in Northwestern Switzerland. All patients aged ≥65 years were included from March 18 to May 20, 2019, after informed consent. Frailty status was assessed using CFS, excluding level 9 (palliative). Acuity level was assessed using ESI. Both CFS and ESI were adjusted for age, sex and presenting condition in multivariable logistic regression. Prognostic performance was assessed for discrimination and calibration separately. Estimates were internally validated by Bootstrapping. Restricted mean survival time (RMST) was determined for all levels of CFS. RESULTS In the final study population of 2191 patients, 1-year all-cause mortality was 17% (n = 372). RMST values ranged from 219 days for CFS 8 to 365 days for CFS 1. The adjusted CFS model had an area under receiver operating characteristic of 0.767 (95% confidence interval [CI]: 0.741-0.793), compared to 0.703 (95% CI: 0.673-0.732) for the adjusted ESI model. CONCLUSION The CFS predicts 1-year all-cause mortality for older ED patients and predicts survival time in a graded manner. The CFS is superior to the ESI when adjusted for age, sex, and presenting condition.
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Affiliation(s)
- Marco Rueegg
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Søren Kabell Nissen
- Institute of Regional Health Research, Centre South‐West JutlandUniversity of Southern DenmarkOdenseDenmark
| | - Mikkel Brabrand
- Institute of Regional Health Research, Centre South‐West JutlandUniversity of Southern DenmarkOdenseDenmark
- Department of Emergency MedicineOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Tobias Kaeppeli
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Thomas Dreher
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Christopher R. Carpenter
- Department of Emergency MedicineWashington University in St. Louis School of Medicine, Emergency Care Research CoreSt. LouisMichiganUSA
| | - Roland Bingisser
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Christian H. Nickel
- Emergency DepartmentUniversity Hospital Basel, University of BaselBaselSwitzerland
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Benzinger P, Eidam A, Bauer JM. [87/f-Mild fever and confussion : Preparation for the medical specialist examination: part 138]. Internist (Berl) 2022; 63:219-223. [PMID: 35262744 DOI: 10.1007/s00108-022-01289-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- P Benzinger
- Geriatrisches Zentrum, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland.
- Institut Gesundheit und Generationen, Hochschule für angewandte Wissenschaften Kempten, Bahnhofstraße 61, 87435, Kempten, Deutschland.
| | - A Eidam
- Geriatrisches Zentrum, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland
| | - J M Bauer
- Geriatrisches Zentrum, Universität Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland
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Hunold KM, Goldberg EM, Caterino JM, Hwang U, Platts-Mills TF, Shah MN, Rosen T. Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal. Acad Emerg Med 2022; 29:376-383. [PMID: 34582613 PMCID: PMC8958170 DOI: 10.1111/acem.14386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
Medical research across all fields has historically excluded older adults (aged 65 years and older). Because older adults have a higher burden of chronic illness, respond differently to treatment, and are more prone to medication side effects, the results of current research may not be applicable to this important population. To address this major research deficiency, the National Institutes of Health established the Inclusion Across the Lifespan policy, effective January 2019. We present important considerations and proven strategies for successful inclusion of older adults in emergency care research relating to study design, participant recruitment and retention, and sources of support for investigators.
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Affiliation(s)
| | | | | | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven CT
- Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY
| | | | - Manish N. Shah
- BarbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tony Rosen
- Department of Emergency Medicine, Division of Geriatric Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical Center, New York, NY
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Haddad T, Mulpuru S, Salter I, Hladkowicz E, Des Autels K, Gagne S, Bryson GL, McCartney CJL, Huang A, Huang S, Forster A, van Walraven C, Kyeremanteng K, Fernando SM, Nagpal S, Moloo H, Boet S, Le Blanc V, Lalu MM, McIsaac DI. Development and evaluation of an evidence-based, theory-grounded online Clinical Frailty Scale tutorial. Age Ageing 2022; 51:6523679. [PMID: 35136898 DOI: 10.1093/ageing/afab258] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/23/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Frailty is a robust predictor of adverse outcomes in older people. Practice guidelines recommend routine screening for frailty; however, this does not occur regularly. The Clinical Frailty Scale (CFS) is a validated, feasible instrument that can be used in a variety of clinical settings and is associated with many adverse outcomes. Our objective was to develop and evaluate an online training module to guide frailty assessment using the CFS. METHODS A multidisciplinary team of clinical experts developed an evidence-based, theory-grounded online training module for users who wished to perform frailty assessment using the CFS. The module was prospectively evaluated for user satisfaction, effectiveness and feasibility using a standardised questionnaire. Qualitative feedback was analysed with thematic analysis. RESULTS Version 1 of the CFS module was used 627 times from 21 October 2019 to 24 March 2020. Satisfaction, effectiveness and feasibility of the module were positively rated (≥4/5 on a 5-point Likert scale n = 582 [93%], n = 507, [81%], n = 575, [91%], respectively). Qualitative feedback highlighted ease of use, likelihood of users to share the module with others and opportunities to increase multimedia content. CONCLUSION An online tutorial, designed using evidence and theory to guide frailty assessment using the CFS, was positively rated by users. The module's content and structure was rated effective and feasible, and users were satisfied with, and likely to share, the module. Research evaluating the module's impact on the accuracy of frailty assessment is required.
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Affiliation(s)
- Taleen Haddad
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
- Department of Medicine, Division of Geriatric Medicine, Queens University, Kingston, ON K7L 3N6, Canada
| | - Sunita Mulpuru
- Department of Medicine, Division of Respirology, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Ivy Salter
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Emily Hladkowicz
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Kathryne Des Autels
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Sylvain Gagne
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Gregory L Bryson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Colin J L McCartney
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Allen Huang
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Shirley Huang
- Department of Medicine, Division of Geriatric Medicine, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Alan Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Carl van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Kwadwo Kyeremanteng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Sudhir Nagpal
- Department of Surgery, Division of Vascular and Endovascular Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Husein Moloo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Department of Surgery, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ONCanada
- Institut du Savoir Montfort, Ottawa, ON Canada
| | - Vicki Le Blanc
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
- Regenerative Medicine Program, Department of Cellular and Molecular Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
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The Diagnostic Accuracy and Clinimetric Properties of Screening Instruments to Identify Frail Older Adults Attending Emergency Departments: A Protocol for a Mixed Methods Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031380. [PMID: 35162397 PMCID: PMC8834939 DOI: 10.3390/ijerph19031380] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 01/23/2023]
Abstract
Background: Prompt and efficient identification and stratification of patients who are frail is important, as this cohort are at high risk of adverse healthcare outcomes. Numerous frailty screening tools have been developed to support their identification across different settings, yet relatively few have emerged for use in emergency departments (EDs). This protocol provides details for a systematic review aiming to synthesize the accumulated evidence regarding the diagnostic accuracy and clinimetric properties of frailty screening instruments to identify frail older adults in EDs. Methods: Six electronic databases will be searched from January 2000 to March 2021. Eligible studies will include adults aged ≥60 years screened in EDs with any available screening instrument to identify frailty (even if not originally designed for this purpose). Studies, including case-control, longitudinal, and cohort studies, will be included, where instruments are compared to a reference standard to explore diagnostic accuracy. Predictive accuracy for a selection of outcomes, including mortality, institutionalization, and readmission, will be assessed. Clinical and methodological heterogeneity will be examined, and a random effects meta-analysis performed if appropriate. Conclusion: Understanding whether frailty screening on presentation to EDs is accurate in identifying frailty, and predicting these outcomes is important for decision-making and targeting appropriate management.
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Boreskie KF, Hay JL, Boreskie PE, Arora RC, Duhamel TA. Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC Geriatr 2022; 22:13. [PMID: 34979966 PMCID: PMC8722007 DOI: 10.1186/s12877-021-02722-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/15/2021] [Indexed: 12/14/2022] Open
Abstract
Healthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at increased risk for adverse health outcomes. Furthermore, frailty assessments offer an opportunity to optimize patient care in various healthcare settings. While the vast number of frailty assessment tools available can be a source of confusion for clinicians, each tool has features adaptable to the constraints and goals of different healthcare settings. This review discusses and compares barriers, facilitators, and the application of frailty assessments in primary care, the emergency department/intensive care unit and surgical care to cover a breadth of settings with different frailty assessment considerations. The implementation of frailty-aware care across healthcare settings potentiates better healthcare outcomes for older adults.
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Affiliation(s)
- Kevin F Boreskie
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada.
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Jacqueline L Hay
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Patrick E Boreskie
- Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
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Lewis ET, Howard L, Cardona M, Radford K, Withall A, Howie A, Rockwood K, Peters R. Frailty in Indigenous Populations: A Scoping Review. Front Public Health 2021; 9:785460. [PMID: 34881221 PMCID: PMC8646043 DOI: 10.3389/fpubh.2021.785460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Indigenous populations experience high rates of age-related illness when compared to their non-Indigenous counterparts. Frailty is a challenging expression of aging and an important public health priority. The purpose of this review was to map what the existing literature reports around frailty in Indigenous populations and to highlight the current gaps in frailty research within the Indigenous landscape. Method: Scoping review of English language original research articles focusing on frailty within Indigenous adult populations in settler colonial countries (Australia, Canada, New Zealand and USA). Ten electronic databases and eight relevant institutional websites were searched from inception to October 2020. Results: Nine articles met our inclusion criteria, finding this population having a higher prevalence of frailty and frailty occurring at younger ages when compared to their non-Indigenous counterparts, but two did not use a formal frailty tool. Females presented with higher levels of frailty. No culturally specific frailty tool was identified, and the included articles did not assess strategies or interventions to manage or prevent frailty in Indigenous peoples. Conclusions: There was little definitive evidence of the true frailty prevalence, approaches to frailty screening and of potential points of intervention to manage or prevent the onset of frailty. Improvements in the quality of evidence are urgently needed, along with further research to determine the factors contributing to higher rates of frailty within Indigenous populations. Incorporation of Indigenous views of frailty, and instruments and programs that are led and designed by Indigenous communities, are crucial to address this public health priority.
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Affiliation(s)
- Ebony T Lewis
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Leanne Howard
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Magnolia Cardona
- Gold Coast Hospital and Health Service, Southport, QLD, Australia.,Institute for Evidence-Based Healthcare, Bond University, Robina, QLD, Australia
| | - Kylie Radford
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Adrienne Withall
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Adam Howie
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ruth Peters
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
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García-Blas S, Bonanad C, Fernández-Cisnal A, Sastre-Arbona C, Ruescas-Nicolau MA, González D’Gregorio J, Valero E, Miñana G, Palau P, Tarazona-Santabalbina FJ, Ruiz Ros V, Núñez J, Sanchis J. Frailty Scales for Prognosis Assessment of Older Adult Patients after Acute Myocardial Infarction. J Clin Med 2021; 10:jcm10184278. [PMID: 34575389 PMCID: PMC8465296 DOI: 10.3390/jcm10184278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 12/30/2022] Open
Abstract
We aimed to compare the prognostic value of two different measures, the Fried's Frailty Scale (FFS) and the Clinical Frailty Scale (CFS), following myocardial infarction (MI). We included 150 patients ≥ 70 years admitted from AMI. Frailty was evaluated on the day before discharge. The primary endpoint was number of days alive and out of hospital (DAOH) during the first 800 days. Secondary endpoints were mortality and a composite of mortality and reinfarction. Frailty was diagnosed in 58% and 34% of patients using the FFS and CFS scales, respectively. During the first 800 days 34 deaths and 137 admissions occurred. The number of DAOH decreased significantly with increasing scores of both FFS (p < 0.001) and CFS (p = 0.049). In multivariate analysis, only the highest scores (FFS = 5, CFS ≥ 6) were independently associated with fewer DAOH. At a median follow-up of 946 days, frailty assessed both by FFS and CFS was independently associated with death and MI (HR = 2.70 95%CI = 1.32-5.51 p = 0.001; HR = 2.01 95%CI = 1.1-3.66 p = 0.023, respectively), whereas all-cause mortality was only associated with FFS (HR = 1.51 95%CI = 1.08-2.10 p = 0.015). Frailty by FFS or CFS is independently associated with shorter number DAOH post-MI. Likewise, frailty assessed by either scale is associated with a higher rate of death and reinfarction, whereas FFS outperforms CFS for mortality prediction.
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Affiliation(s)
- Sergio García-Blas
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Clara Bonanad
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Agustín Fernández-Cisnal
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Clara Sastre-Arbona
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | | | - Jessika González D’Gregorio
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Ernesto Valero
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Gema Miñana
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Patricia Palau
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | | | - Vicente Ruiz Ros
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Julio Núñez
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- Correspondence:
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Ruiz VR, Grande-Ratti MF, Martínez B, Midley A, Sylvestre V, Mayer GF. In-hospital mortality associated factors in elderly patients with invasive mechanical ventilation in the emergency department. ENFERMERIA INTENSIVA 2021; 32:145-152. [PMID: 34340950 DOI: 10.1016/j.enfie.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/04/2020] [Indexed: 10/20/2022]
Abstract
AIMS To identify factors associated with in-hospital mortality, to estimate the intubation rate and to describe in-hospital mortality in patients over 65 years old with invasive mechanical ventilation (IMV) in the emergency department (ED). METHODS Retrospective cohort study of patients over 65 years old, who were intubated in an ED of a high complexity hospital between 2016 and 2018. Demographic data, comorbidities, and severity scores on admission were described. Bivariate and multivariate analyses were performed with logistic regression according to mortality and possible confounders. RESULTS A total of 285 patients with a mean age of 80 years required IMV in the emergency department, for a median of 3 days, and with a mean APACHE II score of 20 points of severity. The IMV rate was .48% (95% CI .43-.54), and 55.44% (158) died. Mortality-associated factors after age and sex adjustment were stroke (OR 2.13; 95% CI 1.21-3.76), chronic kidney failure, (OR 4.,38; 95% CI 1.91-10.04), Charlson index (OR 1.19; 95% CI 1.02-1.38), APACHE II score (OR 1.07; 95% CI 1.02-1.12), and SOFA score (OR 1.14; 95% CI 1.03-1.27). DISCUSSION Our IMV rate was lower than that stated by Johnson et al. in the United States in 2018 (.59%). In-hospital mortality in our study exceeded that predicted by the APACHE II score (40%) and SOFA (33%). However it was consistent with that reported by Lieberman et al. in Israel and Esteban et al. in the United States. CONCLUSIONS Although the IMV rate was low in the ED, more than half the patients died during hospitalization. Pre-existing cerebrovascular and renal diseases and high results in the comorbidities index and severity scores on admission were independent factors associated with in-hospital mortality.
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Affiliation(s)
- V R Ruiz
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M F Grande-Ratti
- Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - B Martínez
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Midley
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - V Sylvestre
- Central de Emergencias del Adulto, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G F Mayer
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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A narrative review of frailty assessment in older patients at the emergency department. Eur J Emerg Med 2021; 28:266-276. [PMID: 33883392 DOI: 10.1097/mej.0000000000000811] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Optimizing emergency care for the aging population is an important future challenge, as the proportion of older patients at the emergency department (ED) rapidly increases. Older patients, particularly those who are frail, have a high risk of adverse outcomes after an ED visit, such as functional decline, institutionalization, and death. The ED can have a key position in identifying frail older patients who benefit most from comprehensive geriatric care [including delirium preventive measures, early evaluation of after-discharge care, and a comprehensive geriatric assessment (CGA)]. However, performing extensive frailty assessment is not suitable at the ED. Therefore, quick and easy-to-use instruments are needed to identify older patients at risk for adverse outcomes. This narrative review outlines the importance and complexity of frailty assessment at the ED. It aligns the available screening instruments, including clinical judgment as frailty assessment, and summarizes arguments for and against frailty assessment at the ED.
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The Accuracy of Four Frequently Used Frailty Instruments for the Prediction of Adverse Health Outcomes Among Older Adults at Two Dutch Emergency Departments: Findings of the AmsterGEM Study. Ann Emerg Med 2021; 78:538-548. [PMID: 34304915 DOI: 10.1016/j.annemergmed.2021.04.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE Older adults presenting to the emergency department (ED) are at high risk of adverse health outcomes. This study aimed to evaluate the accuracy of 4 frequently used screening instruments for the prediction of adverse health outcomes among older adults in the ED. METHODS This was a prospective cohort study in patients ≥70 years of age presenting to the ED in 2 hospitals in the Netherlands. Screening instruments included the acutely presenting older patient screening program (APOP) (providing 2 risk scores-functional decline [APOP1] and mortality [APOP2]), the International Resident Assessment Instrument Emergendy Department screener (InterRAI ED), the Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP), and the safety management system (VMS). The primary outcome measure was a composite outcome encompassing functional decline, institutionalization, and mortality at 3 months after ED presentation. Other follow-up time points were 1 and 6 months. Analyses were performed to assess prognostic accuracy. RESULTS In total, 889 patients were included. After 3 months, 267 (31%) patients experienced at least 1 adverse outcome. The positive likelihood ratio ranged from 1.67 (VMS) to 3.33 (APOP1), and the negative likelihood ratio ranged from 0.41 (ISAR-HP) to 0.88 (APOP2). Sensitivity ranged from 17% (APOP2) to 74% (ISAR-HP), and specificity ranged from 63% (ISAR-HP) to 94% (APOP2). The area under the curve ranged from 0.62 (APOP2) to 0.72 (APOP1 and ISAR-HP). Calibration was reasonable for APOP1 and VMS. The prognostic accuracy was comparable across all outcomes and at all follow-up time points. CONCLUSION The frailty screening instruments assessed in this study showed poor to moderate prognostic accuracy, which brings into question their usability in the prediction of adverse health outcomes among older adults who present to the ED.
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Alakare J, Kemp K, Strandberg T, Castrén M, Jakovljević D, Tolonen J, Harjola VP. Systematic geriatric assessment for older patients with frailty in the emergency department: a randomised controlled trial. BMC Geriatr 2021; 21:408. [PMID: 34215193 PMCID: PMC8252275 DOI: 10.1186/s12877-021-02351-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/13/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Comprehensive geriatric assessment provided in hospital wards in frail patients admitted to hospital has been shown to reduce mortality and increase the likelihood of living at home later. Systematic geriatric assessment provided in emergency departments (ED) may be effective for reducing days in hospital and unnecessary hospital admissions, but this has not yet been proven in randomised trials. METHODS We conducted a single-centre, randomised controlled trial with a parallel-group, superiority design in an academic hospital ED. ED patients aged ≥ 75 years who were frail, or at risk of frailty, as defined by the Clinical Frailty Scale, were included in the trial. Patients were recruited during the period between December 11, 2018 and June 7, 2019, and followed up for 365 days. For the intervention group, systematic geriatric assessment was added to their standard care in the ED, whereas the control group received standard care only. The primary outcome was cumulative hospital stay during 365-day follow-up. The secondary outcomes included: admission rate from the index visit, total hospital admissions, ED-readmissions, proportion of patients living at home at 365 days, 365-day mortality, and fall-related ED-visits. RESULTS A total of 432 patients, 63 % female, with median age of 85 years, formed the analytic sample of 213 patients in the intervention group and 219 patients in the control group. Cumulative hospital stay during one-year follow-up as rate per 100 person-years for the intervention and control groups were: 3470 and 3149 days, respectively, with rate ratio of 1.10 (95 % confidence interval, 0.55-2.19, P = .78). Admission rates to hospital wards from the index ED visit for the intervention and control groups were: 62 and 70 %, respectively (P = .10). No significant differences were observed between the groups for any outcomes. CONCLUSION Systematic geriatric assessment for older adults with frailty in the ED did not reduce hospital stay during one-year follow-up. No statistically significant difference was observed for any secondary outcomes. More coordinated, continuous interventions should be tested for potential benefits in long-term outcomes. TRIAL REGISTRATION The trial was registered in the ClinicalTrials.gov (registration number and date NCT03751319 23/11/2018).
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Affiliation(s)
- Janne Alakare
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, PL 340
- Haartmaninkatu 4, 00029 HUS, Helsinki, Finland.
| | - Kirsi Kemp
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, PL 340
- Haartmaninkatu 4, 00029 HUS, Helsinki, Finland
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Centre for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Maaret Castrén
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, PL 340
- Haartmaninkatu 4, 00029 HUS, Helsinki, Finland
| | - Dimitrije Jakovljević
- Päijät-Häme Joint Authority for Health and Wellbeing, Services for Older People, Lahti, Finland
| | - Jukka Tolonen
- Department of Internal Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Veli-Pekka Harjola
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, PL 340
- Haartmaninkatu 4, 00029 HUS, Helsinki, Finland
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Factores asociados a mortalidad intrahospitalaria en pacientes adultos mayores con asistencia ventilatoria mecánica invasiva en el servicio de urgencias. ENFERMERIA INTENSIVA 2021. [DOI: 10.1016/j.enfi.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Vrettos I, Voukelatou P, Panayiotou S, Kyvetos A, Kalliakmanis A, Makrilakis K, Sfikakis PP, Niakas D. Validation of the revised 9-scale clinical frailty scale (CFS) in Greek language. BMC Geriatr 2021; 21:393. [PMID: 34187373 PMCID: PMC8243421 DOI: 10.1186/s12877-021-02318-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Among many screening tools that have been developed to detect frailty in older adults, Clinical Frailty Scale (CFS) is a valid, reliable and easy-to-use tool that has been translated in several languages. The aim of this study was to develop a valid and reliable version of the CFS to the Greek language. METHODS A Greek version was obtained by translation (English to Greek) and back translation (Greek to English). The "known-group" construct validity of the CFS was determined by using test for trends. Criterion concurrent validity was assessed by evaluating the extent that CFS relates to Barthel Index, using Pearson's correlation coefficient. Both inter-rater and test-retest reliability were assessed using intraclass correlation coefficient. RESULTS Known groups comparison supports the construct validity of the CFS. The strong negative correlation between CFS and Barthel Index (rs = - 0,725, p ≤ 0.001), supports the criterion concurrent validity of the instrument. The intraclass correlation was good for both inter-rater (0.87, 95%CI: 0.82-0.90) and test-retest reliability (0.89: 95%CI: 0.85-0.92). CONCLUSION The Greek version of the CFS is a valid and reliable instrument for the identification of frailty in the Greek population.
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Affiliation(s)
- Ioannis Vrettos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
- Department of Health Economics, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias street, Athens, Greece
| | - Panagiota Voukelatou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
| | - Stefani Panayiotou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
| | - Andreas Kyvetos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
| | - Andreas Kalliakmanis
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Noufaron and 14 Timiou Stavrou street, Athens, Greece
| | - Konstantinos Makrilakis
- 1st Department of Propedeutic Internal Medicine, Laikon General Hospital, 17 Agiou Thoma street, Athens, Greece
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, Athens, Greece
| | - Petros P. Sfikakis
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias street, Athens, Greece
- 1st Department of Propedeutic Internal Medicine-Rheumatology Unit, Laikon General Hospital, 17 Agiou Thoma street, Athens, Greece
| | - Dimitris Niakas
- Department of Health Economics, School of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias street, Athens, Greece
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47
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Kilkenny MF, Phan HT, Lindley RI, Kim J, Lopez D, Dalli LL, Grimley R, Sundararajan V, Thrift AG, Andrew NE, Donnan GA, Cadilhac DA. Utility of the Hospital Frailty Risk Score Derived From Administrative Data and the Association With Stroke Outcomes. Stroke 2021; 52:2874-2881. [PMID: 34134509 DOI: 10.1161/strokeaha.120.033648] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (M.F.K., H.T.P., J.K., L.L.D., R.G., A.G.T., N.E.A., D.A.C.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (M.F.K., J.K., D.A.C.)
| | - Hoang T Phan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (M.F.K., H.T.P., J.K., L.L.D., R.G., A.G.T., N.E.A., D.A.C.).,Menzies Institute for Medical Research, University of Tasmania, Australia (H.T.P.)
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia (R.I.L.).,George Institute for Global Health, Sydney, New South Wales, Australia (R.I.L.)
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (M.F.K., H.T.P., J.K., L.L.D., R.G., A.G.T., N.E.A., D.A.C.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (M.F.K., J.K., D.A.C.)
| | - Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Australia (D.L.)
| | - Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (M.F.K., H.T.P., J.K., L.L.D., R.G., A.G.T., N.E.A., D.A.C.)
| | - Rohan Grimley
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (M.F.K., H.T.P., J.K., L.L.D., R.G., A.G.T., N.E.A., D.A.C.).,Sunshine Coast Clinical School, Griffith University, Birtinya, Queensland, Australia (R.G.)
| | - Vijaya Sundararajan
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia (V.S.)
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (M.F.K., H.T.P., J.K., L.L.D., R.G., A.G.T., N.E.A., D.A.C.)
| | - Nadine E Andrew
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (M.F.K., H.T.P., J.K., L.L.D., R.G., A.G.T., N.E.A., D.A.C.).,Department of Medicine, Peninsula Clinical School, Monash University, Victoria, Australia (N.E.A.)
| | - Geoffrey A Donnan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia (G.A.D.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (M.F.K., H.T.P., J.K., L.L.D., R.G., A.G.T., N.E.A., D.A.C.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (M.F.K., J.K., D.A.C.)
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48
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Lin CF, Lin PC, Hu SY, Tsan YT, Liao WK, Lin SY, Lin TC. Comprehensive Geriatric Assessment and Clinical Outcomes in the Older People at the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6164. [PMID: 34200317 PMCID: PMC8201329 DOI: 10.3390/ijerph18116164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
Visits by older people to the Emergency Department (ED) have increased in recent decades with higher revisiting and admission rates after discharge, particularly for those with frailties. This study used a before-after design aimed at evaluating Comprehensive Geriatric Assessment (CGA) screening in older ED patients (aged ≥ 75 years) during the 12-month preintervention period. Additionally, a CGA-based structured follow-up program after ED discharge was executed during the next 12-month intervention period. Amongst the 358 participants (median age 82 years), involving 122 in the preintervention period and 236 in the intervention period, 77 participants (21.5%) were identified as pre-frailty, while 274 (76.5%) were identified as frail using the Fried frailty phenotype. One-hundred ten (110) (30.7%) patients revisited the ED with 73 (20.4%) being admitted and 20 (5.6%) dying within three months after ED discharge. Compared with preintervention and intervention period, it was shown that the rates of admission at the index ED visit (50.8% vs. 23.1%), and mortality (10.7% vs. 3.0%), were both were significantly reduced. Using multivariate regression analysis, it was shown frailty was significantly associated with three-month mortality after adjusting for potential confounders. On the contrary, the program significantly decreased admission and death rate. It is suggested that frailty was prevalent amongst the older ED patients, and should be screened for in order to decrease revisits/admissions after ED discharge.
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Affiliation(s)
- Cheng-Fu Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-F.L.); (P.-C.L.); (S.-Y.H.); (Y.-T.T.); (W.-K.L.)
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Po-Chen Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-F.L.); (P.-C.L.); (S.-Y.H.); (Y.-T.T.); (W.-K.L.)
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-F.L.); (P.-C.L.); (S.-Y.H.); (Y.-T.T.); (W.-K.L.)
| | - Yu-Tse Tsan
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-F.L.); (P.-C.L.); (S.-Y.H.); (Y.-T.T.); (W.-K.L.)
| | - Wei-Kai Liao
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-F.L.); (P.-C.L.); (S.-Y.H.); (Y.-T.T.); (W.-K.L.)
| | - Shih-Yi Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-F.L.); (P.-C.L.); (S.-Y.H.); (Y.-T.T.); (W.-K.L.)
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Tzu-Chieh Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-F.L.); (P.-C.L.); (S.-Y.H.); (Y.-T.T.); (W.-K.L.)
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49
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Jarman H, Crouch R, Baxter M, Wang C, Peck G, Sivapathasuntharam D, Jennings C, Cole E. Feasibility and accuracy of ED frailty identification in older trauma patients: a prospective multi-centre study. Scand J Trauma Resusc Emerg Med 2021; 29:54. [PMID: 33785031 PMCID: PMC8011126 DOI: 10.1186/s13049-021-00868-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The burden of frailty on older people is identifiable by its adverse effect on mortality, morbidity and long term functional and health outcomes. In patients suffering from a traumatic injury there is increasing evidence that it is frailty rather than age that impacts greatest on these outcomes and that early identification can guide frailty specific care. The aim of this study was to evaluate the feasibility of nurse-led assessment of frailty in older trauma patients in the ED in patients admitted to major trauma centres. METHODS Patients age 65 years and over attending the Emergency Departments (ED) of five Major Trauma Centres following traumatic injury were enrolled between June 2019 and March 2020. Patients were assessed for frailty whilst in the ED using three different screening tools (Clinical Frailty Scale [CFS], Program of Research to Integrate Services for the Maintenance of Autonomy 7 [PRIMSA7], and the Trauma Specific Frailty Index [TSFI]) to compare feasibility and accuracy. Accuracy was determined by agreement with geriatrician assessment of frailty. The primary outcome was identification of frailty in the ED using three different assessment tools. RESULTS We included 372 patients whose median age was 80, 53.8% of whom were female. The most common mechanism of injury was fall from less than 2 m followed by falls greater than 2 m. Completion rates for the tools were variable, 31.9% for TSFI, compared to 93% with PRISMA7 and 98.9% with the CFS. There was substantial agreement when using CFS between nurse defined frailty and geriatrician defined frailty. Agreement was moderate using PRISMA7 and slight using TSFI. CONCLUSIONS This prospective study has demonstrated that screening for frailty in older major trauma patients within the Emergency Department is feasible and accurate using CFS. TRIAL REGISTRATION ISRCTN, ISRCTN10671514 . Registered 22 October 2019.
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Affiliation(s)
- Heather Jarman
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
| | - Robert Crouch
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Baxter
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Chao Wang
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - George Peck
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Cara Jennings
- King's College Hospital NHS Foundation Trust, London, UK
| | - Elaine Cole
- Blizard Institute, Queen Mary's, University of London, London, UK
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50
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Papathanasiou IV, Fradelos EC, Mantzaris D, Rammogianni A, Malli F, Papagiannis D, Gourgoulianis KI. Multimorbidity, Trauma Exposure, and Frailty of Older Adults in the Community. Front Genet 2021; 12:634742. [PMID: 33868372 PMCID: PMC8044890 DOI: 10.3389/fgene.2021.634742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study is to investigate the relation between multimorbidity, traumatic events and frailty among older adults in the community. The studied population consisted of 257 older people who were recipients of the services and active members of Open Care Centers for the Elderly (OCCE) of the Municipality of Grevena and meet a set of selection criteria. The collection of the data was carried out using a fully structured questionnaire, which consisted of two sections: a form of individual features and the Tilburg Frailty Indicator (TFI). The sample consisted of 114 men (44.4%) and 143 women (55.6%) aged between 61 and 96 years with an average of 75.12 years. The results showed that the mean scores were 2.70 for the Physical Frailty (standard deviation = 2.16), 1.43 for the Psychological Frailty (standard deviation = 1.21), 1.32 for the Social Frailty (standard deviation = 0.64) and 5.44 for the total Frailty (standard deviation = 3.02). We took into account the cut-off point five of 54.1% (n = 139) in terms of the participants' frailty. Physical, Psychological, and Total Frailty are related to (a) the presence of two or more chronic diseases or disorders, (b) the experience of a serious illness in the previous year, and (c) the experience of a serious illness of a loved one during the previous year. The outcomes helped to identify frailty syndrome in older people and the factors associated with it.
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Affiliation(s)
| | | | - Dimitrios Mantzaris
- Computational Intelligence and Health Informatics Lab, Faculty of Nursing, University of Thessaly, Volos, Greece
| | - Anna Rammogianni
- National Organization of Public Health, Refugees Reception Centre of Agia Varvara, Veroia, Greece
| | - Foteini Malli
- Faculty of Nursing, University of Thessaly, Volos, Greece
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