Background/objectives: A systematic review was conducted to assess if frailty and sarcopenia were associated with poorer outcomes in older adults admitted to an acute medical unit (AMU).
Methods: Eligible studies included older adults with an unplanned admission to an AMU and included a measure of frailty or sarcopenia, completed within 72 hours of admission. Risk of bias was assessed.
Results: Of 1659 identified articles, 16 were included (4 on sarcopenia and 12 on frailty). There was significant study heterogeneity. Overall, frailty and sarcopenia were associated with worse outcomes. Targeted interventions appeared to improve outcomes.
Conclusion: Current evidence suggests some benefit in screening older adults admitted to an AMU for frailty and sarcopenia. However, further studies are required before clinical adoption.
References
- Gonçalves-Bradley DC, Lannin NA, Clemson LM, et al. Discharge planning from hospital. Cochrane Database of Systematic Reviews. 2016.
- Pendlebury S, Lovett N, Smith S, et al. Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission. BMJ Open. 2015; 5(11): e007808-e.
- Ellis G, Gardner M, Tsiachristas A, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017; 9: CD006211.
- Morley JE, Vellas B, Abellan van Kan G, et al. Frailty Consensus: A Call to Action. Journal of the American Medical Directors Association. 2013; 14(6): 392–7.
- Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. The Lancet.2013; 381(9868): 752–62.
- Wilson D, Jackson T, Sapey E, et al. Frailty and sarcopenia: The potential role of an aged immune system. Ageing Res Rev. 2017;36: 1–10.
- Leng S, Chaves P, Koenig K, et al. Serum interleukin-6 and hemoglobin as physiological correlates in the geriatric syndrome of frailty: a pilot study. Journal of the American Geriatrics Society. 2002;50(7): 1268–71.
- Leng SX, Cappola AR, Andersen RE, et al. Serum levels of insulinlike growth factor-I (IGF-I) and dehydroepiandrosterone sulfate (DHEA-S), and their relationships with serum interleukin-6, in the geriatric syndrome of frailty. Aging clinical and experimental research. 2004; 16(2): 153–7.
- Walston J, McBurnie MA, Newman A, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Archives of internal medicine. 2002; 162(20): 2333–41.
- Schoufour JD, Echteld MA, Boonstra A, et al. Biochemical measures and frailty in people with intellectual disabilities. Age and ageing. 2016; 45(1): 142–8.
- Schaap LA, Pluijm SMF, Deeg DJH, et al. Inflammatory markers and loss of muscle mass (sarcopenia) and strength. The American journal of medicine. 2006; 119(6): 526.e9–17.
- Collard RM, Boter H, Schoevers RA, et al. Prevalence of frailty in community-dwelling older persons: a systematic review. Journal of the American Geriatrics Society. 2012; 60(8): 1487–92.
- Renne I, Gobbens RJJ. Effects of frailty and chronic diseases on quality of life in Dutch community-dwelling older adults: a crosssectional study. Clinical interventions in Aging. 2018; 13: 325–34.
- Muscedere J, Waters B, Varambally A, et al. The impact of frailty on intensive care unit outcomes: a systematic review and metaanalysis. Intensive Care Medicine. 2017; 43(8): 1105–22.
- Hewitt J, Long S, Carter B, et al. The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis. Age and ageing. 2018; 47(6): 793–800.
- Hajek A, Bock J-O, Saum K-U, et al. Frailty and healthcare costslongitudinal results of a prospective cohort study. Age and ageing. 2018; 47(2): 233–41.
- Fried et al. - 2001 - Frailty in Older Adults Evidence for a Phenotype.pdf.
- Kojima G. Prevalence of Frailty in Nursing Homes: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2015; 16(11):940–5.
- Hao Q, Zhou L, Dong B, et al. The role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective study. Sci Rep. 2019; 9(1): 1207.
- Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. The Scientific World Journal. 2001; 1: 323–36.
- Turgeon J, Michaud V, Steffen L. The Dangers of Polypharmacy in Elderly Patients. JAMA Intern Med. 2017; 177(10): 1544.
- Sanchez-Rodriguez D, Hope S, Piotrowicz K, et al. Sarcopenia in Acute Care Patients: Protocol for the European Collaboration of Geriatric Surveys: Sarcopenia 9+ EAMA Project. Journal of the American Medical Directors Association. 2019;20.
- Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019; 48(1): 16–31.
- Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and ageing. 2010; 39(4): 412–23.
- Stringer HJ, Wilson D. The Role of Ultrasound as a Diagnostic Tool for Sarcopenia. The Journal of frailty & aging. 2018; 7(4):258–61.
- Nijholt W, Scafoglieri A, Jager-Wittenaar H, et al. The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. Journal of cachexia, sarcopenia and muscle. 2017; 8(5): 702–12.
- Ismail C, Zabal J, Hernandez HJ, et al. Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia. Frontiers in physiology. 2015; 6: 302.
- Wilson DV, Moorey H, Stringer H, et al. Bilateral Anterior Thigh Thickness: A New Diagnostic Tool for the Identification of Low Muscle Mass? Journal of the American Medical Directors Association. 2019; 20(10): 1247–53.e2.
- Wilson DV, Moorey H, Stringer H, et al. Bilateral Anterior Thigh Thickness: A New Diagnostic Tool for the Identification of Low Muscle Mass? J Am Med Dir Assoc. 2019; 20(10): 1247–53 e2.
- Bano G, Trevisan C, Carraro S, et al. Inflammation and sarcopenia: A systematic review and meta-analysis. Maturitas. 2017; 96: 10–5.
- Welch C, K Hassan-Smith Z, A Greig C, et al. Acute Sarcopenia Secondary to Hospitalisation - An Emerging Condition Affecting Older Adults. Aging and disease. 2018; 9(1): 151–64.
- Marchiori GF, Tavares DMDS. Changes in frailty conditions and phenotype components in elderly after hospitalization. Revista latino-americana de enfermagem. 2017; 25(0): e2905-e.
- Tanner RE, Brunker LB, Agergaard J, et al. Age-related differences in lean mass, protein synthesis and skeletal muscle markers of proteolysis after bed rest and exercise rehabilitation. The Journal of physiology. 2015; 593(18): 4259–73.
- Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016; 5(1): 210.
- Ahlund K, Back M, Oberg B, et al. Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients. Clinical Interventions in Aging. 2017; 12:1929–39.
- Ekerstad N, Dahlin Ivanoff S, Landahl S, et al. Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care. Clin Interv Aging. 2017; 12: 1239–49.
- Basile G, Catalano A, Mandraffino G, et al. Frailty modifications and prognostic impact in older patients admitted in acute care. Aging Clin Exp Res. 2019; 31(1): 151–5.
- Beauchet O, Fung S, Launay CP, et al. Screening for older inpatients at risk for long length of stay: which clinical tool to use? BMC Geriatr. 2019; 19(1): 156.
- Chua XY, Toh S, Wei K, et al. Evaluation of clinical frailty screening in geriatric acute care. J Eval Clin Pract. 2019.
- Evans SJ, Sayers M, Mitnitski A, et al. The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment. Age and Ageing. 2014; 43(1):127–32.
- Juma S, Taabazuing M-M, Montero-Odasso M. Clinical Frailty Scale in an Acute Medicine Unit: a Simple Tool That Predicts Length of Stay. Canadian Geriatrics Journal. 2016; 19(2): 34–9.
- McAlister F, van Walraven C. External validation of the Hospital Frailty Risk Score and comparison with the Hospital-patient One-year Mortality Risk Score to predict outcomes in elderly hospitalised patients: a retrospective cohort study. BMJ Qual Saf. 2019; 28(4): 284–8.
- MacKenzie HT, Tugwell B, Theou O, et al. Frailty and diabetes in older hospitalized adults: What drives outcomes? Endocrine Reviews Conference: 99th Annual Meeting of the Endocrine Society, ENDO. 2017; 38(3).
- Martin-Marero C, Rolph G, Dineros C, et al. Successful specialist intervention of older people with frailty at the front door at west middlesex university hospital: Improving patients outcomes. Age and Ageing. 2018; 47: ii25.
- McKay L, Russell R, Rimer J, et al. Rapid elderly assessment and care in hospital (reach): Proactive identification of frailty within an acute medical unit. Age and Ageing. 2018; 47: ii25.
- Wou F, Gladman JRF, Bradshaw L, F et al. The predictive properties of frailty-rating scales in the acute medical unit. Age and Ageing. 2013; 42(6): 776–81.
- Cerri AP, Bellelli G, Mazzone A, et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: Prevalence and outcomes. Clinical Nutrition. 2015; 34(4): 745–51.
- Martone AM, Bianchi L, Abete P, et al. The incidence of sarcopenia among hospitalized older patients: results from the Glisten study. J Cachexia Sarcopenia Muscle. 2017; 8(6): 907–14.
- Perez-Zepeda MU, Sgaravatti A, Dent E. Sarcopenia and posthospital outcomes in older adults: A longitudinal study. Arch Gerontol Geriatr. 2017; 69: 105–9.
- Vetrano DL, Landi F, Volpato S, et al. Association between sarcopenia, in-hospital and 1-year mortality in older adults admitted to acute care wards: Results from the crime study. European Geriatric Medicine. 2013; 4: S43.
- McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-ofbias assessments. Research Synthesis Methods. 2020;n/a(n/a).
- Fallon A, Kilbane L, Briggs R, et al. Screening for frailty in older emergency department patients: the utility of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument. QJM. 2018;111(3): 151–4.
- Aminzadeh F, Dalziel WB. Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Annals of Emergency Medicine. 2002; 39(3): 238–47.
- Avelino-Silva TJ, Gil LA, Curiati PK, et al. Using the frail scale and the identification of seniors at risk tool to predict delirium in hospitalized older adults: Results from a novel geriatric emergency department. Journal of the American Geriatrics Society. 2018; 66: S60-S1.
- Curiati PK, Gil Junior L, Cabral KD, et al. Predictors of prolonged length of hospital stay in older adults: 12-month results from a geriatric emergency department. Journal of the American Geriatrics Society. 2019; 67: S83.
- Alexander K, Adamson J, Cunningham C, et al. The effect of delirium and dementia on length of stay (LOS) and functional recovery of patients in elderly medical wards. Physiotherapy. 2016; 102: e180-e1.
- Saez de Asteasu ML, Martinez-Velilla N, Zambom-Ferraresi F, et al. Physical Exercise Improves Function in Acutely Hospitalized Older Patients: Secondary Analysis of a Randomized Clinical Trial. J Am Med Dir Assoc. 2019; 20(7): 866–73.
- Morais JA, Jacob KW, Chevalier S. Effects of aging and insulin resistant states on protein anabolic responses in older adults. Exp Gerontol. 2018; 108: 262–8.
- Aijaz F, Conroy S, Banerjee J. Embedding the clinical frailty scale in the emergency department and its impact on patient care. Age and Ageing. 2018; 47: iii20.
- Aprahamian I, Arico de Almeida GV, de Vasconcellos Romanin CF, et al. Frailty Could Predict Death in Older Adults After Admission at Emergency Department? A 6-Month Prospective Study from a Middle-Income Country. Journal of Nutrition, Health and Aging. 2019.
- Arora A, Holmes E, Morris AM, et al. Admission avoidance in emergency department - What works for frail older people: The exemplar front door (EFD) initiative. Age and Ageing. 2018; 47: iii31.
- Greening NJ, Harvey-Dunstan TC, Chaplin EJ, et al. Bedside assessment of quadriceps muscle by ultrasound after admission for acute exacerbations of chronic respiratory disease. American Journal of Respiratory and Critical Care Medicine. 2015; 192(7): 810–6.
- Barratt R, Keelan R. The older person’s assessment and liason (OPAL) team in emergency department: Impact of embedding specialty staff in ED. European Geriatric Medicine. 2017;8:S84.
- Chan D, Ashrafi T, Agogbua C, et al. Frail and older person advice and liaison service (FOPALS), improving care for the frail and elderly people at acute hospitals. European Geriatric Medicine. 2017; 8: S151.
- Park H, Ko B. Predictive value of sarcopenia on outcome of sepsis in the emergency department. Critical Care Conference: 37th International Symposium on Intensive Care and Emergency Medicine Belgium. 2017; 21(1).
- Farhat JS, Velanovich V Fau - Falvo AJ, Falvo Aj Fau - Horst HM, et al. Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. 2019(2163-0763 (Electronic)).
- Jung C, Wernly B, Muessig JM, et al. A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention. J Crit Care. 2019; 52: 141–8.
- Lee KC, Sturgeon D, Lipsitz S, et al. Mortality and Health Care Utilization Among Medicare Patients Undergoing Emergency General Surgery vs Those With Acute Medical Conditions. JAMA Surg. 2019; 155(3): 216–23.
- Maxwell CA, Patel MB, Suarez-Rodriguez LC, et al. Frailty and Prognostication in Geriatric Surgery and Trauma. Clin Geriatr Med. 2019; 35(1): 13–26.
