scholarly journals Reversibility of Frailty after Lung Transplantation

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Elyn Montgomery ◽  
Peter S. Macdonald ◽  
Phillip J. Newton ◽  
Sungwon Chang ◽  
Kay Wilhelm ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Handgrip Strength ◽  
Rehabilitation Program ◽  
Morbidity And Mortality ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Frailty Assessment ◽  
Frail Patients ◽  
Lung Transplants ◽  
Frailty Score

Background. Frailty contributes to increased morbidity and mortality in patients referred for and undergoing lung transplantation (LTX). The study aim was to determine if frailty is reversible after LTX in those classified as frail at LTX evaluation. Methods. Consecutive LTX recipients were included. All patients underwent modified physical frailty assessment during LTX evaluation. For patients assessed as frail, frailty was reassessed on completion of the post-LTX rehabilitation program. Frailty was defined by the presence of ≥ 3 domains of the modified Fried Frailty Phenotype (mFFP). Results. We performed 166 lung transplants (frail patients, n = 27, 16%). Eighteen of the 27 frail patients have undergone frailty reassessment. Eight frail patients died, and one interstate recipient did not return for reassessment. In the 18 (66%) patients reassessed, there was an overall reduction in their frailty score post-LTX ((3.4 ± 0.6 to 1.0 ± 0.7), p<0.001) with 17/18 (94%) no longer classified as frail. Improvements were seen in the following frailty domains: exhaustion, mobility, appetite, and activity. Handgrip strength did not improve posttransplant. Conclusions. Physical frailty was largely reversible following LTX, underscoring the importance of considering frailty a dynamic, not a fixed, entity. Further work is needed to identify those patients whose frailty is modifiable and establish specific interventions to improve frailty.

scholarly journals Weak Handgrip at Index Admission for Acute Exacerbation of COPD Predicts All-Cause 30-Day Readmission

2021 ◽  
Vol 8 ◽  
Author(s):  
Leah J. Witt ◽  
W. Alexandra Spacht ◽  
Kyle A. Carey ◽  
Vineet M. Arora ◽  
Steven R. White ◽  
...  
Keyword(s):  
Grip Strength ◽  
Handgrip Strength ◽  
General Medicine ◽  
Predictive Biomarker ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Academic Center ◽  
Acute Exacerbations ◽  
Exacerbation Of Copd ◽  
The University

Rationale: Identifying patients hospitalized for acute exacerbations of COPD (AECOPD) who are at high risk for readmission is challenging. Traditional markers of disease severity such as pulmonary function have limited utility in predicting readmission. Handgrip strength, a component of the physical frailty phenotype, may be a simple tool to help predict readmission.Objective(s): To investigate if handgrip strength, a component of the physical frailty phenotype and surrogate for weakness, is a predictive biomarker of COPD readmission.Methods: This was a prospective, observational study of patients admitted to the inpatient general medicine unit at the University of Chicago Medicine, US. This study evaluated age, sex, ethnicity, degree of obstructive lung disease by spirometry (FEV1 percent predicted), and physical frailty phenotype (components include handgrip strength and walk speed). The primary outcome was all-cause hospital readmission within 30 days of discharge.Results: Of 381 eligible patients with AECOPD, 70 participants agreed to consent to participate in this study. Twelve participants (17%) were readmitted within 30 days of discharge. Weak grip at index hospitalization, defined as grip strength lower than previously established cut-points for sex and body mass index (BMI), was predictive of readmission (OR 11.2, 95% CI 1.3, 93.2, p = 0.03). Degree of airway obstruction (FEV1 percent predicted) did not predict readmission (OR 1.0, 95% CI 0.95, 1.1, p = 0.7). No non-frail patients were readmitted.Conclusions: At a single academic center weak grip strength was associated with increased 30-day readmission. Future studies should investigate whether geriatric measures can help risk-stratify patients for likelihood of readmission after admission for AECOPD.

scholarly journals Principles and Issues for Physical Frailty Measurement and Its Clinical Application

2019 ◽  
Vol 75 (6) ◽  
pp. 1107-1112 ◽  
Author(s):  
Karen Bandeen-Roche ◽  
Alden L Gross ◽  
Ravi Varadhan ◽  
Brian Buta ◽  
Michelle C Carlson ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Measurement Issues ◽  
Frailty Assessment ◽  
Validity Criterion ◽  
Efficacy Research ◽  
Clinical Considerations ◽  
Dynamic Measures ◽  
Potential Use

Abstract Introduction “Frailty” has attracted attention for its promise of identifying vulnerable older adults, hence its potential use to better tailor geriatric health care. There remains substantial controversy, however, regarding its nature and ascertainment. Recent years have seen a proliferation of frailty assessment methods. We argue that the development of frailty assessments should be grounded in “validation”—the process of substantiating that a measurement accurately and precisely measures what it intends, identify unresolved measurement issues, and highlight measurement-related considerations for clinical practice. Methods Principles for validating frailty measures are elucidated. We follow principles—articulated, for example, by Borsboom—in which a construct must be clearly defined and then analyses undertaken to substantiate that a measurement accurately and precisely measures what it intends. Key elements are content validity, criterion validity, and construct validity, with an emphasis on the latter. Results We illustrate the principles for a physical frailty phenotype construct. Conclusions Unresolved conceptual issues include the roles of intersecting concepts such as cognition, disease severity, and disability in frailty measurement, conceptualization of frailty as a state versus a continuum, and the potential need for dynamic measures and systems concepts in furthering understanding of frailty. Clinical considerations include needs to distinguish interventions designed to address frailty “symptoms” versus underlying physiology, improve “prefrailty” measures intended to screen individuals early in their frailty progression, address feasibility demands, and further visioning followed by rigorous efficacy research to address the landscape of potential uses of frailty assessment in clinical practice.

P0253FRAILTY SCREENING TOOLS, FUNCTIONAL STATUS AND LIFE EXPECTANCY IN ELDERLY PATIENTS WITH PRE-DIALYSIS ADVANCED CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hani Hussien ◽  
Mugurel Apetrii ◽  
Mihai Onofriescu ◽  
Andra Nastasa ◽  
Gabriel Mircea ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Life Expectancy ◽  
Elderly Patients ◽  
Functional Status ◽  
Handgrip Strength ◽  
Assessment Tools ◽  
Frailty Assessment ◽  
Frail Patients ◽  
The Mean ◽  
Physical Tools

Abstract Background and Aims Patients with chronic kidney disease (CKD) are at high risk of being frail, which is associated with poor outcomes including falls, low functional status, decreased quality of life, hospitalization, and mortality. Furthermore, the presence of frailty might decrease the potential benefits of renal replacement therapy initiation or even leads to worse outcomes. Currently, there are over 51 known tools for screening of frailty in the general population. The aim of this study was to describe the prevalence of frailty in elderly patients with pre-dialysis advanced CKD (G4 and G5) according to different frailty assessment tools from the 4 main categories of frailty screening: self-reporting questionnaires, subjective scores, simple single physical tools and complex scores. Also, we compared the functional status and the 10-year survival expectancy in frail Vs non-frail patients. Method In this cross-sectional study, we included patients from the Outpatient Department from Nephrology unit in a tertiary health facility “Dr C. I. Parhon Clinical Hospital’’ who were ≥65 years old with CKD G4–5 (eGFR &lt; 30 ml/min/1.73 m2 using the CKD-EPI formula) on at least two occasions in the previous 3 months prior to the time of inclusion. The frailty was assessed using one method from each frailty screening category: self-reporting score as PRISMA-7, subjective score as Clinical Frailty Scale (CFS), a complex score as Frailty Phenotype (FP) and two simple single physical tools as gait speed in 4.5 meters (GS) and handgrip strength using a dynamometer (HGS). All participants had the Charlson Comorbidity Index (CCI) score calculated and the Karnofsky Performance Status Scale (KPS) performed. Results We included a total number of 201 patients, of which 53.23 % were males with a mean age of 73.9 ± 6.8 years. Mean eGFR was 19 ± 6.21 ml/min/1.73 m2. Using the three proposed scores, 69.15% of patients were at risk of frailty using PRISMA-7, compared to 45.77% and 40.3% who were frail according to CFS and FP respectively. HGS was weak in 51.74% of the patients while only 35.82% had slow GS. Half of the patients (50.25 %) had a Karnofsky score of ≤ 60, which corresponds to different degrees of losing autonomy. Comparing functional status in frail Vs. non-frail patients, we found that the mean KPS points for non-frail patients was similar regardless of the used tool: 73 according to FP, 75 according to CFS and 76 points according to PRISMA 7. Same results were obtained in patients with normal GS or with a normal HGS with mean KPS of 71 points. The 10-year survival expectancy was significantly lower in frail patients with similar mean values: 20% for both CFS and FP and 26 % for PRISMA-7, compared to non-frail patients with a predicted survival of 43% for CFS, 41% for FP and 47% for PRISMA-7. Similarly, in patients with slow GS and weak HGS, the mean CCI was 24 % for both groups, in comparison with 42% and 37 % in patients with normal HGS and normal GS respectively. Conclusion To the best of our knowledge, this is the first study to compare five frailty assessment tools in terms of functional status and life expectancy in elderly patients with pre-dialysis advanced CKD, but taking into consideration that those tools must be from different frailty assessment categories. Our study has shown that non-frail elderly patients with pre-dialysis advanced CKD have enjoyed a significantly higher degree of autonomy as well as higher 10-year survival expectancy in comparison with frail patients. The proposed frailty assessment tools have shown very close results in terms of functional status and life expectancy regardless of the complexity of the tool being used. Therefore, we suggest that using a simple self-reporting tool as PRISMA-7 or a simple single physical tool like handgrip strength or gait speed would be appropriate for screening of frailty in elderly patients with pre-dialysis advanced CKD who are at a high risk of losing autonomy and lower life expectancy.

Validation of frailty assessment batteries in relation to prognosis in older patients with cardiovascular disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Marinus ◽  
P Dendale ◽  
P Feys ◽  
R Meesen ◽  
A Timmermans ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Older Patients ◽  
Assessment Tool ◽  
Handgrip Strength ◽  
Mini Nutritional Assessment ◽  
Test Battery ◽  
Dominant Hand ◽  
Frailty Assessment ◽  
Frail Patients ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background Frailty is accompanied by, or can be caused by, a combination of several physical, psychosocial and cognitive problems, and is highly prevalent in older patients with cardiovascular disease (CVD). However, different frailty assessment batteries (e.g. Fried and Vigorito) remain to be compared in terms of prognosis, as well as the subcomponents within those batteries. Purpose To examine which frailty measurements contribute to the prediction of frailty in CVD patients, and prognosis, and thus should be executed in clinical settings. Methods In 133 CVD patients (mean age 78.1 ± 6.7 years) the presence of frailty was examined by the Fried criteria and compared with the outcome from the multi-component frailty assessment tool of Vigorito including the Mini Nutritional Assessment (MNA), Katz-scale, 4.6 m gait speed, Timed Up and Go Test (TUG), handgrip strength, Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and number of medications. Additional tests were executed to further enhance the prediction of frailty. Patients were followed to register hospitalisations (general and urgent) and mortality up to 6 months after the frailty assessment. First, it was then analysed whether the Fried or Vigorito test battery would equally predict complications during follow-up, and secondly a new frailty test battery was developed with evaluation towards complication risk predictions. Results According to the tool of Vigorito, significantly more CVD patients suffered from minor vs. moderate frailty (34% vs. 10%, p &lt; 0.001) while the Phenotype of Fried did not succeed in detecting any significant difference in the number of pre-frail vs. frail patients (26% vs. 38%, p = 0.11). Moreover, the largest part of the pre-frail patients of Fried seems to be not frail according to Vigorito and the frail patients of Fried seems to be mainly minor frail according to Vigorito. Significant associations were found between hospitalisations and frailty according to Fried while mortality was significantly associated with frailty according to Vigorito and the newly developed formula (p = 0.013). Finally, based on the multivariate regression model (R2 = 0.95), sex, MNA, Katz scale, TUG, handgrip strength (dominant hand), MMSE, GDS-15, total number of medications and the interaction effect between the Katz-scale and TUG should be assessed to detect frailty.  Based on these  parameters, a new formula to detect frailty was developed (r = 0.95 with Vigorito score, p &lt; 0.001). Conclusions In comparison with the frailty assessment tool of Vigorito, the Fried criteria may overestimate frailty and its severity. Moreover, frailty seems to be significantly associated with 6-months hospitalisations as well as with mortality. The newly developed frailty assessment battery has the potential to detect frailty in a multidimensional way, and, moreover, to predict mortality.

Association between physical frailty and inflammation in late-life depression

2016 ◽  
Vol 33 (S1) ◽  
pp. S84-S85
Author(s):  
M. Arts ◽  
R. Collard ◽  
H. Comijs ◽  
P. Naudé ◽  
R. Risselada ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Gait Speed ◽  
Inflammatory Markers ◽  
Handgrip Strength ◽  
Low Grade ◽  
Late Life Depression ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Low Grade Inflammation

IntroductionAlthough the criteria for physical frailty and depression partly overlap, both represent unique, but reciprocally related constructs. The association between inflammation and frailty has been reported consistently, in contrast to the association between inflammation and late-life depression (LLD).Aim and objectivesTo determine whether physical frailty is associated with low-grade inflammation in LLD.MethodsThe physical frailty phenotype, defined as three out of five criteria (weight loss, weakness, exhaustion, slowness, low physical activity level), and three inflammatory markers [C-reactive protein (CRP), interleukin-6 (IL-6), and neutrophil gelatinase–associated lipocalin (NGAL)] were assessed in a sample of individuals aged 60 and older with depression according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (n = 366).ResultsThe physical frailty phenotype was not associated with inflammatory markers in linear regression models adjusted for sociodemographic characteristics, lifestyle characteristics, and somatic morbidity. Of the individual criteria, handgrip strength was associated with CRP and IL-6, and gait speed was associated with NGAL. Principal component analysis identified two dimensions within the physical frailty phenotype: performance-based physical frailty (encompassing gait speed, handgrip strength, and low physical activity) and vitality-based physical frailty (encompassing weight loss and exhaustion). Only performance-based physical frailty was associated with higher levels of inflammatory markers.ConclusionThe physical frailty phenotype is not a unidimensional construct in individuals with depression. Only performance-based physical frailty is associated with low-grade inflammation in LLD, which might point to a specific depressive subtype.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Frailty, with or without Cognitive Impairment, is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults

2021 ◽  
Author(s):  
Mei-Ling Ge ◽  
Eleanor M Simonsick ◽  
Bi-Rong Dong ◽  
Judith D Kasper ◽  
Qian-Li Xue
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Strong Predictor ◽  
Word Recall ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Clock Drawing Test ◽  
Recurrent Falls ◽  
Health Aging ◽  
Marginal Means

Abstract Background Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults. Methods The analysis included 6000 older adults in community or non-nursing home residential care settings who were ≥65 years and participated in the National Health Aging Trends Study (NHATS). Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of clock drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score≥ 2. The marginal means/rates models were used to analyze the associations of frailty (by the physical frailty phenotype) and cognitive impairment with recurrent falls over 6 years follow-up (2012-2017). Results Of the 6000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: Rate ratio (RR)=1.31, 95% confidence interval (CI)=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR=1.07, 95% CI=1.00-1.13). Conclusions Frailty and cognitive impairment were independently associated with recurrent falls in non-institutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment.

scholarly journals Dairy Product Intake and Long-Term Risk for Frailty among French Elderly Community Dwellers

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2151
Author(s):  
Berna Rahi ◽  
Hermine Pellay ◽  
Virginie Chuy ◽  
Catherine Helmer ◽  
Cecilia Samieri ◽  
...  
Keyword(s):  
Older Adults ◽  
Dairy Product ◽  
Food Group ◽  
Community Dwelling ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Cross Sectional ◽  
Sectional Analysis ◽  
Community Dwelling Older Adults

Dairy products (DP) are part of a food group that may contribute to the prevention of physical frailty. We aimed to investigate DP exposure, including total DP, milk, fresh DP and cheese, and their cross-sectional and prospective associations with physical frailty in community-dwelling older adults. The cross-sectional analysis was carried out on 1490 participants from the Three-City Bordeaux cohort. The 10-year frailty risk was examined in 823 initially non-frail participants. A food frequency questionnaire was used to assess DP exposure. Physical frailty was defined as the presence of at least 3 out of 5 criteria of the frailty phenotype: weight loss, exhaustion, slowness, weakness, and low physical activity. Among others, diet quality and protein intake were considered as confounders. The baseline mean age of participants was 74.1 y and 61% were females. Frailty prevalence and incidence were 4.2% and 18.2%, respectively. No significant associations were observed between consumption of total DP or DP sub-types and frailty prevalence or incidence (OR = 1.40, 95%CI 0.65–3.01 and OR = 1.75, 95%CI 0.42–1.32, for a total DP consumption >4 times/d, respectively). Despite the absence of beneficial associations of higher DP consumption on frailty, older adults are encouraged to follow the national recommendations regarding DP.

“Hybrid Lung Transplantation” Combining Living Donor and Cadaveric Lung Transplants: Report of 2 Cases

2021 ◽  
Author(s):  
Takeshi Kurosaki ◽  
Takahiro Oto ◽  
Shinji Otani ◽  
Kentaroh Miyoshi ◽  
Seiichiro Sugimoto ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Living Donor ◽  
Lung Transplants

scholarly journals Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 777-777
Author(s):  
Qian-Li Xue ◽  
Kristine Ensrud ◽  
Shari Lin
Keyword(s):  
Cohort Studies ◽  
Healthcare Utilization ◽  
Risk Adjustment ◽  
Healthcare Services ◽  
Self Report ◽  
Added Value ◽  
Care Organization ◽  
Frailty Phenotype ◽  
Frailty Assessment ◽  
The Impact

Abstract As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.

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