Keep in tune with the latest articles on Frailty and save time in your research and clinical practice. This section provides a panel of recently published articles on Frailty selected by the editorial board.
Effectiveness of a primary care based multifactorial intervention to improve frailty parameters in the elderly: a randomised clinical trial: rationale and study design
Frailty is a highly prevalent condition in old age leading to vulnerability and greater risk of adverse health outcomes and disability. Detecting and tackling frailty at an early stage can prevent disability. The authors present the rationale and design of a study aimed at evaluating the effectiveness of a multifactorial intervention program to modify frailty parameters, muscle strength, and physical and cognitive performance in people aged 65 years or more.
This study explored the relationship between cognitive function and frailty in 4,659 individuals aged 50 and older without a history of stroke, Parkinson’s disease or severe cognitive impairment (Mini-Mental State Examination (MMSE) score <18) and not taking antidepressants. Cognitive function was significantly worse in prefrail and frail participants than in those who were robust. However, the absolute differences are small after adjustment for confounding factors.
Screening for frailty in elderly subjects living at home: validation of the modified short emergency geriatric assessment (SEGAm) instrument
The objective of this study by Oubaya et al. was to validate the modified version of the Short Emergency Geriatric Assessment (SEGAm) frailty instrument in elderly people living at home. The SEGAm appears to be an easy-to-use instrument that is particularly suitable for use in the community to identify frail elderly people who could benefit from early targeted interventions.
A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability: the FiND questionnaire
Currently available screening tools for the identification of frail older persons have two major limitations: very few are designed for self-completion, and none discriminates between frailty and disability. In order to foster the identification of non-disabled older persons living in the community, the authors designed the Frail non-Disabled (FiND) questionnaire, which follows the main multidimensional construct of the widely adopted frailty phenotype, but also includes a specific section for excluding the presence of mobility disability.
Early prediction of discharge disposition is an important component in the management of trauma patients. The authors have developed a 15-variable Trauma-Specific Frailty Index (TSFI). In a 2-year prospective observational study of 200 consecutive trauma patients older than 65 years presenting to their Level trauma center, the TSFI was the only significant predictor for unfavorable discharge disposition.
This is a prospective, observational study in patients aged ≥ 70 years admitted to a Geriatric Evaluation and Management Unit (GEMU) in Australia, evaluating the ability of commonly used frailty and functional decline indices to predict GEMU outcomes both at discharge and at 6 months.
The number of older patients who undergo surgery is increasing, and these patients often have comorbid conditions that may lead to postoperative mortality and morbidity. Therefore, it is important to identify at-risk patients. The authors found that a multidimensional frailty model is more useful than conventional methods for predicting outcomes in geriatric patients undergoing surgery.
Frailty is a predictor of poor outcomes following many types of operations. In this study, videos of standarized patients exhibiting varying degrees of frailty were rated with internal consistency by thoracic surgeons as accurately as geriatrics specialists when referenced to an anchored scale. Ratings were less consistent for moderate degrees of frailty, suggesting that physicians require training to recognize early frailty. Such videos may be useful in assessing and teaching frailty recognition.
The authors investigated the prevalence of physical frailty in a Dutch population-based cohort and evaluated its impact on adverse health outcomes independent of comorbidities over a 3-year period. Of 2833 assessed individuals aged 55 years or older, 5.8% were frail. After adjustment for age, sex and comorbidity, frailty was associated with a more than threefold increased risk of death.
This is a longitudinal cohort study of men aged more than 65 years in the Osteoporotic Fractures in Men Study, examining the association of hip osteoarthritis with frailty status (assessed using the Fried’s frailty phenotype).
The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting.
In this study, 399 community-dwelling older adults were assessed using Fried’s frailty phenotype and the Timed Up and Go (TUG) test, a standard mobility assessment. The results indicate that a simple protocol using the TUG and inertial sensors can be a fast and effective means of automatic, non-expert assessment of frailty.
Description of 1,108 older patients referred by their physician to the “Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability” at the Gerontopole
The authors report on the first two years of operation of the Geriatric Frailty Clinic, which was created in Toulouse, France, in 2011. This study demonstrates that general practitioners can screen for frailty and that, when frail persons are referred for a full geriatric assessment, a variety of treatable conditions are identified.
Association between nutritional status (MNA(R)-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients
The authors explored the association between the impaired nutritional status and frailty in acute hospitalized elderly patients by using the MNA®-SF (Mini Nutritional Assessment® short-form) and the SHARE-FI (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe). This study underlines the association and the overlap between frailty and impaired nutritional status.
Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study
The development of critical illness may lead to frailty in vulnerable patients, and critical illness may be a key factor impeding recovery and functional autonomy in those already considered to be frail. The authors performed a prospective multicenter study in an unselected cohort of critically ill patients in order to determine the prevalence of frailty and its association with outcomes among adults admitted to intensive care.
Construct validity and reliability of a two-step tool for the identification of frail older people in primary care
The EASY-Care Two-step Older persons Screening (EASY-Care TOS) tool is a practice-based tool designed to help family physicians identify frail older patients. This article by van Kempen and colleagues is one of the first reports to describe the construct validity of the EASY-Care TOS by comparing it with other commonly used other frailty constructs, the Fried Frailty Criteria (FFC) and the Frailty Index (FI), and other related constructs: multimorbidity, disability, cognition, mobility, psychosocial functioning, and quality of life.
There are several nutritional strategies purported to be useful in the treatment of sarcopenia. In recent years, the n-3 polyunsaturated fatty acids (PUFAs) found in fish oil have been of increasing interest. In a review article published in the December 2013 issue of the Journal of Frailty & Aging, Gray and Da Boit discuss the main nutritional interventions used in the treatment of sarcopenia, with a focus on fish oils.
In this longitudinal, observational study conducted at 39 sites in the United States and Europe between 2006 and 2009, the authors evaluated the association between dependence, cognitive function, functional ability and neuropsychiatric symptoms, on the one hand, and resource utilization, on the other hand. Increasing dependence was associated with an increase in resource utilization. Worsening of all measures of cognition, function and behavior were also associated with quantified increases in total care cost
In this editorial, the authors comment on a consensus statement on cognitive frailty published in the September 2013 of the Journal of Nutrition, Health & Aging. The concept of “cognitive frailty” appears to be an important one, recognizing the synergistic effect that mild cognitive impairment (MCI) can have in persons with physical frailty. The Rapid Cognitive Screen (RCS), in concert with the FRAIL test, may be an excellent tool to identify cognitive frailty. It is important to recognize that a number of treatment strategies exist for MCI. Finally, it needs to be recognized that there is a broader spectrum of psychosocial risk factors for creating frailty.
The authors comment on the report of an international consensus conference on cognitive frailty published in the September 2013 of the Journal of Nutrition, Health & Aging. The term “cognitive frailty”, they note, is used to describe the presence of both physical frailty and cognitive impairment in the absence of neurodegenerative dementia. The proposed condition might also have been presented as a “physical frailty-related cognitive impairment”. More refined and accurate biomarkers of dementia will better support the identification of cognitive impairment cases related to non-neurodegenerative causes.
The authors comment on the report of an international consensus conference on cognitive frailty published in the September 2013 of the Journal of Nutrition, Health & Aging. Physical frailty, whose core features include loss of strength and muscle bulk, slowed gait and fatigue, may share a common etiopathogenesis with late-life cognitive impairment. Considering both physical frailty and cognition together as a single complex phenotype may have important clinical and research implications.
The authors comment on the report of an international consensus conference on cognitive frailty published in the September 2013 of the Journal of Nutrition, Health & Aging. While age-associated cognitive dysfunction has been studied for many years, for the most part it was not conceptualized in a manner that is consistent with current definitions of physical frailty. While cognitive reserve is an important element of cognitive frailty, it is also dependent on the existence of physical frailty. The primary diagnostic criteria proposed by Kelaiditi et al. is the presence of mild cognitive impairment as defined by a clinical dementia rating score of 0.5, without Alzheimer’s disease or another progressive brain disturbance that would lead to dementia.
The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials
The authors performed a systemic review of the current evidence to determine whether fall-prevention exercise programs are associated with a significantly lower risk of fractures and other injuries due to falls. Tai Chi was the exercise in two of the trials but the rest consisted of gait, balance and functional training. Most trials also included strength / resistance training exercises.
Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review
The authors performed a systematic review with the aim to determine which of the frailty screening methods available show the best sensitivity and specificity for predicting the presence of impairments on comprehensive geriatric assessment in elderly patients with cancer. Geriatric 8 and Triage Risk Screening Tool had the highest sensitivity for frailty, but both had poor specificity and negative predictive value. The authors conclude that, for now, it might be beneficial for all elderly patients with cancer to receive a complete geriatric assessment.
Patterns of frailty in older adults: comparing results from higher and lower income countries using the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Study on Global AGEing and Adult Health (SAGE)
Frailty is increasingly common as a result of population aging. Assessing levels of frailty in higher versus lower income countries gives a unique perspective on health status at different stages of demographic transitions, and the effect of different policies on functioning and, in turn, on well-being over the life course. This article provides evidence on frailty in older adults across 14 higher income countries and 6 lower income countries, using a common set of variables to define frailty.
How to empower the primary care physician in the identification of the vulnerable older person with a view to preventing frailty and all its consequences
Effective primary healthcare should include systematic approaches to the identification of the vulnerable older person and target threats to independence. The EASY-Care program allows front-line practitioners and voluntary workers to undertake a brief multi-dimensional assessment of the physical mental and social functioning of the older person. An international database has been developed for analysing data derived from EASY-Care assessments for poulation needs, differences between cultures and change in status over time. This approach is intended as a global means to empower primary care physicians in the identification of the vulnerable older person with a view to preventing frailty and its consequences.
Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial
The authors randomly allocated 12 general practices in the Netherlands to a “Prevention of Care” approach or usual care for the management of frail community-dwelling older patients. The primary outcome measure was disability at 24 months. In the intervention group, frail older persons received a multidimensional assessment and interdisciplinary care based on an individualized treatment plan and regular evaluation and follow-up.
In the context of a rapidly growing interest in frailty, the authors identify several valuable strategies for inclusion of special attention to the syndrome in the clinical care of older persons as well as a number of specific clinical research opportunities. Recognition of the importance and prevalence of frailty, and its various stages, is crucial to the effective management of geriatric patients. Screening for frailty should be incorporated into patients’ regular evaluations. In clinical studies involving older patients, individuals should be routinely characterized as to their frailty status, as this may be an important determinant of their response to the various interventions.
This article summarizes the main characteristics of the Platform for Evaluation of Frailty and Prevention of Disability (Toulouse, France), a tool that specifically aims at supporting the comprehensive and multidisciplinary assessment of frail older persons.
While biological and evolutionary ageing theories have been analysed for centuries, our current knowledge of how we age remains incomplete. In this article, the authors discuss the complexity of the ageing process, and identify critical issues to consider when applying research to clinical practice.
Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST)
Vellas and colleagues present the Gérontopôle Frailty Screening Tool (GFST), an 8-item questionnaire intended to help general practitioners identify frailty in community-dwelling persons 65 years or older without functional disability or current acute disease. The first 6 questions evaluate the patient’s status, whereas the last two assess the general practitioner’s personal view about the frailty status of the individual and the patient’s willingness to be referred to the Frailty Clinical for further evaluation.
The healthcare systems of today are characterized primarily by single-system illnesses, despite the fact that many elderly people have multi-organ problems that often result naturally from aging. Frailty in particular is a prevalent, unifying aspect of aging that warrants attention away from organ-specific treatment but towards a more holistic study of the body and existing diseases.
This article reports on a presentation by Malmstrom and Morley at the December 2012 meeting of the International Task Force on Sarcopenia in Orlando, Florida, USA. In their presentation, and this supplemental article, the authors discuss the ideal population of patients for sarcopenia clinical trials.
Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial
This study assessed whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults. At the end of the follow-up period the adjusted prevalence of frailty in the NV+AB group was 23.3% versus 58.3% in the control group.
Older age is linked with significant changes in body composition, the most notable of which is loss of skeletal muscle, or sarcopenia. Adults over 35 lose muscle mass at a rate of 1-2% per year, a rate which increases to 3% after age 60.
The aim of this study was to validate the 5-item FRAIL scale in a late middle-aged African American population. Being pre-frail at baseline significantly predicted future ADL difficulties, worse one-leg stand scores and mortality. Being frail at baseline significantly predicted future ADL difficulties, IADL difficulties and mortality. The FRAIL scale is an excellent screening test for clinicians to identify frail persons at risk of developing disability as well as decline in health functioning and mortality.
Biomarkers of sarcopenia in clinical trials: recommendations from the International Working Group on Sarcopenia
In this consensus document, the International Working Group on Sarcopenia discusses the current state of the art in the development of biomarkers to be used in clinical trials on sarcopenia, and make recommendations for the adoption of comprehensive operative definitions of sarcopenia, the use of imaging techniques, and adequate length of study.
In this article by Vellas and colleagues, the authors reiterate the need to continue to take care of elderly patients with severe disabilities, but they also underscore the need to assess risk for pre-frailty and frailty.
Nutritional supplementation during resistance improved skeletal muscle mass in community-dwelling frail older adults
Yamada and colleagues aimed to assess changes in physical performance and muscle mass in frail older adults when adding a nutritional supplementation program (including vitamin D and proteins) to an existing resistance training program.
A multidisciplinary platform for the screening, assessment, and treatment of frail community-dwelling older persons has been developed at the University Hospital of Toulouse, France. General practitioners were instructed to refer their frail patients to the platform in case of evidence of increased vulnerability to stressors. Frailty was identified on the basis of a questionnaire evaluating the patient’s health status and the subsequent assessment of 4-meter gait speed. Slow gait speed (<1 meter/second) was considered the key criterion for confirming the presence of frailty.
Social factors are increasingly recognized as relevant to understand frailty. However, research into the prevalence of frailty and its correlates, particularly social influences, remains limited. Identification of these social factors and assessment of their role in the pathophysiology of frailty might be of great importance for the development of multidimensional models and for the comprehensive management of frail individuals.
Gutiérrez-Robledo LM, Avila-Funes JA
J Frailty Aging 2012;1:13-7
Publication date: March 1, 2012