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: An improved version of the HABAM was developed, suitable in its graphical form for everyday clinical use and for research, using the interval numbers that were generated.
59 citations
"Failure to complete performance-bas..." refers background in this paper
...For example, the Hierarchical Assessment of Balance and Mobility (HABAM) observes simple movement in routine clinical encounters [24]....
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Journal Article•
TL;DR: Healthy individuals aged 75 to 84 years, compared with those aged 65 to 74 years, showed a trend to a lower reference range for all three screening tests that may have reflected survival of the fittest individuals to the higher decade.
Abstract: Tests of the acute-phase response are used to screen for occult disease in the elderly, but there is little consensus as to their diagnostic value because of uncertainty as to the effect of age on reference ranges. We have therefore measured, as a function of age, the blood concentration of acute-phase proteins (C-reactive protein, alpha 1-acid glycoprotein, fibrinogen, albumin, and globulin) in parallel with three screening tests of the acute-phase response (erythrocyte sedimentation rate, plasma viscosity, and zeta sedimentation ratio). The study included 164 healthy individuals (age range, 25 to 84 years) plus 91 elderly ill but ambulant patients (age range, 65 to 84 years) from a family practitioner screening clinic. Reference ranges for the erythrocyte sedimentation rate, plasma viscosity, and zeta sedimentation ratio rose with age, with the erythrocyte sedimentation rate showing a particularly wide reference range. Healthy individuals aged 75 to 84 years, compared with those aged 65 to 74 years, showed a trend to a lower reference range for all three screening tests that may have reflected survival of the fittest individuals to the higher decade. Precise reference ranges are therefore required in the elderly; when these were used, the three screening tests showed a significant difference between elderly well and ill individuals.
56 citations
TL;DR: The effects of terminal decline, or indeed of any other variable affecting cognitive performance, are miscalculated if dropout is ignored, and the effects of impending death and dropout did not differ, decreasing with time from initial assessment.
Abstract: Investigations of terminal declines in mental abilities have assessed cognitive performance at a single time point and retrospectively compared survivors and decedents at a single later census date. Neglect of outcomes other than death, such as dropout, causes a loss of information on the relative frailty of survivors and deceased persons before the census date and on incidence of mortality and frailty among survivors after the census date. This discards information on differences in health status between younger and older survivors. The Heim AH4-1 intelligence test was given to 4,228 people between the ages of 42 and 92 years, and both deaths and dropouts were logged during three successive census periods during the subsequent 11 years. Within and across census periods, effects of impending death and dropout did not differ, decreasing with time from initial assessment. Thus the effects of terminal decline, or indeed of any other variable affecting cognitive performance, are miscalculated if dropout is ignored.
27 citations
"Failure to complete performance-bas..." refers background in this paper
...Such difficulty in undertaking the tests yields missing data, most frequently in those who are ill [13], or frail [14]....
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TL;DR: To establish whether the relationship between interleukin‐6 and plasma lipid and C‐reactive protein (CRP) concentrations is different in Finnish nonagenarians than in middle‐aged subjects with lower inflammatory status.
Abstract: OBJECTIVES: To establish whether the relationship between interleukin-6 (IL-6) and plasma lipid and C-reactive protein (CRP) concentrations is different in Finnish nonagenarians than in middle-aged subjects with lower inflammatory status. DESIGN: Cross-sectional. SETTING: Observational cohort study concentrating on the oldest old. PARTICIPANTS: Nonagenarians (n = 291, mean age ± standard deviation 90 ± 1; 68 men, 223 women) who lived in the Tampere municipality in southern Finland and a middle-aged control population from the same area (n = 227, aged 44 ± 8). MEASUREMENTS: Plasma high sensitive CRP and lipid concentrations were analyzed using an automatic analyzer and IL-6 levels using enzyme-linked immunosorbent assay. RESULTS: Plasma concentrations of IL-6 (4.39 ± 5.25 vs 1.88 ± 1.98 pg/mL) and CRP (3.54 ± 4.98 vs 1.53 ± 1.91 mg/L) were significantly higher in nonagenarians than in middle-aged subjects (P<.001). In nonagenarians, plasma CRP levels increased (P<.001) and plasma total cholesterol (P=.006), low-density lipoprotein cholesterol (P=.02), and high-density lipoprotein cholesterol (P=.002) levels decreased according to IL-6 quartiles. In middle-aged subjects, similar associations were not found. CONCLUSION: The relationship between IL-6 and plasma CRP and cholesterol levels in nonagenarians with enhanced systemic inflammation differs from that of middle-aged subjects.
27 citations
TL;DR: Delirium is a clinical syndrome distinct from that of dementia, and constructed by consensus, but there is no known specific biochemical or pathological substrate, so how can the authors tell whether the consensus is flawed without knowing the syndrome's distinct pathological substrate?
Abstract: Of all the challenges posed by delirium, one can be singled out for its rarity in the literature, if not in the committee room; the problem of its definition. The two dominant international definitions are those of lCD-10, 1 and DSM-III-R. The latter has been converted into rating scalesr':\" and remains in DSM-IV. 5 One of us has criticized these on conceptual grounds elsewhere\"; a syndrome cannot be defined by its outcome because clinicians can't determine whether it is present or not until after it has disappeared, and the importance of provoking medical causes is both impossible to rate reliably and pre-judges the relationship between the syndrome and these disorders. The main published research definition of delirium is the CAMDEX,7 which is free of these difficulties. However defined, a syndrome must be validated against some external criterion. The history of the word 'delirium' and its underlying concepts is ever-shifting\" and would otherwise continue to shift. While an agreement about what phenomena constitute a syndrome (for example, whether fluctuating consciousness is legitimately part of the syndrome) is an absolute prerequisite to research progress, we need to attend to the validity of the agreed definition itself before launching a research program such as that described by one of us\" and others. 10,11 History abounds with examples of dogged hunts for the etiology or pathology of ephemeral syndromes. This is the conundrum: delirium is a clinical syndrome distinct from that of dementia, and constructed by consensus. Unlike dementia, there is no known specific biochemical or pathological substrate. If the consensus is flawed, then no such substrate will ever be found, but how can we tell whether the consensus is flawed without knowing the syndrome's distinct pathological substrate? One key to the problem may lie in the concept of validation. This word appears rarely in the delirium literature, and then usually to describe the correlation between DSM-III-R criteria, variously operationalizedr':\" and independent clinical assessment. This is open to the criticism that it is reliability that is being described rather than validity, since the physicians are part of the consensus that defines the DSM-III-R syndrome. Rabins and Folstein'a'f influential study compared dementia and delirium as predictors of mortality, but attempts to validate the syndrome itself against any other external criterion are rare. One reason for this avoidance may be a misunderstanding of the concept of validation. Validation comes from the Latin validus, meaning strong; it is not,
26 citations