Frailty index -Assessment Tools in elderly: feasibility in India (original) (raw)
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Clinical Interventions in Aging
Background: Frailty is a major challenge for healthcare systems in ageing societies. This dynamic state of health is a reflection of reduced reserve in various organ systems and enhanced vulnerability to stressors. Research in this area of geriatrics and gerontology is limited in low-and middle-income countries (LMICs) like India. This study is directed at development of a culturally appropriate and validated assessment scale for frailty among older Indians. Methods: After extensive review of the literature on existing scales, a preliminary draft scale was formed. This draft was pre-and pilot-tested to check feasibility and modified accordingly. The final scale was validated on 107 older adults by confirmatory factor analysis and was named the Frailty Assessment and Screening Tool (FAST). The Fried's frailty phenotype was also administered on the same 107 older adults and scores of both were corelated. Suitable cutoff scores were found for frail and pre-frail older adults. Results: The final version of the FAST consisted of 14 questions pertaining to 10 domains. It has good reliability. Cronbach's alpha coefficient was 0.99; test-retest reliability was 0.97 and validity by confirmatory factor analysis was adequate. The Kaiser-CMeyer-Olkin (KMO) of sampling adequacy was 0.699, and Bartlett's test of sphericity was significant (χ 2 = 353.471, p < 0.001). FAST scores had a cutoff of ≥ 7/14 for frail and ≥ 5/14 for prefrail elderly. Conclusion: The FAST is a validated tool with good psychometric properties. It is expected that it will be helpful in screening pre-frail and frail older adults in India and other LMICs and guide in clinical decision making for intervention.
Journal of the Indian Academy of Geriatrics, 2024
Background: Despite the unfavorable impact of frailty on the health of the elderly, research on frailty in Northeast India remains scarce. This study aimed to assess the prevalence of frailty among elderly inpatients and identify associated factors. Subjects and Methods: This cross-sectional study was conducted among 200 elderly (above 60 years of age) inpatients at a tertiary care hospital. A semistructured pro forma was used to collect data on sociodemographic details and other laboratory parameters. The Fried frailty phenotype was used to assess frailty. Quantitative data were presented as means ± standard deviation, whereas qualitative data were presented as frequency and percentages. The Chi-square/Fisher’s exact test was applied to determine the association, and P < 0.05 was considered statistically significant. Results: The majority of the study participants were male, <70 years, and had a caretaker at home. The proportion of frail among the hospitalized elderly was 50% (95% confidence interval = 42.87%–57.13%). The rest 49.5% were categorized as robust and 0.5% were categorized as prefrail. Frailty was significantly associated with increased age, status of presence of caretaker, addiction, and higher body mass index. Comorbidities such as hypertension, chronic kidney disease, stroke, anemia, diabetes, chronic pulmonary disease, ischemic heart disease, and malignancy were also significantly associated. Conclusions: Frailty is a significant concern among hospitalized elderly individuals. Further research is needed to identify effective interventions to alleviate its impact. Community-level studies should elucidate the relationship between modifiable risk factors and frailty, aiming to enhance the quality of life for our aging population.
Journal of Family Medicine and Primary Care
Context: "Frailty" is a multidimensional geriatric syndrome that increases the risk for adverse health outcomes, such as falls, hospitalization, increased morbidity, and mortality, among elderly persons. Aim: The objective of this study is to find out the proportion of frailty and its associates among elderly (aged ≥60 years) in a rural area of West Bengal. Settings and Design: It is a community-based cross-sectional observational study done during May-August 2018 among 165 elderly persons selected by systematic random sampling by probability proportionate to size method from three villages at the rural field practice area of our institute. Materials and Methods: Tilburg frailty indicator is used to measure frailty. An elderly is considered as frail if s/he scores ≥6 in this scale. Statistical Analysis: Data analysis is done by SPSS Version 16. The logistic regression is done to find out the associates of frailty. Results: Proportion of frailty is 38.8% (mean age ± SD: 67.03 ± 3.43 years) among the study subjects. Age, female gender, loss of spouse, illiteracy, economic dependency, no job/at home status, ≥2 chronic diseases are significantly associated with frailty in univariate logistic regression. In multivariable logistic regression, ≥2 chronic diseases [AOR: 8.4, CI: 4.6, 11.33] and illiteracy [AOR: 3.3, CI: 1.05, 9.8] retain their significance. Conclusion: Frailty should be recognized as a public health priority and awareness generation among elderly population for healthy ageing including self-motivation for proper management of their ailments should be emphasized for reduction of morbidity as well as for augmenting their quality of life.
Asian Journal of Gerontology and Geriatrics, 2019
Background. Frailty is a reversible age-related condition characterised by declines across multiple physiologic systems and associated with an increased risk of mortality or unplanned hospitalisation. We developed and validated a new frailty index that is easy to apply in elderly people in rural India and has predictive accuracy for all-cause mortality at 6 and 12 months. Methods. 1000 participants aged >60 years who were admitted to a geriatric unit of a rural hospital for screening or treatment of any illness were recruited for development and validation of the Frailty Index in Rural Elderly-Mental status, Activities of daily living, Depression, and Events (FIRE-MADE), which combines the Cumulative Deficits Model and the Comprehensive Geriatric Assessment Model and takes into account of four domains: physical, cognitive, psychosocial, and functional. Results. The FIRE-MADE score increased with age and was higher in men than in women. Higher FIRE-MADE score was associated with higher rates of mortality and unplanned hospitalisation. In multivariable analysis, predictors for mortality were Mini-Mental State Examination, activities of daily living, ischaemic heart disease, history of stroke, and polypharmacy. In Kaplan-Meier survival analysis, 4.9%, 7.1%, and 16.7% of participants with mild (FIRE-MADE score, 0.3-0.4), moderate (0.5-0.6), and severe (>0.7) frailty died at the end of 1 year. The cutoff values for mortality and unplanned hospitalisation were 0.32 and 0.27, respectively, with the area under the receiver operating characteristic curve for the severity being 0.883 and 0.794, respectively. Compared with the Longitudinal Aging Study Amsterdam frailty index score in predicting mortality and unplanned hospitalisation, the FIRE-MADE score had positive predictive values of 88.89% and 88.89%, respectively, and negative predictive values of 65.93% and 41.10%, respectively. Association between the two indices was strong. Conclusions. FIRE-MADE is easy to apply in clinical practice as a screening tool to detect frailty in elderly people in rural India.
FRAILTY SYNDROME: A PROBLEM LURKING IN INDIAN GERIATRIC POPULATION
Indian Journal of Social Research, 2019
Human ageing has been observed as a progressive decline in both the physical and psychological functioning and consequently a growing health care burden on the society. Elderly population in India is also exponentially increasing. To understand diverse nature of human ageing, researchers have studied and explained variety of dimensions and concepts related to ageing. The Frailty is one of those important concepts of age related phenomenon. It is a multidimensional complex geriatric syndrome. This article highlighted that frailty syndrome is an evolving concept for India and it is still much less explored. Higher prevalence is reported from India, particularly from elderly women of rural areas and it is associated with several physical, psychological and social factors. In India, it is the high time to increase the awareness of early reorganization and subsequent prevention of frailty syndrome to reduce the expenses of healthcare in future. This review article discusses the concept, defi nitions and most used diagnostic tools of frailty, formal work on frailty instrument in India and the present scenario of frailty syndrome in Indian ageing population.
Frailty, Disability, and Mortality in a Rural Community-Dwelling Elderly Cohort from Northern India
Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine, 2021
Introduction: With increasing proportion of the elderly in the world, detecting and preventing frailty assumes importance to improve the quality of life and health. The study aimed to estimate the prevalence of frailty, disability and its determinants and their relation with mortality among community dwelling elderly cohort. Materials and Methods: The study was conducted in a cohort in rural Haryana, India, and was followed till October 2018. Frailty was assessed using the Edmonton Frailty Scale and disability was assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) scale by trained physicians. Results: The prevalence of frailty was found to be 47.3% (95% confidence interval [CI]: 44.0–50.8). The median WHODAS-2 score was found to be 10.4 (2.1–29.2). Those who were older (odds ratio [OR] – 2.5; 95% CI: 1.8–3.4), women (OR – 3.3; 95% CI: 2.2–4.9) and those with chronic disease (OR 2.3; 95% CI: 1.7–3.1) had higher rates of frailty. The adjusted ...
Frailty: A Multifactorial Association
https://www.ijhsr.org/IJHSR\_Vol.11\_Issue.3\_March2021/IJHSR-Abstract.03.html, 2021
Background: Ageing has been attributed as an universal and inevitable process for mankind. Frailty is commonly seen in elderly and has been associated with adverse health outcomes. There are a number of personal and contextual factors that may be associated with frailty. The association of these factors in Indian Context is not known. Objectives: To explore the association of various lifestyle factors with frailty in community dwelling and institutionalised older persons Methods: This was prospective, cross sectional descriptive study carried out in local community and old age homes in Miraj and Kupwad. Healthy aged older adults devoid of major chronic illness, in age group of 60 years and above (N=470, 382 Community dwelling, 88 Institutionalised older adults) were recruited. Sociodemographic characteristics and various lifestyle factors were recorded and its association with the frailty was established. The frailty status using FiND questionnaire was recorded. Results: Significant association was observed between socio demographic factors, life style, mobility, comorbidity, cognition and depression at p<0.05. Conclusion: Early detection of predisposing factors associated with frailty is crucial for the achievement of health ageing.
Implementing frailty assessment into a healthcare system: a clinical opinion paper
Journal of Frailty, Sarcopenia and Falls
Frailty is a multifactorial medical syndrome characterized by reduced endurance and decreased physiological ability. The aim of this narrative literature review is to present the frailty diagnostic instruments that are already used in most Western countries and provide recommendations for use in clinical practice. Among the numerous available frailty instruments identified in current literature, the Frailty Index and the Physical Frailty Phenotype are most commonly used. There are large differences in each instrument design, ease of use by healthcare teams and also significant heterogeneity in the design of the studies based on these instruments. Therefore, future studies should be designed to properly address the discrepancy in the comparison of the existent instruments and consider their validity and feasibility of implementation in different healthcare settings with different healthcare providers.
Aging and Disease, 2023
The concept frail elderly has been used to highlight the biological, rather than chronological, age. International and national bodies recommend that individuals over age 70 who visit healthcare facilities should be screened for frailty. There are important objections to the concept. Diagnostics: 'Frailty' is used for several completely different types of health problems. There are no useful biomarkers, but more than 60 different published rating methods for frailty, where different methods provide very different prevalence of frailty and also do not identify the same groups of elderly people. There is significant overlap between Clinical Frailty Scalescores and activity of daily living (ADL)-scores. There is no gold standard method against which published frailty rating scales can be validated. It is unclear when, where and how often screening for frailty should occur in healthcare. Treatment: The evidence for treatment of frailty is very weak. A recent systematic overview found that the 21 included randomised, controlled studies (RCTs) were very heterogeneous as regards inclusion/exclusion criteria, how the condition of frailty was defined, what treatment was given and what health outcomes were assessed. In addition, there are often problems with the quality of the studies. The lack of a clear definition and evidence-based treatment of frailty means that it is inappropriate to introduce assessments of frailty in individual elderly patients in health care