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

BioMed Research International ◽

10.1155/2018/9849475 ◽

2018 ◽

Vol 2018 ◽

pp. 1-36 ◽

Cited By ~ 8

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.

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Bedside Ultrasound Measures of Muscle Mass and Frailty Measures in Community-Dwelling Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.861 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 269-269

Author(s):

Kenneth Madden ◽

Boris Feldman ◽

Shane Arishenkoff ◽

Graydon Meneilly

Keyword(s):

Older Adults ◽

Muscle Mass ◽

Frailty Index ◽

Geriatric Medicine ◽

Muscle Thickness ◽

Vancouver General Hospital ◽

Community Dwelling ◽

Point Of Care Ultrasound ◽

Clinical Frailty Scale ◽

Community Dwelling Older Adults

Abstract The age-associated loss of muscle mass and strength in older adults is called sarcopenia, and it is associated with increased rates of falls, fractures, hospitalizations and death. Sarcopenia is one of the most common physical etiologies for increased frailty in older adults, and some recent work has suggested the use of Point-of care ultrasound (PoCUS) measures as a potential measure of muscle mass. The objective of this study was to examine the association of PoCUS measures of muscle thickness (MT) with measures of frailty in community-dwelling older adults. We recruited 150 older adults (age >= 65; mean age 80.0±0.5 years, 66 women, 84 men) sequentially from 5 geriatric medicine clinics (Vancouver General Hospital). We measured lean muscle mass (LMM, by bioimpedance assay) and an ultrasonic measure of muscle quantity (MT, vastus medialis muscle thickness) in all subjects, as well as two outcome measures of frailty (FFI, Fried Frailty Index; RCFS, Rockwood Clinical Frailty Scale). In our models, MT showed an inverse correlation with the FFI (Standardized β=-0.2320±0.107, p=0.032) but no significant correlation with the RCFS (Standardized β = -0.025±0.086, p=0.776). LMM showed no significant association with either FFI (Standardized β=-0.232±0.120, p=0.055) or RCFS (Standardized β = -0.043±0.119, p=0.719). Our findings indicate that PoCUS measures show potential as a way to screen for physical manifestations of frailty and might be superior to other bedside methods such as bioimpedance assay. However, PoCUS measures of muscle thickness will likely miss patients showing frailty in the much broader context captured by the RCFS.

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Clinical Frailty Assessment and Formal Frailty Testing—Clinical Decision Making in Severe Coronary and Valvular Heart Disease

Heart Lung and Circulation ◽

10.1016/j.hlc.2013.04.029 ◽

2013 ◽

Vol 22 (7) ◽

pp. 559

Author(s):

F. Gudex ◽

G. Willox ◽

G. Smith ◽

A. Chataline ◽

P. Ruygrok ◽

...

Keyword(s):

Decision Making ◽

Heart Disease ◽

Valvular Heart Disease ◽

Clinical Decision Making ◽

Clinical Decision ◽

Frailty Assessment

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Impact of valvular heart disease on activities of daily living of nonagenarians: the leiden 85-plus study a population based study

BMC Geriatrics ◽

10.1186/1471-2318-10-17 ◽

2010 ◽

Vol 10 (1) ◽

Cited By ~ 15

Author(s):

Thomas van Bemmel ◽

Victoria Delgado ◽

Jeroen J Bax ◽

Jacobijn Gussekloo ◽

Gerard J Blauw ◽

...

Keyword(s):

Heart Disease ◽

Activities Of Daily Living ◽

Valvular Heart Disease ◽

Daily Living ◽

Population Based ◽

Population Based Study

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251 The frailty in major trauma study (FRAIL-T): feasibility of nurse lead frailty assessment in elderly trauma and the impact on outcomes

Emergency Medicine Journal ◽

10.1136/emj-2020-rcemabstracts.30 ◽

2020 ◽

Vol 37 (12) ◽

pp. 840.2-840

Author(s):

Heather Jarman ◽

Robert Crouch ◽

Mark Baxter ◽

Bebhinn Dillane ◽

Chao Wang ◽

...

Keyword(s):

Best Practice ◽

Major Trauma ◽

Frailty Index ◽

Kappa Statistic ◽

Trauma Team ◽

Trauma Patients ◽

Clinical Frailty Scale ◽

Frailty Assessment ◽

Trauma Population ◽

The Impact

Aims/Objectives/BackgroundFrailty screening for major trauma patients has recently become part of the best practice commissioning tariff within NHS England, yet there is no consensus as to who should carry out this assessment or which tool best identifies frailty in the Emergency Department (ED). As the trauma population ages there is a need for accurate early identification of frailty in the ED to underpin frailty specific major trauma pathways. The primary aim of this study was to determine the feasibility and accuracy of ED nurse-led frailty assessment in patients ≥ 65 years admitted to Major Trauma Centres (MTCs).Methods/DesignA prospective observational study was conducted across five UK MTCs, enrolling 370 participants over nine months. Eligible patients were aged 65 or more requiring trauma team activation. Frailty was assessed in the ED using three different tools: Trauma Specific Frailty Index (TSFI); Clinical Frailty Scale (CFS); PRISMA-7. ED nurse frailty assessment was correlated with Geriatrician assessment within 72 hours of admission using Spearman’s correlation coefficient and kappa statistic for measuring the interrater agreement.Results/ConclusionsComplete frailty assessments were calculated for CFS in 99.4% of patients, PRISMA7 in 95.9% and TSFI in 37.58%. Rates of frailty differed between tools: CFS 32%, PRISMA7 57% and TSFI 92% whilst Geriatrician determined frailty was 37%. In all tools frail patients were older (p<0.001) and falls <2 m were the leading mechanism of injury (p<0.05). CFS showed both strong correlation (rs 0.639,p<0.001) and substantial agreement (kappa 0.637,p<0.001) with Geriatrician assessment within 72 hours of admission.ED nurses can accurately assess older major trauma patients for frailty using the Clinical Frailty Scale. These findings support assessment of frailty in the ED in order to identify patients who would benefit from early frailty specific care.

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