The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project.

BACKGROUND: To compare the performance of eight frailty instruments to identify relevant adverse outcomes for older people across different settings over a 12 month follow-up. METHODS: Observational longitudinal prospective study of people aged 75 + years enrolled in different settings (acute geriatric wards, geriatric clinic, primary care clinics, and nursing homes) across five European cities. Frailty was assessed using the following: Frailty Phenotype, SHARE-FI, 5-item Frailty Trait Scale (FTS-5), 3-item FTS (FTS-3), FRAIL scale, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool, and Clinical Frailty Scale. Adverse outcomes ascertained at follow-up were as follows: falls, hospitalization, increase in limitation in basic (BADL) and instrumental activities of daily living (IADL), and mortality. Sensitivity, specificity, and capacity to predict adverse outcomes in logistic regressions by each instrument above age, gender, and multimorbidity were calculated. RESULTS: A total of 996 individuals were followed (mean age 82.2 SD 5.5 years, 61.3% female). In geriatric wards, the FI-35 (69.1%) and the FTS-5 (67.9%) showed good sensitivity to predict death and good specificity to predict BADL worsening (70.3% and 69.8%, respectively). The FI-35 also showed good sensitivity to predict BADL worsening (74.6%). In nursing homes, the FI-35 and the FTSs predicted mortality and BADL worsening with a sensitivity > 73.9%. In geriatric clinic, the FI-35, the FTS-5, and the FRAIL scale obtained specificities > 85% to predict BADL worsening. No instrument achieved high enough sensitivity nor specificity in primary care. All the instruments predict the risk for all the outcomes in the whole sample after adjusting for age, gender, and multimorbidity. The associations of these instruments that remained significant by setting were for BADL worsening in geriatric wards [FI-35 OR = 5.94 (2.69-13.14), FTS-3 = 3.87 (1.76-8.48)], nursing homes [FI-35 = 4.88 (1.54-15.44), FTS-5 = 3.20 (1.61-6.38), FTS-3 = 2.31 (1.27-4.21), FRAIL scale = 1.91 (1.05-3.48)], and geriatric clinic [FRAIL scale = 4.48 (1.73-11.58), FI-35 = 3.30 (1.55-7.00)]; for IADL worsening in primary care [FTS-5 = 3.99 (1.14-13.89)] and geriatric clinic [FI-35 = 3.42 (1.56-7.49), FRAIL scale = 3.27 (1.21-8.86)]; for hospitalizations in primary care [FI-35 = 3.04 (1.25-7.39)]; and for falls in geriatric clinic [FI-35 = 2.21 (1.01-4.84)]. CONCLUSIONS: No single assessment instrument performs the best for all settings and outcomes. While in inpatients several commonly used frailty instruments showed good sensitivities (mainly for mortality and BADL worsening) but usually poor specificities, the contrary happened in geriatric clinic. None of the instruments showed a good performance in primary care. The FI-35 and the FTS-5 showed the best profile among the instruments assessed.

A Comparison of Frailty Assessment Instruments in Different Clinical and Social Care Settings: The Frailtools Project.

OBJECTIVE: To determine which of 8 commonly employed frailty assessment tools demonstrate the most appropriate characteristics to be employed in different clinical and social settings. DESIGN: Cross-sectional multicenter European-based study. SETTING AND PARTICIPANTS: 1440 patients aged ≥75 years evaluated in geriatric inpatient wards, geriatric outpatient clinics, primary care clinics, and nursing homes. METHODS: The frailty instruments used were Frailty Phenotype, SHARE-FI, 3-item Frailty Trait Scale (FTS-3), 5-item Frailty Trait Scale (FTS-5), FRAIL, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool (GFST), and Clinical Frailty Scale (CFS). The settings were geriatrics wards, outpatient clinics, primary care, and nursing homes. Suitability was evaluated by considering the feasibility (patients with the test fully completed), administration time (time spent for administering the test), and interscale agreement (Cohen kappa index among instruments to detect frailty). RESULTS: The prevalence of frailty varied across settings and adopted tests. The scales with the mean highest feasibility were the FRAIL scale (99.4%), SHARE-FI (98.3%), and GFST (95.0%). The mean shortest administration times were obtained with CFS (24 seconds), GFST (72 seconds), and FRAIL scale (90 seconds). The interscale agreement between most of the tests was fair. CFS followed by FTS-5 agreed at least moderately with a greater number of scales overall and in almost all settings. CONCLUSIONS AND IMPLICATIONS: Based on feasibility, time to undertake the tool, and agreement with other scales, different scales would be recommended according to the setting considered. Our findings suggest that most of the tools evaluated are actually assessing different frailty constructs.

Monitoring and Intervention Technologies to Manage Diabetic Older Persons: The CAPACITY Case-A Pilot Study.

Diabetes Mellitus is a chronic disease with a high prevalence among older people, and it is related to an increased risk of functional and cognitive decline, in addition to classic micro and macrovascular disease and a moderate increase in the risk of death. Technology aimed to improve elder care and quality of life needs to focus in the early detection of decline, monitoring the functional evolution of the individuals and providing ways to foster physical activity, to recommend adequate nutritional habits and to control polypharmacy. But apart from all these core features, some other elements or modules covering disease-specific needs should be added to complement care. In the case of diabetes these functionalities could include control mechanisms for blood glucose and cardiovascular risk factors, specific nutritional recommendations, suited physical activity programs, diabetes-specific educational contents, and self-care recommendations. This research work focuses on those core aspects of the technology, leaving out disease-specific modules. These central technological components have been developed within the scope of two research and innovation projects (FACET and POSITIVE, funded by the EIT-Health), that revolve around the provision of integrated, continuous and coordinated care to frail older population, who are at a high risk of functional decline. Obtained results indicate that a geriatric multimodal intervention is effective for preventing functional decline and for reducing the use of healthcare resources if administered to diabetic pre-frail and frail older persons. And if such intervention is supported by the CAPACITY technological ecosystem, it becomes more efficient.

Manejo y control de síntomas en pacientes hospitalizados con demencia avanzada / Management and control of symptoms in hospitalized patients with advanced dementia

INTRODUCCIÓN: La dificultad que supone concluir que un paciente con demencia avanzada se encuentra al final de su vida conlleva a que no siempre se cumpla con la adecuación del esfuerzo terapéutico, pudiendo ser sometido a técnicas diagnósticas y terapéuticas desproporcionadas. El presente estudio pretende analizar el manejo paliativo y el control de síntomas en estos pacientes. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo y retrospectivo mediante la revisión de historias clínicas. Se incluyeron de forma consecutiva pacientes mayores de 75 años ingresados en las Unidades Geriátricas de Agudos de tres hospitales de Madrid con diagnóstico de demencia avanzada y que fallecieron por cualquier causa, hasta alcanzar un total de 50 individuos por hospital. RESULTADOS: Se obtuvo una muestra de 150 pacientes con una edad media de 89 años. Se registró dolor en el 18 %, disnea en el 55 % y agitación en el 30 %. El 87 % tenía prescritos opioides, el 67 % benzodiacepinas y antitérmicos, el 21 % neurolépticos y el 31 % antibióticos en las últimas 72 horas de vida. La orden médica de no reanimación estaba registrada en el 91 % de las historias clínicas y en el 96 % de los casos se informó a los familiares. En el 70 % se retiró el tratamiento específico en las 72 horas previas al exitus. CONCLUSIONES: A pesar de que un gran porcentaje de pacientes con demencia avanzada en situación de últimos días recibió tratamiento sintomático, identificándose la fase de terminalidad, la adecuación de cuidados al fi nal de la vida continúa siendo un área de mejora

INTRODUCTION: The difficulty of concluding that a patient with advanced dementia is at the end of his or her life means that the adequacy of therapeutic efforts is not always achieved, and patients may be subjected to disproportionate diagnostic and therapeutic techniques. This study aims to analyze palliative management and symptom control in these patients. MATERIAL AND METHODS: This was an observational, descriptive, and retrospective study based on a review of medical records. Patients over 75 years of age, admitted to the acute geriatric units of three hospitals in Madrid with a diagnosis of advanced dementia, and who subsequently died from any cause were included. A total of 50 individuals were enrolled per hospital. RESULTS: A sample of 150 patients with an average age of 89 years was obtained. Pain was reported in 18 %, dyspnea in 55 %, and agitation in 30 %. In all, 87 % had opioids prescribed, 67 % benzodiazepines and antithermals, 21 % neuroleptics, and 31 % antibiotics during the last 72 hours of life. A medical non-resuscitation order was recorded in 91 % of the medical records, and 96 % of cases were reported to family members. In 70 % specific treatments were withdrawn within the final 72 hours of life. CONCLUSIONS: Although a large percentage of patients with advanced dementia in their last days received symptomatic treatment, and their terminal phase identified, the adequacy of end-of-life care remains an area open for improvement

FriWalk robotic walker: usability, acceptance and UX evaluation after a pilot study in a real environment.

Background: Scientific evidence supports that prevention strategies like multicomponent physical exercise help avoiding functional decline, falls and frailty. The robotic walker FriWalk, developed within the ACANTO project, supports the execution of controlled physical activities during hospital admission to prevent functional deterioration associated to prolonged bedrest. FriWalk shows in a clinical validation study a positive relationship with improvement in physical performance, basic activities of daily living execution and frailty status. Usability, acceptance and user experience (UX) are key aspects to ease the adoption of assistive technologies in the elderly.Objective: This work pursues the evaluation of the usability, acceptance and UX of the FriWalk from the patients and clinical professionals' perspectives.Methods: Data collected during the validation of FriWalk in a real environment have been used. Forty-two patients recruited at Getafe University Hospital (Acute Care and Orthogeriatric Units) and one clinical professional participated. SUS, TAM, UX and ad hoc questionnaires were administered.Results: Patients provided an average SUS of 52.86 and provided valuable information in the qualitative acceptance interviews. The clinical professional provided an averaged SUS and TAM of 67 and 46.6, respectively, and evaluated all UX categories as above average.Conclusions: Usability results do not qualify FriWalk as above average; the reasons explaining this have been identified and point out to the prototypical stage of the hardware. Acceptance and UX were positively evaluated and allowed the research team to propose a new organizational model to deliver the FriWalk-based prevention program. FriWalk will be soon evolved.Implications for rehabilitationFriWalk showed in a randomized clinical trial a positive relationship with improvement in physical performance, basic activities of daily living execution and frailty status.In terms of usability, user experience (UX) and acceptance, participants of the study have valued the FriWalk robotic walker as a promising help, considering that the device that has been under evaluation was still in a prototype stage.Clinical professional reported FriWalk and its corresponding exercise program description software regarding usability, acceptance and UX as satisfactory tool to prescribe and assess a rehabilitation program for hospitalized patients.

FRAILTOOLS study protocol: a comprehensive validation of frailty assessment tools to screen and diagnose frailty in different clinical and social settings and to provide instruments for integrated care in older adults.

BACKGROUND: Dozens of scales and questionnaires have been used in the detection of frailty; however, a generalized method for its screening and diagnosis is still lacking in clinical settings. FRAILTOOLS´ main objective is to evaluate the usefulness of frailty scales in the detection of frailty in different clinical and social settings, and its integration in management algorithms for the frail older patient. METHODS: FRAILTOOLS is an observational, longitudinal and prospective study with a follow-up of 6, 12 and 18 months. People older than 75 years old will be recruited from three separate clinical settings (acute geriatric wards, geriatric outpatient clinics and primary care) and one social setting (nursing homes). Exclusion criteria include Mini-mental State Examination < 20 points, and a Barthel index < 90 points, except in nursing home residents (< 40 points). The participants will be recruited in Spain, Italy, France, United Kingdom and Poland. The total sample size will be of 1.940 subjects, 97 subjects in each clinical setting by center. A personal interview with each participant will take place to register data on comorbidity (Charlson Index), functional (SPPB, Barthel and Lawton indexes), cognitive (MMSE) and frailty status (Fried Phenotype, Frailty Trait Scale - short version, SHARE-FI, 35-Items Rockwood Frailty Index, Clinical Frailty Scale, FRAIL scale and Gérontopôle Frailty Screening Tool) in the baseline visit, month 12 and month 18 visit of follow up. At 6 month a phone call will be made to assess whether there have been falls and to check the vital status. DISCUSSION: Currently, the usefulness of certain assessment tools in social and clinical settings have not been properly assessed, including their ability to predict the individual risk for different adverse outcomes, which is the main interest in daily practice. The FRAILTOOLS project concentrates on providing screening and diagnostic tools for frailty in those settings where its prevalence is the highest and where efforts in prevention could make a significant change in the trend towards disability. TRIAL REGISTRATION: Comprehensive validation of frailty assessment tools in older adults in different clinical and social settings (FRAILTOOLS), NCT02637518 (date of registration: 12/18/2015).

Neutropenia febril grave inducida por mesalazina / Severe febrile neutropenia induced by mesalazine

No disponible

Hiperpigmentación inducida por minociclina / Minocycline induced hyperpigmentation

No disponible

Síndrome de Tako-Tsubo tras intento de homicidio a una anciana de 89 años / Tako-Tsubo syndrome after homicide attempt on an 89 year-old woman

No disponible

Hidrotórax masivo derecho en una paciente con hepatopatía crónica / Massive hydrothorax in a patient with chronic liver disease

No disponible