scholarly journals Paramedic assessment of frailty: An exploratory study of perceptions of frailty assessment tools

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Wayne Harris ◽  
Peter Vincent Lucas ◽  
Helen Eyles ◽  
Leigh Parker
Keyword(s):  
Older Adults ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Frailty Index ◽  
Economic Benefits ◽  
Assessment Tools ◽  
Screening Tools ◽  
Hospital Environment ◽  
Significant Variable ◽  
Frailty Assessment

<p><strong>Introduction: </strong>Frailty is recognised as a significant variable in the health of older adults. Early identification by paramedics of those at risk of frailty may assist in timely entry to an appropriate clinical care pathway. Early referral to such pathways has been shown to improve patient outcomes and quality of life, as well as deliver economic benefits. To date, little research has been completed regarding assessment of frailty by paramedic professionals using validated assessment tools. The objective of this study was to determine paramedicine students’ perceptions of screening tools to facilitate assessment and knowledge of frailty of older adults. The Edmonton Frail Scale (EFS) and the Groningen Frailty Index (GFI) were determined suitable for this purpose.</p><p><strong>Methods</strong>: The research adopted a mixed methods approach using a survey tool developed to gather both qualitative and quantitative data from students at the completion of a structured aged care clinical placement. Thematic analysis of the qualitative data identified key features of the tools, while a Likert-type scale was used to measure perspectives about the suitability of the tools for use in paramedic practice.</p><p><strong>Results</strong>: Thirty-seven paramedicine students were invited to participate in the study. Thirteen were able to use both tools to conduct frailty assessments and submitted survey responses. Student perspectives indicated both the EFS and GFI are potentially suitable for paramedicine and as clinical learning tools regarding geriatric assessments. Median time to administer the tools was eight minutes for the EFS and ten minutes for the GFI.</p><p><strong>Conclusion</strong>: Paramedicine students support a frailty assessment tool to assist clinical decision making regarding older adults. Further appraisal of validated frailty assessment tools by operational paramedics in a pre-hospital environment is warranted to determine absolute utility for Australian paramedics.</p>

P4514Agreement and prognostic significance of 6 frailty tools in patients with chronic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Sze ◽  
P Pellicori ◽  
J Zhang ◽  
J Weston ◽  
A L Clark
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Nyha Class ◽  
Frailty Index ◽  
Prognostic Significance ◽  
Assessment Tools ◽  
Screening Tools ◽  
Misclassification Rate ◽  
Frailty Assessment ◽  
Frail Patients

Abstract Background Frailty is common in patients with chronic heart failure (CHF) and is associated with adverse outcome. Many frailty tools are available, however, there is no standard way of evaluating frailty in patients with CHF. Purpose To report the prevalence of frailty, agreement and prognostic significance amongst 3 frailty assessment tools and 3 screening tools in CHF patients. Methods We comprehensively studied frailty using 6 frailty tools. Frailty screening tools include: Clinical frailty scale (CFS); Derby frailty index & Acute frailty network frailty criteria. Frailty assessment tools include: Fried criteria; Edmonton frailty score & Deficit index. Since there is no gold standard in evaluating frailty in CHF patients, for each of the frailty tools, we used the results of the other 5 tools to produce a combined frailty index which we used as a “standard” frailty tool. Subjects were defined as frail if so identified by at least 3 out of 5 tools. Results 467 consecutive ambulatory CHF patients (67% male, median age 76 (IQR: 69–82) years, median NTproBNP 1156 (IQR: 469–2463) ng/L) and 87 controls (79% male, median age 73 (IQR: 69–77 years) were studied. Prevalence of frailty was much higher in CHF patients than in controls (30–52% vs 2–15%, respectively). Amongst the frailty screening tools, DFI scored the greatest proportion of patients as frail (48%) while CFS scored the lowest proportion as frail (44%). Amongst the assessment tools, Fried criteria scored the greatest proportion of patients as frail (52%) while EFS scored the lowest proportion as frail (30%). Frail patients were older, have worse symptoms, higher NTproBNP and more co-morbidities compared to non-frail patients. Of the screening tools, CFS had the strongest agreement with assessment tools (kappa coefficient: 0.65–0.72, all p<0.001). CFS had the highest sensitivity (87%) and specificity (89%) amongst screening tools and the lowest misclassification rate (12%) amongst all 6 frailty tools in identifying frailty according to the combined frailty index. During a median follow-up of 559 days (IQR 512–629 days), 82 (18%) patients died. 55% (N=45) of frail patients died of non-cardiovascular causes. Worsening frailty as detected by all 6 frailty tools was associated with worse outcome. A base model for mortality prediction including sex, NYHA class (III/IV vs I/II), BMI, log NTproBNP and haemoglobin had a C-statistics of 0.78. Amongst frailty tools: CFS and Fried criteria increased model performance most compared with base model (c-statistics: 0.80 for both). Patients who were frail according to CFS had a 9 times greater mortality risk than non-frail patients (Figure). Conclusion Frailty is common in CHF patients and is associated with worse outcome. CFS is a simple screening tool which identifies a similar group as lengthy assessment tools and has similar prognostic significance. Frailty screening should be incorporated into routine care of patients with CHF. Acknowledgement/Funding None

A systematic review of evidence-based aftercare for older adults following self-harm

2022 ◽  
pp. 000486742110671
Author(s):  
Anne PF Wand ◽  
Roisin Browne ◽  
Tiffany Jessop ◽  
Carmelle Peisah
Keyword(s):  
Older Adults ◽  
Qualitative Studies ◽  
Assessment Tools ◽  
Screening Tools ◽  
Safety Planning ◽  
Level Of Evidence ◽  
Heritage Foundation ◽  
Quality Ratings ◽  
Self Harm

Objective: Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. Methods: Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. Results: Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. Conclusion: Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.

scholarly journals Evaluation of Clinically Meaningful Changes in Measures of Frailty

2020 ◽  
Vol 75 (6) ◽  
pp. 1143-1147 ◽  
Author(s):  
Il-Young Jang ◽  
Hee-Won Jung ◽  
Hea Yon Lee ◽  
Hyungchul Park ◽  
Eunju Lee ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Trials ◽  
Clinical Care ◽  
Frailty Index ◽  
Large Change ◽  
Community Dwelling ◽  
Deficit Accumulation ◽  
Frailty Phenotype ◽  
Euroqol 5D ◽  
Community Dwelling Older Adults

Abstract Background To determine the clinically meaningful changes and responsiveness of widely used frailty measures. Methods We analyzed data from a prospective cohort study of 1,135 community-dwelling older adults who underwent assessments of frailty and health-related quality of life using the EuroQol-5D at baseline and 1 year later. Frailty measures included deficit-accumulation frailty index (FI); frailty phenotype; Fatigue, Resistance, Ambulation, Illness, and Loss of Weight scale; and the Study of Osteoporotic Fracture (SOF) index. We determined the clinically meaningful changes by the distribution-based method and the anchor-based method using the EuroQol-5D score and responsiveness indices. Results Frailty measures were available in 925 participants at 1 year (81.5%). Based on the distribution-based method, small and large clinically meaningful changes were 0.019 and 0.057 for FI, 0.249 and 0.623 for frailty phenotype, 0.235 and 0.587 for FRAIL scale, and 0.116 and 0.289 for SOF index, respectively. The anchor-based estimates of small and large changes were 0.028 and 0.076 for FI, 0.097 and 0.607 for frailty phenotype, 0.269 and 0.368 for FRAIL scale, and 0.023 and 0.287 for SOF index, respectively. Based on the responsiveness index, per-group sample sizes to achieve 80% power in clinical trials, ranged from 51 (FI) to 7,272 (SOF index) for a small change and 9 (FI) to 133 (FRAIL scale) for a large change. Conclusions The estimates of clinically meaningful change of frailty measures can inform the choice of frailty measures to track longitudinal changes of frailty in clinical trials and clinical care of community-dwelling older adults.

scholarly journals Comparison of drug-related problem risk assessment tools for older adults: a systematic review

2019 ◽  
Vol 76 (3) ◽  
pp. 337-348
Author(s):  
Emmi Puumalainen ◽  
Marja Airaksinen ◽  
Sanni E. Jalava ◽  
Timothy F. Chen ◽  
Maarit Dimitrow
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Web Of Science ◽  
Assessment Tools ◽  
Screening Tools ◽  
Content Development ◽  
Disease Therapy ◽  
Risk Assessment Tools ◽  
Based Medicine ◽  
Development Methods

Abstract Purpose This study aims to systematically review studies describing screening tools that assess the risk for drug-related problems (DRPs) in older adults (≥ 60 years). The focus of the review is to compare DRP risks listed in different tools and describe their development methods and validation. Methods The systematic search was conducted using evidence-based medicine, Medline Ovid, Scopus, and Web of Science databases from January 1, 1985, to April 7, 2016. Publications describing general DRP risk assessment tools for older adults written in English were included. Disease, therapy, and drug-specific tools were excluded. Outcome measures included an assessment tool’s content, development methods, and validation assessment. Results The search produced 15 publications describing 11 DRP risk assessment tools. Three major categories of risks for DRPs included (1) patient or caregiver related risks; (2) pharmacotherapy-related risks; and (3) medication use process-related risks. Of all the risks included in the tools only 8 criteria appeared in at least 4 of the tools, problems remembering to take the medication being the most common (n=7). Validation assessments varied and content validation was the most commonly conducted (n = 9). Reliability assessment was conducted for 6 tools, most commonly by calculating internal consistency (n = 3) and inter-rater reliability (n = 2). Conclusions The considerable variety between the contents of the tools indicates that there is no consensus on the risk factors for DRPs that should be screened in older adults taking multiple medicines. Further research is needed to improve the accuracy and timeliness of the DRP risk assessment tools.

Differences in comprehension of somatic genomic profiling between younger and older adults with advanced genitourinary cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 228-228
Author(s):  
Cristiane Decat Bergerot ◽  
Paulo Gustavo Bergerot ◽  
Joann Hsu ◽  
Nazli Dizman ◽  
Stacy W. Gray ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Genomic Profiling ◽  
Younger Patients ◽  
Low Health Literacy ◽  
Genitourinary Cancers

228 Background: Genomic profiling (GP) plays an important role in the care of patients diagnosed with advanced cancer, and has been used to guide clinical decision making. As age has been associated with low health literacy, we sought to determine comprehension of the goals and objectives of GP between younger (age < 65) and older (age ≥65) with genitourinary cancers. Methods: Eligible patients had agreed to receive somatic GP as a part of routine clinical care through a CLIA-certified commercially available platform. Participating physicians conducted a standardized dialogue with patients pertaining to the rationale for and clinical utility of somatic GP. Patients then received an in-person survey lasting approximately 10-15 min and assessing a broad range of perceptions related to GP. Results: Among 47 patients, 62% were characterized as older adults. Diagnoses encountered included kidney (43%), prostate (32%), and bladder (25%). Only older adults perceived any shortcomings in the description of GP. These shortcomings related to the clarity of the descriptions of genomic data, as well as the accuracy, detail and compassion with which this information was conveyed. Older adults demonstrated a very strong reliance on physician input in their decision to obtain somatic GP - 42% of older adults suggested that trust in their physician was among the top three reasons for which they opted to do genomic testing, in contrast to just 10% of younger patients (P = 0.04). Both older and younger patients demonstrated frequent misconceptions pertaining to the role of GP. For example, the majority of younger (78%) and older (52%) patients suggested the test was being performed for prognostic purposes. Both groups also frequently held the notion that somatic testing could identify hereditary cancer-related disorders (younger: 78% vs older: 66%). Conclusions: Detailed surveys of patients with genitourinary cancers reveal varied comprehension of somatic GP between younger and older patients. Interventions to enhance understanding of the principles of GP may be helpful in facilitating shared decision-making, particularly among older patients.

scholarly journals A U-Shaped Relationship between the Prevalence of Frailty and Body Mass Index in Community-Dwelling Japanese Older Adults: The Kyoto–Kameoka Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1367 ◽  
Author(s):  
Daiki Watanabe ◽  
Tsukasa Yoshida ◽  
Yuya Watanabe ◽  
Yosuke Yamada ◽  
Misaka Kimura
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Body Mass ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Assessment Tools ◽  
Cross Sectional ◽  
Frailty Assessment ◽  
Japanese Older Adults ◽  
The Relationship

The relationship between body mass index (BMI) and frailty remains unclear. Using two validated frailty assessment tools, this study aimed to investigate the relationship between the prevalence of frailty and BMI in Japanese older adults. This cross-sectional study used baseline data of 7191 individuals aged ≥65 years, living in Kameoka City, Kyoto, Japan. The BMI was calculated based on self-reported height and body weight, and classified into six categories. Frailty was defined using two validated assessment tools, the Fried phenotype (FP) model and Kihon Checklist (KCL). We evaluated the relationship between frailty and BMI using a multivariate restricted cubic spline logistic regression. The prevalence of frailty defined using the FP model was 25.3%, 19.6%, 14.3%, 12.4%, 12.6%, and 19.4% for each BMI category of <18.5, 18.5–19.9, 20.0–22.4, 22.5–24.9, 25.0–27.4, and ≥27.5 kg/m2, respectively. The spline model showed a significant U-shaped relationship between BMI and the prevalence of frailty defined using both, KCL and FP models. This study found that the BMI range corresponding to lowest prevalence of frailty defined using both tools was 21.4–25.7 kg/m2. Thus, a healthy BMI may reduce the prevalence of frailty, and the risk of frailty needs to be evaluated in individuals who are underweight or overweight.

scholarly journals OPERATIONALIZING THE FRAILTY INDEX BASED ON WEARABLE SENSOR TO ASSESS FUNCTIONAL PERFORMANCE IN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S680-S680
Author(s):  
Hung Nguyen ◽  
Jacqueline Yang ◽  
Mohsen Zahiri ◽  
Bijan Najafi
Keyword(s):  
Older Adults ◽  
Grip Strength ◽  
Assessment Tool ◽  
Functional Performance ◽  
Frailty Index ◽  
Activity Level ◽  
Wearable Sensor ◽  
Frailty Status ◽  
Frailty Assessment ◽  
Flexion And Extension

Abstract Frailty status is a well-known predictor of adverse health outcomes and functional performance. An assessment tool based on a wearable sensor was developed to quickly assess frailty using an upper extremity flexion and extension test. However, the current tool has relied on conventional frailty assessment to classify the frailty status of the participant. The aim of this study is to operationalize the frailty index based on wearable sensor to classify frailty status of older adults. 104 older adults were recruited for the study (age=78.6 ±9.7 years old). Participants were asked to perform a quick 20-second upper flexion and extension task while wearing a gyroscope on the wrist. A sensor-based frailty index (FI) was derived using parameters extracted from the sensor. Participants were also assessed using the Fried Phenotype Criteria (FC) and were classified into three groups: robust, pre-frail, and frail. Mean-shift clustering algorithm was used to operationalize the FI by identifying the cut-off point for each group. Grip strength and physical activity level were used as functional outcome measures. Regression analysis (r) was used to compare the correlation of the FC and FI with the identified metrics. Bivariate analysis show that grip strength was highly associated with the sensor-based frailty classification (r=-0.547) and FC (r =-0.503). The sensor-based classification was significantly associated with walking activity (r=-0.355). The results showed that the sensor-based frailty assessment tool could be used to quickly classify frailty status in older adults and eliminated the need for subjective and time-consuming evaluation.

scholarly journals Feasibility and accuracy of ED frailty identification in older trauma patients: a prospective multi-centre study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Heather Jarman ◽  
Robert Crouch ◽  
Mark Baxter ◽  
Chao Wang ◽  
George Peck ◽  
...  
Keyword(s):  
Major Trauma ◽  
Frailty Index ◽  
Traumatic Injury ◽  
Assessment Tools ◽  
Screening Tools ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Clinical Frailty Scale ◽  
Multi Centre Study ◽  
Trauma Centres

Abstract Background The burden of frailty on older people is identifiable by its adverse effect on mortality, morbidity and long term functional and health outcomes. In patients suffering from a traumatic injury there is increasing evidence that it is frailty rather than age that impacts greatest on these outcomes and that early identification can guide frailty specific care. The aim of this study was to evaluate the feasibility of nurse-led assessment of frailty in older trauma patients in the ED in patients admitted to major trauma centres. Methods Patients age 65 years and over attending the Emergency Departments (ED) of five Major Trauma Centres following traumatic injury were enrolled between June 2019 and March 2020. Patients were assessed for frailty whilst in the ED using three different screening tools (Clinical Frailty Scale [CFS], Program of Research to Integrate Services for the Maintenance of Autonomy 7 [PRIMSA7], and the Trauma Specific Frailty Index [TSFI]) to compare feasibility and accuracy. Accuracy was determined by agreement with geriatrician assessment of frailty. The primary outcome was identification of frailty in the ED using three different assessment tools. Results We included 372 patients whose median age was 80, 53.8% of whom were female. The most common mechanism of injury was fall from less than 2 m followed by falls greater than 2 m. Completion rates for the tools were variable, 31.9% for TSFI, compared to 93% with PRISMA7 and 98.9% with the CFS. There was substantial agreement when using CFS between nurse defined frailty and geriatrician defined frailty. Agreement was moderate using PRISMA7 and slight using TSFI. Conclusions This prospective study has demonstrated that screening for frailty in older major trauma patients within the Emergency Department is feasible and accurate using CFS. Trial registration ISRCTN, ISRCTN10671514. Registered 22 October 2019

scholarly journals Web-based software applications for frailty assessment in older adults: a scoping review of current status with insights into future development

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Riley Chang ◽  
Hilary Low ◽  
Andrew McDonald ◽  
Grace Park ◽  
Xiaowei Song
Keyword(s):  
Older Adults ◽  
User Interface ◽  
Future Development ◽  
Scoping Review ◽  
Assessment Tools ◽  
Current Status ◽  
Web Based ◽  
Specific Patient ◽  
Software Applications ◽  
Frailty Assessment

Abstract Background A crucial aspect of continued senior care is the early detection and management of frailty. Developing reliable and secure electronic frailty assessment tools can benefit virtual appointments, a need especially relevant in the context of the COVID-19 pandemic. An emerging effort has targeted web-based software applications to improve accessibility and usage. The objectives of this scoping review are to identify and evaluate web-based frailty assessment tools currently available and to identify challenges and opportunities for future development. Methods We conducted a review with literature (e.g., using MEDLINE databases) and Google searches (last updated on October 10, 2021). Each of the identified web applications were assessed based on eight featured categories and assigned a rating score accordingly. Results Twelve web-based frailty assessment applications were found, chiefly provided by the USA (50%) or European countries (41%) and focused on frailty grading and outcome prediction for specific patient groups (59%). Categories that scored well among the applications included the User Interface (2.8/3) and the Cost (2.7/3). Other categories had a mean score of 1.6/3 or lower. The least developed feature was Data Saving. Conclusions Web-based applications represent a viable option for remote frailty assessments and multidisciplinary integrated care of older adults. Despite the available web-based frailty assessments on the Internet, many missed certain needed features for professional use in healthcare settings. This situation calls for fully comprehensive web-based applications, taking into consideration a number of key functions linking graphical user interface and functionalities, and paying special attention to secure data management.

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