Such programmes are likely to be part of our frailty-ready health system of the future, in which community nurses will be available to support primary care physicians and patients when the need arises. The target for elderly persons should be 22–26 kg/m2. It has shown to be a quick, simple and cost-effective screening tool for frailty14 and has been validated for frailty Singapore Medical Association. All Rights Reserved. Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: An observational study. 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All healthcare providers and patients, as well as the general public, need to be aware that frailty is a distinct and recognisable syndrome that is independent of disease and disability, and is potentially reversible with interventions. Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in … Search for more papers by this author. 2020 Jun 16;12(3):1-10. doi: 10.1007/s41649-020-00130-6. Once a patient is screened to be pre-frail or frail, a targeted medical review at the primary care clinic can be carried out. Geriatric patients may be referred to a geriatrician or the appropriate specialist or allied health professional when they have the following (the list is not exhaustive): (a) possible medical conditions that warrant further assessment, e.g. You noted that her walking speed had improved. See also: Appendix in Morley et al., 2012. A targeted medical review is recommended to identify potentially treatable medical conditions that may contribute to frailty, and patients can be referred to the specialist setting where appropriate. Clinical Frailty Scale* I Very Fit — People who are robust, active, energetic and motivated. From a pathophysiological point of view, it is an accelerated decrease in physiological reserve related to ageing. 2021 Feb 5;21(1):111. doi: 10.1186/s12877-021-02049-5. The pathophysiology of frailty is a complex interaction of diseases and age-related decline that leads to a general state of low functional reserve capacities, affecting multiple domains. Intermediate frailty = 1 or 2 deficits. It has demonstrated very good inter-rater reliability [ 10, 11 ]. This site needs JavaScript to work properly. [1] The CFS is commonly used to predict health outcomes that are significantly associated are mortality, comorbidity, functional decline, mobility, and cognitive decline. Frailty and Malnutrition: Related and Distinct Syndrome Prevalence and Association among Community -Dwelling Older Adults: Singapore Longitudinal Ageing Studies. We analysed records of 314 inpatients aged 70 years and older. anaemia requiring further work-up or weight loss with red flags; (b) possible cognitive impairment or depression that needs specialist review and management; (c) falls or acute, significant functional decline that requires a more comprehensive geriatric assessment and multidisciplinary management in the tertiary healthcare setting; (d) poor social support that can be referred to a community case manager; and (e) a more gradual decline in function that may benefit from a physiotherapist review or a more intensive programme at a day rehabilitation centre. She did her chores herself and was a familiar face in the neighbourhood. Bethesda, MD 20894, Copyright A survey of doctors working in public tertiary healthcare institutions, Managing unhealthy alcohol use in general practice, Health-seeking behaviour of the elderly living alone in an urbanised low-income community in Singapore, Mental health and psychosocial support during healthcare emergencies – COVID-19 pandemic. Currently a nine-point global scale ranging from very fit to severely frail to terminally ill. Hatcher VH, Galet C, Lilienthal M, Skeete DA, Romanowski KS. J Am Med Dir Assoc. Although it was originally developed for use by physicians trained in Comprehensive Geriatric Assessment, it has also been shown to predict functional decline and mortality 7 There is no gold standard screening test for frailty, and multiple tools have been developed for different settings and populations. 2017;18(7):583-587. Management of frailty involves collaboration with various care providers from the health and social sectors. Clinical Frailty Scale. Singapore’s prevalence for pre-frailty and frailty was 37% and 6.2% respectively.9 Ng TP, Feng L, Nyunt MSZ, Larbi A, Yap KB. A local prevalence study of 1,051 older adults showed that the prevalence of pre-frailty and frailty was 37% and 6.2%, respectively. E-mail address: edward_chong@ttsh.com.sg. Early identification and intervention can potentially decrease or reverse frailty, especially in the early stages. (12) In this article, we aimed to discuss physical frailty, and the approach to and management of frailty in the primary care setting. Careers. J Am Med Dir Assoc. Park CM, Kim W, Rhim HC, Lee ES, Kim JH, Cho KH, Kim DH. The disability and disease burden of our society is increasing with the rapidly ageing population in Singapore. doi: 10.1001/jamanetworkopen.2019.12409. Frailty encompasses physical frailty,(1) which is the most widely studied and most easily recognised state. Hence, shorter geriatric screening tools have been developed. Often, they active occasionally, e.g. Conference videos > Popular slide sets covering the frailty syndrome. Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore. Frailty is a distinct syndrome in the elderly that is under-recognised but can be reversed with interventions, especially in the pre-frail and mildly frail stages. The CFS is a global clinical assessment of frailty based on physical function and level of independence with activities of daily living proposed by Rockwood et al. 2017 Jul 1;18(7):638.e7-638.e11. At baseline, premorbid frailty was assessed using the CFS of the Canadian Study on Health and Aging. Primary outcomes were mortality and rehospitalization during the 6-month follow-up. Association of Clinical Frailty Scores With Hospital Readmission for Falls After Index Admission for Trauma-Related Injury. Frailty status determined by CFS adds to disease severity and comorbidity in predicting short-term mortality but not rehospitalization in older inpatients who received geriatric acute care in our setting. These people commonly exercise regularly. Time to complete: Less than 5 minutes. Annie also received support from a community case manager whom you had referred her to. Currently, community volunteers are undergoing training to screen for frailty in the community-dwelling elderly, and community nurses are also performing targeted and rapid geriatric and frailty assessments at community health posts. Chong E, Ho E, Baldevarona-Llego J, Chan M, Wu L, Tay L, Ding YY, Lim WS. Our aim was to translate, reproduce and validate the Clinical Frailty Scale (CFS) for the Brazilian Portuguese language. Detailed Description: Frailty is a state of loss of functional reserve resulting in an increased vulnerability to a stressor event. Results: clinical frailty scale; geriatric acute care; mortality; rehospitalization. As part of delivering quality patient-centred care, primary care physicians should involve patients and their families in individualising treatment modalities, preferences and options. Hence, the opportunity should be taken to identify them in the primary care setting. According to the Clinical Frailty Scale (CFS),(16) the patient’s degree of frailty can then be assessed through a synthesis of the FRAIL scale and the functional state of the patient, based on his reported ability to perform basic and instrumental activities of daily living (see Appendix). Special Article The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty ElsaDentPhDa,*,ChristopherLienMBBS,MPAb,WeeShiongLimMBBS,MRCP,MHPEdc, Wei Chin Wong MBBSc, Chek Hooi Wong MBBS, MPHd, Tze Pin Ng MDe, Jean Woo MDf, Birong Dong MDg, Shelley de la Vega MD, MSch, Philip Jun Hua Poi MB, ChBi, Shahrul Bahyah Binti Kamaruzzaman MDi, Chang Won … 2016 Nov;35:24-34. doi: 10.1016/j.ejim.2016.08.033. J Am Med Dir Assoc. Epub 2017 Jun 3. Frailty = 3 or more deficits. Literature summaries > Conference webcasts and video interviews. Objectives: Our aim was to translate, reproduce and validate the Clinical Frailty Scale (CFS) for the Brazilian Portuguese language. Annie Lim, who had Type 2 diabetes mellitus, hypertension and hyperlipidaemia, visited you at your clinic one day. Prevention and treatment information (HHS). The National Institute for Health and Care Excellence (NICE) recently published COVID‐19 rapid guidelines for critical care in adults. Chong E, Ho E, Baldevarona-llego J, Chan M, Wu L, Tay L. Frailty and risk of adverse outcomes in hospitalized older adults: a comparison of different frailty measures. (c) Identify any red flags for more sinister diseases requiring specialist referral, especially problems of unintentional weight loss or any swallowing problems. Her walking speed was noticeably slower and she had been visiting the coffeeshop less often. With ongoing training and education, the multidisciplinary engagement and coordination of care of the elderly in the community can help to build resilience and combat frailty in our rapidly ageing society. (22-26) There are ongoing efforts to engage with the Health Promotion Board, ActiveSG and other community partners to improve such programmes, as well as train and equip the exercise trainers. Patients usually seek healthcare attention only when they experience symptoms or when crises emerge. Annie told you that this was part of normal ageing and asked for a pill to strengthen her legs. BMC Geriatr. The FRAIL scale has been recommended by the International Academy on Nutrition and Aging (IANA)12 and the Asia-Pacific clinical practice guidelines13 for use in clinical practice. These people commonly exercise regularly. Frailty in Hospitalized Older Adults: Comparing Different Frailty Measures in Predicting Short- and Long-term Patient Outcomes. Interventions that can be easily initiated at the point of primary health contact are: (a) Improve protein or caloric intake, especially in those who are malnourished or experiencing weight loss, with appropriate nutritional advice. Tan KY, Kawamura YJ, Tokomitsu A, Tang T. Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. They are among the fittest for their age. exercise or are very 3 Managing Well COVID‐19: Use of the Clinical Frailty Scale for critical care decisions. Primary care physicians can start interventions for frailty in the community by providing appropriate nutritional advice and improving patients’ exercise participation. A multidimensional approach that goes beyond physical frailty and acknowledges cognitive and psychosocial elements is important to produce significant and sustained improvement. Similar to the PFP but includes a question about diseases instead of low activity. Project Title: Clinical Frailty Scale Score Implementation into a Provincial Bedside Clinical Information System (eCritical) Overview: Frailty is a multi-dimensional syndrome characterized by the loss of physiologic and cognitive reserves that gives rise to heightened vulnerability to adverse outcomes. Frailty is often described as a transitional phase between successful ageing and disability. (9,18) (b) Replace vitamin D if there is vitamin D deficiency. 1Department of Geriatric Medicine, Changi General Hospital, Singapore2Community Nursing Department, Changi General Hospital, Singapore3Department of Care and Health Integration, Changi General Hospital, Singapore4Family Medicine-Academic Clinical Programme, Duke-NUS Academic Medical Centre, Singapore Correspondence: Dr Christine Yuanxin Chen, Consultant, Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889. Frailty in older persons: multisystem risk factors and the frailty risk index (FRI). This guideline has been updated and replaced by NICE rapid guideline on managing COVID-19 (NG191) These include screening for other geriatric syndromes such as falls and cognitive impairment, as well as performing more detailed assessments of the seniors’ drug history, functional and psychosocial challenges. 2017;18(7):638.e7-638.e11. Free to use. The CFS is an ordinal hierarchical scale that numerically ranks frailty on a scale 1–9, with a score of 1 being very fit, 2 well, 3 managing well, 4 vulnerable, 5 mildly frail, 6 moderately frail, 7 severely frail, 8 very severely frail, and 9 terminally ill. The CFS is utilized to predict the outcomes of older people hospitalized with acute illnesses. JAMA Netw Open. 39 Each point on its scale has a visual chart and a written description of frailty to assist the classification process. To identify frailty in the community and primary care setting, we recommend performing an initial screening using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale,(14,15) which is most useful in communities with little or no functional disability. Progression of frailty leads to increased risk of falls, disability, immobility, hospitalisations, institutionalisation, caregiver burden, decreased quality of life and even death. Clinical Frailty Scale (CFS) was introduced as a promising, easy to apply and inexpensive tool to assess and score frailty with comparable predic-tive ability as more time-consuming testing strat-egies like the Fried Frailty Criteria or the Short Physical Performance Battery.5 In the context of The Clinical Frailty Scale appears to be a valid and reliable instrument to identify frailty in the ED. (b) Evaluate any possible underlying medical causes of frailty, e.g. Primary care physicians, community nurses and community social networks have important roles in the identification of pre-frail and frail elderly through the use of simple frailty screening tools and rapid geriatric assessments. 2012;204(2):139-143. Education and health coaching are an important function of community nurses. Frailty is recognised as an emerging geriatric giant and poses wide-reaching consequences for the individual, family and the society in the future. (9) The World Health Organization has also recently published the Integrated Care for Older People guidelines on community-level interventions to manage declines in intrinsic capacity.(10). 2020 Oct 23;49(6):1071-1079. doi: 10.1093/ageing/afaa089. In the community, the majority of the elderly aged 65 years and older may appear healthy and independent, even though they could already be in the pre-frail and mildly frail stages and exhibiting the physical frailty phenotype of weakness, slowing down, being tired, having less physical activity and loss of weight. MAY–JUN 2018 SINGAPORE HEALTH NEWS 03 > Continued on page 4 Hospitals and community services are partners in running a fitness test to detect the early signs of frailty in senior citizens, before they become vulnerable to serious health problems. 14.4: 1. (1) Unfortunately, these symptoms of frailty are commonly attributed to normal ageing, without the recognition that they are potentially reversible and preventable. We refer to NICE guidelines and wish to share our … Together with the engagement of the patient and family, elderly individuals can be empowered to live independently within their individual environments. However, the Clinical Frailty Scale has not yet been culturally adapted and validated into Brazilian Portuguese language. The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine. Conclusion: Christine_chen@cgh.com.sg, Copyright: © Singapore Medical Association. Apóstolo J, Cooke R, Bobrowicz-Campos E, Santana S, Marcucci M, Cano A, Vollenbroek-Hutten M, Germini F, Holland C. JBI Database System Rev Implement Rep. 2017 Apr;15(4):1154-1208. doi: 10.11124/JBISRIR-2016-003018. 2015;108(12):943-949. Many pre-frail and mildly frail seniors’ first point of contact with the healthcare system is with the primary care physician. Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. hypothyroidism, anaemia, cognitive impairment, depression as a cause of fatigue, weakness and weight loss (with history, physical examination and measurements of full blood count, renal panel, thyroid panel and serum 25-hydroxyvitamin D levels). weight, BMI, blood pressure) and advice on diet, lifestyle and exercise to individuals, with the aim of promoting health and wellness. Please enable it to take advantage of the complete set of features! Pulok MH, Theou O, van der Valk AM, Rockwood K. Age Ageing. Currently, evaluation of the outcome after cardiac surgery is commonly based on scores not taking into account the concept of frailty … They are among the fittest for their age. Frailty is multidimensional and its pathophysiology is complex. National Library of Medicine In this study, we evaluated the feasibility of frailty screening with the simple clinical frailty scale (CFS) by different clinicians, and its association with mortality and rehospitalization in a geriatric acute care setting. Most recent summaries of articles on frailty in aging linking to the literature. FOIA 2 Well People who have no active disease symptoms but are less fit than category I . (29) Case management entails active case finding, assessments, coordination and monitoring of patients’ progress. Am J Surg. This study took place in Geriatric Medicine Department of a General Hospital in Singapore. Healthcare providers can also educate their patients, friends and families about this condition so that they can encourage vulnerable older adults to get screenings, early interventions and access to other appropriate resources. Frailty is a biological syndrome that causes adverse events in the health of older adults. Asian Bioeth Rev. (e) Ensure that chronic disease control is optimised. Frailty is a distinct clinical syndrome wherein the individual has low reserves and is highly vulnerable to internal and external stressors. Currently, finding an exercise programme that is intensive and effective enough to target frailty in the elderly is challenging, although there are already some programmes in place. Edward Chong MBChB. She had also heeded your advice to increase her protein intake on top of her diabetic diet. Wei K et al. Frailty is also conceptualised as the accumulation of deficits,(2) including physiologic changes that occur with ageing, physical and cognitive diseases, as well as socioeconomic factors. Activities may include case discussions and conferences with relevant care providers or disciplines in the management of patients with complex needs. She had bought a walking stick three months ago on your advice and was using it to help her get around. Copyright 2021. Privacy, Help Methods: This study took place in Geriatric Medicine Department of a General Hospital in Singapore. Keys to building a successful frailty-friendly community will also be discussed. It does not require any equipment or measurement, and can be self-administered by the patient or their families in the waiting area of any busy primary care clinic. Tan LF, Lim ZY, Choe R, Seetharaman S, Merchant R. Screening for frailty and sarcopenia among older persons in medical outpatient clinics and its associations with healthcare burden. Appropriate interventions that can be initiated in a primary care setting include a targeted medical review for reversible medical causes of frailty, medication appropriateness, nutritional advice and exercise prescription. Of loss of functional reserve resulting in an increased vulnerability to a stressor event can start interventions for frailty aging! 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