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Soulis G, Kyriakopoulou E, Leventouri A, Zigkiri E, Efthymiou V, Kentros Z, Koutsouri A. Pilot Testing of Useful Tools' Validity for Frailty Assessment in Greece: Translated PRISMA-7 Tool, Modified Fried Criteria and Clinical Frailty Scale. Healthcare (Basel) 2024; 12:930. [PMID: 38727487 PMCID: PMC11083930 DOI: 10.3390/healthcare12090930] [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: 03/26/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
The importance of frailty in older people is getting constant recognition as an important aspect both in terms of public health, as well as at a personal level, for the appropriate management of an older person's health condition. This is reflected by the continuously increasing number of research studies carried out in several settings across different countries. Sometimes, this is very solid, but in other cases, there is a considerable gap in terms of accurate and well-grounded documentation of frailty status. This is the case in Greece, where we are missing clinically validated tools to approach frailty. We are missing frailty screening tools, such as, for instance, Program of Research on Integration of Services for the Maintenance of Autonomy 7 (PRISMA 7), the gold standard tool of Fried criteria, is somehow problematic since the question referring to physical activity originates from a questionnaire that has not been translated and validated, while Clinical Frailty Scale (CFS) has been validated for translation but not for the capacity to detect frailty. The aim of this study is to validate these tools for their accuracy to detect frailty by using a measurable index of frailty, previously proposed for use in clinical studies: the Short Physical Performance Battery (SPPB). Seventy-four male and female participants (mean age 80.47 years SD = ±7.45 years, minimum-maximum age = 65-95) have been evaluated for their frailty status using different tools. We observed that the PRISMA 7 translation detects frailty only when one question is removed at a cut-off of ≥2 and indicates a sensitivity of 88.1% and specificity of 99.9% with a good correlation with SPPB measurements (r = -0.858; p < 0.001). When CFS was validated using SPPB, it demonstrated a very good correlation (r = -0.838; p < 0.001 respectively) as was the case for the modified Fried Criteria (r = -0.725; p < 0.001). All items demonstrated a good correlation between them. We here propose that we can accurately assess frailty status in the community setting by using a modified version of Fried criteria, Clinical Frailty Scale translation in Greek, and we can screen for frailty by using the Greek translation of PRISMA 7 only after removing item 6 of the questionnaire.
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Affiliation(s)
- George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.Z.); (A.K.)
- Hellenic Society for the Study and Research of Ageing, 10677 Athens, Greece
| | - Efstathia Kyriakopoulou
- Department of Physiotherapy, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.K.); (Z.K.)
| | - Aristea Leventouri
- Department of Neurology, University General Hospital of Patra, 26504 Patra, Greece;
| | - Eleni Zigkiri
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.Z.); (A.K.)
- Department of Physiotherapy, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.K.); (Z.K.)
| | - Vasiliki Efthymiou
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Zikos Kentros
- Department of Physiotherapy, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.K.); (Z.K.)
| | - Anastasia Koutsouri
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, 11526 Athens, Greece; (E.Z.); (A.K.)
- 1st Department of Internal Medicine, Henry Dunant Hospital Center, 11526 Athens, Greece
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Kyvetos A, Kyritsi E, Vrettos I, Voukelatou P, Manoli AD, Papadopoulou E, Katsaros OF, Toutouzas K. Association Between Chronic Diseases and Frailty in a Sample of Older Greek Inpatients. Cureus 2024; 16:e58568. [PMID: 38765349 PMCID: PMC11102568 DOI: 10.7759/cureus.58568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Previous reports have associated frailty with the existence of various chronic diseases. Especially for cardiovascular diseases, this relationship seems to be bidirectional as common pathophysiological mechanisms lead to the progression of both diseases and frailty. The study aimed to examine the relationship between chronic diseases and frailty in a sample of older Greek inpatients Methodology: In 457 consecutively admitted older patients (226, 49.5% females), the median age was 82 years (interquartile range [IQR] 75-89), and demographic factors, medical history, cause of admission, and the degree of frailty assessed with the Clinical Frailty Scale were recorded. The level of frailty was calculated for the pre-hospital status of the patients. Parametric tests and logistic regression analysis were applied to identify diseases independently associated with frailty. RESULTS Using the scale, 277 patients (60.6%) were classified as frail and 180 as non-frail (39.4%). In univariate analysis, frail patients were more likely to have respiratory disease, dementia, Parkinson's disease, chronic kidney disease (CKD), atrial fibrillation (AFIB), neoplastic disease, depression, stroke, heart failure (HF), and coronary artery disease. In binomial regression analysis, the diseases that were statistically significantly associated with frailty were respiratory diseases (P = 0.009, odds ratio [OR] = 2.081, 95% confidence interval [CI] 1.198-3.615), dementia (P ≤ 0.001, OR = 20.326, 95% CI 8.354-49.459), Parkinson's disease (P = 0.049, OR = 3.920, 95% CI 1.005-15.295), CKD (P = 0.018, OR = 2.542, 95% CI 1.172-5.512), AFIB (P = 0.017, OR = 1.863, 95% CI 1.118-3.103), HF (P = 0.002, OR = 2.411, 95% CI 1.389-4.185), and coronary artery disease (P = 0.004, OR = 2.434, 95% CI 1.324-4.475). CONCLUSIONS Among diseases independently associated with frailty, chronic diseases such as respiratory diseases, dementia, Parkinson's disease, CKD, and cardiovascular diseases (AFIB, HF, and coronary heart disease) have an important role. Recognizing the diseases that are highly related to frailty may contribute, by their optimal management, to delaying the progression or even reversing frailty in a large proportion of the elderly.
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Affiliation(s)
- Andreas Kyvetos
- Second Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, GRC
| | - Eleni Kyritsi
- First Department of Cardiology, Medical School, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, GRC
| | - Ioannis Vrettos
- Second Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, GRC
| | - Panagiota Voukelatou
- Second Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, GRC
| | - Anastasia D Manoli
- Department of Pediatric Medicine, Pendelis General Children's Hospital, Athens, GRC
| | | | - Odysseas F Katsaros
- First Department of Cardiology, Medical School, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, GRC
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School, Hippokration General Hospital of Athens, National and Kapodistrian University of Athens, Athens, GRC
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Deng Y, Sato N. Global frailty screening tools: Review and application of frailty screening tools from 2001 to 2023. Intractable Rare Dis Res 2024; 13:1-11. [PMID: 38404737 PMCID: PMC10883846 DOI: 10.5582/irdr.2023.01113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/27/2024] Open
Abstract
As the aging population increases globally, health-related issues caused by frailty are gradually coming to light and have become a global health priority. Frailty leads to a significantly increased risk of falls, incapacitation, and death. Early screening leads to better prevention and management of frailty, increasing the possibility of reversing it. Developing assessment tools by incorporating disease states of older adults using effective interventions has become the most effective approach for preventing and controlling frailty. The most direct and effective tool for evaluating debilitating conditions is a frailty screening tool, but because there is no globally recognized gold standard, every country has its own scale for national use. The diversity and usefulness of the frailty screening tool has become a hot topic worldwide. In this article, we reviewed the frailty screening tool published worldwide from January 2001 to June 2023. We focused on several commonly used frailty screening tools. A systematic search was conducted using PubMed database, and the commonly used frailty screening tools were found to be translated and validated in many countries. Disease-specific scales were also selected to fit the disease. Each of the current frailty screening tools are used in different clinical situations, and therefore, the clinical practice applications of these frailty screening tools are summarized graphically to provide the most intuitive screening and reference for clinical practitioners. The frailty screening tools were categorized as (ⅰ) Global Frailty Screening Tools in Common; (ⅱ) Frailty Screening Tools in various countries; (ⅲ) Frailty Screening Tools for various diseases. As science and technology continue to advance, electronic frailty assessment tools have been developed and utilized. In the context of Coronavirus disease 2019 (COVID-19), electronic frailty assessment tools played an important role. This review compares the currently used frailty screenings tools, with a view to enable quick selection of the appropriate scale. However, further improvement and justification of each tool is needed to guide clinical practitioners to make better decisions.
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Affiliation(s)
- Yi Deng
- Graduate School of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naomi Sato
- Department of Clinical Nursing, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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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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Vrettos I, Voukelatou P, Kyvetos A, Makrilakis K, Sfikakis PP, Raptis A, Niakas D. The role of frailty among the predictors of depression on informal caregivers of older adults: a mediation analysis. Psychogeriatrics 2023; 23:973-984. [PMID: 37704194 DOI: 10.1111/psyg.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Providing care for older adults has been associated with the presence of depressive symptoms among their informal caregivers. Numerous caregivers and older adults' characteristics have been mentioned as predictors of caregivers' depression. However, studies dealing with the impact of older adults' frailty status on caregivers' depression are scarce. This study was conducted to clarify the precise relationship between caregivers' depression, caregivers' burden, caregivers' characteristics and patients' characteristics, including frailty, among the variables that may have an impact on caregivers' depression. METHODS In this cross-sectional study, patients and caregivers' characteristics were recorded for 311 patient-caregiver dyads, when the patient was admitted to the hospital. For the purpose of the study, a mediation analysis was used with patients and caregiver characteristics considered to be predictors, subjective caregivers' burden as the mediator, and caregivers' depression as the outcome variable. RESULTS Only patients' frailty and caregivers' subjective burden had a direct effect on caregivers' depression. Moreover, caregivers' gender, patients' frailty status and comorbidity, duration of caregiving, and the relationship with the patient, had an indirect effect through caregivers' burden that acted as mediator. Regarding total effects, caregivers burden followed by patients' frailty status had the greater impact on caregivers' depression. CONCLUSIONS By organising interventions to reduce caregivers' depression, patients' frailty status could be among the targets of those interventions considering that frailty might be delayed or reversed.
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Affiliation(s)
- Ioannis Vrettos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia 'Agioi Anargyroi', Athens, Greece
| | - Panagiota Voukelatou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia 'Agioi Anargyroi', Athens, Greece
| | - Andreas Kyvetos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia 'Agioi Anargyroi', Athens, Greece
| | - Konstantinos Makrilakis
- 1st Department of Propedeutic Internal Medicine, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- 1st Department of Propedeutic Internal Medicine-Rheumatology Unit, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Raptis
- 2nd Department of Propedeutic Internal Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Niakas
- Department of Health Economics, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Voukelatou P, Kyvetos A, Kollia D, Ellisaiou P, Vrettos I. Translation of the Pictorial Fit-Frail Scale Into the Greek Language and Examination of Its Validity and Reliability. Cureus 2023; 15:e41553. [PMID: 37554610 PMCID: PMC10405557 DOI: 10.7759/cureus.41553] [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] [Accepted: 06/24/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND For the evaluation of frailty, a great variety of research tools are used internationally; however, only two have been translated and validated in Greek. The aim of the study was to translate the Pictorial Fit-Frail Scale (PFFS) into the Greek language and examine its validity and reliability. METHODS Initially, the PFFS scale was translated into the Greek language through a six-step process. Subsequently, in a sample of 157 elderly patients (47.1% women), construct validity was examined with the known-groups method using the one-way ANOVA test and criterion concurrent validity by comparison with the Clinical Frailty Scale (CFS) using Pearson's correlation coefficient. Finally, inter-rater reliability and test-retest reliability were checked using the intraclass correlation coefficient. RESULTS A comparison of known groups showed that older patients with greater dependence on activities of daily living, greater impairment of cognitive function, reduced mobility, balance, and swallowing disorders, as well as those who were socially withdrawn, scored higher on the PFFS scale, supporting the construct validity. The positive correlation between PFFS and CFS (r = 0.625, p ≤ 0.001) demonstrated the concurrent criterion validity of the PFFS scale. Intraclass correlation was excellent for both inter-rater reliability (0.951 (95% CI: 0.934-0.964)) and test-retest reliability (0.948 (95% CI: 0.930-0.962)). CONCLUSION The translated PFFS scale in Greek is a valid and reliable tool.
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Affiliation(s)
- Panagiota Voukelatou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, GRC
| | - Andreas Kyvetos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, GRC
| | - Dafni Kollia
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, GRC
| | - Pantelitsa Ellisaiou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, GRC
| | - Ioannis Vrettos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, GRC
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Vrettos I, Anagnostopoulos F, Voukelatou P, Panayiotou S, Kyvetos A, Nikas A, Kollia D, Niakas D. Factors associated with health-related quality of life of informal caregivers of older patients and the mediating role of subjective caregivers' burden. Psychogeriatrics 2023; 23:286-297. [PMID: 36597270 DOI: 10.1111/psyg.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Caregiving has been associated with increased subjective burden and decreased health-related quality of life (HRQOL) for caregivers. The aim of the study was to clarify the precise relationship between caregivers' burden, caregivers' HRQOL, and other risk factors, considering that subjective burden was a risk factor for poor HRQOL, which may also mediate the effects of some known risk factors. METHODS In this cross-sectional study, patients' and their informal caregivers' characteristics were recorded for 311 patient-caregiver dyads. Subjective caregiver burden and caregivers' HRQOL were assessed using the Zarit Burden Interview and the 12-item Short-Form Health Survey (SF-12), respectively. Mediation analysis was used to examine the relationships between variables. Caregivers' mental component summary (MCS) and physical component summary (PCS) scores were regarded as outcome variables, caregivers' subjective burden was considered the mediator, and patients' and caregivers' characteristics were treated as predictors. RESULTS Caregivers' subjective burden was negatively related to both PCS and MCS of caregivers' HRQOL, after controlling for the effects of demographic and clinical variables. Moreover, significant associations, mostly indirect via caregivers' subjective burden, existed between caregivers' socio-demographic characteristics, duration of caregiving, patients' frailty status, patients' co-morbidity, and caregivers' HRQOL. CONCLUSION Caregivers' subjective burden plays a major and mediating role on influencing caregivers' HRQOL. Our findings may direct future research and promote the implementation of interventions to reduce caregivers' burden and improve caregivers' HRQOL.
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Affiliation(s)
- Ioannis Vrettos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Fotios Anagnostopoulos
- Department of Psychology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Panagiota Voukelatou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Stefani Panayiotou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Andreas Kyvetos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Anastasios Nikas
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Dafni Kollia
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Dimitris Niakas
- Department of Health Economics, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Vrettos I, Voukelatou P, Panayiotou S, Kyvetos A, Nikas A, Makrilakis K, Sfikakis PP, Niakas D. Factors Affecting Caregivers' Burden in a Sample of Greek Family Caregivers Caring for Older Adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022:1-14. [PMID: 36256953 DOI: 10.1080/01634372.2022.2135658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Caregivers' burden may vary across different countries. The aim of this study was to evaluate factors associated with caregivers' burden in a sample of Greek patient-caregiver dyads, including patients' frailty status among the evaluated variables. In 204 patient-caregiver dyads, patients' and caregivers' characteristics were recorded. Caregiver burden was evaluated by using the Zarit Burden Interview, and patients' frailty status by using Clinical Frailty Scale (CFS). Parametric and non-parametric tests and logistic regression analysis were applied to identify the factors that had a significant association with caregivers' burden. Increasing CFS score (p = .001, OR = 1.467, 95%CI 1.178-1.826) and longer duration of caregiving (p = .003, OR = 1.017, 95%CI 1.006-1.028) were associated with an increased likelihood of caregivers' burden. Patients' frailty status is probably a modifiable factor among them that has an impact on caregivers' burden. Strategies and interventions in order to prevent, delay or reverse frailty may have a positive impact on reducing this burden.
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Affiliation(s)
- Ioannis Vrettos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Panagiota Voukelatou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Stefani Panayiotou
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Andreas Kyvetos
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Anastasios Nikas
- 2nd Department of Internal Medicine, General and Oncology Hospital of Kifissia "Agioi Anargyroi", Athens, Greece
| | - Konstantinos Makrilakis
- 1st Department of Propedeutic Internal Medicine, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- 1st Department of Propedeutic Internal Medicine, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Niakas
- Department of Health Economics, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Aşık Z, Kılınç Ş, Kurşun Ö, Özen M. Validation of the Clinical Frailty Scale version 2.0 in Turkish older patients. Geriatr Gerontol Int 2022; 22:730-735. [PMID: 35871523 DOI: 10.1111/ggi.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
AIM Frailty is a syndrome that affects certain older adults more than others, and it has physical, cognitive, psychological, social and environmental aspects. The aim of our study was to determine the validity and reliability of the Clinical Frailty Scale (CFS) version 2.0 in Turkish. In total, 204 older adults aged ≥65 years took part in this study. METHODS The necessary permissions were obtained from Rockwood et al. The Turkish version of CFS version 2.0 had been appropriately translated through translation to the back-translation process. A questionnaire was used to investigate certain descriptive features, as well as the newly edited Turkish translation of CFS version 2.0, the Turkish version of the FRAIL Scale and the Turkish version of the Edmonton Frail Scale. RESULTS The age range was 65-95 years. In a Pearson correlation analysis, a positive link was discovered between FRAIL and CFS (r = 0.761 and P = 0.000) as well as CFS and Edmonton (r = 0.895 and P = 0.000). CONCLUSION The Turkish translation of CFS version 2.0 has been determined to be suitable, valid and reliable for use in frailty screening in outpatient clinics. Geriatr Gerontol Int 2022; 22: 730-735.
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Affiliation(s)
- Zeynep Aşık
- Department of Family Medicine Antalya Training and Research Hospital Antalya Turkey
| | - Şule Kılınç
- Department of Family Medicine Karaman Sarıveliler Country State Hospital Sarıveliler Turkey
| | - Özge Kurşun
- Department of Family Medicine Çaldıran Soğuksu Family Health Center Çaldıran Turkey
| | - Mehmet Özen
- Department of Family Medicine Antalya Training and Research Hospital Antalya Turkey
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Chou YC, Tsou HH, Chan DCD, Wen CJ, Lu FP, Lin KP, Wu MC, Chen YM, Chen JH. Validation of clinical frailty scale in Chinese translation. BMC Geriatr 2022; 22:604. [PMID: 35858829 PMCID: PMC9298166 DOI: 10.1186/s12877-022-03287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identification of frailty is crucial to guide patient care for the elderly. The Clinical Frailty Scale (CFS) is a reliable, synthesis and clinical judgment-based tool. However, a validated Chinese version of CFS (CFS-C) is lacking. The aim of this study is to describe the translation process of CFS into traditional Chinese and to evaluate its reliability and validity in a geriatric study population in Taiwan. METHODS This cross-sectional study recruited 221 geriatric outpatients aged 65 years or older at a medical center in Taipei, Taiwan. The Chinese version of CFS was produced following Brislin's translation model. Weighted kappa for agreement and Kendall's tau for correlation were used to assess inter-rater reliability (a subgroup of 52 outpatients) between geriatricians and one research assistant, and validity tests (221 outpatients) by comparing CFS-C with Fried frailty phenotype and Frailty Index based on Comprehensive Geriatric Assessment (FI-CGA). Correlation between CFS-C and other geriatric conditions were also assessed. RESULTS The inter-rater reliability revealed moderate agreement (weighted kappa = 0.60) and strong correlation (Kendall's tau = 0.67). For criterion validity, CFS-C categorisation showed fair agreement (weighted kappa = 0.37) and significant correlation (Kendall's tau = 0.46) with Fried frailty phenotype, and higher agreement (weighted kappa = 0.51) and correlation (Kendall's tau = 0.63) with FI-CGA categorisation. CFS-C was significantly correlated with various geriatric assessments, including functional disability, physical performance, hand grip, comorbidity, cognition, depression, and nutrition status. No significant correlation was found between CFS-C and appendicular muscle mass. CONCLUSIONS The CFS-C demonstrated acceptable validity and reliability in Chinese older adults in Taiwan. Development of CFS-C enhanced consistency and accuracy of frailty assessment, both in research and clinical practice.
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Affiliation(s)
- Yi-Chun Chou
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Hsiao-Hui Tsou
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 350, Taiwan
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Chiung-Jung Wen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Family Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Feng-Ping Lu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Meng-Chen Wu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Neurology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Yung-Ming Chen
- Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan.,Superintendent Office, National Taiwan University Hospital Bei-Hu Branch, No. 87, Neijiang Street, Taipei, 108, Taiwan
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan. .,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan.
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Vrettos I, Anagnostopoulos F, Voukelatou P, Panayiotou S, Kyvetos A, Tsigkri A, Boulmetis G, Niakas D. The Indirect Effect of the Frailty of Dependent Elderly People Needing Hospitalization on Their Informal Caregivers' Anxiety. Cureus 2022; 14:e25144. [PMID: 35747056 PMCID: PMC9206522 DOI: 10.7759/cureus.25144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/05/2022] Open
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Vrettos I, Voukelatou P, Panayiotou S, Kyvetos A, Tsigkri A, Makrilakis K, Sfikakis PP, Niakas D. Factors Associated With Mortality in Elderly Hospitalized Patients at Admission. Cureus 2022; 14:e22709. [PMID: 35386138 PMCID: PMC8967403 DOI: 10.7759/cureus.22709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Several factors have been associated with mortality prediction among older inpatients. The objective of this study was to assess the factors associated with mortality in hospitalized elderly patients. Methods A total of 353 consecutively admitted elderly patients (47.9% women), with a median age of 83 years (interquartile range 75.00-88.00), were enrolled in the study and patient characteristics were recorded. Comorbidities were assessed using Charlson Comorbidity Index (CCI), activities of daily living by Barthel Index (BI), frailty was assessed using the Clinical Frailty Scale (CFS), cognition by Global Deterioration Scale (GDS) and symptom severity at admission by quick Sequential Organ Function Assessment (qSOFA) score. CFS, GDS and BI were estimated for the premorbid patients’ status. Parametric and non-parametric tests and binary logistic regression analysis were applied to identify the factors associated with mortality. A receiver operating characteristic (ROC) curve was used to analyse the prognostic value of CFS and qSOFA. Results In total, 55 patients (15.6%) died during hospitalization. In regression analysis, the factors associated with mortality were the qSOFA score at admission (p=0.001, odds ratio [OR]=1.895, 95% confidence interval [CI] 1.282-2.802) and the premorbid CFS score (p=0.001, OR=1.549, 95% CI 1.1204-1.994). The classifiers both have almost similar area under the curve (AUC) scores, with CFS performing slightly better. More specifically, both CFS (AUC 0.79, 95% CI 0.73-0.85, p=0.001) and qSOFA (AUC 0.75, 95% CI 0.67-0.83, p<0.001) showed almost the same accuracy for predicting inpatients’ mortality. Conclusion This study strengthens the perception of premorbid frailty and disease severity at admission as factors closely related to mortality in hospitalized elderly patients. Simple measures such as CFS and qSOFA score may help identify, in the emergency department, elderly patients at risk, in order to provide timely interventions.
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