Predicting risk and outcomes for frail older adults:a protocol for an umbrella review of available frailty screening tools

The aim of this systematic review is to comprehensively search the available literature and to summarize the best available evidence from systematic reviews in relation to published screening tools to identify pre-frailty and frailty in older adults, that is: (i) to determine their psychometric proprieties; (ii) to assess their capacity to detect pre-frail and frail conditions against established methods; and (iii) to evaluate their predictive ability. More specifically, the review will focus on the following questions: Frailty is an age-related state of vulnerability resulting from a balance between the maintenance of health and the deficits threatening it.1,2 This clinical condition compromises the ability to cope with daily or acute stressors and, further, increases the risk of adverse outcomes, predisposing those involved to disability and dependency on others for daily life activities, and leading to hospitalization and institutional placement.3,4 It is also a predictor of higher mortality rates.4-7 In the absence of biological markers, an operational definition of frailty has been proposed.2,8 This definition is based on physical markers, including weakness with low muscle strength (e.g. poor grip strength), overall slowness (particularly of gait), decreased balance and mobility, fatigability or exhaustion, low physical activity and involuntary weight loss. For diagnostic purposes, at least three of these symptoms must be observed.8 The presence of only one or two of them indicates the earlier stage of frailty, namely, pre-frailty. Despite high predictive validity of this operational definition, and despite its common use in clinical settings, many researchers believe it is insufficient, asserting that it should also include cognitive and mental health domains, and possibly also social domains such as living alone.9-12 Other dimensions recognized as important for identifying frailty are the ability to deal with activities of daily living and quality of life, as for individuals with this clinical condition both of these areas tend to be decreased.9,13 This lack of consensus on the definition of frailty (based on physical markers as opposed to a broader multidimensional approach) is also reflected in divergences related to the prevalence data obtained from epidemiological studies. Systematic comparison of these data14 shows that frailty prevalence differs from 4% to 17% in the population aged 65 and over, and in case of pre-frailty, prevalence varies from 19% to 53% of the same age group, with average values of 10.7% and 41.6%, respectively. The divergences between estimates are also conditioned by demographic variables such as age and gender. Namely, for elders aged 80-84 the prevalence of frailty is estimated as 15.7%, and for elders over the age of 84, 26.1%. Additionally, women tend to have higher rates of frailty than men. Although the condition of frailty has been studied for years, there is no consensus on its pathophysiologic mechanism. According to some authors2,8,15, this state of increased vulnerability is due to accumulation of subthreshold decrements in physiologic reserves that affects multiple physiologic systems. Other authors16,17 have described frailty in terms of progressive dysregulation in a number of main physiologic systems and their complex interconnected network, and subsequent depletion of homeostatic reserve and resiliency. Recently, discussion on the psychopathological mechanism of this clinical condition has been enriched by new theoretical proposals associating frailty to reduced capacity to compensate ageing-related molecular and cellular damage.13,18 In all these approaches it is assumed that the development of frailty may be modulated by disease. In other words, it can be precipitated or exacerbated by the occurrence of comorbid pathological conditions.19-21 It is also suggested that increased vulnerability for adverse health outcomes can precede the onset of chronic diseases.19,20 However, according to Bergman et al19, it is probable that in this case, frailty is just a manifestation of subclinical and undiagnosed stages of such diseases. Because of the high prevalence and the severity of adverse outcomes of frailty, its screening should be a priority in appropriate components of primary care networks (including general practice, geriatrics, psychology, etc.), as well as in institutional or community care settings. Early diagnosis of this clinical condition can help improve care for older adults, making possible the minimization of the risk of pre-frail states developing into frail states (primary prevention), and implementation of therapeutic measures in order to attenuate or delay underlying conditions and symptoms, or to ameliorate the impact on independence or healthy and engaged lifestyles (loss of which would in turn have a further impact on frailty development, i.e. secondary prevention).2,4 In more advanced stages, frailty assessment provides valuable data necessary to plan and implement intervention strategies oriented to the preservation of functional status or to control the progression of adverse outcomes, such as recurrent hospitalizations, institutionalization or death (tertiary prevention).2,4 The evidence obtained from the implementation of various types of interventions for frailty indicates that the frailty condition can be managed and reduced.22-25 Screening for frailty can also provide information on populations at high risk of disability and poor prognosis, and help to identify reversible risk factors.2 These data are especially important for determining variables that make specific interventions more beneficial to specific patients. In order to identify individuals at risk of frailty, several assessment tools have been developed. The most widely cited focus on physical markers of frailty2,8 or are based on the accumulation of deficits from physical, cognitive, mental health and functional domains.13,26 However, both types of measures seem to be insufficient. The first one does not cover all dimensions of frailty and consequently does not provide indications useful to treatment choice and care planning, and the last one is time consuming and thus is difficult to integrate into day-to-day health care practice.27 In more recent approaches, the indices created for frailty assessment integrate demographic, medical, social and functional information, and demonstrate their usefulness either for diagnostic purposes or to predict adverse health outcomes.28 According to the literature, there are more than 20 different measures being used for frailty screening. Nonetheless, it is still unknown how their characteristics match different samples within the frail/pre-frail condition and robust populations, and what is the best fit between these measures, purposes (e.g. to predict need for care, mortality or potential response to intervention) and contexts/populations to assess frailty in older age. Also, the reliability and validity of these measures need to be clarified, as well as the comparative sensitivity and specificity in identifying patients at risk of a poor prognosis. A scoping search identified a large number of relevant systematic reviews; however in most cases they are confined to specific assessment measures related to a specific clinical model (phenotype model8, cumulative deficits model13 and predictive model28). For a clear view and objective evaluation of existing tools, this set of evidence needs to be systematized, compared and synthesized. In other words, it is essential to conduct an umbrella review. A preliminary search of the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, Prospero, CINAHL and Medline has revealed that there is currently no overview of reviews or umbrella review (neither published nor in progress) on this topic of sufficient reliability, validity and capacity to detect pre-frail and frail conditions, and with predictive accuracy of available screening tools for frailty in older adults29 The main goal of this umbrella review is to consolidate the available evidence regarding screening for pre-frailty and frailty from the published literature. More specifically, reviews will be summarized in order to determine the quality of screening tools in terms of frailty diagnosis and frailty prognosis

The experiences and effectiveness of canine-assisted interventions (CAIs) on the health and well-being of older people residing in long-term care: a mixed methods systematic review protocol. [Protocol]

The aim of this mixed methods review is to synthesize and integrate the best available evidence on the experiences and effectiveness of canine-assisted interventions (CAIs) on the health and well-being of older people residing in long-term care. More specifically the review questions are: 1) What are the experiences of older people residing in long-term care who receive CAIs? 2) What are the views of people directly or indirectly involved in delivering CAIs to older adults (such as family and friends of the residents, healthcare workers and volunteers) regarding CAIs for older people residing in long-term care facilities? 3) What is the effectiveness of CAIs on the health and well-being of older people residing in long-term care facilities

Correction:Stakeholders' views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

[This corrects the article DOI: 10.1371/journal.pone.0180127.]

Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review

: Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care

Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA)

Introduction Mild cognitive impairment (MCI) is a term used to describe a level of decline in cognition which is seen as an intermediate stage between normal ageing and dementia, and which many consider to be a prodromal stage of neurodegeneration that may become dementia. That is, it is perceived as a high risk level of cognitive change. The increasing burden of dementia in our society, but also our increasing understanding of its risk factors and potential interventions, require diligent management of MCI in order to find strategies that produce effective prevention of dementia. Aim To update knowledge regarding mild cognitive impairment, and to bring together and appraise evidence about the main features of clinical interest: definitions, prevalence and stability, risk factors, screening, and management and intervention. Methods Literature review and consensus of expert opinion. Results and conclusion MCI describes a level of impairment in which deteriorating cognitive functions still allow for reasonable independent living, including some compensatory strategies. While there is evidence for some early risk factors, there is still a need to more precisely delineate and distinguish early manifestations of frank dementia from cognitive impairment that is less likely to progress to dementia, and furthermore to develop improved prospective evidence for positive response to intervention. An important limitation derives from the scarcity of studies that take MCI as an endpoint. Strategies for effective management suffer from the same limitation, since most studies have focused on dementia. Behavioural changes may represent the most cost-effective approach

Presenteeism and mental health of workers during the COVID-19 pandemic: a systematic review

BackgroundA large number of workers attend work despite being ill. Attending work during sickness can have a number of consequences for the worker (e.g., worsening of physical and mental condition), for co-workers, and for the company, and for service users.ObjectivesThe aim of this study was to assess the factors influencing presenteeism and mental health of workers during the COVID-19 pandemic.MethodsA systematic review following the PRISMA format was conducted in the PubMed, Scopus, Web of Science (WoS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, and ScienceDirect electronic databases in January 2023, using the following key words: Presenteeism, Mental Health, and COVID-19. The eligibility criteria applied were original articles published in English, Spanish, French, German, and Portuguese, workers during the COVID-19 pandemic (data collection date: January 01, 2020 – January 01, 2023), and articles assessing at least one measure of presenteeism and mental health status. Methodological quality was assessed using the critical appraisal tools of the Joanna Briggs Institute. The followed protocol is listed in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42023391409.ResultsA total of 25 studies were included in this review recruiting a total of 164,274 participants. A number of factors influencing mental health and sickness presenteeism were identified: (1) mental health-related factors (burnout [in 4 studies], stress [in 9 studies], depression [in 1 study], fear of COVID-19 [in 1 study], no well-being [in 2 studies], etc.); (2) individual factors (health status [in 1 study], being young [in 1 study], workers who experienced interrupted medical care [in 2 studies], having a chronic disease [in 1 study], etc.); (3) factors related to the situation caused by COVID-19 (confinement, symptoms, loss of contract, risk of bankruptcy, etc. [in 1 study each one]); and (4) factors derived from working conditions (organisational support [in 1 study], patient care [in 1 study], work functioning or task performance impairment [in 4 studies], work fatigue [in 2 studies], safety climate [in 1 study], workload [in 1 study], etc.).ConclusionIdentifying the key determinants of presenteeism and understanding the phenomena and origins of sickness presenteeism will help to create a safe working environment and optimal organisational systems to protect vulnerable workers in a pandemic context.Systematic review registrationThe unique identifier is CRD42023391409

Creating a Culture of Health in Planning and Implementing Innovative Strategies Addressing Non-communicable Chronic Diseases

Ongoing demographic changes are challenging health systems worldwide especially in relation to increasing longevity and the resultant rise of non-communicable diseases (NCDs). To meet these challenges, a paradigm shift to a more proactive approach to health promotion, and maintenance is needed. This new paradigm focuses on creating and implementing an ecological model of Culture of Health. The conceptualization of the Culture of Health is defined as one where good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities where citizens have the opportunity to make choices and be co-producers of healthy lifestyles. Based on Antonovsky's Salutogenesis model which asserts that the experience of health moves along a continuum across the lifespan, we will identify the key drivers for achieving a Culture of Health. These include mindset/expectations, sense of community, and civic engagement. The present article discusses these drivers and identifies areas where policy and research actions are needed to advance positive change on population health and well-being. We highlight empirical evidence of drivers within the EU guided by the activities within the thematic Action Groups of the European Innovation Partnership on Active and Healthy Aging (EIP on AHA), focusing on Lifespan Health Promotion and Prevention of Age-Related Frailty and Disease (A3 Action Group). We will specifically focus on the effect of Culture on Health, highlighting cross-cutting drivers across domains such as innovations at the individual and community level, and in synergies with business, policy, and research entities. We will present examples of drivers for creating a Culture of Health, the barriers, the remaining gaps, and areas of future research to achieve an inclusive and sustainable asset-based community

Stakeholders' views and experiences of care and interventions for addressing frailty and pre-frailty:a meta-synthesis of qualitative evidence

Frailty is a common condition in older age and is a public health concern which requires integrated care and involves different stakeholders. This meta-synthesis focuses on experiences, understanding, and attitudes towards screening, care, intervention and prevention for frailty across frail and healthy older persons, caregivers, health and social care practitioners. Studies published since 2001 were identified through search of electronic databases; 81 eligible papers were identified and read in full, and 45 papers were finally included and synthesized. The synthesis was conducted with a meta-ethnographic approach. We identified four key themes: Uncertainty about malleability of frailty; Strategies to prevent or to respond to frailty; Capacity to care and person and family-centred service provision; Power and choice. A bottom-up approach which emphasises and works in synchrony with frail older people's and their families' values, goals, resources and optimisation strategies is necessary. A greater employment of psychological skills, enhancing communication abilities and tools to overcome disempowering attitudes should inform care organisation, resulting in more efficient and satisfactory use of services. Public health communication about prevention and management of frailty should be founded on a paradigm of resilience, balanced acceptance, and coping. Addressing stakeholders' views about the preventability of frailty was seen as a salient need