Frailty and cognitive status evaluation can better predict mortality in older adults?. (July 2018)

• Record Type: Journal Article
• Authors: Aprahamian, Ivan; Suemoto, Claudia Kimie; Aliberti, Márlon Juliano Romero; de Queiroz Fortes Filho, Sileno; de Araújo Melo, Juliana; Lin, Sumika Mori; Filho, Wilson Jacob
• Is Part Of: Archives of gerontology and geriatrics. Volume 77(2018)
• Page Start: 51
• Page End: 56
• Publication Date: 2018-07
• Subjects: Frailty -- Cognitive impairment -- Acute care -- Mortality -- Prognosis; Aging -- Periodicals; Geriatrics -- Periodicals; Gerontology -- Periodicals; Electronic journals; 305.26
• DOI: 10.1016/j.archger.2018.04.005
• Languages: English
• ISSNs: 0167-4943

Abstract

Highlights: Frailty was an independent strong predictor for death at a geriatric day-hospital. The presence of cognitive impairment increased the risk of death in prefrail and robust patients. The identification of cognitive frailty remains a challenge in clinical practice. Abstract: Objectives: to evaluate the improvement in one-year mortality prediction after adding a 2-min cognitive screening to a simple 1-min frailty detection instrument. Secondary outcomes were new activities of daily living (ADL) disability and falls. Design: Prospective cohort study. Setting: A geriatric day-hospital for intermediate care. Participants: A total of 701 older adults with an acute or decompensated disease (79.5 (8.3) years, 64% female). Measurements: A rapid and simple frailty evaluation was performed using the FRAIL questionnaire. The presence of cognitive impairment was defined by previous diagnosis of dementia or a score of five or less on an education-corrected 10-point cognitive screening tool. Results: Frail participants with normal (hazard risk [HR] 4.0, 95% confidence interval [CI], 1.73–9.25) and impaired cognition had a higher risk of death (HR 4.38, 95% CI, 1.95–9.87) than robust participants. The presence of cognitive impairment increased the risk of death in prefrail (HR 3.60, 95% CI, 1.55–8.34) and robust participants (HR 3.49, 95% CI, 1.22–9.96). Cognitive impairment was associated with an increased risk of incident ADL disability in all frailty categories. The presence of cognitive impairment was associated with a significantly higher risk of fall in robust seniors. The predictive accuracy of the FRAIL scale was lower than expected (between 0.58 and 0.69), and a small improvement was observed after adding the cognitive screening (between 0.61 and 0.72). Conclusion: Despite of significant results in predicting relevant clinical events, the present combination of the FRAIL and 10-CS scales may not be ideal in clinical practice.