The impact of frailty in critically ill patients after trauma: A prospective observational study

BackgroundAs our population ages, older adults are increasingly exposed to trauma. Frailty could be a useful measure to identify patients at risk of a poor outcome. This study aimed to determine the impact of frailty in an Australian trauma intensive care unit (ICU) population.MethodsA prospective observational study of critically ill trauma patients ≥50 years of age. Frailty was determined on admission to the ICU using the frailty phenotype. Demographic and hospital data were collected, and patients were followed up at 6 and 12 months. The primary outcome was 12-month mortality, and multiple regression was used to determine associated factors.ResultsOne hundred thirty-eight patients were included, whose mean age was 68 years; 78.2% (108/138) were classified as major trauma (Injury Severity Score >12). Twenty-two percent (30/138) of patients were identified as frail. Patients with frailty were significantly older: however, they were less severely injured and required lower rates of surgical interventions and mechanical ventilation. Frailty was independently associated with mortality at 6 and 12 months (odds ratio: 5.9, 95% confidence interval: 1.9–18.1 and odds ratio: 7.3, 95% confidence interval: 2.5–21.9, respectively). Patients with frailty had lower measures of global functioning (Glasgow Outcome Scale-Extended frail 3 [1–5] vs nonfrail 6 [(5–7], p = 0.002) and health status (Euro Qol 5Q-5D-5L utility score 0.6 [0.5–0.7] vs 0.7 [0.6–0.9], p = 0.02) at 12 months than patients without frailty.ConclusionFrailty is a useful predictor of poor outcomes in critically ill trauma patients.Registration of protocol numberACTRN12615000039583.     

Frailty among older people in a community setting in China

Frailty is the most common manifestation of serious health issues in the world, and it is becoming more prevalent worldwide as the aging population grows. Changes that occur in an individual during the aging process have physical, psychological, social, and environmental aspects that make an individual more frail. In China, older people may live in communities for aging individuals. This study aimed to describe the presence and severity of frailty and to analyze influencing factors among this population in China. The Frailty Index 35 (FI-35) scale, which includes 35 items in physical, psychological, social, and environmental domains, was used to investigate frailty. The FI-35 score ranges from zero to one, with a score closer to one indicating greater frailty. Biographical, socioeconomic, and lifestyle factors were measured as potential determinants of frailty. We relied on the November 2017–February 2018 waves of the Chinese cross-sectional study survey that comprised a sample of 513 adults, aged 60 or older, who were living in China. Linear regression was performed to identify factors associated with FI-35 scores. We categorized the determinants of frailty into three models: Model 1: biographical variables; Model 2: biographical and socioeconomic variables; and Model 3: biographical, economic, and lifestyle variables. Frailty scores ranged from 0.00 to 0.89, with a median of 0.31, and the prevalence of frailty was 67.6%. The final model obtained after variable selection included age, minority status, marriage status, income, diet, and exercise. The adjusted R-squared indicated that the analysis explained 13.8% of the variance in frailty scores. Adding household, marriage status, education level, medical insurance, and income as elements in Model 2 explained 25.7%. Adding diet, smoking, drinking, exercise, and hobbies in Model 3 explained 27.9%. The degree of frailty varies considerably among Chinese community-dwelling older people and is partly determined by biographical, socioeconomic, and lifestyle factors.     

Association of swallowing problems with frailty in Chinese hospitalized older patients

ObjectiveTo estimate the prevalence of dysphagia and frailty among hospitalized older patients and to analyze the relationship between dysphagia and frailty in these people.MethodsData were collected on 386 participants aged 65 and older in a general hospital from April to December 2017. Patients were asked to complete a self-designed demographic questionnaire. Frailty and swallowing function assessments were performed using the Fried frailty phenotype and the 30-ml water swallowing test, respectively. Multiple stepwise logistic regression analyses were used to identify the association between frailty and dysphagia.ResultsDysphagia developed in 31.1% of older people, and 24.4% developed frailty. Frailty was statistically significantly related with dysphagia. Dysphagia was more prevalent in frail and pre-frail patients (48.9% and 32.4%, respectively) than those who were non-frail (13.6%). In multivariate analyses, frail（OR, 5.420; 95% CI, 2.684–10.944；P＜0.001） and history of choking/coughing while drinking（OR, 2.954; 95% CI, 1.844–4.733；P＜0.001）were associated with dysphagia.result.ConclusionsFrailty is associated with dysphagia. More attention should be paid to frailty and dysphagia of the elderly and further studies are needed to evaluate the correlated mechanism and develop targeted nursing interventions.     

老年非瓣膜性心房颤动住院患者衰弱现状及影响因素分析

目的 调查老年非瓣膜性心房颤动住院患者的衰弱现状及其影响因素。 方法 采用便利抽样法,选取2020年3月—10月在温州市某三级甲等医院心血管内科住院的183例老年非瓣膜性心房颤动患者,采用一般资料调查表、FRAIL衰弱问卷、Barthel指数评定量表、Padua风险评估表进行调查。采用Logistic回归分析老年非瓣膜性心房颤动住院患者衰弱的影响因素。 结果 老年非瓣膜性心房颤动住院患者衰弱前期和衰弱的发生率分别为39.9%和28.4%,仅有31.7%患者无衰弱。Logistic回归结果显示,年龄、性别、左心室射血分数、左心房内径、Barthel指数得分和Padua得分是老年非瓣膜性心房颤动患者衰弱的影响因素（P<0.05）。 结论 老年非瓣膜性心房颤动患者合并衰弱的发生率高。高龄、左心室射血分数低、左心房内径增大等非瓣膜性心房颤动患者更易出现衰弱。     

Frailty as a predictor of short- and long-term mortality in critically ill older medical patients

PurposeFrailty is a common condition among critically ill patients. Usually evaluated in a mixed population of medical, cardiac and surgical patients, we aimed to assess the impact of frailty on short- and long-term mortality exclusively in critically ill older medical patients.Materials and methodsWe included 285 patients aged≥70 years admitted to ICU (2009–2017). Comorbidities, severity scores, treatment intensity and complications were recorded. Pre-hospital frailty, measured by Clinical Frailty Scale (CFS), was defined as a score ≥ 5 according to this scale.ResultsPrevalence of frailty (CFS ≥ 5) of 18.6%. Frail patients were more likely to be female (64.2% vs. 35.6%, p < .001) or suffer from heart failure (17% vs. 6%,p = .021). Apache II score was higher in frail than in non-frail patients (27.4 ± 7.1 vs. 24.8 ± 8.6,p = .041). Age, comorbidities, treatment intensity, complications, and ICU and hospital length of stay were similar between frail and non-frail patients. Life-sustaining treatment limitation was more frequent in frail patients (47.2% vs. 20.7%,p < .001). Except for ICU mortality, frailty was an independent predictor of short- and long-term mortality after adjustment for sociodemographic, comorbidities, severity scores, treatment intensity and complications.ConclusionsFrailty (CFS ≥ 5) was independently associated with short- and long-term mortality in older patients admitted to ICU exclusively due to a medical reason.     

社区老年糖尿病患者认知衰弱现状及影响因素分析

目的 :调查社区老年糖尿病患者认知衰弱现状,并分析其影响因素。方法 :采用便利抽样法,选取郑州市某社区卫生服务中心260例老年糖尿病患者为研究对象,采用一般资料调查表、衰弱表型、蒙特利尔认知评估量表、临床痴呆评定量表进行调查。结果 :共回收255份有效问卷。研究对象中共有28例发生认知衰弱,认知衰弱发生率为11.0%。多因素Logistic回归分析显示,高龄(≥75岁)及抑郁是认知衰弱的危险因素,规律运动是认知衰弱的保护因素(P<0.05)。结论 :社区老年糖尿病患者认知衰弱发生率较高,社区医护人员应重视该人群认知衰弱的评估,及时采取针对性的整体干预措施,预防或减缓老年糖尿病患者认知衰弱的发生发展。     

Frailty assessment of older adults,first-time applicants of public home care service in Norway

ObjectiveEarly detection of frailty is essential to prevent or delay disability. The most appropriate screening tool for frailty among home-dwelling older adults is under debate. The present study estimates the prevalence of frailty among older adults, first-time applicants of public home care service in Norway, and investigates the appropriateness of gait speed and Short Physical Performance Battery as screening-tools for frailty.Design and settingWe conducted a cross-sectional study of 116 older adults >65 years applying for public home care service for the first time. Frailty was assessed by an adapted version of the Fried Frailty Phenotype. The test accuracies of gait speed and Short Physical Performance Battery to detect frailty were calculated for a general population >70 years in Norway.Results62.1% of the participants were frail, 29.3% were prefrail, and 8.6% were robust. Mean gait speed and Short Physical Performance Battery-scores were significantly lower in frail compared to prefrail individuals, and significantly lower in prefrail compared to robust individuals. The sensitivity and specificity of gait speed at a cut point of 0.8 m/s to detect physical frailty phenotype was 99% and 68%, respectively.Conclusions The high prevalence of frailty in the present study indicates that screening for frailty should be considered at an earlier time point than when older adults apply for public home care service for the first time. Gait speed may be an appropriate screening tool for frailty in a general population >70 years in Norway.

KEY POINTS

• The prevalence of frailty among older adults, first-time applicants of public home care services in Norway is major.
• Screening for frailty should be considered before older adults apply for public home care service for the first time.
• Gait speed at a cut point at 0.8 m/s may be an appropriate screening tool for frailty in a general population >70 years in Norway.

     

Frailty and its significance in older people's nursing

The term frail is commonly used to describe older people, but reports on the care of older adults in hospital highlight that the clinical implications of frailty are not understood fully by all nurses. Frailty can be an indicator of older people's health status and healthcare needs. An understanding of frailty and its mechanisms will help nurses to determine care priorities, particularly the urgency for anticipatory, proactive, preventive and compensatory care to prevent unnecessary mortality and morbidity. This article discusses the significance of frailty in older people's nursing. It highlights the responsibility of registered nurses to recognise deterioration in health as a result of frailty and to implement appropriate interventions.     

Frailty Assessment in the Emergency Department

Background

Frailty (defined as weakness, slowness, weight loss, exhaustion, and physical inactivity) is characterized by increased vulnerability to stressors. Frail older patients are at increased risk of Emergency Department (ED) visits, hospitalization, disability, and death.

Objectives

Our aims were to determine the prevalence of frailty (and assess the feasibility of measuring frailty) in older ED patients. We also assessed the correlation of self-reported speed and weakness to measured values and the association between frailty and function.

Methods

We performed a study of discharged ED patients aged ≥ 65 years. We used Fried’s frailty definition and a validated activities-of-daily-living (ADL) scale. We measured self-reported and objective weakness and slowness. Data were reported as means and proportions with 95% confidence interval (CI); associations were measured using 95% CI for the differences. Ninety patients provided a 95% CI of ± 10%.

Results

The mean age of the 90 patients was 76 ± 6.4 SD years; 51% were male. Mean assessment time was 7.4 min (95% CI 6.9–7.9). Twenty percent of patients were frail (18/90, 95% CI 12–30%). Self-report was 18% sensitive and 90% specific for objective weakness; self-report was 42% sensitive and 86% specific for objective slowness. Frail and weak patients were more likely dependent in one or more ADLs (26% difference, 95% CI 1–51% and 20% difference, 95% CI 1–41%, respectively).

Conclusions

Frailty is common in discharged older ED patients. Self-reported weakness and slowness are poor predictors of their objective counterparts. Frailty was associated with ADL dependence. These two domains may be reliable markers for elderly ED patients at high risk for adverse outcomes.     

消化道肿瘤患者衰弱的研究进展

消化道肿瘤患者的疾病治疗与身体机能受损相伴随,衰弱现象在消化道肿瘤患者中十分普遍,且与其多种不良健康结局密切相关,严重影响其预后。本文综述了消化道肿瘤患者衰弱的危险因素、与不良健康结局相关性及干预方式,指出医护人员应尽早识别消化道肿瘤患者的衰弱状态,并做出早期干预,从而改善患者预后。     

老年冠心病患者PCI术后衰弱现状调查及影响因素分析

目的探讨老年冠心病患者PCI术后衰弱发生现状及影响因素。方法采用便利抽样法,选取2018年7月—2019年7月在江苏省连云港市第二人民医院心内科和连云港市第一人民医院心内科住院并接受PCI治疗的老年冠心病患者300例为研究对象。采用问卷调查法,于PCI术后24 h内收集人口学资料、疾病资料,并使用衰弱评估指数评估患者。结果老年冠心病患者PCI术后衰弱发生率为80.67%(242/300)。单因素分析结果显示,不同年龄、学历、经济状况、保险情况、婚姻情况、合并疾病种类、心功能分级、放入支架数、以及是否吸烟、饮酒的患者术后衰弱发生情况差异有统计学意义(P<0.05)。多重线性回归分析结果显示,年龄、学历、经济状况、饮酒、医疗保险情况、合并疾病种类数、心功能分级是老年冠心病患者PCI术后衰弱的影响因素(P<0.05)。结论老年冠心病患者PCI术后衰弱发生率高,临床中应重点加强衰弱评估,对高危人群及早开展风险干预,进而减少老年冠心病患者PCI术后衰弱的发生。     

FRAIL量表和Tilburg量表在社区老年糖尿病患者衰弱评估中的应用比较

目的比较衰FRAIL量表和Tilburg衰弱量表(TFI)在社区老年糖尿病人群中的诊断能力及预测能力。方法便利抽样法选取衡阳市4个社区的343名年龄≥60岁的糖尿病患者为研究对象,采用一般情况调查表、衰弱表型、FRAIL量表、TFI量表进行资料收集。结果当处于原始临界值时,衰弱表型、FRAIL量表、TFI量评估的衰弱比例分别为26.53%(91/343)、25.07%(86/343)、57.73%(198/343);以衰弱表型为参考标准,FRAIL量表和TFI量表的ROC曲线下面积分别为0.962和0.890,两者的面积之差为0.072(Z=3.357,P<0.01),FRAIL量表和TFI量表的最佳临界值分别为2.5和5.5;以跌倒和住院为预测指标,3种衰弱评估工具对跌倒和住院的预测能力均较低(0.656~0.687),且三者的ROC曲线下面积差异无统计学意义(Z=0.695,P>0.05)。结论在社区老年糖尿病患者中,FRAIL量表的诊断性能优于TFI量表,但3种衰弱评估工具对社区老年糖尿病患者跌倒和住院的预测能力均较低。     

衰弱表型和衰弱筛查量表在老年住院患者中的应用比较

目的 比较衰弱表型和衰弱筛查量表(FRAIL量表)对老年住院患者衰弱风险的筛查能力,为临床选择合适的衰弱筛查工具提供参考.方法 采用便利抽样法,选取2019年11月—2020年7月在宁夏回族自治区某三级甲等医院住院的462例老年住院患者为研究对象,采用衰弱表型、衰弱筛查量表和衰弱指数进行衰弱评价.以衰弱指数为诊断标准,...     

Frailty: Identifying elderly patients at high risk of poor outcomes

Objective

To help family physicians better recognize frailty and its implications for managing elderly patients.

Sources of information

PubMed-MEDLINE was searched from 1990 to 2013. The search was restricted to English-language articles using the following groups of MeSH headings and key words: frail elderly, frail, frailty; aged, geriatrics, geriatric assessment, health services for the aged; and primary health care, community health services, and family practice.

Main message

Frailty is common, particularly in elderly persons with complex chronic conditions such as heart failure and chronic obstructive pulmonary disease. Emerging evidence demonstrates the value of frailty as a predictor of adverse outcomes in older persons. While there is currently a lack of consensus as to how best to assess and diagnose frailty in primary care practice, individual markers of frailty such as low gait speed offer a promising feasible means of screening for frailty. Identification of frailty in primary care might provide an opportunity to delay the progression of frailty through proactive interventions such as exercise, and awareness of frailty can guide appropriate counseling and anticipatory preventive measures for patients when considering medical interventions. Recognition of frailty might also help identify and optimize the management of coexisting conditions that might contribute to or be affected by frailty. Further research should be directed at identifying feasible and effective ways to appropriately assess and manage these vulnerable patients at the primary care level.

Conclusion

Despite its importance, little attention has been given to the concept of frailty in family medicine. Frailty is easily overlooked because its manifestations can be subtle, slowly progressive, and thus dismissed as normal aging; and physician training has been focused on specific medical diseases rather than overall vulnerability. For primary care physicians, recognition of frailty might help them provide appropriate counseling to patients and family members about the risks of medical interventions.     

Sleep quality,depression and frailty among Chinese community-dwelling older adults

We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.     

老年科住院患者认知衰弱状况调查及其影响因素分析

目的:调查老年科住院患者认知衰弱患病状况并分析其影响因素。方法:本研究为横断面研究。采用便利抽样法,选择2019年6月—2020年6月在首都医科大学宣武医院就诊的老年科住院患者。符合纳入及排除标准的共486例老年患者完成问卷调查、体格检查及实验室检查。以FRAIL衰弱评估量表及简易精神状态量表进行认知衰弱的评估。采用单...     

Cross-cultural adaptation and psychometric properties of the Groningen Frailty Indicator (GFI) among Chinese community-dwelling older adults

The objective was to examine the feasibility, reliability and validity of the Groningen Frailty Indicator (GFI) among Chinese community-dwelling older adults. Of the 1230 participants, 1202 (97.7%) completed all items on the GFI. The internal consistency was acceptable (Cronbach's α = 0.64), and the test–retest reliability within a 7–15-day interval was good (ICC = 0.87). The GFI showed good diagnostic accuracy in the identification of frailty with reference to the frailty index (AUC = 0.84), and the optimal frailty cut-point was 3. Convergent validity was supported by significant correlations between each domain of the GFI and the corresponding alternative measurement(s). Higher proportions of frailty (GFI ≥ 3) were found in those who were older, female, less-educated, lived alone, and had 2 or more chronic diseases than in their counterparts, supporting its known-group discriminant validity. The Chinese GFI has good feasibility, acceptable reliability and satisfactory validity among community-dwelling older adults.     

老年肺癌患者衰弱现状及影响因素分析

目的 调查老年肺癌住院患者衰弱的发生现状并分析其影响因素。方法 采用方便抽样法,选取广西某三级甲等肿瘤医院胸瘤外科146例60岁及以上的肺癌患者,应用一般资料调查表、中文版格列宁根衰弱指标量表、中文版Barthel指数进行问卷调查,采用多元线性回归分析老年肺癌患者衰弱的影响因素。结果 在老年肺癌住院患者中,衰弱患者占36.3%,衰弱总分为（3.01±1.58）分,其中躯体衰弱（1.27±0.90）分,认知衰弱（0.58±0.49）分,社交衰弱（0.52±0.50）分,心理衰弱（0.65±0.49）分。多元线性回归分析结果显示：年龄、肺癌分期、疾病病程、合并多病、日常生活能力对老年肺癌患者衰弱得分影响有统计学意义（P<0.001）,5个因素共解释总变异的50.4%。结论 老年肺癌患者在躯体、认知、社交、心理方面存在不同程度的衰弱状态,多种因素可影响其衰弱的发生,肿瘤专科医护人员应重视对该人群衰弱情况的评估,及时采取有效可行的干预措施,改善其生活质量,减轻医疗负担。     

Frailty and its association with the Mediterranean diet,life-space,and social participation in community-dwelling older people

Frailty is a common and vulnerable state in older people, which leads to a higher risk of adverse health outcomes. This cross-sectional study examined the association between frailty and its phenotypic components with the Mediterranean diet, life-space, and social participation in community-dwelling older people. 263 community-dwelling older people recruited from three community centers in Hong Kong completed the study (robust = 85, pre-frail = 120, frail = 58). The results showed that the Mediterranean diet (OR = 0.29), life-space (OR = 0.32), and social participation (OR = 0.31) were associated with frailty. All factors were preferentially associated with slowness. The Mediterranean diet and social participation were additionally associated with weakness and low activity, respectively. To reduce the risk of frailty among diverse populations of older people in community settings, eliminating foods considered detrimental in the Mediterranean diet is advocated. Older people's satisfaction with social participation should be taken into consideration. Environmental designs should accommodate slow-walking older people to maximize their life-space     

Frailty: an indication for palliative care

Chronological age alone does not determine the vulnerability or frailty of an older adult.Frailty can, however, profoundly affect the quality of an older adult's life. Frail adults could benefit from palliative care provided by an interdisciplinary team. The principles of palliative care apply to any population that could benefit from a comprehensive, person-centered plan of care from the time of diagnosis through the illness trajectory. This article presents a conceptual overview of frailty and describes its clinical presentation and treatment options, including palliative care, an intervention used by gerontological nurses to improve the quality of life for frail older adults.