Abstract One of the leading causes of morbidity and premature mortality in older people is frailty. Frailty occurs when multiple physiological systems decline, to the extent that an individual's ...cellular repair mechanisms cannot maintain system homeostasis. This review gives an overview of the definitions and measurement of frailty in research and clinical practice, including: Fried's frailty phenotype; Rockwood and Mitnitski's Frailty Index (FI); the Study of Osteoporotic Fractures (SOF) Index; Edmonton Frailty Scale (EFS); the Fatigue, Resistance, Ambulation, Illness and Loss of weight (FRAIL) Index; Clinical Frailty Scale (CFS); the Multidimensional Prognostic Index (MPI); Tilburg Frailty Indicator (TFI); PRISMA-7; Groningen Frailty Indicator (GFI), Sherbrooke Postal Questionnaire (SPQ); the Gérontopôle Frailty Screening Tool (GFST) and the Kihon Checklist (KCL), among others. We summarise the main strengths and limitations of existing frailty measurements, and examine how well these measurements operationalise frailty according to Clegg's guidelines for frailty classification — that is: their accuracy in identifying frailty; their basis on biological causative theory; and their ability to reliably predict patient outcomes and response to potential therapies.
Abstract
Background
two popular operational definitions of frailty, the frailty phenotype and Frailty index (FI), are based on different theories. Although FI was shown to be superior in predicting ...mortality to the frailty phenotype, no meta-analysis on mortality risk according to FI has been found in the literature.
Methods
an electronic systematic literature search was conducted in August 2016 using four databases (Embase, Medline, CINAHL and PsycINFO) for prospective cohort studies published in 2000 or later, examining the mortality risk according to frailty measured by FI. A meta-analysis was performed to synthesise pooled mortality risk estimates.
Results
of 2,617 studies identified by the systematic review, 18 cohorts from 19 studies were included. Thirteen cohorts showed hazard ratios (HRs) per 0.01 increase in FI, six cohorts showed HRs per 0.1 increase in FI and two cohorts each showed odds ratios (ORs) per 0.01 and 0.1 increase in FI, respectively. All meta-analyses suggested that higher FI was significantly associated with higher mortality risk (pooled HR per 0.01 FI increase = 1.039, 95% CI = 1.033–1.044, P < 0.001; pooled HR per 0.1 FI increase = 1.282, 95% CI = 1.258–1.307, P < 0.001; pooled OR per 0.01 FI increase = 1.054, 95% CI = 1.040–1.068, P < 0.001; pooled OR per 0.1 FI increase = 1.706, 95% CI = 1.547–1.881, P < 0.001). Meta-regression analysis among 13 cohorts with HR per 0.01 increase in FI showed that the studies with shorter follow-up periods and with lower female proportion were associated with higher mortality risks by FI.
Conclusions
this systematic review and meta-analysis was the first to quantitatively demonstrate that frailty measured by the FI is a significant predictor of mortality.
Frailty is a well-established risk factor for adverse health outcomes. However, comparatively little is known about the dynamic nature of frailty and the extent to which it can improve. The purposes ...of this study were to systematically search for studies examining frailty transitions over time among community-dwelling older people, and to synthesise pooled frailty transitions rates. Four electronic databases (Medline, Embase, PsycINFO and CINAHL) were searched in July 2018. Inclusion criteria were: prospective design, community-dwelling older people with mean age>60, using 5-item frailty phenotype criteria to define three states: robust, prefrail and frail and the numbers of participants with 9 frailty transition patterns based on frailty status at baseline and follow-up. Exclusion criteria were: selected populations, using fewer than 5 frailty phenotype criteria. Two investigators independently screened 504 studies for eligibility and identified 16 studies for this review. Data were extracted by the two investigators independently. Pooled rates of frailty transition patterns were calculated by random-effects meta-analysis. Among 42,775 community-dwelling older people from 16 studies with a mean follow-up of 3.9 years (range: 1-10 years), 13.7% (95%CI = 11.7-15.8%) improved, 29.1% (95%CI = 25.9-32.5%) worsened and 56.5% (95%CI = 54.2-58.8%) maintained the same frailty status. Among those who were robust at baseline, pooled rates of remaining robust or transitioning to prefrail and frail were 54.0% (95%CI = 48.8-59.1%), 40.6% (95%CI = 36.7-44.7%) and 4.5% (95%CI = 3.2-6.1%), respectively. Among those who were prefrail at baseline, corresponding rates to robust, prefrail and frail were 23.1% (95%CI = 18.8-27.6%), 58.2% (95%CI = 55.6-60.7%) and 18.2% (95%CI = 14.9-21.7%), respectively. Among those who were frail at baseline, pooled rates of transitioning to robust, prefrail and remaining frail were 3.3% (95%CI = 1.6-5.5%), 40.3% (95%CI = 34.6-46.1%) and 54.5% (95%CI = 47.6-61.3%), respectively. Stratified and meta-regression analyses showed age, gender and follow-up period were associated with frailty transition patterns. Older people make dynamic changes in their frailty status. Given that while one quarter of prefrail older people improved to robust only 3% of frail older people did, early interventions should be considered.
The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic ...indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.
A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded.
The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.
Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities. Trial registration Clinicaltrials.gov: NCT04321265 , registered 19 March 2020.
To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty.
An adapted Grading of Recommendations, Assessment, Development, and ...Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation.
Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan.
The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
frailty is an especially problematic expression of population ageing. International guidelines recommend routine identification of frailty to provide evidence-based treatment, but currently available ...tools require additional resource.
to develop and validate an electronic frailty index (eFI) using routinely available primary care electronic health record data.
retrospective cohort study. Development and internal validation cohorts were established using a randomly split sample of the ResearchOne primary care database. External validation cohort established using THIN database.
patients aged 65-95, registered with a ResearchOne or THIN practice on 14 October 2008.
we constructed the eFI using the cumulative deficit frailty model as our theoretical framework. The eFI score is calculated by the presence or absence of individual deficits as a proportion of the total possible. Categories of fit, mild, moderate and severe frailty were defined using population quartiles.
outcomes were 1-, 3- and 5-year mortality, hospitalisation and nursing home admission.
hazard ratios (HRs) were estimated using bivariate and multivariate Cox regression analyses. Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was assessed using pseudo-R(2) estimates.
we include data from a total of 931,541 patients. The eFI incorporates 36 deficits constructed using 2,171 CTV3 codes. One-year adjusted HR for mortality was 1.92 (95% CI 1.81-2.04) for mild frailty, 3.10 (95% CI 2.91-3.31) for moderate frailty and 4.52 (95% CI 4.16-4.91) for severe frailty. Corresponding estimates for hospitalisation were 1.93 (95% CI 1.86-2.01), 3.04 (95% CI 2.90-3.19) and 4.73 (95% CI 4.43-5.06) and for nursing home admission were 1.89 (95% CI 1.63-2.15), 3.19 (95% CI 2.73-3.73) and 4.76 (95% CI 3.92-5.77), with good to moderate discrimination but low calibration estimates.
the eFI uses routine data to identify older people with mild, moderate and severe frailty, with robust predictive validity for outcomes of mortality, hospitalisation and nursing home admission. Routine implementation of the eFI could enable delivery of evidence-based interventions to improve outcomes for this vulnerable group.
Objectives
To compare the FRAIL‐NH scale with the Frailty Index in assessing frailty in residential aged care facilities.
Design
Cross‐sectional.
Setting
Six Australian residential aged care ...facilities.
Participants
Individuals aged 65 and older (N = 383, mean aged 87.5 ± 6.2, 77.5% female).
Measurements
Frailty was assessed using the 66‐item Frailty Index and the FRAIL‐NH scale. Other measures examined were dementia diagnosis, level of care, resident satisfaction with care, nurse‐reported resident quality of life, neuropsychiatric symptoms, and professional caregiver burden.
Results
The FRAIL‐NH scale was significantly associated with the Frailty Index (correlation coefficient = 0.81, P < .001). Based on the Frailty Index, 60.8% of participants were categorized as frail and 24.4% as most frail. Based on the FRAIL‐NH, 37.5% of participants were classified as frail and 35.9% as most frail. Women were assessed as being frailer than men using both tools (P = .006 for FI; P = .03 for FRAIL‐NH). Frailty Index levels were higher in participants aged 95 and older (0.39 ± 0.13) than in those aged younger than 85 (0.33 ± 0.13; P = .008) and in participants born outside Australia (0.38 ± 0.13) than in those born in Australia (0.34 ± 0.13; P = .01). Both frailty tools were associated with most characteristics that would indicate higher care needs, with the Frailty Index having stronger associations with all of these measures.
Conclusion
The FRAIL‐NH scale is a simple and practical method to screen for frailty in residential aged care facilities.
Frailty is one of the greatest challenges facing our aging population, as it can lead to adverse outcomes such as institutionalization, hospitalization, and mortality. However, the factors that are ...associated with frailty are poorly understood. We performed a systematic review of longitudinal studies in order to identify the sociodemographic, physical, biological, lifestyle-related, and psychological risk or protective factors that are associated with frailty among community-dwelling older adults.
A systematic literature search was conducted in the following databases in order to identify studies that assessed the factors associated with of frailty among community-dwelling older adults: Embase, Medline Ovid, Web of Science, Cochrane, PsychINFO Ovid, CINAHL EBSCOhost, and Google Scholar. Studies were selected if they included a longitudinal design, focused on community-dwelling older adults aged 60 years and older, and used a tool to assess frailty. The methodological quality of each study was assessed using the Quality of Reporting of Observational Longitudinal Research checklist.
Twenty-three studies were included. Significant associations were reported between the following types of factors and frailty: sociodemographic factors (7/7 studies), physical factors (5/6 studies), biological factors (5/7 studies), lifestyle factors (11/13 studies), and psychological factors (7/8 studies). Significant sociodemographic factors included older age, ethnic background, neighborhood, and access to private insurance or Medicare; significant physical factors included obesity and activities of daily living (ADL) functional status; significant biological factors included serum uric acid; significant lifestyle factors included a higher Diet Quality Index International (DQI) score, higher fruit/vegetable consumption and higher tertile of all measures of habitual dietary resveratrol exposure; significant psychological factors included depressive symptoms.
A broad range of sociodemographic, physical, biological, lifestyle, and psychological factors show a longitudinal association with frailty. These factors should be considered when developing interventions aimed at preventing and/or reducing the burden associated with frailty among community-dwelling older adults.
•Multicomponent exercises enhance physical functions in frail elderly.•Significant improvement in Timed Up and Go Test times.•Enhanced physical performance scores with both short and long-term ...interventions.•Muscle strength, including handgrip and knee extensor, significantly increased.•No significant change in walking speed observed between groups.
To assess the impact of multicomponent exercises on physical functions of frail elderly in communities, evaluating their effect on muscle strength, balance, and endurance, and their influence on quality of life.
PubMed, Embase, Cochrane, and Web of Science were searched to collect relevant randomized controlled trials. The search cutoff date was January 24, 2024. Included studies met pre-specified inclusion and exclusion criteria. Data analysis was performed using Revman 5.4 and Stata 15.0 software.
This analysis included 19 studies. After 12 weeks, the multicomponent exercises significantly enhanced participants' performance in various physical function assessments. Specifically, in the Timed Up and Go Test, the exercise group showed a significant reduction in time SMD = -0.86 (95 % CI: -1.40 to -0.33). In the Short Physical Performance Battery, interventions shorter than 6 weeks significantly increased scores SMD = 1.01 (95 % CI: 0.64 to 1.37), and those longer than 6 weeks showed improvements SMD = 0.53 (95 % CI: 0.26 to 0.80). Muscle strength also improved, with handgrip strength and knee extensor strength enhancements SMD = 0.93 (95 % CI: 0.27 to 1.59); SMD = 0.72 (95 % CI: 0.24 to 1.20). However, there was no statistically significant difference in walking speed between the groups SMD = 0.04 (95 % CI: -0.33 to 0.40).
Although multicomponent exercises significantly improve muscle strength, balance, and endurance in frail elderly individuals, there is no conclusive evidence of their effect on enhancing quality of life or long-term health outcomes. Further research is needed to explore the specific impacts of different types and intensities of exercises on this population.
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