LETTER TO THE EDITOR: SETTING GOALS OR SHIFTING GOALPOSTS: ROLE OF FRAILTY FOR CRITICAL CARE DECISIONS DURING COVID-19

Frailty is characterized by a loss of physiological reserves leading to increased susceptibility to adverse outcomes with stressor events (1). With healthcare resources worldwide overstretched by the unprecedented COVID-19 pandemic, there is intense interest in reliable assessment tools to inform patient prioritization for scarce intensive care resource. Not surprisingly, frailty tools have been thrust into the spotlight as the panacea to age-based criteria for critical care triage decisions. However, detractors worry that rigid and indiscriminate application of frailty tools may ironically exacerbate the deprioritising of older adults and other vulnerable populations. Herein, we describe the 3F approach to guide thinking about the role of frailty in critical care decisions for older adults during the COVID-19 pandemic.

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Protocol for a prospective observational study to develop a frailty index for use in perioperative and critical care

BMJ Open ◽

10.1136/bmjopen-2018-024682 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024682 ◽

Cited By ~ 3

Author(s):

Jai N Darvall ◽

Sabine Braat ◽

David A Story ◽

Kate Greentree ◽

Tony Bose ◽

...

Keyword(s):

Critical Care ◽

Observational Study ◽

Risk Stratification ◽

Prospective Observational Study ◽

Frailty Index ◽

Primary Objective ◽

Adverse Outcomes ◽

Assessment Tools ◽

Hospital Data ◽

Human Research Ethics

IntroductionFrailty is of increasing importance to perioperative and critical care medicine, as the proportion of older patients increases globally. Evidence continues to emerge of the considerable impact frailty has on adverse outcomes from both surgery and critical care, which has led to a proliferation of different frailty measurement tools in recent years. Despite this, there remains a lack of easily implemented, comprehensive frailty assessment tools specific to these complex populations. Development of a frailty index using routinely collected hospital data, able to leverage the automated aspects of an electronic medical record, would aid risk stratification and benefit clinicians and patients alike.Methods and analysisThis is a prospective observational study. 150 intensive care unit (ICU) patients aged ≥50 years and 200 surgical patients aged ≥65 years will be enrolled. The primary objective is to develop a frailty index. Secondary objectives include assessing its ability to predict in-hospital mortality and/or discharge to a new non-home location; the performance of the frailty index in predicting postoperative and ICU complications, as well as health-related quality of life at 6 months; to compare the performance of the frailty index against existing frailty measurement and risk stratification tools; and to assess its modification by patients’ health assets.Ethics and disseminationThis study has been approved by the Melbourne Health Human Research Ethics Committee(20 January 2017, HREC/16/MH/321). Dissemination will be via international and national anaesthetic and critical care conferences, and publication in the peer-reviewed literature.

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Frailty, sarcopenia, and falls in cardiovascular disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0713 ◽

2018 ◽

pp. 2950-2954

Author(s):

Antonio Cherubini ◽

Massimiliano Fedecostante

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Clinical Manifestations ◽

Drug Effects ◽

Adverse Outcomes ◽

Assessment Tools ◽

Management Approach ◽

Older Individuals ◽

Related Factors ◽

Age Related

Frailty reflects a state of high vulnerability to stressors, even at low intensity, putting frail older adults at high risk of adverse outcomes. Sarcopenia (i.e. skeletal muscle decline) explains many of the clinical manifestations of the frailty syndrome and is the key component of physical frailty. Many frailty assessment tools are built around the concept of sarcopenia. Frailty is not only a consequence of the ageing process, but cardiovascular disease can contribute to its genesis, also sharing common pathogenetic pathways. Falls are very common in older individuals and are the best example of the interplay between age-related conditions and diseases. Falls, as well as frailty and sarcopenia, are most often multifactorial in nature. Cardiovascular disorders are among the risk factors that have been identified to cause falls in older adults; in particular, unexplained and recurrent falls. Orthostatic hypotension, carotid sinus syndrome, and adverse drug effects are the most important cardiovascular disease-related factors that have been found to be associated with falls in older people. Implementing the comprehensive geriatric assessment, a multidomain and multidisciplinary evaluation and management approach, represents the best strategy to properly manage older patients with cardiovascular disease.

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Frailty in Critical Care: Examining Implications for Clinical Practices

Critical Care Nurse ◽

10.4037/ccn2018336 ◽

2018 ◽

Vol 38 (3) ◽

pp. 29-35 ◽

Cited By ~ 4

Author(s):

Jennifer A. Gibson ◽

Sarah Crowe

Keyword(s):

Older Adults ◽

Critical Care ◽

Functional Decline ◽

Hospital Length ◽

Adverse Outcomes ◽

Hospital Length Of Stay ◽

Clinical State ◽

Clinical Practices ◽

Delivery Of Care ◽

Prolonged Hospital

Frailty is an aging-related, multisystem clinical state characterized by loss of physiological reserves and diminished capacity to withstand exposure to stressors. Frailty increases the risk of serious adverse outcomes, compared with that of nonfrail people of the same age. Adverse outcomes can be severe and may include procedural complications, delirium, significant functional decline and disability, prolonged hospital length of stay, extended recovery periods, and death. As older adults make up a continually growing proportion of hospitalized patients, critical care nurses need to understand how to recognize frailty and be familiar with related clinical practice implications. Such knowledge underpins effective organization and delivery of care strategies aimed at minimizing harm and maximizing positive outcomes for frail older adults. Drawing from recent literature, this article explores frailty and critical illness by discussing 2 dominant models of the concept. Using a clinical case study, links between frailty and critical care nursing practices are highlighted and clinical considerations are explored.

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New horizons in iron deficiency anaemia in older adults

Age and Ageing ◽

10.1093/ageing/afz199 ◽

2020 ◽

Vol 49 (3) ◽

pp. 309-318 ◽

Cited By ~ 2

Author(s):

Jennifer Kirsty Burton ◽

Luke C Yates ◽

Lindsay Whyte ◽

Edward Fitzsimons ◽

David J Stott

Keyword(s):

Older Adults ◽

Iron Deficiency ◽

Iron Deficiency Anaemia ◽

Adverse Outcomes ◽

Future Research ◽

Deficiency Anaemia ◽

Research Areas ◽

Dosing Regimens ◽

Iv Iron

Abstract Iron deficiency anaemia (IDA) is common in older adults and associated with a range of adverse outcomes. Differentiating iron deficiency from other causes of anaemia is important to ensure appropriate investigations and treatment. It is possible to make the diagnosis reliably using simple blood tests. Clinical evaluation and assessment are required to help determine the underlying cause and to initiate appropriate investigations. IDA in men and post-menopausal females is most commonly due to occult gastrointestinal blood loss until proven otherwise, although there is a spectrum of underlying causative pathologies. Investigation decisions should take account of the wishes of the patient and their competing comorbidities, individualising the approach. Management involves supplementation using oral or intravenous (IV) iron then consideration of treatment of the underlying cause of deficiency. Future research areas are outlined including the role of Hepcidin and serum soluble transferrin receptor measurement, quantitative faecal immunochemical testing, alternative dosing regimens and the potential role of IV iron preparations.

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Evaluation of the functionality and mobility of community-dwelling older adults in primary health care

Revista Brasileira de Geriatria e Gerontologia ◽

10.1590/1981-22562019022.190086 ◽

2019 ◽

Vol 22 (5) ◽

Cited By ~ 1

Author(s):

Laize Gabriele de Castro Silva ◽

Franciele Santos de Oliveira ◽

Ítala da Silva Martins ◽

Frankly Eudes Sousa Martins ◽

Tulia Fernanda Meira Garcia ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Health Care ◽

Primary Health Care ◽

Functional Capacity ◽

Adverse Outcomes ◽

Community Dwelling ◽

Assessment Tools ◽

Primary Health ◽

Reduced Mobility

Abstract Objective : To evaluate the functional capacity and mobility of older adults treated in primary health care and the association between adverse outcomes (functional dependence and reduced mobility) and sociodemographic and health conditions. Method : A cross-sectional and analytical epidemiological study was carried out in the municipal region of Caicó, Rio Grande do Norte, Brazil. Sociodemographic variables, presence of comorbidities, practice of physical activity, functional capacity (Lawton Scale) and mobility (Timed Up and Go Test) were investigated. Data analysis was performed using descriptive statistics, followed by bivariate analysis to investigate association variables and multivariate analysis (logistic regression). Results : Among the 109 elderly people evaluated, 29.4% were dependent in instrumental activities of daily living (IADL) and 67.9% had reduced mobility. The present study found a significant association between dependence in IADL and age equal to or greater than 75 years; while not practicing physical activity remained a factor of association with reduced mobility, regardless of sex, age and presence of co-morbidities. Conclusion : The findings emphasize the importance of the practice of physical activity, which was associated with better mobility, the construction of spaces of health promotion and disease prevention to encourage active aging for older adults, as well as a multi and interprofessional approach to comprehensive health care for older adults, with the use of functionality assessment tools.

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The Role of Neuropsychological Factors in Perceived Threat of SARS-CoV-2 in Healthy Ageing

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115847 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5847

Author(s):

Massimo Bartoli ◽

Nicola Canessa ◽

Giuseppina Elena Cipriani ◽

Stefano F. Cappa ◽

Martina Amanzio

Keyword(s):

Older Adults ◽

Interaction Model ◽

Adverse Outcomes ◽

Perceived Threat ◽

Information Processing Speed ◽

Physical Frailty ◽

Information Campaigns ◽

Linguistic Resources ◽

Neuropsychological Factors

The COVID-19 pandemic is known to increase older adults’ vulnerability to adverse outcomes. Alongside increased physical frailty, anxiety symptoms associated with the risk of SARS-CoV-2 contagion appear to represent its most prominent ‘sequelae’. The attentional and linguistic resources required for decoding virus-related information may also influence the perceived threat of contagion. However, the possible role of neuropsychogeriatric factors on the latter dimension has never been assessed in a longitudinal study on the older population. To fill this gap, 50 healthy cognitively preserved older adults underwent a neuropsychological and physical frailty assessment before the pandemic (T0). Subsequently, they agreed to be interviewed and re-assessed during the lockdown (T1) and immediately after it (T2) through a longitudinal one-year study. Perceived threat of SARS-CoV-2 at T2 was predicted both by baseline anxiety and frailty scores, and by decreased performance in information processing speed and language comprehension tests. While confirming the joint role of frailty and anxiety, a moderation/interaction model showed that each of them was sufficient, at its highest level, to support the maximum degree of perceived threat of contagion. The contribution of neuropsychological factors to perceived threat of SARS-CoV-2 highlights their importance of tailoring information campaigns addressed to older people.

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Sports Concussions (TBI), Imbalance, and Dizziness

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld25.1.36 ◽

2015 ◽

Vol 25 (1) ◽

pp. 36-41 ◽

Cited By ~ 1

Author(s):

Steven M. Doettl

Keyword(s):

Assessment Tools ◽

Vestibular Evoked Myogenic Potentials ◽

Post Injury ◽

Management Tools ◽

Concussion Management ◽

Post Concussion Syndrome ◽

Behavioral Marker ◽

Valid Assessment ◽

Injury Assessment

It has been widely accepted that the assessment of balance after concussion plays a large role in determining deficit. Qualitative balance assessments have been an established piece of the post-injury assessment as a clinical behavioral marker of concussion for many years. Recently more specific guidelines outlining the role of balance evaluation in concussion identification and management have been developed as part of concussion management tools. As part of the ongoing development of concussions protocols, quantitative assessment of balance function following concussion has also been identified to have an important role. Frequently imbalance and dizziness reported following concussion is assumed to be associated with post-concussion syndrome (PCS). While imbalance and dizziness are common complaints in PCS, they can also be a sign of additional underlying pathology. In cases of specific dizziness symptoms or limited balance recovery beyond the initial post-concussive period, a quantitative vestibular assessment may also be needed. Electronystagmography and videonystagmography (ENG/VNG), rotary chair testing (RCT), and vestibular evoked myogenic potentials (VEMPs) have all been identified as valid assessment tools for vestibular dysfunction following traumatic brain injury (TBI). The assessment of balance and dizziness following sports-related concussions is an integral piece of the puzzle for removal from play, assessment of severity, and management.

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