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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of cognitive function, reduced mobility, balance, and swallowing disorders, as well as those who were socially withdrawn, scored higher on the PFFS scale, supporting the construct validity.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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Donaghy E, Still F, Frost H, Lutte J, Shenkin SD, Jones HE, Mercer SW. GP-led adapted comprehensive geriatric assessment for frail older people: a multi-methods evaluation of the 'Living Well Assessment' quality improvement project in Scotland. BJGP Open 2023; 7:BJGPO.2022.0184. [PMID: 36564081 DOI: 10.3399/bjgpo.2022.0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Evidence to support comprehensive geriatric assessment (CGA) in primary care for frail older people is limited. AIM To evaluate a GP-led adapted CGA quality improvement project. DESIGN & SETTING Multi-methods evaluation in a large practice in Midlothian in Scotland. METHOD The intervention was conducted by 10 GPs in a practice of approximately 11 000 patients, initially in the patient's home, and then remotely (by telephone or video consultation) during the COVID-19 pandemic. Evaluation included a patient questionnaire, and qualitative interviews with GPs delivering the Living Well Assessment (LWA), analysed by thematic analysis. RESULTS A total of 165/220 (75%) patients responded to the survey, of which 86% reported a 'very good experience' of the LWA. The method of delivery did not significantly influence this although most (58%) stated a preference for face-to-face consultation. For the 31% who preferred remote LWA, most (23%) preferred telephone to video consultation (8%). Problems in remote consultations related to technical issues (video), poor vision (video), or deafness (telephone or video). GPs felt that home-based LWAs had real benefits but switching to remote during the pandemic had proven feasible. Concerns included potential increase in GP workload owing to the LWA and whether it was an efficient use of GPs' time. CONCLUSION GP-led adapted CGA was feasible in a large practice, even during the pandemic, and highly valued by frail patients. Questions regarding efficient use of GPs' time, effectiveness in terms of important patient outcomes and impact, and cost-effectiveness, requires further investigation in a larger study.
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Affiliation(s)
- Eddie Donaghy
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Franca Still
- Medical School, University of Edinburgh, Edinburgh, UK
| | - Helen Frost
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julia Lutte
- Penicuik Medical Practice, Midlothian, Penicuik, UK
| | | | - Helen E Jones
- Department of Medicine of the Elderly, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Stewart W Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
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3
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Arizaga-Iribarren N, Irazusta A, Mugica-Errazquin I, Virgala-García J, Amonarraiz A, Kortajarena M. Sex Differences in Frailty Factors and Their Capacity to Identify Frailty in Older Adults Living in Long-Term Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:54. [PMID: 36612378 PMCID: PMC9819974 DOI: 10.3390/ijerph20010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a phenomenon that precedes adverse health events in older people. However, there is currently no consensus for how to best measure frailty. Several studies report that women have a higher prevalence of frailty than men, but there is a gap in studies of the high rates of frailty in older people living in long-term nursing homes (LTNHs) stratified by sex. Therefore, we analyzed health parameters related to frailty and measured their capacity to identify frailty stratified by sex in older people living in LTNHs. According to the Fried Frailty Phenotype (FFP), anxiety increased the risk of frailty in women, while for men functionality protected against the risk of frailty. Regarding the Tilburg Frailty Indicator (TFI), functionality had a protective effect in men, while for women worse dynamic balance indicated a higher risk of frailty. The analyzed parameters had a similar capacity for detecting frailty measured by the TFI in both sexes, while the parameters differed in frailty measured by the FFP. Our study suggests that assessment of frailty in older adults should incorporate a broad definition of frailty that includes not only physical parameters but also psycho-affective aspects as measured by instruments such as the TFI.
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Affiliation(s)
- Nagore Arizaga-Iribarren
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
- Osakidetza Basque Health Service, Hematology Service, Donostia University Hospital, 20014 Donostia/San Sebastián, Spain
| | - Amaia Irazusta
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country, 48940 Leioa, Spain
| | - Itxaso Mugica-Errazquin
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
| | - Janire Virgala-García
- Osakidetza Basque Health Service, OSI Tolosaldea, Tolosa Primary Care Center, 20400 Tolosa, Spain
| | | | - Maider Kortajarena
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
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4
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Zheng Z, Xu W, Wang F, Qiu Y, Xue Q. Association between vitamin D3 levels and frailty in the elderly: A large sample cross-sectional study. Front Nutr 2022; 9:980908. [PMID: 36238456 PMCID: PMC9553132 DOI: 10.3389/fnut.2022.980908] [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: 06/29/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Frailty is recognized as a cornerstone of geriatric medicine. Accurately screening and identifying frailty can promote better quality and personalized medical services for the elderly. Previous studies have shown that the association between vitamin D and frailty in the elderly population is still controversial. More research is needed to explore the association between them. Materials and methods We used three waves of data from the National Health and Nutrition Examination Survey (NHANES). Based on the widely accepted AAH FRAIL Scale, we measured and evaluated the participants’ frailty from five aspects: fatigue, resistance, ambulation, illness, and loss of weight. All possible relevant variables are included. Machine learning XGboost algorithm, the Least Absolute Shrinkage Selection Operator (LASSO) regression and univariate logistic regression were used to screen variables, and multivariate logistic regression and generalized additive model (GAM) were used to build the model. Finally, subgroup analysis and interaction test were performed to further confirm the association. Results In our study, XGboost machine learning algorithm explored the relative importance of all included variables, which confirmed the close association between vitamin D and frailty. After adjusting for all significant covariates, the result indicated that for each additional unit of 25-hydroxyvitamin D3, the risk of frailty was reduced by 1.3% with a statisticaldifference. A smooth curve was constructed based on the GAM. It was found that there was a significant negative correlation between 25-hydroxyvitamin D3 and the risk of frailty. Conclusion There may be a negative correlation between 25-hydroxyvitamin D3 and the risk of frailty. However, more well-designed studies are needed to verify this relationship.
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Affiliation(s)
- Zitian Zheng
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Wennan Xu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fei Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yudian Qiu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingyun Xue
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Peking University Fifth School of Clinical Medicine, Beijing, China
- *Correspondence: Qingyun Xue,
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Yuan K, Luo Y, Sun J, Chang H, Hu H, Zhao B. Depression and Cognition Mediate the Effect of Self-Perceptions of Aging Over Frailty Among Older Adults Living in the Community in China. Front Psychol 2022; 13:830667. [PMID: 35783795 PMCID: PMC9243527 DOI: 10.3389/fpsyg.2022.830667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe aims of the study were first to investigate the association between self-perceptions of aging and frailty and second to determine whether self-perceptions of aging affects frailty via depressive symptoms and cognitive status among older adults living in the community in China.MethodsAmong 850 older adults who participated in this cross-sectional study, 822 older adults made valid responses to Tilburg Frailty Indicator, Brief Aging Perceptions Questionnaire, UCLA loneliness scale-8, Mini-Mental State Examination, and Patient Health Questionnaire-9 between March to December 2019. The possible pathways of self-perceptions of aging affecting frailty were analyzed based on the structural equation modeling analysis.ResultsA total of 21.53% of older adults reported frailty. Correlation analyses showed that higher degrees of frailty were related to greater loneliness, more depressive symptoms, more negative self-perceptions of aging, worse locomotive function, and cognitive status (r = 0.267, r = 0.440, r = 0.481, r = 0.451, r = −0.337; p < 0.001). Multiple regression analysis showed that loneliness, depressive symptoms, self-perceptions of aging, locomotive function, and cognitive status were the five factors to be entered the regression equation, and the variance of joint explanation was 46.60%. SPA had a direct effect on frailty (β = 0.306 and p < 0.001), and SPA indirectly affects frailty by independently affecting depressive symptoms (β = 0.391, 95% CI [0.027, 0.061], and p < 0.001) or cognitive status (β = 0.148, 95% CI [0.009, 0.024], and p < 0.001) of older adults.ConclusionThese findings help explain the potential psychological mechanisms through which SPA impacts frailty and may aid community healthcare providers in China in identifying individuals at high risk of frailty. The results suggest that health staff should help older adults improve their perspectives on aging, alleviate or prevent depressive symptoms, and improve cognitive status to delay the progress of frailty and promote healthy aging.
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Affiliation(s)
- Kun Yuan
- School of Nursing, Xinxiang Medical University, Xinxiang, China
| | - Yanyan Luo
- School of Nursing, Xinxiang Medical University, Xinxiang, China
- *Correspondence: Yanyan Luo,
| | - Junjun Sun
- School of Nursing, Xinxiang Medical University, Xinxiang, China
| | - Hongjuan Chang
- School of Nursing, Xinxiang Medical University, Xinxiang, China
| | - Huijie Hu
- Faculty of Nursing, Sanquan College of Xinxiang Medical University, Xinxiang, China
| | - Bingwei Zhao
- School of Nursing, Huzhou University, Huzhou, China
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You HS, Kwon YJ, Kim S, Kim YH, Kim YS, Kim Y, Roh YK, Park B, Park YK, Park CH, Son JS, Shin J, Shin HY, Oh B, Lee JW, Shim JY, Won CW, Yoo JW, Lee SH, Kang HT, Lee DC. Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings. Korean J Fam Med 2021; 42:413-424. [PMID: 34871482 PMCID: PMC8648485 DOI: 10.4082/kjfm.21.0162] [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: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 01/06/2023] Open
Abstract
Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.
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Affiliation(s)
- Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ye-Seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yong-Kyun Roh
- Department of Family Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Byoungjin Park
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Young Kyu Park
- Department of Family Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang-Hae Park
- Department of Family Medicine, Haengbokhankajung Clinic, Seoul, Korea
| | - Joung Sik Son
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun-Young Shin
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Bumjo Oh
- Department of Family Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae Yong Shim
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Won Yoo
- School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sang-Hyun Lee
- Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Duk Chul Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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7
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Liotta G, Madaro O, Scarcella P, Inzerilli MC, Frattini B, Riccardi F, Accarino N, Mancinelli S, Terracciano E, Orlando S, Marazzi MC. Assessing the Impact of A Community-Based Pro-Active Monitoring Program Addressing the need for Care of Community-Dwelling Citizens aged more than 80: Protocol for a Prospective Pragmatic Trial and Results of the Baseline Assessment. TRANSLATIONAL MEDICINE AT UNISA 2021. [PMID: 34447708 PMCID: PMC8370536 DOI: 10.37825/2239-9747.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The aim of this paper is to describe the protocol of a study assessing the impact of a Community-based pro-Active Monitoring Program, by measuring the effect in counteracting the adverse outcomes related to frailty. Methods a prospective pragmatic trial will be carried out to describe the impact of an intervention on people aged>80, adjusted for relevant parameters: demographic variables, comorbidities, disability and bio-psycho-social frailty. They have been assessed with the Functional Geriatric Evaluation questionnaire that is a validated tool. Mortality, Acute Hospital Admission rates, Emergency Room Visit rates and Institutionalization rates are the main outcomes to be evaluated annually, over three years. Two groups of patients, made up by 578 cases (undergoing the intervention under study) and 607 controls have been enrolled and interviewed. Results at baseline the two groups are quite similar for age, living arrangement, comorbidity, disability and cognitive status. They differ in education, economic resources and physical status (that are better in the control group) and in social resources (that is better in the case group). The latter was expected since the intervention is focused on increasing social capital at individual and community level and aimed at improving survival among the cases as well as reducing the recourse to hospital and residential Long Term Care. Conclusion The proposed study addresses a crucial issue: assessing the impact of a bottom up care service consisting of social and health interventions aimed at reducing social isolation and improving access to health care services.
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Affiliation(s)
- G Liotta
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00173, Rome, Italy
| | - O Madaro
- Community of Sant'Egidio, "Long Live the Elderly!" program, Via San Gallicano 25, 00153, Rome, Italy
| | - P Scarcella
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00173, Rome, Italy
| | - M C Inzerilli
- Community of Sant'Egidio, "Long Live the Elderly!" program, Via San Gallicano 25, 00153, Rome, Italy
| | - B Frattini
- Community of Sant'Egidio, "Long Live the Elderly!" program, Via San Gallicano 25, 00153, Rome, Italy
| | - F Riccardi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00173, Rome, Italy
| | - N Accarino
- Community of Sant'Egidio, "Long Live the Elderly!" program, Via San Gallicano 25, 00153, Rome, Italy
| | - S Mancinelli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00173, Rome, Italy
| | - E Terracciano
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00173, Rome, Italy
| | - S Orlando
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00173, Rome, Italy
| | - M C Marazzi
- LUMSA University, Via della Traspontina 21, 00193, Rome, Italy
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Gobbens RJ, Uchmanowicz I. Assessing Frailty with the Tilburg Frailty Indicator (TFI): A Review of Reliability and Validity. Clin Interv Aging 2021; 16:863-875. [PMID: 34040363 PMCID: PMC8140902 DOI: 10.2147/cia.s298191] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The Tilburg Frailty Instrument (TFI) is an instrument for assessing frailty in community-dwelling older people. Since its development, many studies have been carried out examining the psychometric properties. The aim of this study was to provide a review of the main findings with regard to the reliability and validity of the TFI. Methods We conducted a literature search in the PubMed and CINAHL databases on May 30, 2020. An inclusion criterion was the use of the entire TFI, part B, referring to the 15 components. No restrictions were placed on language or year of publication. Results In total, 27 studies reported about the psychometric properties of the TFI. By far, most of the studies (n = 25) were focused on community-dwelling older people. Many studies showed that the internal consistency and test–retest reliability are good, which also applies for the criterion and construct validity. In many studies, adverse outcomes of interest were disability, increased health-care utilization, lower quality of life, and mortality. Regarding disability, studies predominantly show results that are excellent, with an area under the curve (AUC) >0.80. In addition, the TFI showed good associations with lower quality of life and the findings concerning mortality were at least acceptable. However, the association of the TFI with some indicators of health-care utilization can be indicated as poor (eg, visits to a general practitioner, hospitalization). Conclusion Since population aging is occurring all over the world, it is important that the TFI is available and well known that it is a user-friendly instrument for assessing frailty and its psychometric properties being qualified as good. The findings of this assessment can support health-care professionals in selecting interventions to reduce frailty and delay its adverse outcomes, such as disability and lower quality of life.
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Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Izabella Uchmanowicz
- Division of Nursing in Internal Medicine Procedures, Department of Clinical Nursing, The Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Thompson A, Gida S, Nassif Y, Hope C, Brooks A. The impact of frailty on trauma outcomes using the Clinical Frailty Scale. Eur J Trauma Emerg Surg 2021; 48:1271-1276. [PMID: 33682027 PMCID: PMC7937544 DOI: 10.1007/s00068-021-01627-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/21/2021] [Indexed: 12/17/2022]
Abstract
Background Population ageing is a worldwide phenomenon; thanks to improvements in medical care and living standards. The Office of National Statistics in the UK predicts that the fastest growing age group in coming decades will be those over 85 years. This is reflected in Trauma Audit and Research Network data, which has highlighted a shift in caseload from a majority of young males to elderly patients at UK Major Trauma Centres (MTC). This study of elderly trauma patients admitted to a UK MTC reviews the links between frailty, using the Canadian Study of Health and Aging Clinical Frailty Scale (CFS), and outcomes from trauma. Methods A retrospective database review of patients > 65 years old admitted to our MTC was performed. We identified 1125 eligible patients of which 729 had a recorded CFS. Those without a CFS were omitted. The primary outcome measured was in-hospital mortality. Secondary measures were Injury Severity Score, length of stay, trauma team activation on arrival and discharge destination. Multivariate regression analyses were performed using STATA v 15. Results Those of CFS 5–9 (frail) were 2.6 times more likely to die than the CFS 1–4 (pre-frail) (OR 2.65, 95% CI 1.47–4.78). The frail group was also 56% less likely to have a trauma call on admission (OR 0.44, 95% CI 0.30–0.65) and 61% less likely to be discharged to their usual place of residence (OR 0.39, 95% CI 0.28–0.55). Conclusion We advocate the use of the Clinical Frailty Scale as a screening tool for frailty in trauma patients, highlighting those at risk of increased length of stay and mortality, subsequently assisting healthcare providers with setting realistic expectations with family members. Level of evidence Level III, prognostic and epidemiological
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Affiliation(s)
- Amari Thompson
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, England, UK.
| | - Sunil Gida
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, England, UK
| | - Yasar Nassif
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, England, UK
| | - Carla Hope
- Royal Derby Hospital, Derby, England, UK
| | - Adam Brooks
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham University Hospitals Trust, Nottingham, NG7 2UH, England, UK
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10
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Broad A, Carter B, Mckelvie S, Hewitt J. The Convergent Validity of the electronic Frailty Index (eFI) with the Clinical Frailty Scale (CFS). Geriatrics (Basel) 2020; 5:geriatrics5040088. [PMID: 33182222 PMCID: PMC7709678 DOI: 10.3390/geriatrics5040088] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Different scales are being used to measure frailty. This study examined the convergent validity of the electronic Frailty Index (eFI) with the Clinical Frailty Scale (CFS). Method: The cross-sectional study recruited patients from three regional community nursing teams in the South East of England. The CFS was rated at recruitment, and the eFI was extracted from electronic health records (EHRs). A McNemar test of paired data was used to compare discordant pairs between the eFI and the CFS, and an exact McNemar Odds Ratio (OR) was calculated. Findings: Of 265 eligible patients consented, 150 (57%) were female, with a mean age of 85.6 years (SD = 7.8), and 78% were 80 years and older. Using the CFS, 68% were estimated to be moderate to severely frail, compared to 91% using the eFI. The eFI recorded a greater degree of frailty than the CFS (OR = 5.43, 95%CI 3.05 to 10.40; p < 0.001). This increased to 7.8 times more likely in men, and 9.5 times in those aged over 80 years. Conclusions: This study found that the eFI overestimates the frailty status of community dwelling older people. Overestimating frailty may impact on the demand of resources required for further management and treatment of those identified as being frail.
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Affiliation(s)
- Antoinette Broad
- Community Services, Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK;
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Sara Mckelvie
- Emergency Medical Unit, Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK; or
- Primary Care Research Group, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Penarth CF64 2XX, UK
- Correspondence:
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11
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Gorroñogoitia Iturbe A, López-Torres Hidalgo J, Martin Lesende I, Herreros Herreros Y, Acosta Benito MÁ, de Hoyos Alonso MDC, Baena Díez JM, Magán Tapia P, García Pliego R. [PAPPS GdT Major 2020 Update]. Aten Primaria 2020; 52 Suppl 2:114-124. [PMID: 33388111 PMCID: PMC7801214 DOI: 10.1016/j.aprim.2020.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022] Open
Abstract
In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social isolation. Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.
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Zamora-Sánchez JJ, Gea-Caballero V, Julián-Rochina I, Jódar-Fernández L, Lumillo-Gutiérrez I, Sastre-Rus M, Urpí-Fernández AM, Zabaleta-Del-Olmo E. Multidimensional instruments with an integral approach to identify frailty in community-dwelling people: protocol for a systematic psychometric review. BMJ Open 2019; 9:e033160. [PMID: 31843847 PMCID: PMC6924862 DOI: 10.1136/bmjopen-2019-033160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people. METHODS AND ANALYSIS Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined. ETHICS AND DISSEMINATION Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019120212.
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13
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Liotta G, Gilardi F, Orlando S, Rocco G, Proietti MG, Asta F, De Sario M, Michelozzi P, Mancinelli S, Palombi L, Marazzi MC, Scarcella P. Cost of hospital care for the older adults according to their level of frailty. A cohort study in the Lazio region, Italy. PLoS One 2019; 14:e0217829. [PMID: 31185033 PMCID: PMC6559705 DOI: 10.1371/journal.pone.0217829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 01/15/2023] Open
Abstract
Background The increasing burden of chronic diseases associated with the ageing of the European population constitutes one of the main challenges for the welfare systems in developed western countries, especially through its impact on the use of hospital services and the cost of care. This study aims at evaluating the cost of hospital care for older adults living in the Lazio Region, Italy, according to their level of frailty. Methods Since 2014 a longitudinal randomized cohort study has been carried out on a sample consisting of 1280 older adults aged over 64 years resident in the Lazio region (Italy), with their being evaluated for multidimensional frailty. Accesses to Hospital Services (acute care and Day Hospital care admissions and Emergency Room accesses) during the first year after enrolment, as well as the related costs have been recorded through a regional database. Costs have been stratified on the basis of the state of frailty. Results The analysis of hospital services and costs highlights the role played by pre-frail individuals who generated 49.3% of the hospital care cumulative costs. Hospital Admission (HA) costs arising from robust and pre-frail subjects are 70% of the total HA costs. Pre-frail individuals also showed the highest average HA cost per person/year (7062.89 Euros). The main determinant of the highest HA costs was given by the number of HAs during the follow-up (multivariate linear regression, ß coefficient = 0.319; p<0.001), which was higher among pre-frail individuals than in any other group of patients. Conclusions Pre-frail individuals generated the highest cost for hospital care in a sample of representative subjects living in an Italian Region with a low rate of community care services, as is the case in the Lazio region. Assessment of the multidimensional frailty of older adults permits a better definition of the important target of the pre-frail population as the main category within which interventions to prevent or mitigate frailty should be carried out.
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Affiliation(s)
- Giuseppe Liotta
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - Francesco Gilardi
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
- * E-mail:
| | - Stefano Orlando
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | | | | | - Federica Asta
- Regione Lazio Department of Epidemiology, Rome, Italy
| | | | | | - Sandro Mancinelli
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - Leonardo Palombi
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | | | - Paola Scarcella
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
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14
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Jansen-Kosterink S, van Velsen L, Frazer S, Dekker-van Weering M, O'Caoimh R, Vollenbroek-Hutten M. Identification of community-dwelling older adults at risk of frailty using the PERSSILAA screening pathway: a methodological guide and results of a large-scale deployment in the Netherlands. BMC Public Health 2019; 19:504. [PMID: 31053090 PMCID: PMC6500037 DOI: 10.1186/s12889-019-6876-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. Methods The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. Results In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. Conclusion Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.
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Affiliation(s)
- Stephanie Jansen-Kosterink
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands. .,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Sanne Frazer
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Marit Dekker-van Weering
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522, AL, Enschede, The Netherlands.,University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, Cork City, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland
| | - Miriam Vollenbroek-Hutten
- University of Twente, Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, Enschede, the Netherlands.,ZiekenhuisGroep Twente (ZGT), scientific office ZGT academie, Almelo, the Netherlands
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15
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Faller JW, Pereira DDN, de Souza S, Nampo FK, Orlandi FDS, Matumoto S. Instruments for the detection of frailty syndrome in older adults: A systematic review. PLoS One 2019; 14:e0216166. [PMID: 31034516 PMCID: PMC6488093 DOI: 10.1371/journal.pone.0216166] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022] Open
Abstract
Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.
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Affiliation(s)
- Jossiana Wilke Faller
- Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil
- * E-mail:
| | - David do Nascimento Pereira
- Program in Health Promotion and Care in Hospital Care of the Medical School of the University of São Paulo, São Paulo, Brazil
| | - Suzana de Souza
- Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil
| | - Fernando Kenji Nampo
- Latin-American Institute of Life and Natural Sciences, Federal University of Latin-American Integration, Foz do Iguassu, Paraná, Brazil
| | - Fabiana de Souza Orlandi
- Department of Gerontology of the Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Silvia Matumoto
- Department of Maternal and Child Health and Public Health, University of São Paulo, PAHO/WHO Collaborating Center for Nursing Research Development, Ribeirão Preto School of Nursing, Ribeirão Preto, Brazil
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16
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Tziraki-Segal C, De Luca V, Santana S, Romano R, Tramontano G, Scattola P, Celata C, Gelmi G, Ponce Márquez S, Lopez-Samaniego L, Zavagli V, Halkoaho A, Grimes C, Tomás MT, Fernandes B, Calzà L, Speranza P, Coppola L, Jager-Wittenaar H, O'Caoimh R, Pietilä AM, Carriazo AM, Apostolo J, Iaccarino G, Liotta G, Tramontano D, Molloy W, Triassi M, Viggiani V, Illario M. Creating a Culture of Health in Planning and Implementing Innovative Strategies Addressing Non-communicable Chronic Diseases. FRONTIERS IN SOCIOLOGY 2019; 4:9. [PMID: 33869336 PMCID: PMC8022497 DOI: 10.3389/fsoc.2019.00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/01/2019] [Indexed: 06/12/2023]
Abstract
Ongoing demographic changes are challenging health systems worldwide especially in relation to increasing longevity and the resultant rise of non-communicable diseases (NCDs). To meet these challenges, a paradigm shift to a more proactive approach to health promotion, and maintenance is needed. This new paradigm focuses on creating and implementing an ecological model of Culture of Health. The conceptualization of the Culture of Health is defined as one where good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities where citizens have the opportunity to make choices and be co-producers of healthy lifestyles. Based on Antonovsky's Salutogenesis model which asserts that the experience of health moves along a continuum across the lifespan, we will identify the key drivers for achieving a Culture of Health. These include mindset/expectations, sense of community, and civic engagement. The present article discusses these drivers and identifies areas where policy and research actions are needed to advance positive change on population health and well-being. We highlight empirical evidence of drivers within the EU guided by the activities within the thematic Action Groups of the European Innovation Partnership on Active and Healthy Aging (EIP on AHA), focusing on Lifespan Health Promotion and Prevention of Age-Related Frailty and Disease (A3 Action Group). We will specifically focus on the effect of Culture on Health, highlighting cross-cutting drivers across domains such as innovations at the individual and community level, and in synergies with business, policy, and research entities. We will present examples of drivers for creating a Culture of Health, the barriers, the remaining gaps, and areas of future research to achieve an inclusive and sustainable asset-based community.
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Affiliation(s)
- Chariklia Tziraki-Segal
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV- Community Clubs for Elders, Jerusalem, Israel
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | - Rosa Romano
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Paola Scattola
- Health Protection Agency of the Metropolitan City of Milan, Milan, Italy
| | - Corrado Celata
- Health Promotion, Screening and Prevention Unit, Milan, Italy
| | - Giusi Gelmi
- Health Protection Agency of the Metropolitan City of Milan, Milan, Italy
| | - Sara Ponce Márquez
- International Research Projects Office (IRPO), Universidad de Deusto, Bilbao, Spain
| | - Luz Lopez-Samaniego
- Progress and Health Foundation, Regional Ministry of Health of Andalucía, Seville, Spain
| | | | - Arja Halkoaho
- School of Health Care and Social Services Education and R&D, Tampere University of Applied Sciences, Tampere, Finland
| | - Corrina Grimes
- Public Health Agency of Northern Ireland, Belfast, United Kingdom
| | - Maria Teresa Tomás
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Beatriz Fernandes
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Laura Calzà
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Patrizia Speranza
- General Affairs Unit, Federico II University Hospital, Naples, Italy
| | - Liliana Coppola
- Health Promotion, Screening and Prevention Unit, Milan, Italy
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Rónán O'Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Anna-Maija Pietilä
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Joao Apostolo
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Guido Iaccarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - William Molloy
- Clinical Gerontology and Rehabilitation Centre, Gerontology and Rehabilitation School of Medicine, University College of Cork, Cork, Ireland
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | | | - Maddalena Illario
- Health Innovation Division, General Directorate for Health, Naples, Italy
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Abstract
Frailty is a geriatric syndrome associated with adverse outcomes such as falls, disability, and mortality. Frailty is common and contributes to rising health care costs. Early screening and timely tailored intervention may effectively prevent or delay the adverse outcomes in older adults. Studies on frailty and its specific measurement tools are increasing in number, but the debate on the screening instruments remains. Currently, self-reported screening tools can identify frailty and predict the risk of adverse outcomes in older adults. Because they are easy to use and quickly provide information, self-reported frailty screening tools have significant implication in primary care settings and clinics. We reviewed the frailty screening instruments in older adults and proposed a two-step pathway for frailty identification, and to manage declines in intrinsic capacity as well as boost resilience.
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Affiliation(s)
- L Ma
- Dr. Lina Ma, Department of Geriatrics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing 100053, China. E-mail:
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18
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Pel EL, van Wijngaarden E, van Dongen EPA, Noordzij PG. Anesthesia Geriatric Evaluation (AGE): A Care-Ethical Perspective of a Multi-Disciplinary Approach for Tailored Preoperative Interventions. Gerontol Geriatr Med 2019; 5:2333721419876126. [PMID: 31555720 PMCID: PMC6747854 DOI: 10.1177/2333721419876126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Frailty is considered to be an important risk factor for mortality in hospitalized patients. This study evaluates a preoperative frailty-screening tool called Anesthesia Geriatric Evaluation (AGE). Research into the concept of frailty, with a focus on multidisciplinary team meetings, may provide further insight for health care professionals in the understanding of frailty in everyday care situations. Methods: The research method chosen for this research is QUAGOL: Qualitative Analysis Guide of Leuven, which aims to reconstruct the story of the participants on a theoretical level and analyze the concepts found. Results: The following themes illustrate the analyzed concepts found: competence, resilience, sharing responsibility, broad frame of reference, obligation, and significance. Conclusion: AGE seems to create more awareness among health care professionals about frailty and tries to involve patients in their care process by making them aware of their abilities, motivation, and involving them in decisions to be made. This study shows that a shared decision-making process for surgical patients is often difficult to accomplish since AGE is still a paternalistic process of a multidisciplinary team with a medical perspective.
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Affiliation(s)
- E. L. Pel
- University of Humanistic Studies, Utrecht, The Netherlands
- St. Antonius Hospital, Nieuwegein, The Netherlands
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Liotta G, Ussai S, Illario M, O'Caoimh R, Cano A, Holland C, Roller-Wirnsberger R, Capanna A, Grecuccio C, Ferraro M, Paradiso F, Ambrosone C, Morucci L, Scarcella P, De Luca V, Palombi L. Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122843. [PMID: 30551599 PMCID: PMC6313423 DOI: 10.3390/ijerph15122843] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 12/19/2022]
Abstract
Background: The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. Here, we report on the activities of the A3 Action Group, focusing on managing frailty and supporting healthy ageing at community level. Methods: A three-phased search strategy was used to select papers published between January 2016 and May 2018. In the third phase, the first manuscript draft was sent to all A3-Action Group members who were invited to suggest additional contributions to be included in the narrative review process. Results: A total of 56 papers were included in this report. The A3 Action Group developed three multidimensional tools predicting short–medium term adverse outcomes. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. Conclusions: This review shows the importance of taking a multifaceted approach when addressing frailty at community level. From a Public Health perspective, it is vital to identify factors that contribute to successful health and social care interventions and to the health systems sustainability.
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Affiliation(s)
- Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Silvia Ussai
- International Healthcare Programs, Lombardy Region/LISPA, 20124 Milan, Italy.
| | - Maddalena Illario
- Unità Operativa Dipartimentale 14 Promozione e Potenziamento dei Programmi di Healths Innovation, Direzione Generale per la Tutela della Salute ed il Coordinamento del Sistema Sanitario Regionale, Regione Campania, 80143 Naples, Italy.
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80138 Naples, Italy.
| | - Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, H91 TK33 Ireland.
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia-INCLIVA, 46010 Valencia, Spain.
| | - Carol Holland
- Centre for Ageing Research, University of Lancaster, Lancaster, LA1 4YG, UK.
| | | | - Alessandra Capanna
- School of Specialization in Hygiene and Medicine Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Chiara Grecuccio
- School of Specialization in Hygiene and Medicine Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Mariacarmela Ferraro
- School of Specialization in Hygiene and Medicine Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Francesca Paradiso
- School of Specialization in Hygiene and Medicine Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Cristina Ambrosone
- School of Specialization in Hygiene and Medicine Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Luca Morucci
- School of Specialization in Hygiene and Medicine Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Paola Scarcella
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - Vincenzo De Luca
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, 80138 Naples, Italy.
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy.
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