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Inter-Relationships between Frailty, Sarcopenia, Undernutrition and Dysphagia in Older People Who Are Admitted to Acute Frailty and Medical Wards: Is There an Older Adult Quartet?

ABSTRACT: Introduction: With increasing age the prevalence of frailty, sarcopenia, undernutrition and dysphagia increases. These are all independent markers of outcome. This study explores the prevalence of these four and explores relationships between them. Methods: A convenience sample of 122 patients admitted to acute medical and frailty wards were recruited. Each was assessed using appropriate screening tools; Clinical Frailty Score (CFS) for frailty, SARC-F for sarcopenia, Nutritional Risk Tool (NRT) for nutritional status and 4QT for dysphagia. Results: The mean age of the participants was 80.53 years (65-99 years), and 50.37% (68) were female. Overall, 111 of the 122 (91.0%) reported the presence of at least one of the quartet. The median CFS was 5 (1-9), with 84 patients (68.9%) having a score of ?5 (moderate or severely frail); The median SARC-F was 5 (0-10), with 64 patients (52.5%) having a score of ?5; The median NRT was 0 (0-8) and 33 patients (27.0%) scored ? 1. A total of 77 patients (63.1%) reported no difficulty with swallowing/dysphagia (4QT ? 1) and 29 (23.7%) had only one factor. Sixteen patients (13.1%) had all four. There was a significant correlation between nutritional status and dysphagia, but not with frailty or sarcopenia. There were significant correlations between frailty and both sarcopenia and dysphagia. Conclusions: In our sample of acute medical and frailty ward patients, there was a much higher prevalence than expected (91%) of either: frailty, sarcopenia, undernutrition or dysphagia. The prevalence of all four was present in 13% of patients. We suggest that frailty, sarcopenia, nutritional risk and dysphagia comprise an "Older Adult Quartet". Further study is required to investigate the effect of the "Older Adult Quartet" on morbidity and mortality.

SUBMITTER: Smithard D

PROVIDER: S-EPMC7555188 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Inter-Relationships between Frailty, Sarcopenia, Undernutrition and Dysphagia in Older People Who Are Admitted to Acute Frailty and Medical Wards: Is There an Older Adult Quartet?

Smithard David D Hansjee Dharinee D Henry Darrien D Mitchell Laura L Sabaharwal Arjun A Salkeld Jo J Yeung Eirene E Younus Osman O Swaine Ian I

Geriatrics (Basel, Switzerland) 20200630 3

<i>Introduction</i>: With increasing age the prevalence of frailty, sarcopenia, undernutrition and dysphagia increases. These are all independent markers of outcome. This study explores the prevalence of these four and explores relationships between them. <i>Methods</i>: A convenience sample of 122 patients admitted to acute medical and frailty wards were recruited. Each was assessed using appropriate screening tools; Clinical Frailty Score (CFS) for frailty, SARC-F for sarcopenia, Nutritional R ...[more]

PMID: 32630034

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Project description:BackgroundGrowth differentiation factor-15 (GDF-15) has been associated with senescence, lower muscle strength, and physical performance in healthy older people. Still, it is not clear whether GDF-15 can be utilized as a biomarker of sarcopenia and frailty in the early stages of hospitalization. We investigated the association of plasma GDF-15 with sarcopenia and frailty in older, acutely admitted medical patients.MethodsThe present study is based on secondary analyses of cross-sectional data from the Copenhagen PROTECT study, a prospective cohort study including 1071 patients ≥65 years of age admitted to the acute medical ward at Copenhagen University Hospital, Bispebjerg, Denmark. Muscle strength was assessed using handgrip strength, and lean mass was assessed using direct segmental multifrequency bioelectrical impedance analyses and used to clarify the potential presence of sarcopenia defined according to guidelines from the European Working Group on Sarcopenia in Older People. Frailty was evaluated using the Clinical Frailty Scale. Plasma GDF-15 was measured using electrochemiluminescence assays from Meso Scale Discovery (MSD, Rockville, MD, USA).ResultsWe included 1036 patients with completed blood samples (mean age 78.9 ± 7.8 years, 53% female). The median concentration of GDF-15 was 2669.3 pg/mL. Systemic GDF-15 was significantly higher in patients with either sarcopenia (P < 0.01) or frailty (P < 0.001) compared with patients without the conditions. Optimum cut-off points of GDF-15 relating to sarcopenia and frailty were 1541 and 2166 pg/mL, respectively.ConclusionsSystemic GDF-15 was higher in acutely admitted older medical patients with sarcopenia and frailty compared with patients without. The present study defined the optimum cut-off for GDF-15, related to the presence of sarcopenia and frailty, respectively. When elevated above the derived cutoffs, GDF-15 was strongly associated with frailty and sarcopenia in both crude and fully adjusted models.

Project description:IntroductionFalls are a major health problem for older people; 35% of people aged 65+ years fall every year, leading to fractures in 10%-15%. Upper limb fractures are often the first sign of osteoporosis and routine screening for osteoporosis is recommended by the National Institute for Health and Care Excellence to prevent subsequent hip fractures. However, both frailty and sarcopenia (muscle weakness) are associated with increased risk of falling and fracture but are not routinely identified in this group. The aim of this study is to evaluate the feasibility of assessing and managing frailty and sarcopenia among people aged 65+ years with an upper limb fracture.Methods and analysisThis study will be conducted in three fracture clinics in one acute trust in England. 100 people aged 65+ years with an upper arm fracture will be recruited and assessed using six validated frailty measures and two sarcopenia tools. The prevalence of the two conditions and the best tools to use will be determined. Those with either condition will be referred to geriatric clinical teams for comprehensive geriatric assessment (CGA). We will document the proportion who are referred for CGA and those who receive CGA. Other outcome measures including falls, fractures and healthcare resource use over 6 months will be collected. In-depth interviews with a purposive sample of patients who undergo the frailty and sarcopenia assessments and healthcare professionals in fracture clinics and geriatric services will be carried out to their acceptability of assessing frailty and sarcopenia in a busy environment.Ethics and disseminationThe study was given the relevant ethical approvals from NHS Research Ethics Committee (REC No: 18/NE/0377), the University Hospital Southampton NHS Foundation Trust, and the University of Southampton, Faculty of Medicine Ethics Committee and Research Governance Office. Findings will be published in scientific journals and presented to local, national and international conferences.Trial registration numberISRCTN13848445.

Dataset Information

Inter-Relationships between Frailty, Sarcopenia, Undernutrition and Dysphagia in Older People Who Are Admitted to Acute Frailty and Medical Wards: Is There an Older Adult Quartet?

Publications

Inter-Relationships between Frailty, Sarcopenia, Undernutrition and Dysphagia in Older People Who Are Admitted to Acute Frailty and Medical Wards: Is There an Older Adult Quartet?

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