Differential utility of various frailty diagnostic tools in non-geriatric hospital departments of several countries: A longitudinal study

Muscle power predicts frailty and other adverse events across different settings

OBJECTIVES

To evaluate the association between lower-limb muscle power (MP) and frailty, measured using eight different scales, in older adults from four clinical settings. Additionally, to examine the predictive capacity of MP for adverse health events.

DESIGN

A cross-sectional and longitudinal analysis using data from the Spanish cohort of the Frailtools project.

SETTING

Nursing homes, primary care clinics, geriatric inpatient wards, and outpatient clinics.

PARTICIPANTS

245 older adults (mean age 82 ± 4.6 years, 64% women).

MEASUREMENTS

MP measures were estimated using the five-time sit-to-stand (5STS) test and validated equations to obtain absolute (AMP), relative to body weight (RMP), and allometric (ALMP) values. Frailty was evaluated using eight scales, including the Frailty Phenotype and the Frailty Trait Scale. The incidence of adverse events (e.g., frailty, hospitalization, falls, and disability) was recorded over 12 months.

RESULTS

Frailty prevalence varied significantly across scales and settings, with the lowest rates observed in primary care and the highest in nursing homes. Cross-sectional analysis revealed significant associations between all MP measures and frailty for most scales. RMP demonstrated the strongest associations, particularly with the Frailty Trait Scale-5 and FRAIL scale, across primary care, nursing homes, and outpatient clinics. Longitudinally, RMP was significantly associated with incident frailty and several adverse events, including hospitalizations (AUC: 0.71) and disability in activities of daily living (AUC: 0.71). Sex-specific MP cut-off points were identified for predicting health events. No significant differences were observed among MP measurements.

CONCLUSION

Lower-limb MP is a valid clinical biomarker associated with frailty and negative health events in older adults. The degree of associations varied according to frailty scale and clinical context, but no significant differences were observed when we compared their predictive ability. The proposed MP cut-off points may enhance frailty assessment and screening, particularly in primary care, nursing homes, and outpatient clinics. These findings highlight the clinical potential of incorporating MP measures into frailty tools and stress the need for further research to refine age-specific cut-off points and explore the influence of body composition.

Evaluation of frailty in geriatric patients undergoing cardiac rehabilitation after cardiac procedure: results of a prospective, cross-sectional study

BACKGROUND

Frailty is an indicator of a decline in quality of life and functional capacity in cardiac rehabilitation (CR) patients. Currently, there is no standardized assessment tool for frailty used in CR. The aim of this study was to determine if the Clinical Frailty Scale (CFS) is feasible for assessing frailty in CR.

METHODS

Prospective, cross-sectional study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". Patients ≥75 years undergoing CR after cardiac procedure (n=122) were recruited in four German inpatient CR facilities. Assessments included: CFS, Katz-Index, hand grip strength (HGS), Short Physical Performance Battery (SPPB) and six-minute-walk test (6MWT). Outcomes were frailty (CFS≥4) and the correlation of frailty with assessments of functional capacity, activities of daily living and clinical parameters. Statistical analysis included descriptive statistics and correlations, using the spearman correlation coefficient and chi-square test to test for significance.

RESULTS

Data from 101 patients (79.9±4.0 years; 63% male) were analyzed. The mean CFS score was 3.2±1.4; 41.6% were defined as frail (CFS≥4). The mean time required to assess the CFS was 0.20 minutes. The findings show that CFS correlates significantly (p<0.001) with the following factors: Katz-Index, HGS, SPPB-Score and 6MWT (r≤-0.575). In addition, CFS correlated with small to moderate effects with co-morbidities (r=0.250), as-needed medications and need for nursing assistance (r≤0.248).

CONCLUSIONS

The CFS assessment can be performed in under one minute and it correlates significantly with assessments of functional capacity, activities of daily living and clinical parameters in the CR setting.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS; http:// www. drks. de; DRKS00032256). Retrospectively registered on 13 July 2023.

Biomarkers of frailty

Several biomarkers have been proposed to identify frailty, a multisystemic age-related syndrome. However, the complex pathophysiology and the absence of a consensus on a comprehensive and universal definition make it challenging to pinpoint a singular biomarker or set of biomarkers that conclusively characterize frailty. This review delves into the main laboratory biomarkers, placing special emphasis on those associated with various pathways closely tied to the frailty condition, such as inflammation, oxidative stress, mitochondrial dysfunction, metabolic and endocrine alterations and microRNA. Additionally, we provide a summary of different clinical biomarkers encompassing different tools that have been proposed to assess frailty. We further address various imaging biomarkers such as Dual Energy X-ray Absorptiometry, Bioelectrical Impedance analysis, Computed Tomography and Magnetic Resonance Imaging, Ultrasound and D3 Creatine dilution. Intervention to treat frailty, including non-pharmacological ones, especially those involving physical exercise and nutrition, and pharmacological interventions, that include those targeting specific mechanisms such as myostatin inhibitors, insulin sensitizer metformin and with special relevance for hormonal treatments are mentioned. We further address the levels of different biomarkers in monitoring the potential positive effects of some of these interventions. Despite the availability of numerous biomarkers, their performance and usefulness in the clinical arena are far from being satisfactory. Considering the multicausality of frailty, there is an increasing need to assess the role of sets of biomarkers and the combination between laboratory, clinical and image biomarkers, in terms of sensitivity, specificity and predictive values for the diagnosis and prognosis of the different outcomes of frailty to improve detection and monitoring of older people with frailty or at risk of developing it, being this a need in the everyday clinical practice.

Is the clinical frailty scale feasible to use in an emergency department setting? A mixed methods study

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).