Abstract
Globally, the ageing population is increasing with corresponding tendencies for the population projection in Denmark. The longer life expectancy does not necessarily lead to more healthy years. Thus, the ageing demography will indisputably increase the group of older adults with presence of frailty. Frailty increases the risk of functional impairment, hospitalization, disabilities, and even mortality for older adults. The composition of this multifactorial syndrome and the factors causing frailty vary between older adults. This is by far one of the most complicating challenges regarding the initial treatment and care of acutely admitted older medical patients.
The older patients as a population are very heterogeneous in terms of independence, degree of morbidity, potential cognitive impairment, presentation of atypical clinical symptoms, and limited social network. Thereby, same-aged older patients will not present the same number of morbidities, disabilities, and other health deficits.
The Clinical Frailty Scale (CFS) score reflects the patient's degree of frailty and provides healthcare professionals with information on the older patient’s risk of adverse outcomes. However, the score does not provide information on where treatment and intervention to prevent or reverse frailty should be targeted. Therefore, this thesis aims to investigate frailty assessed by the CFS in a broader perspective. Here, a threefold aim, preceded with an examination of the feasibility of the assessments used in the cohort (sub-study I), will first examine the predictive ability of 90 days post-admission mortality by frailty assessed by CFS in older, acutely admitted medical patients (sub-study II). Here, the association between frailty and 90-day mortality will be investigated as a single variable model and a combined model with the results of the Braden Scale. Second, the aim was to explore the prevalence of frailty and sarcopenia and investigate the co-occurrence of these two geriatric syndromes (sub-study III). Last, an investigation of underlying clinical domains of frailty is performed, and the estimated associations of these domains to clinical frailty subgroups (sub-study IV) will be presented. This was completed to examine how frailty acts as exposure to underlying domains. Information provided by the association between the domains and frailty could be a clinically feasible method to operationalize the frailty score in the acute care and treatment of older patients.
All four sub-studies are based on the Copenhagen PROTECT Study, a prospective cohort study with 1071 older (≥65 years) acutely admitted medical patients. All patients were enrolled in the study and assessed with a comprehensive baseline test battery within the first 24 hours of their acute admission. The participants were followed for 90 days after the index admission regarding information on mortality.
The four sub-studies revealed that enrolling and assessing older patients in clinical trials is possible, even at the very beginning of their acute admission. Regarding the prognostic ability of 90-day mortality investigated in sub-study II, the CFS as a single variable performed poorly, and the combination with the Braden Scale did not improve the association to mortality.
In sub-study III, the findings showed that frailty and sarcopenia are frequently occurring geriatric syndromes in this population. Nonetheless, these two syndromes do not always occur within the same individual.
Lastly, the results in sub-study IV revealed a significant association between the clinical domains of cognition, malnutrition, muscle strength, multimorbidity, and frailty/severe frailty. This highlights the relevance of considering these domains integrated in the clinical evaluation of older acute patients.
The older patients as a population are very heterogeneous in terms of independence, degree of morbidity, potential cognitive impairment, presentation of atypical clinical symptoms, and limited social network. Thereby, same-aged older patients will not present the same number of morbidities, disabilities, and other health deficits.
The Clinical Frailty Scale (CFS) score reflects the patient's degree of frailty and provides healthcare professionals with information on the older patient’s risk of adverse outcomes. However, the score does not provide information on where treatment and intervention to prevent or reverse frailty should be targeted. Therefore, this thesis aims to investigate frailty assessed by the CFS in a broader perspective. Here, a threefold aim, preceded with an examination of the feasibility of the assessments used in the cohort (sub-study I), will first examine the predictive ability of 90 days post-admission mortality by frailty assessed by CFS in older, acutely admitted medical patients (sub-study II). Here, the association between frailty and 90-day mortality will be investigated as a single variable model and a combined model with the results of the Braden Scale. Second, the aim was to explore the prevalence of frailty and sarcopenia and investigate the co-occurrence of these two geriatric syndromes (sub-study III). Last, an investigation of underlying clinical domains of frailty is performed, and the estimated associations of these domains to clinical frailty subgroups (sub-study IV) will be presented. This was completed to examine how frailty acts as exposure to underlying domains. Information provided by the association between the domains and frailty could be a clinically feasible method to operationalize the frailty score in the acute care and treatment of older patients.
All four sub-studies are based on the Copenhagen PROTECT Study, a prospective cohort study with 1071 older (≥65 years) acutely admitted medical patients. All patients were enrolled in the study and assessed with a comprehensive baseline test battery within the first 24 hours of their acute admission. The participants were followed for 90 days after the index admission regarding information on mortality.
The four sub-studies revealed that enrolling and assessing older patients in clinical trials is possible, even at the very beginning of their acute admission. Regarding the prognostic ability of 90-day mortality investigated in sub-study II, the CFS as a single variable performed poorly, and the combination with the Braden Scale did not improve the association to mortality.
In sub-study III, the findings showed that frailty and sarcopenia are frequently occurring geriatric syndromes in this population. Nonetheless, these two syndromes do not always occur within the same individual.
Lastly, the results in sub-study IV revealed a significant association between the clinical domains of cognition, malnutrition, muscle strength, multimorbidity, and frailty/severe frailty. This highlights the relevance of considering these domains integrated in the clinical evaluation of older acute patients.
| Original language | Danish |
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| Publication status | Published - 10 Jun 2024 |
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