The opinions and experiences of nurses on frailty screening among older hospitalized patients. An exploratory study

Perspectives of healthcare professionals on frailty assessment among older patients with colorectal cancer: A qualitative study

PURPOSE

Exploring the perspectives of healthcare professionals (HCPs) working at the outpatient clinic on the value and practice of standardized frailty assessment in older adults with colorectal cancer (CRC). In current practice, frailty assessment comprises initial frailty screening using the G8 measurement, followed by a comprehensive geriatric assessment (CGA) to further evaluate frailty detected during screening.

METHODS

This is a qualitative study involving semi-structured interviews with 17 HCPs, conducted from February to July 2023. Physicians specializing in oncology, surgery, gastroenterology, and geriatrics were asked to participate as well as nurses and nurse practitioners at the outpatient clinic of a large teaching hospital involved in frailty assessment of patients with CRC.

RESULTS

Two main themes emerged: 1) the perceived value of the G8 measurement for frailty screening and 2) the perceived value of the CGA. The moment, content, and outcome of the G8 and CGA were discussed. Other issues discussed were the complexity of frailty appreciation and collaboration between HCPs. The integration of perspectives proved important to the overall added value of frailty assessment. The CGA is considered most beneficial in patients with suspected cognitive impairment or if there is uncertainty about the degree of frailty or about the optimal treatment.

CONCLUSION

We conclude that the G8 is not an appropriate screening instrument for this patient population. CGA adds value in a specific subset of patients if it is conducted before treatment decisions are made and integrated into an efficient, multidisciplinary pathway, focusing on collaborative decision-making, including with the patient.

Knowledge, attitude, and practice of frailty management among clinical nurses: a cross-sectional study

BACKGROUND

Frailty is a leading risk factor of falls, incapacitation, functional decline, and even death in aging populations globally. Clinical nurses play pivotal roles in screening, prevention, and intervention to reverse or slow the progression of frailty. The present study aimed to (1) understand the extent and influencing factors of knowledge, attitudes, and practices of clinical nurses for managing frailty, (2) elucidate the relationships of the knowledge, attitudes, and practices of clinical nurses for frailty management.

METHODS

This cross-sectional study was conducted from March to April 2024 on 524 clinical nurses in a tertiary hospital in Zhejiang Province, China. The survey instruments included a questionnaire inquiring about the knowledge, attitudes, and practices of nurses in terms of frailty management, a demographic data form, and a self-designed frailty educational information questionnaire. Data were analyzed by descriptive statistics, univariate analysis, multiple linear regression, and structural equation modeling.

RESULTS

Of 524 nurses, Only 37.2% were rated as good in terms of knowledge, attitude, and practice of frailty management, while 55.7% were rated as moderate. Among them, the proportion of nurses with good knowledge (10.3%) and practical skills (13.4%) is much lower than their attitude (65.3%). Structural equation modeling found that knowledge and attitudes were related to frailty management practices, with significant associations between knowledge and practices(β = 0.499, p < 0.001). Of the total effect size of knowledge influencing practice (total effect = 0.624, 95% CI: 0.455,0.791), approximately 20.0% was mediated by attitudes (indirect effect = 0.125, 95% CI: 0.076,0.187). Multiple linear regression analysis showed that age, organizational support, familiarity with relevant guidelines, familiar with the term frailty, and department all had a significant effect on the total score(adjusted R2 = 0.264, p < 0.001).

CONCLUSIONS

Despite inadequate knowledge and limited experience in frailty management, clinical nurses' attitudes towards frailty management were positive, indicating potential for improvement. The model was useful to explain practices in frailty management, thereby providing a theoretical basis for development of targeted training programs.

CLINICAL TRIAL NUMBER

Not applicable.

Behaviors and influencing factors of Chinese oncology nurses towards frailty care: A cross-sectional study based on knowledge-attitude-practice theory in 2024

BACKGROUND

The demand for frailty care is continuously increasing in hospitalized tumor patients with the aging of the population. Nurses are the primary care providers of hospitalized tumor patients with frailty but research on exploring their behavior and associated factors is limited. This study aims to describe the current situation of frailty care behaviors in oncology nurses and to explore the factors influencing frailty care behaviors.

METHODS

From August 1, 2023, to March 31, 2024, this cross-sectional study was conducted among nurses from oncology-related departments in 5 Secondary A (mid-tier hospitals providing comprehensive care) or above hospitals in South China. Convenience sampling was employed to recruit participants. In China, a "Secondary A hospital is a mid-tier hospital that provides comprehensive medical care and handles more complex cases than primary hospitals but is smaller and less specialized than tertiary hospitals. Data were collected using the standardized frailty-knowledge, attitudes, and practices questionnaire (F-KAP) and general information questionnaire including sociodemographic and work-related details. The sub-scale scores of knowledge, attitude, and practice were calculated by summing up the items within each sub-scale. Student's independent t-test, one-way ANOVA, Pearson's correlation coefficient, and two kinds of multiple linear regression models were used for data analysis.

RESULTS

We included a total of 17 (3.70%) male and 443 (96.30%) female participants in this study. The mean total score of oncology nurses for frailty care behaviors was 33.26±6.61. The three lowest scoring behaviors were "conduct frailty measurements and screening for patients (3.30±1.12)", "accumulate frailty-related knowledge in daily work (3.59±0.87)", and "actively pay attention to the patient's debilitating condition". Pearson's correlations analysis showed that nursing grades (r = 0.13), frailty-related training willingness (r = 0.18), nursing frail patients experience (r = 0.22), frailty-related knowledge learning experience (r = 0.33), frailty-related training experience (r = 0.17), frailty care knowledge (r = 0.23), and hospice care attitudes (r = 0.54) were positively associated with frailty care behaviors. Two kinds of multiple linear regression models both showed that the factors most significantly associated with the oncology nurses' frailty care behaviors are their self-rated subjective knowledge and attitudes towards frailty identification.

CONCLUSION

Oncology nurses practiced relatively low-frequency frailty in daily work. Our findings provide theoretical support for improving frailty care attitudes among nurses and enhancing patient quality of life.

Definition and assessment of psychological frailty in older adults: A scoping review

OBJECTIVES

The confusion surrounding psychological frailty and its components prompts the need for a standardized conceptual definition. To address this, we aimed to (1) identify the psychological variables included in multicomponent frailty assessment instruments used with older adults and examine their operationalization; and (2) formulate a thorough conceptualization of psychological frailty based on the variables identified.

METHODS

This study followed the most recent recommendations for conducting scoping reviews and is reported in accordance with PRISMA-ScR guidelines. We systematically searched the CINAHL, MEDLINE, PsycInfo, Scopus, and Web of Science databases, with additional searches in Google Scholar and reference lists.

RESULTS

Sixteen instruments were identified. The results suggested that: (1) In multicomponent frailty assessment instruments, psychological variables are poorly represented; (2) A wide variety of psychological variables are included in the instruments, the most frequent being cognitive functioning and affective functioning (e.g., depressive symptoms, emotional loneliness, anxiety symptoms, poor coping, and suicidal ideation); and (3) The way in which variables are referred to and operationalized varies across instruments.

CONCLUSIONS

Including both cognitive and affective variables in psychological frailty assessments may lead to inaccuracies. We suggest distinguishing between two separate dimensions within psychological frailty: cognitive frailty and affective frailty. A conceptual definition for each dimension is provided. This proposal aims to advance the debate regarding the conceptualization and assessment of psychological frailty, with further research and discussion needed to ensure its practical applicability.

Frailty knowledge, training and barriers to frailty management: A national cross-sectional survey of health professionals in Australia

OBJECTIVE(S)

To understand Australian health professionals' perceptions of their knowledge and previous training about frailty, as well as barriers to frailty assessment and management in their practice.

METHODS

A cross-sectional online survey was developed and distributed to health professionals (medical, nursing and allied health) engaged in clinical practice in Australia through convenience and snowball sampling techniques from March to May 2022. The survey consisted of five sections: frailty training and knowledge; confidence in recognising and managing adults with frailty; the importance and relevance of frailty; barriers to assessing and managing frailty in practice; and interest in further frailty training. Responses were analysed using descriptive statistics.

RESULTS

The survey was taken by 736 health professionals. Less than half of respondents (44%, 321/733) reported receiving any training on frailty, with 14% (105/733) receiving training specifically focussed on frailty. Most respondents (78%, 556/712) reported 'good' or 'fair' understanding of frailty. The majority (64%, 448/694) reported being 'fairly' or 'somewhat' confident with identifying frailty. Almost all respondents (>90%) recognised frailty as having an important impact on outcomes and believed that there are beneficial interventions for frailty. Commonly reported barriers to frailty assessment in practice included 'lack of defined protocol for managing frailty' and 'lack of consensus about which frailty assessment tool to use'. Most respondents (88%, 521/595) were interested in receiving further education on frailty, with a high preference for online training.

CONCLUSIONS

The findings suggest frailty is important to health professionals in Australia, and there is a need for and interest in further frailty education.

Depressive Symptoms, Sleep Quality, and Pain Are Associated With Frailty in Nursing Home Residents During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has caused severe effects on older adults. Depressive symptoms, poor sleep quality, and pain are common in older adults with frailty. However, it is unknown the relationship between these symptoms and frailty in nursing home residents and the difference of importance between pain intensity and pain impact on frailty during the COVID-19 Pandemic. Therefore, this study aims to explore the associations between depressive symptoms, poor sleep quality, pain intensity, and pain impact with frailty in older adults living in nursing homes.

METHODS

In this cross-sectional population-based study, 172 older adults living in nursing homes from Changsha in China were included. We collected data on depressive symptoms, sleep quality, pain, and frailty using the Patient Health Questionnaire, the Pittsburgh Sleep Quality, the Brief Pain Inventory-short form, and the FRAIL-NH Scale. Generalized linear regression models were used to explore the interaction association between these symptoms with frailty.

RESULTS

Most older adults were between 80 and 90 years old. Approximately 11.6% of older adults experienced one of the following symptoms: depressive symptoms, poor sleep quality, pain intensity, or pain impact. Moreover, 76.7% of older adults experienced at least two of these symptoms. The most common overlapping symptoms were depressive symptoms and poor sleep quality (14.5%). Among nursing home residents, the most common sites of pain were the lower limbs, followed by the back. There was a strong correlation between depressive symptoms, sleep quality, pain intensity, pain impact, and frailty. After adjusting for covariates, the interaction term between any two or three symptoms of depressive symptoms, poor sleep quality, pain intensity, and pain impact was found to be associated with a higher likelihood of frailty in older adults residing in nursing homes (p< .05).

CONCLUSIONS

Depressive symptoms, poor sleep quality, pain intensity, and pain impact are common among nursing home residents. Furthermore, these symptoms interacted with each other. In future studies, multidisciplinary interventions aimed at releasing these symptoms and reducing the adverse outcome of frailty are needed.

Nurses' and patients' perceptions of physical health screening for patients with schizophrenia spectrum disorders: a qualitative study

BACKGROUND

Despite worldwide concern about the poor physical health of patients with schizophrenia spectrum disorders (SSD), physical health screening rates are low. This study reports nurses' and patients' experiences of physical health screening among people with SSD using the Finnish Health Improvement Profile (HIP-F) and their ideas for implementation improvements.

METHODS

A qualitative exploratory study design with five group interviews with nurses (n = 15) and individual interviews with patients with SSD (n = 8) who had experience using the HIP-F in psychiatric outpatient clinics. Inductive content analysis was conducted.

RESULTS

Two main categories were identified. First, the characteristics of the HIP-F were divided into the subcategories of comprehensive nature, facilitating engagement, interpretation and rating of some items and duration of screening. Second, suggestions for the implementation of physical health screening consisted of two subcategories: improvements in screening and ideas for practice. Physical health screening was felt to increase the discussion and awareness of physical health and supported health promotion. The HIP-F was found to be a structured, comprehensive screening tool that included several items that were not otherwise assessed in clinical practice. The HIP-F was also considered to facilitate engagement by promoting collaboration in an interactive way. Despite this, most of the nurses found the HIP-F to be arduous and too time consuming, while patients found the HIP-F easy to use. Nurses found some items unclear and infeasible, while patients found all items feasible. Based on the nurses' experiences, screening should be clear and easy to interpret, and condensation and revision of the HIP-F tool were suggested. The patients did not think that any improvements to the HIP-F were needed for implementation in clinical settings.

CONCLUSIONS

Patients with schizophrenia spectrum disorders are willing to participate in physical health screening. Physical health screening should be clear, easy to use and relatively quick. With this detailed knowledge of perceptions of screening, further research is needed to understand what factors affect the fidelity of implementing physical health screening in clinical mental health practice and to gain an overall understanding on how to improve such implementation.

High Sarcopenia Awareness Contrasts a Lack of Clinical Implementation Among Geriatric Rehabilitation Health Care Professionals in the Netherlands: EMPOWER-GR

BACKGROUND AND PURPOSE

Despite being associated with serious adverse outcomes, such as mortality, sarcopenia remains largely undiagnosed in older individuals. This study aimed to assess the awareness, practices, and barriers and enablers to clinical implementation of sarcopenia diagnosis and treatment among geriatric rehabilitation health care professionals in the Netherlands.

METHODS

As part of EMPOWER-GR, a cross-sectional survey among geriatric rehabilitation health care professionals working in the Netherlands was undertaken between September 23, 2020, and January 28, 2021. Professionals were recruited via a geriatric rehabilitation care provider, health care professional associations, professional networks of the research team, and social media. Descriptive statistics were used to assess the study outcomes.

RESULTS AND DISCUSSION

Of the 501 geriatric rehabilitation health care professionals, 12.2% were physicians, 23.0% physical therapist/occupational therapists, 30.3% dietitians, 19.6% nurses, and 11.0% health care assistants. The concept of sarcopenia was known by 83.8% of the participants, 92.5% correctly identified sarcopenia as low muscle mass and strength (and low physical performance), and 73.8% identified sarcopenia as very important in the management of older adults admitted for rehabilitation. Although 26.2% and 18.9% of the participants reported screening and diagnosing sarcopenia, respectively, in their current practice, only 3.0% adequately used the (revised) definition of the European Working Group on Sarcopenia in Older People. When sarcopenia has been diagnosed, 65.0% reported initiating treatment consisting of resistance exercise training (78.7%), food fortification/high-energy or protein diet (85.4%), and oral nutritional supplements (70.4%). Most important barriers to screening and diagnosis were lack of knowledge, access to tools, and equipment and time, while enablers were protocol implementation, access to training, and clear responsibilities.

CONCLUSIONS

Sarcopenia awareness is high among geriatric rehabilitation health care professionals in the Netherlands, but adequate screening and diagnosis is almost nonexistent in current clinical practice, which hampers interventions. Better knowledge, clear responsibilities, and access to tools and protocols, as well as prioritization, are needed for sarcopenia to be diagnosed and treated in geriatric rehabilitation in the Netherlands.

The Association between Functional Health Patterns and Frailty in Hospitalized Geriatric Patients

This study investigates the association between the Functional Health Pattern Assessment Screening Tool (FHPAST) and frailty in hospitalized geriatric patients. One hundred and forty patients (mean age 78.2 years, age range 65-90) were screened for frailty using the Frail Scale during hospitalization in the geriatric unit. Among them, 57 patients were identified as prefrail (40.7%), and 83 were identified as frail (59.3%). A comparative analysis between groups in terms of the FHPAST components covering health risk, general well-being, and health promotion was performed. Correlations between FHAPST components, socio-demographic data, frailty criteria, as well as logistic regression to identify variables that better predict frailty were also sought. Frailty was mainly associated with difficulty urinating, limitations in performing activities of daily living and walking, physical discomfort, less positive feelings in controlling one's own life, lower compliance with recommendations from the healthcare provider, and engagement in seeking healthcare services. Patients with difficulty urinating and walking had a probability of 4.38 times (OR = 4.38, CI 95% [1.20-15.94]), p = 0.025) and 65.7 times (OR = 65.7, CI 95% [19.37-223.17], p < 0.001) higher of being frail rather than prefrail. The relationship between frailty and prefrailty in hospitalized geriatric patients and components of nursing Functional Health Patterns (FHP) has yet to be explored. This study provides evidence of the most prevalent needs of frail geriatric patients in hospital settings.

Defining and assessing psychological frailty in older adults: a scoping review protocol

INTRODUCTION

Frailty is widely acknowledged as a multidimensional construct encompassing physical, psychological and social aspects. However, the lack of consensus in defining and operationalising psychological frailty challenges the holistic approach to frailty advocated by health professionals. Consequently, there is a need to develop a comprehensive definition of psychological frailty based on contributions made by experts in the field, primarily existing frailty assessment tools. This scoping review will aim to identify the key psychological variables that are considered in frailty assessment tools used with older adults as well as to analyse how these psychological variables have been operationalised.

METHODS AND ANALYSIS

The study will be conducted in accordance with recommendations from several methodological frameworks for scoping reviews and will be reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement guidelines. A systematic literature search will be performed in the CINAHL, MEDLINE, PsycInfo, Scopus and Web of Science databases, supplemented by a search in Google Scholar and reference lists. The focus will be on studies that describe the development of multicomponent frailty assessment tools including at least one psychological variable. Study selection and data extraction will be independently conducted by three reviewers working in pairs. Data will be presented in tabular form, and the data will be analysed using qualitative content analysis.

ETHICS AND DISSEMINATION

This study does not require ethical approval since it is based on secondary data analysis. The findings of the review will be disseminated through publication in a peer-reviewed scientific journal and will be presented at conferences and seminars.

TRIAL REGISTRATION NUMBER

The scoping review was registered in Open Science Framework on 29 March 2022 (https://osf.io/bn24y).

Global frailty screening tools: Review and application of frailty screening tools from 2001 to 2023

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.

Core requirements of frailty screening in the emergency department: an international Delphi consensus study

INTRODUCTION

Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate accurate, yet prompt ED screening. To understand the core requirements of frailty screening in ED, we conducted an international, modified, electronic two-round Delphi consensus study.

METHODS

A two-round electronic Delphi involving 37 participants from 10 countries was undertaken. Statements were generated from a prior systematic review examining frailty screening instruments in ED (logistic, psychometric and clinimetric properties). Reflexive thematic analysis generated a list of 56 statements for Round 1 (August-September 2021). Four main themes identified were: (i) principles of frailty screening, (ii) practicalities and logistics, (iii) frailty domains and (iv) frailty risk factors.

RESULTS

In Round 1, 13/56 statements (23%) were accepted. Following feedback, 22 new statements were created and 35 were re-circulated in Round 2 (October 2021). Of these, 19 (54%) were finally accepted. It was agreed that ideal frailty screens should be short (<5 min), multidimensional and well-calibrated across the spectrum of frailty, reflecting baseline status 2-4 weeks before presentation. Screening should ideally be routine, prompt (<4 h after arrival) and completed at first contact in ED. Functional ability, mobility, cognition, medication use and social factors were identified as the most important variables to include.

CONCLUSIONS

Although a clear consensus was reached on important requirements of frailty screening in ED, and variables to include in an ideal screen, more research is required to operationalise screening in clinical practice.

A survey of nurses' knowledge, attitudes, and practice of sarcopenia: A cross-sectional study

AIM

This paper aims to assess the current knowledge, attitudes, and behaviors of nursing staff regarding sarcopenia and explore associating factors that influence them.

BACKGROUND

Sarcopenia has an insidious onset and is easily overlooked. However, it is has become very common in older people, seriously jeopardizing the quality of life in patients. The present situation of nurses in China is inadequate, even though they are the primary professionals tasked with screening for sarcopenia, the ability to recognize and effectively manage the disease, and the critical role they play in preventing and controlling sarcopenia in patients.

DESIGN

We conducted a cross-sectional design of nurses.

METHODS

Facilitated sampling was used in seven hospitals in Jiangsu Province, China. A total of 409 hospital nursing staff participated in the survey from December 2022 to March 2023. The main survey instruments were the nursing staff about the knowledge of sarcopenia, beliefs, a behavior questionnaire, and a self-designed general information questionnaire. Descriptive of general data, t-test, and ANOVA for influencing factors of three dimensions, whereas multiple linear regression analyses were performed using SPSS23.0 software.

RESULTS

Questionnaires were distributed to 460 nurses, and of the 426 (92.6%) questionnaires returned, 409 (96.0%) were valid. The total mean score of nurses' knowledge, beliefs, and behavior about sarcopenia was 125.42 (SD 18.97), the mean score of knowledge latitude was 29.09 (SD 7.80), the mean score of attitude dimension was 57.53 (SD 7.63), and the mean score of behavior latitude was 38.80 (SD 10.71). Multiple linear regression analysis revealed that the nurse's position, Knowledge of sarcopenia, whether or not they were specialist nurses and years of experience in the workplace were the most significant factors correlated with the level of knowledge, belief, and practice (P < 0.05).

CONCLUSIONS

In China, nurses have little knowledge about sarcopenia, but their attitude towards sarcopenia care is positive. However, there is potential for improvement in nursing behavior toward sarcopenia management.

RELEVANCE TO CLINICAL PRACTICE

Managers are advised to develop targeted training programs for nurses. Further, it improves their screening and diagnosing abilities, allowing them to prevent and control sarcopenia more effectively.

Frailty Knowledge, Use of Screening Tools, and Educational Challenges in Emergency Departments in Ireland: A Multisite Survey

BACKGROUND

Recognizing frailty and providing evidenced-based management in busy emergency departments is challenging. Understanding the knowledge and educational needs of ED staff is important to design training that might improve patient outcomes.

OBJECTIVE

This study aimed to explore frailty knowledge of ED staff, use of frailty screening instruments in Irish emergency departments, and educational challenges in the emergency department.

METHODS

A multisite survey of ED staff (different specialties) was conducted between April and September 2021. An anonymous online survey was distributed via email. Free-text sections were analyzed using content analysis.

RESULTS

In total, 168 staff (nursing, medical and allied health) participated, representing 9 of 26 Irish emergency departments (35%). Most respondents were nurses (n = 78, 46%). Less than half of respondents had received frailty identification training (n = 81, 48%). One-fifth of emergency doctors and nurses (20%) were unsure how to define frailty. Major barriers to ED frailty screening were resource deficits, insufficient diagnostic pathways from the emergency departments, and lack of education on suitable instruments.

CONCLUSIONS

Most of the ED staff surveyed relied on clinical judgment rather than formal training in frailty identification. A high proportion reported poor knowledge and low confidence in recognizing frailty. Dedicated staff with frailty management expertise, bespoke education initiatives, and clearly defined frailty screening pathways may help address the issues identified.

[Estudio cuasi-experimental sobre intervenciones enfermeras en la valoración, manejo y prevención del síndrome confusional agudo.]

OBJECTIVE

Acute confusional syndrome (ACS) is one of the complications with the highest morbidity and mortality in hospitalization units, but it is a reversible situation if detected early, representing a clear challenge for nursing. The objectives of this study were to assess the interventions carried out by nurses for the identification and non-pharmacological preventive measures applied in acute confusional syndrome and relate them to the years of professional experience and training received.

METHODS

A quasi-experimental, prospective and analytical study was carried out through a self-administered structured questionnaire pre-post intervention (extracted from the JBI PACES program-Practical Application of Clinical Evidence System) on the identification and preventive measures applied in ACS. A total of 520 questionnaires (pre and post assessment) were distributed to nurses from the emergency department and the internal medicine unit of the Miguel Servet University Hospital in Zaragoza (Aragón, Spain) from January 2021 to April 2022. Statistical analysis carried out with the program Jamovi®2.3.13.

RESULTS

180 correctly completed questionnaires (94 pre and 86 post) were received. For 100%, the ACS supposed an extra workload and significant differences were found between the ability to manage ACS with the years of professional experience (p≤0.028). 97.2% of the nurses applied non-pharmacological interventions.

CONCLUSIONS

Despite being perceived as an extra burden in daily work, nurses perform non-pharmacological prevention for the management of ACS. It is necessary to improve training to provide guidance strategies.

Association of Frailty Status with Risk of Fall among Hospitalized Elderly Patients: A Cross-Sectional Study in an Acute Geriatric Unit

Introduction: The objective was to study the association of frailty status in hospitalized elderly patients with risk of fall in an acute geriatric unit and to characterize elderly “fallers” using a comprehensive gerontological assessment. Patients and Methods: A cross-sectional study was conducted in patients over 65 years of age and hospitalized in an acute geriatric unit. This work was carried out in the Acute Geriatric Medicine Unit, Saint-Julien Hospital, Center Hospitalier Universitaire de Rouen from 1 June 2016 to 15 August 2016. Results: 172 patients were included during the collection period, with a female predominance of 115 patients (66.9%). The average age of the sample was 79.37 years old (65−85). The average CHARLSON score was 6.93 (3−16). Patients came from home in 81.4% of cases (i.e., 140 patients), and from a nursing home in 18.6% of cases (i.e., 32 patients). The risk of falling, as assessed by the Monopodal Support Test, returned as abnormal for 127 patients. In our series, there was a statistically strong link between the risk of falling and the presence of a dementia pathology (p = 0.009), the presence of a vitamin D deficiency (p = 0.03), the presence of frailty, as assessed by the three scales (modified SEGA scale, Fried scale and CFS/7 (<0.001), a high comorbidity score (p = 0.04), and a disturbed autonomy assessment according to IADL (p = 1.02 × 10−5) and according to ADL (p = 6.4 × 10−8). There was a statistically strong link between the risk of falling and the occurrence of death (p = 0.01). Conclusion: The consequences of the fall in terms of morbidity and mortality and the frequency of this event with advancing age and its impact on the quality of life as well as on health expenditure justify a systematic identification of the risk of falling in the elderly population. It is therefore important to have sensitive, specific, and reproducible tools available for identifying elderly people at high risk of falling.

Nurses' Opinions on Frailty

Nurses come into frequent contact with frail older people in all healthcare settings. However, few studies have specifically asked nurses about their views on frailty. The main aim of this study was to explore the opinions of nurses working with older people on the concept of frailty, regardless of the care setting. In addition, the associations between the background characteristics of nurses and their opinions about frailty were examined. In 2021, members of professional association of nurses and nursing assistants in the Netherlands (V&VN) received a digital questionnaire asking their opinions on frailty, and 251 individuals completed the questionnaire (response rate of 32.1%). The questionnaire contained seven topics: keywords of frailty, frailty domains, causes of frailty, consequences of frailty, reversing frailty, the prevention of frailty, and addressing frailty. Regarding frailty, nurses especially thought of physical deterioration and dementia. However, other domains of human functioning, such as the social and psychological domains, were often mentioned, pointing to a holistic approach to frailty. It also appears that nurses can identify many causes and consequences of frailty. They see opportunities to reverse frailty and an important role for themselves in this process.

[Frailty in primary care: Diagnosis and multidisciplinary management]

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.