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BMC Medicine
Published in: BMC Medicine 1/2011

Open Access 01-12-2011 | Opinion

Treating frailty-a practical guide

Authors: Nicola Fairhall, Colleen Langron, Catherine Sherrington, Stephen R Lord, Susan E Kurrle, Keri Lockwood, Noeline Monaghan, Christina Aggar, Liz Gill, Ian D Cameron

Published in: BMC Medicine | Issue 1/2011

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Abstract

Frailty is a common syndrome that is associated with vulnerability to poor health outcomes. Frail older people have increased risk of morbidity, institutionalization and death, resulting in burden to individuals, their families, health care services and society. Assessment and treatment of the frail individual provide many challenges to clinicians working with older people. Despite frailty being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. In this paper we review methods for identification of frailty in the clinical setting, propose a model for assessment of the frail older person and summarize the current best evidence for treating the frail older person. We provide an evidence-based framework that can be used to guide the diagnosis, assessment and treatment of frail older people.
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Literature
1.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001, 56: M146-156. 10.1093/gerona/56.3.M146.CrossRefPubMed
2.
Pel-Littel RE, Schuurmans MJ, Emmelot-Vonk MH, Verhaar HJ: Frailty: defining and measuring of a concept. J Nutr Health Aging. 2009, 13: 390-394. 10.1007/s12603-009-0051-8.CrossRefPubMed
3.
Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B: The assessment of frailty in older adults. Clin Geriatr Med. 2010, 26: 275-286. 10.1016/j.cger.2010.02.002.CrossRefPubMed
4.
Espinoza S, Walston JD: Frailty in older adults: insights and interventions. Cleve Clin J Med. 2005, 72: 1105-1112. 10.3949/ccjm.72.12.1105.CrossRefPubMed
5.
Daniels R, van Rossum E, de Witte L, Kempen GI, van den Heuvel W: Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res. 2008, 8: 278-10.1186/1472-6963-8-278.CrossRefPubMedPubMedCentral
6.
Milne AC, Potter J, Vivanti A, Avenell A: Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009, CD003288-2
7.
Latham NK, Anderson CS, Lee A, Bennett DA, Moseley A, Cameron ID: A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc. 2003, 51: 291-299. 10.1046/j.1532-5415.2003.51101.x.CrossRefPubMed
8.
Landi F, Onder G, Carpenter I, Cesari M, Soldato M, Bernabei R: Physical activity prevented functional decline among frail community-living elderly subjects in an international observational study. J Clin Epidemiol. 2007, 60: 518-524. 10.1016/j.jclinepi.2006.09.010.CrossRefPubMed
9.
Faber MJ, Bosscher RJ, Chin APMJ, van Wieringen PC: Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Arch Phys Med Rehabil. 2006, 87: 885-896. 10.1016/j.apmr.2006.04.005.CrossRefPubMed
10.
Ko FC: The clinical care of frail, older adults. Clin Geriatr Med. 2011, 27: 89-100. 10.1016/j.cger.2010.08.007.CrossRefPubMed
11.
Gill TM, Gahbauer EA, Allore HG, Han L: Transitions between frailty states among community-living older persons. Arch Intern Med. 2006, 166: 418-423. 10.1001/.418.CrossRefPubMed
12.
13.
Sackett DL, Richardson WS, Rosenberg W, RB H: Evidence-Based Medicine-How to Practice and Teach EBM. 1997, New York: Churchill Livingstone
14.
Herbert R, Jamtfedt G, Mead J, Hagen K: Practical Evidence-Based Physiotherapy. 2005, Edinburgh: Butterworth Heinemann
15.
Gill TM, McGloin JM, Gahbauer EA, Shepard DM, Bianco LM: Two recruitment strategies for a clinical trial of physically frail community-living older persons. J Am Geriatr Soc. 2001, 49: 1039-1045. 10.1046/j.1532-5415.2001.49206.x.CrossRefPubMed
16.
Studenski S, Hayes RP, Leibowitz RQ, Bode R, Lavery L, Walston J, Duncan P, Perera S: Clinical Global Impression of Change in Physical Frailty: development of a measure based on clinical judgment. J Am Geriatr Soc. 2004, 52: 1560-1566. 10.1111/j.1532-5415.2004.52423.x.CrossRefPubMed
17.
Winograd CH, Gerety MB, Chung M, Goldstein MK, Dominguez F, Vallone R: Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc. 1991, 39: 778-784.CrossRefPubMed
18.
Mitnitski AB, Song X, Rockwood K: The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci. 2004, 59: M627-632. 10.1093/gerona/59.6.M627.CrossRefPubMed
19.
Mitnitski AB, Mogilner AJ, Rockwood K: Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001, 1: 323-336.CrossRefPubMed
20.
Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB: Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000, 55: M221-231. 10.1093/gerona/55.4.M221.CrossRefPubMed
21.
van Kan A, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, Cesari M, Donini LM, Gillette Guyonnet S, Inzitari M, Nourhashemi F, Onder G, Ritz P, Salva A, Visser M, Vellas B: Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people. An International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging. 2009, 13: 881-889. 10.1007/s12603-009-0246-z.CrossRef
22.
Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K: A standard procedure for creating a frailty index. BMC Geriatr. 2008, 8: 24-10.1186/1471-2318-8-24.CrossRefPubMedPubMedCentral
23.
Rockwood K, Mitnitski A: Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011, 27: 17-26. 10.1016/j.cger.2010.08.008.CrossRefPubMed
24.
Jones DM, Song X, Rockwood K: Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc. 2004, 52: 1929-1933. 10.1111/j.1532-5415.2004.52521.x.CrossRefPubMed
25.
Gallo JJ, Fulmer T, Paveza GJ, Richel W: Handbook of Geriatric Assessment. 2000, Maryland: Aspen Publishers, 3
26.
WHO: International Classification of Functioning, Disability and Health. 2001, Geneva: World Health Organization
27.
Mottram P, Wilson K, Strobl J: Antidepressants for depressed elderly. Cochrane Database Syst Rev. 2006, CD003491.
28.
Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009, CD007146.
29.
Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, Kerse N: Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev. 2010, CD005465.
30.
Mann WC, Ottenbacher KJ, Fraas L, Tomita M, Granger CV: Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly. A randomized controlled trial. Arch Fam Med. 1999, 8: 210-217. 10.1001/archfami.8.3.210.CrossRefPubMed
31.
Logan PA, Gladman JR, Avery A, Walker MF, Dyas J, Groom L: Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke. BMJ. 2004, 329: 1372-1375. 10.1136/bmj.38264.679560.8F.CrossRefPubMedPubMedCentral
32.
DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW: Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002, 40: 794-811. 10.1097/00005650-200209000-00009.CrossRefPubMed
33.
34.
Maly RC, Leake B, Frank JC, DiMatteo MR, Reuben DB: Implementation of consultative geriatric recommendations: the role of patient-primary care physician concordance. J Am Geriatr Soc. 2002, 50: 1372-1380. 10.1046/j.1532-5415.2002.50358.x.CrossRefPubMed
35.
Productivity Commission: Trends in aged care services: some implications. Commission Research Paper, Canberra. 2008
36.
Henderson EJ, Caplan GA: Home sweet home? Community care for older people in Australia. J Am Med Dir Assoc. 2008, 9: 88-94. 10.1016/j.jamda.2007.11.010.CrossRefPubMed
37.
38.
Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V, Rubenstein LZ, Carbonin P: Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ. 1998, 316: 1348-1351.CrossRefPubMedPubMedCentral
39.
Melis RJ, van Eijken MI, Teerenstra S, van Achterberg T, Parker SG, Borm GF, van de Lisdonk EH, Wensing M, Rikkert MG: A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study). J Gerontol A, Biol Sci Med sci. 2008, 63: 283-290.CrossRef
40.
Johri M, Beland F, Bergman H: International experiments in integrated care for the elderly: a synthesis of the evidence. Int J Geriatr Psychiatry. 2003, 18: 222-235. 10.1002/gps.819.CrossRefPubMed
41.
Gravelle H, Dusheiko M, Sheaff R, Sargent P, Boaden R, Pickard S, Parker S, Roland M: Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. BMJ. 2007, 334: 31-10.1136/bmj.39020.413310.55.CrossRefPubMed
42.
Reilly S, Hughes J, Challis D: Case management for long-term conditions: implementation and processes. Ageing Soc. 2010, 30: 125-155. 10.1017/S0144686X09990183.CrossRef
43.
Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC: Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008, 56: 2234-2243. 10.1111/j.1532-5415.2008.02014.x.CrossRefPubMed
44.
Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, Monaghan N, Cameron ID: Frailty Intervention Trial (FIT). BMC Geriatr. 2008, 8: 27-10.1186/1471-2318-8-27.CrossRefPubMedPubMedCentral
45.
46.
47.
Cieza A, Ewert T, Ustun TB, Chatterji S, Kostanjsek N, Stucki G: Development of ICF Core Sets for patients with chronic conditions. J Rehabil Med. 2004, 9-11. Suppl
48.
Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, Garry P: Overview of the MNA-Its history and challenges. J Nutr Health Aging. 2006, 10: 456-463. discussion 463-455PubMed
49.
Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983, 17: 37-49.CrossRef
50.
Wilson K, Mottram P, Sivanranthan A, Nightingale A: Antidepressant versus placebo for depressed elderly. Cochrane Database Syst Rev. 2001, CD000561.
51.
Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed
52.
Jorm AF, Korten AE: Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry. 1988, 152: 209-213. 10.1192/bjp.152.2.209.CrossRefPubMed
53.
Lord SR, Menz HB, Tiedemann A: A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003, 83: 237-252.PubMed
54.
Metadata
Title
Treating frailty-a practical guide
Authors
Nicola Fairhall
Colleen Langron
Catherine Sherrington
Stephen R Lord
Susan E Kurrle
Keri Lockwood
Noeline Monaghan
Christina Aggar
Liz Gill
Ian D Cameron
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2011
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-9-83

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