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Objective The surgical population is ageing and often frail. Frailty increases the risk for poor post-operative outcomes such as delirium, which carries significant morbidity, mortality and cost. Frailty is often measured in a binary manner, limiting pre-operative counselling. The goal of this study was to determine the relationship between categorical frailty severity level and post-operative delirium. Methods We performed an analysis of a retrospective cohort of older adults from 12 January 2018 to 3 January 2020 admitted to a tertiary medical center for elective surgery. All participants underwent frailty screening prior to inpatient elective surgery with at least two post-operative delirium assessments. Planned ICU admissions were excluded. Procedures were risk-stratified by the Operative Stress Score (OSS). Categorical frailty severity level (Not Frail, Mild, Moderate, and Severe Frailty) was measured using the Edmonton Frail Scale. Delirium was determined using the 4 A's Test and Confusion Assessment Method-Intensive Care Unit. Results In sum, 324 patients were included. The overall post-operative delirium incidence was 4.6% (15 individuals), which increased significantly as the categorical frailty severity level increased (2% not frail, 6% mild frailty, 23% moderate frailty; P  < 0.001) corresponding to increasing odds of delirium (OR 2.57 [0.62, 10.66] mild vs. not frail; OR 12.10 [3.57, 40.99] moderate vs. not frail). Conclusions Incidence of post-operative delirium increases as categorical frailty severity level increases. This suggests that frailty severity should be considered when counselling older adults about their risk for post-operative delirium prior to surgery. [ABSTRACT FROM AUTHOR]

IntroductionThe comprehensive geriatric assessment (CGA) is recommended for assessing frailty in older cancer patients but is time-consuming. The G8 screening tool was developed to select frail patients requiring CGA to optimize resources. The Edmonton Frail Scale (EFS) is another frailty scale validated for preoperative frailty screening, but scarcely studied in the field of oncogeriatrics. In this study, we examined the added value of the EFS in older cancer patients already considered as frail by the G8, by analyzing the association of EFS with CGA adjusted for age, gender, metastatic stage and comorbidity. We also analyzed the association of EFS with the one-year mortality rate after adjusting for cancer type and metastatic stage.MethodologyThis retrospective study included patients aged over 70 years old with a new diagnosis of cancer, considered as potentially frail according to the G8 and who had had a CGA (N = 380).ResultsThe EFS identified 329 (86.58%) patients as frail and having a statistically significant predicted number of pathological components on the CGA (r = 0.64, p

Background: The risk assessment for outcomes of older people undergoing cardiac surgery employ scales such as the Euro-Score II, and STS (Society for Thoracic Surgeons), which use clinical and laboratory data. Some studies have suggested a lower accuracy in older patients. Frailty assessment, using functional parameters, has shown promise in this age group. The aim of this study is to compare the validity of risk prediction of Euro-score II, with the Edmonton Frail Scale (EFS), in older patients undergoing elective coronary artery bypass grafting (CABG). Methods: This was a prospective, observational study of a cohort of patients above 60 years scheduled for elective CABG in a single centre. The patients were graded on the Euro-Score II scale and the EFS scales. The primary outcome of 30th day mortality, and the secondary outcome of immediate post-operative complications during hospitalization were recorded. Results: A total of 487 patients were recruited. The mean age was 68 years. Male subjects comprised 81.1% of the study group. Classification of risk as per the EFS placed 76.3 % as low risk, 23.4% as intermediate, and none were considered to be high risk. The EuroScore II classification placed 86% in the intermediate and high risk groups. The AUC in the ROC (receiver operator curve) for the EFS was 0.793 and for the and EuroScoreII it was 0.752. The 30th day mortality threshold fit occurred at 5/6 score for both EuroScore II and EFS. Euroscore- II sensitivity/specificity was 66.7%/75.1% respectively. The EFS had a sensitivity of 66.7% and a specificity of 77.1%. The ROC curves for the secondary outcomes were not significant. Conclusion: Both scales are of modest value in predicting short-term mortality in older patients, and require further refinements for improving clinical decision-making in the individual patient.

Background: This study was developed to determine the effectiveness of climbing up and down exercise on frailty among geriatric population. Purpose: To find the effectiveness of climbing up and down stairs exercise on frailty among geriatric population. Materials and Methods: This research is the Quasi experimental study. The subjects were collected from Jeevan Jothi Home for Aged and Destitute, Kanyakumari. There are 54 subjects were selected based on inclusion and exclusion criteria. All the subjects were assessed with Edmonton frail scale as pre test and the same test was performed for post test at the end of 4 weeks from May 2023 to July 2023. 5 days per week 11 steps* 3 repetition* 3 sets. Each set 5 min rest is given. Pre test and post test values were calculated and tabulated. Results: The collected data was statistically analyzed using the paired t-test. Statistical analysis of Edmonton frail scale examination post value revealed the constantly significant differences, with the p value of <0.0001. Conclusion: According to the study, climbing up and down exercise is effective for reducing frailty among geriatric population. [ABSTRACT FROM AUTHOR]

Background: The risk assessment for outcomes of older people undergoing cardiac surgery employ scales such as the Euro-Score II, and STS (Society for Thoracic Surgeons), which use clinical and laboratory data. Some studies have suggested a lower accuracy in older patients. Frailty assessment, using functional parameters, has shown promise in this age group. The aim of this study is to compare the validity of risk prediction of Euro-score II, with the Edmonton Frail Scale (EFS), in older patients undergoing elective coronary artery bypass grafting (CABG). Methods: This was a prospective, observational study of a cohort of patients above 60 years scheduled for elective CABG in a single centre. The patients were graded on the Euro-Score II scale and the EFS scales. The primary outcome of 30th day mortality, and the secondary outcome of immediate post-operative complications during hospitalization were recorded. Results: A total of 487 patients were recruited. The mean age was 68 years. Male subjects comprised 81.1% of the study group. Classification of risk as per the EFS placed 76.3 % as low risk, 23.4% as intermediate, and none were considered to be high risk. The EuroScore II classification placed 86% in the intermediate and high risk groups. The AUC in the ROC (receiver operator curve) for the EFS was 0.793 and for the and EuroScoreII it was 0.752. The 30th day mortality threshold fit occurred at 5/6 score for both EuroScore II and EFS. Euroscore-II sensitivity/specificity was 66.7%/75.1% respectively. The EFS had a sensitivity of 66.7% and a specificity of 77.1%. The ROC curves for the secondary outcomes were not significant. Conclusion: Both scales are of modest value in predicting short-term mortality in older patients, and require further refinements for improving clinical decision-making in the individual patient. [ABSTRACT FROM AUTHOR]

Background/Aim: The association of frailty with heart failure (HF) is common in the elderly, and its presence is a poor prognostic factor; it increases the risk of falls, disability, hospitalization, and mortality. The aim of this prospective study was to assess the incidence of physical frailty in patients with HF and the role of physical exercise in improving physical performance. Patients and Methods: A total of 141 patients with musculoskeletal pathology, aged over 65 years, who followed a specific physical training program were included. The patients were assigned to two groups: HF patients -group HF (n=53) and patients without HF -group N-HF (n=88). Results: At cohort level, mild and moderate frailty was detected in 20.56% of patients enrolled in the study (n=29). Severe form of frailty was identified in 2.83% of cases (n=4). The prevalence of mild, moderate, and severe frailty in the two groups differed significantly (p<0.05). Patients with mild frailty and moderate frailty in the HF group represented 24.52% compared to 18.18% in the N-HF group (p=0.007). Severe frailty was present in 5.66% in the HF group, not significantly different from the N-HF group (1.13%), p=0.317. The values obtained in the functional independence and functional performance domains were significantly improved at the reassessment after 6 months. Conclusion: Exercise-based rehabilitation is a primary therapy for improving physical performance, reflected by increased independence related to daily activities and functional performance in HF patients. [ABSTRACT FROM AUTHOR]

Abstract Introduction In the era of virtual care, self-reported tools are beneficial for preoperative assessments and facilitating postoperative planning. We have previously reported the use of the Edmonton Frailty Scale (EFS) as a valid preoperative assessment tool. Objective We wished to validate the self-reported domains of the EFS (srEFS) by examining its association with loss of independence (LOI) and mortality. Methods This is a post-hoc analysis of a single-institution observational study of patients 65 years of age or older undergoing multi-specialty surgical procedures and assessed with the EFS in the preoperative setting. Exploratory data analysis was used to determine the threshold for identifying frailty using the srEFS. Procedures were classified using the Operative Stress Score (OSS) scored 1 to 5 (lowest to highest). Hierarchical Condition Category (HCC) was utilized to risk-adjust. LOI was described as requiring more support at discharge and mortality was defined as death occurring up to 30 days following surgery. Receiver operating characteristic (ROC) curves were used to determine the ability of the srEFS to predict the outcomes of interest in relation to the EFS. Results Five hundred thirty-five patients were included. Exploratory analysis confirmed best positive predictive value for srEFS was greater or equal to 5. Overall, 113 (21 percent) patients were considered high risk for frailty (HRF) and 179 (33 percent) patients had an OSS greater or equal to 5. LOI occurred in 7 percent (38 patients) and the mortality rate was 4 percent (21 patients). ROC analysis showed that the srEFS performed similar to the standard EFS with no difference in discriminatory thresholds for predicting LOI and mortality. Examination of the domains of the EFS not included in the srEFS demonstrated a lack of association between cognitive decline and the outcomes of interest. However, functional status assessed with either the Get up and Go (EFS only) or self-reported ADLs was independently associated with increased risk for LOI. Conclusion This study shows that self-reported EFS may be an optional preoperative tool that can be used in the virtual setting to identify patients at HRF. Early identification of patients at risk for LOI and mortality provides an opportunity to implement targeted strategies to improve patient care.

Background: Frailty is described by the collective decline of multiple physiological systems and increased vulnerability to multiple stressors. It is also linked to emotional distress and mental illness, especially depression. Both frailty and depression are correlated with many harmful consequences in the elderly, including decreased quality of life, escalated utilization of health services, and elevated morbidity and mortality. Given the prominence of frailty and depression in the elderly, and the deleterious consequences when they coexist, understanding the association between these factors is essential. Aim: This study aims to analyze the association between frailty and depression among the elderly in the nursing home. Material and Methods: This research was cross-sectional, and conducted at 3 nursing homes in South Sulawesi. Frailty and depression were measured. Frailty was assessed by Edmonton Frail Scale (EFS), while depression was evaluated by Geriatric Depression Scale (GDS). The data were analyzed with the Pearson test in SPSS 25. Results: There were 27 participants, consisting of females 19 (70.3%), and males 8 (29.6%) with a mean age was 73.15±8, included in this study. The mean EFS was 5.89±3.15. The mean GDS result was 3.74±3.14. Frailty has positive strong association with depression (r=0.6, p=0.001). Conclusion: There was a strong and substantial association between frailty and depression among the elderly in the nursing home.

Introduction: In the era of virtual care, self-reported tools are beneficial for preoperative assessments and facilitating postoperative planning. We have previously reported the use of the Edmonton Frailty Scale (EFS) as a valid preoperative assessment tool. Objective: We wished to validate the self-reported domains of the EFS (srEFS) by examining its association with loss of independence (LOI) and mortality. Methods: This is a post-hoc analysis of a single-institution observational study of patients 65 years of age or older undergoing multi-specialty surgical procedures and assessed with the EFS in the preoperative setting. Exploratory data analysis was used to determine the threshold for identifying frailty using the srEFS. Procedures were classified using the Operative Stress Score (OSS) scored 1 to 5 (lowest to highest). Hierarchical Condition Category (HCC) was utilized to risk-adjust. LOI was described as requiring more support at discharge and mortality was defined as death occurring up to 30 days following surgery. Receiver operating characteristic (ROC) curves were used to determine the ability of the srEFS to predict the outcomes of interest in relation to the EFS. Results: Five hundred thirty-five patients were included. Exploratory analysis confirmed best positive predictive value for srEFS was greater or equal to 5. Overall, 113 (21 percent) patients were considered high risk for frailty (HRF) and 179 (33 percent) patients had an OSS greater or equal to 5. LOI occurred in 7 percent (38 patients) and the mortality rate was 4 percent (21 patients). ROC analysis showed that the srEFS performed similar to the standard EFS with no difference in discriminatory thresholds for predicting LOI and mortality. Examination of the domains of the EFS not included in the srEFS demonstrated a lack of association between cognitive decline and the outcomes of interest. However, functional status assessed with either the Get up and Go (EFS only) or self-reported ADLs was independently associated with increased risk for LOI. Conclusion: This study shows that self-reported EFS may be an optional preoperative tool that can be used in the virtual setting to identify patients at HRF. Early identification of patients at risk for LOI and mortality provides an opportunity to implement targeted strategies to improve patient care. [ABSTRACT FROM AUTHOR]

Objectives: Frailty has been suggested to take part in the recently demonstrated link between olfactory dysfunction and overall mortality risk. Preoperative assessment of frailty is essential to detect the most vulnerable patients scheduled for surgery. The aim of this study was to evaluate whether olfactory dysfunction is a reliable predictor of preoperative frailty and postoperative outcome. Design: This was a single-center prospective observational study conducted between July and October 2020 in Brussels, Belgium. Setting And Participants: 155 preoperative patients aged from 65 years old and scheduled for elective non-cardiac surgery. Measurements: Olfactory function was examined using the Sniffin' Sticks 12-item identification test. Frailty was assessed using the Edmonton Frail Scale (EFS) and handgrip strength. The clock drawing test (CDT) from the EFS was also analyzed separately to evaluate cognitive function. Patients were followed for postoperative complications and mortality over one year. Results: Olfactory dysfunction was significantly associated with the EFS score, anosmic patients having a higher median EFS score than normosmic patients (6[4–7] vs 4[2–5], p =.025). Anosmic patients had an increased odds of being frail after adjusting for possible confounding factors (OR: 6.19, 95% CI: 1.65–23.20, p =.007) and were more at risk of poor postoperative outcome (including complications and death) (OR: 4.33, 95% CI: 1.28–14.67, p =.018). Conclusions: Olfactory dysfunction is associated with preoperative frailty determined by the EFS and with poor post-surgical outcome at one-year. [ABSTRACT FROM AUTHOR]

Background To examine the relationship between an institutionally prepared standardized patient evaluation form and the Edmonton Frail Scale (EFS) in patients receiving home health care. Material and Methods Our prospective, observational study included 200 patients over the age of 18 who requested home health care, regardless of gender. The EFS and institutional data collection forms were applied consecutively on the same day to all patients included in the study. Results Among the 200 individuals recruited for the study, 59% were female and 41% were male; the overall average age was 80 years. According to the EFS results, 4.5% of the patients were classified as non-frail, 6% were vulnerable, and 89.5% had varying degrees of frailty (mild, moderate and severe). There was a significant positive correlation between EFS score and age (p<0.001). There was no significant relationship between EFS score and confinement to bed; however, EFS scores were higher in bedridden patients (p=0.017). The EFS score was higher in those with chronic disease (p<0.001). A >9 threshold for EFS score could identify those in need of home health care services, with a sensitivity of 80.34% and a specificity of 90.91%. Conclusion Age is an important risk factor for frailty, and the presence of chronic illness and confinement to bed may potentiate its effects. On the contrary, the level of personal care, pain conditions and pressure sores/ulcers were unassociated with frailty. It was determined that the EFS score could be supportive in distinguishing patients in need of home health care services. [ABSTRACT FROM AUTHOR]

Abstract Background Frailty refers to the reduction in homeostatic reserve resulting from an accumulation of physiological deficits over a lifetime. Frailty is common in older patients undergoing surgery and is an independent risk factor for post-operative mortality, morbidity and increased length of hospital stay. In frail individuals, stressors, such as surgery, can precipitate an acute deterioration in health, manifesting as delirium, falls, reduction in mobility or continence, rendering these individuals at an increased risk of adverse perioperative outcomes. However, little is known about how frailty affects the patient experience, functional ability and quality of life (QoL) after surgery. In addition, the distribution of frailty in this population is unknown. Methods We will conduct a multi-centre observational trial to investigate the relationship between patient reported outcome measures and preoperative frailty. We aim to recruit approximately two-hundred patients with operable, potentially curative colorectal cancer. Eligible patients will be identified at three hospital sites. QoL and functional ability (measured using EORTC QLQ-C30 and WHO-DAS 2.0 respectively) will be recorded at the pre-operative assessment clinic, and at 6 and 12 weeks postoperatively. Frailty scores including the Edmonton Frail Scale (EFS) and Rockwood clinical frailty scale (CFS) will be calculated both preoperatively, and at 12 weeks post-operatively. Secondary outcome measures including post-operative morbidity and mortality will be measured using Clavien Dindo classification and 90-day mortality. Discussion This observational feasibility study seeks to define the prevalence of frailty in older (> 65 years) colorectal cancer patients and understand how frailty impacts on patient reported outcome measures. This information will help to inform larger studies relating to treatment decision algorithms and promote shared decision making in this population.

Introduction: The comprehensive geriatric assessment (CGA) is recommended for assessing frailty in older cancer patients but is time-consuming. The G8 screening tool was developed to select frail patients requiring CGA to optimize resources. The Edmonton Frail Scale (EFS) is another frailty scale validated for preoperative frailty screening, but scarcely studied in the field of oncogeriatrics. In this study, we examined the added value of the EFS in older cancer patients already considered as frail by the G8, by analyzing the association of EFS with CGA adjusted for age, gender, metastatic stage and comorbidity. We also analyzed the association of EFS with the one-year mortality rate after adjusting for cancer type and metastatic stage., Methodology: This retrospective study included patients aged over 70 years old with a new diagnosis of cancer, considered as potentially frail according to the G8 and who had had a CGA ( N  = 380)., Results: The EFS identified 329 (86.58%) patients as frail and having a statistically significant predicted number of pathological components on the CGA ( r  = 0.64, p  < 0.001). When adjusted for age, sex, comorbidity, and metastatic stage, the EFS was independently associated with the CGA ( p  < 0001), as well as with comorbidity ( p  = 0.004). The patients who died in the first year (43%) had a significantly higher mean EFS score (8/17) than living patients (6/17) ( p  < 0.0001). After adjustment for cancer type and stage, EFS independently predicted one-year mortality (OR 1.17; 95% CI 1.08-1.28; pseudo R 2  = 0.228, p  < 0.001)., Discussion: The EFS is a reliable tool for predicting frailty identified by the CGA in an older cancer population pre-selected as frail by the G8. EFS is an independent predictor of one-year mortality after adjustment for confounding factors. Validation of the EFS as a screening tool for frailty in cancer requires further studies to assess its performance in patients with normal G8 scores., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 De Schrevel, Faucon, Sibille, Dumont, Herrmann, Rouvière and De Breucker.)

Introduction Frailty, a key issue in geriatric health, signifies heightened vulnerability due to the decline in various physiological systems, exacerbated by conditions such as diabetes. Diabetes and frailty together lead to significant disabilities and higher mortality, necessitating early screening and targeted interventions. The relationship between frailty and diabetes remains under-researched, prompting this study to explore their association in individuals over 50 years of age using the Edmonton Frail Scale (EFS). Methods and materials The study was an observational cross-sectional study conducted at MM Institute of Medical Sciences & Research (MMIMSR), Mullana, India, among 102 diabetic and 100 non-diabetic individuals aged more than 50 years, with data collected through interviews using a pre-validated proforma. Frailty was assessed using the EFS, categorizing patients into fit, vulnerable, and various levels of frailty based on their scores. Results The study found a higher prevalence and severity of frailty among diabetic individuals (61.8%) compared to non-diabetics (29%), with frailty being more pronounced across all age groups and both genders in diabetics. The severity of frailty increased with the duration of diabetes but showed no significant correlation with glycemic control (HbA1c). Strengths and limitations The study prospectively collected data, including middle-aged participants starting from age 50, and uniquely used the EFS to assess frailty in diabetic patients, excluding those with other chronic diseases (end-stage renal disease (ESRD), malignancy, etc.). However, limitations included a small sample size, recruitment from a single institution in India, and some EFS questions being less relevant to the Indian diabetic population. Conclusion The study found a 61.8% prevalence of frailty in diabetics compared to 29% in non-diabetics, with frailty being more severe and positively correlated with the duration of diabetes but not with glycemic control (HbA1c)., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethical Committee, Maharishi Markandeshwar Institute of Medical Science & Research, Mullana, issued approval IEC- 2514. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Golchha et al.)

Background and Objectives: Frailty and malnutrition are overlapping geriatric syndromes and leads to poor clinical outcomes in older patients. This study determined whether Malnutrition Universal Screening Tool (MUST) can predict frailty in older hospitalised patients.Methods and Study Design: This prospective study recruited 243 patients ≥65 years in a tertiary-teaching hospital in Australia. Frailty assessment was performed by use of the Edmonton-Frail-Scale (EFS), while malnutrition-risk was determined by use of the MUST. Patients with an EFS score >8 were classified as frail, while patients with a MUST score of 1 as at moderate malnutritionrisk and ≥2 as at high malnutrition-risk. Multivariable logistic regression determined whether malnutrition-risk predicts frailty after adjustment for various co-variates.Results: The mean (SD) age was 83.9 (6.5) years) and 126 (51.9%) were females. One-hundred and forty-nine (61.3%) patients were classified as frail, while 66 (27.2%) were found to be at high malnutrition-risk according to the MUST. Frail patients were more likely to be older with a higher Charlson-index and on polypharmacy than non-frail patients. Patients who were at high malnutrition- risk were more likely to be living alone and on vitamin D supplementation than those at low malnutritionrisk. Patients who were at a high malnutrition-risk but not those who were at moderate malnutrition-risk, were more likely to be deemed frail (aOR 2.6, 95% CI 1.2-5.5, p=0.015) when compared to those who were at low malnutrition-risk.Conclusions: Only patients who were classified as at high malnutrition-risk according to the MUST are more likely to be deemed frail. [ABSTRACT FROM AUTHOR]

At present there is strong evidence demonstrating that not chronological age, but the presence of frailty before surgery is associated with a significant increase in postoperative morbidity, mortality, along with increased risk of delirium, disability, increased length of hospital stay and resource use. Therefore, preoperative frailty evaluations should become obligatory prior to high-risk surgery of older patients suffering from cancer. Currently, the golden standard is the full Geriatric Assessment. However, it requires time and, first of all, experience. Various simple frailty screening tools have been developed,, however, currently there is no single ideal one. Therefore, there is a constant search for the “holy grail” of preoperative geriatric evaluations. The Tilburg Frailty Indicator, the Edmonton Frail Scale, the Cardiovascular Health Study index, the Clinical Frailty Scale, the Study of Osteoporotic Fractures index and Frailty Index are examples of evaluation tools that have some features of screening scores and the full Geriatric Assessment. In the present article they were characterised briefly to familiarize the reader with the advantages and disadvantages of each. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery risk scoring systems predict operative mortality but not outcomes related to preoperative frailty. The aim of this study was to assess frailty in a cohort of older cardiac surgery patients as a predictor of postoperative outcomes.Methods: Prospective data was collected on patients 65 years of age and older undergoing cardiac surgery between September 2015 and October 2016 at Dunedin Hospital. Frailty was assessed with the Edmonton frail scale and five-metre gait speed. The primary endpoint was length of hospital stay. Secondary outcomes included postoperative complications, major adverse events, death and 12-month readmission rate.Results: Among the 96 patients, median age was 74 (interquartile range 10.5) and 65 (68%) were males. Of the sample 64 (67%) were scored as not frail, 22 (23%) as vulnerable, and 10 (10%) as frail. The median (interquartile range) postoperative days' stay were: not frail 6 (2), vulnerable 9.5 (8), and frail 15 (13). Survival analysis adjusting for EuroSCORE II, age, sex and surgery type showed that greater Edmonton Frail Scale scores were independently predictive of longer post-surgery hospital stay with a hazard ratio for discharge of 0.83 (95% confidence interval 0.76-0.91, p<0.001) per point. The Edmonton Frail Scale score was associated with the 12-month post discharge number of readmissions (adjusted incidence rate ratio 1.24 (95% confidence interval 1.13-1.37, p<0.001) per point.Conclusions: The Edmonton Frail Scale score predicts length of hospital stay post cardiac surgery and 12-month readmission rate in patients older than 65 years of age. [ABSTRACT FROM AUTHOR]

Aim: Laboratory deficit‐based frailty index (LFI) exhibited outcome‐prediction ability in the elderly, but not in those with end‐stage renal disease (ESRD). We hypothesized that LFI results might have outcome correlation and correlate closely with other instruments in ESRD patients. Methods: We prospectively enroled ESRD patients between 2014 and 2015 and administered self‐report frailty instruments (Strawbridge questionnaire, Edmonton frail scale (EFS), Groningen frailty indicator (GFI), Tilburg frailty indicator, G8 questionnaire and FRAIL scale), and Cardiovascular Health Study (CHS) scale, with two types of LFI calculated. They were followed up until June 30, 2017. Correlations between the results of six instruments, CHS scale, and those of LFI were identified, followed by Kaplan–Meier survival analyses and logistic regression analyses to compare those with high and low LFI. Results: The frailty prevalence was 33.3% (CHS), 78.8% Strawbridge questionnaire, 45.5% (EFS), 57.6% (GFI), 27.3% (Tilburg frailty indicator), 84.8% (G8) and 18.2% (FRAIL) among ESRD participants. LFI‐1 results were significantly correlated with those of LFI‐2 (P < 0.01), EFS (P = 0.04) and GFI (P < 0.01), while LFI‐2 results were not. Those with CHS or GFI‐identified frailty had significantly lower 1,25‐(OH)2‐D levels than those without. After 32.3 ± 5.4 months, patients with high LFI‐1 scores, but not LFI‐2, had a significantly higher mortality than those with lower scores. GFI and EFS scores were also independently associated with LFI‐1, while CHS scores exhibited borderline association only. Conclusion: Among a group of predominantly older ESRD patients, LFI differentiates patients with good and poor outcomes, supporting its applicability in these patients. SUMMARY AT A GLANCE: The study sought correlations between six self‐report frailty instruments and laboratory deficit‐based frailty index. The authors propose applicability of laboratory deficit‐based frailty index in differentiating patients with good and poor outcomes, among a group of predominantly older end‐stage renal disease patients. [ABSTRACT FROM AUTHOR]

Oily fish are recommended as part of a healthy diet due to their high content of long-chain omega-3 polyunsaturated fatty acids (ω-3 PUFAs), proteins, and other nutrients. There is preliminary evidence of beneficial effects of ω-3 PUFAs in the prevention of sarcopenia (a major component of frailty). In this study, we aimed to assess the relationship between dietary oily fish intake and a measure of frailty – the Edmonton Frail Scale (EFS) score – in community-dwelling older adults living in rural coastal Ecuador. A total of 363 Atahualpa residents were enrolled. The mean fish servings per week were 8.8 ± 5.2 and mean EFS score was 5 ± 2.8 points. A linear regression model showed no association between the amount of oily fish intake and EFS scores. However, an interaction model, with participants stratified according to their median age and fish intake in quintiles, showed a significant effect for both variables on the EFS score (ß coefficient = 0.104; 95% C.I.: 0.003–0.206; p = 0.044). At the lowest quintile of fish intake, younger individuals have lower EFS scores than their older counterparts. As the consumption of oily fish increases, mean EFS scores margins were found to be progressively reduced in subjects aged 60–69 years but were largely unaffected in persons aged ≥70 years. It appears that oily fish intake has a positive effect on the frailty status of younger subjects but is superseded by the effects of age in the older population. [ABSTRACT FROM AUTHOR]

International guidelines for the management of valvular heart disease recommend frailty assessment prior to Transcatheter Aortic Valve Implantation (TAVI), however there is no consensus how to assess frailty. We investigated whether frailty status assessed with the Edmonton Frail Scale (EFS, range 0–17 points) relates to length of stay (LOS), short- and long-term mortality and adverse outcomes after TAVI. In this study we included 357 patients between April 2016 till December 2018. EFS was assessed at baseline. Patients were classified into low (0–3), intermediate (4–7) or high frailty status (8‐17). LOS was defined as the number of days between admission and discharge. Mortality data were obtained up to four years after TAVI. Adverse events were defined by Valve Academic Research Consortium (VARC)-2 criteria and collected <30 days after TAVI. Patients with higher frailty status had longer median LOS (days (IQR): low 5 (3), intermediate 6 (4) and high 7 (5), p < 0.001) and higher mortality: low vs intermediate vs high at 30 days 0.5%, 2.2%, 7.0% (p = 0.050), 1 year 3.7%, 10.0%, 15.2% (p = 0.052), 2 years 9.2%, 17.8%, 31.7% (p = 0.003), 3 years 17.2%, 24.0, 47.0% (p = 0.001) and 4 years 19.6%, 30.8%, 55.6% (p < 0.001). Frail patients received more often a pacemaker (2.6%, 6.6%, 13.5%, p = 0.048). In clinical practice, the EFS is a useful tool to screen for frailty in TAVI patients. This tool may possibly be expanded to determine benefit versus harm-risk in these patients and whether specific pre-procedurally interventions are needed in order to reduce mortality. • Edmonton Frail Scale is a useful tool to screen for frailty in TAVI patients. • High frailty is related to length of stay and mortality after TAVI. • Longer length of stay and short term mortality are not due to stroke or vascular complications. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether the Edmonton Frail Scale (EFS), a multidimensional frailty assessment tool, improves the prediction of 30-day or in-hospital mortality over the use of the European System for Cardiac Outcome Risk Evaluation (EuroSCORE) II alone. Design Single-center prospective observational study. Setting University hospital. Participants Patients aged 75 years or older undergoing cardiac surgery between February 2014 and May 2017. Intervention No intervention was performed. The EFS was administered the day before surgery. Measurements and Main Results The primary endpoint was 30-day or in-hospital mortality. Secondary endpoints were times to discharge from the intensive care unit (ICU) and from the hospital, discharge to a health care facility, and ability to return home by postoperative day 30. The EFS had a good discriminative ability for 30-day mortality (area under the receiver operating characteristic curve = 0.69; 95% confidence interval [CI], 0.56-0.82). Adding frailty, defined by an EFS ≥8, to the EuroSCORE II significantly improved the prediction of 30-day (p = 0.04) mortality. The integrated discrimination index was 0.03 (95% CI, 0.01-0.06, p = 0.01), meaning that the difference in predicted risk between patients who died and those who survived increased by 3% due to the addition of frailty determined by the EFS to the EuroSCORE II. Frailty also was associated significantly with a decreased cumulative probability of discharge from the ICU (p = 0.02) and an increased incidence of discharge to a health care facility (p = 0.01). Conclusion The EFS has a good predictive ability for 30-day mortality after cardiac surgery in elderly patients and improves the prediction of 30-day mortality over the use of the EuroSCORE II. [ABSTRACT FROM AUTHOR]

Abstract Objective To assess the influence of frailty on cognitive decline. Design Population-based prospective cohort study. Settings/participants Community-dwelling older adults living in a rural Ecuadorian village, fulfilling the following criteria: age ≥60 years at baseline Montreal Cognitive Assessment (MoCA) and frailty assessment, a baseline brain magnetic resonance imaging, and a follow-up MoCA performed at least 12 months after the baseline. Measures Frailty was evaluated by the Edmonton Frailty Scale (EFS) and cognitive performance by MoCA. The relationship between baseline EFS and MoCA decline was assessed by longitudinal linear and fractional polynomial models, adjusted for relevant confounders. The score of the cognitive component of the EFS was subtracted, and an alternative fractional polynomial model was fitted to settle the impact of such cognitive question on the model. Results A total of 252 individuals, contributing 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years) were included. The mean EFS score was 4.7 ± 2.5 points. The mean baseline MoCA score was 19.5 ± 4.5 points, and that of the follow-up MoCA was 18.1 ± 4.9 points (P =.001). Overall, 154 (61%) individuals had lower MoCA scores in the follow-up. The best fitted longitudinal linear model showed association between baseline EFS score and MoCA decline (P =.027). There was a continuous increase in MoCA decline in persons with an EFS ≥7 points (nonlinear relationship). Fractional polynomials explained the effect of the EFS on MoCA decline. For the complete EFS score, the β coefficient was 2.43 (95% confidence interval 1.22–3.63). For the effect of the EFS (without its cognitive component) on MoCA decline, the relationship was still significant (β 4.86; 95% confidence interval 2.6–7.13). Conclusions/implications Over a 3.7-year period, 61% of older adults living in Atahualpa experienced cognitive decline. Such decline was significantly associated with frailty status at baseline. Region-specific risk factors influencing this relationship should be further studied to reduce its burden in rural settings. [ABSTRACT FROM AUTHOR]

Introduction and objective Frailty is characterized by the body's increased susceptibility to stressors due to aging and a concurrent decline in its resilience. A dominant hypothesis suggests that oncological interventions may amplify this vulnerability. Consequently, elderly individuals with cancer may pose challenges for conventional treatments. This research sought to assess the effects of radiotherapy (RT) on the frailty of elderly cancer patients by utilizing the Edmonton Frail Scale (EFS). Methods This research was designed as a prospective observational study. Patients aged 65 and older, receiving treatment at the radiation oncology clinic, were asked to complete the EFS form both before and at the end of their RT course. The scores achieved before and after the RT were obtained, and the medical histories of the patients were recorded. The difference between the pre- and post-RT scores was calculated by subtracting the post-RT score from the pre-RT score to determine any increase or decrease in the score. For the statistical evaluations, a suite of tests (including the Shapiro-Wilk test, Kolmogorov-Smirnov test, paired sample t-test, independent t-tests, analysis of variance {ANOVA}, and Pearson correlation) were implemented. All analyses were conducted using the Statistical Package for Social Sciences (SPSS) software (version 29.0) (IBM SPSS Statistics, Armonk, NY). Results From April 2021 to August 2023, a total of 121 patients participated in the study. Out of these, 81 underwent assessments both pre- and post-RT. The median age was 73; the median follow-up period was five months. The predominant diagnoses included prostate cancer, breast cancer, and gynecological malignancies. A significant proportion of patients was diagnosed with stage IV cancer and underwent palliative RT. Post-RT evaluations revealed a decline in scores for some patients, while an increase was observed for others. Certain score variations were statistically significant. Moreover, an inverse correlation was discerned between the RT dose and fraction number and the post-RT EFS score. Conclusion Our research confirmed that a substantial number of patients either experienced a decrease or maintained stability in their EFS scores after RT. This observation suggests that RT might not exacerbate frailty in the elderly in the short term. Nevertheless, to elucidate the long-term impact of RT on frailty, there is a pressing need for a comprehensive assessment correlating EFS scores with survival rates., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Güzelöz et al.)

Objectives With an aging population and increase in multimorbidity, the importance of screening for frailty and sarcopenia has become a public health priority. Several tools to do so exist. This study aimed to examine whether the SARC-F and Edmonton frail screening tools are useful in clinical practice to identify at-risk patients for negative health outcomes who would benefit from intervention. Design This is a cross-sectional study of patients attending medical specialist outpatient clinics at the National University Hospital, Singapore from May 2015 to February 2016. Measurements Frailty and sarcopenia were identified using the Edmonton Frail Scale and SARC-F questionnaires, respectively. Other clinically relevant data including basic demographics, presence of caregiver, number of follow-ups, medications and hospital readmissions in the past 1 year, Charlson comorbidity index, and modified Barthel index were collected from chart review. Results A total of 115 patients 65 years old and older were screened. Of the sample, 44.3% (n = 51) of patients were sarcopenic, whereas 27.0% (n = 31) were classified as frail; 23.5% (n = 27) were both frail and sarcopenic; and 87.1% of frail patients were sarcopenic, whereas 47.1% of sarcopenic patients were frail. Sarcopenia and frailty were associated with a higher Charlson comorbidity index, higher likelihood of requiring a caregiver, more medical specialty follow-ups, polypharmacy, more than 2 hospital admissions within a year, a higher number of falls and falls with serious consequences. This affected their perceived health status with 50.0% of robust patients rating their health excellent compared with 19.6% of sarcopenic patients ( P < .001), 9.7% of frail patients ( P < .001) and sarcopenic and frail patients scoring the lowest with 3.7% (P < .001). Conclusions The prevalence of frailty and sarcopenia among older adults attending medical outpatient clinic is high. Both syndromes are predictors of recurrent hospital admissions, polypharmacy, multiple medical clinic appointments, higher rate of falls, and falls with serious consequences. Early identification of older adults at risk of adverse health outcomes would aid in instituting timely intervention to reduce healthcare burden and improve quality of life. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the performance of Edmonton Frail Scale (EFS) on frailty assessment in association with multi-dimensional conditions assessed with specific screening tools and to explore the prevalence of frailty by gender.Methods: We enrolled 366 hospitalised patients (women\men: 251\115), mean age 81.5 years. The EFS was given to the patients to evaluate their frailty. Then we collected data concerning cognitive status through Mini-Mental State Examination (MMSE), health status (evaluated with the number of diseases), functional independence (Barthel Index and Activities Daily Living; BI, ADL, IADL), use of drugs (counting of drugs taken every day), Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS), Skeletal Muscle Index of sarcopenia (SMI), osteoporosis and functionality (Handgrip strength).Results: According with the EFS, the 19.7% of subjects were classified as non frail, 66.4% as apparently vulnerable and 13.9% with severe frailty. The EFS scores were associated with cognition (MMSE: β = 0.980; p < 0.01), functional independence (ADL: β = -0.512; p < 0.00); (IADL: β = -0.338; p < 0.01); use of medications (β = 0.110; p < 0.01); nutrition (MNA: β = -0.413; p < 0.01); mood (GDS: β = -0.324; p < 0.01); functional performance (Handgrip: β = -0.114, p < 0.01) (BI: β = -0.037; p < 0.01), but not with number of comorbidities (β = 0.108; p = 0.052). In osteoporotic patients versus not-osteoporotic patients the mean EFS score did not differ between groups (women: p = 0.365; men: p = 0.088), whereas in Sarcopenic versus not-Sarcopenic patients, there was a significant differences in women: p < 0.05.Conclusions: This study suggests that measuring frailty with EFS is helpful and performance tool for stratifying the state of fragility in a group of institutionalized elderly. As matter of facts the EFS has been shown to be associated with several geriatric conditions such independence, drugs assumption, mood, mental, functional and nutritional status. [ABSTRACT FROM AUTHOR]

Frailty is the core of geriatric syndromes in the elderly. However, there is no solid prevalence data in Taiwan even with the rapid growth of the elderly population. The aim of this study was to explore the prevalence of frailty defined by different instruments and to identify the factors associated with frailty in a northern Taiwan community. Methods: The 65-79-year old community-dwelling residents randomly selected from Toufen were first screened with a telephone version of the Chinese Canadian Study of Health and Aging Clinical Frailty Scale (CCSHA-CFS; level 1-7). Those who scored 3-6 with this instrument were evaluated at a local hospital with the Fried Frailty Index (FFI) and the Edmonton Frail Scale (EFS). Other baseline characteristics including health and functional performance were also evaluated. Results: Among the 2900 population representative samples, 845 (29.1%) completed the CCSHA-CFS telephone interview with the prevalence of frailty approximately 11.0% [95% confidence interval (CI) 8.9-13.1]. Among the 275 who completed assessments with FFI and EFS, prevalence of frailty was 11.3% (95% CI = 7.6-15.0) by FFI and 14.9% (95% CI = 10.7-19.1) by EFS. About 57.5% of respondents had memory impairment, 29.8% experienced pain, 25.1% experienced falls, 16.7% had depression, 14.5% had urinary incontinence, and 5.8% had polypharmacy. Being older, having more complaints with falls, pain, dysphagia, polypharmacy, depression, comorbidity, longer time for the Timed Up and Go test, less education, lower Mini-Mental State Examination score, and lower Barthel Index were associated with frailer status. In multinomial logistic regression analysis, increasing age, less education status, lower Barthel Index score and depression were positively associated with physical frailty. Conclusion: In this study, the prevalence of frailty was from 11.0% to 14.9% by different criteria and methodology. Various correlates were independently associated with frailty status. It is suggested that intervention for frailty requires an interdisciplinary approach.

Aim To translate the Japanese Kihon Checklist (frailty index) into the Portuguese language, and to validate the use of the checklist for the assessment of the elderly Brazilian population. Methods A semantic analysis was carried out, along with pretesting of bilingual participants. The checklist was validated against the Edmonton Frail Scale. Results A total of 188 Brazilian older adults (mean age 69.5 ± 7.47 years) participated in the present study. In the semantic analysis, six elderly participants reported no difficulty with responding to the Portuguese version of the Kihon Checklist. During pretesting with 21 bilingual participants, we found a strong correlation between the total scores of the original version of the Kihon Checklist in Japanese and the translated version in Portuguese ( r = 0.764, P < 0.001). According to the validation process, which involved 161 participants, there was a significant correlation between the total scores of the Kihon Checklist and the Edmonton Frail Scale ( r = 0.535, P < 0.001), and between each domain of the checklist with the total score of Edmonton Frail Scale (lifestyle τ = 0.429, P < 0.001; physical strength τ = 0.367, P < 0.001; nutrition τ = 0.211, P = 0.002; eating τ = 0.213, P = 0.001; socialization τ = 0.269, P < 0.001; memory τ = 0.285, P < 0.001; and mood τ = 0.359, P < 0.001). Furthermore, the Portuguese version of the Kihon Checklist showed satisfactory internal consistency ( Cronbach's α coefficient: 0.787). Conclusions The Portuguese language version of the Kihon Checklist presented good internal consistency and validity. Therefore, we encourage its application in the elderly Brazilian population with an aim of monitoring their frailty to prevent or delay the functional dependence and any other adverse health outcomes. [Correction added on 14 January 2013, after first online publication: the phrase 'loss of' has been deleted from the preceding statement.] Geriatr Gerontol Int 2014; 14: 561-569. [ABSTRACT FROM AUTHOR]

Background/purpose: Frailty is the core of geriatric syndromes in the elderly. However, there is no solid prevalence data in Taiwan even with the rapid growth of the elderly population. The aim of this study was to explore the prevalence of frailty defined by different instruments and to identify the factors associated with frailty in a northern Taiwan community.Methods: The 65-79-year old community-dwelling residents randomly selected from Toufen were first screened with a telephone version of the Chinese Canadian Study of Health and Aging Clinical Frailty Scale (CCSHA-CFS; level 1-7). Those who scored 3-6 with this instrument were evaluated at a local hospital with the Fried Frailty Index (FFI) and the Edmonton Frail Scale (EFS). Other baseline characteristics including health and functional performance were also evaluated.Results: Among the 2900 population representative samples, 845 (29.1%) completed the CCSHA-CFS telephone interview with the prevalence of frailty approximately 11.0% [95% confidence interval (CI) 8.9-13.1]. Among the 275 who completed assessments with FFI and EFS, prevalence of frailty was 11.3% (95% CI = 7.6-15.0) by FFI and 14.9% (95% CI = 10.7-19.1) by EFS. About 57.5% of respondents had memory impairment, 29.8% experienced pain, 25.1% experienced falls, 16.7% had depression, 14.5% had urinary incontinence, and 5.8% had polypharmacy. Being older, having more complaints with falls, pain, dysphagia, polypharmacy, depression, comorbidity, longer time for the Timed Up and Go test, less education, lower Mini-Mental State Examination score, and lower Barthel Index were associated with frailer status. In multinomial logistic regression analysis, increasing age, less education status, lower Barthel Index score and depression were positively associated with physical frailty.Conclusion: In this study, the prevalence of frailty was from 11.0% to 14.9% by different criteria and methodology. Various correlates were independently associated with frailty status. It is suggested that intervention for frailty requires an interdisciplinary approach. [ABSTRACT FROM AUTHOR]

Purpose To assess the effect of age in the association between poor sleep quality and frailty status. Design and Setting Population-based, cross-sectional study conducted in Atahualpa, a rural village located in coastal Ecuador. Methods Out of 351 Atahualpa residents aged ≥60 years, 311 (89%) were interviewed with the Pittsburgh Sleep Quality Index (PSQI) and the Edmonton Frail Scale (EFS). The independent association between PSQI and EFS scores was evaluated by the use of a generalized linear model adjusted for relevant confounders. A contour plot with Shepard interpolation was constructed to assess the effect of age in this association. Results Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers. Mean score in the EFS was 5 ± 3 points, with 46% individuals classified as robust, 23% as prefrail, and 31% as frail. In the fully adjusted model, higher scores in the PSQI were significantly associated with higher scores in the EFS (β 0.23; 95% CI 0.11–0.35; P < .0001). Several clusters depicted the strong effect of age in the association between PSQI and EFS scores. Older individuals were more likely to have high scores in the EFS and the PSQI, and younger individuals had low EFS scores and were good sleepers. Clusters of younger individuals who were poor sleepers and had high EFS scores accounted for the independent association between PSQI and EFS scores. Conclusions This study shows the strong effect of age in the association between poor sleep quality and frailty status. [ABSTRACT FROM AUTHOR]

[Purpose] Global aging has led to a dramatic increase in the number of frail people, who are likely to become bedridden. Since frailty can be partially reversed, early intervention would be beneficial for patients, family members, and clinicians. This study was designed to develop a screening tool for an accurate and comprehensive assessment of frailty by modulating the Edmonton Frail Scale (EFS). [Participants and Methods] The EFS, covering multiple domains, is one of the major diagnostic tools for frailty. Frail and non-frail participants (n=67) were evaluated for each diagnostic item of the EFS to identify the most efficient combination of questions by evaluating its sensitivity and specificity. [Results] The Kyoto Frailty Scale (KFS) was developed as a rapid frailty scale, based on the EFS. The KFS comprises nine questions about health status, polypharmacy, hospitalization, living with a reliable caregiver, shopping, transportation, housework, money management, and forgetting to take medicine. The KFS has an excellent negative predictive value (100%) for screening frailty and a positive predictive value (97%) for screening prefrailty and frailty if we regard KFS ≥4 as a test positive. [Conclusion] The KFS permits clinician to rapidly and accurately screen for frailty and prefrailty, or exclude frailty., (2021©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Objectives: The importance of screening for frailty and sarcopenia has grown. They have both been shown to be associated with disability, mortality and poor healthcare outcomes. With increasing subspecialisation in tertiary healthcare institutions, at risk older adults often receive fragmented care from organ-specific subspecialists. Several tools to do so exist and this study aimed to examine if the SARC-F and Edmonton frail screening tools are useful in clinical practice to identify at risk patients for intervention. Methods: This is a cross-sectional study of patients attending medical specialist outpatient clinics at the National University Hospital, Singapore from May 2015 to August 2016. Frailty and sarcopenia were identified using the Edmonton Frail Scale and SARC-F questionnaires respectively. Other clinically relevant data including basic demographics, presence of caregiver, number of follow-ups, medications and hospital readmissions in the past 1 year, Charlson's comorbidity index and their Modified Barthel's Index were collected. Results: A total of 115 patients 65years old and above were screened. The mean age of all patients was 76.6±6.5 years. 52.2% were female and 75.7% (n=87) were of Chinese ethnicity. 50% (n=57) of patients were independent and did not require a caregiver. Of the sample,44% (n=51) of patients were sarcopenic while 27% (n=31) were classified as frail. 23% (n=27) were both frail and sarcopenic. Women were more likely to be frail (67.7% vs 32.3%, p=0.042) and sarcopenic (58.3% vs 29.0%, p=0.001). Sarcopenic patients had a higher Charlson Comorbidities Index (5.0 vs 6.6, p=0.001) and lower modified Barthel's Index (33 vs 78, p=0.001). Being sarcopenic was associated with a higher likelihood of having a caregiver (p=0.001) with an increasing dependence on children and domestic helpers. They had an average of 3.0 medical specialty follow ups compared to 2.3 follow ups for non-sarcopenic patients (p=0.004). Sarcopenia was significantly associated with polypharmacy (74.5% vs 42.1%, p=0.001), more than 2 hospital readmissions within a year (23.5% vs 9.4%, p=0.043), a higher number of falls (1.20 vs 0.17, p<0.001) and falls with significant consequences (0.14 vs. 0.02, p<0.001). Frail patients similarly had a higher Charlson Comorbidities Index (6.7 vs 5.3, p=0.013) and lower Modified Barthel's Index (78 vs 97, p<0.001). They had 2.9 vs 2.1 specialty follow ups (p = 0.032). Frailty is associated with polypharmacy (87.1% vs. 45.2%, p<0.001), more than 2 hospital readmissions yearly (66.7% vs 33.3%, p<0.001), a higher number of falls (1.39 vs 0.35, p=0.001) and falls with significant consequences (0.16 vs 0.04, p=0.019). Conclusions: The prevalence of frailty and sarcopenia among elderly patients is high. Both syndromes are predictors of recurrent hospital admissions, polypharmacy, multiple medical clinic appointments, higher rate of falls and falls with serious consequences. Using simple screening tools to identify such at risk elderly to facilitate streamlining of care and care integration is likely to be beneficial and cost effective in the long run. [ABSTRACT FROM AUTHOR]

Background: Gait disturbance and falls are serious events that can impair activities of daily living (ADL) in the elderly. On the other hand, carnitine plays essential roles in energy production, and carnitine deficiency leads to low activity levels., Objectives: We examined whether a lower serum carnitine concentration was correlated with falls and gait disturbances in the elderly., Design, Setting, and Participants: We performed a cross-sectional study. One hundred and ninety-eight elderly patients (male, 83; female, 115; 81 ± 6 years old) were enrolled in this study., Measurements: Physical performance (hand grip strength, leg strength, walking speed, one-leg standing time, and tandem gait steps) and frailty status (The Edmonton Frail Scale: EFS) were evaluated. The serum total, free, and acylated carnitine levels were measured using an enzyme cycling method. We then investigated the associations between the serum carnitine level, history of falls, and the results of these physical examinations., Results: Of the 198 subjects, 56 (28%) had a history of falls within the past one year. The patients with a history of falls had lower serum total carnitine and free carnitine levels than those without a history of falls. Regarding the physical performance results, the patients with a history of falls had higher EFS scores, a weaker hand grip strength, a slower walking speed, a shorter one-leg standing time, and a smaller number of tandem gait steps than those without a history of falls. A logistic regression analysis showed that the low serum total carnitine concentration was identified as an independent factor associated with a history of falls, a slow walking speed after adjustments for age, sex and modified EFS., Conclusions: A low serum carnitine level is associated with a history of falls and gait disturbances in elderly people., Competing Interests: No potential conflicts of interest were disclosed.

Abstract: This study explored the association between vitamin D insufficiency and frailty syndrome defined by the Fried Frailty Index (FFI) and the Edmonton Frail Scale (EFS) in a northern Taiwan community. Data of 215 subjects participating in an integrated interventional trial involving community-dwelling older adults with a high frailty risk were analyzed. Subjects were first screened by telephone interview and then evaluated at a local hospital with questionnaires, physical performance tests, and serum 25(OH)D measurements. Of the 215 participants, 31% had 25(OH)D insufficiency (< 20 ng/ml). Frail subjects based on the FFI were older, had lower Mini-Mental Status Exam (MMSE) scores, Barthel Index (BI) scores, and 25(OH)D levels. Using the EFS, frailer cases were more likely to be female, have less education, higher comorbid conditions, lower MMSE scores, lower Barthel Index scores, and lower 25(OH)D levels. The associations between insufficient 25(OH)D status and both frailty scales were significant. After adjustment of variables, the odds ratio of 25(OH)D insufficiency was 10.74 (95% CI 2.60–44.31) for frail versus robust individuals. The prevalence of vitamin D insufficiency was high in this population. There was a strong association between vitamin D insufficiency and the FFI. Vitamin D measurements and supplements are suggested for high-risk older people. [Copyright &y& Elsevier]