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Chaplin WJ, Lewis HR, Shahtaheri SM, Millar BS, McWilliams DF, Gladman JRF, Walsh DA. The association of painful and non-painful morbidities with frailty: a cross sectional analysis of a cohort of community dwelling older people in England. BMC Geriatr 2024; 24:158. [PMID: 38360542 PMCID: PMC10870594 DOI: 10.1186/s12877-023-04602-w] [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: 07/11/2023] [Accepted: 12/14/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The association between chronic pain and frailty might indicate that pain is an independent driver of frailty but might alternatively be explained by inclusion within frailty identification tools of morbidities that commonly lead to chronic pain. This research examines the extent to which the association of pain with frailty might be attributed to morbidities. METHODS A cross-sectional analysis of older people in a UK cohort with or at risk of musculoskeletal problems or frailty (Investigating Musculoskeletal Health and Wellbeing study), used multivariable logistic regression and Z-tests to assess the degrees of associations of pain (McGill Pain Rating Index), and painful and non-painful morbidity counts with frailty (modified FRAIL questionnaire). RESULTS Data were from 2,185 participants, 56% female, median age 73 (range 60 to 96) years. 430 (20%) participants were classified as frail. In a fully adjusted standardised model, pain (aOR 2.07 (95%CI 1.83 to 2.33) and 'any' morbidity aOR (1.74 (95%CI 1.54 to 1.97) were both significantly associated with frailty. When morbidity was subclassified as painful or non-painful, painful (aOR 1.48 (95%CI 1.30 to 1.68) and non-painful (aOR1.39 (95%CI 1.24 to 1.56)) morbidities each were associated with frailty, as also was pain (aOR 2.07 (95%CI 1.83 to 2.34, p < 0.001). CONCLUSIONS Pain is associated with frailty, over and above any effect of painful and non-painful morbidities. This forms the justification for future research which focuses on pain management in the identification, prevention, and treatment of frailty.
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Affiliation(s)
- W J Chaplin
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England.
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England.
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England.
- Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, England.
| | - H R Lewis
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- School of Medicine, University of Nottingham, Nottingham, England
| | - S M Shahtaheri
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
| | - B S Millar
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
| | - D F McWilliams
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
| | - J R F Gladman
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
- Centre for Rehabilitation & Ageing Research, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
| | - D A Walsh
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, England
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, England
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, England
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, Nottingham, England
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Karunananthan S, Bonacci G, Fung C, Huang A, Robert B, McCutcheon T, Houghton D, Hakimjavadi R, Keely E, Liddy C. What do primary care providers want to know when caring for patients living with frailty? An analysis of eConsult communications between primary care providers and specialists. BMC Health Serv Res 2024; 24:76. [PMID: 38225619 PMCID: PMC10790473 DOI: 10.1186/s12913-024-10542-x] [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: 06/01/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Frailty is a complex condition that primary care providers (PCPs) are managing in increasing numbers, yet there is no clear guidance or training for frailty care. OBJECTIVES The present study examined eConsult questions PCPs asked specialists about patients with frailty, the specialists' responses, and the impact of eConsult on the care of these patients. DESIGN Cross-sectional observational study. SETTING ChamplainBASE™ eConsult located in Eastern Ontario, Canada. PARTICIPANTS Sixty one eConsult cases closed by PCPs in 2019 that use the terms "frail" or "frailty" to describe patients 65 years of age or older. MEASUREMENTS The Taxonomy of Generic Clinical Questions (TGCQ) was used to classify PCP questions and the International Classification for Primary Care 3 (ICPC-3) was used to classify the clinical content of each eConsult. The impact of eConsult on patient care was measured by PCP responses to a mandatory survey. RESULTS PCPs most frequently directed their questions to cardiology (n = 7; 11%), gastroenterology (n = 7; 11%), and endocrinology (n = 6; 10%). Specialist answers most often pertained to medications (n = 63, 46%), recommendations for clinical investigation (n = 24, 17%), and diagnoses (n = 22, 16%). Specialist responses resulted in PCPs avoiding referral in 57% (n = 35) of cases whereas referrals were still required in 15% (n = 9) of cases. Specialists responded to eConsults in a median 1.11 days (IQR = 0.3-4.7), and 95% (n = 58) of cases received a response within 7 days. Specialists recorded a median of 15 min to respond (IQR = 10-20), with a median cost of $50.00 CAD (IQR = 33.33 - 66.66) per eConsult. CONCLUSIONS Through the analysis of questions and responses submitted to eConsult, this study provides novel information on PCP knowledge gaps and approaches to care for patients living with frailty. Furthermore, these analyses provide evidence that eConsult is a feasible and valuable tool for improving care for patients with frailty in primary care settings.
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Affiliation(s)
- Sathya Karunananthan
- Interdisciplinary School of Health Sciences, University of Ottawa, 200 Lees Ave #516F, Ottawa, ON, Canada.
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.
| | | | - Celeste Fung
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- St Patrick's Home of Ottawa, Ottawa, ON, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
| | - Allen Huang
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Benoit Robert
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Perley Health Centre of Excellence in Frailty-Informed Care™, Ottawa, ON, Canada
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Deanne Houghton
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
| | - Ramtin Hakimjavadi
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Erin Keely
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, ON, Canada
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Olsson H, Åhlund K, Alfredsson J, Andersson D, Boström AM, Guidetti S, Prytz M, Ekerstad N. Cross-cultural adaption and inter-rater reliability of the Swedish version of the updated clinical frailty scale 2.0. BMC Geriatr 2023; 23:803. [PMID: 38053055 PMCID: PMC10696827 DOI: 10.1186/s12877-023-04525-6] [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: 04/24/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Worldwide, there is a large and growing group of older adults. Frailty is known as an important discriminatory factor for poor outcomes. The Clinical Frailty Scale (CFS) has become a frequently used frailty instrument in different clinical settings and health care sectors, and it has shown good predictive validity. The aims of this study were to describe and validate the translation and cultural adaptation of the CFS into Swedish (CFS-SWE), and to test the inter-rater reliability (IRR) for registered nurses using the CFS-SWE. METHODS An observational study design was employed. The ISPOR principles were used for the translation, linguistic validation and cultural adaptation of the scale. To test the IRR, 12 participants were asked to rate 10 clinical case vignettes using the CFS-SWE. The IRR was assessed using intraclass correlation and Krippendorff's alpha agreement coefficient test. RESULTS The Clinical Frailty Scale was translated and culturally adapted into Swedish and is presented in its final form. The IRR for all raters, measured by an intraclass correlation test, resulted in an absolute agreement value among the raters of 0.969 (95% CI: 0.929-0.991) and a consistency value of 0.979 (95% CI: 0.953-0.994), which indicates excellent reliability. Krippendorff's alpha agreement coefficient for all raters was 0.969 (95% CI: 0.917-0.988), indicating near-perfect agreement. The sensitivity of the reliability was examined by separately testing the IRR of the group of specialised registered nurses and non-specialised registered nurses respectively, with consistent and similar results. CONCLUSION The Clinical Frailty Scale was translated, linguistically validated and culturally adapted into Swedish following a well-established standard technique. The IRR was excellent, judged by two established, separately used, reliability tests. The reliability test results did not differ between non-specialised and specialised registered nurses. However, the use of case vignettes might reduce the generalisability of the reliability findings to real-life settings. The CFS has the potential to be a common reference tool, especially when older adults are treated and rehabilitated in different care sectors.
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Affiliation(s)
- Henrik Olsson
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
- Department of Cardiology, NU Hospital Group, Trollhättan, Sweden
| | - Kristina Åhlund
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - David Andersson
- Department of Management and Engineering, Division of Economics, Linköping University, Linköping, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Division of Nursing, Karolinska Institutet, Care Sciences&Society (NVS), Huddinge, Sweden
- Karolinska University Hospital, Theme Inflammation and Aging, Stockholm, Sweden
- Stockholms Sjukhem, Research and Development Unit, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Division of Occupational Therapy, Karolinska Institutet, Care Sciences&Society (NVS), Huddinge, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Solna, Sweden
| | - Mattias Prytz
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy,, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, NU-Hospital Group, Region Västra Götaland, Trollhättan, Sweden
| | - Niklas Ekerstad
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
- Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden.
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Willemsen RF, Meijer E, van den Berg LN, van der Burg L, Chavannes NH, Aardoom JJ. A Health App Platform Providing a Budget to Purchase Preselected Apps as an Innovative Way to Support Public Health: Qualitative Study With End Users and Other Stakeholders. JMIR Form Res 2023; 7:e49473. [PMID: 37773608 PMCID: PMC10576224 DOI: 10.2196/49473] [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: 05/30/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of €100 (US $107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. OBJECTIVE The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews. METHODS This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of €100 (US $107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method. RESULTS A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications. CONCLUSIONS This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health.
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Affiliation(s)
- Romy Fleur Willemsen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Liselot Nicoline van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Luuk van der Burg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Niels Henrik Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska Joelle Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
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Lound A, Bruton J, Jones K, Shah N, Williams B, Gross J, Post B, Day S, Brett SJ, Ward H. "I'd rather wait and see what's around the corner": A multi-perspective qualitative study of treatment escalation planning in frailty. PLoS One 2023; 18:e0291984. [PMID: 37733669 PMCID: PMC10513333 DOI: 10.1371/journal.pone.0291984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION People living with frailty risk adverse outcomes following even minor illnesses. Admission to hospital or the intensive care unit is associated with potentially burdensome interventions and poor outcomes. Decision-making during an emergency is fraught with complexity and potential for conflict between patients, carers and clinicians. Advance care planning is a process of shared decision-making which aims to ensure patients are treated in line with their wishes. However, planning for future care is challenging and those living with frailty are rarely given the opportunity to discuss their preferences. The aim of the ProsPECT (Prospective Planning for Escalation of Care and Treatment) study was to explore perspectives on planning for treatment escalation in the context of frailty. We spoke to people living with frailty, their carers and clinicians across primary and secondary care. METHODS In-depth online or telephone interviews and online focus groups. The topic guide explored frailty, acute decision-making and planning for the future. Data were thematically analysed using the Framework Method. Preliminary findings were presented to a sample of study participants for feedback in two online workshops. RESULTS We spoke to 44 participants (9 patients, 11 carers and 24 clinicians). Four main themes were identified: frailty is absent from treatment escalation discussions, planning for an uncertain future, escalation in an acute crisis is 'the path of least resistance', and approaches to facilitating treatment escalation planning in frailty. CONCLUSION Barriers to treatment escalation planning include a lack of shared understanding of frailty and uncertainty about the future. Emergency decision-making is focussed on survival or risk aversion and patient preferences are rarely considered. To improve planning discussions, we recommend frailty training for non-specialist clinicians, multi-disciplinary support, collaborative working between patients, carers and clinicians as well as broader public engagement.
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Affiliation(s)
- Adam Lound
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Jane Bruton
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Kathryn Jones
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Nira Shah
- ProsPECT Study Public Advisor, Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Barry Williams
- ProsPECT Study Public Advisor, Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Jamie Gross
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Benjamin Post
- Department of Bioengineering and Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre in AI for Healthcare, Imperial College London, London, United Kingdom
| | - Sophie Day
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Stephen J. Brett
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- National Institute for Health Research Imperial Biomedical Research Centre, London, United Kingdom
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Lyndon H, Latour JM, Marsden J, Kent B. A nurse-led comprehensive geriatric assessment intervention in primary care: A feasibility cluster randomized controlled trial. J Adv Nurs 2023; 79:3473-3486. [PMID: 37002595 DOI: 10.1111/jan.15652] [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: 04/06/2022] [Revised: 02/02/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023]
Abstract
AIM To determine the feasibility of a nurse-led, primary care-based comprehensive geriatric assessment (CGA) intervention. DESIGN A feasibility cluster randomized controlled trial. METHODS The trial was conducted in six general practices in the United Kingdom from May 2018 to April 2020. Participants were moderately/severely frail people aged 65 years and older living at home. Clusters were randomly assigned to the intervention arm control arms. A CGA was delivered to the intervention participants, with control participants receiving usual care. Study outcomes related to feasibility of the intervention and of conducting the trial including recruitment and retention. A range of outcome measures of quality of life, function, loneliness, self-determination, mortality, hospital admission/readmission and number of prescribed medications were evaluated. RESULTS All pre-specified feasibility criteria relating to recruitment and retention were met with 56 participants recruited in total (30 intervention and 26 control). Retention was high with 94.6% of participants completing 13-week follow-up and 87.5% (n = 49) completing 26-week follow-up. All outcome measures instruments met feasibility criteria relating to completeness and responsiveness over time. Quality of life was recommended as the primary outcome for a definitive trial with numbers of prescribed medications as a secondary outcome measure. CONCLUSION It is feasible to implement and conduct a randomized controlled trial of a nurse-led, primary care-based CGA intervention. IMPACT The study provided evidence on the feasibility of a CGA intervention for older people delivered in primary care. It provides information to maximize the success of a definitive trial of the clinical effectiveness of the intervention. PATIENT OR PUBLIC CONTRIBUTION Patient and public representatives were involved in the study design including intervention development and production of participant-facing documentation. Representatives served on the trial management and steering committees and, as part of this role, interpreted feasibility data. ISRCTN Number: 74345449.
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Affiliation(s)
| | - Jos M Latour
- University of Plymouth, Plymouth, UK
- Curtin University, Perth, Australia
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Mirzaeian R, Nopour R, Asghari Varzaneh Z, Shafiee M, Shanbehzadeh M, Kazemi-Arpanahi H. Which are best for successful aging prediction? Bagging, boosting, or simple machine learning algorithms? Biomed Eng Online 2023; 22:85. [PMID: 37644599 PMCID: PMC10463617 DOI: 10.1186/s12938-023-01140-9] [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: 03/12/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The worldwide society is currently facing an epidemiological shift due to the significant improvement in life expectancy and increase in the elderly population. This shift requires the public and scientific community to highlight successful aging (SA), as an indicator representing the quality of elderly people's health. SA is a subjective, complex, and multidimensional concept; thus, its meaning or measuring is a difficult task. This study seeks to identify the most affecting factors on SA and fed them as input variables for constructing predictive models using machine learning (ML) algorithms. METHODS Data from 1465 adults aged ≥ 60 years who were referred to health centers in Abadan city (Iran) between 2021 and 2022 were collected by interview. First, binary logistic regression (BLR) was used to identify the main factors influencing SA. Second, eight ML algorithms, including adaptive boosting (AdaBoost), bootstrap aggregating (Bagging), eXtreme Gradient Boosting (XG-Boost), random forest (RF), J-48, multilayered perceptron (MLP), Naïve Bayes (NB), and support vector machine (SVM), were trained to predict SA. Finally, their performance was evaluated using metrics derived from the confusion matrix to determine the best model. RESULTS The experimental results showed that 44 factors had a meaningful relationship with SA as the output class. In total, the RF algorithm with sensitivity = 0.95 ± 0.01, specificity = 0.94 ± 0.01, accuracy = 0.94 ± 0.005, and F-score = 0.94 ± 0.003 yielded the best performance for predicting SA. CONCLUSIONS Compared to other selected ML methods, the effectiveness of the RF as a bagging algorithm in predicting SA was significantly better. Our developed prediction models can provide, gerontologists, geriatric nursing, healthcare administrators, and policymakers with a reliable and responsive tool to improve elderly outcomes.
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Affiliation(s)
- Razieh Mirzaeian
- Department of Health Information Management, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Raoof Nopour
- Student Research Committee, School of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Asghari Varzaneh
- Department of Computer Science, Faculty of Mathematics and Computer, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mohsen Shafiee
- Department of Nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran.
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8
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Chaplin WJ, McWilliams DF, Millar BS, Gladman JRF, Walsh DA. The bidirectional relationship between chronic joint pain and frailty: data from the Investigating Musculoskeletal Health and Wellbeing cohort. BMC Geriatr 2023; 23:273. [PMID: 37147635 PMCID: PMC10161600 DOI: 10.1186/s12877-023-03949-4] [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: 12/19/2022] [Accepted: 04/02/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Pain and frailty are associated, but this relationship is insufficiently understood. We aimed to test whether there is a unidirectional or bidirectional relationship between joint pain and frailty. METHODS Data were from Investigating Musculoskeletal Health and Wellbeing, a UK-based cohort. Average joint pain severity over the previous month was assessed using an 11-point numerical rating scale (NRS). Frailty was classified as present/absent using the FRAIL questionnaire. Multivariable regression assessed the association between joint pain and frailty, adjusted for age, sex, and BMI class. Two-wave cross-lagged path modelling permitted simultaneous exploration of plausible causal pathways between pain intensity and frailty at baseline and 1-year. Transitions were assessed using t-tests. RESULTS One thousand one hundred seventy-nine participants were studied, 53% female, with a median age of 73 (range 60 to 95) years. FRAIL classified 176 (15%) participants as frail at baseline. Mean (SD) baseline pain score was 5.2 (2.5). Pain NRS ≥ 4 was observed in 172 (99%) of frail participants. Pain severity was associated with frailty at baseline (aOR 1.72 (95%CI 1.56 to 1.92)). In cross-lagged path analysis, higher baseline pain predicted 1-year frailty [β = 0.25, (95%CI 0.14 to 0.36), p < 0.001] and baseline frailty predicted higher 1-year pain [β = 0.06, (95%CI 0.003 to 0.11), p = 0.040]. Participants transitioning to frailty over one year had higher mean pain scores (6.4 (95%CI 5.8 to 7.1)) at baseline than those who remained non-frail (4.7 (95%CI 4.5 to 4.8)), p < 0.001. CONCLUSIONS The bidirectional relationship between pain and frailty could lead to a vicious cycle in which each accelerates the other's progression. This justifies attempts to prevent frailty by addressing pain and to include pain measures as an outcome in frailty studies.
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Affiliation(s)
- Wendy J Chaplin
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK.
- Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Daniel F McWilliams
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Bonnie S Millar
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - John R F Gladman
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Centre for Rehabilitation & Ageing Research, Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - David A Walsh
- Academic Rheumatology, Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Sherwood Forest Hospitals NHS Foundation Trust, Rheumatology, Mansfield, UK
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Ambagtsheer RC, Thompson MQ, Tucker GR, Schultz T, Beilby J, Visvanathan R. Does CGA Improve Health Outcomes in the Community? An Umbrella Review. J Am Med Dir Assoc 2023:S1525-8610(23)00297-9. [PMID: 37088103 DOI: 10.1016/j.jamda.2023.03.018] [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: 12/06/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES To perform an umbrella review of systematic reviews with meta-analyses (MAs) examining the effectiveness of comprehensive geriatric assessment (CGA) delivered within community settings to general populations of community-dwelling older people against various health outcomes. DESIGN Umbrella review of MAs of randomized controlled trials (RCTs). SETTING AND PARTICIPANTS Systematic reviews with MAs examining associations between CGA conducted within the community and any health outcome, where participants were community-dwelling older people with a minimum mean age of 60 years or where at least 50% of study participants were aged ≥60 years. Studies focusing on residential care, hospitals, post-hospital care, outpatient clinics, emergency department, or patients with specific conditions were excluded. METHODS We examined CGA effectiveness against 12 outcomes: not living at home, nursing home admission, activities of daily living (ADLs) and instrumental ADLs (IADLs), physical function, falls, self-reported health status, quality of life, frailty, mental health, hospital admission, and mortality, searching the MEDLINE/PubMed, Cochrane Library, CINAHL, Embase databases from January 1, 1999, to August 10, 2022. AMSTAR-2 was used to assess the quality of included systematic reviews, including risk of bias. RESULTS We identified 10 MAs. Only not living at home (combined mortality and nursing home admission) demonstrated concordance between effect direction, significance, and magnitude. Significant effects were more typically observed in earlier rather than later studies. CONCLUSION AND IMPLICATIONS Given the widespread adoption of CGA as a component of usual care within geriatric medicine, the lack of strong evidence demonstrating the protective effects of CGA may be indicative of a cohort effect. If so, future RCTs examining CGA effectiveness are unlikely to demonstrate significant findings. Future studies of CGA in the community should focus on implementation and adherence to key components. TRIAL REGISTRATION Study protocol registered in PROSPERO 2020 CRD42020169680.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Torrens University Australia, South Australia, Australia.
| | - Mark Q Thompson
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Graeme R Tucker
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia
| | - Timothy Schultz
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Flinders Health and Medical Research Institute, Flinders University, South Australia, Australia
| | - Justin Beilby
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Torrens University Australia, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
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Lees C, Andrew MK. MAiD for geriatric syndromes: Special considerations. Healthc Manage Forum 2023; 36:162-165. [PMID: 36803074 PMCID: PMC10133828 DOI: 10.1177/08404704221141048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Medical Assistance in Dying (MAiD) brings unique considerations in the context of geriatric syndromes such as frailty and cognitive or functional impairment. These conditions are associated with complex vulnerability across health and social domains and often do not have predicable trajectories or responses to healthcare interventions. In this paper, we focus on four categories of gaps in care that are particularly relevant for MAiD in geriatric syndromes, namely, inadequacies in access to medical care, appropriate advance care planning, social supports, and funding for supportive care. We conclude by arguing that appropriately situating MAiD in the context of care for older adults requires careful consideration of these gaps in care to enable real, robust, and respectful healthcare choices for people living with geriatric syndromes and approaching end-of-life.
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Affiliation(s)
- Caitlin Lees
- 12361Dalhousie University, Halifax, Nova Scotia, Canada
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11
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Murray S, Langdahl B, Casado E, Brooks K, Libanati C, Di Lecce L, Lazure P. Preparing the Leaders of Tomorrow: Learnings from a Two-Year Community of Practice in Fragility Fractures. J Eur CME 2022; 11:2142405. [DOI: 10.1080/21614083.2022.2142405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Suzanne Murray
- Department of Research, AXDEV Group Inc, Brossard, QC, Canada
| | - Bente Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Enrique Casado
- Department of Rheumatology, University Hospital Parc Taulí, I3PT Research Institute, Sabadell, Barcelona, Spain
| | | | | | | | - Patrice Lazure
- Department of Research, AXDEV Group Inc, Brossard, QC, Canada
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12
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Sunkersing D, Martin FC, Sullivan P, Bell D. Care and support networks of community-dwelling frail individuals in North West London: a comparison of patient and healthcare workers' perceptions. BMC Geriatr 2022; 22:953. [PMID: 36494627 PMCID: PMC9737751 DOI: 10.1186/s12877-022-03561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evidence suggests that successful assessment and care for frail individuals requires integrated and collaborative care and support across and within settings. Understanding the care and support networks of a frail individual could therefore prove useful in understanding need and designing support. This study explored the care and support networks of community-dwelling older people accessing a falls prevention service as a marker of likely frailty, by describing and comparing the individuals' networks as perceived by themselves and as perceived by healthcare providers involved in their care. METHODS A convenience sample of 16 patients and 16 associated healthcare professionals were recruited from a community-based NHS 'Falls Group' programme within North-West London. Individual (i.e., one on one) semi-structured interviews were conducted to establish an individual's perceived network. Principles of quantitative social network analysis (SNA) helped identify the structural characteristics of the networks; qualitative SNA and a thematic analysis aided data interpretation. RESULTS All reported care and support networks showed a high contribution level from family and friends and healthcare professionals. In patient-reported networks, 'contribution level' was often related to the 'frequency' and 'helpfulness' of interaction. In healthcare professional reported networks, the reported frequency of interaction as detailed in patient records was used to ascertain 'contribution level'. CONCLUSION This study emphasises the importance of the role of informal carers and friends along with healthcare professionals in the care of individuals living with frailty. There was congruence in the makeup of 'patient' and 'provider' reported networks, but more prominence of helper/carers in patients' reports. These findings also highlight the multidisciplinary makeup of a care and support network, which could be targeted by healthcare professionals to support the care of frail individuals.
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Affiliation(s)
- David Sunkersing
- grid.7445.20000 0001 2113 8111Department of Primary Care and Public Health, Imperial College London, London, W6 8RP UK
| | - Finbarr C. Martin
- grid.13097.3c0000 0001 2322 6764King’s College London (Population Health Sciences), London, UK
| | - Paul Sullivan
- grid.7445.20000 0001 2113 8111Department of Primary Care and Public Health, Imperial College London, London, W6 8RP UK
| | - Derek Bell
- grid.7445.20000 0001 2113 8111Department of Primary Care and Public Health, Imperial College London, London, W6 8RP UK
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Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 5: Co-creative qualitative approaches for emerging themes in primary care research: Experience-based co-design, user-centred design and community-based participatory research. Eur J Gen Pract 2022; 28:1-12. [PMID: 35037811 PMCID: PMC8765256 DOI: 10.1080/13814788.2021.2010700] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/03/2022] Open
Abstract
This article, the fifth in a series aiming to provide practical guidance for qualitative research in primary care, introduces three qualitative approaches with co-creative characteristics for addressing emerging themes in primary care research: experience-based co-design, user-centred design and community-based participatory research. Co-creation aims to define the (research) problem, develop and implement interventions and evaluate and define (research and practice) outcomes in partnership with patients, family carers, researchers, care professionals and other relevant stakeholders. Experience-based co-design seeks to understand how people experience a health care process or service. User-centred design is an approach to assess, design and develop technological and organisational systems, for example, eHealth, involving end-users in the design and decision-making processes. Community-based participatory research is a collaborative approach addressing a locally relevant health issue. It is often directed at hard-to-reach and vulnerable people. We address the context, what, why, when and how of these co-creative approaches, and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.
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Affiliation(s)
- Albine Moser
- Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Irene Korstjens
- Research Centre for Midwifery Science, Zuyd University of Applied Sciences, Maastricht, The Netherlands
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14
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Wennberg AM, Ebeling M, Ek S, Meyer A, Ding M, Talbäck M, Modig K. Trends in Frailty Between 1990 and 2020 in Sweden Among 75-, 85-, and 95-Year-Old Women and Men: A Nationwide Study from Sweden. J Gerontol A Biol Sci Med Sci 2022; 78:342-348. [PMID: 36190806 PMCID: PMC9951059 DOI: 10.1093/gerona/glac210] [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: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aging is the primary risk factor for frailty, which is defined as an inability to respond to acute or chronic stressors. Individuals are living longer with greater multimorbidity, but there is a paucity of evidence examining frailty across birth cohorts and ages. METHODS We investigated frailty prevalence and its association with mortality at ages 75, 85, and 95 in the 1895-1945 birth cohorts in Sweden with data from population registries. Frailty was assessed with the Hospital Frailty Risk Score (HFRS). RESULTS We observed that frailty increased with increasing age and that it has become more common in more recent birth cohorts. At age 75, the percent frail in the Total Population Register increased from 1.1% to 4.6% from birth cohorts 1915-1945, corresponding to calendar years 1990-2020. At age 85, the percentage of frail increased from 3.5% to 11.5% from birth cohorts 1905-1935, and at age 95 from birth cohorts 1895-1925, from 4.7% to 18.7%. Our results show that the increase was primarily driven by an increase in the distribution of individuals with scores in the highest quartile of HFRS, while the bottom 3 quartiles remained relatively stable across birth cohorts. Women accounted for a greater distribution of the overall population and frail population, though these disparities decreased over time. Despite increasing levels of frailty, the relationship between frailty and mortality did not change over time, nor did it differ by sex. CONCLUSION Increased frailty with improved survival points to a chronic condition that could be intervened upon.
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Affiliation(s)
- Alexandra M Wennberg
- Address correspondence to: Alexandra M. Wennberg, PhD, Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77 Stockholm, Sweden. E-mail:
| | - Marcus Ebeling
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Wilkinson TJ, Miksza J, Zaccardi F, Lawson C, Nixon AC, Young HML, Khunti K, Smith AC. Associations between frailty trajectories and cardiovascular, renal, and mortality outcomes in chronic kidney disease. J Cachexia Sarcopenia Muscle 2022; 13:2426-2435. [PMID: 35851589 PMCID: PMC9530530 DOI: 10.1002/jcsm.13047] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/11/2022] [Accepted: 06/25/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Frailty is characterized by the loss of biological reserves and vulnerability to adverse outcomes. In individuals with chronic kidney disease (CKD), numerous pathophysiological factors may be responsible for frailty development including inflammation, physical inactivity, reduced energy intake, and metabolic acidosis. Given that both CKD and frailty incur a significant healthcare burden, it is important to understand the relationship of CKD and frailty in real-world routine clinical practice, and how simple frailty assessment methods (e.g. frailty indexes) may be useful. We investigated the risk of frailty development in CKD and the impact of frailty status on mortality and end-stage kidney disease (ESKD). METHODS A retrospective cohort study using primary care records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics and the UK Office for National Statistics was undertaken in 819 893 participants aged ≥40 years, of which 140 674 had CKD. Frailty was defined using an electronic frailty index, generated electronically from primary care records. Cox proportional hazard and flexible parametric survival models were used to investigate the risk of developing frailty and the effect of frailty on risk of all-cause and cardiovascular mortality, and ESKD. RESULTS The mean age of those with CKD was 77.5 (SD 9.7) years [61.0 (SD 12.1) years in no-CKD group]; 62.0% of the CKD group were female (compared with 53.3% in no-CKD group). The mean estimated glomerular filtration rate of those with CKD was 46.1 (SD 9.9) mL/min/1.73 m2 . The majority of those with CKD (75.3%) were frail [vs. 45.4% in those without CKD (no-CKD)]. Over 3 years (median), 69.5% of those with CKD developed frailty. Compared with no-CKD, those with CKD had increased rates of developing mild (hazard ratio: 1.02; 95% confidence interval: 1.01-1.04), moderate (1.30; 1.26-1.34), and severe (1.50; 1.37-1.65) frailty. Mild (1.22; 1.19-1.24), moderate (1.60; 1.56-1.63), and severe (2.16; 2.11-2.22) frailty was associated with increased rates of all-cause and cardiovascular-related mortality (mild 1.35; 1.31-1.39; moderate 1.96; 1.90-2.02; and severe 2.91; 2.81-3.02). All stages of frailty significantly increased ESKD rates. CONCLUSIONS Frailty is highly prevalent and associated with adverse outcomes in people with CKD, including mortality and risk of ESKD. Preventative interventions should be initiated to mitigate the development of frailty. The use of a simple frailty index, generated electronically from health records, can predict outcomes and may aid prioritization for management of people with frailty.
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Affiliation(s)
- Thomas J Wilkinson
- NIHR Applied Research Collaboration East Midlands, Leicester Diabetes Research Centre, Leicester, UK.,Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Joanne Miksza
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Claire Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Andrew C Nixon
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- NIHR Applied Research Collaboration East Midlands, Leicester Diabetes Research Centre, Leicester, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.,Leicester NIHR Biomedical Research Centre, Leicester, UK
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16
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Ayeni A, Sharples A, Hewson D. The Association between Social Vulnerability and Frailty in Community Dwelling Older People: A Systematic Review. Geriatrics (Basel) 2022; 7:geriatrics7050104. [PMID: 36286207 PMCID: PMC9601580 DOI: 10.3390/geriatrics7050104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/28/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this systematic literature review was to determine whether social vulnerability is associated with frailty in older people. Databases were searched for literature from January 2001 to March 2022. Hand searches of reference lists of the selected articles were also used to identify other relevant studies. Studies that met the inclusion criteria were selected. Two independent reviewers assessed the methodological quality using an established tool. Eleven eligible studies from Canada, Europe, USA, Tanzania, Mexico, and China were selected. The level of social vulnerability measured by the Social Vulnerability Index (SVI) from a meta-analysis was 0.300 (95% CI: 0.242, 0.358), with the highest SVI in Tanzania (0.49), while the lowest level of SVI was reported in China (0.15). The highest frailty level of 0.32 was observed in both Tanzania and Europe, with the lowest frailty reported in a USA study from Hawaii (0.15). In all studies, social vulnerability was a significant predictor of mortality for both sexes at subsequent data collection points. The association between SVI and frailty was high in Tanzania (r = 0.81), with other studies reporting stronger correlations for females compared to males, but at small to moderate levels. In one study, an increase of 1SD in SVI was linked to a 20% increase in frailty score at a subsequent evaluation. Additional study is warranted to determine a potential causality between social vulnerability and frailty.
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Affiliation(s)
- Ayodele Ayeni
- Institute for Health Research, University of Bedfordshire, Luton LU1 3JU, UK
- Hertfordshire Partnership University National Health Service (NHS) Foundation Trust, Hatfield AL10 8YE, UK
| | - Adrienne Sharples
- Faculty of Health and Social Sciences, School of Applied Social Science, University of Bedfordshire, Luton LU1 3JU, UK
| | - David Hewson
- Institute for Health Research, University of Bedfordshire, Luton LU1 3JU, UK
- Correspondence: ; Tel.: +44-(0)1582-743939
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17
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Siqueri CAS, Pereira GA, Sumida GT, Mafra ACCN, Bonfim D, Almeida LYD, Monteiro CN. What are the implications of problem-solving capacity at Primary Health Care in older adult health? EINSTEIN-SAO PAULO 2022; 20:eGS6791. [PMID: 35766675 PMCID: PMC9239563 DOI: 10.31744/einstein_journal/2022gs6791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate Primary Health Care attributes and analyze the association between the fulfilment of these attributes and problem-solving capacity of services for elderly patients. Methods A cross-sectional, observational, quantitative study. The Primary Care Assessment Tool, designed to assess Primary Health Care attributes, was employed to evaluate elderly users of Primary Care Units located in the south region of the city of São Paulo (SP). Results Many attributes assessed at the reference services were considered as unsatisfactory by users. Overall scores were also below the cut-off point. “First contact access – use”, “longitudinality” and “coordination – information system” were the only attributes considered as satisfactory. Also, more than half (62.7%) of respondent patients reported having been referred to specialized services. A combined analysis of these three outcomes revealed users referred to other services had a significantly better perception of Primary Health Care attributes. Conclusion The study provides important insights on satisfaction of elderly individuals and the problem-solving capacity of health care services, especially for the study population. Findings reported emphasize the association between Primary Health Care attributes and the problem-solving capacity of health care services at this level.
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Affiliation(s)
| | - Gabriel Apolinário Pereira
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Giuliana Tamie Sumida
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Daiana Bonfim
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Ambagtsheer RC, Casey MG, Lawless M, Archibald MM, Yu S, Kitson A, Beilby JJ. Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study. BMC PRIMARY CARE 2022; 23:160. [PMID: 35754037 PMCID: PMC9235102 DOI: 10.1186/s12875-022-01778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Frailty is a highly prevalent clinical syndrome increasing older people's vulnerability to risk of adverse outcomes. Better frailty identification through expanded screening implementation has been advocated within general practice settings, both internationally and within Australia. However, little is known about practitioner perceptions of the feasibility of specific instruments, and the underlying motivations behind those perceptions. Consequently, the purpose of this study was to explore the attitudes and perceptions of a convenience and volunteer sample of Australian general practitioners (GPs) and practice nurses (PNs) towards common frailty screening instruments. METHODS The feasibility of several frailty screening instruments (PRISMA-7 [P7], Edmonton Frail Scale [EFS], FRAIL Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC] and Timed Up and Go [TUG]) to 43 Australian GPs and PNs was assessed. The study adopted a concurrent embedded mixed-methods design incorporating quantitative (ranking exercise) and qualitative (content analysis) data collection integrated during the analysis phase. RESULTS Practitioners assessed multi-dimensional instruments (EFS, GFI, KC) as having relatively higher clinical utility, better integration into existing assessment processes and stronger links to intervention over uni-dimensional (GST, TUG) and simple (FQ, P7) instruments. CONCLUSIONS While existing frailty screening instruments show promise as an initial step in supporting better care for older people, all the included instruments were associated with perceived advantages and disadvantages. Ultimately, clinicians will need to weigh several factors in their selection of the optimal screening instrument. Further translational research, with a focus on contextual fit, is needed to support clinical decision-making on the selection of instruments for frailty screening.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia.
- Torrens University Australia, Adelaide, Australia.
| | - Mavourneen G Casey
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Michael Lawless
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Mandy M Archibald
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Solomon Yu
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Alison Kitson
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Justin J Beilby
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- Torrens University Australia, Adelaide, Australia
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Acosta-Benito MÁ, Martín-Lesende I. [Frailty in primary care: Diagnosis and multidisciplinary management]. Aten Primaria 2022; 54:102395. [PMID: 35700618 PMCID: PMC9198324 DOI: 10.1016/j.aprim.2022.102395] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
El envejecimiento poblacional se asocia a un mayor uso de recursos sociales sanitarios, asociados a la mayor morbimortalidad y discapacidad de este grupo etario. La fragilidad es un síndrome geriátrico previo a la aparición de la dependencia funcional, que permite la identificación de individuos de mayor riesgo de dependencia, institucionalización, efectos adversos de fármacos, mortalidad y otros eventos negativos de salud. Este síndrome es potencialmente reversible con una intervención multicomponente. La atención primaria de salud es el lugar preferente para el diagnóstico y seguimiento de la fragilidad, a través de escalas como la FRAIL scale, el fenotipo de Fried o modelos de acumulación de déficits. Para el seguimiento se precisa la intervención multidimensional y coordinada de diferentes profesionales sanitarios y sociales, con la implicación del paciente y su familia. Se debe fomentar la investigación para determinar las intervenciones más eficaces y los cursos clínicos más frecuentes.
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Affiliation(s)
- Miguel Ángel Acosta-Benito
- Medicina Familiar y Comunitaria. CS Joaquín Rodrigo, Madrid. Servicio Madrileño de Salud, Madrid, España; Miembro del Grupo de Trabajo de Atención al Mayor de semFYC y Coordinador del grupo PAPPS-semFYC del Mayor.
| | - Iñaki Martín-Lesende
- Médico de familia, Centro de Salud Indautxu, Bilbao, País Vasco, España; Miembro del Grupo de Trabajo de Atención al Mayor de semFYC y del grupo PAPPS-semFYC del Mayor
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20
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Traditional Chinese Medicine Constitution Is Associated with the Frailty Status of Older Adults: A Cross-Sectional Study in the Community. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8345563. [PMID: 35664935 PMCID: PMC9159867 DOI: 10.1155/2022/8345563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022]
Abstract
Objective This study explored the relationship between traditional Chinese medicine (TCM) constitution and frailty status in older adults. Methods A total of 3,586 participants, 65 years of age and older, with complete data were evaluated. All received a complete frailty assessment and completed a TCM geriatric constitution questionnaire. Baseline characteristics and demographic information were collected. The relationship between the TCM constitution and frailty was evaluated by binary regression analysis. The consistency of the result was tested by multivariate linear regression. Results The average prevalence of frailty among older adult participants was 12.5%. The three most prevalent biased constitutions in the frail older adult participants were phlegm dampness 140 (31.3%), Yin deficiency 77 (17.2%), and Yang deficiency 47 (10.5%). Univariate analysis showed that TCM constitution significantly correlated with frailty. After adjusting for potential confounders, binary logistic regression found a significant correlation between biased constitutions and frailty, including Qi stagnation (odds ratio (OR) = 3.51, 95% confidence interval (CI): 1.94–6.36)), Qi deficiency ((OR = 3.23, (95% CI: 1.76–5.94)), Yang deficiency ((OR = 2.37, (95% CI: 1.50–3.74)), phlegm dampness ((OR = 1.75, (95% CI: 1.24–2.48)), and Yin deficiency ((OR = 1.70, (95% CI: 1.15–2.50)). Results of multiple linear regression were consistent. Conclusions TCM constitution was significantly associated with frailty status in older adults, and the distribution was different. Compared with a neutral constitution, older adults with Qi stagnation, Qi deficiency, Yang deficiency, phlegm dampness, and Yin deficiency were more likely to experience frailty.
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Oviedo-Briones M, Rodríguez-Laso Á, Carnicero JA, Gryglewska B, Sinclair AJ, Landi F, Vellas B, Rodríguez Artalejo F, Checa-López M, Rodriguez-Mañas L. The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project. J Cachexia Sarcopenia Muscle 2022; 13:1487-1501. [PMID: 35429109 PMCID: PMC9178160 DOI: 10.1002/jcsm.12990] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/04/2022] [Accepted: 03/07/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To compare the performance of eight frailty instruments to identify relevant adverse outcomes for older people across different settings over a 12 month follow-up. METHODS Observational longitudinal prospective study of people aged 75 + years enrolled in different settings (acute geriatric wards, geriatric clinic, primary care clinics, and nursing homes) across five European cities. Frailty was assessed using the following: Frailty Phenotype, SHARE-FI, 5-item Frailty Trait Scale (FTS-5), 3-item FTS (FTS-3), FRAIL scale, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool, and Clinical Frailty Scale. Adverse outcomes ascertained at follow-up were as follows: falls, hospitalization, increase in limitation in basic (BADL) and instrumental activities of daily living (IADL), and mortality. Sensitivity, specificity, and capacity to predict adverse outcomes in logistic regressions by each instrument above age, gender, and multimorbidity were calculated. RESULTS A total of 996 individuals were followed (mean age 82.2 SD 5.5 years, 61.3% female). In geriatric wards, the FI-35 (69.1%) and the FTS-5 (67.9%) showed good sensitivity to predict death and good specificity to predict BADL worsening (70.3% and 69.8%, respectively). The FI-35 also showed good sensitivity to predict BADL worsening (74.6%). In nursing homes, the FI-35 and the FTSs predicted mortality and BADL worsening with a sensitivity > 73.9%. In geriatric clinic, the FI-35, the FTS-5, and the FRAIL scale obtained specificities > 85% to predict BADL worsening. No instrument achieved high enough sensitivity nor specificity in primary care. All the instruments predict the risk for all the outcomes in the whole sample after adjusting for age, gender, and multimorbidity. The associations of these instruments that remained significant by setting were for BADL worsening in geriatric wards [FI-35 OR = 5.94 (2.69-13.14), FTS-3 = 3.87 (1.76-8.48)], nursing homes [FI-35 = 4.88 (1.54-15.44), FTS-5 = 3.20 (1.61-6.38), FTS-3 = 2.31 (1.27-4.21), FRAIL scale = 1.91 (1.05-3.48)], and geriatric clinic [FRAIL scale = 4.48 (1.73-11.58), FI-35 = 3.30 (1.55-7.00)]; for IADL worsening in primary care [FTS-5 = 3.99 (1.14-13.89)] and geriatric clinic [FI-35 = 3.42 (1.56-7.49), FRAIL scale = 3.27 (1.21-8.86)]; for hospitalizations in primary care [FI-35 = 3.04 (1.25-7.39)]; and for falls in geriatric clinic [FI-35 = 2.21 (1.01-4.84)]. CONCLUSIONS No single assessment instrument performs the best for all settings and outcomes. While in inpatients several commonly used frailty instruments showed good sensitivities (mainly for mortality and BADL worsening) but usually poor specificities, the contrary happened in geriatric clinic. None of the instruments showed a good performance in primary care. The FI-35 and the FTS-5 showed the best profile among the instruments assessed.
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Affiliation(s)
- Myriam Oviedo-Briones
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain.,Facultad de Medicina, Universidad de las Américas, Quito, Ecuador
| | - Ángel Rodríguez-Laso
- CIBERFES: CIBER (Centers of the Network of Biomedical Research) thematic area of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Carnicero
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical Collegium Medicum, Cracow, Poland
| | | | - Francesco Landi
- Hospital Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Vellas
- Gerontopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Marta Checa-López
- Jefe de Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain
| | - Leocadio Rodriguez-Mañas
- CIBERFES: CIBER (Centers of the Network of Biomedical Research) thematic area of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain.,Jefe de Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain
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Wang D, Yin P, Li Y, Chen M, Cui X, Cheng S, Lin Y, Yan J, Zhang L, Tang P. Frailty Factors and Outcomes in Patients Undergoing Orthopedic Surgery: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2022; 11:e28338. [PMID: 35436222 PMCID: PMC9055486 DOI: 10.2196/28338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 01/05/2022] [Accepted: 01/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Frailty is an aggregate expression of susceptibility to adverse health outcomes because of age- and disease-related deficits that accumulate across multiple domains. Previous studies have found the presence of preoperative frailty is associated with an increased risk of adverse outcomes. The number of older adults undergoing orthopedic surgery is rapidly increasing. However, there has been no evidence-based study on the relationship between frailty and outcomes in patients undergoing orthopedic surgery.
Objective
The aims of this study are to investigate the association between frailty and outcomes in patients who underwent orthopedic surgery as well as patient factors associated with frailty.
Methods
The methods to be used for this systematic review are reported according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) 2015 checklist. An extensive search will be conducted in PubMed, Embase, the Cochrane Library, and other mainstream databases. Any study where patients undergoing orthopedic surgery were assessed using a defined or validated measure of frailty and the association of frailty with patient factors and/or outcomes was reported will be included. A total of 2 researchers will independently screen articles for inclusion, with disagreements resolved by a third reviewer. We will perform a narrative synthesis of the factors associated with frailty, prevalence of frailty, effect of frailty on patient outcomes, and interventions for patients who are frail. A meta-analysis focusing on individual factors associated with frailty and the effect of frailty on patient outcomes will be performed, if applicable. The risk of bias will be evaluated. A subgroup analysis and sensitivity analysis will be performed.
Results
Literature searches were conducted in September 2021 and the review is anticipated to be completed by the end of July 2022.
Conclusions
This systematic review and meta-analysis will provide an overview of frailty and investigate the relationship between frailty and patient outcomes as well as the relationship between patient factors and frailty in patients undergoing orthopedic surgery. This study could potentially increase patients’ awareness of the outcomes associated with frailty, compel clinical specialties to further acknowledge the concept of frailty, and enhance the development of assessment instruments and tools for frailty.
Trial Registration
PROSPERO CRD42020181846; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=181846
International Registered Report Identifier (IRRID)
DERR1-10.2196/28338
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Affiliation(s)
- Duanyang Wang
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Pengbin Yin
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yi Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Ming Chen
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xiang Cui
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Shi Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yuan Lin
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Jinglong Yan
- Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Licheng Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
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Lu SC, Mathiason MA, Monsen KA. Frailty and Social and Behavioral Determinants of Health: Algorithm Refinement and Pattern Validation. J Gerontol Nurs 2022; 48:41-48. [PMID: 35343839 DOI: 10.3928/00989134-20220308-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Existing frailty and social and behavioral determinants of health (SBDH) algorithms were refined and used to examine SBDH and frailty groups, revealing patterns in interventions and outcomes of older adults in a large community-based care data-set. The dataset was randomly split into training (n = 2,881) and testing (n = 1,441) sets. The training set was used to visually identify patterns in associations among SBDH, frailty, intervention doses, and outcomes, and the testing set was used to validate the patterns. Seven valid patterns were identified, showing increases in SBDH and frailty were associated with poorer health outcomes and more interventions (all p < 0.01). Findings suggest that the refined SBDH and frailty algorithms facilitate the identification of older adults with SBDH and frailty for intervention tailoring. [Journal of Gerontological Nursing, 48(4), 41-48.].
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24
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Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study. BMJ 2022; 376:e068208. [PMID: 35273014 PMCID: PMC9316948 DOI: 10.1136/bmj-2021-068208] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors. DESIGN Systematic analysis. SETTING Participants were aged ≥70 from 204 countries and territories, 1990-2019. MAIN OUTCOMES MEASURES Years of life lost, years lived with disability, disability adjusted life years, life expectancy at age 70 (LE-70), healthy life expectancy at age 70 (HALE-70), proportion of years in ill health at age 70 (PYIH-70), risk factors, and data coverage index were estimated based on standardised GBD methods. RESULTS Globally the population of older adults has increased since 1990 and all cause death rates have decreased for men and women. However, mortality rates due to falls increased between 1990 and 2019. The probability of death among people aged 70-90 decreased, mainly because of reductions in non-communicable diseases. Globally disability burden was largely driven by functional decline, vision and hearing loss, and symptoms of pain. LE-70 and HALE-70 showed continuous increases since 1990 globally, with certain regional disparities. Globally higher LE-70 resulted in higher HALE-70 and slightly increased PYIH-70. Sociodemographic and healthcare access and quality indices were positively correlated with HALE-70 and LE-70. For high exposure risk factors, data coverage was moderate, while limited data were available for various dietary, environmental or occupational, and metabolic risks. CONCLUSIONS Life expectancy at age 70 has continued to rise globally, mostly because of decreases in chronic diseases. Adults aged ≥70 living in high income countries and regions with better healthcare access and quality were found to experience the highest life expectancy and healthy life expectancy. Disability burden, however, remained constant, suggesting the need to enhance public health and intervention programmes to improve wellbeing among older adults.
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Hall A, Boulton E, Kunonga P, Spiers G, Beyer F, Bower P, Craig D, Todd C, Hanratty B. Identifying older adults with frailty approaching end-of-life: A systematic review. Palliat Med 2021; 35:1832-1843. [PMID: 34519246 PMCID: PMC8637378 DOI: 10.1177/02692163211045917] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND People with frailty may have specific needs for end-of-life care, but there is no consensus on how to identify these people in a timely way, or whether they will benefit from intervention. AIM To synthesise evidence on identification of older people with frailty approaching end-of-life, and whether associated intervention improves outcomes. DESIGN Systematic review (PROSPERO: CRD42020462624). DATA SOURCES Six databases were searched, with no date restrictions, for articles reporting prognostic or intervention studies. Key inclusion criteria were adults aged 65 and over, identified as frail via an established measure. End-of-life was defined as the final 12 months. Key exclusion criteria were proxy definitions of frailty, or studies involving people with cancer, even if also frail. RESULTS Three articles met the inclusion criteria. Strongest evidence came from one study in English primary care, which showed distinct trajectories in electronic Frailty Index scores in the last 12 months of life, associated with increased risk of death. We found no studies evaluating established clinical tools (e.g. Gold Standards Framework) with existing frail populations. We found no intervention studies; the literature on advance care planning with people with frailty has relied on proxy definitions of frailty. CONCLUSION Clear implications for policy and practice are hindered by the lack of studies using an established approach to assessing frailty. Future end-of-life research needs to use explicit approaches to the measurement and reporting of frailty, and address the evidence gap on interventions. A focus on models of care that incorporate a palliative approach is essential.
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Affiliation(s)
- Alex Hall
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Elisabeth Boulton
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Patience Kunonga
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gemma Spiers
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Fiona Beyer
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Dawn Craig
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Chris Todd
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Barbara Hanratty
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
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Rombouts M, Raaijmakers LGM, Kuunders TJM, Van Steijn-Martens R, de Vuijst T, van Donkersgoed H, van de Goor LAM. The Acceptance and Use of the e-Health Instrument 'The Personal Health Check' in Four Dutch Municipalities: Lessons Learned. J Prim Prev 2021; 43:25-48. [PMID: 34714455 PMCID: PMC8887919 DOI: 10.1007/s10935-021-00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
This pilot study assessed the acceptance and use of the e-Health instrument “the Personal Health Check” (PHC) among clients and professionals in primary care settings. By filling in the online PHC instrument, participants were provided insights into their health and lifestyle. When results revealed an increased health risk, participants were advised to undertake additional lab tests measuring blood pressure and haemaglobin levels. Based on the online questionnaire and optional lab tests, participants then received a report that included individually-tailored feedback from the e-Health application about personal health risks and suggestions for health interventions. The PHC was implemented in 2016 in four Dutch municipalities that determined which neighbourhood(s) the PHC targeted and how participants were invited. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework to address our research questions. Methods used to assess acceptance were: PHC instrument data, data from additional questionnaires completed by PHC participants, focus groups with PHC participants and professionals in primary care, and telephone interviews with non-responders to the invitation to participate in the online PHC. Of the 21,735 invited, 12% participated. Our results showed that participants and professionals in this pilot were predominantly positive about the PHC. Participants reported that they made an effort to apply the PHC lifestyle advice they received. Almost all had the knowledge and resources needed to use the PHC online instrument. Invitations from general practitioners almost doubled participation relative to invitations from the sponsoring municipalities. The overall low response rate, however, suggests that the PHC is unsuitable as a foundation on which to develop local public health policy.
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Affiliation(s)
- M Rombouts
- Municipal Health Service West-Brabant, Breda, The Netherlands
| | | | - T J M Kuunders
- Municipal Health Service Hart Voor Brabant, 'S-Hertogenbosch, The Netherlands.,Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | - T de Vuijst
- Municipal Health Service Hart Voor Brabant, 'S-Hertogenbosch, The Netherlands
| | - H van Donkersgoed
- Netherlands Institute for Prevention and E-Health Development (NIPED), Amsterdam, The Netherlands
| | - L A M van de Goor
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Seda-Gombau G, Montero-Alía JJ, Moreno-Gabriel E, Torán-Monserrat P. Impact of the COVID-19 Pandemic on Burnout in Primary Care Physicians in Catalonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179031. [PMID: 34501618 PMCID: PMC8431168 DOI: 10.3390/ijerph18179031] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Background: Recent demands to raise the clinical quality, improve the patient experience, and decrease costs have progressively increased burnout among primary care physicians. This overstretched situation has been greatly aggravated since the onset of the COVID-19 pandemic. The aim of the study is to analyse the prevalence of burnout among primary care physicians and to assess the impact of the COVID-19 pandemic on burnout. Methods: This was a multicentre longitudinal descriptive study of occupational factors and burnout before and since the start of the COVID-19 pandemic. In order to assess the impact of the pandemic on burnout in primary care physicians, two paired groups of physicians were compared using Wilcoxon’s and McNemar’s tests. Results: In January 2019, 10% of primary care physicians scored high on all burnout domains. Seven months into the COVID-19 pandemic (October 2020), this percentage increased to 50%. Paired groups analysis showed unprecedented worsening due to the pandemic: emotional exhaustion, which already affected 55% of primary care physicians, jumped to 77%. Conclusions: Burnout is endemic among primary care physicians. It has been associated with lower patient satisfaction, reduced health outcomes, and increased costs. The COVID-19 pandemic has pushed burnout in primary care professionals to the edge.
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Affiliation(s)
- Gemma Seda-Gombau
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.J.M.-A.); (E.M.-G.); (P.T.-M.)
- Departament d’Empresa, Facultat d’Economia i Empresa, Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-741-53-38
| | - Juan José Montero-Alía
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.J.M.-A.); (E.M.-G.); (P.T.-M.)
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
- Centre d’Atenció Primària Mataró-3 (Rocafonda-Palau), Gerència Àmbit Metropolitana Nord, Institut Català de la Salud, 08304 Mataró, Spain
| | - Eduard Moreno-Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.J.M.-A.); (E.M.-G.); (P.T.-M.)
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.J.M.-A.); (E.M.-G.); (P.T.-M.)
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
- Department de Medicina, Facultat de Medicina, Universitat de Girona, 17004 Girona, Spain
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Alharbi K, Blakeman T, van Marwijk H, Reeves D. Identification and management of frail patients in English primary care: an analysis of the General Medical Services 2018/2019 contract dataset. BMJ Open 2021; 11:e041091. [PMID: 34408025 PMCID: PMC8375730 DOI: 10.1136/bmjopen-2020-041091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore the extent of implementation of the General Medical Services 2018/2019 'frailty identification and management' contract in general practitioner (GP) practices in England, and link implementation outcomes to a range of practice and Clinical Commissioning Group (CCG) factors. DESIGN A cross-sectional study design using publicly available datasets relating to the year 2018 for all GP practices in England. SETTINGS English general practices. DATA The analysis was conducted across 6632 practices in 193 CCGs with 9 995 558 patients aged 65 years or older. OUTCOMES Frailty assessment rates, frailty coding rates and frailty prevalence rates, plus rates of medication reviews, falls assessments and enriched Summary Care Records (SCRs). ANALYSIS Summary statistics were calculated and multilevel negative binomial regression analysis was used to investigate relationships of the six outcomes with explanatory factors. RESULTS 14.3% of people aged 65 years or older were assessed for frailty, with 35.4% of these-totalling 5% of the eligible population-coded moderately or severely frail. 59.2% received a medications review, but rates of falls assessments (3.7%) and enriched SCRs (21%) were low. However, percentages varied widely across practices and CCGs. Practice differences in contract implementation were most strongly accounted for by their grouping within CCGs, with weaker but still important associations with some practice and CCG factors, particularly healthcare demand-related factors of chronic caseload and (negatively) % of patients aged 65 years or older. CONCLUSION CCG appears the strongest determinant of practice engagement with the frailty contract, and fuller implementation may depend on greater engagement of CCGs themselves, particularly in commissioning suitable interventions. Practices understandably targeted frailty assessments at patients more likely to be found severely frail, resulting in probable underidentification of moderately frail individuals who might benefit most from early interventions. Frailty prevalence estimates based on the contract data may not reflect actual rates.
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Affiliation(s)
- Khulud Alharbi
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Harm van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | - David Reeves
- National Institute for Health Research School for Primary Care Research, School of Health Sciences, University of Manchester, Manchester, UK
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
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Blanco-Reina E, Aguilar-Cano L, García-Merino MR, Ocaña-Riola R, Valdellós J, Bellido-Estévez I, Ariza-Zafra G. Assessing Prevalence and Factors Related to Frailty in Community-Dwelling Older Adults: A Multinomial Logistic Analysis. J Clin Med 2021; 10:jcm10163576. [PMID: 34441873 PMCID: PMC8397006 DOI: 10.3390/jcm10163576] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022] Open
Abstract
Frailty is an age-related clinical condition that typically involves a deterioration in the physiological capacity of various organ systems and heightens the patient’s susceptibility to stressors. For this reason, one of the main research goals currently being addressed is that of characterising the impact of frailty in different settings. The main aim of this study is to determine the prevalence of Fried’s frailty phenotype among community-dwelling older people and to analyse the factors associated with frailty. In this research study, 582 persons aged 65 years or more participated in this cross-sectional study that was conducted at primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional and comprehensive drug therapy data were compiled. The relationship between the independent variables and the different states of frailty was analysed by using a multinomial logistic regression model. Frailty was present in 24.1% of the study sample (95% CI = 20.7–27.6) of whom 54.3% were found to be pre-frail and 21.6% were non-frail. The study variable most strongly associated with frailty was the female gender (OR = 20.54, 95% CI = 9.10–46.3). Other factors found to be associated with the state of frailty included age, dependence for the instrumental activities of daily living (IADL), polymedication, osteoarticular pathology and psychopathology. This study confirms the high prevalence of frailty among community-dwelling older people. Frailty may be associated with many factors. Some of these associated factors may be preventable or modifiable and, thus, provide clinically relevant targets for intervention. This is particularly the case for depressive symptoms, the clinical control of osteoarthritis and the use of polypharmacy.
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Affiliation(s)
- Encarnación Blanco-Reina
- Pharmacology and Therapeutics Department, Instituto de Investigación Biomédica de Málaga-IBIMA, School of Medicine, University of Málaga, 29016 Málaga, Spain;
- Correspondence: ; Tel.: +34-952136648
| | - Lorena Aguilar-Cano
- Physical Medicine and Rehabilitation Department, Hospital Regional Universitario, 29010 Málaga, Spain;
| | | | - Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18011 Granada, Spain
| | - Jenifer Valdellós
- Health District of Málaga-Guadalhorce, 29009 Málaga, Spain; (M.R.G.-M.); (J.V.)
| | - Inmaculada Bellido-Estévez
- Pharmacology and Therapeutics Department, Instituto de Investigación Biomédica de Málaga-IBIMA, School of Medicine, University of Málaga, 29016 Málaga, Spain;
| | - Gabriel Ariza-Zafra
- Geriatrics Department, Complejo Hospitalario Universitario, 02006 Albacete, Spain;
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[Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care]. Rev Esp Geriatr Gerontol 2021; 57:13-19. [PMID: 34330542 DOI: 10.1016/j.regg.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health. METHOD Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult. The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index. RESULTS Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications. The best scored items according to centralization statistics were smoking and memory, and considering the best score (4-5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3-96.8), mouth/teeth condition (92.7%, 95% CI: 86.2-96.2), mood (91.7%, 95% CI: 85.1-95.6), and capacity for ADL (91.7%, 95% CI:85.1-95.6). CONCLUSIONS Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant.
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Pattern of Use of Electronic Health Record (EHR) among the Chronically Ill: A Health Information National Trend Survey (HINTS) Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147254. [PMID: 34299705 PMCID: PMC8304473 DOI: 10.3390/ijerph18147254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/20/2022]
Abstract
Effective patient–provider communication is a cornerstone of patient-centered care. Patient portals provide an effective method for secure communication between patients or their proxies and their health care providers. With greater acceptability of patient portals in private practices, patients have a unique opportunity to manage their health care needs. However, studies have shown that less than 50% of patients reported accessing the electronic health record (EHR) in a 12-month period. We used HINTS 5 cycle 1 and cycle 2 to assess disparities among US residents 18 and older with any chronic condition regarding the use of EHR for secure direct messaging with providers, to request refills, to make clinical decisions, or to share medical records with another provider. The results indicate that respondents with multimorbidity are more likely to share their medical records with other providers. However, respondents who are 75 and older are less likely to share their medical records with another provider. Additionally, respondents who are 65 and older are less likely to use the EHR for secure direct messaging with their provider. Additional health care strategies and provider communication should be developed to encourage older patients with chronic conditions to leverage the use of patient portals for effective disease management.
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Giebel C, Rodgers S, Barr B, Collins B, Akpan A, Shenton J, Fuller E, Gabbay M. Does Social Support Affect Older Adults' General Practitioner Attendance Rates? Findings from the North West Coast Household Health Survey. Clin Gerontol 2021; 44:381-391. [PMID: 32594861 DOI: 10.1080/07317115.2020.1783044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to explore whether social support and socio-economic status have an effect on primary care attendance in older adults (aged 65+). METHODS This study used data from the longitudinal North West Coast (NWC) Household Health Survey (HHS) from across 20 disadvantaged and 8 less disadvantaged neighborhoods. Data included the EQ-5D, social support, frailty-related measures, healthcare utilization, and the Index of Multiple Deprivation (IMD). Principal component analysis was used to derive a factor for social support. Poisson regression analysis was employed to explore the effects of frailty, social support, General Practitioner (GP) distance, education, IMD, living situation, and depression on the number of GP attendances in the past 12 months. RESULTS 1,685 older adults were included in this analysis. Of those older adults who visited their GP (87.4%), most had visited their GP twice in the past 12 months. Having an educational qualification, higher levels of social support, and being physically fit reduced GP utilization. Being moderately frail, depressed, and living further away from the nearest GP increased attendance. Older adults living in the most disadvantaged neighborhoods were more likely to visit their GP. CONCLUSIONS Increasing social support impacts to a small, but important, extent on reducing GP attendance in older adults. Future research needs to explore whether improving social support in old age can reduce GP utilization. CLINICAL IMPLICATIONS Findings suggest a need for improving social prescribing in older adults to reduce some GP visits which could be avoided and might not be necessary.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| | - Sarah Rodgers
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| | - Ben Barr
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
| | - Brendan Collins
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Asan Akpan
- Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK.,Aintree University Hospital, Liverpool, UK.,NIHR CRN NWC, Liverpool, UK
| | | | | | - Mark Gabbay
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
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Winter R, Al-Jawad M, Wright J, Shrewsbury D, Van Marwijk H, Johnson H, Levett T. What is meant by "frailty" in undergraduate medical education? A national survey of UK medical schools. Eur Geriatr Med 2021; 12:355-362. [PMID: 33651346 PMCID: PMC7990827 DOI: 10.1007/s41999-021-00465-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/02/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE All UK medical schools are required to include frailty in their curriculum. The term is open to interpretation and associated with negative perceptions. Understanding and recognising frailty is a prerequisite for consideration of frailty in the treatment decision-making process across clinical specialities. The aim of this survey was to describe how frailty has been interpreted and approached in UK undergraduate medical education and provide examples of educational strategies employed. METHODS All UK medical schools were invited to complete an electronic survey. Schools described educational strategies used to teach and assess frailty and provided frailty-related learning outcomes. Learning Outcomes were grouped into categories and mapped to the domains of Outcomes for Graduates (knowledge, skills and values). RESULTS 25/34 Medical schools (74%) participated. The interpretation of what frailty is vary widely and the diversity of teaching strategies reflect this. The most common Learning outcomes included as "Frailty" are about the concept of frailty, Comprehensive Geriatric Assessments and Roles of the MDT. Frailty teaching is predominantly opportunistic and occurred within geriatric medicine rotations in all medical schools. Assessments focus on frailty syndromes such as falls and delirium. CONCLUSION There is variation regarding how frailty has been interpreted and approached by medical schools. Frailty is represented in an array of teaching and assessment methods, with a lack of constructive alignment to related learning outcomes. Consensus should be agreed as to what frailty means in medical education. Further research is required to explore which frailty-specific educational strategies in undergraduate medical education enhance learning.
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Affiliation(s)
- Rebecca Winter
- Department of Medical Education, Brighton and Sussex Medical School, Room 344A Mayfield House, Falmer, Brighton, BN1 9PH, UK.
| | - Muna Al-Jawad
- Department of Medical Education, Brighton and Sussex Medical School, Room 344A Mayfield House, Falmer, Brighton, BN1 9PH, UK
| | - Juliet Wright
- Department of Medical Education, Brighton and Sussex Medical School, Room 344A Mayfield House, Falmer, Brighton, BN1 9PH, UK
| | - Duncan Shrewsbury
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, BN1 9PH, UK
| | - Harm Van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, BN1 9PH, UK
| | - Helen Johnson
- School of Applied Social Science, University of Brighton, Brighton, BN1 9PH, UK
| | - Tom Levett
- Department of Clinical and Experimental Medicine Brighton, Brighton, BN1 9PH, UK
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Is proactive frailty identification a good idea? A qualitative interview study. Br J Gen Pract 2021; 71:e604-e613. [PMID: 33657008 PMCID: PMC8252857 DOI: 10.3399/bjgp.2020.0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 02/22/2021] [Indexed: 11/06/2022] Open
Abstract
Background In England, GPs are independent contractors working to a national contract. Since 2017, the contract requires GPs to use electronic tools to proactively identify moderate and severe frailty in people aged ≥65 years, and offer interventions to help those identified to stay well and maintain independent living. Little is currently known about GPs’ views of this contractual requirement. Aim To explore GPs’ views of identifying frailty and offering interventions for those living with moderate or severe frailty. Design and setting A sequential mixed-methods study of GPs in the East Midlands region of England — namely Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire, and Northamptonshire — undertaken between January and May 2019. Method GPs were made aware of the study via professional organisations’ newsletters and bulletins, GP email lists, and social media, and were invited to complete an online questionnaire. Responses were analysed using descriptive statistics and, based on those survey responses, GPs with a range of GP and practice characteristics, as well as views on identifying frailty, were selected to participate in a semi-structured telephone interview. Interview transcripts were analysed using framework analysis. Results In total, 188 out of 3058 (6.1%) GPs responded to the survey and 18 GPs were interviewed. GPs were broadly supportive of identifying frailty, but felt risk-stratification tools lacked sensitivity and specificity, and wanted evidence showing clinical benefit. Frailty identification increased workload and was under-resourced, with limited time for, and access to, necessary interventions. GPs felt they lacked knowledge about frailty and more education was required to better understand it. Conclusion Proactively identifying and responding to frailty in primary care requires GP education, highly sensitive and specific risk-stratification tools, better access to interventions to lessen the impact of frailty, and adequate resourcing to achieve potential clinical impact.
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Kotsani M, Avgerinou C, Haidich AB, Smyrnakis E, Soulis G, Papageorgiou DI, Andreou M, Zeimbekis D, Kokkali S, Gavana M. Feasibility and impact of a short training course on frailty destined for primary health care professionals. Eur Geriatr Med 2021; 12:333-346. [PMID: 33646537 DOI: 10.1007/s41999-021-00467-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is an unmet need for training primary health care professionals on frailty, especially in countries where geriatrics is still emerging. PURPOSE We aimed to evaluate the feasibility and efficacy of a training course for primary health care professionals on the detection, assessment, and management of frailty. METHODS A single-day training course, developed and facilitated by three physicians trained in geriatrics abroad, was organized by the Aristotle University of Thessaloniki Primary Hearth Care Research Network. Primary health care professionals' attitudes, knowledge, and everyday practices regarding frailty were assessed by self-administered anonymous questionnaires (using Likert-type scales) at three time-points (before, upon completion of the training course, and 3 months afterward). RESULTS Out of 31 participants (17 physicians, 12 nurses, 2 health visitors; 87.1% women; mean age 46.4 years), 31(100%) filled in the first, 30(97%) the second, and 25(81%) the third questionnaire. Improvements were reported in familiarization with the frailty syndrome (p = 0.041) and in self-perception of knowledge and skills to detect (p < 0.001) and manage (p < 0.001) frailty, that were also sustained 3 months afterward (p = 0.001 and p = 0.003 respectively). Improvement was also observed in the attitude that frailty is an inevitable consequence of aging (p = 0.007) and in the frequency of application of screening (but not management) strategies, 3 months following the workshop compared to baseline (p = 0.014). Participants reported less disagreement with the statement that systematic screening for frailty was unfeasible in their daily practice at 3 months compared to baseline (p = 0.006), mainly due to time restrictions. CONCLUSION A short skill-oriented training course can significantly and sustainably improve primary health care professionals' attitudes and practices regarding frailty.
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Affiliation(s)
- Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle «Maladies du Vieillissement, Gérontologie et Soins Palliatifs», 54000, Nancy, France.
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, London, UK
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Dimitra Iosifina Papageorgiou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Stamatia Kokkali
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Robinson TE, Boyd ML, North D, Wignall J, Dawe M, McQueen J, Frey RA, Raphael DL, Kerse N. Proactive primary care model for frail older people in New Zealand delays aged-residential care: A quasi-experiment. J Am Geriatr Soc 2021; 69:1617-1626. [PMID: 33629356 DOI: 10.1111/jgs.17064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/13/2021] [Accepted: 01/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES To determine the effect of a proactive primary care program on acute hospitalization and aged-residential care placement for frail older people. DESIGN Controlled before and after, and controlled after only quasi-experimental studies, with a comparison group created via propensity score matching. One-year follow-up. SETTING Nine general practices in Auckland, New Zealand. PARTICIPANTS Community-dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks. INTERVENTION Primary healthcare based, registered nurse-led, comprehensive geriatric assessment, goal-setting, care planning, and regular follow-up. Patients were also provided self-management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists. MEASUREMENTS Outcomes from routinely collected administrative data. Primary: aged-residential care placement. SECONDARY OUTCOMES acute hospitalization, mortality, and other health service utilization. RESULTS Aged-residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48-0.91) and mortality (OR 0.66, 95% CI = 0.49-0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = -0.01-0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased. CONCLUSION The Kare participants had lower aged-residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.
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Affiliation(s)
- Thomas E Robinson
- Waitematā District Health Board, Auckland District Health Board, Auckland, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Michal L Boyd
- Waitematā District Health Board, Auckland District Health Board, Auckland, New Zealand.,School of Nursing, University of Auckland, Auckland, New Zealand
| | - Diana North
- Waitematā District Health Board, Auckland District Health Board, Auckland, New Zealand
| | - Jean Wignall
- Waitematā District Health Board, Auckland District Health Board, Auckland, New Zealand
| | - Martin Dawe
- Waitematā District Health Board, Auckland District Health Board, Auckland, New Zealand
| | - Jean McQueen
- Waitematā District Health Board, Auckland District Health Board, Auckland, New Zealand
| | - Rosemary A Frey
- School of Nursing, University of Auckland, Auckland, New Zealand
| | | | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand.,General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
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Alves PCG, Stevenson FA, Mylan S, Pires N, Winstock A, Ford C. How do people who use drugs experience treatment? A qualitative analysis of views about opioid substitution treatment in primary care (iCARE study). BMJ Open 2021; 11:e042865. [PMID: 33568374 PMCID: PMC7878162 DOI: 10.1136/bmjopen-2020-042865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To understand the most significant aspects of care experienced by people in opioid substitution treatment (OST) in primary care settings. DESIGN Semistructured individual interviews were conducted, following the critical incidents technique. Interview transcripts were analysed following a thematic analysis approach. PARTICIPANTS Adults aged 18 years or older, receiving OST in UK-based primary care services. RESULTS Twenty-four people in OST were interviewed between January and March 2019. Participants reported several aspects which were significant for their treatment, when engaging with the primary care service. These were grouped into 10 major themes: (1) humanised care; (2) individual bond/connection with the professional; (3) professionals' experience and knowledge; (4) having holistic care; (5) familiarity; (6) professionals' commitment and availability to help; (7) anonymity; (8) location; (9) collaborative teamwork; and (10) flexibility and changes around the treatment plan. CONCLUSIONS This study included first-hand accounts of people who use drugs about what supports them in their recovery journey. The key lessons learnt from our findings indicate that people who use drugs value receiving treatment in humanised and destigmatised environments. We also learnt that a good relationship with primary care professionals supports their recovery journey, and that treatment plans should be flexible, tailor-made and collaboratively designed with patients.
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Affiliation(s)
- Paula Cristina Gomes Alves
- Institute for Lifecourse Development, University of Greenwich, London, UK
- Primary Care and Population Health, University College London, London, UK
| | - Fiona A Stevenson
- Primary Care and Population Health, University College London, London, UK
| | - Sophie Mylan
- Primary Care and Population Health, University College London, London, UK
| | - Nuno Pires
- Higher Institute of Social Work of Porto, Senhora da Hora, Portugal
- Lusiada Research Center on Social Work and Social Intervention, Lusiada University of Lisbon, Lisboa, Portugal
| | - Adam Winstock
- Epidemiology and Public Health, University College London, London, UK
| | - Chris Ford
- International Doctors for Healthier Drug Policies, London, UK
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Ambagtsheer RC, Visvanathan R, Dent E, Yu S, Schultz TJ, Beilby J. Commonly Used Screening Instruments to Identify Frailty Among Community-Dwelling Older People in a General Practice (Primary Care) Setting: A Study of Diagnostic Test Accuracy. J Gerontol A Biol Sci Med Sci 2021; 75:1134-1142. [PMID: 31689342 DOI: 10.1093/gerona/glz260] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rapid frailty screening remains problematic in primary care. The diagnostic test accuracy (DTA) of several screening instruments has not been sufficiently established. We evaluated the DTA of several screening instruments against two reference standards: Fried's Frailty Phenotype [FP] and the Adelaide Frailty Index [AFI]), a self-reported questionnaire. METHODS DTA study within three general practices in South Australia. We randomly recruited 243 general practice patients aged 75+ years. Eligible participants were 75+ years, proficient in English and community-dwelling. We excluded those who were receiving palliative care, hospitalized or living in a residential care facility.We calculated sensitivity, specificity, predictive values, likelihood ratios, Youden Index and area under the curve (AUC) for: Edmonton Frail Scale [EFS], FRAIL Scale Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC], Polypharmacy [POLY], PRISMA-7 [P7], Reported Edmonton Frail Scale [REFS], Self-Rated Health [SRH] and Timed Up and Go [TUG]) against FP [3+ criteria] and AFI [>0.21]. RESULTS We obtained valid data for 228 participants, with missing scores for index tests multiply imputed. Frailty prevalence was 17.5% frail, 56.6% prefrail [FP], and 48.7% frail, 29.0% prefrail [AFI]. Of the index tests KC (Se: 85.0% [70.2-94.3]; Sp: 73.4% [66.5-79.6]) and REFS (Se: 87.5% [73.2-95.8]; Sp: 75.5% [68.8-81.5]), both against FP, showed sufficient diagnostic accuracy according to our prespecified criteria. CONCLUSIONS Two screening instruments-the KC and REFS, show the most promise for wider implementation within general practice, enabling a personalized approach to care for older people with frailty.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Torrens University Australia, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria
| | - Solomon Yu
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy J Schultz
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Justin Beilby
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, Adelaide, South Australia, Australia.,Torrens University Australia, Adelaide, South Australia, Australia
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Shafiee M, Hazrati M, Motalebi SA, Gholamzade S, Ghaem H, Ashari A. Can healthy life style predict successful aging among Iranian older adults? Med J Islam Repub Iran 2021; 34:139. [PMID: 33437735 PMCID: PMC7787035 DOI: 10.34171/mjiri.34.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Indexed: 11/11/2022] Open
Abstract
Background: Successful aging is a prominent and worldwide theme in gerontology. However, until recently, only few studies were conducted about successful aging in Iran. This study examined whether a healthy lifestyle could predict successful aging among older Iranians.
Methods: This cross sectional and descriptive study included 975 older Iranians who were selected through a multistage cluster-quota method from the health centers of Shiraz, Iran. A 5-part questionnaire, including demographic characteristics, the Seniors’ Healthy Lifestyle, Barthel Index, the Diner Life Satisfaction and Quality of Life, was used to collect the data. A logistic regression analysis was used in data analysis; data were analyzed using SPSS 21; and significance level was set at α = 0.05.
Results: The prevalence of successful aging among older Iranians was calculated at 24.0%. Results of multiple logistic regression analysis revealed that age (95% CI = 1.129- 1.702 and OR = 1.352), gender (95% CI = 0.412-0.764 and OR = 0.687), education level (95% CI = 1.443 – 1.699 and OR = 1.454), job (95% CI = 1.063-1.413 and OR = 1.185), monthly income (95% CI = 1.355-4.055 and OR = 2.272), insurance (95% CI = 0.344-0.842 and OR = 0.540), source of income (95% CI = 1.014-1.298 and OR = 1.145), and healthy lifestyle (95% CI = 0.772 - 0.858 and OR = 0.814) were predictors for successful aging.
Conclusion: Findings indicated that successful agers were mostly younger men, with higher education level and monthly income, who had insurance and a job and a healthy lifestyle. Thus, to age successfully, one must maintain and improve healthy lifestyle to prolong one’s health.
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Affiliation(s)
- Mohsen Shafiee
- Department of Nursing Geriatric, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Maryam Hazrati
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Deputy Ministry of Nursing Affaires, Ministry of Health and Medical Education, Tehran, Iran
| | - Seyedeh Ameneh Motalebi
- Social Determinants of Health Research Center, Research Institute for Prevention of Noncommunicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sakineh Gholamzade
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Ghaem
- Department of Epidemiology School of Health, Shiraz University of Medical Sciences. Shiraz, Iran
| | - Asmidawati Ashari
- Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor
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Simo N, Cesari M, Tchiero H, Rolland Y, de Souto Barreto P, Dartigues JF, Vellas B, Tabue-Teguo M. Frailty Index, Hospital Admission and Number of Days Spent in Hospital in Nursing Home Residents: Results from the Incur Study. J Nutr Health Aging 2021; 25:155-159. [PMID: 33491028 DOI: 10.1007/s12603-020-1561-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the predictive capacity of an age-related deficit accumulation index (the so-called Frailty Index [FI] proposed by Rockwood) for hospital admission (HA) and number of days spent in hospital (DSH) among nursing home residents. DESIGN, SETTING AND PARTICIPANTS Data are from a longitudinal cohort study, the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR), of 768 elder people (75.4% women) living in 13 nursing homes in France. MEASUREMENTS The FI was computed taking into account 30 possible deficits at the baseline visit. Hospital admissions were defined as all urgent and involuntary admissions including unplanned readmissions. The length of stay was the total number of days spent by the resident in the hospital. Cox proportional hazard models in the presence of competing risks (death) were performed to study the relationship between the FI and HA over a 12-month follow-up. A Zero-inflated negative binomial regression was performed to study the association between the FI and DSH. RESULTS Mean age of participants was 86.7 (standard deviation [SD] 6.9) years, with a mean FI of 0.37 (SD 0.11). At the end of the follow-up, 238 (30.9%) HA events were recorded. Positive associations of the FI with DSH and HA were reported (per 0.01 FI increment: age- and gender-adjusted hazard ratio 1.15, 95% confidence interval 1.020-1.297, p=0.02 and OR 1.209 (1.075 - 1.359, p<0.001, respectively). CONCLUSIONS AND IMPLICATIONS The FI is a strong predictor of negative health-related outcomes as HA and DSH events, even with very old and complex nursing home residents.
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Affiliation(s)
- N Simo
- Maturin Tabue-Teguo, MD, PhD. CHU de Pointe-à-Pitre (Guadeloupe), Equipe LAMIA, Université des Antilles (Guadeloupe), Centre de Recherche INSERM, U1219, 146 rue Léo Saignat, 33076 Bordeaux cedex, France, E-mail:
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41
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Zhang S, Stubbs B, Das-Munshi J. Complex mental health needs in older people living with frailty. Br J Hosp Med (Lond) 2020; 81:1-11. [PMID: 33377829 DOI: 10.12968/hmed.2020.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Frailty describes a state of health whereby people develop multiple or cumulative deficits in physiological systems over the life course, leading to vulnerability and being less able to respond to acute and/or physiological stressors, which at times may be relatively minor. Mental health should be an important consideration in the assessment and management of frailty in older people. This article provides an overview and clinical perspective on the evidence relating to frailty and mental health assessment and management.
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Affiliation(s)
- Shuo Zhang
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London/South London & Maudsley NHS Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London/South London & Maudsley NHS Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London/South London & Maudsley NHS Trust, London, UK
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Adja KYC, Lenzi J, Sezgin D, O'Caoimh R, Morini M, Damiani G, Buja A, Fantini MP. The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective. Front Public Health 2020; 8:599170. [PMID: 33282818 PMCID: PMC7689262 DOI: 10.3389/fpubh.2020.599170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Across the world, life expectancy is increasing. However, the years of life gained do not always correspond to healthy life years, potentially leading to an increase in frailty. Given the extent of population aging, the association between frailty and age and the impact of frailty on adverse outcomes for older people, frailty is increasingly being recognized to be a significant public health concern. Early identification of the condition is important to help older adults regain function and to prevent the negative outcomes associated with the syndrome. Despite the importance of diagnosing frailty, there is no definitive evidence or consensus of whether screening should be routinely implemented. A broad range of screening and assessment instruments have been developed taking a biopsychosocial approach, characterizing frailty as a dynamic state resulting from deficits in any of the physical, psychological and social domains, which contribute to health. All these aspects of frailty should be identified and addressed using an integrated and holistic approach to care. To achieve this goal, public health and primary health care (PHC) need to become the fulcrum through which care is offered, not only to older people and those that are frail, but to all individuals, favoring a life-course and patient-centered approach centered around integrated, community-based care. Public health personnel should be trained to address frailty not merely from a clinical perspective, but also in a societal context. Interventions should be delivered in the individuals' environment and within their social networks. Furthermore, public health professionals should contribute to education and training on frailty at a community level, fostering community-based interventions to support older adults and their caregivers to prevent and manage frailty. The purpose of this paper is to offer an overview of the concept of frailty for a public health audience in order to raise awareness of the multidimensional aspects of frailty and on how these should be addressed using an integrated and holistic approach to care.
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Affiliation(s)
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Duygu Sezgin
- School of Nursing and Midwifery, College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Rónán O'Caoimh
- Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Mara Morini
- Italian Scientific Society of Hygiene and Preventive Medicine - Primary Care Group, Bologna, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Buja
- Laboratory of Health Care Services and Health Promotion, Evaluation Unit of Hygiene and Public Health Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Cross-sectoral inter-rater reliability of the clinical frailty scale - a Danish translation and validation study. BMC Geriatr 2020; 20:443. [PMID: 33143651 PMCID: PMC7640648 DOI: 10.1186/s12877-020-01850-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Focus on frailty status has become increasingly important when determining care plans within and across health care sectors. A standardized frailty measure applicable for both primary and secondary health care sectors is needed to provide a common reference point. The aim of this study was to translate the Clinical Frailty Scale (CFS) into Danish (CFS-DK) and test inter-rater reliability for key health care professionals in the primary and secondary sectors using the CFS-DK. METHODS The Clinical Frailty Scale was translated into Danish using the ISPOR principles for translation and cultural adaptation that included forward and back translation, review by the original developer, and cognitive debriefing. For the validation exercise, 40 participants were asked to rate 15 clinical case vignettes using the CFS-DK. The raters were distributed across several health care professions: primary care physicians (n = 10), community nurses (n = 10), hospital doctors from internal medicine (n = 10) and intensive care (n = 10). Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), and sensitivity analysis was performed using multilevel random effects linear regression. RESULTS The Clinical Frailty Scale was translated and culturally adapted into Danish and is presented in this paper in its final form. Inter-rater reliability in the four professional groups ranged from ICC 0.81 to 0.90. Sensitivity analysis showed no significant impact of professional group or length of clinical experience. The health care professionals considered the CFS-DK to be relevant for their own area of work and for cross-sectoral collaboration. CONCLUSION The Clinical Frailty Scale was translated and culturally adapted into Danish. The inter-rater reliability was high in all four groups of health care professionals involved in cross-sectoral collaborations. However, the use of case vignettes may reduce the generalizability of the reliability findings to real-life settings. The CFS has the potential to serve as a common reference tool when treating and rehabilitating older patients.
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Wong AKC, Wong FKY, Ngai JSC, Hung SYK, Li WC. Effectiveness of a health-social partnership program for discharged non-frail older adults: a pilot study. BMC Geriatr 2020; 20:339. [PMID: 32912218 PMCID: PMC7488104 DOI: 10.1186/s12877-020-01722-5] [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: 07/12/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies supporting discharged patients are hospital-based which admission criteria tend to include mainly those with complex needs and/or specific disease conditions. This study captured the service gap where these non-frail older patients might have no specific medical problem upon discharge but they might encounter residual health and social issues when returning home. Methods Discharged community-dwelling non-frail older adults from an emergency medical ward were recruited and randomized into either intervention (n = 37) or control (n = 38) group. The intervention group received a 12-week complex interventions that included structured assessment, health education, goal empowerment, and care coordination supported by a health-social team. The control group received usual discharge care and monthly social call. The primary outcome was health-related quality of life (HRQoL). Secondary outcomes included activities of daily living (ADL), the presence of depressive symptoms, and the use of health services. The outcomes were measured at pre-intervention (T1) and at three months post-intervention (T2). The independent t-test or the Mann-Whitney U test was used to analyze the group differences in HRQoL, ADL, and presence of depressive symptoms according to the normality of data. Results Analysis showed that the intervention group experienced a statistically significantly improvement in the mental component scale of quality of life (p = .036), activities of daily living (p = .005), and presence of depressive symptoms (p = .035) at T2 compared with at T1. No significant differences were found in the control group. Conclusions Supporting self-care is necessary to enable community-dwelling non-frail older adults to be independent to the fullest extent possible in the community. The promising results found in this pilot study suggested that the integration of the health-social partnership into transitional care practice is effective and can be sustained in the community. Future studies can draw on these findings and maximize the integrated care quality during the transition phase. Trial registration NCT04434742 (date: 17 June 2020, retrospectively registered).
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Affiliation(s)
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Jenny Sau Chun Ngai
- Queen Elizabeth Hospital, Kowloon Central Cluster, Hong Kong Hospital Authority, Kowloon, Hong Kong
| | - Shirley Yu Kan Hung
- Queen Elizabeth Hospital, Kowloon Central Cluster, Hong Kong Hospital Authority, Kowloon, Hong Kong
| | - Wah Chun Li
- Queen Elizabeth Hospital, Kowloon Central Cluster, Hong Kong Hospital Authority, Kowloon, Hong Kong
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Abstract
OBJECTIVE To assess the feasibility, reliability, and validity of the Pictorial Fit-Frail Scale (PFFS) among patients, caregivers, nurses, and geriatricians in an outpatient memory clinic. DESIGN Observational study. SETTING A Canadian referral-based outpatient memory clinic. PARTICIPANTS Fifty-one consecutive patients and/or their caregivers, as well as attending nurses and geriatricians. MEASUREMENTS Participants (patients, caregivers, nurses, and geriatricians) were asked to complete the PFFS based on the patient's current level of functioning. Time-to-complete and level of assistance required was recorded. Participants also completed a demographic survey and patients' medical history (including the Mini-Mental State Examination [MMSE], and Comprehensive Geriatric Assessment [CGA]) was obtained via chart review. RESULTS Patient participants had a mean age of 77.3±10.1 years, and average MMSE of 22.0±7.0, and 53% were female. Participants were able to complete the PFFS with minimal assistance, and their average times to completion were 4:38±2:09, 3:11±1:16, 1:05±0:19, and 0:57±0:30 (mins:sec) for patients, caregivers, nurses, and geriatricians, respectively. Mean PFFS scores as rated by patients, caregivers, nurses, and geriatricians were 9.0±5.7, 13.1±6.6, 11.2±4.5, 11.9±5.9, respectively. Patients with low MMSE scores (0-24) took significantly longer to complete the scale and had higher PFFS scores. Inter-rater reliability between nurses and geriatricians was 0.74, but it was lower when assessments were done for patients with low MMSE scores (0.47, p<0.05). The correlation between PFFS and a Frailty Index based on the CGA was moderately high and statistically significant for caregivers, nurses, and geriatricians (r=0.66, r=0.59, r=0.64, respectively), but not patients. CONCLUSIONS The PFFS is feasible, even among people with some slight cognitive impairment, though it may be less useful when patients with severe dementia administer it to themselves. Further, the PFFS may help inform clinicians about areas of concern as identified by patients, enabling them to contribute more to diagnostic and treatment decisions or helping with health tracking and care planning.
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46
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Masoli JAH, Delgado J, Pilling L, Strain D, Melzer D. Blood pressure in frail older adults: associations with cardiovascular outcomes and all-cause mortality. Age Ageing 2020; 49:807-813. [PMID: 32133525 PMCID: PMC7444671 DOI: 10.1093/ageing/afaa028] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/20/2019] [Accepted: 01/24/2020] [Indexed: 01/04/2023] Open
Abstract
Background Blood pressure (BP) management in frail older people is challenging. An randomised controlled trial of largely non-frail older people found cardiovascular and mortality benefit with systolic (S) BP target <120 mmHg. However, all-cause mortality by attained BP in routine care in frail adults aged above 75 is unclear. Objectives To estimate observational associations between baseline BP and mortality/cardiovascular outcomes in a primary-care population aged above 75, stratified by frailty. Methods Prospective observational analysis using electronic health records (clinical practice research datalink, n = 415,980). We tested BP associations with cardiovascular events and mortality using competing and Cox proportional-hazards models respectively (follow-up ≤10 years), stratified by baseline electronic frailty index (eFI: fit (non-frail), mild, moderate, severe frailty), with sensitivity analyses on co-morbidity, cardiovascular risk and BP trajectory. Results Risks of cardiovascular outcomes increased with SBPs >150 mmHg. Associations with mortality varied between non-frail <85 and frail 75–84-year-olds and all above 85 years. SBPs above the 130–139-mmHg reference were associated with lower mortality risk, particularly in moderate to severe frailty or above 85 years (e.g. 75–84 years: 150–159 mmHg Hazard Ratio (HR) mortality compared to 130–139: non-frail HR = 0.94, 0.92–0.97; moderate/severe frailty HR = 0.84, 0.77–0.92). SBP <130 mmHg and Diastolic(D)BP <80 mmHg were consistently associated with excess mortality, independent of BP trajectory toward the end of life. Conclusions In representative primary-care patients aged ≥75, BP <130/80 was associated with excess mortality. Hypertension was not associated with increased mortality at ages above 85 or at ages 75–84 with moderate/severe frailty, perhaps due to complexities of co-existing morbidities. The priority given to aggressive BP reduction in frail older people requires further evaluation.
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Affiliation(s)
- Jane A H Masoli
- Epidemiology and Public Health Group, University of Exeter Medical School, Exeter, UK
- Department of Healthcare for Older People, Royal Devon and Exeter Hospital, Exeter, UK
| | - Joao Delgado
- Epidemiology and Public Health Group, University of Exeter Medical School, Exeter, UK
| | - Luke Pilling
- Epidemiology and Public Health Group, University of Exeter Medical School, Exeter, UK
| | - David Strain
- Department of Healthcare for Older People, Royal Devon and Exeter Hospital, Exeter, UK
- Diabetes and Vascular Research, University of Exeter Medical School, Exeter, UK
| | - David Melzer
- Epidemiology and Public Health Group, University of Exeter Medical School, Exeter, UK
- UConn Center on Aging, University of Connecticut Health Center, Farmington CT, USA
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Wong ST, Katz A, Williamson T, Singer A, Peterson S, Taylor C, Price M, McCracken R, Thandi M. Can Linked Electronic Medical Record and Administrative Data Help Us Identify Those Living with Frailty? Int J Popul Data Sci 2020; 5:1343. [PMID: 33644409 PMCID: PMC7893852 DOI: 10.23889/ijpds.v5i1.1343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction Frailty is a complex condition that affects many aspects of patients’ wellbeing and health outcomes. Objectives We used available Electronic Medical Record (EMR) and administrative data to determine definitions of frailty. We also examined whether there were differences in demographics or health conditions among those identified as frail in either the EMR or administrative data. Methods EMR and administrative data were linked in British Columbia (BC) and Manitoba (MB) to identify those aged 65 years and older who were frail. The EMR data were obtained from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) and the administrative data (e.g. billing, hospitalizations) was obtained from Population Data BC and the Manitoba Population Research Data Repository. Sociodemographic characteristics, risk factors, prescribed medications, use and costs of healthcare are described for those identified as frail. Results Sociodemographic and utilization differences were found among those identified as frail from the EMR compared to those in the administrative data. Among those who were >65 years, who had a record in both EMR and administrative data, 5%-8% (n=191 of 3,553, BC; n=2,396 of 29,382, MB) were identified as frail. There was a higher likelihood of being frail with increasing age and being a woman. In BC and MB, those identified as frail in both data sources have approximately twice the number of contacts with primary care (n=20 vs. n=10) and more days in hospital (n=7.2 vs. n=1.9 in BC; n=9.8 vs. n=2.8 in MB) compared to those who are not frail; 27% (BC) and 14% (MB) of those identified as frail in 2014 died in 2015. Conclusions Identifying frailty using EMR data is particularly challenging because many functional deficits are not routinely recorded in structured data fields. Our results suggest frailty can be captured along a continuum using both EMR and administrative data.
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Affiliation(s)
- S T Wong
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
| | - A Katz
- University of Manitoba, 408-727 McDermot Ave, Winnipeg, Mb, R3E 3P5
| | - T Williamson
- University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1
| | - A Singer
- University of Manitoba, 408-727 McDermot Ave, Winnipeg, Mb, R3E 3P5
| | - S Peterson
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
| | - C Taylor
- University of Manitoba, 408-727 McDermot Ave, Winnipeg, Mb, R3E 3P5
| | - M Price
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
| | - R McCracken
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
| | - M Thandi
- University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5
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Okpechi I, Randhawa G, Hewson D. Knowledge and attitude of healthcare professionals to frailty screening in primary care: a systematic review protocol. BMJ Open 2020; 10:e037523. [PMID: 32616492 PMCID: PMC7333811 DOI: 10.1136/bmjopen-2020-037523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/23/2020] [Accepted: 05/29/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Frailty is an increasingly common condition in which physiological decline as a result of accumulated deficits renders older people more vulnerable to adverse outcomes. An increasing range of frailty screening programmes have been introduced in primary care to identify frail older people in order to deliver appropriate interventions. However, limited information on the knowledge and attitude of healthcare professionals (HCPs) with respect to frailty screening is known. The aim of this systematic review is to provide evidence on the knowledge and attitude of HCP in terms of frailty screening, and potentially identify barriers and facilitators to frailty screening to improve implementation of frailty screening in primary care. METHODS/DESIGN A systematic review of qualitative research will be conducted. Databases searched will be MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Web of Science from January 2001 to August 2019. Methods will be reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Population, interest, context and study design methodology was used to develop inclusion and exclusion criteria with HCPs as population, frailty screening as interest and knowledge or attitude of HCPs to frailty screening as context. Studies with a qualitative methodology or a mixed-method design where the qualitative component is analysed separately will also be included. Quality appraisal will be carried out using the Joanna Briggs Institute appraisal tool for qualitative studies. Data will be extracted from each selected study with thematic framework analysis used to synthesise findings. ETHICS AND DISSEMINATION This systematic review does not require ethical approval as primary data will not be collected. The findings will be disseminated at conferences and in a relevant academic journal. This review will assist HCPs and relevant stakeholders to tackle the challenges of frailty screening in primary care. PROSPERO REGISTRATION NUMBER CRD42019159007.
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Affiliation(s)
- Ijeoma Okpechi
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - David Hewson
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
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Gallagher J, Bolt T, Tamiya N. Advance care planning in the community: factors of influence. BMJ Support Palliat Care 2020; 12:bmjspcare-2020-002221. [PMID: 32513679 DOI: 10.1136/bmjspcare-2020-002221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aims to identify factors among British community-based adults associated with advance care planning engagement. Factors are then compared among six domains of wishes: medical care, spiritual and religious needs, privacy and peace, dignified care, place of death and pain relief. METHODS Cross-sectional data were analysed from a stratified random sample of adults across Great Britain (England, Scotland and Wales) who were interviewed on their attitudes towards death and dying. Weighted multivariable logistic regression tested for associations with expressing any end-of-life wishes and then for each separate domain. RESULTS Analysis of 2042 respondents (response rate: 53.5%) revealed those less likely to have discussed their wishes were: male, younger, born in the UK, owned their residence, had no experience working in health or social care, had no chronic conditions or disabilities, had not experienced the death of a close person in the last 5 years and feel neither comfortable nor uncomfortable or uncomfortable talking about death. Additional factors among the six domains associated with having not discussed wishes include: having less and more formal education, no religious beliefs, lower household income and living with at least one other person. CONCLUSIONS This study is the first to be conducted among a sample of community-dwelling British adults and the first of its kind to compare domains of end-of-life wishes. Our findings provide an understanding of social determinants which can inform a public health approach to end-of-life care that promotes advance care planning among compassionate communities.
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Affiliation(s)
- Joshua Gallagher
- School of Global and Area Studies, University of Oxford, Oxford, UK
- Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan
| | - Timothy Bolt
- Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan
- Department of Economics, Saitama University, Saitama, Japan
| | - Nanako Tamiya
- Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Seaman R, Höhn A, Lindahl-Jacobsen R, Martikainen P, van Raalte A, Christensen K. Rethinking morbidity compression. Eur J Epidemiol 2020; 35:381-388. [PMID: 32418023 PMCID: PMC7250949 DOI: 10.1007/s10654-020-00642-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Abstract
Studies of morbidity compression routinely report the average number of years spent in an unhealthy state but do not report variation in age at morbidity onset. Variation was highlighted by Fries (1980) as crucial for identifying disease postponement. Using incidence of first hospitalization after age 60, as one working example, we estimate variation in morbidity onset over a 27-year period in Denmark. Annual estimates of first hospitalization and the population at risk for 1987 to 2014 were identified using population-based registers. Sex-specific life tables were constructed, and the average age, the threshold age, and the coefficient of variation in age at first hospitalization were calculated. On average, first admissions lasting two or more days shifted towards older ages between 1987 and 2014. The average age at hospitalization increased from 67.8 years (95% CI 67.7-67.9) to 69.5 years (95% CI 69.4-69.6) in men, and 69.1 (95% CI 69.1-69.2) to 70.5 years (95% CI 70.4-70.6) in women. Variation in age at first admission increased slightly as the coefficient of variation increased from 9.1 (95% CI 9.0-9.1) to 9.9% (95% CI 9.8-10.0) among men, and from 10.3% (95% CI 10.2-10.4) to 10.6% (95% CI 10.5-10.6) among women. Our results suggest populations are ageing with better health today than in the past, but experience increasing diversity in healthy ageing. Pensions, social care, and health services will have to adapt to increasingly heterogeneous ageing populations, a phenomenon that average measures of morbidity do not capture.
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Affiliation(s)
- Rosie Seaman
- Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, Germany. .,Faculty of Social Sciences, University of Stirling, Stirling, UK.
| | - Andreas Höhn
- Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, Germany.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark.,Interdisciplinary Centre On Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, Germany.,Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Alyson van Raalte
- Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, Germany
| | - Kaare Christensen
- Department of Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense, Denmark.,Danish Aging Research Centre, University of Southern Denmark, Odense, Denmark
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