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Ranee Wates
Background: Frail older adults are at increased risk of postoperative morbidity compared with robust counterparts. Simple methods testing frailty such as grip strength have shown promising results for predicting post-operative outcome, but there is a debate regarding the most appropriate and precise frailty assessment method. Objectives: We compared the predictive value of multidimensional frailty score (MFS) with grip strength or conventional risk stratification tool for predicting postoperative complications in older hip fracture patients. Methods: From January 2016 to December 2018, 277 older hip fracture patients (age >= 65 years) who underwent surgery and comprehensive geriatric assessment (CGA) were retrospectively included for analysis. Hip-MFS was calculated based on the CGA with component of Sex, Charlson Comorbidity Index, serum albumin, Koval grade, cognitive function, risk of falling, mini-nutritional assessment and mid-arm circumference. Grip strength was also measured before surgery. The primary outcome was a composite of postoperative complications (e.g. pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). Results: Among 277 patients (mean age 81.7 6.8 years, 73.3% female), 127 (45.8%) patients experienced postoperative complications and the mean total and postoperative length of hospital stays were 14.4 and 11.8 days, respectively. Grip strength, Hip-MFS, and American Society of Anesthesiologists (ASA) classification could predict postoperative complication. Grip strength (C-index = 0.673) had comparable prognostic utility compared to Hip-MFS (0.661, p = 0.745) and ASA classification (0.594, p = 0.156). However, both Hip-MFS (C-index of 0.592 [ASA] vs 0.675 [ASA + Hip-MFS], p = 0.011) and grip strength (C index of 0.594 [ASA] to 0.671 [ASA + grip strength], p = 0.024) improved the predictive value on ASA classification for postoperative complication. Conclusion: Grip strength showed comparable predictive utility on Hip-MFS which based on preoperative CGA or ASA classification for predicting postoperative complication. Both grip strength and Hip-MFS also showed incremental predictive ability for postoperative complications with the addition of ASA classification. Accordingly, grip strength could be used for screening tool to identify high-risk patients who need for further comprehensive geriatric assessment among older hip fracture patients.
Background: Dependence and cognitive disorder are very common among elders in nursing homes. Psychological disorders such as depression and anxiety have increased among this group of population. This has direct impact on risk of frailty, decreasing the quality of life and the happiness of seniors. Objectives: Analyze the physical, psychic, cognitive and health parameters of the seniors in nursing homes in Quipzcoa, region in north of Spain. Methods: 81 people have participated in total, 45 men and 36 women. On average, they are 84,286,58 years old and they are from 6 nursing homes in Quipuzcoa. The measured parameters are: general data and anthropometry. Physical state: TUQ, Handgrip and SPPB test. Cognitive and psycho affective state: MOCA, EADQ and SHS. Functionality: Barthel and Lawton and Brody. Frailty: Tillburg scale and quality of life: QoL-AD. Comparison of the average values, correlation among parameters and multiple linear regressions of the results have been analised during the statistical analysis. Results: The parameters that have an impact to the quality of life are Tilburg scale of frailty (p
Background: Grip strength is a noninvasive method of risk stratification; however, the association with frailty, hospitalization and mortality is unknown in our Qeriatric day hospital. Objectives: To know if the strength of decreased grip is associated with frailty and adverse outcomes in older people who come to Geriatric day Hospital of the Peruvian Air Force. Methods: Study: descriptive, observational and prospective. Patients older than 59 years of age attending to Qeriatric day hospital were included. The grip strength of the dominant hand was measured during the outpatient clinic visit in older people who came to Geriatric day hospital. Frailty was assessed using the Edmonton scale. The association between decreased grip strength, frailty and adverse outcomes at 3 months follow-up was evaluated using the Chi-square test. Results: The grip strength was measured in 82 older people. According to the Edmonton frailty scale they had decreased grip strength: 83.3% of older people with severe frailty, 87.8% of older people with moderate frailty, 86.7% of older people with mild frailty and 46.7% of vulnerable older adults for frailty. Older adults: not fragile according to Edmonton had no reduced grip strength. The decrease in grip strength was associated with frailty (p = 0.002). Hospitalization and mortality at 3 months follow-up were frequent in: older people with reduced grip strength (p = 0.49), as well as in those with frailty (p = 0.55) according to Edmonton; although they were not statistically significant. Conclusion: The presence of a decreased tension force is associated with fragility. At 3 months of follow-up, older people with reduced grip strength, as well as the Fragile have adverse outcomes (hospitalization and mortality). Key words: Older people- Qrip strength- Frailty- Hospitalization- Mortality.
Background: Old homedwelling persons with home care nursing service are assumed to be characterized by a high degree of frailty. However, the degree of frailty in this population is not previously studied. Whether degree of frailty is associated with risk of hospitalization and death, are unknown. Objectives: To assess degree of frailty using a Frailty Index, and explore whether frailty is associated with increased risk of hospitalization and death among homedwelling older persons with home care nursing service. Methods: We included 210 persons aged 65 and older with weekly home care nursing service. At inclusion the patients went through a comprehensive geriatric assessment performed in the patients own home. Cognitive function was assessed using Montreal Cognitive Assessment, activities in daily living was registered using Barthel Index together with screening questions on instrumental activities in daily living. Nutrition was assessed using Mini Nutritional Assessment, and chronic diseases and regular medications was registered from the patients medical record. Patients performed a 4 meter gait speed test, and griph strength was assessed. Based on these assessments, a Frailty Index consisting of 34 items was calculated. Patients were followed for 2 years, and all hospitalizations were registered from the hospital database, and time of death were registered from national registry. Results: 43 % of the patients suffered from severe frailty, 33% suffered from moderate frailty. and 24% of the patients had mild frailty, pre-frailty or no frailty. The patients had in total 436 hosptializations, and patients with mild frailty had a significantly lower risk for admission to hospital (p=0.001). Patients with severe frailty had a significantly higher mortality risk. Conclusion: Frailty is common in old homedwelling persons with home care nursing service. Assessment of frailty is useful in predicting risk of hospitalizations and death in this population.
Background: Progression of frailty, an age-associated decline of physiological reserve and function, leads to adverse health outcomes. Studies have suggested that frailty progression might be reversible with exercise and nutritional intervention. Therefore, efforts to identify and prevent frailty amongst the elderly become critical for a sustainable nation, economically and socially. Objectives: The primary aim of this study was to evaluate the effectiveness of a multi-factorial intervention comprising physical exercise and nutrition education programmes to improve functional performance of pre-frail community-dwelling elderly aged >=55 years, in Singapore. The effectiveness of preventing frailty progression was also evaluated. Methods: This study was conducted on 94 eligible pre-frail participants (mean age = 71.2 7.3 years; 75.5% female) recruited from various senior activity centres in Singapore. Pre-frailty was operationally defined using FRAIL scale including participants scoring >= 3 but fulfilling the Asian Working Group for Sarcopenia defined cut-offs for weakness and slowness. As this was set out to be a pragmatic study, no control group was selected. Of the 94 participants, 68 completed the intervention and underwent pre- and post-intervention evaluations. Intervention comprised group- and home-based weekly physical exercise and 6 group-based nutritional education sessions, over a 4-month period. Primary outcome was functional performance, evaluated using several fitness tests for balance, gait, power, flexibility and cardio-respiratory endurance. A composite measure using the Short Physical Performance Battery (SPPB) score was also computed. The secondary outcome was frailty status progression. We compared performance measures pre- and post-intervention using paired-sample t-test. Results: The SPPB total score improved post-intervention by 0.32 (95% CI: 0.034, 0.610, p = 0.029) although a score increase of >=0.5 was defined as clinically significant. The SPPB balance sub-total score improved post-intervention by 0.15 (95% CI: 0.001, 0.299, p = 0.049). The time taken for 5 chair-stand repetitions improved post-intervention by 0.73 seconds (95% CI: 0.03, 1.43, p = 0.041). Out of the 68 pre-frail participants, 21 (30.9%) transitioned to robust phenotype while 47 (69.1%) remained as pre-frail phenotype. Conclusion: This multi-factorial intervention comprising physical exercise therapy and nutrition education sessions showed functional performance improvement and demonstrated promise of reversing frailty progression in pre-frail community-dwelling older adults in Singapore.
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