Factors associated with frailty in hospitalized elderly: an integrative review

Freire, Júlio César Guimarães; Nóbrega, Isabelle Rayanne Alves Pimentel da; Dutra, Marina Carneiro; Silva, Luan Medeiros da; Duarte, Heloisa Alencar

doi:10.1590/0103-1104201711517

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REVIEW • Saúde debate 41 (115) • Oct-Dec 2017 • https://doi.org/10.1590/0103-1104201711517 copy

Factors associated with frailty in hospitalized elderly: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This review aimed to synthesize and evaluate the production of knowledge about factors significantly associated with frailty in hospitalized elderly. Therefore, the Medical Literature and Retrieval System Online (Medline), Literatura Latino-Americana em Ciências da Saúde (Lilacs) and Índice Bibliográfico Español em Ciencias de la Salud (Ibecs) databases were consulted from 2012 to 2016, whose analysis of twenty articles identified the following factors associated with frailty: increased hospital and post-discharge mortality, prolonged hospitalization, rehospitalization, transfers, advanced age, women and widows, as well as psychosocial, physical and / or functional factors. It is expected that the results of the review will facilitate improvement of the practices and the decision-making of the multiprofessional teams that provide elderly care in the hospital.

KEYWORDS
Frail elderly; Hospitalization; Aging

Databases	Found	Pre-selected	Excluded	Analyzed
Ibecs	09	-	-	-
Lilacs	17	05	01	04
Medline	433	61	45	16
Total	459	66	46	20

Nº	Title of the Article	Authors	Databases and Journal	Origin	Research Design	Casp	Year
01	Endoflife care during and after an acute hospitalization in older patients with cancer, endstage organ failure, or frailty: a subanalysis of a prospective cohort study.	Huijberts S, Buurman BM, de Rooij SE.		Netherlands	Prospective cohort study	9/10	2016
02	Associação das variáveis socioeconômicas e clínicas com o estado de fragilidade entre idosos hospitalizados.	Tavares DMS, Pegorari MS, Dias FA, Paiva MM, Nader ID.	LilacsRevista Latino-Americana de Enfermagem	Brazil	Cross-sectional, analytical and observational study	9/10	2015
03	Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit.	Zeng A, Song X, Dong J, Mitnitski A, Liu J, Guo Z, Rockwood K.	MedlineJournals of Gerontology: medical sciences	China	Prospective cohort study	8/10	2015
04	Association of the clinical frailty scale with hospital outcomes.	Wallis SJ, Wall J, Biram RWS, Romero-Ortuno R.	MedlineQJM: An International Journal of Medicine	United Kingdom	Retrospective observational study	9/10	2015
05	The relationship between frailty, anxiety and depression, and health-related quality of life in elderly patients with heart failure.	Uchmanowicz I, Gobbens RJJ.	MedlineClinical Interventions in Aging	Poland	Cross-sectional, analytical and observational study	8/10	2015
06	Avaliação da fragilidade de idosos internados em serviço de emergência de um hospital universitário.	Antunes JFS, Okuno MFP, Lopes MCBT, Campanharo CRV, Batista REA.	LilacsCogitare Enfermagem	Brazil	Cross-sectional study	9/10	2015
07	Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes.	Basic D, Shanley C.	MedlineJournal of Aging and Health	Australia	Prospective cohort study	9/10	2015
08	Psychosocial factors modify the association of frailty with adverse outcomes: a prospective study of hospitalised older people.	Dent E, Hoogendijk EO.	MedlineBMC Geriatrics	Australia	Prospective observational study	9/10	2014
09	Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis.	Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Hashmi A, Green DJ, O'Keeffe T, Tang A, Vercruysse G, Fain MJ, Friese RS, Rhee P.	MedlineJAMA Surgery	USA	Prospective cohort study	8/10	2014
10	Relationship between lower-limb muscle strength and functional independence among elderly people according to frailty criteria: a cross-sectional study.	Batista FS, Gomes GAO, Souza MLR, Guariento ME, Neri AL, Cintra FA, D'Elboux MJ.	LilacsSão Paulo Medical Journal	Brazil	Cross-sectional quantitative study	9/10	2014
11	The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors.	Baldwin MR, Reid MC, Westlake AA, Rowe JW, Granieri EC, Wunsch H, Dam T, Rabinowitz D, Goldstein NE, Maurer MS, Lederer DJ.	MedlineJournal of Critical Care	USA	Prospective unicentric cohort study	10/10	2014
12	Frailty and outcomes after implantation of left ventricular assist device as destination therapy.	Dunlay SM, Park SJ, Joyce LD, Daly RC, Stulak JM, McNallan SM, Roger VL, Kushwaha SS.	MedlineJournal of heart and lung transplantation	USA	Prospective unicentric cohort study	7/10	2014
13	Relationship between frailty and discharge outcomes in subacute care.	Haley MN, Wells YD, Holland AE.	MedlineAustralian Health Review	Australia	Prospective observational study	10/10	2014
14	Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients.	Joosten E, Demuynck M, Detroyer E, Milisen K.	MedlineBMC Geriatrics	Belgium	Prospective cohort study	9/10	2014
15	Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results.	Krishnan M, Beck S, Havelock W, Eeles E, Hubbard RE, Johansen A.	MedlineAge and Ageing	United Kingdom	Prospective cohort study	7/10	2014
16	The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment.	Evans SJ, Sayers M, Mitnitski A, Rockwood K.	MedlineAge and Ageing	USA	Prospective cohort study	7/10	2014
17	Assessing frailty in the acute medical admission of elderly patients.	Oo MT, Tencheva A, Khalid N, Chan YP, Ho SF.	MedlineJournal of the Royal College of Physicians of Edinburgh	United Kingdom	Cross-sectional observational study	9/10	2013
18	Simple Frailty Score Predicts Post-Operative Complications Across Surgical Specialties.	Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC, Moss M.	MedlineAmerican Journal of surgery	USA	Prospective cohort study	9/10	2013
19	Fragilidade de idosos internados na clínica médica da unidade de emergência de um hospital geral terciário.	Storti LB, Marques S, Rodrigues RAP, Kusumota L, Fabrício-Whebe SCC.	LilacsTexto & Contexto Enfermagem	Brazil	Descriptive and cross-sectional study	8/10	2013
20	Predictors of adverse outcomes on an acute geriatric rehabilitation ward.	Singh I, Gallacher J, Davis K, Johansen A, Eeles E, Hubbard, RE.	MedlineAge and Ageing	United Kingdom	Observational prospective cohort study	7/10	2012

N°	Instrument	Results
01	Multidimensional Evaluation of the Elderly	Fragility associated with delirium and/or severe cognitive impairment, preexisting comorbidities and post-discharge hospital mortality.
02	Fried Frailty Phenotype	Strong association of frailty with age equal to or higher than 80 years old, widowhood and higher number of days of hospitalization.
03	Frailty Index.	Fragility was associated with an increased risk of 30-day mortality in elderly patients admitted to the ICU.
04	Clinical Frailty Scale	Fragility as an independent predictor of inpatient mortality, transfer to a geriatric ward and hospitalization time equal to or greater than 10 days.
05	Tilburg Frailty Indicator	Increasing levels of fragility were associated with increased anxiety and depression and deterioration in the quality of life of elderly patients with heart failure.
06	Edmonton Frail Scale	Elderly people with neurological diseases, dementia, older age and with caregiver presented a higher degree of fragility.
07	Clinical Frailty Scale	The fragility predicted in-hospital mortality, readmission in Long-stay Institutions, and longer hospital stay.
08	Fried Frailty Phenotype	Fragile elderly patients were more likely to die at 12 months, high for a higher level of attention, longer hospital stay and emergency rehospitalization at one month. The associated psychosocial factors: anxiety, depression, poor perception of well-being and sense of control.
09	Frailty Index	Fragile patients were more likely to have intra-hospital complications and had an adverse disposition to hospital discharge. All elderly patients who died were fragile.
10	Fried Frailty Phenotype	There was a significant association between muscle strength of lower limb and functional independence in accordance with the number of fragility criteria.
11	Fried Frailty Phenotype	The increase in the fragility score was associated with an increase in the level of incapacity incident in one month and triple the increase in mortality in six months.
12	Deficit Index	The pre-frail and fragile patients presented an increased risk of death and re-hospitalization.
13	Edmonton Frail Scale	Elderly people with high levels of fragility achieved more satisfactory participation and development in physiotherapy sessions than those with low fragility.
14	Frailty Indexes based on the CHS (Cardiovascular Health Study) and SOF (Study of Osteoporotic Fracture)	The fragility, defined by CHS and SOF indexes, represented a risk factor for mortality in six months.
15	Frailty Index based on Multidimensional Evaluation of the Elderly	The elderly of the high fragility group remained more hospitalized and had a higher mortality rate in 30 days.
16	Frailty Index based on Multidimensional Evaluation of the Elderly	Increasing values of the fragility index were significantly associated with a longer hospitalization time and increased risk of death.
17	Multidimensional Evaluation of the Elderly	Fragility was associated with advancing age (over 85 years old), lack of mobility over 24 hours, greater number of falls, dementia/delirium and admission to Long Stay Institutions.
18	Frailty Index	Fragility was associated with increased postoperative complications in colorectal and cardiac surgeries, longer hospitalization, and higher readmission rates in 30 days.
19	Edmonton Frail Scale	Among the individuals who presented severe fragility, there was a predominance of women, of the elderly with 80 years old or more, of those who lived without partners and those who described their health as bad.
20	Frailty Index	Fragility status correlated significantly with hospital stay time and was a predictor of low functional gain.

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[1] Collaborators

1. Isabelle Rayanne Alves Pimentel da Nóbrega: contributed substantially to the conception and analysis and interpretation of the data, as well as contributed significantly to the elaboration of the draft and critical review of the content and participated in the approval of the final version of the manuscript;

2. Marina Carneiro Dutra: contributed significantly to the conception and planning;

3. Luan Medeiros da Silva: contributed significantly to the elaboration of the draft;

4. Heloisa Alencar Duarte: contributed significantly in the critical review of the content.