Search

Background: there are several different frailty measures available for identifying the frail elderly. However, their predictive performance in an Australian population has not been examined. Objective: to examine the predictive performance of four internationally validated frailty measures in an older Australian population. Methods: a retrospective study in the Australian Longitudinal Study of Ageing (ALSA) with 2,087 participants. Frailty was measured at baseline using frailty phenotype (FP), simplified frailty phenotype (SFP), frailty index (FI) and prognostic frailty score (PFS). Odds ratios (OR) were calculated to measure the association between frailty and outcomes at Wave 3 including mortality, hospitalisation, nursing home admission, fall and a combination of all outcomes. Predictive performance was measured by assessing sensitivity, specificity, positive and negative predictive values (PPVand NPV) and likelihood ratio (LR). Area under the curve (AUC) of dichotomised and the multilevel or continuous model of the measures was examined. Results: prevalence of frailty varied from 2% up to 49% between the measures. Frailty was significantly associated with an increased risk of any outcome, OR (95% confidence interval) for FP: 1.9 (1.4-2.8), SFP: 3.6 (1.5-8.8), FI: 3.4 (2.7-4.3) and PFS: 2.3 (1.8-2.8). PFS had high sensitivity across all outcomes (sensitivity: 55.2-77.1%). The PPV for any outcome was highest for SFP and FI (70.8 and 69.7%, respectively). Only FI had acceptable accuracy in predicting outcomes, AUC: 0.59-0.70. Conclusions: being identified as frail by any of the four measures was associated with an increased risk of outcomes; however, their predictive accuracy varied. [ABSTRACT FROM AUTHOR]

Background: The Beers criteria are used to identify potentially inappropriate medications (PIMs) in the elderly. Few studies have examined the Beers criteria in elderly hospitalised patients in Australia. Aim: To identify the prevalence of PIM use in elderly patients admitted to an Australian hospital using the 2003 Beers criteria. Method: A prospective cross-sectional study of 100 elderly inpatients was undertaken using the Beers criteria to identify and compare PIM on admission and discharge. Logistic regression analysis examined the risk factors for PIM use. Results: 42% of patients had at least one PIM on admission compared to 39% at discharge. The most common PIMs were amitriptyline, senna, amiodarone and benzodiazepines (nitrazepam and diazepam). Excluding senna, the prevalence decreased to 36% at admission and 24% at discharge. At admission (including and excluding senna), PIM was not significantly associated with age, gender, living arrangements, number of comorbidities and number of medications. At discharge, PIM (including senna) was significantly associated with age (OR 1.1; 95%CI 1.02-1.3; p = 0.02), female gender (OR 3.6; 95%CI 1.3-10; p = 0.01) and number of medications (OR 1.2; 95%CI 1.0-1.3; p = 0.02). When senna was excluded PIM at discharge was only significantly higher in female patients (OR 5.4; 95%CI 1.7-16.9; p = 0.004). Conclusion: The Beers criteria detected a high prevalence of PIM use in elderly hospitalised patients. [ABSTRACT FROM AUTHOR]