Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions assessed with specific screening tools

BMC Geriatrics, Jan 2017

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.

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Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions assessed with specific screening tools

Perna et al. BMC Geriatrics Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions assessed with specific screening tools Simone Perna 0 Matthew D'Arcy Francis 2 Chiara Bologna 0 Francesca Moncaglieri 0 Antonella Riva 1 Paolo Morazzoni 1 Pietro Allegrini 1 Antonio Isu 0 Beatrice Vigo 0 Fabio Guerriero 2 Mariangela Rondanelli 0 0 Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition and Dietetics, University of Pavia, Azienda di Servizi alla Persona di Pavia , Via Emilia 12, Pavia , Italy 1 Research and Development Unit , Indena, Milan , Italy 2 Deprtment of Internal Medicine and Medical Therapy, Section of Geriatrics University of Pavia, Azienda di Servizi alla Persona , Pavia , Italy 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. Edmonton frail scale; Frailty; Functional status; Nutrition; Geriatric assessment - Background The main characteristics of frailty is a decrease of the reserves in multiple organ systems. The distinction between age and frailty appear to be so blurred that it has been hypothesized that everyone becomes frail when they grow old [1, 2]. In fact, physicians have often used the term frailty to characterize the weakest and most vulnerable subset of older adults. However, ‘frail’ does not mean comorbidity or disability, so this term cannot be chosen to describe the elderly [3]. We can individuate three steps in the frailty process: a pre-frail process, the frailty state and frailty complications [4]. The pre-frail process is clinically silent and the physiological reserves are enough to allow the body to respond adequately to acute diseases, injury, stress or generally any insult with the possibility of complete recovery. The frailty state is characterized by a slow, incomplete recovery after any new acute disease, injury or stress, confirming that the available functional reserves are insufficient to allow a complete recovery. Complications of the frailty process are directly related to physiologic vulnerability resulting from impaired homeostatic reserves and a reduced capacity of the organism to withstand stresses. The risk of falls increases and a functional decline also occurs, leading to disability, poly-medication, an increased risk of hospitalization, cross-infection, institutionalization and death [5–8]. We can conceptualize frailty as a phenotypical state of weight loss, fatigue, and weakness or alternatively as a multidimensional state of vulnerability arising from a complex interplay of biological, cognitive, and social factors [8]. In order to assess frailty in the elderly, Rolfson et al. tested a brief and user-friendly screening interview in both the inpatient and outpatient settings. The “Edmonton Frail Scale”(EFS) was a valid measure of frailty compared to the clinical impression of geriatric specialists after their more comprehensive assessment. The EFS had good construct validity, good reliability and acceptabl (...truncated)


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Simone Perna, Matthew Francis, Chiara Bologna, Francesca Moncaglieri, Antonella Riva, Paolo Morazzoni, Pietro Allegrini, Antonio Isu, Beatrice Vigo, Fabio Guerriero, Mariangela Rondanelli. Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions assessed with specific screening tools, BMC Geriatrics, 2017, pp. 2, 17, DOI: 10.1186/s12877-016-0382-3