Failure to complete performance-based measures is associated with poor health status and an increased risk of death
TL;DR: The aim of the study was to establish whether the use of antipsychotic medication in elderly people with dementia is aversive to their quality of life and promote well-being.
Abstract: design, execution, analysis and interpretation of data, or preparation of the study. ALASTAIR MACDONALD1∗, DIMITRIOS ADAMIS2, ADRIAN TRELOAR2, FINBARR MARTIN3 1Institute of Psychiatry, Psychological Medicine, London, UK Email: alastair.macdonald@iop.kcl.ac.uk 2Oxleas NHS Trust, Old Age Psychiatry, London, UK 3Guy’s and St Thomas’ NHS Foundation Trust, Elderly Care Unit, London, UK ∗To whom correspondence should be addressed
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TL;DR: To operationalize frailty using eight scales and to compare their content validity, feasibility, prevalence estimates of frailty, and ability to predict all‐cause mortality, it is shown that the former are more reliable than the latter.
Abstract: Objectives: To operationalize frailty using eight scales and to compare their content validity, feasibility, prevalence estimates of frailty, and ability to predict all-cause mortality.
Design: Secondary analysis of the Survey of Health, Ageing and Retirement in Europe (SHARE).
Setting: Eleven European countries.
Participants: Individuals aged 50 to 104 (mean age 65.3 ± 10.5, 54.8% female, N = 27,527).
Measurements: Frailty was operationalized using SHARE data based on the Groningen Frailty Indicator, the Tilburg Frailty Indicator, a 70-item Frailty Index (FI), a 44-item FI based on a Comprehensive Geriatric Assessment (FI-CGA), the Clinical Frailty Scale, frailty phenotype (weighted and unweighted versions), the Edmonton Frail Scale, and the FRAIL scale.
Results: All scales had fewer than 6% of cases with at least one missing item, except the SHARE-frailty phenotype (11.1%) and the SHARE-Tilburg (12.2%). In the SHARE-Groningen, SHARE-Tilburg, SHARE-frailty phenotype, and SHARE-FRAIL scales, death rates were 3 to 5 times as high in excluded cases as in included ones. Frailty prevalence estimates ranged from 6% (SHARE-FRAIL) to 44% (SHARE-Groningen). All scales categorized 2.4% of participants as frail. Of unweighted scales, the SHARE-FI and SHARE-Edmonton scales most accurately predicted mortality at 2 (SHARE-FI area under the receiver operating characteristic curve (AUC) = 0.77, 95% confidence interval (CI) = 0.75�0.79); SHARE-Edmonton AUC = 0.76, 95% CI = 0.74�0.79) and 5 (both AUC = 0.75, 95% CI = 0.74�0.77) years. The continuous score of the weighted SHARE-frailty phenotype (AUC = 0.77, 95% CI = 0.75�0.78) predicted 5-year mortality better than the unweighted SHARE-frailty phenotype (AUC = 0.70, 95% CI = 0.68�0.71), but the categorical score of the weighted SHARE-frailty phenotype did not (AUC = 0.70, 95% CI = 0.68�0.72).
Conclusion: Substantive differences exist between scales in their content validity, feasibility, and ability to predict all-cause mortality. These frailty scales capture related but distinct groups. Weighting items in frailty scales can improve their predictive ability, but the trade-off between specificity, predictive power, and generalizability requires additional evaluation.
506 citations
TL;DR: Patients deemed frail, determined using an objective assessment tool, have a higher likelihood of experiencing mortality, morbidity, functional decline, and MACCE following cardiac surgery, regardless of definition.
301 citations
Cites background from "Failure to complete performance-bas..."
...In other settings, nonperformance of performance measures, as well as inability or unwillingness to undertake the test, is associated with worse outcomes.(22) There is clinical and research relevance to the findings of our systematic review....
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TL;DR: Frailty is a robust concept and however defined, elderly people who are frail have worse outcomes than those who are not frail and Random combinations of 15 variables used to make up alternate 5-item Frail-CHS definitions showed any stratification based on 5 variables allowed tertiles of risk to be discriminated.
242 citations
TL;DR: This review seeks to address how frailty is recognised and managed, especially in the realm of primary care, including tools to identify frailty in the primary care setting.
Abstract: Frail, older patients pose a challenge to the primary care physician who may often feel overwhelmed by their complex presentation and tenuous health status. At the same time, family physicians are ideally suited to incorporate the concept of frailty into their practice. They have the propensity and skill set that lends itself to patient-centred care, taking into account the individual subtleties of the patient's health within their social context. Tools to identify frailty in the primary care setting are still in the preliminary stages of development. Even so, some practical measures can be taken to recognize frailty in clinical practice and begin to address how its recognition may impact clinical care. This review seeks to address how frailty is recognised and managed, especially in the realm of primary care.
209 citations
Cites background from "Failure to complete performance-bas..."
...One caveat when using abbreviated or simplified frailty screens is that people who cannot perform performance measures should be seen as especially at risk, and not as having “missing data”, which is a common practice in epidemiological studies, and can also be the case where protocols require adherence to specific measures [46]....
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TL;DR: This study shows that the disability in self-care is common among older patients on hemodialysis and strategies are needed to routinely identify those older dialysis patients at risk of functional impairment and to limit their disabilities.
200 citations
Cites background from "Failure to complete performance-bas..."
...This has important implications as the inability to complete physical performance tasks such as the TUG test is associated with the onset of new functional dependence, poor health status, and increased risk of death in seniors without ESRD.(6,32) In other words, using these measures routinely may be helpful in identifying seniors on dialysis who are at high risk of subsequently developing disability and other adverse outcomes....
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...This has important implications as the inability to complete physical performance tasks such as the TUG test is associated with the onset of new functional dependence, poor health status, and increased risk of death in seniors without ESRD.6,32 In other words, using these measures routinely may be helpful in identifying seniors on dialysis who are at high risk of subsequently developing disability and other adverse outcomes....
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References
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TL;DR: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition, and finds that there is an intermediate stage identifying those at high risk of frailty.
Abstract: Background: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established.
Methods: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality.
Results: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline).
Conclusions: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.
16,255 citations
"Failure to complete performance-bas..." refers background in this paper
...Sir—Mobility impairment is common in elderly people, often leads to adverse outcomes [1–4] and is intertwined with frailty [5, 6]....
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TL;DR: A new Geriatric Depression Scale (GDS) designed specifically for rating depression in the elderly was tested for reliability and validity and compared with the Hamilton Rating Scale for Depression (HRS-D) and the Zung Self-Rating Depression Scale(SDS) as discussed by the authors.
13,014 citations
TL;DR: This study evaluated a modified, timed version of the “Get‐Up and Go” Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital and suggested that the timed “Up & Go’ test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time.
Abstract: This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.
12,004 citations
"Failure to complete performance-bas..." refers background or methods in this paper
...We did not use the original cutpoints for the TUG, but rather used the performance tertiles....
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...Here, those with missing data on either one of the TUG or FR had worse outcomes than those with poor performance, and those with missing data for both had the worst outcomes....
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...As with those whose performance on both the FR and TUG was impaired, patients with missing data on either or both the FR/TUG were more likely to be older women and to have worse scores for mood, cognition, function and co-morbidity (Table 1)....
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...Kaplan-Meier curves of survival over 5 years for each of the FR (Panel A) and TUG (Panel B) ability and inability groups....
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...However, in three recent investigations of mobility in the elderly, the proportion with missing data varied widely from 1.0 to 19.5% for the FR and 0.7 to 51% for the TUG [10, 13, 23]....
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TL;DR: A large number of changes, distant from the site or sites of inflammation and involving many organ systems, may accompany inflammation, and the mechanisms mediating them are becoming better understood.
Abstract: A large number of changes, distant from the site or sites of inflammation and involving many organ systems, may accompany inflammation. In 1930 interest was focused on these changes by the discovery of C-reactive protein (so named because it reacted with the pneumococcal C-polysaccharide) in the plasma of patients during the acute phase of pneumococcal pneumonia.1 Accordingly, these systemic changes have since been referred to as the acute-phase response,2 even though they accompany both acute and chronic inflammatory disorders. New acute-phase phenomena continue to be recognized, and the mechanisms mediating them are becoming better understood. This review summarizes much of . . .
6,157 citations