The role of the Sunfrail tool in the screening of frailty and in integrated community-hospital care pathways: a retrospective observational study.

BACKGROUND: One of the most problematic expression of ageing is frailty, and an approach based on its early identification is mandatory. The Sunfrail-tool (ST), a 9-item questionnaire, is a promising instrument for screening frailty. AIMS: To assess the diagnostic accuracy and the construct validity between the ST and a Comprehensive Geriatric Assessment (CGA), composed by six tests representative of the bio-psycho-social model of frailty; To verify the discriminating power of five key-questions of the ST; To investigate the role of the ST in a clinical-pathway of falls' prevention. METHODS: In this retrospective study, we enrolled 235 patients from the Frailty-Multimorbidity Lab of the University-Hospital of Parma. The STs' answers were obtained from the patient's clinical information. A patient was considered frail if at least one of the CGAs' tests resulted positive. RESULTS: The ST was associated with the CGA's judgement with an Area Under the Curve of 0.691 (CI 95%: 0.591-0.791). Each CGA's test was associated with the ST total score. The five key-question showed a potential discriminating power in the CGA's tests of the corresponding domains. The fall-related question of the ST was significantly associated with the Short Physical Performance Battery total score (OR: 0.839, CI 95%: 0.766-0.918), a proxy of the risk of falling. DISCUSSION: The results suggest that the ST can capture the complexity of frailty. The ST showed a good discriminating power, and it can guide a second-level assessment to key frailty domains and/or clinical pathways. CONCLUSIONS: The ST is a valid and easy-to-use instrument for the screening of frailty.

Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients.

BACKGROUND: The capacity of Short-Physical Performance Battery (SPPB) test to discriminate between fallers and non-fallers is controversial, and has never been compared with fall risk assessment-specific tools, such as Performance-Oriented Mobility Assessment (POMA). AIM: To verify the association of SPPB and POMA scores with falls in older outpatients. METHODS: 451 older subjects (150 males, mean age 82.1 ± 6.8) evaluated in a geriatric outpatient clinic for suspected frailty were enrolled in this cross-sectional study. Self-reported history of falls and medication history were carefully assessed. Each participant underwent comprehensive geriatric assessment, including SPPB, POMA, Geriatric Depression Scale (GDS), mini-mental state examination (MMSE) and mini-nutritional assessment-short form (MNA-SF). Multivariate logistic regression and receiver-operating characteristic (ROC) analyses were performed to determine the factors associated with the status of faller. RESULTS: 245 (54.3%) subjects were identified as fallers. They were older and had lower SPPB and POMA test scores than non-fallers. At ROC analysis, SPPB (AUC 0.676, 95% CI 0.627-0.728, p < 0.001) and POMA (AUC 0.677, 95% CI 0.627-0.726, p < 0.001) scores were both associated with falls. At multivariate logistic regression models, SPPB total score (OR 0.83, 95% CI 0.76-0.92, p < 0.001), POMA total score (OR 0.94, 95% CI 0.91-0.98, p = 0.002) and SPPB balance score alteration (OR 2.88, 95% CI 1.42-5.85, p = 0.004), but not POMA balance subscale score alteration, were independently associated with recorded falls, as also GDS, MMSE and MNA-SF scores. CONCLUSIONS: SPPB total score was independently associated with reported falls in older outpatients, resulting non-inferior to POMA scale. The use of SPPB for fall risk assessment should be implemented.

Impact of Nutritional Status on Caregiver Burden of Elderly Outpatients. A Cross-Sectional Study.

The assistance to older community-dwellers provided by family caregivers is crucial for the maintenance of an acceptable quality of life, especially when dementia is present. The caregiver burden may be extremely high, but few data are available on what patient domains mainly affect the caregiver. The aim of this cross-sectional study, performed in older outpatients, was to examine the impact of cognitive, physical and nutritional status of elderly community-dwellers on the caregiver burden, as evaluated by the Caregiver Burden Inventory (CBI). A group of 406 elderly outpatients (161 M, 245 F, mean age of 83.20 ± 6.40) was enrolled. A significant correlation was observed between Mini Nutritional Assessment Instrument-Short Form (MNA-SF) and CBI (r = -0.34; p < 0.001), suggesting that a poor nutritional status is significantly associated with the caregiver burden. There was also a significant correlation between CBI and Short Physical Performance Battery score (r = -0.29; p < 0.001), hand grip strength (r = -0.25; p < 0.001), Mini-Mental State Examination score (r = -0.39; p < 0.001), Geriatric Depression Scale (r = 0.23; p < 0.001), Body Mass Index (BMI) (r = 0.01; p = 0.03), Activities of Daily Living and Instrumental Activities of Daily Living (ADL/IADL) (r = -0.61 and -0.62, respectively; p < 0.001), and with the 4-m walking speed (r = -0.42; p < 0.001). In the multivariate analysis, only the relationships of the CBI (in particular the physical subcomponent) with ADL, IADL and MNA-SF remained statistically significant (ß ± SE -0.89 ± 0.20, p < 0.001; -0.58 ± 0.15, p < 0.001 and -0.25 ± 0.11, p = 0.02, respectively). The relationship between CBI and BMI remained statistically significant only for the physical subcomponent (ß ± SE 0.14 ± 0.05; p = 0.006). Thus, in this study, we confirmed that the impairment in the activities of daily living is associated with a significant impact on the caregiver burden, and we found also that a poor nutritional status of the older outpatient is independently more associated with the caregiver burden than cognitive and physical disability. The combined evaluation of both patients and caregivers can improve the knowledge and assistance to the elderly subjects.

Muscle weakness, cognitive impairment and their interaction on altered balance in elderly outpatients: results from the TRIP observational study.

BACKGROUND: The determinants of altered balance in older subjects and, particularly, the contribution of muscle strength and cognitive impairment are still uncertain. We hypothesized that both these conditions and their interactions could affect balance in older persons. To address this hypothesis, we studied the cross-sectional association between handgrip strength and balance performance in subjects with and without cognitive impairment. METHODS: Two hundred and sixty-three elderly outpatients (104 men and 159 women, aged 81.44 ± 7.36 years) were evaluated for the comprehensive geriatric assessment. The patients were enrolled from the cross-sectional observational Traumatic Risk Identikit Parma study that was aimed at identifying risk factors for falling in older outpatients. RESULTS: Balance deficit, defined as an inability to maintain tandem position for at least 10 seconds, was present in 185 patients (70.34%). The mean mini-mental state examination score was 20.79 ± 6.5, the median short physical performance battery score was 5.0 and the mean grip strength was 18.54 ± 9.14 kg. After dividing the subjects into four categories according to the presence of low grip strength and/or cognitive impairment, we found that the mini nutritional assessment short-form scale score was negatively and independently (ß: -0.02 ± 0.01; p=0.04) associated with balance deficit in the group with low grip strength and cognitive impairment. In the other three categories, grip strength was negatively and significantly associated with balance deficit. CONCLUSION: The loss of muscle strength, presence of cognitive impairment and their interaction, influenced probably by malnutrition, could affect balance in older persons.

Cultural Competence Assessment Instrument: Initial Italian validation and proposed refinement.

BACKGROUND AND AIM OF THE WORK: Italy has become a target of immigration in the last three decades. Accordingly, the Italian population is progressively changing, becoming increasingly culturally different. Cultural competences are a fundamental requirement for many industries and, especially, for healthcare organizations. The aim of this paper is to propose an initial Italian validation of the Cultural Competence Assessment Instrument (CCAI) and to propose a refinement of this scale in terms of measured constructs. METHODS: The CCAI was translated into Italian through a team-based iterative approach and then administered to a sample of 289 nurses with symbolic and realistic threat scale and social dominance orientation scale. An on-line cross-sectional survey questionnaire was used. RESULTS: Confirmatory factor analysis revealed that the original two dimensions of the CCAI can be divided into two other sub-scales, thus leaving us with the following dimensions: cultural awareness, cultural sensitivity, seeking information and active behavior. These dimensions appeared to be sufficiently reliable and independent one from another. Moreover, they showed specific and different correlations with other measured constructs. CONCLUSIONS: The Italian version of the CCAI would seem to be a useful instrument for measuring both attitudes and behavioral intention of nurses with respect to intercultural care. Using four dimensions instead of two appears to increase the understanding of professionals' cultural competence and supply a deeper picture of dimensions which compose cultural competence in healthcare settings.