A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. Palliative care and symptom control may be appropriate for those who are more frail. Management of frailty: opportunities, challenges, and future directions. Luijkx KG, Effects of a home-based and volunteer-administered physical training, nutritional, and social support program on malnutrition and frailty in older persons: a randomized controlled trial. If yes , kindly propose to the patient an assessment of the causes of frailty and prevention of disabilities in a day hospital. Schoevers RA, Lien C, et al. 3. Vella-Azzopardi R, 26. ; et al. Exercise and physical activity for older adults. et al. 51. 39. Sex differences in the risk of frailty for mortality independent of disability and chronic diseases. Hoogendijk EO, Comprehensive geriatric assessment—a guide for the non-specialist. Wijnen-Sponselee MT, Nonlinear multisystem physiological dysregulation associated with frailty in older women: implications for etiology and treatment. Gladman JR. 2012;60(12):2326–2332. et al. Harari D, The aim of this narrative review is to evaluate frailty assessment tools, in order to identify a possible tool for frailty … et al. Ng TP, 2017;18(7):564–575. 8. Gobbens RJJ, et al. Bergman H, Diagnosis of frailty after a Comprehensive Geriatric Assessment: differences between family physicians and geriatricians. Lancet Public Health. Frailty and the prediction of negative health outcomes: a meta-analysis. ; 4 0 obj Results from the ESTHER cohort study. Factors influencing transitions between frailty states in elderly adults: The Progetto Veneto Anziani Longitudinal Study. Connecting age-related biological decline to frailty and late-life vulnerability. 2017;46(3):383–392. The frailty represents a key determinant of elderly clinical assessment, especially because it allows the identification of risk factors potentially modifiable by clinical and therapeutic interventions. et al. 2005;173(5):489–495. 1993;25(1):71–80. Gil SM, et al. et al. 2012;13(10):e437–e444. ; Rezola-Pardo C, Transitions in frailty states among community-living older adults and their associated factors. Puts MTE, stream ; 48. et al. Initial manifestations of frailty criteria and the development of frailty phenotype in the Women's Health and Aging Study II. Update on interventions to prevent or reduce frailty in community-dwelling older adults: a scoping review and community translation. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Proactive and Personalised Primary Care of the Elderly. Geriatric assessment: an office-based approach. Rezola-Pardo C, Multicomponent program to reduce functional decline in frail elderly people: a cluster controlled trial. 1 Fried et al. Varadhan R, Taljaard M, <> Pre frail 80: multifactorial intervention to prevent progression of pre-frailty to frailty in the elderly. 35. van Kempen JAL, 2019 American Geriatrics Society Beers Criteria Update Expert Panel. Dent E, March 20, 2020. Cappola AR, The frailty syndrome. 16. Lips P, 103/No. Ruikes FGH, Connecting age-related biological decline to frailty and late-life vulnerability. The CES-D scale: a self-report depression scale for research in the general population. 2019 American Geriatrics Society Beers Criteria Update Expert Panel. There is no current recommendation for routine screening. Guyonnet S, Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: a randomised controlled trial. Rait G, 10. Consider screening men older than 60 years; women; current and former smokers; patients who are single, socially isolated, and of low socioeconomic status; and those who have lower levels of education. Lim WS, 2001;56(3):M146–M156.... 2. Lipsitz LA. Boter H, BMJ Open. Walston J, Mazidi M, Richardson CR. et al. Ainsworth BE, 41. Chen X, 19. 2011;11(1): 72–75. Schucker B, This content is owned by the AAFP. March 20, 2020. et al. 6. Physical Frailty Assessment: The assessment of physical frailty is most commonly performed using the physical frailty phenotype. / afp Luger E, et al. Chamberlain AM, Mazidi M, Frailty: Validation that the whole is greater than the sum of the parts • Criterion and construct validity (Fried, 2001; Bandeen-Roche 2006) • Validation as a syndrome (Bandeen-Roche, 2006) • Aggregate phenotype predicted mobility disability and other outcomes better than than any 1 or 2 … et al. et al. Auyeung T-W, Freiheit EA, 2020;271(2):283–289. <> Physical frailty: ICFSR international clinical practice guidelines for identification and management. Physical frailty: ICFSR international clinical practice guidelines for identification and management. Allore HG, Nicholl BI, 2018;97(12):776–784. Frailty as a predictor of death or new disability after surgery: a prospective cohort study. Haskell WL, Schöttker B, Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants. The frailty assessment in elderly patients usually is made by using of Fried criteria. Espinoza SE, Fhon JRS, Luger E, Frailty should be measured in clinical … Dent E, The Asia-Pacific clinical practice guidelines for the management of frailty [published correction appears in J Am Med Dir Assoc. 20. Ross JS. All five Fried frailty components were assessed in 65% of patients (95% confidence interval [CI] =60.8-69.2) (diagnostic group). 2017;95(7):425–432. et al. National Institute for Health and Care Excellence. Dynamics of stability: the physiologic basis of functional health and frailty. et al. 2017;46(3):401–407. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Dent E, Leung J, et al. et al. Scores from this assessment predict adverse outcomes in many different patient populations —that is, worsening chronic disease, loss of ability to bounce back from physical stressors such as injuries or surgeries, new or worsening disability, health crises such as … Collard RM, Cruz-Jentoft AJ, Jani BD, Frailty and the prediction of negative health outcomes: a meta-analysis. Frailty is, in general, characterized as an increased vulnerability to stressors with a decline in reserve and function of multiple physiologic systems. Feng L, Bandeen-Roche K, Nicholl BI, Dorner TE, Print, Consider screening men older than 60 years; women; current and former smokers; patients who are single, socially isolated, and of low socioeconomic status; and those who have lower levels of education.2,13,14,17–19, Systematic reviews on prevalence and risk factors, Consider screening patients diagnosed with diabetes mellitus, chronic obstructive pulmonary disease or respiratory disease, stroke, dementia, multiple sclerosis, connective tissue disease, osteoarthritis, or chronic fatigue syndrome.15,21,22, Prospective study and observational studies on associated conditions, Use a validated frailty assessment tool to diagnose frailty.39, Frailty management should be individualized for each patient based on their degree of frailty, goals of care, and life expectancy.49,50, Patients diagnosed as prefrail or frail who have no contraindications to physical activity should be offered a multicomponent physical activity program.50–56, Expert opinion, reviews, and lower-quality randomized controlled trials. LaCroix AZ, Dorner TE, 2018;8(3):e018195. A score of 3–5 indicates that someone is frail [ 5 ]. PLOS ONE in press If A+B ≥1, the individual is considered as "disabled". et al. Andrew MK, Immediate, unlimited access to all AFP content. Beckwée D, Palliative and Therapeutic Harmonization. https://www.aafp.org/afp/2018/0615/p776.html, https://www.brc-rea.be/wp-content/uploads/2020/03/Ethical-decision-making-in-emergencies_COVID19_22032020_final.pdf, https://www.aafp.org/afp/2017/0401/p425.html, Health Maintenance for Women of Reproductive Age, Bipolar Disorders: Evaluation and Treatment. Get Permissions, Access the latest issue of American Family Physician. Frailty Phenotype Template - CGA Toolkit Plus. et al. Want to use this article elsewhere? et al. J Am Geriatr Soc. Previous: Health Maintenance for Women of Reproductive Age, Next: Bipolar Disorders: Evaluation and Treatment, Home Nestle Nutr Inst Workshop Ser. Dynamics of stability: the physiologic basis of functional health and frailty. Chen CW, Fried LP, Mao G, et al. Biella MM, Wijnen-Sponselee MT, Dhesi JK. Xue QL, The Fried frailty phenotype uses five predefined variables to assess patients assumed to be frail. 2017;65(2):e27–e32. Rodrigues RAP, Snih SA, Domenich R, Aprahamian I, Copyright © 2020 American Academy of Family Physicians. Dent E, Hui-Min Ng D, Cawthon PM, 2014;9:433–441. Copyright © 2021 by the American Academy of Family Physicians. Rodrigues RAP, In search of an integral conceptual definition of frailty: opinions of experts. et al. Transitions between frailty states among community-living older persons. Ageing Res Rev 2016;26:53–61. Berges IM, Taylor HL, measure and assess frailty. Proctor DN, Vahtera J, Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study [published correction appears in. A questionnaire for the assessment of leisure time physical activities. Jacobs DR Jr, Schoevers RA, Int J Behav Nutr Phys Act. Frailty in older adults: evidence for a phenotype. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Clin Med (Lond). The frailty index defines frailty as cumulative deficits identified in a comprehensive geriatric assessment. et al. et al. et al. Comprehensive geriatric assessment—a guide for the non-specialist. J Nutr Health Aging. et al. 43. Med Sci Sports Exerc. Trampisch US, Choose a single article, issue, or full-access subscription. Gerontology. Palliative and therapeutic harmonization: a model for appropriate decision-making in frail older adults. American College of Sports Medicine. et al. 2021 Feb 15;103(4):219-226. et al. Walston JD. Clegg A, et al. 32. <> Exercise prescriptions in older adults. 2018;52:74. Clin Interv Aging. Cesari M et al. This clinical content conforms to AAFP criteria for CME. Gil SM, J Gerontol A Biol Sci Med Sci. van Assen MALM, et al. Bandeen-Roche K, Screening and assessment for frailty should consider a person’s physical performance, nutritional status, cognition, mental health and health supports, such as resources that protect against negative health outcomes and promote wellbeing. 23. Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study [published correction appears in J Am Geriatr Soc. It is a syndrome recognized primarily in older adults that affects health, energy, and physical abilities by increasing a patient's vulnerability to stressors (e.g., falls, infection) and risk of further decline.1,6,7 Recognizing frailty and understanding its progression will help physicians develop treatment plans and better discuss prognosis with patients and their families. 2009;57(3):492–498. 22. Schöttker B, Scores of 0.2 and over are considered as approaching frailty. Liu X, 2002;57(3):B115–B125. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort. 2019;2(8):e198398. Valsecchi MG, Kostov B, Zuidema SU, Cruz-Jentoft AJ, Int J Clin Pract. Patients with a larger number of frail attributes are at higher risk of poor outcomes. J Am Board Fam Med. Geriatric assessment: an office-based approach. Background: Frailty is common in patients with CHF. Lee JSW, van Kan GA, 4. The two most common measurements are Fried's phenotype and Rockwood and Mitnitski's Frailty Index. Category I. J Am Board Fam Med. Implementation: frailty within the health system. Several validated frailty assessment tools can evaluate a patient for frailty. Talebreza S, Moorhouse P, Prevalence of frailty in community-dwelling older persons: a systematic review. Lorenzo-López L, et al. Gahbauer EA, / Diagnosis of frailty after a Comprehensive Geriatric Assessment: differences between family physicians and geriatricians. Factors associated with frailty in older adults: a longitudinal study. Compendium of physical activities: classification of energy costs of human physical activities. 6 0 obj Appl Psychol Meas. Ensrud KE, et al. Mallery LH. 55. et al. 21. Varadhan R, ��? Accessed June 4, 2020. Graham JE, A joint statement of the Belgian Society of Emergency and Disaster Medicine and the Belgian Resuscitation Council. Gobbens RJJ, A comprehensive geriatric assessment can identify risk factors and symptoms that suggest frailty. 38. Preoperative Evaluation and Frailty Assessment in Older Patients. Hsieh TJ, Rev Saude Publica. 61. 2019;67(4):674–694. González MN, Hogan DB, Ethical principles and guidance with regard to ethical decisions in pre-hospital and emergency medicine in Belgium during the COVID-19 pandemic. Gobbens RJJ, 2012;60(4):652–660. Med Sci Sports Exerc. Chin KL, 50. March 22, 2020. Klaaßen-Mielke R, LaCroix AZ, Freiheit EA, 37. et al. Is polypharmacy associated with frailty in older people? 9. J Gerontol A Biol Sci Med Sci. Polypharmacy but not potential inappropriate prescription was associated with frailty in older adults from a middle-income country outpatient clinic. Xue QL, Related Lown Right Care: Preoperative Evaluation and Frailty Assessment in Older Patients. et al. Richardson CR. Bellelli G, Song X, Song X, Bryson GL, et al. et al. Exercise prescriptions in older adults. Melis RJF, endobj J Am Geriatr Soc. Andrew MK, 18. de Labra C, Perceived health and healthcare use American Geriatrics Society 2019 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. American College of Sports Medicine. Siriwardhana DD, 47. Mallery LH. Rieckert A, Frailty Phenotype. Cappola AR, Arrieta H, Akkermans RP, Jonker JM, 2017;65(7):1631–1632]. J Am Geriatr Soc. Curr Geriatr Rep. Persons with a score of 1 or 2 are at intermediate risk for adverse outcomes or are considered to be pre-frail. 46. Chen CW, 7. et al. Accessed June 5, 2020. https://www.aafp.org/afp/2017/0401/p425.html. Gerontopole Frailty Screening Tool. An older person ( … Deeg DJH. Ewing SK, et al. Vahtera J, Lips P, 12. et al. Pre frail 80: multifactorial intervention to prevent progression of pre-frailty to frailty in the elderly. Fried LP, Tangen CM, Walston J, et al. To see the full article, log in or purchase access. Jacobson DJ, Jackson EA, et al. Veronese N, Toubasi S, Components of the frailty phenotype in relation to the frailty index: results from the Toulouse frailty platform. Palliative and therapeutic harmonization: a model for appropriate decision-making in frail older adults. Accessed June 4, 2020. https://pathclinic.ca/implementation/. 59. <>>> <> Additionally, the prevalence of frailty was assessed according to Fried criteria et al. 2009;64(10):1049–1057. et al. All five Fried frailty components were assessed in 65% of patients (95% confidence interval [CI] =60.8-69.2) (diagnostic group). Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Is polypharmacy associated with frailty in older people? Leng SX. Proposed clinical definition of the frailty phenotype (McDermid et al, 2009) (aka Fried’s definition or Cardiovascular Health Study (CHS) definition) McIsaac DI, Siriwardhana DD, 33. Tatum PE III, American College of Sports Medicine position stand. Talebreza S, et al. Individualized home-based exercise and nutrition interventions improve frailty in older adults: a randomized controlled trial [published correction appears in. 60. Sist X, Morley JE, Women's Health Initiative. 30. Enlarge Frailty in Older Adults: Evidence for a Phenotype Linda P. Fried, I Catherine M. Tangen,2 Jeremy Walston,l Anne B. Newman,3 Calvin Hirsch,' ... basis for clinical assessment for those or at risk. 2019;394(10206):1376–1386. Santos JLF, x����j�@�����P�gf� et al. Frailty measurements can be used for population screening or clinical screening/assessment. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. 2018;3(7):e323–e332. et al. 24. et al. Guyonnet S, Huguet LG, Hui-Min Ng D, Rockwood K, Global incidence of frailty and pre-frailty among community-dwelling older adults: a systematic review and meta-analysis. et al. Osteoporotic Fractures in Men Research Group. Frailty transitions in the San Antonio Longitudinal Study of Aging. 2012;60(8):1487–1492. 2016;17(7):671e9–671e16. Determinants of frailty. Haider S, et al. Tangen CM, Using data from the US Cardiovascular Health Study, the Fried investigators recorded a frailty prevalence of 6.9% in a cohort of 5,201 men and women aged 65 years or above. Valsecchi MG, 2009;41(7):1510–1530. Su SC, 2015;83:1–10. Social and behavioural factors associated with frailty trajectories in a population-based cohort of older adults. B���B�m=�BQL��Z�9��{�t$;�U�v�`���}�}�Ïp~>�/.�r�=xF�aY�ї3X��prgaZ��t�����gq�)���v�G�. Gray SL, afpserv@aafp.org for copyright questions and/or permission requests. and for to develop intetventtons for frailty based a standardized ascertainment of ��� 14. Individualized home-based exercise and nutrition interventions improve frailty in older adults: a randomized controlled trial [published correction appears in Int J Behav Nutr Phys Act. Haider S, Collard RM, Van de Voorde P, Monsieurs K, Renier W, et al. 56. J Nutr Health Aging. Ofori-Asenso R, 2018;19(1):113. Several studies have demonstrated that frail adults are at increased risk of adverse health outcomes.3–5 However, there is no unifying definition for frailty. Allore HG, For information about the SORT evidence rating system, go to https://ww. A joint statement of the Belgian Society of Emergency and Disaster Medicine and the Belgian Resuscitation Council. Frailty assessment tools in cardiology: • Gait speed and PFP common in studies of CVD (Afilalo, 2014) • Gait speed recommended among heart failure patients (Boxer, 2014) • Clinical Frailty Scale highlighted for cardiac intervention(due to its graded scale from very fit to severely frail) (Rowe, 2014) Cardiology and Frailty Assessment Melis RJF, A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.
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