scholarly journals EP.FRI.997 Recognising frailty: the scale of the problem

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Laura Martin ◽  
Susan Chapman ◽  
Elizabeth Broadbent ◽  
Christopher Payne ◽  
Christina Beecroft
Keyword(s):  
Vascular Surgery ◽  
Age Groups ◽  
Surgical Patient ◽  
Staff Education ◽  
Clinical Frailty Scale ◽  
Frailty Assessment ◽  
Surgical Unit ◽  
Surgical Admission ◽  
Frailty Score ◽  
Frailty Criteria

Abstract Aim To assess compliance with frailty scoring in acute surgical admissions. Method Data including age, admitting speciality, whether the frailty score was completed and the recorded score if completed, were collected for all admissions to an acute surgical unit over a 7 day period in November 2019. Results The average age of the 139 patients was 56.25 years (range 16-89). Frailty scoring was completed in 53 patients (38.1%); 8 patients (15%) met the criteria for frailty. Sixty-four patients (46%) were aged over 65 years, 26 (40.6%) had the score completed and 7 (27%) met the frailty criteria. Of 36 patients (26%) aged 75 or over, 16 (44.4%) were scored and 6 (37.5%) met the frailty criteria. Scoring was most frequently completed in patients admitted under the Vascular Surgery team (52.9% compliance) with a mean score 3.8. Conclusion Worsening frailty is associated with increased morbidity and mortality in acute surgical admissions. The 7-point Clinical Frailty Scale has been added our acute surgical admission document and should be completed for every patient. Our compliance with scoring is a long way from our recommended 100%, with compliance with assessing frailty across age groups similar, despite the increased rates of frailty seen in older age groups. Poor compliance with frailty assessment may hamper future progress with the management of the frail, older surgical patient. We are planning documentation changes, staff education sessions and to appoint frailty ‘champions’ with a repeat audit of compliance to assess the effects of these changes.

scholarly journals 160 The Effect of Frailty and COVID-19 Infection on Clinical Outcomes in Older Adults—A Single Centre Retrospective Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
O Okuwoga ◽  
S Mufti
Keyword(s):  
Older Patients ◽  
Single Centre ◽  
Clinical Frailty Scale ◽  
Health Records ◽  
Frail Patients ◽  
Nice Guidance ◽  
Data Points ◽  
Continued Use ◽  
Support Decision Making ◽  
Frailty Score

Abstract Introduction It was anticipated that the COVID-19 pandemic would put a strain on our healthcare system, disproportionately affecting older people. NICE guidance recommended using frailty scoring to support decision making around escalation of care. This study aimed to assess frailty, demographics and COVID-19 infection and to investigate how these related to outcomes of patients aged over 65 years admitted to hospital. Methods A single centre retrospective cohort study was carried out by reviewing the electronic health records of all admissions over 65 years. Data points collected included length of stay (LOS), frailty score using the Rockwood Clinical Frailty Scale (CFS) and mortality. Patients were stratified into COVID and non-COVID based on health records and into non-frail (CFS 1–4) and frail (CFS 5–9). Results A total of 257 patients admitted between 30th March and 30th April 2020 were included in the study (mean age 79 years, 43% female). 141 (54.9%) of patients were diagnosed with COVID-19 infection. 120 patients had CFS 1–4 and 136 has CFS 5–9. 1 patient did not have a frailty score due to insufficient information. 68 (26.8%) of all patients died during the admission. The relative risk (RR) of mortality of patients with coronavirus was 6.3 (95% CI 3.1–12.6, p < 0.0001). The RR of mortality for frail patients compared to the non-frail was 2.1 (95% CI 1.3–3.2, p = 0.002). The median LOS for patients with COVID-19 was 5 days, compared to 4 days for patients who did not have coronavirus. Frailty did not predict longer admission, with median LOS of 5 days for both non-frail and frail patients. Conclusion The results demonstrated in this study show that COVID-19 infection and frailty were significantly associated with increased mortality in older patients. This validates the continued use of frailty scoring of older patients on admission to support care planning.

scholarly journals Preoperative frailty assessment predicts loss of independence after vascular surgery

2018 ◽  
Vol 68 (5) ◽  
pp. 1382-1389 ◽  
Author(s):  
Graham W. Donald ◽  
Amir A. Ghaffarian ◽  
Farid Isaac ◽  
Larry W. Kraiss ◽  
Claire L. Griffin ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Frailty Assessment

scholarly journals Frailty and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention for Elder Patients with Valvular Heart Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-36 ◽  
Author(s):  
Egle Tamuleviciute-Prasciene ◽  
Kristina Drulyte ◽  
Greta Jurenaite ◽  
Raimondas Kubilius ◽  
Birna Bjarnason-Wehrens
Keyword(s):  
Heart Disease ◽  
Exercise Training ◽  
Muscle Mass ◽  
Valvular Heart Disease ◽  
Daily Living ◽  
Frailty Index ◽  
Psychosocial Health ◽  
Clinical Frailty Scale ◽  
Frailty Assessment ◽  
Elder Patients

The aim of this literature review was to evaluate existing evidence on exercise-based cardiac rehabilitation (CR) as a treatment option for elderly frail patients with valvular heart disease (VHD). Pubmed database was searched for articles between 1980 and January 2018. From 2623 articles screened, 61 on frailty and VHD and 12 on exercise-based training for patients with VHD were included in the analysis. We studied and described frailty assessment in this patient population. Studies reporting results of exercise training in patients after surgical/interventional VHD treatment were analyzed regarding contents and outcomes. The tools for frailty assessment included fried phenotype frailty index and its modifications, multidimensional geriatric assessment, clinical frailty scale, 5-meter walking test, serum albumin levels, and Katz index of activities of daily living. Frailty assessment in CR settings should be based on functional, objective tests and should have similar components as tools for risk assessment (mobility, muscle mass and strength, independence in daily living, cognitive functions, nutrition, and anxiety and depression evaluation). Participating in comprehensive exercise-based CR could improve short- and long-term outcomes (better quality of life, physical and functional capacity) in frail VHD patients. Such CR program should be led by cardiologist, and its content should include (1) exercise training (endurance and strength training to improve muscle mass, strength, balance, and coordination), (2) nutrition counseling, (3) occupational therapy (to improve independency and cognitive function), (4) psychological counseling to ensure psychosocial health, and (5) social worker counseling (to improve independency). Comprehensive CR could help to prevent, restore, and reduce the severity of frailty as well as to improve outcomes for frail VHD patients after surgery or intervention.

scholarly journals The Addenbrookes Vascular Frailty Score Predicts Adverse Outcomes in Vascular Surgery Patients

2019 ◽  
Vol 58 (6) ◽  
pp. e630
Author(s):  
Prasanti Alekhya Kotta ◽  
G.K. Ambler ◽  
A. Kalyanasundaram ◽  
P.A. Coughlin
Keyword(s):  
Vascular Surgery ◽  
Adverse Outcomes ◽  
Frailty Score

scholarly journals Surgical complications of abortions at periphery

2016 ◽  
Vol 10 (4) ◽  
Author(s):  
Hassan Mahmood Tabassum ◽  
Muhammad Anwar Chaudhry ◽  
Mansoorul Haq
Keyword(s):  
Birth Control ◽  
Surgical Complications ◽  
Age Groups ◽  
Case Series ◽  
Financial Loss ◽  
Birth Attendants ◽  
Surgical Unit ◽  
Significant Mortality

Objectives: To study the patients presented with catastrophic abdominal misadventure due to abortion performed by untrained birth attendants to get rid of unwanted fetus by un-indicated procedures in unfavorable circumstances. Design: Observational case series. Place and Duration of Study: Surgical Unit I, Sh. Zayed Hospital, Rahim Yar Khan from July, 2001 to August, 2004. Patients and Methods: Forty patients from different age groups presented with this killer problem. Majority was concealing it. They were resuscitated, operated and managed postoperatively. Results: These patients presented late, suffered financial loss, morbidity and significant mortality. Conclusion: Unplanned abortions are catastrophic. Education of masses in regard to birth control is mandatory.

scholarly journals 973 The Effect of Implementing A Proactive Care of Older People Undergoing Surgery (‘POPS’) Team on Length of Stay in Older Surgical Patients

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J M Bayram ◽  
D Rangar ◽  
J Dikiciyan ◽  
I Smith
Keyword(s):  
Length Of Stay ◽  
Older People ◽  
Vascular Surgery ◽  
Patient Outcomes ◽  
Nurse Practitioner ◽  
Surgical Patients ◽  
Medical Complications ◽  
Hospital Data ◽  
Proactive Care ◽  
Frailty Score

Abstract Introduction POPS is a well-established service which supports care of older surgical patients across multiple UK hospitals. POPS teams have been shown to reduce peri-operative medical complications, reduce length of stay (LOS) and improve multiple other patient outcomes. Method A POPS team consisting of two consultants, one foundation doctor and one nurse practitioner was implemented to provide dedicated care to older surgical patients on the general and vascular surgery wards of a large urban teaching hospital. Data were collected over 8 weeks from June 2020 - July 2020 following implementation of the POPS team and compared to pre-POPS data from March 2018 - March 2019. All inpatients were screened by age and Clinical Frailty Score (CFS) for appropriateness and received POPS input based on clinical need. Prior to the POPS team, liaison geriatric input was provided by a sole consultant. Results The 36 patients from the POPS group had an average LOS of 15.9 days, which was significantly lower than the LOS of 37.4 days in the 537 patients in the pre-POPS group (p < 0.01). There were no significant differences in demographics between the two groups. Conclusions The implementation of a POPS team significantly reduced length of stay in older surgical patients.

scholarly journals A scoping review of the Clinical Frailty Scale

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sophie Church ◽  
Emily Rogers ◽  
Kenneth Rockwood ◽  
Olga Theou
Keyword(s):  
Scoping Review ◽  
Literature Search ◽  
Research Evidence ◽  
Web Of Science ◽  
Cochrane Library ◽  
Publication Date ◽  
Clinical Frailty Scale ◽  
And Function ◽  
Comprehensive Literature Search ◽  
Frailty Score

Abstract Background Frailty is increasingly recognized as an important construct which has health implications for older adults. The Clinical Frailty Scale (CFS) is a judgement-based frailty tool that evaluates specific domains including comorbidity, function, and cognition to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill). The aim of this scoping review is to identify and document the nature and extent of research evidence related to the CFS. Methods We performed a comprehensive literature search to identify original studies that used the Clinical Frailty Scale. Medline OVID, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane Library and Embase were searched from January 2005 to March 2017. Articles were screened by two independent reviewers. Data extracted included publication date, setting, demographics, purpose of CFS assessment, and outcomes associated with CFS score. Results Our search yielded 1688 articles of which 183 studies were included. Overall, 62% of studies were conducted after 2015 and 63% of the studies measured the CFS in hospitalized patients. The association of the CFS with an outcome was examined 526 times; CFS was predictive in 74% of the cases. Mortality was the most common outcome examined with CFS being predictive 87% of the time. CFS was associated with comorbidity 73% of the time, complications 100%, length of stay 75%, falls 71%, cognition 94%, and function 91%. The CFS was associated with other frailty scores 94% of the time. Conclusions This scoping review revealed that the CFS has been widely used in multiple settings. The association of CFS score with clinical outcomes highlights its utility in the care of the aging population.

scholarly journals Contamination and Decontamination of Doppler Probes

2006 ◽  
Vol 88 (5) ◽  
pp. 479-481 ◽  
Author(s):  
Emma J Whitehead ◽  
John F Thompson ◽  
David R Lewis
Keyword(s):  
Nosocomial Infection ◽  
Vascular Surgery ◽  
Revision Surgery ◽  
Medical Staff ◽  
Staff Education ◽  
Bacterial Colonisation ◽  
Coagulase Negative Staphylococci ◽  
Bacteriological Culture ◽  
Surgical Ward ◽  
Skin Flora

INTRODUCTION Nosocomial infection occurs in 2–9% of patients undergoing vascular surgery and can lead to death, amputation or require complex revision surgery. Neck ties, pagers, stethoscopes and Doppler probes have been shown to carry pathogens. We measured bacterial colonisation of Doppler probes on a vascular unit and audited the effect of staff education at reducing this contamination. MATERIALS AND METHODS Bacteriological culture swabs were taken from hand-held Doppler probes on the vascular surgical ward and clinic. There was no protocol for cleaning the Doppler probes, so manufacturers were contacted for their recommendations. The results of cultures were presented to nursing and medical staff, who were then asked to clean the probes with alcohol wipes after each use. After an interval of 1 week, bacteriological cultures from the same Doppler probes was repeated. RESULTS Fifty bacteriological cultures were performed from 10 Doppler probes over a 4-week period. Thirteen (26%) cultures were positive for diphtheroids, coliforms, coagulase-negative staphylococci and skin flora. After staff education, 42 further swabs were taken from the same probes; two positive cultures were obtained with scanty growth of skin flora (χ2 P < 0.05). CONCLUSIONS Staff education and simple cleaning significantly reduces the contamination of hand-held Doppler probes and may help prevent nosocomial infection.

scholarly journals P0197CLINICAL FRAILTY SCORING IN PATIENTS WITH END STAGE RENAL DISEASE: A PREDICTOR OF DECLINING HEALTH?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lucy Hetherington ◽  
Joanna Prentice ◽  
Mark Findlay ◽  
Tara Collidge
Keyword(s):  
Diabetic Nephropathy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Clinical Frailty Scale ◽  
Simple Method ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage ◽  
Frailty Score

Abstract Background and Aims The incidence of frailty increases as GFR decreases. In the end stage renal disease (ESRD) population frailty is associated with early mortality, increased hospitalisations, and significant symptom burden. We examined the use of formal frailty scoring and its role in identifying deteriorating patients with advanced renal disease. Method The Rockwood Clinical Frailty Scale (CFS) has high inter-rater reliability and correlates well with objective measures of frailty. We introduced routine recording of the CFS from January 2018 in the renal electronic record for patients on hospital haemodialysis therapy and those undergoing renal replacement therapy (RRT) planning. Based on CFS scoring patients were divided into ‘frail’ (CFS≥6) or ‘robust’ based (CFS&lt;6) and patient demographics are described. The association of being ‘frail’ or a decline in score with mortality at seven months were described using adjusted logistic regression analyses. Results A total of 1663 scores were recorded in 800 patients. 57.3% of patients were male. The median age at entry date was 66 (IQR 55,75) years. The median CFS score was 4 (IQR 3,5). At follow-up 74 (9.3%) had died. The median score prior to death was 5.5. 182 (22.8%) were ‘frail’. During the study period 469 patients had more than one score documented. Death at follow-up was more common in those who were ‘frail’, 20.9 vs 5.8%, p&lt;0.001. Patients who were deceased at follow-up were more likely to have had a deterioration in frailty score, 51.9% vs 24.4%, p=0.002. Being ‘frail’ or having a deteriorating frailty score was associated with death at seven-month follow-up independent of age, sex or diabetic nephropathy status. Conclusion The presence of ‘frailty’ as measured by CFS, or deterioration in CFS is associated with death at follow-up, independent of age, sex or diabetic nephropathy. Routine monitoring of frailty using the CFS provides a simple method to identify patients who are deteriorating and at risk of death. High or deteriorating CFS score should trigger clinical review and anticipatory care planning where appropriate.

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