frailty score; FRAIL scale, frailty index, Edmonton Frail Scale
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Indications
- may predict postoperative mortality in the elderly[1][12]
- improves CMS prediction of healthcare costs[10]
* Frailty assessment trumps cognitive assessment in informing elderly of therapeutic decisions[8]
Clinical significance
- frailty predicts higher 30 day mortality, longer hospital stay, & 30-day emergency department visits in hospitalized elderly[7]
- frailty predicts postoperative complications[3][5]
- score > 5 associated with:
- longer postoperative hospital stays (median, 9 vs 6 days)
- increased 1-year mortality (RR = 9.0)[1]
- more useful than American Society of Anesthesiologists score in the elderly[1]
- a frailty score (FI34) predicts mortality better than DNA methylation
* no gold standard in screening for frailty[3]
Procedure
- derived from the comprehensive geriatric assessment[1]
- score based on 9 preoperative characteristics:
- maximum score = 15
- score based on 7 baseline frailty traits (may be Frailty index)
- Katz bADL score <= to 5
- timed Up & Go test >= 15 seconds
- Charlson Index >= 3
- hematocrit < 35%
- Mini-Cog score <= 3
- serum albumin < 3.4 g/dL
- 1 or more falls within 6 months
- nonfrail: 0-1, prefrail: 2-3; frail: >= 4 traits
- Edmonton Frail Scale assesses 9 domains
- cognition, health status, functional independence, social support, medications, nutrition, mood, continence, functional performance[3]
- FRAIL score, FRAIL scale (score of 3-5 = frail) is easiest to administer[8]
- Fatigue most of time over past 4 weeks
- Resistance; difficulty walking 10 steps alone
- Ambulation: difficulty walking several hundred yards
- Illness: presence of >= 5 illnesses
- Loss of > 5% of body weight in past year
- Clinical Frailty Scale
- Global Burden of Disease Frailty Index (GBD-FI)
- 36 item frailty index based upon disease burden
- Osteoporotic Fractures Frailty score[8]
- ability to rise from an armless chair 5 times
- response to the question "Do you feel full of energy?"
- weight loss > 5% in past year
- a 4th score based entirely on ICD-10 codes for hospitalized elderly[7]
- score based on 27 lab tests commonly performed within 72 hours of hospitalization[9]
- a crosswalk between frailty scores[13]
- agreement between 35 published Frailty Scores[14]
More general terms
More specific terms
Additional terms
- frailty
- Makizako Social Frailty Index
- office-based geriatric assessment
- preoperative evaluation & management
- Social Frailty Screening Index
- Tilburg Frailty Indicator
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Kim SW et al Multidimensional Frailty Score for the Prediction of Postoperative Mortality Risk. JAMA Surg. Published online May 07, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24804971 <Internet> http://archsurg.jamanetwork.com/article.aspx?articleid=1867407
Zenilman ME More Powerful Than the American Society of Anesthesiology Score. JAMA Surg. Published online May 07, 2014. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24804608 <Internet> http://archsurg.jamanetwork.com/article.aspx?articleid=1867404 - ↑ Pijpers E, Ferreira I, Stehouwer CD The frailty dilemma. Review of the predictive accuracy of major frailty scores. Eur J Intern Med. 2012 Mar;23(2):118-23. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22284239
- ↑ 3.0 3.1 3.2 3.3 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc. 2013 Sep;61(9):1537-51. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24028357
- ↑ 5.0 5.1 Robinson TN, Wu DS, Pointer L Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013 Oct;206(4):544-50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23880071 Free PMC Article
- ↑ Kim S, Myers L, Wyckoff J, Cherry KE, Jazwinski SM The frailty index outperforms DNA methylation age and its derivatives as an indicator of biological age. GeroScience. February 2017, Volume 39, Issue 1, pp 83-92 http://link.springer.com/article/10.1007/s11357-017-9960-3
- ↑ 7.0 7.1 7.2 Gilbert T, Neuburger J, Kraindler J et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: An observational study. Lancet 2018 May 5; 391:1775. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29706364 Free PMC Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30668-8/fulltext
Searle SD, Rockwood K. What proportion of older adults in hospital are frail? Lancet 2018 May 5; 391:1751. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29706363 Free Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30907-3/fulltext - ↑ 8.0 8.1 8.2 8.3 Medical Knowledge Self Assessment Program (MKSAP) 18, 19 American College of Physicians, Philadelphia 2018, 2021,2022
- ↑ 9.0 9.1 Ellis HL, Wan B, Yeung M et al Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results. CMAJ January 06, 2020 192 (1) E3-E8; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31907228 Free PMC Article https://www.cmaj.ca/content/192/1/E3
Appendix1(assuppliedbytheauthors):Supplementaryfiguresandtables https://www.cmaj.ca/content/cmaj/suppl/2019/12/27/192.1.E3.DC1/190952-res-1-at.pdf - ↑ 10.0 10.1 Johnston KJ, Wen H, Joynt Maddox KE. et al. Relationship of a claims-based frailty index to annualized Medicare costs: A cohort study. Ann Intern Med 2020 Apr 7; 172:533 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32252070 https://annals.org/aim/article-abstract/2764240/relationship-claims-based-frailty-index-annualized-medicare-costs-cohort-study
- ↑ Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-605 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22836700 PMCID: PMC4515112 Free PMC article
- ↑ 12.0 12.1 Alvarez-Nebreda ML, Bentov N, Urman RD, et al. Recommendations for preoperative management of frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI). J Clin Anesth. 2018;47:33-42. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29550619
- ↑ 13.0 13.1 Sison SDM, Shi SM, Kim KM, Steinberg N, Jeong S, McCarthy EP, Kim DH. A crosswalk of commonly used frailty scales. J Am Geriatr Soc. 2023 Oct;71(10):3189-3198. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37289180 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18453
- ↑ 14.0 14.1 Aguayo GA, Donneau AF, Vaillant MT et al Agreement Between 35 Published Frailty Scores in the General Population. Am J Epidemiol. 2017 Aug 15;186(4):420-434. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28633404 PMCID: PMC5860330 Free PMC article.
- ↑ Clinics: Frailty Scale http://www.managingmds.com/content/Clinical_Frailty_Scale.pdf
- ↑ Frail scale https://www.mass.gov/doc/frail-scale-screening-tool/download?_ga=2.77702676.1469380698.1627576393-1437046581.1627576393