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Frailty Could Predict Death in Older Adults after Admission at Emergency Department? A 6-month Prospective Study from a Middle-Income Country

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The journal of nutrition, health & aging

Abstract

Background

The number of older adults attending emergency department (ED) is increasing all over the world. Usually, those patients are potentially more complex due to their greater number of comorbidities, cognitive disorders, and functional or physical disabilities. Frailty is a vulnerable state that could predict adverse outcomes of those patients. There are very few studies that addressed this topic in the ED, and none of them used a simple instrument for frailty assessment.

Objectives

The primary outcome was to evaluate the association between frailty identified through the FRAIL questionnaire at baseline and death after a 6-month follow-up period after hospital discharge from the ED. Secondary outcomes were readmission to the ED and disability after 6 months.

Methods

A 6-month follow-up prospective study (FASES study) was conducted at a university-based trauma-center ED in Jundiaí, southwestern of Brazil. A total of 316 older adults aged 60 or older were randomly included based on a lottery of their medical record admission number. Frailty was evaluated through the FRAIL questionnaire. The association between frailty and death was estimated through a binary logistic regression adjusted for age, sex, and cognitive performance.

Results

From the total sample, the mean age was 72.11±8.0 years, and 51.6% were women. Participants presented 2.28±1.4 comorbidities and 25.6% were frail. Mean hospital stay was 5.43±5.6 days. Death occurred in 52 participants, readmission to the emergency in 55, and new disability in 16 after 6 months. Frailty was associated with an odds ratio of 2.18 for death after 6 months (95% CI = 1.10–4.31; p = 0.024). This association lost significance after multivariate analysis taking into account cognitive performance. There was no association between frailty status at baseline and readmission to the ED or disability.

Conclusion

The identification of frailty using the FRAIL at admission was not predictive of death after a 6-month period after discharge from the ED. Simple frailty assessment could identify patients at higher risk for death in the follow-up.

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References

  1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013; 381: 752–762. doi: https://doi.org/10.1016/S0140-6736(12)62167-9.

    Article  PubMed  Google Scholar 

  2. 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(8):1487–1492. doi: https://doi.org/10.1111/j.1532-5415.2012.04054.x.

    Article  PubMed  Google Scholar 

  3. Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2018; 8(3):e018195. doi: https://doi.org/10.1136/bmjopen-2017-018195.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kiely DK, Cupples LA, Lipsitz LA. Validation and comparison of two frailty indexes: the MOBILIZE Boston Study. J Am Geriatr Soc. 2009; 57: 1532–1539. doi: https://doi.org/10.1111/j.1532-5415.2009.02394.x.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ensrud KE, Ewing SK, Cawthon PM, Fink HA, Taylor BC, Cauley JA, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc. 2009; 57: 492–498. doi: https://doi.org/10.1111/j.1532-5415.2009.02137.x.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wilber ST, Gerson LW. Emergency department care. In: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S, eds. Hazzard’s geriatric medicine and gerontology. 6th ed. New York: McGraw-Hill Professional; 2009: 221–228.

    Google Scholar 

  7. McNamara RM, Rousseau E, Sanders AB. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med. 1992; 21: 796–801.

    Article  CAS  PubMed  Google Scholar 

  8. McCusker J, Verdon J, Tousignant P, de Courval LP, Dendukuri N, Belzile E. Rapid emergency department intervention for older people reduces risk of functional decline: results of a multicenter randomized trial. J Am Geriatr Soc. 2001; 49: 1272–1281.

    Article  CAS  PubMed  Google Scholar 

  9. Carpenter CR, Platts-Mills TF. Evolving prehospital, emergency department, and “inpatient” management models for geriatric emergencies. Clin Geriatr Med. 2013; 29(1): 31–47.

    Article  PubMed  Google Scholar 

  10. Mion LC, Palmer RM, Anetzberger GJ, Meldon SW. Establishing a case-finding and referral system for at-risk older individuals in the emergency department setting: the SIGNET model. J Am Geriatr Soc. 2001; 49: 1379–1386.

    Article  CAS  PubMed  Google Scholar 

  11. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department - the DEED II study. J Am Geriatr Soc. 2004; 52: 1417–1423.

    Article  PubMed  Google Scholar 

  12. Hustey FM, Mion LC, Connor JT, Emerman CL, Campbell J, Palmer RM. A brief risk stratification tool to predict functional de- cline in older adults discharged from emergency departments. J Am Geriatr Soc. 2007; 55: 1269–1274.

    Article  PubMed  Google Scholar 

  13. Aprahamian I, Suemoto CK, Aliberti MJR, de Queiroz Fortes Filho S, de Araújo Melo J, Lin SM, et al. Frailty and cognitive status evaluation can better predict mortality in older adults? Arch Gerontol Geriatr. 2018; 77: 51–56. doi: https://doi.org/10.1016/j.archger.2018.04.005.

    Article  PubMed  Google Scholar 

  14. Stiffler KA, Finley A, Midha S, Wilber ST. Frailty assessment in the emergency department. J Emerg Med. 2013; 45(2): 291–298. doi: https://doi.org/10.1016/j.jemermed.2012.11.047.

    Article  PubMed  Google Scholar 

  15. Jørgensen R, Brabrand M. Screening of the frail patient in the emergency department: A systematic review. Eur J Intern Med. 2017; 45: 71–73. doi: https://doi.org/10.1016/j.ejim.2017.09.036.

    Article  PubMed  Google Scholar 

  16. Hastings SN, Purser JL, Johnson KS, Sloane RJ, Whitson HE. Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. J Am Geriatr Soc. 2008; 56(9):1651–1657. doi: https://doi.org/10.1111/J.1532-5415.2008.01840.x.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Aprahamian I, Lin SM, Suemoto CK, Apolinario D, Oiring de Castro Cezar N, Elmadjian SM, et al. Feasibility and Factor Structure of the FRAIL Scale in Older Adults. J Am Med Dir Assoc. 2017; 18: 367.e11–18. doi: https://doi.org/10.1016/j.jamda.2016.12.067.

    Article  PubMed  Google Scholar 

  18. Barbosa-Silva TG, Menezes AM, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: Improving Sarcopenia Screening in the Clinical Practice. J Am Med Dir Assoc. 2016; 17(12): 1136–41. doi: https://doi.org/10.1016/j.jamda.2016.08.004.

    Article  PubMed  Google Scholar 

  19. Almeida OP, Almeida SA. Confiabilidade da versão brasileira da Escala de Depressão em Geriatria (GDS) versão reduzida. Arq Neuro-Psiquiatr. 1999; 57:421–426.

    Article  CAS  Google Scholar 

  20. Santos JG, Pereira JR, Teixeira CVL, Corazza DI, Vital TM, Costa JLR. Sintomas depressivos e prejuízo funcional de idosos de um Centro-Dia Geriátrico. J Bras de Psiquiatr. 2012; 61:2.

    Article  Google Scholar 

  21. Apolinario D, Lichtenthaler DG, Magaldi RM, Soares AT, Busse AL, Amaral JR, et al. Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS). Int J Geriatr Psychiatry. 2016; 31: 4–12. doi: https://doi.org/10.1002/gps.4282.

    Article  PubMed  Google Scholar 

  22. 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  PubMed Central  Google Scholar 

  23. Aprahamian I, Cezar NO, Izbicki R, Lin SM, Paulo DL, Fattori A, et al. Screening for Frailty with the FRAIL Scale: A Comparison With the Phenotype Criteria. J Am Med Dir Assoc. 2017; 18: 592–596. doi: https://doi.org/10.1016/j.jamda.2017.01.009.

    Article  PubMed  Google Scholar 

  24. Salvi F, Morichi V, Grilli A, Lancioni L, Spazzafumo L, Polonara S, et al. Screening for frailty in elderly emergency department patients by using the Identification of Seniors At Risk (ISAR). J Nutr Health Aging. 2012; 16(4): 313–318.

    Article  CAS  PubMed  Google Scholar 

  25. Sirois MJ, Griffith L, Perry J, Daoust R, Veillette N, Lee J, et al. Measuring frailty can help emergency departments identify independent seniors at risk of functional decline after minor injuries. J Gerontol A Biol Sci Med Sci. 2015; 72(1):68–74.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wallis SJ, Wall J, Biram RW, Romero-Ortuno R. Association of the clinical frailty scale with hospital outcomes. QJM. 2015; 108(12):943–949. doi: https://doi.org/10.1093/qjmed/hcv066.

    Article  CAS  PubMed  Google Scholar 

  27. Wou F, Gladman JR, Bradshaw L, Franklin M, Edmans J, Conroy SP. The predictive properties of frailty-rating scales in the acute medical unit. Age Ageing. 2013; 42: 776–781. doi: https://doi.org/10.1093/ageing/aft055.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Aguayo GA, Donneau AF, Vaillant MT, Schritz A, Franco OH, Stranges S, et al. Agreement Between 35 Published Frailty Scores in the General Population. Am J Epidemiol. 2017; 186(4): 420–434. doi: https://doi.org/10.1093/aje/kwx061.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pink J, O’Brien J, Robinson L, Longson D; Guideline Committee. Dementia: assessment, management and support: summary of updated NICE guidance. BMJ. 2018; 361: k2438. doi: https://doi.org/10.1136/bmj.k2438.

    Article  PubMed  Google Scholar 

  30. Buurman BM, Hoogerduijn JG, van Gemert EA, de Haan RJ, Schuurmans MJ, de Rooij SE. Clinical characteristics and outcomes of hospitalized older patients with distinct risk profiles for functional decline: a prospective cohort study. PLoS One. 2012; 7: e29621. doi: https://doi.org/10.1371/journal.pone.0029621.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Prof. Aprahamian receives National public grant level 2 from the National Council for Scientific and Technological Development (Ministry of Science, Technology, Innovation and Communications, Brazil).

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Authors and Affiliations

  1. Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, Jundiaí, Brazil, 250 Francisco Telles street, ZIP 13.202-550

    Ivan Aprahamian, G. V. Aricó de Almeida, C. F. de Vasconcellos Romanin, T. Gomes Caldas, N. T. Antunes Yoshitake, L. Bataglini, S. Mori Lin, A. Alves Pereira, L. Nara Alegrini Longhi, R. L. Mamoni & J. E. Martinelli

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  1. Ivan Aprahamian
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  2. G. V. Aricó de Almeida
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Correspondence to Ivan Aprahamian.

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Aprahamian, I., Aricó de Almeida, G.V., de Vasconcellos Romanin, C.F. et al. Frailty Could Predict Death in Older Adults after Admission at Emergency Department? A 6-month Prospective Study from a Middle-Income Country. J Nutr Health Aging 23, 641–647 (2019). https://doi.org/10.1007/s12603-019-1207-9

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  • DOI: https://doi.org/10.1007/s12603-019-1207-9

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