Treating frailty-a practical guide

Frailty is a common syndrome that is associated with vulnerability to poor health outcomes. Frail older people have increased risk of morbidity, institutionalization and death, resulting in burden to individuals, their families, health care services and society. Assessment and treatment of the frail individual provide many challenges to clinicians working with older people. Despite frailty being increasingly recognized in the literature, there is a paucity of direct evidence to guide interventions to reduce frailty. In this paper we review methods for identification of frailty in the clinical setting, propose a model for assessment of the frail older person and summarize the current best evidence for treating the frail older person. We provide an evidence-based framework that can be used to guide the diagnosis, assessment and treatment of frail older people

Frailty Intervention Trial (FIT)

<p>Abstract</p> <p>Background</p> <p>Frailty is a term commonly used to describe the condition of an older person who has chronic health problems, has lost functional abilities and is likely to deteriorate further. However, despite its common use, only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence. The criteria Fried and colleagues used to define the frailty syndrome will be used in this study (i.e. weight loss, fatigue, decreased grip strength, slow gait speed, and low physical activity). Previous studies have shown that clinical outcomes for frail older people can be improved using multi-factorial interventions such as comprehensive geriatric assessment, and single interventions such as exercise programs or nutritional supplementation, but no interventions have been developed to specifically reverse the syndrome of frailty.</p> <p>We have developed a multidisciplinary intervention that specifically targets frailty as defined by Fried et al. We aim to establish the effects of this intervention on frailty, mobility, hospitalisation and institutionalisation in frail older people.</p> <p>Methods and Design</p> <p>A single centre randomised controlled trial comparing a multidisciplinary intervention with usual care. The intervention will target identified characteristics of frailty, functional limitations, nutritional status, falls risk, psychological issues and management of chronic health conditions. Two hundred and thirty people aged 70 and over who meet the Fried definition of frailty will be recruited from clients of the aged care service of a metropolitan hospital. Participants will be followed for a 12-month period.</p> <p>Discussion</p> <p>This research is an important step in the examination of specifically targeted frailty interventions. This project will assess whether an intervention specifically targeting frailty can be implemented, and whether it is effective when compared to usual care. If successful, the study will establish a new approach to the treatment of older people at risk of further functional decline and institutionalisation. The strategies to be examined are readily transferable to routine clinical practice and are applicable broadly in the setting of aged care health services.</p> <p>Trial Registration</p> <p>Australian New Zealand Clinical Trails Registry: ACTRN12608000250336.</p

Non-intentional farm injury fatalities in NSW, Australia, 2001–2015

Background: Agriculture is one of the most hazardous industries in Australia. The Australian Centre for Agricultural Health and Safety is the only agency that records all non-intentional injury-related events (work and nonwork) on Australian farms. Materials and methods: Drawing on records from the National Coronial Information System, data for New South Wales (NSW), Australia, were analysed to assess cases in the 2001–2015 period. Each case was reviewed in accordance with the Farm Injury Optimal Dataset to ascertain gender, age, work relatedness and causal agents. The location of each incident was also mapped by Statistical Area Level 4. Denominator data on the number of agricultural establishments in each area and the number of workers involved in agriculture across all of NSW were sourced from the Australian Bureau of Statistics (ABS). Two-piece linear regressions using 2007 as the change point were completed to ascertain trends for the work-related cases and all deaths (work and nonwork). Differences in rates of all deaths by regions were assessed using Poisson regression models. Results: Results indicate no change in the rate of work-related deaths per 100 000 workers over the 15-year period (mean 17.3). Although there was a statistically significant reduction in all deaths (work and nonwork) per 10 000 farms through to 2007, the rate has remained stable since this time. There was no significant variation in the all-deaths rate (work and nonwork) between any of the geographic areas. Study limitations included estimations based on ABS data for the distribution of farms, the lack of data by statistical area on agricultural worker numbers and a case closure rate of 87%. Lessons learnt: There has been no improvement in work-related fatality rates in the sector in NSW for at least 15 years, and similarly no improvement in the all-injury fatality rate (work and nonwork) since 2007. Data in this study can be used to strengthen investment and revitalise the adoption of evidence based approaches that address relevant issues