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Zeitschrift für Gerontologie und Geriatrie

, Volume 49, Issue 7, pp 567–572 | Cite as

Significance of frailty for predicting adverse clinical outcomes in different patient groups with specific medical conditions

  • Martin RittEmail author
  • Karl-Günter Gaßmann
  • Cornel Christian Sieber
Beiträge zum Themenschwerpunkt

Abstract

Frailty is a major health burden in an aging society. It constitutes a clinical state of reduced physiological reserves that is associated with a diminished ability to withstand internal and external stressors. Frail patients have an increased risk for adverse clinical outcomes, such as mortality, readmission to hospital, institutionalization and falls. Of further clinical interest, frailty might be at least in part reversible in some patients and subject to preventive strategies. In daily clinical practice older patients with a complex health status, who are mostly frail or at least at risk of developing frailty, are frequently cared for by geriatricians. Recently, clinicians and scientists from other medical disciplines, such as cardiology, pulmonology, gastroenterology, nephrology, endocrinology, rheumatology, surgery and critical care medicine also discovered frailty to be an interesting instrument for risk stratification of patients, including younger patients. In this review we highlight the results of recent studies that demonstrated the significance of frailty to predict adverse clinical outcomes in patients with specific medical conditions, such as cardiac, lung, liver and kidney diseases as well as diabetes mellitus, osteoarthritis, trauma patients, patients undergoing surgery and critically ill patients. Multiple studies in patients with the aforementioned specific medical conditions could be identified demonstrating a predictive role of frailty for several adverse clinical outcomes. The association between frailty and adverse clinical outcomes reported in these studies was in part independent of several major potential confounder factors, such as age, sex, race, comorbidities and disabilities and were also detected in younger patients.

Keywords

Frail elderly Clinical frailty scale Phenotype Comorbidities Mortality 

Bedeutung von Frailty für die Prädiktion unerwünschter klinischer Outcomes bei verschiedenen Patientengruppen mit spezifischen Erkrankungen

Zusammenfassung

Frailty stellt ein wesentliches medizinisches Problem in einer alternden Gesellschaft dar. Sie ist charakterisiert durch verminderte physiologische Reserven verschiedener Organsysteme und eine verminderte Fähigkeit des Organismus auf interne oder externe Stressoren adäquat zu reagieren. Frailty ist mit einem erhöhten Risiko für klinische Ereignisse wie Tod, wiederholte Krankenhauseinweisungen, Notwendigkeit der Unterbringung in einem Pflegeheim, Stürze etc. assoziiert. Frailty ist potenziell reversibel. Des Weiteren führen möglicherweise präventive Maßnahmen bei einigen Risikopatienten zu einer Verhinderung oder einer Verzögerung des Auftretens einer Frailty. Im klinischen Alltag werden Patienten mit komplexen medizinischen Problemen, die meist gebrechlich sind oder ein Risiko für Frailty aufweisen, von einem Geriater betreut. Zuletzt entdeckten auch Kliniker und Wissenschaftler anderer medizinischer Disziplinen wie Kardiologie, Pulmologie, Gastroenterologie, Nephrologie, Endokrinologie, Rheumatologie, Unfallchirurgie/Orthopädie, Chirurgie und Intensivmedizin die Frailty als Instrument für die Risikostratifizierung auch jüngerer Patienten. In diesem Review werden rezente Studien abgehandelt, welche einen prädiktiven Wert der Frailty für klinische Ereignisse bei Patienten mit Herzerkrankungen, Lungenerkrankungen, Lebererkrankungen, Nierenerkrankungen, Diabetes mellitus, rheumatologischen Erkrankungen, Traumapatienten, chirurgischen und intensivmedizinischen Patienten zeigen. Eine Vielzahl von Studien mit o. g. Patientenkollektiven wiesen auch einen prädiktiven Wert der Frailty für klinische Ereignisse wie Tod, Rehospitalisation, Notwendigkeit der Unterbringung in einem Pflegeheim, Abhängigkeit bei Aktivitäten des täglichen Lebens, Stürze etc. nach. Die Assoziation von Frailty und klinischen Ereignissen war in einem Teil dieser Studien unabhängig von potenziellen Faktoren wie Alter, Geschlecht, Rasse, Komorbiditäten sowie funktionellen Einschränkungen und zeigte sich auch bei jüngeren Patienten.

Schlüsselwörter

Gebrechliche ältere Patienten Klinisch Phänotyp Komorbidität Mortalität 

Notes

Compliance with ethical guidelines

Conflict of interests

M. Ritt, K.-G. Gaßmann and C.C. Sieber state that they have no conflict of interests.

This article does not contain any studies with human participants or animals performed by any of the authors except those studies cited accordingly in the references.

References

  1. 1.
    Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R et al (2013) Frailty consensus: A call to action. J Am Med Dir Assoc 14(6):392–397PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Bollwein J, Volkert D, Diekmann R, Kaiser JJ, Uter W, Vidal K et al (2013) Nutritional status according to the mini nutritional assessment (MNA) and frailty in community dwelling older persons: a close relationship. J Nutr Health Aging 17(4):351–356PubMedCrossRefGoogle Scholar
  3. 3.
    Christner S, Ritt M, Volkert D, Wirth R, Sieber CC, Gaßmann KG (2016) Evaluation of the nutritional status of older hospitalised geriatric patients: a comparative analysis of a Mini Nutritional Assessment (MNA) version and the Nutritional Risk Screening (NRS 2002). J Hum Nutr Diet. doi: 10.1111/jhn.12376 PubMedGoogle Scholar
  4. 4.
    Morley JE, von Haehling S, Anker SD, Vellas B (2014) From sarcopenia to frailty: a road less traveled. J Cachexia Sarcopenia Muscle 5:5–8PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E (2014) Sarcopenia and physical frailty: two sides of the same coin. Front Aging Neurosci 6:192PubMedPubMedCentralGoogle Scholar
  6. 6.
    Ritt M, Schülein S, Lubrich H, Bollheimer LC, Sieber CC, Gaßmann KG (2016) High-technology based gait assessment in frail people: Association between spatio-temporal and three-dimensional gait characteristics with frailty status across four different frailty measures. J Nutr Health Aging. doi: 10.1007/s12603-016-0764-4 PubMedGoogle Scholar
  7. 7.
    Hubbard RE, O’Mahony MS, Savva GM, Calver BL, Woodhouse KW (2009) Inflammation and frailty measures in older people. J Cell Mol Med 13(9B):3103–3109PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Afilalo J (2011) Frailty in patients with cardiovascular disease: why, when and how to measure. Curr Cardiovasc Risk Rep 5:467–472PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Fuchs J, Scheidt-Nave C, Gaertner B, Dapp U, von Renteln-Kruse W, Saum KU et al (2015) Frailty in Germany: status and prespectives: results from a workshop of the German Society for Epidemiology. Z Gerontol Geriatr. doi: 10.1007/s00391-015-0999-4 Google Scholar
  10. 10.
    Ng TP, Feng L, Nyunt MS, Feng L, Niti M, Tan BY et al (2015) Nutritional, physical, cognitive, and combination interventions and frailty reversal among older adults: a randomized controlled trial. Am J Med 128(11):1225–1236PubMedCrossRefGoogle Scholar
  11. 11.
    Kim H, Suzuki T, Kim M, Kojima N, Ota N, Shimatoyodome A et al (2015) Effects of exercise and milk far globule membrane (MFGM) supplementation on body composition, physical function, and mematological parameters in community-dwelling frail Japanese women: a randomized double blind, placebo-controlled, follow-up trial. PLOS ONE 10(2):e0116256PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Schreier MM, Bauer U, Osterbrink J, Niebauer J, Iglseder B, Reiss J (2016) Fitness training for the old and frail: efectiveness and impact on daily life coping and self-care abilities. Z Gerontol Geriatr 49(2):107–114PubMedCrossRefGoogle Scholar
  13. 13.
    Ritt M, Harazny JM, Ott C, Raff U, Bauernschubert P, Lehmann M et al (2012) Impaired increase of retinal capillary blood flow to flicker light exposure in arterial hypertension. Hypertension 60(3):871–876PubMedCrossRefGoogle Scholar
  14. 14.
    Ritt M, Harazny JM, Ott C, Raff U, Schneider MP, Michelson G et al (2011) Basal nitric oxide activity is an independent determinant of arteriolar structure in the human retinal circulation. J Hypertens 29(1):123–129PubMedCrossRefGoogle Scholar
  15. 15.
    Ritt M, Harazny JM, Ott C, Raff U, Lehmann M, Michelson G et al (2012) Influence of blood flow on arteriolar wall-to-lumen ratio in the human retinal circulation in vivo. Microvasc Res 83(2):111–117PubMedCrossRefGoogle Scholar
  16. 16.
    Ritt M, Harazny JM, Ott C, Schliach MP, Schneider MP, Michelson G et al (2008) Impact of the endothelial nitric oxide synthase gene G894T polymorphism on renal endothelial function in patients with type 2 diabetes. Pharmacogenet Genomics 18(8):699–707PubMedCrossRefGoogle Scholar
  17. 17.
    Onder G, Marengoni A (2016) Frailty: The pleasure and pain of geriatric medicine. Eur J Intern Med 31:1–2PubMedCrossRefGoogle Scholar
  18. 18.
    Rockwood K, Mitnitski A (2011) Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 27(1):17–26PubMedCrossRefGoogle Scholar
  19. 19.
    Crome P, Lally F (2011) Frailty: joining the giants. CMAJ 183(8):889–890PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Mitnitski A, Mogilner AJ, Rockwood K (2001) Accumulation of deficits as a proxy measure of ageing. ScientificWorldJournal 1:323–336PubMedCrossRefGoogle Scholar
  21. 21.
  22. 22.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 5(173):489–495CrossRefGoogle Scholar
  23. 23.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56A:M146–M156CrossRefGoogle Scholar
  24. 24.
    Ritt M, Radi KH, Schwarz C, Bollheimer LC, Sieber CC, Gaßmann KG (2016) A comparison of frailty indexes based on a comprehensive geriatric assessment for the prediction of adverse outcomes. J Nutr Health Aging 20(7):760–767CrossRefGoogle Scholar
  25. 25.
    Ritt M, Schwarz C, Kronawitter V, Delinic A, Bollheimer LC, Gaßmann KG et al (2015) Analysis of Rockwood et al’s Clinical Frailty Scale and Fried et al’s frailty phenotype as predictors of mortality and other clinical outcomes in older patients who were admitted to a geriatric ward. J Nutr Health Aging 19(10):1043–1048PubMedCrossRefGoogle Scholar
  26. 26.
    Ritt M, Bollheimer LC, Sieber CC, Gaßmann KG (2016) Prediction of one-year mortality by five different frailty instruments: a comparative study in hospitalized geriatric patients. Arch Gerontol Geriatr 66:66–72PubMedCrossRefGoogle Scholar
  27. 27.
    Ekerstad N, Swahn E, Janzon M, Alfredsson J, Löfmark R, Lindenberger M et al (2011) Frailty is independently assoicated with short-term outcomes for elderly patients with non-ST-segment elevation myocardial infarction. Circulation 124:2397–2404PubMedCrossRefGoogle Scholar
  28. 28.
    Bao Y, Dalrymple L, Chertow GM, Kaysen GA, Johansen KL (2012) Frialty, dialysis initiation, and mortality in end-stage renal disease. Arch Intern Med 172(14):1071–1077PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Arya S, Kim SI, Duwayri Y, Brewster LP, Veeraswamy R, Salam A et al (2015) Frailty increases the risk of 30-day mortality, morbidity, and failure to resuce after elective abdominal aortic aneurysm repair independent of age and co-morbidities. J Vasc Surg 61(2):324–331PubMedCrossRefGoogle Scholar
  30. 30.
    Nguyen TN, Cummings RG, Hilmer SN (2016) The impact of frailty on mortality, length of stay and re-hospitalisation in older paitents with atrial fribrillation. Heart Lung Circ 25(6):551–557PubMedCrossRefGoogle Scholar
  31. 31.
    Vidan MT, Blaya-Novakova V, Sanchez E, Ortiz J, Serra-Rexach JA, Bueno H (2016) Prevalence and prognostic impact of frailty and its components in non-dependent elderly patients with heart failure. Eur J Heart Fail. doi: 10.1002/ejhf.518 Google Scholar
  32. 32.
    Dominiquez-Rodriquez A, Abreu-Gonzales P, Jimenez-Sosa A, Gonzalez J, Cabellero-Estevez N, Martin-Casanas FV et al (2015) The impact of frailty in older paitents with non-ischaemic cardiomyopathy after implantation of cardiac resynchronization therapy defibrillator. Europace 17(4):598–602CrossRefGoogle Scholar
  33. 33.
    Jha SR, Hannu MK, Chang S, Montgomery E, Hrkess M, Eilhelm K et al (2016) The prevalence and prognostic significance of frailty in patients with advanced heart failure referred for heart transplantation. Transplantation 100(2):429–436PubMedCrossRefGoogle Scholar
  34. 34.
    Kang L, Zhang SY, Zhu WL, Pang HY, Zhang L, Zhu ML et al (2015) Is frailty associated with short-term outcomes for elderly patients with acure coronary syndrome? J Geriatr Cardiol 12(6):662–667PubMedPubMedCentralGoogle Scholar
  35. 35.
    Sujino Y, Tanno J, Nakano S, Funada S, Hosoi Y, Senbonmatsu T et al (2015) Impact of hypoalbuminemia, frailty, and body mas index on early prognosis in older paitents (>=85 years) with ST-elevation myocardial infarction. J Cardiol 66(3):263–268PubMedCrossRefGoogle Scholar
  36. 36.
    Galizia C, Cacciatore F, Testa G, Della-Morte D, Mazzella F, Langellotto A, Raucci C et al (2011) Role of clinical frialty on long-term mortality of elderly subjects with and without chronic pulmonary disease. Aging Clin Exp Res 23(2):118–125PubMedCrossRefGoogle Scholar
  37. 37.
    Wilson ME, Vakil AP, Kandel P, Undavalli C, Dunlay SM, Kennedy CC (2016) Pretransplant frailty is associated with decreased wurvivial after lung transplantation. J Heart Lung Transplant 35(2):173–178PubMedCrossRefGoogle Scholar
  38. 38.
    Singer JP, Diamond JM, Gries CJ, McDonnough J, Blanc PD, Shah R et al (2015) Frailty phenotypes, disability, and outcomes in adult candidates for lung transplantation. Am J Respir Crit Care Med 192(11):1325–1334PubMedCrossRefGoogle Scholar
  39. 39.
    Lai JC, Feng S, Terrailt NA, Lizaola B, Hayssen H, VCovinsky K (2014) Frailty predicts waitlist mortality in liver transplant candidates. Am J Transplant 14(8):1870–1879PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Derck JE, Thelen AE, Cron DC, Friedman JF, Gerebics AD, Englesbe MJ et al (2015) Quality of life in liver transplant candidates. Frailty is a better indicator than severity of liver disease. Transplantation 99(2):340–344PubMedCrossRefGoogle Scholar
  41. 41.
    Lee SJ, Son H, Shin SK (2015) Influendce of frailty on health-related quality of life in pre-dialysis patients with chronic kidney disease in Korea: a cross-sectional study. Health Qual Life Outcomes 13:70PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    McAdams-DeMarco MA, Law A, Salter ML, Boyarsky B, Gimenez LZ, Jaar BG et al (2013) Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc 61(6):896–901PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    McAdams-DeMarco MA, Suresh S, Law A, Salter ML, Gimenez LZ, Jaar BG et al (2013) Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study. BMC Nephrol 14:224PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Alfaadhel TA, Soroka SD, Kiberd BA, Landry D, Moorhouse P, Tennankore KK (2015) Frailty and mortality in dialysis: evaluation of a clinical frailty scale. Clin J Am Soc Nephrol 2015(10):832–840CrossRefGoogle Scholar
  45. 45.
    Pugh J, Aggett J, Goodland A, Prichard A, Thomas N, Donovan K et al (2016) Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education. Clin Kidney J 9(2):324–329PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    McAdams-DeMarco MA, Law A, King E, Orandi B, Salter M, Gupta N et al (2015) Frailty and mortality in kidney transplant recipients. Am J Transplant 15(1):149–154PubMedCrossRefGoogle Scholar
  47. 47.
    Cacciatore F, Resta G, Galizia G, Della-Morte D, Mazzella F, Langellotto A et al (2013) Clinical frailty and long-term mortality in elderly subjects with diabetes. Acta Diabetol 50(2):251–260PubMedCrossRefGoogle Scholar
  48. 48.
    Cacciatore F, Della-Morte D, Basile C, Mazella F, Mastrobuoni C, Salsano E et al (2014) Long-term mortality in frail elderly subjects with osteoarthtitis. Rheumatology 53(2):293–299PubMedCrossRefGoogle Scholar
  49. 49.
    Miguel RC, Dias RC, Dias JMD, da Silva SLA, Menicucci Filho PR, Riberio TM (2012) Frailty syndrome in the community dwelling elderly with osteoarthritis. Rev Bras Reumatol 52(3):331–347CrossRefGoogle Scholar
  50. 50.
    Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Hashmi A, Green DJ et al (2014) Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg 149(8):766–772PubMedCrossRefGoogle Scholar
  51. 51.
    Ali R, Schwalb JM, Nerenz DR, Antoine HJ, Rubinfeld I (2016) Use of the modified frailty index to predict 30-day mobidity and mortality from spine surgery. J Neurosurg Spine 6:1–5Google Scholar
  52. 52.
    Tsiouris A, Hammoud ZT, Velanovich V, Hodari A, Borgi J, Rubinfeld I (2013) A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res 183(1):40–46PubMedCrossRefGoogle Scholar
  53. 53.
    Lascano D, Pak JS, Kates M, Finkelstein JB, Silva M, Hagen E et al (2015) Validation of a frailty index in patients undergoing curative surgery for urologic malignancy and comparison with other risk stratification tools. Urol Uncol 33(10):426.e1–426.e12CrossRefGoogle Scholar
  54. 54.
    Suskind AM, Walter LC, Jin C, Boscardin J, Sen S, Cooperberg MR et al (2016) The impact of frailty on complications in patients undergoing common urologic procudures; a study from the American College of Surgeons National Surgical Quality Improvement Database. BJU Int 117(5):836–842PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Li JL, Henderson MA, Reveig LM, Sweeney JF, Kooby DA, Maithel SK et al (2016) Frailty and one-year mortality in major intra-abdomial operations. J Surg Res 203(2):507–512.e1PubMedCrossRefGoogle Scholar
  56. 56.
    Sündermann SH, Dademasch A, Seifert B, Biefer HRC, Emmert MY, Walther T et al (2014) Frailty is a predictor of short-and mid-term mortality after elective cardiac surgery independenlty of age. Interact Cardiovasc Thorac Surg 18(5):580–585PubMedCrossRefGoogle Scholar
  57. 57.
    Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N et al (2014) Association between frailty and short – and long-term outcomes among critically ill paitents: a multicentre prospective cohort study. CMAJ 186(2):E95–E102PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Baldwin MR, Reid MC, Westlake AA, Rowe JW, Granieri EC, Wunsch H et al (2014) The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors. J Crit Care 29(3):401–408PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Martin Ritt
    • 1
    • 2
    Email author
  • Karl-Günter Gaßmann
    • 1
    • 2
  • Cornel Christian Sieber
    • 2
    • 3
  1. 1.Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre ErlangenHospital of the Congregation of St. Francis Sisters of VierzehnheiligenErlangenGermany
  2. 2.Institute for Biomedicine of Ageing (IBA)Friedrich-Alexander Universität Erlangen-Nürnberg (FAU)NürnbergGermany
  3. 3.Department of Internal Medicine and GeriatricsHospital of the Order of St. John of GodRegensburgGermany

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