Frailty-aware care: giving value to frailty assessment across different healthcare settings

AbstractHealthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at increased risk for adverse health outcomes. Furthermore, frailty assessments offer an opportunity to optimize patient care in various healthcare settings. While the vast number of frailty assessment tools available can be a source of confusion for clinicians, each tool has features adaptable to the constraints and goals of different healthcare settings. This review discusses and compares barriers, facilitators, and the application of frailty assessments in primary care, the emergency department/intensive care unit and surgical care to cover a breadth of settings with different frailty assessment considerations. The implementation of frailty-aware care across healthcare settings potentiates better healthcare outcomes for older adults.

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Are trainees working in obstetrics and gynecology confident and competent in the care of frail gynecological oncology patients?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001834 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1959-1965

Author(s):

Gemma Louise Owens ◽

Vanitha Sivalingam ◽

Mohamed Abdelrahman ◽

James P Beirne ◽

Dominic Blake ◽

...

Keyword(s):

Unmet Need ◽

Assessment Tools ◽

Obstetrics And Gynecology ◽

Team Approach ◽

Oncology Patients ◽

Diagnostic Features ◽

Gynecological Oncology ◽

Frailty Assessment ◽

Increased Risk ◽

Operative Complications

IntroductionOlder patients undergoing cancer surgery are at increased risk of post-operative complications, prolonged hospital stay, and mortality. Identification of frailty can help predict patients at high risk of peri-operative complications and allow a collaborative, multidisciplinary team approach to their care. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynecology regarding identification and management of peri-operative issues encountered in frail gynecological oncology patients.MethodsA web-based survey was distributed via the Audit and Research in Gynaecological Oncology (ARGO) collaborative and UK Audit and Research Collaborative in Obstetrics and Gynaecology (UKARCOG) . The survey on the management of frail peri-operative patients was disseminated to doctors-in-training (trainees) working in obstetrics and gynecology in the United Kingdom (UK) and Ireland. Specialty (ST1–7), subspecialty, and general practice trainees, non-training grade doctors, and foundation year doctors currently working in obstetrics and gynecology were eligible. Consultants were excluded. Study data were collected using REDCAP software hosted at the University of Manchester. Responses were collected over a 6-week period between January and February 2020.ResultsOf the 666 trainees who participated, 67% (425/666) reported inadequate training in peri-operative management of frail patients. Validated frailty assessment tools were used by only 9% (59/638) of trainees and less than 1% (4/613) were able to correctly identify all the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority of trainees (76.5%, 448/586) correctly answered a series of questions relating to mental capacity; however, only 6% (36/606) were able to correctly identify all three diagnostic features of delirium. A total of 87% (495/571) of trainees supported closer collaboration with geriatricians and a multidisciplinary approach.ConclusionsObstetrics and gynecology trainees reported inadequate training in the peri-operative care of frail gynecological oncology patients, and overwhelmingly favored input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the peri-operative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish obstetrics and gynecology curriculum.

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The Impact of Frailty on Technique Failure and Mortality in Patients on Home Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00195 ◽

2019 ◽

Vol 39 (6) ◽

pp. 532-538 ◽

Cited By ~ 2

Author(s):

Ranveer Brar ◽

Reid Whitlock ◽

Paul Komenda ◽

Blake Lerner ◽

Bhanu Prasad ◽

...

Keyword(s):

Functional Decline ◽

Fold Increase ◽

Assessment Tools ◽

Composite Outcome ◽

Cox Models ◽

Home Dialysis ◽

Adverse Health Outcomes ◽

Increased Risk ◽

The Impact ◽

Technique Failure

Background Patients on home dialysis therapies experience technique failure, which is associated with morbidity and mortality. Reasons for technique failure are complex, and often related to functional decline in the patient or caregiver. Frailty is associated with an increased risk of adverse health outcomes. We investigated the impact of frailty on technique failure and mortality in a prospective cohort of patients on home dialysis therapies. Methods We collected objective (Fried criteria and Short Physical Performance Battery [SPPB]), and subjective (physician and nurse impression) measures of frailty from 109 prevalent home dialysis patients. Our primary outcome was a composite of technique failure, defined as a permanent unplanned transition (> 30 days in duration) to facility-based hemodialysis or all-cause death. The association between different frailty assessment tools and the primary composite outcome was evaluated using Cox models. Results Fried criteria and physician impression was associated with a greater than 2-fold increase in risk of our composite outcome (HR: 2.10 [95% CI 1.09 – 3.99], 2.15 [95% CI 1.15 – 4.00, respectively] in adjusted analyses. Weakness and weight loss subdomains of the Fried criteria were both associated with an increased risk of our composite outcome in adjusted analyses (HR: 2.16 [95% CI 1.23 – 3.78], 2.69 [95% CI 1.39 – 5.40], respectively). Conclusions Objective and subjective measures of frailty are associated with a more than 2-fold higher risk of technique failure or death in patients undergoing home dialysis. Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management.

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Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

The Journal of Vascular Access ◽

10.1177/1129729821989902 ◽

2021 ◽

pp. 112972982198990

Author(s):

Kulli Kuningas ◽

Nicholas Inston

Keyword(s):

Decision Making ◽

Kidney Disease ◽

Vascular Access ◽

Clinical Condition ◽

The Elderly ◽

Dialysis Access ◽

Adverse Health Outcomes ◽

Risk Of Mortality ◽

Increased Risk ◽

First Choice

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

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Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000639 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000639

Author(s):

Danielle Ní Chróinín ◽

Nevenka Francis ◽

Pearl Wong ◽

Yewon David Kim ◽

Susan Nham ◽

...

Keyword(s):

Older Patients ◽

Multivariable Analysis ◽

Primary Outcome Measure ◽

Hospital Length ◽

Assessment Tools ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Level Of Evidence ◽

Increased Risk ◽

History Of

BackgroundGiven the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay—and patient factors associated therewith—and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).MethodsWe conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.ResultsAmong 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).DiscussionIn this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.Level of evidenceIII.

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“The feasibility and reliability of frailty assessment tools applicable in acute in-hospital trauma patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000003472 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Charlotte I. Cords ◽

Inge Spronk ◽

Francesco U.S. Mattace-Raso ◽

Michiel H.J. Verhofstad ◽

Cornelis H. van der Vlies ◽

...

Keyword(s):

Assessment Tools ◽

Trauma Patients ◽

Frailty Assessment

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Global neurosurgery: models for international surgical education and collaboration at one university

Neurosurgical FOCUS ◽

10.3171/2018.7.focus18291 ◽

2018 ◽

Vol 45 (4) ◽

pp. E5 ◽

Cited By ~ 6

Author(s):

Joao Paulo Almeida ◽

Carlos Velásquez ◽

Claire Karekezi ◽

Miguel Marigil ◽

Mojgan Hodaie ◽

...

Keyword(s):

Organizational Support ◽

Surgical Education ◽

Care Delivery ◽

Surgical Care ◽

Outcome Evaluation ◽

Assessment Tools ◽

Ethical Challenges ◽

University Of Toronto ◽

The World ◽

The University

OBJECTIVEInternational collaborations between high-income (HICs) and low- and middle-income countries (LMICs) have been developed as an attempt to reduce the inequalities in surgical care around the world. In this paper the authors review different models for international surgical education and describe projects developed by the Division of Neurosurgery at the University of Toronto in this field.METHODSThe authors conducted a review of models of international surgical education reported in the literature in the last 15 years. Previous publications on global neurosurgery reported by the Division of Neurosurgery at the University of Toronto were reviewed to exemplify the applications and challenges of international surgical collaborations.RESULTSThe most common models for international surgical education and collaboration include international surgical missions, long-term international partnerships, fellowship training models, and online surgical education. Development of such collaborations involves different challenges, including limited time availability, scarce funding/resources, sociocultural barriers, ethical challenges, and lack of organizational support. Of note, evaluation of outcomes of international surgical projects remains limited, and the development and application of assessment tools, such as the recently proposed Framework for the Assessment of International Surgical Success (FAIRNeSS), is encouraged.CONCLUSIONSActions to reduce inequality in surgical care should be implemented around the world. Different models can be used for bilateral exchange of knowledge and improvement of surgical care delivery in regions where there is poor access to surgical care. Implementation of global neurosurgery initiatives faces multiple limitations that can be ameliorated if systematic changes occur, such as the development of academic positions in global surgery, careful selection of participant centers, governmental and nongovernmental financial support, and routine application of outcome evaluation for international surgical collaborations.

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The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians

The Open Neurology Journal ◽

10.2174/1874205x01812010031 ◽

2018 ◽

Vol 12 (1) ◽

pp. 31-40 ◽

Cited By ~ 8

Author(s):

Christos Bakirtzis ◽

Panagiotis Ioannidis ◽

Lambros Messinis ◽

Grigorios Nasios ◽

Elina Konstantinopoulou ◽

...

Keyword(s):

Multiple Sclerosis ◽

Clinical Practice ◽

Cognitive Function ◽

Cognitive Rehabilitation ◽

Assessment Tools ◽

Systematic Evaluation ◽

Presenting Symptoms ◽

Increased Risk ◽

Medication Side ◽

Multiple Sclerosis Patients

About half of patients with multiple sclerosis exhibit cognitive impairment which negatively affects their quality of life. The assessment of cognitive function in routine clinical practice is still undervalued, although various tools have been proposed for this reason. In this article, we describe the potential benefits of implementing cognitive assessment tools in routine follow -ups of MS patients. Early detection of changes in cognitive performance may provide evidence of disease activity, could unmask depression or medication side-effects and provide suitable candidates for cognitive rehabilitation. Since apathy and cognitive deficiencies are common presenting symptoms in Progressive Multifocal Leukoencephalopathy, we discuss the utility of frequent monitoring of mental status in multiple sclerosis patients at increased risk. In addition, we propose a relevant algorithm aiming to incorporate a systematic evaluation of cognitive function in every day clinical practice in multiple sclerosis.

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Nonoperative Treatment of Appendicitis during Pregnancy in a Remote Area

American Journal of Perinatology Reports ◽

10.1055/s-0037-1620279 ◽

2018 ◽

Vol 08 (01) ◽

pp. e37-e38 ◽

Cited By ~ 3

Author(s):

Anne-Kathrine Carstens ◽

Lise Fensby ◽

Luit Penninga

Keyword(s):

Antibiotic Treatment ◽

Treatment Option ◽

Fetal Loss ◽

Surgical Care ◽

Weather Conditions ◽

Nonoperative Treatment ◽

Definitive Treatment ◽

Bridge To Surgery ◽

Increased Risk ◽

Geographical Distances

AbstractAppendicitis is the most common nonobstetric surgical disease during pregnancy. Appendicitis during pregnancy is associated with an increased risk of morbidity and perforation compared with the general population. Furthermore, it may cause preterm birth and fetal loss, and quick surgical intervention is the established treatment option in pregnant women with appendicitis. In Greenland, geographical distances are very large, and weather conditions can be extreme, and surgical care is not always immediately available. Hence, antibiotic treatment is often initiated as a bridge-to-surgery. We report on a pregnant Greenlandic Inuit woman with appendicitis who was treated with intravenous antibiotics. Antibiotic treatment was successful before surgical care became available and the patient was not operated. No complications occurred, and further pregnancy was uneventful. Our case suggests that antibiotic treatment of appendicitis during pregnancy as a bridge-to-surgery may be a sensible treatment option in remote areas, where no surgical care is immediately available. In some cases, antibiotic treatment may turn out to be definitive treatment.

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A Multidisciplinary Perspective of Ultra-Processed Foods and Associated Food Processing Technologies: A View of the Sustainable Road Ahead

Nutrients ◽

10.3390/nu13113948 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3948

Author(s):

Francesco Capozzi ◽

Faidon Magkos ◽

Fabio Fava ◽

Gregorio Paolo Milani ◽

Carlo Agostoni ◽

...

Keyword(s):

Health Outcomes ◽

Food Processing ◽

Low Cost ◽

Classification Systems ◽

Processed Foods ◽

Processing Technologies ◽

Adverse Health Outcomes ◽

Increased Risk ◽

Multidisciplinary Perspective ◽

By Products

Ultra-processed foods (UPFs) are negatively perceived by part of the scientific community, the public, and policymakers alike, to the extent they are sometimes referred to as not “real food”. Many observational surveys have linked consumption of UPFs to adverse health outcomes. This narrative synthesis and scientific reappraisal of available evidence aims to: (i) critically evaluate UPF-related scientific literature on diet and disease and identify possible research gaps or biases in the interpretation of data; (ii) emphasize the innovative potential of various processing technologies that can lead to modifications of the food matrix with beneficial health effects; (iii) highlight the possible links between processing, sustainability and circular economy through the valorisation of by-products; and (iv) delineate the conceptual parameters of new paradigms in food evaluation and classification systems. Although greater consumption of UPFs has been associated with obesity, unfavorable cardiometabolic risk factor profiles, and increased risk for non-communicable diseases, whether specific food processing techniques leading to ultra-processed formulations are responsible for the observed links between UPFs and various health outcomes remains elusive and far from being understood. Evolving technologies can be used in the context of sustainable valorisation of food processing by-products to create novel, low-cost UPFs with improved nutritional value and health potential. New paradigms of food evaluation and assessment should be funded and developed on several novel pillars—enginomics, signalling, and precision nutrition—taking advantage of available digital technologies and artificial intelligence. Research is needed to generate required scientific knowledge to either expand the current or create new food evaluation and classification systems, incorporating processing aspects that may have a significant impact on health and wellness, together with factors related to the personalization of foods and diets, while not neglecting recycling and sustainability aspects. The complexity and the predicted immense size of these tasks calls for open innovation mentality and a new mindset promoting multidisciplinary collaborations and partnerships between academia and industry.

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Proven pulmonary aspergillosis in a COVID-19 patient: A case report

Current Medical Mycology ◽

10.18502/cmm.7.2.7031 ◽

2021 ◽

Author(s):

Sadegh Khodavaisy ◽

Nasim Khajavirad ◽

Seyed Jamal Hashemi ◽

Alireza Izadi ◽

Seyed Ali Dehghan Manshadi ◽

...

Keyword(s):

Case Report ◽

Fungal Infections ◽

Left Lung ◽

Aspergillus Species ◽

Pulmonary Aspergillosis ◽

Biopsy Material ◽

Cavitary Lesion ◽

Healthcare Settings ◽

Increased Risk ◽

History Of

Background and Purpose: Coronavirus disease 2019 (COVID-19) has become a significant clinical challenge in healthcare settings all over the world. Critically ill COVID-19 patients with acute respiratory distress syndrome may be at increased risk of co-infection with pulmonary aspergillosis. This study aimed to describe a clinical case of proven pulmonary aspergillosis caused by Aspergillus tubingensis in a 59-year-old man with a history of hospitalization due to COVID-19 infection. Case report: The Covid-19 infection was confirmed by positive nasopharyngeal polymerase chain reaction. He had a cavitary lesion measured 20 mm in diameter with intracavitary soft tissue density in the left lung in the first chest computerized tomography scan. After 25 days, he showed two cavitary lesions in both lungs which raised suspicion of fungal infection; hence, the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed Aspergillus species. To confirm the Aspergillus species identification, the beta-tubulin region was sequenced. The patient was treated with oral voriconazole. Conclusion: This report underlined the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patients

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