The identification of frailty: a systematic literature review.

An operational definition of frailty is important for clinical care, research, and policy planning. The literature on the clinical definitions, screening tools, and severity measures of frailty were systematically reviewed as part of the Canadian Initiative on Frailty and Aging. Searches of MEDLINE from 1997 to 2009 were conducted, and reference lists of retrieved articles were pearled, to identify articles published in English and French on the identification of frailty in community-dwelling people aged 65 and older. Two independent reviewers extracted descriptive information on study populations, frailty criteria, and outcomes from the selected papers, and quality rankings were assigned. Of 4,334 articles retrieved from the searches and 70 articles retrieved from the pearling, 22 met study inclusion criteria. In the 22 articles, physical function, gait speed, and cognition were the most commonly used identifying components of frailty, and death, disability, and institutionalization were common outcomes. The prevalence of frailty ranged from 5% to 58%. Despite significant work over the past decade, a clear consensus definition of frailty does not emerge from the literature. The definition and outcomes that best suit the unique needs of the researchers, clinicians, or policy-makers conducting the screening determine the choice of a screening tool for frailty. Important areas for further research include whether disability should be considered a component or an outcome of frailty. In addition, the role of cognitive and mood elements in the frailty construct requires further clarification.

Screening for carotid artery disease in the general public.

BACKGROUND: Screening for various diseases is now being offered to the public in settings other than their physicians' office, often using expensive and sophisticated technology. Little is known about how patients decide to participate in such programs, whether they understand the implications of a positive or negative test, or if their primary care physician is involved in the decision to screen. METHODS: We surveyed a cohort of patients who participated in a free carotid artery screening using Doppler ultrasound at a tertiary care academic medical center. RESULTS: One hundred twenty-four patients participated and underwent the ultrasound exam. Their mean age was 68.8 (+/-9.8) years and 54% were female. Some 117 patients (94%) completed the survey. Five patients (4%) tested positive for significant carotid artery stenosis. Sixty-two percent (95% CI: 53-71%) of the patients learned about the program through a newspaper advertisement. Eighty-eight percent (95% CI: 82-94%) of the subjects stated that their primary physician had not suggested that they have the test, and 59% (95% CI: 50-68%) did not know that carotid artery surgery is often recommended for patients who test positive. CONCLUSIONS: This study of one group of patients who voluntarily took a screening test for carotid artery stenosis raises some important questions since most subjects did not understand the implications of a positive result, nor did they involve their physicians in their decision to take the test. Further studies are needed to evaluate whether providing patients with more information about the implications of a screening test would change their desire to have the test and about the nature of the informed consent required before such screening is carried out.