Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients

BMC Geriatrics

Koen Milisen²  Elke Detroyer³  Mathias Demuynck¹  Etienne Joosten¹ 

[1] Department of Internal Medicine, Division of Geriatric Medicine, University Hospitals, Leuven, Belgium;Health Services and Nursing Research, KU Leuven, Leuven, Belgium;Department of Health Service, Katholieke Hogeschool Limburg, Hasselt, Belgium

关键词: Mortality;    Falls;    Delirium;    Study of Osteoporotic Fracture (SOF) frailty index;    Cardiovascular Health Study (CHS) frailty index;    Elderly;    Risk assessment;   

Others  :  855545
DOI  :  10.1186/1471-2318-14-1

 received in 2013-08-28, accepted in 2013-12-16,  发布年份 2014

【 摘 要 】

Background

The prevalence and significance of frailty are seldom studied in hospitalized patients. Aim of this study is to evaluate the prevalence of frailty and to determine the extent that frailty predicts delirium, falls and mortality in hospitalized older patients.

Methods

In a prospective study of 220 older patients, frailty was determined using the Cardiovascular Health Study (CHS) and the Study of Osteoporotic Fracture (SOF) frailty index. Patients were classified as nonfrail, prefrail, and frail, according to the specific criteria. Covariates included clinical and laboratory parameters. Outcome variables included in hospital delirium and falls, and 6-month mortality.

Results

The CHS frailty index was available in all 220 patients, of which 1.5% were classified as being nonfrail, 58.5% as prefrail, and 40% as frail. The SOF frailty index was available in 204 patients, of which 16% were classified as being nonfrail, 51.5% as prefrail, and 32.5% as frail. Frailty, as identified by the CHS and SOF indexes, was a significant risk factor for 6-month mortality. However, after adjustment for multiple risk factors, frailty remained a strong independent risk factor only for the model with the CHS index (OR 4.7, 95% CI 1.7-12.8). Frailty (identified by CHS and SOF indexes) was not found to be a risk factor for delirium or falls.

Conclusions

Frailty, as measured by the CHS index, is an independent risk factor for 6-month mortality. The CHS and the SOF indexes have limited value as risk assessment tools for specific geriatric syndromes (e.g., falls and delirium) in hospitalized older patients.

【 授权许可】

   
2014 Joosten et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001, 56:M146-M156.
• [2]Clegg A, Young J, Lliffe S, Rikkert MO, Rockwood K: Frailty in elderly people. Lancet 2013, 381:752-762.
• [3]Rodriguez-Manas L, Féart C, Mann G, Vina J, Chatterji S, Chodzko-Zajko W, Gonzalez-Colaco H, Bergman H, Carcaillon L, Nicholson C, Scuteri A, Sinclair A, Pelaez M, Van der Cammen T, Beland F, Bickenbach J, Delamarche P, Ferrucci L, Fried LP, Gutierrez-Robledo LM, Rockwood K, Artalejo FR, Serviddio G, Vega E: Searching for an operational definition of frailty: a Delphi method based consensus statement. The frailty operative definition-consensus conference project. J Gerontol A Biol Sci Med Scidoi: 10.1093/gerona/gls119
• [4]Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J: Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 2009, 64A:675-681.
• [5]Collard RM, Boter H, Schoevers RA, Oude Voshaar RC: Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012, 60:1487-1489.
• [6]Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP: Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc 2006, 54:1674-1681.
• [7]Ekerstad N, Swahn E, Janzon M, Alfredsson J, Löfmark R, Lindenberger M, Carlsson P: Frailty is independently associated with short-term outcomes for elderly patients with non-ST-segment elevation myocardial infarction. Circulation 2011, 124:2397-2404.
• [8]Andela RM, Dijkstra A, Slaets JPJ, Sanderman R: Prevalence of frailty on clinical wards: description and implications. Int J Nurs Pract 2010, 16:14-19.
• [9]Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochb erg MC, Rodondi N, Tracy JK, Cummings SR: Comparison of 2 frailty indexes for prediction of falls, disability, fractures and death in older women. Arch Intern Med 2008, 168:382-389.
• [10]Kiely DK, Cupples LA, Lipsitz LA: Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. J Am Ger Soc 2009, 57:1532-1539.
• [11]Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A: A global clinical measure of fitness and frailty in elderly people. CMAJ 2005, 173:489-495.
• [12]De Vries NM, Staal JB, van Ravensberg CD, Hobbelen JSM, Olde Rikkert MGM, Nijhuis-van der Sanden MWG: Outcome instruments to measure frailty: a systematic review. Ageing Res Rev 2011, 10:104-114.
• [13]Fulop T, Larbi A, Witkowski JM, McElhaney J, Loeb M, Mitnitski A, Pawelec G: Aging, frailty and age-related diseases. Biogerontology 2010, 11:547-563.
• [14]Blaum CS, Xue QL, Tian J, Semba RD, Fried LP, Walston J: Is hyperglycemia associated with frailty status in older women? J Am Geriatr Soc 2009, 57:840-847.
• [15]Chaves PHM, Semba RD, Leng SX, Woodman RC, Ferrucci L, Guralnik JM, Fried LP: Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the women’s health and aging studies I and II. J Gerontol A Biol Sci Med Sci 2005, 60:729-735.
• [16]Eeles EMP, White SV, O’Mahony SM, Bayer AJ, Hubbard RE: The impact of frailty and delirium on mortality in older patients. Age Ageing 2012, 41:412-416.
• [17]Pilotto A, Rengo F, Marchionni N, Sancarlo D, Fontana A, Panza F, Ferrucci L, on behalf of the FIRI-SIGG study group: Comparing the prognostic accuracy for all-cause mortality of frailty instruments: a multicenter 1-year follow-up in hospitalized older patients. Plos One 2012, 7(1):e29090.
• [18]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987, 40:373-383.
• [19]Braekhus A, Laake K, Engedal K: The mini mental state examination: identifying the most efficient variables for detecting cognitive impairment in the elderly. J Am Geriatric Soc 1992, 40:1139-1145.
• [20]Katz S, Akpom CA: Index of ADL. Med Care 1976, 14:116-118.
• [21]Almeida OP, Almeida SA: Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 1999, 14:858-865.
• [22]Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI: Clarifying confusion. Ann Intern Med 1990, 113:941-948.
• [23]Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006, 145:247-254.
• [24]Segwick P: Cohen’s coefficient K. BMJ 2012, 344:e1178.
• [25]Hubbard RE, O’Mahony MS, Woodhouse KW: Characterising frailty in the clinical setting - a comparison of different approaches. Age Ageing 2009, 38:115-119.
• [26]Pijpers E, Ferreira I, Stehouwer CDA, Nieuwenhuijzen Kruseman AC: The frailty dilemma. Review of the predictive accuracy of major frailty scores. Eur J Intern Med 2012, 23:118-123.
• [27]Sternberg SA, Schwartz AW, Karunananthan S, Bergman H, Clarfield AM: The identification of frailty: a systematic literature review. J Am Geriatr Soc 2011, 59:2129-2138.
• [28]Bao Y, Dalrymple L, Chertow GM, Kaysen GA, Johansen KL: Frailty, dialysis initiation, and mortality in end-stage renal disease. Arch Intern Med 2012, 172:1071-1077.
• [29]Makary MA, Segev DL, Pronovost P, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP: Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010, 210:901-908.
• [30]Stiffler KA, Finley A, Midha S, Wilber ST: Frailty assessment in the emergency department. J Emer Med 2013. http://dx.doi.org/10.1016/j.jemermed.2012.11.047DOI:10.1016/j.jemermed.2012.11.047#doilink webcite
• [31]Fried LP, Ferruci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004, 59:255-263.
• [32]Chang SS, Weiss CO, Xue Q-L, Fried LP: Association between inflammatory-related disease burden and frailty: results from the Women’s Health and Aging Studies (WHAS) I and II. Arch Gerontol Geriatr 2012, 54:9-15.
• [33]Chang SS, Weiss CO, Xue Q-L, Fried LP: Patterns of comorbid inflammatory diseases in frail older women: the women health and aging studies I and II. J Gerontol A Biol Sci Med Sci 2010, 65:407-413.
• [34]Kalyani RR, Tian J, Xue Q-L, Walston J, Cappola AR, Fried LP, Brancati FL, Blaum CS: Hyperglycemia and incidence of frailty and lower extremity mobility limitations in older women. J Am Geriatr Soc 2012, 60:1701-1707.
• [35]Ble A, Cherubine A, Volpato S, Bartali B, Walston JD, Windham BG, Bandinelli S, Lauretani F, Guralnik JM, Ferrucci L: Lower plasma vitamin E levels are associated with the frailty syndrome: the In CHIANTI study. J Gerontol A Biol Sci Med Sci 2006, 61:278-283.
• [36]Kanapuru B, Ershler WB: Inflammation, coagulation and the pathway to frailty. Am J Med 2009, 122:605-613.
• [37]Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, Gottdiener J, Fried LP: Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities. Arch Intern Med 2002, 162:2333-2341.
• [38]Wilhelm-Leen ER, Hall YN, Tamura MK, Chertow GM: Frailty and chronic kidney disease: the third national health and nutrition evaluation survey. Am J Med 2009, 122:664-671.
• [39]Leng S, Chaves P, Koening K, Walston J: Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study. J Am Geriatr Soc 2002, 50:1268-1271.
• [40]Hilmer SN, Perera V, Mitchell QS, Murnion BP: The assessment of frailty in older people in acute care. Australas J Ageing 2009, 28:182-188.
• [41]Wou F, Gladman JFR, Bradshaw L, Franklin M, Edmands J, Conroy SP: The predictive properties of frailty–rating scales in the acute medical unit. Age ageing 2013, 42:776-781.
• [42]Gill TG, Gahbauer EA, Allore HG, Han L: Transitions between frailty states among community-living older persons. Arch Intern Med 2006, 166:418-423.
• [43]Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM, Study of Osteoporotic Fractures Research Group: Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci 2007, 62:744-751.
• [44]Milisen K, Staelens N, Schwendimann R, De Paepe L, Verhaeghe J, Braes T, Boonen S, Pelemans W, Kressig R, Dejaeger E: Fall prediction in inpatients by bedside nurses using the STRATIFY instrument: a multi-center study. J Am Geriatr Soc 2007, 55:725-733.