Literature DB >> 23640761

Implementing frailty into clinical practice: a cautionary tale.

Nadia Sourial1, Howard Bergman, Sathya Karunananthan, Christina Wolfson, Hélène Payette, Luis Miguel Gutierrez-Robledo, François Béland, John D Fletcher, Jack Guralnik.   

Abstract

BACKGROUND: Little is known about the contribution of frailty in improving patient-level prediction beyond readily available clinical information. The objective of this study is to compare the predictive ability of 129 combinations of seven frailty markers (cognition, energy, mobility, mood, nutrition, physical activity, and strength) and quantify their contribution to predictive accuracy beyond age, sex, and number of chronic diseases.
METHODS: Two cohorts from the Established Populations for Epidemiologic Studies of the Elderly were used. The model with the best predictive fit in predicting 6-year incidence of disability was determined using the Akaike Information Criterion. Predictive accuracy was measured by the C statistic.
RESULTS: Incident disability was 23% in one cohort and 20% in the other cohort. The "best model" in each cohort was found to be a model including between five and seven frailty markers including cognition, mobility, nutrition, physical activity, and strength. Predictive accuracy of the 129 models ranged from 0.73 to 0.77 across both cohorts. Adding frailty markers to age, sex, and chronic disease increased predictive accuracy by up to 3% in both cohorts (p < .001). The contribution of frailty increased up to 9% in the oldest age group.
CONCLUSIONS: Adding frailty markers provided a modest increase in patient-level prediction of disability. Such a modest increase may still be worthwhile because while age, sex, and the number of chronic diseases are not modifiable, frailty may be. Further studies examining the contribution of frailty in improving prediction are needed before adopting frailty as a prognostic tool.

Entities:  

Keywords:  Epidemiology; Frailty; Functional performance; Outcomes.; Risk factors

Mesh:

Year:  2013        PMID: 23640761      PMCID: PMC3806754          DOI: 10.1093/gerona/glt053

Source DB:  PubMed          Journal:  J Gerontol A Biol Sci Med Sci        ISSN: 1079-5006            Impact factor:   6.053


  36 in total

Review 1.  Models, definitions, and criteria of frailty.

Authors:  David B Hogan; Chris MacKnight; Howard Bergman
Journal:  Aging Clin Exp Res       Date:  2003-06       Impact factor: 3.636

2.  Why is a good clinical prediction rule so hard to find?

Authors:  Deborah Grady; Seth A Berkowitz
Journal:  Arch Intern Med       Date:  2011-10-24

3.  Searching for an operational definition of frailty: a Delphi method based consensus statement: the frailty operative definition-consensus conference project.

Authors:  Leocadio Rodríguez-Mañas; Catherine Féart; Giovanni Mann; Jose Viña; Somnath Chatterji; Wojtek Chodzko-Zajko; Magali Gonzalez-Colaço Harmand; Howard Bergman; Laure Carcaillon; Caroline Nicholson; Angelo Scuteri; Alan Sinclair; Martha Pelaez; Tischa Van der Cammen; François Beland; Jerome Bickenbach; Paul Delamarche; Luigi Ferrucci; Linda P Fried; Luis Miguel Gutiérrez-Robledo; Kenneth Rockwood; Fernando Rodríguez Artalejo; Gaetano Serviddio; Enrique Vega
Journal:  J Gerontol A Biol Sci Med Sci       Date:  2012-04-16       Impact factor: 6.053

4.  Frailty: an emerging research and clinical paradigm--issues and controversies.

Authors:  Howard Bergman; Luigi Ferrucci; Jack Guralnik; David B Hogan; Silvia Hummel; Sathya Karunananthan; Christina Wolfson
Journal:  J Gerontol A Biol Sci Med Sci       Date:  2007-07       Impact factor: 6.053

5.  A correspondence analysis revealed frailty deficits aggregate and are multidimensional.

Authors:  Nadia Sourial; Christina Wolfson; Howard Bergman; Bin Zhu; Sathya Karunananthan; Jacqueline Quail; John Fletcher; Deborah Weiss; Karen Bandeen-Roche; François Béland
Journal:  J Clin Epidemiol       Date:  2009-10-31       Impact factor: 6.437

6.  Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery.

Authors:  Jonathan Afilalo; Mark J Eisenberg; Jean-François Morin; Howard Bergman; Johanne Monette; Nicolas Noiseux; Louis P Perrault; Karen P Alexander; Yves Langlois; Nandini Dendukuri; Patrick Chamoun; Georges Kasparian; Sophie Robichaud; S Michael Gharacholou; Jean-François Boivin
Journal:  J Am Coll Cardiol       Date:  2010-11-09       Impact factor: 24.094

7.  Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity.

Authors:  Jonathan Afilalo; Salvatore Mottillo; Mark J Eisenberg; Karen P Alexander; Nicolas Noiseux; Louis P Perrault; Jean-Francois Morin; Yves Langlois; Samuel M Ohayon; Johanne Monette; Jean-Francois Boivin; David M Shahian; Howard Bergman
Journal:  Circ Cardiovasc Qual Outcomes       Date:  2012-03-06

8.  Frailty in older adults: evidence for a phenotype.

Authors:  L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie
Journal:  J Gerontol A Biol Sci Med Sci       Date:  2001-03       Impact factor: 6.053

9.  Development of a frailty index for patients with coronary artery disease.

Authors:  Elizabeth A Freiheit; David B Hogan; Misha Eliasziw; Miranda F Meekes; William A Ghali; Lisa A Partlo; Colleen J Maxwell
Journal:  J Am Geriatr Soc       Date:  2010-08       Impact factor: 5.562

10.  Validation and comparison of two frailty indexes: The MOBILIZE Boston Study.

Authors:  Dan K Kiely; L Adrienne Cupples; Lewis A Lipsitz
Journal:  J Am Geriatr Soc       Date:  2009-07-21       Impact factor: 5.562

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  39 in total

1.  Are Performance Measures Necessary to Predict Loss of Independence in Elderly People?

Authors:  Claudio Pedone; Luisa Costanzo; Matteo Cesari; Stefania Bandinelli; Luigi Ferrucci; Raffaele Antonelli Incalzi
Journal:  J Gerontol A Biol Sci Med Sci       Date:  2015-08-13       Impact factor: 6.053

2.  The physical phenotype of frailty for risk stratification of older medical inpatients.

Authors:  P Forti; F Maioli; E Zagni; T Lucassenn; L Montanari; B Maltoni; G Luca Pirazzoli; G Bianchi; M Zoli
Journal:  J Nutr Health Aging       Date:  2014-12       Impact factor: 4.075

3.  Principles and Issues for Physical Frailty Measurement and Its Clinical Application.

Authors:  Karen Bandeen-Roche; Alden L Gross; Ravi Varadhan; Brian Buta; Michelle C Carlson; Megan Huisingh-Scheetz; Mara Mcadams-Demarco; Damani A Piggott; Todd T Brown; Rani K Hasan; Rita R Kalyani; Christopher L Seplaki; Jeremy D Walston; Qian-Li Xue
Journal:  J Gerontol A Biol Sci Med Sci       Date:  2020-05-22       Impact factor: 6.053

4.  Managing frailty in primary care: evidence gaps cannot be ignored.

Authors:  Sathya Karunananthan; Howard Bergman
Journal:  CMAJ       Date:  2018-09-24       Impact factor: 8.262

5.  Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter.

Authors:  Bettina Meinow; Ingemar Kåreholt; Mats Thorslund; Marti G Parker
Journal:  Eur J Ageing       Date:  2015-07-23

6.  Frailty: the quest for new domains, clinical definitions and subtypes. Is this justified on new evidence emerging?

Authors:  L Rodríguez-Mañas; A J Sinclair
Journal:  J Nutr Health Aging       Date:  2014-01       Impact factor: 4.075

7.  Should Sensory Impairment Be Considered in Frailty Assessment? A Study in the GAZEL Cohort.

Authors:  M Linard; M Herr; P Aegerter; S Czernichow; M Goldberg; M Zins; J Ankri
Journal:  J Nutr Health Aging       Date:  2016       Impact factor: 4.075

Review 8.  Frailty Screening and Interventions: Considerations for Clinical Practice.

Authors:  Jeremy Walston; Brian Buta; Qian-Li Xue
Journal:  Clin Geriatr Med       Date:  2018-02       Impact factor: 3.076

9.  Falls among hemodialysis patients: potential opportunities for prevention?

Authors:  Nancy G Kutner; Rebecca Zhang; Yijian Huang; Haimanot Wasse
Journal:  Clin Kidney J       Date:  2014-04-15

10.  Functional impairment, disability, and frailty in adults aging with HIV-infection.

Authors:  Kristine M Erlandson; Jennifer A Schrack; Catherine M Jankowski; Todd T Brown; Thomas B Campbell
Journal:  Curr HIV/AIDS Rep       Date:  2014-09       Impact factor: 5.071

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