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Background: Prompt and efficient identification and stratification of patients who are frail is important, as this cohort are at high risk of adverse healthcare outcomes. Numerous frailty screening tools have been developed to support their identification across different settings, yet relatively few have emerged for use in emergency departments (EDs). This protocol provides details for a systematic review aiming to synthesize the accumulated evidence regarding the diagnostic accuracy and clinimetric properties of frailty screening instruments to identify frail older adults in EDs., Methods: Six electronic databases will be searched from January 2000 to March 2021. Eligible studies will include adults aged ≥60 years screened in EDs with any available screening instrument to identify frailty (even if not originally designed for this purpose). Studies, including case-control, longitudinal, and cohort studies, will be included, where instruments are compared to a reference standard to explore diagnostic accuracy. Predictive accuracy for a selection of outcomes, including mortality, institutionalization, and readmission, will be assessed. Clinical and methodological heterogeneity will be examined, and a random effects meta-analysis performed if appropriate., Conclusion: Understanding whether frailty screening on presentation to EDs is accurate in identifying frailty, and predicting these outcomes is important for decision-making and targeting appropriate management.

Frailty in middle-aged and older adults is associated with diabetes-related complications. The impact of and interaction between diabetes and frailty on psychosocial wellbeing and mortality in Ireland for adults aged ≥50 years were assessed using data from the Survey of Health, Ageing and Retirement in Europe. Measures included diabetes status (self-reported), frailty phenotype (≥3/5 criteria), low self-rated health ("fair" or "poor"), depression screening (EURO-D index score ≥4), and low quality of life (QoL) (CASP-12 index score < 35). Among the 970 participants, those with diabetes ( n = 87) were more likely to be frail (23% vs. 8%; p < 0.001), have low self-rated health (46% vs. 19%; p < 0.001), depression (25% vs. 17%; p = 0.070), and low QoL (25% vs. 18%, p = 0.085). Adjusting for diabetes, age and sex, frailty independently predicted low self-rated health (OR: 9.79 (5.85-16.36)), depression (9.82 (5.93-16.25)), and low QoL (8.52 (5.19-13.97)). Adjusting for frailty, age and sex, diabetes independently predicted low self-rated health (2.70 (1.63-4.47)). The age-sex adjusted mortality hazard ratio was highest for frailty with diabetes (4.67 (1.08-20.15)), followed by frailty without diabetes (2.86 (1.17-6.99)) and being non-frail with diabetes (1.76 (0.59-5.22)). Frailty independently predicts lower self-reported wellbeing and is associated with reduced survival, underpinning its role as an integral part of holistic diabetes care.

Background Frailty is a geriatric syndrome associated with limited function, reduced quality of life and premature death. Chronic conditions, such as diabetes and vascular disease leading to chronic ulceration, may increase the risk of frailty. If chronic wounds are a strong predictor of frailty, researchers and practitioners should proactively and effectively manage both the wound and the potential underlying frailty issues. However, there is a paucity of research evidence in this area. Aim We aim to identify the prevalence of frailty and pre-frailty in older adults with chronic leg ulcers and/or diabetes, and investigate the associations between having diabetes and chronic leg ulcers and being pre-frail or frail. Design Descriptive and cross sectional study protocol. Data collection Frailty and pre-frailty status will be identified using two separate tools -- the Groningen Frailty Indicator (self-reported) for multidimensional frailty screening, and the five criteria of the Physical Frailty Phenotype for physical frailty assessment. Sample Patients aged ≥65 years with chronic leg ulcers and/or diabetes will be recruited from two hospitals in the west of Ireland. Data analysis Associations between the frailty and pre-frailty prevalence and wound aetiology and duration, age, gender and co-comorbidities will be explored using descriptive and comparative analyses. [ABSTRACT FROM AUTHOR]

Introduction The prevalence of frailty at population level is unclear. We examined this in population-based studies, investigating sources of heterogeneity. Methods PubMed, Embase, CINAHL and Cochrane Library databases were searched for observational population-level studies published between 1 January 1998 and 1 April 2020, including individuals aged ≥50 years, identified using any frailty measure. Prevalence estimates were extracted independently, assessed for bias and analysed using a random-effects model. Results In total, 240 studies reporting 265 prevalence proportions from 62 countries and territories, representing 1,755,497 participants, were included. Pooled prevalence in studies using physical frailty measures was 12% (95% CI = 11–13%; n  = 178), compared with 24% (95% CI = 22–26%; n  = 71) for the deficit accumulation model (those using a frailty index, FI). For pre-frailty, this was 46% (95% CI = 45–48%; n  = 147) and 49% (95% CI = 46–52%; n  = 29), respectively. For physical frailty, the prevalence was higher among females, 15% (95% CI = 14–17%; n  = 142), than males, 11% (95% CI = 10–12%; n  = 144). For studies using a FI, the prevalence was also higher in females, 29% (95% CI = 24–35%; n  = 34) versus 20% (95% CI = 16–24%; n  = 34), for males. These values were similar for pre-frailty. Prevalence increased according to the minimum age at study inclusion. Analysing only data from nationally representative studies gave a frailty prevalence of 7% (95% CI = 5–9%; n  = 46) for physical frailty and 24% (95% CI = 22–26%; n  = 44) for FIs. Conclusions Population-level frailty prevalence varied by classification and sex. Data were heterogenous and limited, particularly from nationally representative studies making the interpretation of differences by geographic region challenging. Common methodological approaches to gathering data are required to improve the accuracy of population-level prevalence estimates. Protocol registration PROSPERO-CRD42018105431. [ABSTRACT FROM AUTHOR]

Purpose: To identify transitional palliative care (TPC) interventions for older adults with non-malignant chronic diseases and complex conditions. Design/methodology/approach: A systematic review of the literature was conducted. CINAHL, Cochrane Library, Embase and Pubmed databases were searched for studies reporting TPC interventions for older adults, published between 2002 and 2019. The Crowe Critical Appraisal Tool was used for quality appraisal. Findings: A total of six studies were included. Outcomes related to TPC interventions were grouped into three categories: healthcare system-related outcomes (rehospitalisation, length of stay [LOS] and emergency department [ED] visits), patient-related outcomes and family/carer important outcomes. Overall, TPC interventions were associated with lower readmission rates and LOS, improved quality of life and better decision-making concerning hospice care among families. Outcomes for ED visits were unclear. Research limitations/implications: Positive outcomes related to healthcare services (including readmissions and LOS), patients (quality of life) and families (decision-making) were reported. However, the number of studies supporting the evidence were limited. Originality/value: Studies examining the effectiveness of existing care models to support transitions for those in need of palliative care are limited. This systematic literature review identified and appraised interventions aimed at improving transitions to palliative care in older adults with advanced non-malignant diseases or frailty. [ABSTRACT FROM AUTHOR]

Background: Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level. Aim: This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management. Methods: Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development. Results: The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning. Discussion: This framework facilitates clarification of professionals' roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems. Conclusions: The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission. [ABSTRACT FROM AUTHOR]

The current demographic shift raises the demand for provision of health care tailored to the complex care needs for older adults. Given the growing number of national care plans and best practice models there is an urgent need to build evidence for inter- and multiprofessional care provision for older people when offered an integrated care approach. The aim of this study was to determine whether an inter-professional or multi-professional care intervention, can improve geriatric patients' health determinants. A systematic review was performed according to PRISMA Guidelines. Databases were searched for clinical trials which compare inter-professional or multi-professional complex care interventions with usual care among people aged ≥60 years, in hospital or emergency care settings. Based on nine studies, inter-professional or multi-professional intervention has no impact on mortality rate but either positive or neutral effects on physical health, psychosocial wellbeing and utilization of health care service. It shows that these inter-professional or multi-professional interventions were feasible. This systematic review highlights the scarcity of evidence showing either positive or neutral impact of intervention based on inter-professional or multi-professional teamwork across care settings on the health determinants among geriatric patients. International harmonization of assessment tools may allow direct comparisons for future interventions. [ABSTRACT FROM AUTHOR]

Background Frailty is a common, multi-factorial, age-related syndrome commonly observed in people with diabetes. Although older diabetics are prone to adverse healthcare outcomes and diabetes increases the risk of developing frailty, little is known about the effects of frailty on diabetes. This paper examines the association between diabetes, frailty, and mortality in Europeans aged ≥50 years. Methods Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) waves one and six. A participant's first interview was taken as the baseline and subsequent waves were used for mortality follow-up (time and cause). Frailty and pre-frailty were measured using established cut-offs using the Physical Phenotype (SHARE-FI) and a 55-item Frailty Index (FI-55). Kaplan-Meier survival analysis was used to assess the relationship between frailty and mortality in people with diabetes and significance tested using log-rank test. Cox regression was used to adjust for potential confounders (age, sex, education, income, employment, alcohol use, smoking, hypertension, hypercholesterolaemia, myocardial infarction, stroke, metastatic cancer, chronic lung disease, polypharmacy, self-perceived health and depression). Results Data from 8,954 diabetics aged 50-99 years were included with 1,598 deaths (17.8%). According to the SHARE-FI, 1,971 (22.0%) were frail, 4,183 (46.7%) pre-frail and 2,800 (31.3%) robust. According to the Kaplan-Meier log-rank test survival varied significantly across frailty strata according to both indexes (p<0.001). At 10-year follow-up, adjusting for confounders SHARE-FI frailty and pre-frailty were significantly associated with mortality, adjusted Hazard Ratio (HR) 2.19, (95% CI:1.66-2.89), and 1.38 (95% CI:1.09-1.74), respectively. Results were similar using the FI-55, HR for frailty 1.66 (95% CI:1.09-2.54). Causes of mortality were significantly different according to frailty status (p<0.05). Conclusion Frailty and pre-frailty are independent risk factors for mortality in diabetics. The identification of frailty is important for the risk-stratification and management of middle aged and older patients with diabetes and should be included in the routine assessment of these high-risk individuals. [ABSTRACT FROM AUTHOR]

Background Frailty is a multi-factorial, age-related syndrome, often defined in terms of accumulation of deficits. This approach uses the proportion of a list of age-associated items (signs, symptoms, diseases, impairments, etc.) available to identify frailty. Some frailty indexes (FI) include more functional aspects than others. This study examines whether functional components and diseases or risk factors predict the same phenomena. Methods Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) wave seven for participants age ≥50 years. A 52-item FI was constructed from physical health data with 26 functional and 26 non-functional items. Functional items were obtained from activities of daily living questions (ph048 & ph049), and health-related activity limitation (gali question). Non-functional items were obtained from questions on BMI, self-perceived health, disease/risks (ph006), medication use (sleep, anxiety/depression, osteoporosis), and frailty related symptoms (ph048). Participants missing one or more of the 52 items were excluded. Data were analysed at individual and country-level to assess for significant differences. Results In total, 73,510 (97.3%) participants had complete frailty data available and were included. The mean score for the FI-52 was 0.12 (95% CI: 0.11-0.12). Mean FI scores for the functional and non-functional components were 0.12 (95% CI:0.12-0.12) and 0.11 (95% CI:0.11-0.11), respectively, representing a significant difference (p<0.001). For a cut-off of 0.25 for frailty this difference was 5.4% (95% CI:3.9%-6.2%). Spearman's correlation between these components was 0.66 for individual participants and 0.72 for country-level mean scores, indicating moderate to strong correlation. These were similar using a cut-off of 0.25, at 0.45 and 0.71, respectively. Conclusion Findings suggest that having more functional items in a frailty index results in significantly higher frailty estimates but this only amounted to an approximately 5% difference. Although moderate-strong correlation was observed, further research is needed to investigate if the proportion of functional components influences risk-prediction at population-level. [ABSTRACT FROM AUTHOR]

Background The Royal College of Physicians of Ireland and the National Clinical Programme for Older People conducted a national survey of Specialist Geriatric Services (SGS) in 2014. The survey was repeated in 2018-2019 period to collect data on the resources available for the care of older people attending hospitals and associated communities in Ireland. Methods Participants were geriatrician leads or proxies in each hospital in Ireland. Questions based on the 2014 survey were updated to include frailty and dementia-delirium specific questions. Data were collected between September 2018 and April 2019 using an electronic survey. Comments from open-ended questions were analysed using qualitative analysis methods. Results In total, 20 fully complete and 18 incomplete responses were received. Most complete responses were from model 3 or 4 hospitals (n= 14/20). Less than half (47%) reported having a dedicated specialist geriatric ward in their institution. Half (50%) reported currently developing an integrated plan for services for frail older people with complex care needs. Barriers to managing frailty that were identified included limited access to funding and staffing. 82% reported that their group/area/unit/department engaged in case-finding for frailty. The most commonly used frailty-specific screening tools were the CFS (n=9), VIP (n=6), FRAIL scale (n=4), and PRISMA-7 (n=3). A National Frailty Education Programme governance structure was operational in 9/20 sites. Half (50%) reported that their hospital has an integrated pathway for people with dementia and/or delirium, although (82%) stated that their hospital does not formally screen all older people for cognitive impairment in the ED/AMAU, and does not formally screen people at risk for delirium on wards on a daily basis (100%). Conclusion Limited staffing and resources were reported for many aspects of SGS in Ireland. Although frailty and dementia-delirium are recognised as priority areas, there is need for standardised assessment and screening approaches. [ABSTRACT FROM AUTHOR]

Aim: To identify frailty in older adults with chronic leg ulcers and its association with diabetes. Method: Data was collected from three clinics in Ireland. There were three participant groups, those: 1- with diabetes and a chronic leg ulcer (CLU); 2- without diabetes but with a CLU; 3- with diabetes but no CLU (reference group). A convenience sampling method targeted community-dwellers aged 65 and over who are able to walk, have had a CLU in the past 6 months (currently open or not), and belong to one of the three groups. Frailty status was identified using the Groningen Frailty Indicator (GFI) and Fried Frailty Phenotype (FFP). Results: The pilot study results include data from 57 (25 female, 32 male) participants (mean age 77.3±6.9). Of these, 21 had a CLU (11 were currently open; wound duration: 8 weeks-40 years), 45 had diabetes (mean duration: 11.9±10.2 years). According to GFI, 80.7% of participants (n=46) were frail. The FFP identified 26.3% (n=15) frail and 59.6% (n=34) as pre-frail. Of those with CLUonly (no diabetes), 91.7% were frail according to GFI, and all were either frail or pre-frail according to FFP. There was no significant association between frailty and having both diabetes and a CLU (p>0.05) compared to having either diabetes or a CLU. When the diabetes-only and CLU-only groups were compared, the frailty status was not significantly different (p>0.05) for either frailty identification tool. Conclusion: CLUs are associated with frailty; however, no significant difference was found in the frailty rates of participants with CLUs and diabetes, compared to those with only CLU or diabetes. This needs further investigation with a larger sample size. [ABSTRACT FROM AUTHOR]

Abstract Objective To identify and examine definitions of frailty using qualitative thematic analysis. Design A qualitative meta-aggregative systematic review. Data sources The database search was performed using ASSIA, CINAHL, Cochrane Library, Embase, PsycINFO, PubMed and Google Scholar databases. Studies providing definitions of frailty, published in English from 1st January 2000 to 25th July 2018 were included. Review methods Data were extracted by independent reviewers for qualitative thematic analysis. Results In total, 86 studies met inclusion criteria. Five major themes with specific sub-themes were identified following thematic analysis including: (1) types of definitions (operational, conceptual, theoretical, older adults' perspective); (2) characteristics of frailty (a multi-domain and dimensional state, deficits/decline, weakness, a continuum-dynamic concept, clinically identifiable) ; (3) associated factors (age, comorbidity, nutrition, sarcopenia, social networks and environment) ; (4) mechanism (reduced adaptability, hormonal dysregulation); and (5) changes in health status and adverse outcomes (disability, increased risk of mortality, other healthcare related outcomes such as increased dependency or risk of falls). Conclusions Several themes were found that defined frailty, focusing predominantly on operational definitions and frailty as a physical syndrome. A universally accepted standard definition, which includes all dimensions of frailty is currently warranted. [ABSTRACT FROM AUTHOR]

• People with diabetes have increased rates of physical frailty • Frailty was an independent indicator of low self-rated health in diabetes • Frailty was independently associated with depressive symptoms in diabetes • Frailty and diabetes are independent indicators of low quality of life • Early identification and management of frailty is needed to manage the psychosocial impact of diabetes To assess the impact of diabetes and frailty on self-rated health, depressive symptoms and quality of life (QoL). Data were pooled for participants aged ≥50 years from five waves of the Survey of Health, Ageing and Retirement in Europe. Measures included diabetes (self-reported), physical frailty (≥3/5 criteria), low self-rated health (SRH; "poor" or "fair"), depression (screened using the EURO-D ≥4) and low QoL (CASP-12 <35). Logistic regression was used to adjust for confounding. Participants with diabetes (n=11,661/97,691) were more likely to be older (68 vs. 64 years, p<0.001), male (50% vs. 45%, p<0.001) and frail (21% vs. 8%, p<0.001). Age, sex, diabetes and frailty were all independently associated with low SRH, depression and low QoL. Frailty had the highest adjusted odds ratios for low SRH (9.43; 95% CI:8.89–10.02), depression (6.39; 95% CI:6.07–6.71) and low QoL (9.65; 95% CI:9.17–10.16). For diabetes, the adjusted odds ratios were 2.82 (2.70–2.95), 1.49 (1.42–1.56) and 1.67 (1.60–1.74), respectively. Participants with both diabetes and frailty reported the worst self-rated health, the most depression symptoms and the lowest QoL. Frailty was prevalent in older people with diabetes and independently associated with low self-rated health, depressive symptoms and low QoL. Prompt identification and management of frailty should be a key consideration in diabetes care. [ABSTRACT FROM AUTHOR]