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1.
Angioni Davide Macaron T. Takeda C. Sourdet S. Cesari M. Giudici K. Virecoulon Raffin J. Lu W. H. Delrieu J. Touchon J. Rolland Y. De Souto Barreto P. Vellas B. 《The journal of nutrition, health & aging》2020,24(10):1144-1151
The journal of nutrition, health & aging - No study has tried to distinguish subjects that become frail due to diseases (frailty related to diseases) or in the absence of specific medical... 相似文献
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Gotaro Kojima Yu Taniguchi Akihiko Kitamura Shoji Shinkai 《Journal of the American Medical Directors Association》2018,19(9):797-800.e2
Objectives
To explore comparability of Kihon Checklist (KCL) and Kaigo-Yobo Checklist (KYCL) to Frailty Index (FI) in predicting risks of long-term care insurance (LTCI) certification and/or mortality over 3 years.Design
Prospective cohort study.Setting and Participants
1023 Japanese community-dwelling older adults from the Kusatsu Longitudinal Study of Aging and Health.Measures
Frailty status was quantified at baseline using KCL, KYCL, and 32-deficit and 68-deficit FI. Relationships of the measures were examined using Spearman rank correlation coefficients. Cox regression models examined the risk of new certification of LTCI or mortality according to KCL, KYCL, and FI. Predictive abilities of KCL and KYCL were compared with FI using area under the receiver operating characteristic curve (AUC), C statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).Results
Mean age was 74.7 years and 57.6% were women. KCL and KYCL were significantly correlated to 32-FI (r = 0.60 and 0.36, respectively) and to 68-FI (r = 0.88 and 0.61, respectively). During the follow-up period, 92 participants (9%) were newly certified for LTCI or died. Fully adjusted Cox models showed that higher KCL, KYCL, 32-FI, and 68-FI were all significantly associated with elevated risks [hazard ratio (HR) = 1.03, 95% CI = 1.01-1.04, P < .001; HR = 1.04, 95% CI = 1.02-1.05, P < .001; HR = 1.03, 95% CI = 1.01-1.05, P = .001; HR = 1.04, 95% CI = 1.02-1.06, P < .001, respectively, per 1/100 increase of max score]. AUC and C-statistics of KCL and KYCL were not different statistically from those of 32-FI and 68-FI. Predictive abilities of KCL were superior to 32-FI in NRI and IDI but inferior to 68-FI in category-free NRI, and those of KYCL were superior to 32-FI in IDI but inferior to 68-FI in NRI.Conclusions
Although KCL and KYCL include smaller numbers of items than standard FI, both tools were shown to be highly correlated with FI, significant predictors of LTCI certification and/or mortality, and compatible to FI in the risk prediction. 相似文献3.
Vincent Soler S. Sourdet L. Balardy G. Abellan Van Kan D. Brechemier M. E. Rouge Bugat M. Cassagne F. Malecaze B. Vellas 《The journal of nutrition, health & aging》2016,20(8):870-877
Objectives
To evaluate visual performance and factors associated with abnormal vision in patients screened for frailty at the Geriatric Frailty Clinic (GFC) for Assessment of Frailty and Prevention of Disability at Toulouse University Hospital.Design
Retrospective, observational cross-sectional, single-centre study.Setting
Institutional practice.Participants
Patients were screened for frailty during a single-day hospital stay between October 2011 and October 2014 (n = 1648).Measurements
Collected medical records included sociodemographic data (including living environment and educational level), anthropometric data, and clinical data. The general evaluation included the patient’s functional status using the Activities of Daily Living (ADL) scale and the Instrumental Activity of Daily Living (IADL) scale, the Mini-Mental State Examination (MMSE) for cognition testing, and the Short Physical Performance Battery (SPPB) for physical performance. We also examined Body Mass Index (BMI), the Mini-Nutritional Assessment (MNA), and the Hearing Handicap Inventory for the Elderly Screening (HHIE-S) tool. The ophthalmologic evaluation included assessing visual acuity using the Snellen decimal chart for distant vision, and the Parinaud chart for near vision. Patients were divided into groups based on normal distant/near vision (NDV and NNV groups) and abnormal distant/near vision (ADV and ANV groups). Abnormal distant or near vision was defined as visual acuity inferior to 20/40 or superior to a Parinaud score of 2, in at least one eye. Associations with frailty-associated factors were evaluated in both groups.Results
The mean age of the population was 82.6 ± 6.2 years. The gender distribution was 1,061 females (64.4%) and 587 males (35.6%). According to the Fried criteria, 619 patients (41.1%) were pre-frail and 771 (51.1%) were frail. Distant and near vision data were available for 1425 and 1426 patients, respectively. Distant vision was abnormal for 437 patients (30.7%). Near vision was abnormal for 199 patients (14%). Multiple regression analysis showed that abnormal distant vision as well as abnormal near vision were independently associated with greater age (P < 0.01), lower educational level (P < 0.05), lower performance on the MMSE (P < 0.001), and lower autonomy (P < 0.02), after controlling for age, gender, educational level, Fried criteria, and MMSE score.Conclusion
The high prevalence of visual disorders observed in the study population and their association with lower autonomy and cognitive impairment emphasises the need for systematic screening of visual impairments in the elderly. Frailty was not found to be independently associated with abnormal vision.4.
Ilaria Liguori Gennaro Russo Vincenzo Coscia Luisa Aran Giulia Bulli Francesco Curcio David Della-Morte Gaetano Gargiulo Gianluca Testa Francesco Cacciatore Domenico Bonaduce Pasquale Abete 《Journal of the American Medical Directors Association》2018,19(9):779-785
Background
Orthostatic hypotension (OH) has high prevalence in frail older adults. However, its effect on mortality, disability, and hospitalization in frail older adults is poorly investigated. Thus, we assessed the relationship between the prevalence of OH and its effect on mortality, disability, and hospitalization in noninstitutionalized older adults stratified by frailty degree.Methods
Prospective, observational study of 510 older participants (≥65 years of age) consecutively admitted to a geriatric evaluation unit to perform a geriatric comprehensive assessment.Measurements
Clinical frailty was assessed using the Italian frailty index (40 items). Systolic blood pressure (mm Hg), diastolic blood pressure (mm Hg), and heart rate (bpm) were evaluated in clinostatic position and after 1, 3, and 5 minutes of orthostatic position. OH was defined with a decrease of 20 mm Hg in systolic blood pressure and/or a decrease of 10 mm Hg in diastolic blood pressure.Results
OH prevalence was 22%, and it increased from 9.0% to 66.0% according to frailty degree (P for trend <.001). When stratified by frailty degree, mortality, disability, and hospitalization increased from 1.0% to 24.5%, from 39.0% to 77.0% and from 14.0% to 32.0% in the absence, and from 0.0% to 35.5%, from 42.0% to 95.5% and from 19.0% to 65.5% in the presence of OH, respectively (P < .01 vs absence of OH). Multivariate analysis showed that the Italian frailty index is more predictive of mortality, disability, and hospitalization in the presence than in the absence of OH.Conclusions
OH is a common condition in frail older adults, and it is strongly associated with mortality, disability, and hospitalization in the highest frailty degree. Thus, OH may represent a new marker of clinical frailty. 相似文献5.
Ana Moradell ngel Ivn Fernndez-García David Navarrete-Villanueva Lucía Sagarra-Romero Eva Gesteiro Jorge Prez-Gmez Irene Rodríguez-Gmez Ignacio Ara Jose A. Casajús Germn Vicente-Rodríguez Alba Gmez-Cabello 《Nutrients》2021,13(4)
Frailty is a reversible condition, which is strongly related to physical function and nutritional status. Different scales are used to screened older adults and their risk of being frail, however, Short Physical Performance Battery (SPPB) may be more adequate than others to measure physical function in exercise interventions and has been less studied. Thus, the main aims of our study were: (1) to describe differences in nutritional intakes by SPPB groups (robust, pre-frail and frail); (2) to study the relationship between being at risk of malnourishment and frailty; and (3) to describe differences in nutrient intake between those at risk of malnourishment and those without risk in the no-frail individuals. One hundred one participants (80.4 ± 6.0 year old) were included in this cross-sectional study. A validated semi-quantitative food frequency questionnaire was used to determine food intake and Mini Nutritional Assessment to determine malnutrition. Results revealed differences for the intake of carbohydrates, n-3 fatty acids (n3), and saturated fatty acids for frail, pre-frail, and robust individuals and differences in vitamin D intake between frail and robust (all p < 0.05). Those at risk of malnutrition were approximately 8 times more likely to be frail than those with no risk. Significant differences in nutrient intake were found between those at risk of malnourishment and those without risk, specifically in: protein, PUFA n-3, retinol, ascorbic acid, niacin equivalents, folic acid, magnesium, and potassium, respectively. Moreover, differences in alcohol were also observed showing higher intake for those at risk of malnourishment (all p < 0.05). In conclusion, nutrients related to muscle metabolism showed to have different intakes across SPPB physical function groups. The intake of these specific nutrients related with risk of malnourishment need to be promoted in order to prevent frailty. 相似文献
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Beatriz Bonaga Pedro M. Sánchez-Jurado Marta Martínez-Reig Gabriel Ariza Leocadio Rodríguez-Mañas Danijela Gnjidic Tránsito Salvador Pedro Abizanda 《Journal of the American Medical Directors Association》2018,19(1):46-52
Background/Objectives
To investigate if polypharmacy modifies the association between frailty and health outcomes in older adults.Design
Ongoing cohort study.Setting
Albacete City, Spain.Participants
A total for 773 participants, 457 women (59.1%), over age 70 years from the FRADEA Study.Measurements
Frailty phenotype, polypharmacy considered as the chronic use of 5 or more drugs, and comorbidity were collected at the baseline visit. Participants were categorized in 6 groups according to frailty and polypharmacy, and were followed up for 5.5 years (mean 1057 days, range 1-2007). Mortality or incident disability in basic activities of daily living was considered the main outcome variable. Hospitalization and visits to the emergency department were also recorded. The adjusted association between combined frailty status and polypharmacy with outcome variables was analyzed.Results
The mean age of study population was 78.5 years. In this population, we identified a 15.3% (n = 118) of frail with polypharmacy, 3.4% (n = 26) of frail without polypharmacy, 35.3% (n = 273) of prefrail with polypharmacy, 20.3% (n = 157) of prefrail without polypharmacy, 10.3% (n = 80) of nonfrail with polypharmacy, and 15.4% (n = 119) of nonfrail participants without polypharmacy. Participants with frailty and polypharmacy had a higher adjusted risk of mortality or incident disability [odds ratio (OR) 5.3; 95% confidence interval (CI) 2.3–12.5] and hospitalization (OR 2.3; 95% CI 1.2–4.4), compared with those without frailty and polypharmacy. Frail and prefrail participants with polypharmacy had a higher adjusted mortality risk compared with the nonfrail without polypharmacy, hazard ratio 5.8 (95% CI 1.9–17.5) and hazard ratio 3.1 (95% CI 1.1–9.1), respectively.Conclusions
Polypharmacy is associated with mortality, incident disability, hospitalization, and emergency department visits in frail and prefrail older adults, but not in nonfrail adults. Polypharmacy should be monitored in these patient subgroups to optimize health outcomes. 相似文献10.
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《Journal of the American Medical Directors Association》2022,23(4):581-588
ObjectivesTo evaluate, in a cohort of adults ≥80 years old, the frailty status at the emergency department (ED) admission, for the in-hospital death risk stratification of patients needing major surgical procedures.DesignSingle-center prospective observational cohort study.Setting and ParticipantsThe study was conducted in the ED of a teaching hospital. We enrolled all patients ≥80 years old consecutively admitted to the ED for conditions requiring urgent surgical procedures, between 2018 and 2021.MethodsClinical variables and frailty status assessed in the ED were evaluated for the association with all-cause in-hospital death. The parameters evaluated were frailty [assessed by the Clinical Frailty Scale (CFS)], comorbidities, physiological parameters, type of surgery needed, laboratory values at admission. Cox regression analysis was used to identify independent risk factors for poor outcomes.ResultsThe study enrolled 1039 patients aged ≥80 years [median age 85 years (interquartile range 82-89); 445 males (42.8%)]. Overall, 127 patients (12.2%) were classified as nonfrail (CFS score 1-3), 722 (69.5%) as mild frail (CFS score 4-6), and 190 (18.3%) as frail (CFS score 7-9). The covariate-adjusted analysis revealed that severe frailty [hazard ratio (HR) 12.55, 95% CI 2.96-53.21, P = .016], ≥3 comorbidities (HR 2.08, 95% CI 1.31-3.31, P = .002), shock at ED presentation (HR 3.58, 95% CI 2.16-5.92, P < .001), anemia (HR 1.88, 95% CI 1.17-3.04, P = .009), and neurosurgery procedures (HR 3.97, 95% CI 1.98-7.96, P < .001) were independent risk factors for in-hospital death.Conclusions and ImplicationsIn patients aged ≥80 years undergoing urgent surgical procedures, the evaluation of functional status in the ED could predict the risk of in-hospital death. Frail patients have an increased risk of death and major complications, whereas those with mild frailty have a similar prognosis compared with the more fit ones. Nonsurgical management should be considered in the case of severely frail and comorbid patients aged ≥80 years needing neurosurgery or abdominal surgery. 相似文献
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Kim S. Kim M. Min J. Yoo J. Kim M. Kang J. Won Chang Won 《The journal of nutrition, health & aging》2019,23(6):503-508
The journal of nutrition, health & aging - The aim of this study was to determine how sodium intake can affect frailty, but not anorexia, in community-dwelling older adults in Korea. This was a... 相似文献
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Takeda Catherine Angioni D. Setphan E. Macaron T. De Souto Barreto P. Sourdet S. Sierra F. Vellas B. 《The journal of nutrition, health & aging》2020,24(10):1140-1143
The journal of nutrition, health & aging - In their everyday practice, geriatricians are confronted with the fact that older age and multimorbidity are associated to frailty. Indeed, if we take... 相似文献
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《Journal of the American Medical Directors Association》2021,22(9):1845-1852.e1
ObjectivesTo evaluate, in a cohort of adults aged ≥80 years, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission.DesignSingle-center prospective observational cohort study.Setting and ParticipantsThe study was conducted in the ED of a teaching hospital that is a referral center for COVID-19 in central Italy. We enrolled all patients with aged ≥80 years old consecutively admitted to the ED between April 2020 and March 2021.MethodsClinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes.ResultsA total of 729 patients aged ≥80 years were enrolled [median age 85 years (interquartile range 82-89); 346 were males (47.3%)]. According to the Clinical Frailty Scale, 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.31-2.59], ≥3 comorbidities (HR 1.54, 95% CI 1.11-2.13), male sex (HR 1.46, 95% CI 1.14-1.87), and frailty (HR 6.93, 95% CI 1.69-28.27) for vulnerable and an overall HR of 12.55 (95% CI 2.96-53.21) for frail were independent risk factors for in-hospital death.Conclusions and ImplicationsThe ED approach to older patients with COVID-19 should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multimorbidity, and frailty could effectively predict the clinical risk of in-hospital death for patients with COVID-19 aged ≥80 years at the time of ED presentation. 相似文献
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Ruby Yu Dan Wang Jason Leung Kevin Lau Timothy Kwok Jean Woo 《Journal of the American Medical Directors Association》2018,19(6):528-534
Objectives
To examine whether neighborhood green space was related to frailty risk longitudinally and to examine the relative contributions of green space, physical activity, and individual health conditions to the frailty transitions.Design, setting, and participants
Four thousand community-dwelling Chinese adults aged ≥65 years participating in the Mr. and Ms. Os (Hong Kong) study in 2001-2003 were followed up for 2 years.Methods
The percentage of green space within a 300-meter radial buffer around the participants’ place of residence was derived for each participant at baseline based on the normalized difference vegetation index. Frailty status was classified according to the Fried criteria at baseline and after 2 years. Ordinal logistic regression and path analysis were used to examine associations between green space and the frailty transitions, adjusting for demographics, socioeconomic status, lifestyle factors, health conditions, and baseline frailty status.Results
At baseline, 53.5% of the participants met the criterion for robust, 41.5% were classified as prefrailty, and 5.0% were frail. After 2 years, 3240 participants completed all the measurements. Among these, 18.6% of prefrail or frail participants improved, 66% remained in their frailty state, and 26.8% of robust or prefrail participants progressed in frailty status. In multivariable models, the frailty status of participants living in neighborhoods with more than 34.1% green space (the highest quartile) at baseline was more likely to improve at the 2-year follow-up than it was for those living in neighborhoods with 0 to 4.5% (the lowest quartile) [odds ratio (OR): 1.29, 95% confidence interval (CI): 1.04-1.60; P for trend: 0.022]. When men and women were analyzed separately, the association between green space and frailty remained significant in men (OR: 1.40, 95% CI: 1.03-1.90) but not in women. Path analysis showed that green space directly affects frailty transitions (β = 0.041, P < .05) and also exerts an effect through physical activity (β = 0.034, P < .05). Physical activity directly affects frailty (β = 0.134, P < .05), and also indirectly affects frailty through health conditions including number of diseases (β = ?0.057, P < .05) and cognitive functions (β = 0.041, P < .05). The magnitude of the direct effect of green space on the 2-year frailty transitions is comparable to those of the indirect effect through physical activity.Conclusion
Older people living in neighborhoods with a higher percentage of green space were associated with improvement in frailty status, independent of a wide range of individual characteristics. 相似文献17.
M. Liset Rietman D. L. van der A S. H. van Oostrom H. S. J. Picavet M. E. T. Dollé H. van Steeg W. M. M. Verschuren A. M. W. Spijkerman 《The journal of nutrition, health & aging》2018,22(1):8-15
Objectives
Previous studies showed a U-shaped association between BMI and (physical) frailty. We studied the association between BMI and physical, cognitive, psychological, and social frailty. Furthermore, the overlap between and prevalence of these frailty domains was examined.Design
Cross-sectional study.Setting
The Doetinchem Cohort Study is a longitudinal population-based study starting in 1987-1991 examining men and women aged 20-59 with follow-up examinations every 5 yrs.Participants
For the current analyses, we used data from round 5 (2008-2012) with 4019 participants aged 41-81 yrs.Measurements
Physical frailty was defined as having ≥ 2 of 4 frailty criteria from the Frailty Phenotype (unintentional weight loss, exhaustion, physical activity, handgrip strength). Cognitive frailty was defined as the < 10th percentile on global cognitive functioning (based on memory, speed, flexibility). Psychological frailty was defined as having 2 out of 2 criteria (depression, mental health). Social frailty was defined as having ≥ 2 of 3 criteria (loneliness, social support, social participation). BMI was divided into four classes. Analyses were adjusted for sex, age, level of education, and smoking.Results
A U-shaped association was observed between BMI and physical frailty, a small linear association for BMI and cognitive frailty and no association between BMI and psychological and social frailty. The four frailty domains showed only a small proportion of overlap. The prevalence of physical, cognitive and social frailty increased with age, whereas psychological frailty did not.Conclusion
We confirm that not only underweight but also obesity is associated with physical frailty. Obesity also seems to be associated with cognitive frailty. Further, frailty prevention should focus on multiple domains and target individuals at a younger age (<65yrs).18.
C. Wang X. Ji X. Wu Z. Tang X. Zhang S. Guan H. Liu Xianghua Fang 《The journal of nutrition, health & aging》2017,21(6):648-654
Objectives
To explore the relationship of general health decline assessed by frailty and risk of dementia and Alzheimer’s disease (AD).Design
A seven-year prospective cohort study.Setting
Secondary analysis of data from the Beijing Longitudinal Study on Aging.Participants
Urban and rural communitydwelling people aged 60 and older at baseline.Measurements
Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 40 health deficits at baseline. Dementia was diagnosed by DSM-IIIR. AD and vascular dementia (VaD) were diagnosed by NINCDS-ADRDA and NINDS-AIREN. The relationships between frailty and the risk of dementia, AD and death were evaluated through multivariable models.Results
Of 2788 participants at baseline (1997), 171 (11.1%) reported a history of dementia. In seven years, 351 people developed dementia (13%: 223 AD and 128 other types of dementia) and 813 died (29%). After adjustment for age, sex, education, and baseline cognition, baseline frailty status significantly associated with Alzheimer’s disease and dementia and death. For each deficit accumulated, the odds ratio of death increased by 5.7%, and the odds ratio of dementia increased by 2.9% (p < 0.001).Conclusion
Frailty was associated with Alzheimer’s disease and dementia over a seven years period. Frailty index might facilitate the identification of older adults at high risk of dementia for the application of the most effective, targeted prevention strategies.19.
Neda Tavassoli S. Guyonnet G. Abellan Van Kan S. Sourdet T. Krams M. -E. Soto J. Subra B. Chicoulaa A. Ghisolfi L. Balardy P. Cestac Y. Rolland S. Andrieu F. Nourhashemi S. Oustric M. Cesari B. Vellas 《The journal of nutrition, health & aging》2014,18(5):457-464
Introduction
Frailty is considered as an early stage of disability which, differently from disability, is still amenable for preventive interventions and is reversible. In 2011, the “Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability” was created in Toulouse, France, in association with the University Department of General Medicine and the Midi-Pyrenees Regional Health Authority. This structure aims to support the comprehensive and multidisciplinary assessment of frail older persons, to identify the specific causes of frailty and to design a personalized preventive plan of intervention against disability. In the present paper, we describe the G.F.C structure, organization, details of the global evaluation and preventive interventions against disability, and provide the main characteristics of the first 1,108 patients evaluated during the first two years of operation.Methods
Persons aged 65 years and older, considered as frail by their physician (general practitioner, geriatrician or specialist) in the Toulouse area, are invited to undergo a multidisciplinary evaluation at the G.F.C. Here, the individual is assessed in order to detect the potential causes for frailty and/or disability. At the end of the comprehensive evaluation, the team members propose to the patient (in agreement with the general practitioner) a Personalized Prevention Plan (PPP) specifically tailored to his/her needs and resources. The G.F.C also provides the patient’s follow-up in close connection with family physicians.Results
Mean age of our population was 82.9 6.1 years. Most patients were women (n=686, 61.9%). According to the Fried criteria, 423 patients (39.1%) were pre-frail, and 590 (54.5%) frail. Mean ADL (Activities of Daily Living) score was 5.5±1.0. Consistently, IADL (Instrumental ADL) showed a mean score of 5.6 2.4. The mean gait speed was 0.78±0.27 and 25.6% (272) of patients had a SPPB (Short Physical Performance Battery) score equal to or higher than 10. Dementia was observed in 14.9% (111) of the G.F.C population according to the CDR scale (CDR ≥2). Eight percent (84) presented an objective state of protein-energy malnutrition with MNA (Mini Nutritional Assessment) score < 17 and 39.5% (414) were at risk of malnutrition (MNA=17–23.5). Concerning PPP, for 54.6% (603) of patients, we found at least one medical condition which needed a new intervention and for 32.8% (362) substantial therapeutic changes were recommended. A nutritional intervention was proposed for 61.8% (683) of patients, a physical activity intervention for 56.7% (624) and a social intervention for 25.7% (284). At the time of analysis, a one-year reassessment had been carried out for 139 (26.7%) of patients.Conclusions
The G.F.C was developed to move geriatric medicine to frailty, an earlier stage of disability still reversible. Its particularity is that it is intended for a single target population that really needs preventive measures: the frail elderly screened by physicians. The screening undergone by physicians was really effective because 93.6% of the subjects who referred to this structure were frail or pre-frail according to Fried’s classification and needed different medical interventions. The creation of units like the G.F.C, specialized in evaluation, management and prevention of disability in frail population, could be an interesting option to support general practitioners, promote the quality of life of older people and increase life expectancy without disability. 相似文献20.
Sjors Verlaan Gerdien C. Ligthart-Melis Sander L.J. Wijers Tommy Cederholm Andrea B. Maier Marian A.E. de van der Schueren 《Journal of the American Medical Directors Association》2017,18(5):374-382