Skip to main content
SpringerLink
Log in

Implementing frailty screening, assessment, and sustained intervention: The experience of the gérontopôle

  • Published:
The journal of nutrition, health & aging

Abstract

Despite its interest, frailty is not yet adequately implemented in the everyday clinical practice. Frailty is characterized by an initial functional loss which 1) still allows the individual to be independent in the daily life (although with some difficulties), and 2) may be reversed by targeted interventions. In the present article, we discuss: Why frailty is clinically relevant? Why frailty has not yet been implemented in daily clinical practice? How to implement frailty into clinical practice following the Gérontopôle experience? Intervention to be effective must be targeted, strong, and maintained.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alzheimer Disease International: World Alzheimer Report 2013, Journey of Caring. http://www.alz.co.uk/research/WorldAlzheimerReport2013.pdf (accessed August 19, 2014).

    Google Scholar 

  2. Katz S, Branch LG, Branson MH, Papsidero JA, Beck JC, Greer DS. Active life expectancy. N Engl J Med 1983; 309: 1218–1224.

    Article  CAS  PubMed  Google Scholar 

  3. Fried TR, Bradley EH, Williams CS, Tinetti ME. Functional disability and health care expenditures for older persons. Arch Intern Med 2001; 161: 2602–2607.

    Article  CAS  PubMed  Google Scholar 

  4. 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: M146–56.

    Article  CAS  PubMed  Google Scholar 

  5. Rodríguez-Mañas L, Féart C, Mann G et al. 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 Sci 2012; 68: 62–67.

    Article  Google Scholar 

  6. Morley JE, Vellas B, Abellan van Kan G et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392–397.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Vellas B, Cestac P, Morley JE. Implementing frailty into clinical practice: we cannot wait. J Nutr Health Aging 2012; 16: 599–600.

    Article  CAS  PubMed  Google Scholar 

  8. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–762.

    Article  PubMed  Google Scholar 

  9. Cesari M, Vellas B, Gambassi G. The stress of aging. Exp Gerontol 2013; 48: 451–456.

    Article  PubMed  Google Scholar 

  10. Bernabei R, Landi F, Gambassi G et al. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ 1998; 316: 1348–1351.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Stuck AE, Minder CE, Peter-Wüest I et al. A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Arch Intern Med 2000; 160: 977–986.

    Article  CAS  PubMed  Google Scholar 

  12. Glasziou P, Moynihan R, Richards T, Godlee F. Too much medicine; too little care. BMJ 2013; 347: f4247.

    Article  PubMed  Google Scholar 

  13. Moreno-Aguilar M, Garcia-Lara JMA, Aguilar-Navarro S, Navarrete-Reyes AP, Amieva H, Avila-Funes JA. The phenotype of frailty and health-related quality of life. J Frailty Aging 2013; 2: 2–7.

    Google Scholar 

  14. O’ Connell MDL, Tajar A, O’ Neill TW et al. Frailty is associated with impaired quality of life and falls in middle-aged and older European men. J Frailty Aging 2013; 2: 77–83.

    Google Scholar 

  15. Cesari M, Gambassi G, Abellan van Kan G, Vellas B. The frailty phenotype and the frailty index: different instruments for different purposes. Age Ageing 2014; 43: 10–12.

    Article  PubMed  Google Scholar 

  16. Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middleaged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 2009; 64: 675–681.

    Article  PubMed  Google Scholar 

  17. 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: 1487–92.

    Article  PubMed  Google Scholar 

  18. Gutman GM, Stark A, Donald A, Beattie BL. Contribution of self-reported health ratings to predicting frailty, institutionalization, and death over a 5-year period. Int Psychogeriatr 2001; 13 Supp 1: 223–31.

    Article  PubMed  Google Scholar 

  19. Frisoli A Jr, Chaves PH, Ingham SJ, Fried LP. Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: results from the Women’s Health and Aging Study (WHAS) II. Bone 2011; 48: 952–7.

    Article  PubMed  Google Scholar 

  20. Bandeen-Roche K, Xue QL, Ferrucci L, Walston J, Guralnik JM, Chaves P, Zeger SL, Fried LP. Phenotype of frailty: characterization in the women’s health and aging studies. J Gerontol A Biol Sci Med Sci. 2006; 61: 262–6.

    Article  PubMed  Google Scholar 

  21. Rantanen T, Guralnik JM, Sakari-Rantala R, Leveille S, Simonsick EM, Ling S, Fried LP. Disability, physical activity, and muscle strength in older women: the Women’s Health and Aging Study. Arch Phys Med Rehabil 1999; 80: 130–5.

    Article  CAS  PubMed  Google Scholar 

  22. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg 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: 382–9.

    Article  PubMed  Google Scholar 

  23. Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, Dam TT, Marshall LM, Orwoll ES, Cummings SR. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. Osteoporotic Fractures in Men Research Group. J Am Geriatr Soc 2009; 57: 492–8.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011; 343: d6553.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J, Ebrahim S. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 2008; 371: 725–735.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 2002; 287: 1022–1028.

    Article  PubMed  Google Scholar 

  27. Cummings SR1, Studenski S2, Ferrucci L. A diagnosis of dismobility-giving mobility clinical visibility: a Mobility Working Group recommendation. JAMA 2014; 311: 2061–2062.

    Article  Google Scholar 

  28. International Conference on Frailty and Sarcopenia Research. http://www.frailtysarcopenia.com/ (accessed August 19, 2014).

  29. The Innovative Medicines Initiative. http://www.imi.europa.eu/ (accessed August 19, 2014).

  30. The Journal of Frailty and Aging. www.jfrailtyaging.com/ (accessed August 19, 2014).

  31. Implementing Frailty into Clinical Practice. http://www.frailty.net/ (accessed August 19, 2014).

  32. Ensemble prévenons la dépendence. http://www.ensembleprevenonsladependance.fr/ (accessed August 19, 2014).

  33. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012; 16: 601–608.

    Article  CAS  PubMed  Google Scholar 

  34. Vellas B, Balardy L, Gillette-Guyonnet S, Abellan Van Kan G, Ghisolfi-Marque A, Subra J, Bismuth S, Oustric S, Cesari M. Looking for frailty in community-dwelling older persons: the Gérontopôle Frailty Screening Tool (GFST). J Nutr Health Aging 2013; 17: 629–631.

    Article  CAS  PubMed  Google Scholar 

  35. Xue QL, Varadhan R. What is missing in the validation of frailty instruments? J Am Med Dir Assoc 2014; 15(2): 141–142.

    Article  PubMed  Google Scholar 

  36. Cesari M, Vellas B. Response to the letter to the editor: “what is missing in the validation of frailty instruments?”. J Am Med Dir Assoc 2014; 15(2): 143–144.

    Article  PubMed  Google Scholar 

  37. Subra J, Gillette-Guyonnet S, Cesari M, Oustric S, Vellas B; Platform Team. The integration of frailty into clinical practice: preliminary results from the Gérontopôle. J Nutr Health Aging. 2012; 16: 714–720.

    CAS  Google Scholar 

  38. Tavassoli N, Guyonnet S, Abellan Van Kan G, Sourdet S, Krams T, Soto ME, Subra J, Chicoulaa B, Ghisolfi A, Balardy L, Cestac P, Rolland Y, Andrieu S, Nourhashemi F, Oustric S, Cesari M, Vellas B and the Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability Team. Description of 1,108 Older Patients Referred by their Physician to the “Geriatric Frailty Clinic (G.F.C) for Assessment of Frailty and Prevention of Disability” at the Gerontopole. J Nutr Health Aging 2014; 18: 457–464.

    CAS  Google Scholar 

  39. Fiche points clés et solutions, Haute Autorité de Santé (HAS). http://www.hassante.fr/portail/upload/docs/application/pdf/2013-06/fiche_parcours_fragilite_vf.pdf (accessed August 19, 2014).

  40. Cesari M, Demougeot L, Boccalon H, Guyonnet S, Vellas B, Andrieu S. The Multidomain Intervention to preveNt disability in ElDers (MINDED) project: rationale and study design of a pilot study. Contemp Clin Trials 2014; 38: 145–154.

    Article  PubMed  Google Scholar 

  41. Cesari M, Demougeot L, Boccalon H, Guyonnet S, Abellan Van Kan G, Vellas B, Andrieu S. A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability: the FiND questionnaire. PLoS One 2014; 9: e101745.

    Google Scholar 

  42. Vellas B, Carrie I, Gillette-Guyonnet S, Touchon J, Dantoine T, Dartigues JF, Cuffi MN, Bordes S, Gasnier Y, Robert P, Bories L, Rouaud O, Desclaux F, Sudres K, Bonnefoy M, Pesce A, Dufouil C, Lehericy S, Chupin M, Mangin JF, Payoux P, Adel D, Legrand P, Catheline D, Kanony C, Zaim M, Molinier L, Costa N, Delrieu J, Voisin T, Faisant C, Lala F, Nourhashemi F, Rolland Y, Abellan Van Kan G, Dupuy C, Cantet C, Cestac P, Belleville S, Willis S, Cesari M, Weiner MW, Soto ME, Ousset PJ, Andrieu S. MAPT Study: A Multidomain Approach for Preventing Alzheimer’s Disease: Design and Baseline Data. JPAD 2014; 1: 13–22.

    Google Scholar 

  43. Sourdet S, Lafont C, Rolland Y, Nourhashemi F, Andrieu S, Vellas B. Preventable Iatrogenic Disability in Elderly Patients during hospitalization. PLoS One 2014; in press.

    Google Scholar 

  44. White TA, LeBrasseur NK. Myostatin and sarcopenia: opportunities and challenges — a mini-review. Gerontology 2014; 60: 289–93.

    Article  CAS  PubMed  Google Scholar 

  45. Kelaiditi E, Cesari M, Canevelli M, van Kan GA, Ousset PJ, Gillette-Guyonnet S, Ritz P, Duveau F, Soto ME, Provencher V, Nourhashemi F, Salvà A, Robert P, Andrieu S, Rolland Y, Touchon J, Fitten JL, Vellas B; IANA/IAGG. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. J Nutr Health Aging 2013; 17: 726–734.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalier Universitaire de Toulouse, 170 avenue de Casselardit, 31300, Toulouse, France

    B. Vellas

  2. INSERM U1027, 37 Avenue Jules Guesde, F-31073, Toulouse, France

    B. Vellas

Authors
  1. B. Vellas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Vellas.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vellas, B. Implementing frailty screening, assessment, and sustained intervention: The experience of the gérontopôle. J Nutr Health Aging 19, 673–680 (2015). https://doi.org/10.1007/s12603-015-0505-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-015-0505-0

Keywords

Search

Navigation