Search

Introduction: Limited data in patients with spontaneous intracerebral haemorrhage (SICH) showed that frailty was associated with mortality; however, there was insufficient data on functional outcomes. This study aimed to investigate the effect of frailty on overall mortality and 90-day functional outcomes in SICH., Materials and Methods: We conducted a retrospective study of 1223 patients diagnosed with SICH from January 2014 to December 2020. Frailty was defined as a clinical frailty scale (CFS) score of 4-9. Binary cut-offs were defined using receiver operating curve analysis. 90-day poor functional outcomes (PFO) were defined as modified Rankin Scale (mRS) ≥3, and utility-weighted mRS (UW-mRS) were based on previous validated studies respectively. Regression analyses were conducted to investigate the association between frailty and outcomes. Confounders adjusted for included demographics, cardiovascular risk factors and haematoma characteristics., Results: 1091 patients met the inclusion criterion. 167 (15.3 %) had 30-day mortality and 730 (66.9 %) had 90-day PFO. Frailty was significantly associated with lower overall survival (HR: 1.54; 95 % CI: 1.11-2.14, p=0.010), 90-day PFO (OR: 1.90; 95 % CI: 1.32-2.74; p<0.001) and poorer UW-mRS (β: -0.06; 95 % CI: (-0.08 to -0.04); p<0.001) even after adjusting for confounders., Conclusions: Frailty was significantly associated with greater mortality and PFO after incident SICH, even after adjusting for a priori confounders. Frail male individuals may be predisposed to poorer outcomes from higher prevalence of cortical atrophy. The use of CFS in younger individuals may aid management by predicting outcomes after incident SICH. Identifying frail individuals with incident SICH could aid in decision-making and the surgical management of SICH., Competing Interests: Declaration of Competing Interest We declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Sarcopenia and frailty have been associated with increased mortality and duration of hospitalization in cancer. However, data investigating these effects in patients with brain metastases remain limited. This study aimed to investigate the effects of sarcopenia and frailty on clinical outcomes in patients with surgically treated brain metastases., Methods: Patients who underwent surgical resection of brain metastases from 2011 to 2019 were included. Psoas cross-sectional area and temporalis thickness were measured by two independent radiologists (Cronbach's alpha > 0.98). Frailty was assessed using the Clinical Frailty Scale (CFS) pre-operatively and post-operatively. Overall mortality, recurrence, and duration of hospitalization were collected. Cox regression was performed for mortality and recurrence, and multiple linear regression for duration of hospitalization., Results: 145 patients were included, with median age 60.0 years and 52.4% female. Psoas cross-sectional area was an independent risk factor for overall mortality (HR = 2.68, 95% CI 1.64-4.38, p < 0.001) and recurrence (HR = 2.31, 95% CI 1.14-4.65, p = 0.020), while post-operative CFS was an independent risk factor for overall mortality (HR = 1.88, 95% CI 1.14-3.09, p = 0.013). Post-operative CFS (β = 15.69, 95% CI 7.67-23.72, p < 0.001) and increase in CFS (β = 11.71, 95% CI 3.91-19.51, p = 0.004) were independently associated with increased duration of hospitalization., Conclusion: In patients with surgically treated brain metastases, psoas cross-sectional area was an independent risk factor for mortality and recurrence, while post-operative CFS was an independent risk factor for mortality. Post-operative frailty and increase in CFS significantly increased duration of hospitalization. Measurement of psoas cross-sectional area and CFS may aid in risk stratification of surgical candidates for brain metastases., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Data and clinical guidelines on the management of osteoporosis in nonagenarians are lacking. The aim of this study was to assess the characteristics of osteoporosis management and identify any gaps or trends in a cohort of nonagenarians who were newly diagnosed with osteoporosis during an inpatient admission. A retrospective analysis of nonagenarians admitted to the medicine department of a tertiary hospital who were newly diagnosed with osteoporosis based on extracted ICD-10 codes. Baseline demographics, frailty based on the clinical frailty scale, comorbidities, initiation, compliance and adverse effects on osteoporosis medication were analysed. Mean age of the study group was 93.0 ± 2.5 years. There was a high prevalence of frailty (71.7%), cognitive impairment (34.2%) and recurrent falls (30.0%). 82.5% were started on osteoporosis treatment with denosumab (43.4%) being the most prescribed, followed by alendronate (41.4%). Cognitive impairment and male gender were associated with less likelihood of being on osteoporosis treatment on multivariate analysis. Having a previous fracture was associated with a higher likelihood of being on osteoporosis treatment. There was a discontinuation rate of 49.5% with a mean time to discontinuation of 26.3 ± 22.9 months. There was a high rate of osteoporosis treatment in nonagenarians with osteoporosis. The presence of previous fractures was associated with initiation of osteoporosis medications, whereas frailty and falls had no impact on treatment decisions. Cognitive impairment and males were associated with a lower rate of initiation of osteoporosis medication., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: To evaluate dentition status amongst community-dwelling older adults and its association with frailty and cognitive impairment., Methodology: One thousand forty-seven community-dwelling older adults aged ≥65 years were surveyed in an epidemiologic population-based cohort study in Singapore between April 2015 and August 2016. Data on demographics, dentition status, chronic diseases, activities and instrumental activities on daily-living, cognition (age- and education-specific MMSE cut-offs), frailty (FRAIL scale), perceived health and functional status were collected. Multiple logistic regression was performed to examine the association between dentition, frailty and cognition., Results: Mean age of participants was 71.2 ± 5.5 years. The prevalence of denture use was 70.7% and edentulism 7.9%. Compared to edentulousness, having teeth was associated with lower odds of cognitive impairment and higher odds of being robust or pre-frail. Denture-wearers compared with edentulous persons were less likely to be male, had higher education level and more likely be robust or pre-frail., Conclusion and Implications: There were significant associations between dentition status, frailty and cognition in our study where those with remining teeth and / or dentures had better overall outcomes. As oral health, frailty and cognitive impairments are all modifiable risk factors for healthy ageing, countries should consider population level screening for oral health, frailty and cognitive impairment., (© 2022. The Author(s).)

Background: frailty has been shown to be a better predictor of clinical outcomes than age alone across many diseases. Few studies have examined the relationship between frailty, stroke and stroke interventions such as endovascular thrombectomy (EVT)., Objective: we aimed to investigate the impact of frailty measured by clinical frailty scale (CFS) on clinical outcomes after EVT for acute ischemic stroke (AIS) in older patients ≥70 years., Methods: in this retrospective cohort study, we included all consecutive AIS patients age ≥ 70 years receiving EVT at a single comprehensive stroke centre. Patients with CFS of 1-3 were defined as not frail, and CFS > 3 was defined as frail. The primary outcome was modified Rankin Score (mRS) at 90 days. The secondary outcomes included duration of hospitalisation, in-hospital mortality, carer requirement, successful reperfusion, symptomatic intracranial haemorrhage and haemorrhagic transformation., Results: a total of 198 patients were included. The mean age was 78.1 years and 52.0% were female. Frail patients were older, more likely to be female, had more co-morbidities. CFS was significantly associated with poor functional outcome after adjustment for age, NIHSS and time to intervention (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.04-2.28, P = 0.032). There was trend towards higher mortality rate in frail patients (frail: 18.3%; non-frail: 9.6%; P = 0.080). There were no significant differences in other secondary outcomes except increased carer requirement post discharge in frail patients (frail: 91.6%; non-frail: 72.8%; P = 0.002)., Conclusions: frailty was associated with poorer functional outcome at 90 days post-EVT in patients ≥ 70 years., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Atrial fibrillation (AF) is common in older adults. CHA2DS2-VASC (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65-74, female) and HASBLED(Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) are the most established risk stratification tools in assessing suitability for anticoagulation in AF. However, there are no established screening tools for geriatric syndromes on anticoagulation risks in older adults., Objective: This study examined the association of anticoagulation prescription with geriatric syndromes., Methods: Older adults 65 years and above admitted to a tertiary hospital with atrial fibrillation and CHA2DS2-VASC score ≥ 2. Data on demographics, function (modified Barthel's Index (MBI)), cognition (mini-cog), frailty (Edmonton Frail Scale (EFS) and FRAIL), geriatric syndromes (EFS), sarcopenia (SARC-F), HASBLED and CHA2DS2-VASC were collected., Results: 150 patients aged 65 and above (mean age 79.4 ± 7.1 years) with AF were recruited. 101 (67%) participants were anticoagulated, in univariate analysis comparing those who were anticoagulated with those who were not, age (OR 0.94; 95% CI 0.89-0.99), chronic kidney disease (OR 0.39; 95% CI 0.19-0.80), frailty (OR 0.77; 95% CI 0.60-0.98) and functional status by Barthel's Index (OR 0.75; 95% CI 0.57-0.97) were significantly associated with anticoagulation prescription. In multivariate analysis, age (OR 0.93; 95% CI 0.88-0.99) and CKD (OR 0.35; 95% CI 0.16-0.76) remained significant. There was no significant difference in CHA2DS2-VASC, HASBLED, MBI or falls between the groups., Conclusions: Age and CKD were significantly associated with anticoagulation prescription in patients with AF. Further studies on the impact of geriatric syndromes on anticoagulation prescription and outcomes in older adults are needed with specific guidelines for patients with geriatric syndromes and AF.

Objectives: With an aging population and increase in multimorbidity, the importance of screening for frailty and sarcopenia has become a public health priority. Several tools to do so exist. This study aimed to examine whether the SARC-F and Edmonton frail screening tools are useful in clinical practice to identify at-risk patients for negative health outcomes who would benefit from intervention., Design: This is a cross-sectional study of patients attending medical specialist outpatient clinics at the National University Hospital, Singapore from May 2015 to February 2016., Measurements: Frailty and sarcopenia were identified using the Edmonton Frail Scale and SARC-F questionnaires, respectively. Other clinically relevant data including basic demographics, presence of caregiver, number of follow-ups, medications and hospital readmissions in the past 1 year, Charlson comorbidity index, and modified Barthel index were collected from chart review., Results: A total of 115 patients 65 years old and older were screened. Of the sample, 44.3% (n = 51) of patients were sarcopenic, whereas 27.0% (n = 31) were classified as frail; 23.5% (n = 27) were both frail and sarcopenic; and 87.1% of frail patients were sarcopenic, whereas 47.1% of sarcopenic patients were frail. Sarcopenia and frailty were associated with a higher Charlson comorbidity index, higher likelihood of requiring a caregiver, more medical specialty follow-ups, polypharmacy, more than 2 hospital admissions within a year, a higher number of falls and falls with serious consequences. This affected their perceived health status with 50.0% of robust patients rating their health excellent compared with 19.6% of sarcopenic patients (P < .001), 9.7% of frail patients (P < .001) and sarcopenic and frail patients scoring the lowest with 3.7% (P < .001)., Conclusions: The prevalence of frailty and sarcopenia among older adults attending medical outpatient clinic is high. Both syndromes are predictors of recurrent hospital admissions, polypharmacy, multiple medical clinic appointments, higher rate of falls, and falls with serious consequences. Early identification of older adults at risk of adverse health outcomes would aid in instituting timely intervention to reduce healthcare burden and improve quality of life., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: This study aimed to survey knowledge and perceptions of social prescribing (SP) amongst health and community care workers, and is a cross-sectional online survey conducted in November 2023. Methods: The survey on basic demographics, awareness, knowledge, and practices of SP was completed by 123 health and community care workers. Results: The mean age of respondents was 39.0 years. Nearly two-thirds had heard of SP. A lower proportion of acute hospital doctors (55.6%) and nurses (56.8%) had heard of SP compared with primary and subacute care doctors (75.0%). The majority agreed that SP benefits patients' mental health and reduces healthcare utilization. Primary care physicians, community nurses, and active ageing centres were the top three professionals selected as most responsible for SP by survey respondents. The most commonly cited barriers to SP were seniors' reluctance (63.4%), lacking knowledge on how to refer (59.3%), lack of time (44.7%), and cost to seniors (44.7%). Conclusion: Overall, health and community care workers demonstrated positive attitudes toward SP and were keen to refer patients for SP. However, additional efforts are needed to improve knowledge about how to refer to and provide training on SP. [ABSTRACT FROM AUTHOR]