scholarly journals Validation of “(fr)AGILE”: a quick tool to identify multidimensional frailty in the elderly

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ilaria Liguori ◽  
Gennaro Russo ◽  
Giulia Bulli ◽  
Francesco Curcio ◽  
Veronica Flocco ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Area Under Curve ◽  
Frailty Index ◽  
The Elderly ◽  
Assessment Instruments ◽  
Reliable Assessment ◽  
Administration Time ◽  
Long Time ◽  
Time Of Administration

Abstract Background Several tools have been proposed and validated to operationally define frailty. Recently, the Italian Frailty index (IFi), an Italian modified version of Frailty index, has been validated but its use in clinical practice is limited by long time of administration. Therefore, the aim of this study was to create and validate a quick version of the IFi (AGILE). Methods Validation study was performed by administering IFi and AGILE, after a Comprehensive Geriatric Assessment (CGA) in 401 subjects aged 65 or over (77 ± 7 years). AGILE was a 10-items tool created starting from the more predictive items of the four domains of frailty investigated by IFi (mental, physical, socioeconomic and nutritional). AGILE scores were stratified in light, moderate and severe frailty. At 24 months of follow-up, death, disability (taking into account an increase in ADL lost ≥1 from the baseline) and hospitalization were considered. Area under curve (AUC) was evaluated for both IFi and AGILE. Results Administration time was 9.5 ± 3.8 min for IFi administered after a CGA, and 2.4 ± 1.2 min for AGILE, regardless of CGA (p < 0.001). With increasing degree of frailty, prevalence of mortality increased progressively from 6.5 to 41.8% and from 9.0 to 33.3%, disability from 16.1 to 64.2% and from 22.1 to 59.8% and hospitalization from 17.2 to 58.7% and from 27.0 to 52.2% with AGILE and IFi, respectively (p = NS). Relative Risk for each unit of increase in AGILE was 56, 44 and 24% for mortality, disability and hospitalization, respectively and was lower for IFi (8, 7 and 4% for mortality, disability and hospitalization, respectively). The AUC was higher in AGILE vs. IFi for mortality (0.729 vs. 0.698), disability (0.715 vs. 0.682) and hospitalization (0.645 vs. 0.630). Conclusions Our study shows that AGILE is a rapid and effective tool for screening multidimensional frailty, able to predict mortality, disability and hospitalization, especially useful in care settings that require reliable assessment instruments with short administration time.

scholarly journals 315 Cardiac surgery in the elderly: the underestimate role of frailty in the decision making

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Pasquale Campana ◽  
Maddalena Conte ◽  
Maria Emiliana Palaia ◽  
Laura Petraglia ◽  
Adele Ferro ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Frailty Index ◽  
The Elderly ◽  
Risk Scores ◽  
Surgical Risk ◽  
The Impact

Abstract Aims Elders represent the most common population with indication to cardiac surgery, also presenting the highest mortality/disability after interventions. Both for valve and coronary artery surgery the estimation of the surgical risk, including the frailty assessment, is recommended to guide the decision making. However, frailty results not exhaustively assessed by the commonly used surgical risk scores such as EuroSCORE I-II and score of the Society of Thoracic Surgeons and is mostly used the Kat’s Index (included in the latest European guidelines). This study aims at establishing the feasibility and the value of a Comprehensive Geriatric Assessment (CGA) in elderly undergoing cardiac surgery. Methods From June 2021we consecutively enrolled 50 elderly patients undergoing cardiac surgery (age &gt; 65 years old). All patients underwent CGA with an expert geriatrician and the demographic, biometrics, clinical and echocardiographic data were collected. We evaluated frailty and disability (Kats index, Barthel Index and Frailty Index FI), cognitive status (Montreal Cognitive Assessment MOCA, Mini Mental State Examination MMSE and Geriatric Depression Scale), physical status (Tinetti test, Short Performance Physical Battery SPPB, Physical Activity Scale for the Elderly PASE and 6-min Walking test), delirium condition, sarcopenia and nutritional status (Mini-Nutritional Assessment MNA). A clinical, echocardiographic, and geriatric 3-month follow-up is planned. In particular, we are evaluating the impact of frailty, assessed by CGA, on peri-surgical outcome and the potential additive value of a CGA on the commonly used surgical risk-scores and Kat’s Index. Furthermore, we are assessing the impact of cardiac surgery of frail elderly at GCA. Results The CGA was feasible in all patients and lasted 1 h/patient. In our baseline data, only 23% of the enrolled patients resulted ‘frail’ according to Kat’s Index. However, in the remaining 77% of the study population, the CGA have identified 30% of patients with increased frailty index and 30% with disability, assessed by Barthel Index and physical function indexes (PASE and SPPB). In these patient, frailty and disability were associated to impaired nutritional status, assessed at MNA. Furthermore, 40% of the patients of this group resulted sarcopenic at the hand grip test. The cognitive valuation has shown a cognitive impairment in the 20% of patients at the MMSE and the 70 % at the MOCA. Of note, the 40% of the patients resulted to suffer of depression, not diagnosed before the GCA. At mid-November 2021 the follow-up will be completed. Conclusions The preliminary results of the presents study suggest that in patients undergoing cardiac surgery frailty is currently underdiagnosed. The follow-up analysis will establish if a CGA has an additive value on common surgical risk estimators. This study has a potential impact on the risk stratification of elderly patients undergoing invasive procedures and defines the need of a geriatrician in the heart team.

Depression and cognitive impairment in the elderly: a multicentre study

1995 ◽  
Vol 10 (2) ◽  
pp. 61-74 ◽  
Author(s):  
P Kielholz ◽  
C Adams ◽  
P Bech ◽  
JP Bocksberger ◽  
A Crombecque ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
The Elderly ◽  
Self Report ◽  
World Health ◽  
Control Group ◽  
Assessment Instruments ◽  
Reliable Assessment ◽  
Standard Manner ◽  
Clinically Significant ◽  
Health Organization

SummaryThe present study, conducted in collaboration between the Departments of Psychiatry in Swiss Universities and the World Health Organization, had two main goals: to develop assessment methods which could subsequently be used in the Swiss centres in a standard manner; and to make arrangements for continuing collaboration between the centres in Switzerland and the acquisition of new knowledge about the distinctions between depression and cognitive impairment. For this aim, three different groups of elderly patients of either sex were selected during the period of November 1989 to July 1991 for inclusion in the study. The first two groups included the first ten patients of either sex over 60 years of age consecutively contacting the participating institutions and showing depression with or without clinically significant symptoms of cognitive impairment; the control group included patients showing no depression or clinically significant symptoms of cognitive impairment. A total of 125 patients were included in the initial evaluation, 69 of which were reassessed at a seven-month follow up (on average). Each patient was administered a number of clinician-rated or self-report instruments for the assessment of depression, cognitive impairment, disabilities, physical status and onset of disorders. The study has shown that a variety of instruments can be used for the reliable assessment of depression or cognitive impairment in the elderly; but the instruments for the assessment of depression differentiate only poorly between patients with or without cognitive impairment. Because of the importance of identifying both depressed and cognitively impaired patients among the elderly, different assessment instruments targeted at the different symptom clusters need to be administered simultaneously.

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Evaluation of R-CHOP and R-CVP in the treatment of elderly patient with non-Hodgkin lymphoma

MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 1-6
Author(s):  
Truc Phan ◽  
Tram Huynh ◽  
Tuan Q. Tran ◽  
Dung Co ◽  
Khoi M. Tran
Keyword(s):  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
The Elderly ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Common Sign ◽  
Related Mortality

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam. Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed. Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens. Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.

Automatic Remote Monitoring of Implantable Cardiac Devices in Clinical Practice – The Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) Trial

2010 ◽  
Vol 6 (3) ◽  
pp. 87
Author(s):  
Niraj Varma ◽  
Keyword(s):  
Clinical Practice ◽  
Remote Monitoring ◽  
Home Monitoring ◽  
Implantable Devices ◽  
Cardiac Device ◽  
Cardiac Devices ◽  
Enhance Patient Safety ◽  
Implantable Cardiac Devices ◽  
Post Implantation

The use of implantable electronic cardiac devices is increasing. Post-implantation follow-up is important for monitoring both device function and patient condition; however, clinical practice is inconsistent. For example, implantable cardioverter–defibrillator follow-up schedules vary from every three months to yearly according to facility and physician preference and the availability of resources. Importantly, no surveillance occurs between follow-up visits. By contrast, implantable devices with automatic remote monitoring capability provide a means for performing constant surveillance, with the ability to identify salient problems rapidly. The Lumos-T Reduces Routine Office Device Follow-up Study (TRUST) demonstrated that remote home monitoring reduced clinic burden and allowed early detection of patient and/or system problems, enabling efficient monitoring and an opportunity to enhance patient safety. The results of the trial have significant implications for the management of patients receiving all forms of implantable electronic cardiac device.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

Sign in / Sign up

Export Citation Format

Share Document