Frailty Hinders Recovery From Influenza and Acute Respiratory Illness in Older Adults

Abstract Background We examined frailty as a predictor of recovery in older adults hospitalized with influenza and acute respiratory illness. Methods A total of 5011 patients aged ≥65 years were admitted to Canadian Serious Outcomes Surveillance Network hospitals during the 2011/2012, 2012/2013, and 2013/2014 influenza seasons. Frailty was measured using a previously validated frailty index (FI). Poor recovery was defined as death by 30 days postdischarge or an increase of more than 0.06 (≥2 persistent new health deficits) on the FI. Multivariable logistic regression controlled for age, sex, season, influenza diagnosis, and influenza vaccination status. Results Mean age was 79.4 (standard deviation = 8.4) years; 53.1% were women. At baseline, 15.0% (n = 750) were nonfrail, 39.3% (n = 1971) were prefrail, 39.8% (n = 1995) were frail, and 5.9% (n = 295) were most frail. Poor recovery was experienced by 21.4%, 52.0% of whom had died. Frailty was associated with lower odds of recovery in all 3 seasons: 2011/2012 (odds ratio [OR] = 0.70; 95% confidence interval [CI], 0.59–0.84), 2012/2013 (OR = 0.72; 95% CI, 0.66–0.79), and 2013/2014 (OR = 0.75; 95% CI, 0.69–0.82); results varied by season, influenza status, vaccination status, and age. Conclusions Increasing frailty is associated with lower odds of recovery, and persistent worsening frailty is an important adverse outcome of acute illness.

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Exploring Clinically Meaningful Changes for the Frailty Index in a Longitudinal Cohort of Hospitalized Older Patients

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa084 ◽

2020 ◽

Vol 75 (10) ◽

pp. 1928-1934 ◽

Cited By ~ 3

Author(s):

Olga Theou ◽

Alexandra M van der Valk ◽

Judith Godin ◽

Melissa K Andrew ◽

Janet E McElhaney ◽

...

Keyword(s):

Older Adults ◽

Older Patients ◽

Frailty Index ◽

Respiratory Illness ◽

Research Network ◽

Acute Respiratory Illness ◽

Meaningful Change ◽

Score Change ◽

Surveillance Network ◽

Clinical Frailty Scale

Abstract Background Clinically meaningful change (CMC) for frailty index (FI) scores is little studied. We estimated the CMC by associating changes in FI scores with changes in the Clinical Frailty Scale (CFS) in hospitalized patients. Methods The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network enrolled older adults (65+ years) admitted to hospital with acute respiratory illness (mean age = 79.6 ± 8.4 years; 52.7% female). Patients were assigned CFS and 39-item FI scores in-person at admission and via telephone at 1-month postdischarge. Baseline frailty state was assessed at admission using health status 2 weeks before admission. We classified those whose CFS scores remained unchanged (n = 1,534) or increased (n = 4,390) from baseline to hospital admission, and whose CFS scores remained unchanged (n = 1,565) or decreased (n = 2,546) from admission to postdischarge. For each group, the CMC was represented as the FI score change value that best predicted one level CFS change, having the largest Youden J value in comparison to no change. Results From baseline to admission, 74.1% increased CFS by ≥1 level. From admission to postdischarge, 61.9% decreased CFS by ≥1 levels. A change in FI score of 0.03 best predicted both one-level CFS increase (sensitivity = 70%; specificity = 69%) and decrease (sensitivity = 66%; specificity = 61%) in comparison to no change. Of those who changed CFS by ≥1 levels, 70.9% (baseline to admission) and 72.4% (admission to postdischarge) changed their FI score by at least 0.03. Conclusions A clinically meaningful change of 0.03 in the frailty index score holds promise as a benchmark for assessing the meaningfulness of frailty interventions.

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Influenza surveillance case definitions miss a substantial proportion of older adults hospitalized with laboratory-confirmed influenza: A report from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.22 ◽

2020 ◽

Vol 41 (5) ◽

pp. 499-504 ◽

Cited By ~ 2

Author(s):

Melissa K. Andrew ◽

Janet E. McElhaney ◽

Allison A. McGeer ◽

Todd F. Hatchette ◽

Jason Leblanc ◽

...

Keyword(s):

Older Adults ◽

Influenza A ◽

Frailty Index ◽

Respiratory Illness ◽

Substantial Proportion ◽

Research Network ◽

Influenza Surveillance ◽

Case Definitions ◽

Surveillance Network ◽

Younger Adults

AbstractObjective:Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults.Design:Prospective cohort study.Setting:The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults.Methods:Data were pooled from 3 influenza seasons: 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index.Results:Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58–82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6–52.6) for younger adults versus 44.6% (95% CI, 43.6–45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7–65.6) of younger adults versus 57.1% (95% CI, 55.9–58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions.Conclusions:A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.

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Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm6812a1 ◽

2019 ◽

Vol 68 (12) ◽

pp. 277-280 ◽

Cited By ~ 16

Author(s):

Stephanie A. Kujawski ◽

Claire M. Midgley ◽

Brian Rha ◽

Joana Y. Lively ◽

W. Allan Nix ◽

...

Keyword(s):

United States ◽

Respiratory Illness ◽

Acute Respiratory Illness ◽

Surveillance Network ◽

Enterovirus D68 ◽

Vaccine Surveillance

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Use of clinical frailty scale in acute care settings as a predictor of in-hospital and short-term mortality in older adults with severe acute respiratory illness: A prospective pilot cohort study from India

Journal of the Indian Academy of Geriatrics ◽

10.4103/jiag.jiag_25_21 ◽

2021 ◽

Vol 17 (3) ◽

pp. 89

Author(s):

Sunny Singhal ◽

Pramod Kumar ◽

Akshata Rao ◽

Sunil Jyani ◽

Nayer Jamshed ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Acute Care ◽

Respiratory Illness ◽

Acute Respiratory Illness ◽

Short Term ◽

Clinical Frailty Scale ◽

Short Term Mortality ◽

Acute Care Settings ◽

Severe Acute Respiratory Illness

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A Placebo-Controlled Trial of a Proprietary Extract of North American Ginseng (CVT-E002) to Prevent Acute Respiratory Illness in Institutionalized Older Adults

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2004.52004.x ◽

2004 ◽

Vol 52 (1) ◽

pp. 13-19 ◽

Cited By ~ 51

Author(s):

Janet E. Mcelhaney ◽

Stefan Gravenstein ◽

Sharon K. Cole ◽

Edward Davidson ◽

Dennis O'neill ◽

...

Keyword(s):

Older Adults ◽

North American ◽

Controlled Trial ◽

Respiratory Illness ◽

American Ginseng ◽

Acute Respiratory Illness

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Enterovirus D68-Associated Acute Respiratory Illness ─ New Vaccine Surveillance Network, United States, July–November 2018–2020

MMWR Morbidity and Mortality Weekly Report ◽

10.15585/mmwr.mm7047a1 ◽

2021 ◽

Vol 70 (47) ◽

pp. 1623-1628

Author(s):

Melisa M. Shah ◽

Ariana Perez ◽

Joana Y. Lively ◽

Vasanthi Avadhanula ◽

Julie A. Boom ◽

...

Keyword(s):

United States ◽

Respiratory Illness ◽

Acute Respiratory Illness ◽

Surveillance Network ◽

Enterovirus D68 ◽

Vaccine Surveillance

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Human Coronavirus and Acute Respiratory Illness in Older Adults with Chronic Obstructive Pulmonary Disease

Yearbook of Pulmonary Disease ◽

10.1016/s8756-3452(09)79285-0 ◽

2010 ◽

Vol 2010 ◽

pp. 204-205

Author(s):

J.R. Maurer

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Older Adults ◽

Pulmonary Disease ◽

Respiratory Illness ◽

Chronic Obstructive ◽

Acute Respiratory Illness ◽

Human Coronavirus ◽

Obstructive Pulmonary Disease

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721. Clinical Respiratory Syndromes and Association with Influenza Clinical Diagnostic Testing and Antiviral Treatment among Children Hospitalized with Acute Respiratory Illness, 2015–2016

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.728 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S259-S259

Author(s):

Angela P Campbell ◽

Brian Rha ◽

Constance Ogokeh ◽

Janet Englund ◽

Natasha B Halasa ◽

...

Keyword(s):

Antiviral Treatment ◽

Diagnostic Testing ◽

Respiratory Illness ◽

Clinical Syndrome ◽

Admission Diagnosis ◽

Acute Respiratory Illness ◽

Research Support ◽

Surveillance Network ◽

Missed Opportunities ◽

Percent Positivity

Abstract Background We investigated clinical influenza testing and treatment in children hospitalized with acute respiratory illness (ARI) who had distinct respiratory syndromes. Methods Children <18 years old with ARI were enrolled at seven hospitals in the New Vaccine Surveillance Network (NVSN) between November 1, 2015–June 30, 2016. ICD10 admission diagnosis codes were grouped to define syndromes of bronchiolitis, asthma, pneumonia, and croup. At clinician discretion, influenza testing with a rapid influenza diagnostic test or molecular assay was performed on respiratory samples. As part of the study, each site performed influenza testing using molecular assays on mid-turbinate nasal and throat swabs from all enrolled children. Analysis was restricted to influenza season; children who received antivirals before hospitalization were excluded. Results Among 2,134 children with available ICD10 codes, on preliminary analysis 1,119 (52%) had influenza testing ordered by a clinician: 111 (10%) were positive, and 57 (51%) of 111 received antiviral treatment. Of the 2,134, 858 (40%) had one of the four mutually exclusive syndromes (table). Hospital clinical testing per clinician discretion was influenza positive in 16 of the 858 children (percent positivity per syndrome ranged from <1% to 38%; table). Research study testing of children not undergoing clinical influenza testing identified 11 additional positives. Antiviral treatment was highest for pneumonia patients. Conclusion Understanding testing and treatment practices by clinical syndrome may help to identify missed opportunities for influenza diagnosis and treatment. Table: Disclosures J. Englund, Gilead: Consultant and Investigator, Consulting fee and Research support. Novavax: Investigator, Research support. GlaxoSmithKline: Investigator, Research support. Alios: Investigator, Research support. MedImmune: Investigator, Research support. N. B. Halasa, sanofi pasteur: Investigator, Research support. GSK: Consultant, Consulting fee. Moderna: Consultant, Consulting fee.

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