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      Frailty-aware care: giving value to frailty assessment across different healthcare settings

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          Abstract

          Healthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at increased risk for adverse health outcomes. Furthermore, frailty assessments offer an opportunity to optimize patient care in various healthcare settings. While the vast number of frailty assessment tools available can be a source of confusion for clinicians, each tool has features adaptable to the constraints and goals of different healthcare settings. This review discusses and compares barriers, facilitators, and the application of frailty assessments in primary care, the emergency department/intensive care unit and surgical care to cover a breadth of settings with different frailty assessment considerations. The implementation of frailty-aware care across healthcare settings potentiates better healthcare outcomes for older adults.

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          A global clinical measure of fitness and frailty in elderly people.

          There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.
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            Frailty: implications for clinical practice and public health

            Frailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future.
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              Frailty consensus: a call to action.

              Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                kboreskie@gmail.com
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                3 January 2022
                3 January 2022
                2022
                : 22
                : 13
                Affiliations
                [1 ]GRID grid.21613.37, ISNI 0000 0004 1936 9609, Faculty of Kinesiology and Recreation Management, , University of Manitoba, ; Winnipeg, Manitoba Canada
                [2 ]GRID grid.416356.3, ISNI 0000 0000 8791 8068, Institute of Cardiovascular Sciences, , St. Boniface General Hospital Albrechtsen Research Centre, ; Winnipeg, Manitoba Canada
                [3 ]GRID grid.21613.37, ISNI 0000 0004 1936 9609, Max Rady College of Medicine, Rady Faculty of Health Sciences, , University of Manitoba, ; Winnipeg, Manitoba Canada
                [4 ]GRID grid.21613.37, ISNI 0000 0004 1936 9609, Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, , University of Manitoba, ; Winnipeg, Manitoba Canada
                [5 ]GRID grid.21613.37, ISNI 0000 0004 1936 9609, Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, , University of Manitoba, ; Winnipeg, Manitoba Canada
                Author information
                http://orcid.org/0000-0002-9763-2762
                Article
                2722
                10.1186/s12877-021-02722-9
                8722007
                34979966
                76b95f83-0c6d-4571-9a0b-7760a20b530c
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 9 June 2021
                : 15 December 2021
                Categories
                Review
                Custom metadata
                © The Author(s) 2022

                Geriatric medicine
                frailty,emergency medicine,critical care,primary care,perioperative care
                Geriatric medicine
                frailty, emergency medicine, critical care, primary care, perioperative care

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