Identifying older adults with frailty approaching end-of-life: A systematic review.
Frailty
ROC curve
frail elderly
palliative care
prognosis
Journal
Palliative medicine
ISSN: 1477-030X
Titre abrégé: Palliat Med
Pays: England
ID NLM: 8704926
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
pubmed:
15
9
2021
medline:
15
1
2022
entrez:
14
9
2021
Statut:
ppublish
Résumé
People with frailty may have specific needs for end-of-life care, but there is no consensus on how to identify these people in a timely way, or whether they will benefit from intervention. To synthesise evidence on identification of older people with frailty approaching end-of-life, and whether associated intervention improves outcomes. Systematic review (PROSPERO: CRD42020462624). Six databases were searched, with no date restrictions, for articles reporting prognostic or intervention studies. Key inclusion criteria were adults aged 65 and over, identified as frail via an established measure. End-of-life was defined as the final 12 months. Key exclusion criteria were proxy definitions of frailty, or studies involving people with cancer, even if also frail. Three articles met the inclusion criteria. Strongest evidence came from one study in English primary care, which showed distinct trajectories in electronic Frailty Index scores in the last 12 months of life, associated with increased risk of death. We found no studies evaluating established clinical tools (e.g. Gold Standards Framework) with existing frail populations. We found no intervention studies; the literature on advance care planning with people with frailty has relied on proxy definitions of frailty. Clear implications for policy and practice are hindered by the lack of studies using an established approach to assessing frailty. Future end-of-life research needs to use explicit approaches to the measurement and reporting of frailty, and address the evidence gap on interventions. A focus on models of care that incorporate a palliative approach is essential.
Sections du résumé
BACKGROUND
BACKGROUND
People with frailty may have specific needs for end-of-life care, but there is no consensus on how to identify these people in a timely way, or whether they will benefit from intervention.
AIM
OBJECTIVE
To synthesise evidence on identification of older people with frailty approaching end-of-life, and whether associated intervention improves outcomes.
DESIGN
METHODS
Systematic review (PROSPERO: CRD42020462624).
DATA SOURCES
METHODS
Six databases were searched, with no date restrictions, for articles reporting prognostic or intervention studies. Key inclusion criteria were adults aged 65 and over, identified as frail via an established measure. End-of-life was defined as the final 12 months. Key exclusion criteria were proxy definitions of frailty, or studies involving people with cancer, even if also frail.
RESULTS
RESULTS
Three articles met the inclusion criteria. Strongest evidence came from one study in English primary care, which showed distinct trajectories in electronic Frailty Index scores in the last 12 months of life, associated with increased risk of death. We found no studies evaluating established clinical tools (e.g. Gold Standards Framework) with existing frail populations. We found no intervention studies; the literature on advance care planning with people with frailty has relied on proxy definitions of frailty.
CONCLUSION
CONCLUSIONS
Clear implications for policy and practice are hindered by the lack of studies using an established approach to assessing frailty. Future end-of-life research needs to use explicit approaches to the measurement and reporting of frailty, and address the evidence gap on interventions. A focus on models of care that incorporate a palliative approach is essential.
Identifiants
pubmed: 34519246
doi: 10.1177/02692163211045917
pmc: PMC8637378
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1832-1843Références
J Am Med Dir Assoc. 2016 Dec 1;17(12):1163.e1-1163.e17
pubmed: 27886869
J Pain Symptom Manage. 2011 Nov;42(5):657-62
pubmed: 22045368
J Nutr Gerontol Geriatr. 2016 Oct-Dec;35(4):253-266
pubmed: 27897612
BMJ. 2016 Oct 12;355:i4919
pubmed: 27733354
Age Ageing. 2019 Sep 1;48(5):627-635
pubmed: 31165151
BMJ Support Palliat Care. 2020 Apr 2;:
pubmed: 32241958
Br J Gen Pract. 2014 Sep;64(626):e576-83
pubmed: 25179072
Age Ageing. 2019 May 1;48(3):394-400
pubmed: 30806455
BMJ Support Palliat Care. 2020 Jun;10(2):164-174
pubmed: 32241957
BMJ. 2018 Aug 28;362:k3349
pubmed: 30154082
Age Ageing. 2019 Jul 1;48(4):466-471
pubmed: 31220205
Lancet. 2013 Mar 2;381(9868):752-62
pubmed: 23395245
J Am Med Dir Assoc. 2015 Nov 1;16(11):940-5
pubmed: 26255709
Palliat Med. 2019 Apr;33(4):399-414
pubmed: 30775957
Intern Med J. 2013 Nov;43(11):1210-5
pubmed: 23941077
J Am Geriatr Soc. 2010 Sep;58(9):1642-8
pubmed: 20863323
Biometrics. 2007 Jun;63(2):389-97
pubmed: 17688491
J Gerontol A Biol Sci Med Sci. 1999 Sep;54(9):M440-5
pubmed: 10536646
Age Ageing. 2015 May;44(3):497-501
pubmed: 25652076
Ann Intern Med. 2019 Jan 1;170(1):51-58
pubmed: 30596875
Eur Geriatr Med. 2018;9(6):891-901
pubmed: 30574216
Age Ageing. 2018 Mar 1;47(2):193-200
pubmed: 29040347
JAMA Netw Open. 2019 Aug 2;2(8):e198398
pubmed: 31373653
Clin Interv Aging. 2019 Mar 18;14:577-586
pubmed: 30936688
BMJ. 2021 Mar 29;372:n71
pubmed: 33782057
BMC Med. 2018 Sep 21;16(1):171
pubmed: 30236103
Eur J Intern Med. 2016 Jun;31:3-10
pubmed: 27039014
Singapore Med J. 2017 Mar;58(3):129-133
pubmed: 27917433
J Am Geriatr Soc. 2002 Jun;50(6):1108-12
pubmed: 12110073
JBI Database System Rev Implement Rep. 2017 Apr;15(4):1154-1208
pubmed: 28398987
Age Ageing. 2021 Jan 8;50(1):96-104
pubmed: 33068107
Am J Clin Nutr. 1991 Mar;53(3):599-605
pubmed: 1900382
Arch Gerontol Geriatr. 2007 Mar-Apr;44(2):95-103
pubmed: 16750580
Age Ageing. 2019 Sep 1;48(5):696-702
pubmed: 31211360
BMC Geriatr. 2013 Jun 21;13:64
pubmed: 23786540
Palliat Med. 2019 Apr;33(4):470-474
pubmed: 30688143
Age Ageing. 2011 Jul;40(4):436-43
pubmed: 21616954
PLoS Med. 2013;10(2):e1001381
pubmed: 23393430
Exp Aging Res. 2009 Jan-Mar;35(1):61-82
pubmed: 19173102
JAMA. 2003 May 14;289(18):2387-92
pubmed: 12746362
J Nutr Health Aging. 2016 Apr;20(4):462-8
pubmed: 26999249
Age Ageing. 2010 Nov;39(6):755-8
pubmed: 20858672
Am J Clin Nutr. 2005 Oct;82(4):784-91; quiz 913-4
pubmed: 16210707
J Am Geriatr Soc. 2018 Jul;66(6):1089-1095
pubmed: 29608789
Int J Qual Health Care. 2004 Aug;16(4):293-301
pubmed: 15252003
Eur J Intern Med. 2017 Nov;45:84-90
pubmed: 28993099
J Am Geriatr Soc. 2008 Jan;56(1):68-75
pubmed: 18031487
J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):722-7
pubmed: 17634318
J Nutr Health Aging. 2016 Feb;20(2):192-8
pubmed: 26812516
J Clin Epidemiol. 2016 Jan;69:225-34
pubmed: 26092286
Nutr Clin Pract. 2019 Apr;34(2):304-312
pubmed: 30070732
CMAJ. 2017 Apr 3;189(13):E484-E493
pubmed: 28385893
Age Ageing. 2014 Jan;43(1):10-2
pubmed: 24132852
Am J Epidemiol. 2018 Aug 1;187(8):1752-1762
pubmed: 29688247
Palliat Med. 2019 Jul;33(7):743-756
pubmed: 31057042
BMJ Support Palliat Care. 2015 Mar;5(1):78-90
pubmed: 25613983
PLoS One. 2012;7(2):e32844
pubmed: 22393453
J Aging Health. 2003 Aug;15(3):548-66
pubmed: 12914020
Med Decis Making. 2005 Mar-Apr;25(2):210-21
pubmed: 15800305
Palliat Med. 2014 Oct;28(9):1099-109
pubmed: 24942282
Clin Interv Aging. 2016 Dec 16;12:1-9
pubmed: 28031704
Palliat Med. 2016 Jan;30(1):75-82
pubmed: 26376937
Age Ageing. 2021 Feb 26;50(2):465-471
pubmed: 32997135
Age Ageing. 2019 Dec 1;49(1):32-38
pubmed: 31711099
Arch Gerontol Geriatr. 2007;44 Suppl 1:217-23
pubmed: 17317456
Palliat Med. 2019 Mar;33(3):291-300
pubmed: 30269650
Palliat Med. 2018 Feb;32(2):447-465
pubmed: 28655289
J Am Geriatr Soc. 2012 Apr;60(4):652-60
pubmed: 22316162
Syst Rev. 2016 Dec 5;5(1):210
pubmed: 27919275
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
pubmed: 11253156
Gerontology. 2006;52(2):92-8
pubmed: 16508316
J Gerontol B Psychol Sci Soc Sci. 2019 Oct 4;74(8):e135-e140
pubmed: 31298701
BMC Palliat Care. 2018 Jul 23;17(1):96
pubmed: 30037346
Ann Intern Med. 2013 Feb 19;158(4):280-6
pubmed: 23420236
Dement Geriatr Cogn Disord. 2005;19(2-3):158-63
pubmed: 15627764
BMJ. 2017 Jan 5;356:i6460
pubmed: 28057641
J Women Aging. 2020 May-Jun;32(3):349-360
pubmed: 30897040
J Am Geriatr Soc. 2003 Apr;51(4):492-8
pubmed: 12657068
BMC Med. 2020 Oct 22;18(1):309
pubmed: 33087107
Age Ageing. 2018 Jul 1;47(4):564-569
pubmed: 29546362
Palliat Med. 2010 Jul;24(5):456-61
pubmed: 20427380
BMC Med. 2015 Dec 03;13:287
pubmed: 26631066
Arch Gerontol Geriatr. 2017 May - Jun;70:99-104
pubmed: 28126636
BMC Geriatr. 2014 Sep 19;14:104
pubmed: 25238874
BMJ Open. 2016 Sep 19;6(9):e012340
pubmed: 27645556
Presse Med. 2017 Apr;46(4):360-373
pubmed: 28325586