FUNDACIÓN INVESTIGACIÓN BIOMÉDICA HOSPITAL UNIVERSITARIO GETAFE. Dr. Marta Checa Prof. Rodríguez Mañas MD, PhD Geriatrician H. U.

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1 FUNDACIÓN INVESTIGACIÓN BIOMÉDICA HOSPITAL UNIVERSITARIO GETAFE Dr. Marta Checa Prof. Rodríguez Mañas MD, PhD Geriatrician H. U. Getafe (Madrid)

2 Our research projects as Coordinator A comprehensive validation of tools to screen and diagnose frailty in different clinical and social settings to provide instruments for integrated care in older adults FRAILCLINIC is aimed at assessing the feasibility and effectiveness of programs designed to detect and manage frail older patients in high risk clinical settings The FRAILOMIC initiative is a large scale research project aiming to identify the factors that turn frailty into disability MIDFRAIL: A randomized clinical trial to evaluate the effectiveness of a multi-modal intervention in older people with type 2 diabetes on frailty and quality of life

3 Our research projects as Partner SPRINTT - Sarcopenia and physical frailty in older people: Multi component treatment strategies DECI ACANTO VIVIFRAIL: Promote physical Exercise in frail elderly Digital Environment for Cognitive Inclusion A CyberphysicAl social NeTwOrk using robot friends EIT Health will promote entrepreneurship and develop innovations in healthy living and active ageing. More than 50 core partners and 90 associate partners

4 A comprehensive validation of tools to screen and diagnose frailty in different clinical and social settings to provide instruments for integrated care in older adults Project Grants (HP-PJ) 3rd European Union Health Programme

5 General objectives 1. To assess the usefulness as screening and diagnosis tools of some selected instruments to detect frailty in: Clinical Hospitals Primary Care Social Nursing homes 2. To provide sequential diagnostic algorithms

6 Participating centres SPAIN Servicio Madrileño de Salud (SERMAS) Fundación para la Investigación Biomédica del Hospital Universitario de Getafe (FIBHUG) ITALY Università Cattolica Sacro Cuore (UCSC) FRANCE Centre Hospitalier Universitaire Toulouse (CHUT) UNITED KINGDOM Diabetes Frail Ltd (DIFRAIL) POLAND Jagiellonian University Medical College (JUMC)

7 Methodological approach PARTICIPANTS AND SETTINGS: Sample size is established in 485 person by setting; total of 1940 persons (97 per setting) Inclusion criteria: People 75 years or older. Attended in 4 different settings: In-Hospital Geriatric wards Hospital outpatient offices Primary Care Nursing Homes Exclusion criteria: Subjects unwilling or unable to consent or unable to participate MMSE <20 points Terminal illness (life expectancy <6 months) In Hospital and Primary Care: Dependency in more than 2 IADL (Lawton) In Nursing Homes: Barthel Index < 40

8 Instruments assessed INSTRUMENTS/TOOLS: 1. Frailty Phenotype- Fried criteria 2. FRAIL scale 3. SHARE-FI 4. CHSA- Clinical Frailty Scale 5. The 35 item Rockwood Scale 6. Shorten version of the Frailty Trait Scale- FTS 7. The Gerontopôle Frailty Screening Tool- GFST

9 Outcomes- Follow-up DEATH DEATH (12-18 month) OUTCOMES DISABILITY FALLS COGNITIVE DECLINE FOLLOW-UP DISABILITY(12-18 month) FALLS: 6 month (phone call) month COGNITIVE DECLINE(12-18 month)

10 Feasibility and effectiveness of the implementation of programs to screen and manage frail older patients in different clinical settings Project Grants (HP-PJ) 2nd European Union Health Programme

11 Objective To assess the feasibility and effectiveness of programs designed to detect (observational phase) and manage (interventional phase) frail older patients in high risk clinical settings and to avoid functional impairment and other associated adverse outcomes: Emergency room Cardiology General surgery Oncology

12 Phases PHASES: Observational and interventional 1. Observational phase: Feasibility and effectiveness of frailty screening programs implemented in different clinical settings. 2. Interventional phase: Feasibility and effectiveness of the implementation of programs to screen and manage frail older patients in different clinical settings

13 Participating centres SPAIN o Hospital Universitario de Getafe (Madrid, España) o Hospital Universitario Monte Naranco (Asturias, España) ITALY o Ospedale San Raffaele (Roma, Italia) o Universita Cattolica del Sacro Cuore (Roma, Italia) UNITED KINGDOM o Diabetes Frail Ltd (DIFRAIL)

14 Observational phase Tools assessed for Frailty: Fried criteria FRAIL Scale Tilburg Frailty Indicator Gröningen Frailty Indicator CFS or Rockwood modified ISAR (Emergency room) Balducci criteria (Oncology) VES 13 (Oncology) G8 (Oncology) Time recruitment: 10 months

15 Participants Inclusion criteria: o Patients older than 75 years, assessed in several clinical settings (different from Geriatry); Emergency Room, Cardiology, Elective and Urgent Surgery and Oncology. Exclusion criteria: o Do not able to give informed consent. o Participants with Impairment cognitive moderate or severe according to MMSE scale (score 18 or lower) and/or the GDS scale (score 5 or higher ). o Those with physical disability according to Barthel Scale (lower to 40) o Participants with critical acute disease. o Life expectancy less than six months o Patients living in nursing homes

16 Sociodemographic characteristics Variables Emergency Room Cardiology Elective Surgery Urgent Surgery Oncology Agregate N Age (DT) 83,71(5,66) 80,65(4,30) 79,50(3,04) 82,58(5,06) 78,9(3,19) 81(4,62) Gender (% males) 36,75 54,55 61,04 47,69 64,00 52,81 White race 100,00 99,55 99, ,00 99,50 Civil Status Single 6,84 3,64 2,60 7,69 4,00 4,46 Married or cohabiting 39,32 51,36 70,78 44,62 62,00 54,13 Widow 52,99 43,18 25,32 47,69 32,00 40,10 Necessity of principal caregiver Profesional 12,62 4,78 2,92 13,85 2,00 6,56 Caregiver

17 Frailty classification by tool and setting Setting Emergency Room Fried FRAIL Tilbg Grng Rockw ISAR Bald G8 VES 13 Total 50,51 40,71 68,14 74,34 47,46 78, ,00 Cardiology 61,39 41,36 65,55 62,32 42, ,61 Elective Surgery Urgent Surgery 24,67 15,48 30,32 30,72 5, ,27 53,33 41,54 37,50 50,77 18, ,32 Oncology 47,92 30,00 36,00 40,00 6, ,28 81,63 34,69 36,31 Agregate 47,43 33,67 51,27 53,23 28, ,78

18 Fried scale: sensitivity and specificity Weight lost Fatigue Physical Activity Gait speed Hand grip Setting S E S E S E S E S E Emergency Room 36,73 91,84 94,00 54,17 80,00 87,50 90,24 78,79 97,96 52,08 Cardiology 38,71 96,15 87,10 66,67 73,39 79,49 90,38 63,64 91,80 50,00 Elective Surgery 81,08 84,96 72,97 81,25 43,24 95,58 70,59 85,44 86,49 63,39 Urgent Surgery 91,67 85,71 83,33 80,95 62,50 100,00 75,00 50,00 100,0 52,38 Oncology 86,96 80,00 86,96 76,00 82,61 84,00 58,33 90,48 82,61 52,00 Agregate 53,70 88,81 86,05 72,18 70,16 89,08 84,62 77,97 92,16 55,99

19 Hand grip Physical Activity Gait speed Setting S E S E Emergency Room 80,00 87,50 97,96 52,08 Cardiology 73,39 79,49 91,80 50,00 Physical Activity Elective Surgery 43,24 95,58 86,49 63,39 Urgent Surgery 62,50 100,00 100,0 52,38 Oncology 82,61 84,00 82,61 52,00 Agregate 70,16 89,08 92,16 55,99

20 Feasibility of scales Complete Emergengy Room Cardiology Elective Surgery Urgent Surgery Oncology Fried 68,64 60,17 76,92 87,74 12, FRAIL 98,52 94,07 99,55 99, I. F.Tilburg 92,45 85,59 90,05 96,13 98, I.F.Gröningen 91,13 85,59 90,05 96,13 98, T (min) Rockwood modificada 99, , ISAR* 93,22 93, G8** 98, Balducci** 98, Ves13** 98, *Specífic of Emergency Room ** Specific of Oncology

21 Feasibility Fried scale Setting N Weight lost Medidos Fatigue Medidos Physical Activity Medidos Gait Speed Hand Grip Full Scale Medidos Medidos Medidos Emergency Room ,31 98,31 98,31 62,71 91,53 60,17 5 Cardiology ,10 99,55 99,10 76,92 95,02 76,92 5 Elective Surgery Urgent Surgery ,00 99,35 100,00 88,39 98,71 87,74 7, ,46 98,46 95,38 12,31 98,46 12,31 9 Oncology ,00 100,00 100,00 66,00 100,00 66,00 4 Agregate ,18 99,18 98,85 69,29 96,06 68,64 5 T (m)

22 Causes of non implementation: Fried scale 60 51,46% ,54% Emergency Room Cardiology Elective Surgery Urgent Surgery Oncolgcy Agregate Refusal Enviromental problems Clinical situation

23 Degree of concordance among scales: Global FRAIL Fried Rockw Grng Tilbg INTERPRETATION KAPPA Tilbg Grng Rockw Fried FRAIL (Landis & Koch, 1977) Kappa Index: Slight agreement Fair agreement Moderate agreement Substantial agreement Almost perfect agreement

24 Now Analyse the Final Results of Observational Phase Starting the Interventional Phase

25 THANK YOU