Determining the frailty status in patients who apply for home health care

Year 2022, , 94 - 100, 29.07.2022

Zeynep Erdem Sancak Cemile Haki , Hakan Demirci

https://doi.org/10.46310/tjim.988602

Abstract

Background To examine the relationship between an institutionally prepared standardized patient evaluation form and the Edmonton Frail Scale (EFS) in patients receiving home health care.
Material and Methods Our prospective, observational study included 200 patients over the age of 18 who requested home health care, regardless of gender. The EFS and institutional data collection forms were applied consecutively on the same day to all patients included in the study.
Results Among the 200 individuals recruited for the study, 59% were female and 41% were male; the overall average age was 80 years. According to the EFS results, 4.5% of the patients were classified as non-frail, 6% were vulnerable, and 89.5% had varying degrees of frailty (mild, moderate and severe). There was a significant positive correlation between EFS score and age (p<0.001). There was no significant relationship between EFS score and confinement to bed; however, EFS scores were higher in bedridden patients (p=0.017). The EFS score was higher in those with chronic disease (p<0.001). A >9 threshold for EFS score could identify those in need of home health care services, with a sensitivity of 80.34% and a specificity of 90.91%.
Conclusion Age is an important risk factor for frailty, and the presence of chronic illness and confinement to bed may potentiate its effects. On the contrary, the level of personal care, pain conditions and pressure sores/ulcers were unassociated with frailty. It was determined that the EFS score could be supportive in distinguishing patients in need of home health care services.

Keywords

Home health care, frailty, Edmonton frail scale, aging, bed confinement

References

• Gill TM, Gahbauer EA, Han L, Allore, HG. Trajectories of disability in the last year of life. N Engl J Med. 2010;362:1173-1180. doi: 10.1056/NEJMoa0909087.
• Carneiro JA, Cardoso RR, Durães MS, Guedes MCA, Santos FL, Costa FMD, Caldeira AP. Frailty in the elderly: Prevalence and associated factors. Revista Brasileira de Enfermagem. 2017;70(4):747-52. doi: 10.1590/0034-7167-2016-0633.
• Düzgün G, Üstündag S, Karadakovan A. Assessment of frailty in the elderly. Florence Nightingale Journal of Nursing. 2021;29(1):2-8. doi: 10.5152/FNJN.2021.414736.
• Rivas-Ruiz F, Machón M, Contreras-Fernández E, Vrotsou K, Padilla-Ruiz M, Díez Ruiz A, Group GIFE. Prevalence of frailty among community-dwelling elderly persons in Spain and factors associated with it. Eur J Gen Pract. 2019;25:190-6. doi: 10.1080/13814788.2019.1635113.
• Menéndez-González L, Izaguirre-Riesgo A, et. al. Prevalencia y factores asociados de fragilidad en adultos mayores de 70 años en la comunidad [Prevalence and associated factors of frailty in adults over 70 years in the community]. Aten Primaria. 2021 Dec;53(10):102128. (in Spanish). doi: 10.1016/j.aprim.2021.102128.
• Campbell KE. A new model to identify shared risk factors for pressure ulcers and frailty in older adults. Rehabil Nurs. Nov-Dec 2009;34(6):242-7. doi: 10.1002/j.2048-7940.2009.tb00258.x.
• Jaul E, Calderon-Margalit R. Systemic factors and mortality in elderly patients with pressure ulcers. Int Wound J. 2015 Jun;12(3):254-9. doi: 10.1111/iwj.12086.
• Sağlık bakanlığı ve bağlı kuruluşları tarafından evde sağlık hizmetlerinin sunulmasına dair yönetmelik. Resmî Gazete. 27 Şubat 2015, Sayı: 29280. Available at: https://www.resmigazete.gov.tr/eskiler/2015/02/20150227-14.htm. Accessed August 01, 2021.
• Aygör HE, Fadıloğlu Ç, Aykar FŞ, Akçiçek F. Testing the reliability and validity of the “Edmonton Frail Scale” in Turkish population. European Geriatric Medicine. 2013 Sep 18;4(Suppl.1):S76. doi: 10.1016/j.eurger.2013.07.252.
• Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, Xue QL, Walston JD, Kasper JD. Frailty in older adults: A nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015 Nov;70(11):1427-34. doi: 10.1093/gerona/glv133.
• Akın S, Mazıcıoglu MM, Mucuk S, Gocer S, Deniz Safak E, Arguvanlı S, Ozturk A. The prevalence of frailty and related factors in community-dwelling Turkish elderly according to modified Fried Frailty Index and FRAIL scales. Aging Clin Exp Res. 2015;27:703-9. doi: 10.1007/s40520-015-0337-0.
• Hubbard RE, Peel NM, Samanta M, Gray LC, Mitnitski A, Rockwood K. Frailty status at admission to hospital predicts multiple adverse outcomes. Age Ageing. 2017 Sep 1;46(5):801-6. doi: 10.1093/ageing/afx081.
• Hakı C, Demirci H. The role of frailty in physicians’ decisions for severe disability. Turkish Journal of Geriatrics. 2020;23(4):492-500. doi: 10.31086/tjgeri.2020.187.
• Alqahtani BA, Alenazi AM, Alshehri MM, Osailan AM, Alsubaie SF, Alqahtani MA. Prevalence of frailty and associated factors among Saudi community-dwelling older adults: a cross-sectional study. BMC Geriatr. 2021 Mar 17;21(1):185. doi: 10.1186/s12877-021-02142-9.
• Andrade DC, Faria JW, Caramelli P, Alvarenga L, Galhardoni R, Siqueira SR, Yeng LT, Teixeira MJ. The assessment and management of pain in the demented and non-demented elderly patient. Arq Neuropsiquiatr. 2011;69(2B):387-94. doi: 10.1590/s0004-282x2011000300023.
• Otones Reyes P, García Perea E, Pedraz Marcos A. Chronic pain and frailty in community-dwelling older adults: A systematic review. Pain Manag Nurs. 2019 Aug;20(4):309-15. doi: 10.1016/j.pmn.2019.01.003.
• Saraiva MD, Suzuki GS, Lin SM, Ciampi de Andrade D, Jacob-Filho W, Suemoto CK. Persistent pain is a risk factor for frailty: a systematic review and meta-analysis from prospective longitudinal studies. Age Ageing. 2018;47:785-93. doi: 10.1093/ageing/afy104.
• Ardoino I, Franchi C, Nobili A, Mannucci PM, Corli O; REPOSI Investigators. Pain and frailty in hospitalized older adults. Pain Ther. 2020 Dec;9(2):727-740. doi: 10.1007/s40122-020-00202-3.
• Wade KF, Lee DM, McBeth J, Ravindrarajah R, Gielen E, Pye SR, Vanderschueren D, Pendleton N, Finn JD, Bartfai G, Casanueva FF, Forti G, et. al. Chronic widespread pain is associated with worsening frailty in European men. Age Ageing. 2016;45:268-74. doi: 10.1093/ageing/afv170.
• Coelho T, Paúl C, Gobbens RJJ, Fernandes L. Multidimensional frailty and pain in community dwelling elderly. Pain Med. 2017;18:693-701. doi: 10.1111/pme.12746.