A Prospective Comparison of Frailty Scores and Fall Prediction in Acutely Injured Older Adults.
Elderly
Frailty
Geriatric
Trauma
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
28
02
2020
revised:
17
07
2020
accepted:
02
08
2020
pubmed:
6
9
2020
medline:
5
1
2021
entrez:
5
9
2020
Statut:
ppublish
Résumé
Elderly (65 and older) fall-related injuries are a significant cause of morbidity and mortality. Although frailty predicts poor outcomes in geriatric trauma, literature comparing frailty scoring systems remains limited. Herein, we evaluated which frailty scoring system best predicts falls over time in the elderly. Acute surgical patients 65 y and older were enrolled and prospectively observed. Demographics and frailty, assessed using the FRAIL Scale, Trauma Specific Frailty Index (TSFI), and Canadian Frailty Scale (CSHA-CFS), were collected at enrollment and 3 mo intervals following discharge for 1 y. Surveys queried the total number and timing of falls. Changes in frailty over time were assessed by logistic regression and area under the curve (AUC). Fifty-eight patients were enrolled. FRAIL Scale and CSHA-CFS scores did not change over time, but TSFI scores did (P ≤ 0.01). Worsening frailty was observed using TSFI at 6 (P ≤ 0.01) and 12 mo (P ≤ 0.01) relative to baseline. Mortality did not differ based on frailty using any frailty score. Increasing frailty scores and time postdischarge was associated with increased odds of a fall. AUC estimates with 95% CI were 0.72 [0.64, 0.80], 0.81 [0.74, 0.88], and 0.76 [0.68, 0.84] for the FRAIL Scale, TSFI, and CSHA-CFS, respectively. The risk of falls postdischarge were associated with increased age, time postdischarge, and frailty in our population. No scale appeared to significantly outperform the other by AUC estimation. Further study on the longitudinal effects of frailty is warranted.
Sections du résumé
BACKGROUND
Elderly (65 and older) fall-related injuries are a significant cause of morbidity and mortality. Although frailty predicts poor outcomes in geriatric trauma, literature comparing frailty scoring systems remains limited. Herein, we evaluated which frailty scoring system best predicts falls over time in the elderly.
MATERIALS AND METHODS
Acute surgical patients 65 y and older were enrolled and prospectively observed. Demographics and frailty, assessed using the FRAIL Scale, Trauma Specific Frailty Index (TSFI), and Canadian Frailty Scale (CSHA-CFS), were collected at enrollment and 3 mo intervals following discharge for 1 y. Surveys queried the total number and timing of falls. Changes in frailty over time were assessed by logistic regression and area under the curve (AUC).
RESULTS
Fifty-eight patients were enrolled. FRAIL Scale and CSHA-CFS scores did not change over time, but TSFI scores did (P ≤ 0.01). Worsening frailty was observed using TSFI at 6 (P ≤ 0.01) and 12 mo (P ≤ 0.01) relative to baseline. Mortality did not differ based on frailty using any frailty score. Increasing frailty scores and time postdischarge was associated with increased odds of a fall. AUC estimates with 95% CI were 0.72 [0.64, 0.80], 0.81 [0.74, 0.88], and 0.76 [0.68, 0.84] for the FRAIL Scale, TSFI, and CSHA-CFS, respectively.
CONCLUSIONS
The risk of falls postdischarge were associated with increased age, time postdischarge, and frailty in our population. No scale appeared to significantly outperform the other by AUC estimation. Further study on the longitudinal effects of frailty is warranted.
Identifiants
pubmed: 32889331
pii: S0022-4804(20)30547-3
doi: 10.1016/j.jss.2020.08.007
pmc: PMC7736528
mid: NIHMS1651538
pii:
doi:
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
326-332Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001860
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002537
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
J Clin Endocrinol Metab. 2010 Jul;95(7):3165-72
pubmed: 20410223
J Surg Res. 2018 Oct;230:13-19
pubmed: 30100028
JAMA Netw Open. 2019 Oct 2;2(10):e1912409
pubmed: 31577357
Gerontology. 2009;55(5):539-49
pubmed: 19346741
Am J Surg. 2019 Sep;218(3):484-489
pubmed: 30833015
J Am Med Dir Assoc. 2013 Jun;14(6):392-7
pubmed: 23764209
Arch Gerontol Geriatr. 2016 Sep-Oct;66:66-72
pubmed: 27259029
J Trauma Acute Care Surg. 2016 May;80(5):824-34
pubmed: 26881488
Am J Prev Med. 2012 Jul;43(1):59-62
pubmed: 22704747
J Trauma Acute Care Surg. 2016 Oct;81(4):805
pubmed: 27438682
J Trauma Acute Care Surg. 2016 Feb;80(2):195-203
pubmed: 26595712
Clin Med (Lond). 2011 Feb;11(1):72-5
pubmed: 21404792
CMAJ. 2005 Aug 30;173(5):489-95
pubmed: 16129869
Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007146
pubmed: 22972103
Clin Geriatr Med. 2019 Feb;35(1):13-26
pubmed: 30390979
J Am Geriatr Soc. 2018 Oct;66(10):2022-2030
pubmed: 30238970
J Aging Phys Act. 2007 Jan;15(1):90-102
pubmed: 17387231
Am J Surg. 2019 Jul;218(1):87-94
pubmed: 30477759
J Am Coll Surg. 2019 Jun;228(6):852-859.e1
pubmed: 30959106
Clin Epidemiol. 2018 Nov 08;10:1627-1637
pubmed: 30519111
J Am Coll Surg. 2014 Jul;219(1):10-17.e1
pubmed: 24952434
J Am Med Dir Assoc. 2015 Sep 1;16(9):781-3
pubmed: 26089117
J Nutr Health Aging. 2012 Jul;16(7):601-8
pubmed: 22836700
Int J Behav Nutr Phys Act. 2011 Nov 02;8:121
pubmed: 22047024