Date Presented 03/27/20
Frailty is a state of vulnerability in older adults for adverse outcomes. We aimed to screen for frailty and understand its impact on daily living and participation. A cross-sectional study used a phone survey (Stage I—1,571 participants) and house visits (Stage II—120 participants). Older adults with frailty were significantly different from the nonfrail participants in all demographic and daily activities characteristics. Frailty significantly influenced instrumental activities of daily living and participation.
Primary Author and Speaker: Debbie Rand
Contributing Authors: Netta Bentur, Alona Baram, Reut Gasner-Winograd, Zvi Buckman, Shelley Sternberg
Frailty refers to a state of vulnerability in older persons for adverse outcomes due to a decline in physiological reserve and increase in age. This decreased reserve capacity can lead to loss of mobility and independence, hospitalization, institutionalization and death. Decline in physical function, gait speed and weight loss are commonly identified as components of frailty. However, since most studies have focused on adverse outcome, our study focused on understanding the impact of frailty on daily living and participation.
PURPOSE: We aimed to screen for frailty (Stage I) and to compare the daily functioning and participation of older adults who are frail to older adults who are non-frail. In addition, to determine if frailty (after controlling for cognition and mobility) contributed in explaining the variance of independence in instrumental activities of daily living (IADL) and participation among older adults who were assessed at home (Stage II).
DESIGN: A crossectional study using a phone survey was conducted to reach a large population of older adults and then house visits were conducted to a subgroup of these participants. Community-dwelling participants over the age of 75 were identified via an electronic healthcare database and were approached by phone.
METHOD: Participants were invited to take part in the survey if they could hear, understand and speak the language, walk independently within their home (with or without a device) and did not have a diagnosis of dementia,. Two questionnaires were administered; the Vulnerable Elders Survey-13 (VES-13), which is a simple function-based screening tool for frailty and a demographic and daily living activities questionnaire. The VES-13 scores range from 0-10, higher score indicates more severe frailty. A score of 3 or greater defines “vulnerability” and predicts increased risk for mortality, functional decline and increased health service utilization. Since our population is 75 years old and above, a cut-off score of 5 was used to determine frailty. In addition, participants were asked questions regarding their weekly activities. The home visits included administration of the Montreal Cognitive Assessment (MoCA), Verbal Fluency Test and the Trail Making Test to assess for cognition and executive functioning. Independence in BADL, IADL and participation [using the Reintegration to Normal Living (RNL)] was assessed.
RESULTS: In Stage I, 1602 participants agreed to participate, 1571 of them had full questionnaires and their data was analyzed. The mean (SD) VES score was 4.5 (3.2) points, ranging from 1-10 points. Using the VES-13, 955 participants [60.7%, mean (SD) age was 80.0(3.8) years old] were defined as non-frail and 616 participants [39.2%, 83.3 (5.0) years] were defined as frail. The frail participants were significantly (p<.001) different from the non-frail participants in all demographic and daily activities characteristics. Less participants who were frail reported to work, volunteer, drive, leave the house for social purposes compared to the participants who were non-frail.
In Stage II, 120 house-visits were conducted. Participant’s mean (SD) age was 80.0 (4.0) years old. The majority of them were independent in BADL but their independence in IADL ranged from 3 (dependent) to 23 (independent) points. The mean (SD) MoCA score was 21 (5.7), ranging from 12-27 points. Frailty significantly contributed to explaining the variance in IADL (23%) and RNL (27%) scores.
CONCLUSIONS: Frailty has an impact on the daily lives of older adults. The role of occupational therapy in identifying decline in daily living and participation and preventing adverse outcomes in frail older adults will be discussed.
References
Ramon, D., Erik van, R., Luc de, W., & Wim van den, H. (2008) Frailty in Older Age: Concepts and Relevance for Occupational and Physical Therapy. Physical and Occupational Therapy in Geriatrics, 27, 2, 81-95, DOI: 10.1080/02703180802206181
Fried, L.P., Tangen, C.M., Walston, J., et al. (2001). Frailty in older adults: Evidence for a phenotype. Journal of Gerontology, Series A. biological sciences and medical sciences, 56A, M146–M156. DOI: 10.1093/gerona/56.3.m146
