Assessing Frailty in the General Medical Clinic of a Tertiary Hospital in Northern Malaysia: The FRAIL Scale or the Clinical Frailty Scale

Background. Frailty potentially influences clinicians’ decision making on treatment provided they can select the appropriate assessment tools. This study aims to investigate the difference between the FRAIL scale and the Clinical Frailty Scale (CFS) in assessing frailty among community-dwelling older adults attending the General Medical Clinic (GMC) in Seberang Jaya Hospital, Penang, Malaysia. Methods. The medical records of 95 older patients (age ≥ 65) who attended the GMC from 16 December 2019 to 10 January 2020 were reviewed. Frailty was identified using the FRAIL scale and the CFS. Patient characteristics were investigated for their association with frailty and their difference in the prevalence of frailty by the FRAIL scale and CFS. Results. The CFS identified nonsignificant higher prevalence of frailty compared to the FRAIL scale (21/95; 22.1% vs. 17/95; 17.9%, ratio of prevalence = 1.235, p = 0.481 ). Minimal agreement was found between the FRAIL scale and the CFS (Kappa = 0.272, p < 0.001 ). Three out of 5 components of the FRAIL scale (resistance, ambulation, and loss of weight) were associated with frailty by the CFS. Higher prevalence of frailty was identified by the CFS in those above 70 years of age. The FRAIL scale identified more patients with frailty in ischaemic heart disease patients. Conclusion. Patient characteristics influenced the choice of the frailty assessment tool. The FRAIL scale and the CFS may complement each other in providing optimized care to older patients who attended the GMC.

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What you need to know about malnutrition in older adults

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0393 ◽

2020 ◽

Vol 81 (9) ◽

pp. 1-8

Author(s):

Kerry Cheah ◽

Amy Illsley

Keyword(s):

Older Patients ◽

Nutritional Assessment ◽

Adult Population ◽

Management Strategies ◽

Community Dwelling ◽

Nursing Home Care ◽

Assessment Tools ◽

Ageing Population ◽

Age Related ◽

Older Adult Population

Malnutrition is the disturbance of normal form or function, arising from the deficiency of one or more nutrients, and is a significant issue in the older adult population. Despite their reduced energy requirements, older patients need the same protein intake and micronutrients as younger patients, but age-related changes may impact the ability to meet these requirements. The cause of malnutrition in individuals is likely to be multifactorial and can therefore be complex to manage. Adequate nutrition is important for both community dwelling patients and inpatients, as malnutrition increases the risk of complications and the likelihood of needing residential or nursing home care on discharge. This article discusses the risk factors for the development of malnutrition in older patients and the different nutritional assessment tools available. Management strategies for optimising nutrition can be divided into systems and supplementation. With an ageing population, most doctors will inevitably become increasingly involved with treating older patients and this article highlights the need to consider a patient's nutritional status. Nutrition should be considered during every ward round and the multidisciplinary team as a whole should maintain an awareness and responsibility for managing malnutrition.

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ADOLESCENT GYNECOLOGY—A 5-YEAR STUDY

PEDIATRICS ◽

10.1542/peds.25.4.669 ◽

1960 ◽

Vol 25 (4) ◽

pp. 669-677

Author(s):

Felix P. Heald ◽

Somers H. Sturgis

Keyword(s):

Adolescent Girls ◽

Clinical Characteristics ◽

Adult Women ◽

Medical Clinic ◽

The Difference ◽

General Medical Clinic ◽

Adolescent Gynecology ◽

Type Of Management

One hundred thirty-six girls were seen in 5 years by the consultant in gynecology in a general medical clinic devoted to adolescents. The primary diagnoses were classified in seven categories, the clinical characteristics of which have been presented briefly. In the discussion two points were emphasized: a) the difference in incidence and etiology of certain gynecologic complaints, and b) the indications for a different type of management in adolescent girls as compared to adult women.

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496 NON-RANDOMISED FEASIBILITY STUDY OF THE REHABILITATION POTENTIAL ASSESSMENT TOOL (REPAT) IN FRAIL OLDER PEOPLE IN ACUTE SETTING

Age and Ageing ◽

10.1093/ageing/afab118.06 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii5-ii7

Author(s):

A Cowley ◽

S E Goldberg ◽

A L Gordon ◽

P A Logan

Keyword(s):

Older People ◽

Feasibility Study ◽

Assessment Tool ◽

Occupational Therapists ◽

Patient Characteristics ◽

Structured Interviews ◽

Clinical Frailty Scale ◽

Mean Values ◽

Rehabilitation Potential ◽

Acute Hospitals

Abstract Introduction Clinicians are often required to decide about patients’ potential to respond to rehabilitation. ‘Rehabilitation potential’ can determine what services patients can access. In acute hospitals clinicians have limited time to assess and deliver rehabilitation which takes into account the complexities of frailty and ageing. We set out to evaluate whether the Rehabilitation Potential Assessment Tool (RePAT)—a 15 item assessment tool and training package which emphasises person-centred approaches—was feasible and could aid rehabilitation decisions. Method A non-randomised feasibility study with nested semi-structured interviews, set in the acute hospital, explored whether RePAT was deliverable and acceptable to staff, patient and carers. A maximum variation sample of physiotherapists and occupational therapists was recruited. Patient and carer participants were recruited from Healthcare of Older People wards. Staff and patient characteristics were summarised using descriptive statistics. Interview data were analysed thematically. Fidelity of completed RePAT items was assessed on how closely they matched tool guidance by two reviewers. Mean values of the two scores were calculated. Results Six staff participants were recruited and trained, and assessed a total of 26 patient participants using RePAT. Mean patient age was 86.16 (±6.39) years. 32% were vulnerable or mildly frail, 42% moderately frail and 26% severely or very severely frail using the Clinical Frailty Scale. Mean time to complete RePAT was 32.7 (±9.6) minutes. 13 out of 15 RePAT items achieved fidelity. RePAT was acceptable and tolerated by staff and patients. Staff participants reported RePAT enabled them to consider the complex and dynamic nature of rehabilitation decisions in a more structured and consistent way. Conclusion RePAT was found to be acceptable and tolerated by staff, carers and patients. It allowed clinicians to make explicit their reasoning behind rehabilitation potential decision-making and encouraged them to become more cognisant of ethical dilemmas and biases.

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A Systematic Review of the Guidelines and Delphi Study for the Multifactorial Fall Risk Assessment of Community-Dwelling Elderly

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176097 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6097

Author(s):

Jieun Kim ◽

Worlsook Lee ◽

Seon Heui Lee

Keyword(s):

Systematic Review ◽

Risk Assessment ◽

Delphi Study ◽

Fall Risk ◽

Assessment Tool ◽

The Elderly ◽

Community Dwelling ◽

Assessment Tools ◽

Risk Assessment Tool ◽

Fall Risk Assessment

As falls are among the most common causes of injury for the elderly, the prevention and early intervention are necessary. Fall assessment tools that include a variety of factors are recommended for preventing falls, but there is a lack of such tools. This study developed a multifactorial fall risk assessment tool based on current guidelines and validated it from the perspective of professionals. We followed the Meta-Analysis of Observational Studies in Epidemiology’s guidelines in this systematic review. We used eight international and five Korean databases to search for appropriate guidelines. Based on the review results, we conducted the Delphi survey in three rounds; one open round and two scoring rounds. About nine experts in five professional areas participated in the Delphi study. We included nine guidelines. After conducting the Delphi study, the final version of the “Multifactorial Fall Risk Assessment tool for Community-Dwelling Older People” (MFA-C) has 36 items in six factors; general characteristics, behavior factors, disease history, medication history, physical function, and environmental factors. The validity of the MFA-C tool was largely supported by various academic fields. It is expected to be beneficial to the elderly in the community when it comes to tailored interventions to prevent falls.

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Frailty Scores and Their Utility in Older Patients with Cardiovascular Disease

Interventional Cardiology Review ◽

10.15420/icr.2020.18 ◽

2021 ◽

Vol 16 ◽

Author(s):

Kenneth Jordan Ng Cheong Chung ◽

Chris Wilkinson ◽

Murugapathy Veerasamy ◽

Vijay Kunadian

Keyword(s):

Cardiovascular Disease ◽

Older Patients ◽

Assessment Tool ◽

Assessment Tools ◽

Clinical Settings ◽

Transcatheter Aortic Valve ◽

Frailty Assessment ◽

Growing Body ◽

Aortic Valve Implantation ◽

Valve Implantation

The world’s population is ageing, resulting in more people with frailty receiving treatment for cardiovascular disease (CVD). The emergence of novel interventions, such as transcatheter aortic valve implantation, has also increased the proportion of older patients being treated in later stages of life. This increasing population burden makes the assessment of frailty of utmost importance, especially in patients with CVD. Despite a growing body of evidence on the association between frailty and CVD, there is no consensus on the optimal frailty assessment tool for use in clinical settings. Previous studies have shown limited concordance between validated frailty instruments. This review evaluates the evidence on the utility of frailty assessment tools in patients with CVD, and the effect of frailty on different outcomes measured.

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Development of Lean Assessment Tools Dimensions and Indicators For SMEs in Indonesia

PROZIMA (Productivity Optimization and Manufacturing System Engineering) ◽

10.21070/prozima.v5i1.1426 ◽

2021 ◽

Vol 5 (1) ◽

pp. 21-29

Author(s):

David Dwi Harjanto ◽

Putu Dana Karningsih

Keyword(s):

Lean Manufacturing ◽

Manufacturing Industry ◽

Assessment Tool ◽

Assessment Tools ◽

Lean Implementation ◽

Lean Assessment ◽

The World ◽

Small Industry ◽

The Difference

In advance, the lean concept was used and applicated for big manufacturing industry. However, the lean concept used widely for all kinds of industry in the world. The improvement practice as lean and JIT also used for small industry (SMEs) in any countries which have implemented lean. The SMEs which have implemented lean showed any improvement, as the increasing of efficiency and flexibility, clear of communication and close with the Customers so the response and feedback are quicker and the costs are lower. The lean assessment tools used to value the effectiveness and the efficiency from lean implementation in the certain industry. The development of lean assessment tool for SMEs done by considering the difference between SMEs characteristic with industry a big scale. Have been many studies development of lean assessment to measure lean implementation in manufacturing industry and service generally without considered the size of his industry. However there are just a few development of lean assessment tools study that specific to measure the implementation lean manufacturing on SMEs. Therefore, this study aims to collect and compare the dimensions and indicators of the Lean Assessment Tool from several countries that are suitable for use in manufacture SMEs in Indonesia.

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Geriatric Assessments Can Predict Functional Outcome and Mortality after Urological Tumor Surgery

Urologia Internationalis ◽

10.1159/000518978 ◽

2021 ◽

pp. 1-10

Author(s):

Andreas Kahlmeyer ◽

Christian Fiebig ◽

Marco Mueller ◽

Matthias Kraulich ◽

Jonas Brendel-Suchanek ◽

...

Keyword(s):

Geriatric Assessment ◽

Functional Recovery ◽

Functional Outcomes ◽

Older Patients ◽

Assessment Tool ◽

Assessment Tools ◽

High Grade ◽

Tumor Surgery ◽

Care Dependency ◽

Complications And Mortality

Introduction: Older patients undergoing major urological tumor surgery are at severe risk of functional deterioration, complications, and mortality. We prospectively evaluated geriatric assessment tools and developed a novel easy-to-use assessment tool for clinical use. Methods: In 159 patients, geriatric assessment tools were used prior to cystectomy, prostatectomy, and renal tumor surgery, and their peri- and postoperative courses were recorded. Using all the tests, a short and easy-to-use assessment tool was developed, and nomograms were generated to predict functional outcomes and mortality. Results: Of all the patients, 13.8% underwent radical cystectomy, 37.7% underwent radical prostatectomy, and 48.4% underwent tumor surgery of the kidney at the age of 70 years or older. The average age was 75.6 years. Incomplete functional recovery at day 30 and day 180 was observed in 37.7% and 36.1% of the patients, respectively, and incomplete functional recovery was associated with impaired mobility, previous care dependency, frailty, comorbidities, and a high ASA score. The only predictor for high-grade complications was comorbidities, whereas mortality was associated with the geriatric screening tool scores, impaired mobility, preoperative care dependency, and comorbidities. The Erlangen Index (EI), a combination of the selected assessment tools, showed a good prediction of early (p = 0.002) and medium-term (p = 0.002) functional outcomes and mortality (p = 0.001). Conclusion: Our prospective evaluation confirms the high risk of incomplete functional recovery, high-grade complications, and mortality in older patients undergoing major urological tumor surgery. The EI is an easy-to-use preoperative assessment tool and therefore should be used in preoperative patient counseling.

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