Print
PDF version
Whats New in the
Patient Safety World
January 2021
The Frailty Meter
Our August 17, 2010
Patient Safety Tip of the Week Preoperative Consultation Time to Change suggested the 3 most important
things to screen for during a preoperative evaluation are frailty, delirium
risk, and obstructive sleep apnea. Frailty clearly has been linked to
post-operative adverse events and poorer patient outcomes following surgery
(see our multiple columns listed below).
We are always looking for simple tests for frailty that can
be applied in brief sessions in a surgeons office or other preoperative
assessment setting. In our May 16, 2017 Patient Safety Tip of the Week Are
Surgeons Finally Ready to Screen for Frailty? we noted a study that
looked at individual components of the Fried frailty phenotype measures (gait
speed, hand-grip strength as measured by a dynamometer, and self-reported
exhaustion, low physical activity, and unintended weight loss) in a primary
care setting (Lee
2017). The researchers found that individual criteria all showed
sensitivity and specificity of more than 80%, with the exception
of weight loss. The positive predictive value of the single-item
criteria in predicting the Fried frailty phenotype ranged from 12.5% to 52.5%. When
gait speed and hand-grip strength were combined as a dual measure, the positive
predictive value increased to 87.5%. They conclude that, while use of gait
speed or grip strength alone was found to be sensitive and specific as a proxy
for the Fried frailty phenotype, use of both measures together was found to be
accurate, precise, specific, and more sensitive than other possible
combinations and that assessing both measures is
feasible within the primary care setting.
Almost all the scales we use for detecting frailty include
measures of gait (such as the Timed Up-and-Go test or measures of gait speed).
But what about those patients in whom it is not possible to assess gait?
Najafi and
colleagues (Najafi 2020) came up with an innovative solution to
screen for frailty in those patients where gait could not be assessed. Many of
their patients had chronic limb-threatening ischemia (CLTI) and were often
unable to perform gait-based assessments because of the presence of plantar
wounds. So, they designed and assessed a device they call the Frailty Meter
(FM). The FM consists of a wrist-worn sensor and a wirelessly connected
tablet. It records the angular velocity during a 20-second repetitive elbow
flexion-extension task and quantifies weakness, slowness, rigidity, and
exhaustion during that exercise. It then displays a Frailty Index (FI).
Participants were tested on their dominant arm, according to a standardized protocol.
The frailty
measurement was performed within 1 week before limb revascularization in 152
patients. They then assessed the incidence of major adverse events (MAEs) for up
to 1 month after surgery. 78.2% of the patients were unable to perform the gait
test, while all could perform the FM test. Overall, 34.9%, 38.1%, and 27.0%
were classified as robust, pre-frail, or frail, respectively, by their FI
scores.
Within 30 days after surgery, 15.7%
of patients developed MAEs, either major adverse cardiovascular events (MACE 5.2%)
or major adverse limb events (MALE 10.5%). The FI was approximately 30% higher
in the group that developed MAEs than those who were MAE free.
There was a significantly lower mean
FI score in the non-MAE group compared with MACE and MALE groups, but there was
no significant difference of FI between MACE and MALE groups.
While this study only included
patients with lower extremity vascular disease, we can see how use of the
frailty meter could also be valuable in assessing patients whose gait cannot
be assessed due to neurological or orthopedic conditions.
Some of our prior
columns on preoperative assessment and frailty:
- March 31, 2009 Screening Patients for Risk of Delirium
- January 26, 2010 Preventing Postoperative Delirium
- June 2010 The
Frailty Index and Surgical Outcomes
- August 17, 2010 Preoperative Consultation Time to
Change
- August 31, 2010 Postoperative Delirium
- August 9, 2011 Frailty and the Surgical Patient
- September 2011 Modified HELP Helps Outcomes in Elderly
Undergoing Abdominal Surgery)
- October 18, 2011 High Risk Surgical Patients
- November 2011 Timed Up-and-Go Test and Surgical
Outcomes
- April 3, 2012 New
Risk for Postoperative Delirium: Obstructive Sleep Apnea
- August 7, 2012 Cognition,
Post-Op Delirium, and Post-Op Outcomes
- August 14, 2012 Gait Speed: A New Vital Sign?
- September 25, 2012 Preoperative Assessment for Geriatric
Patients
- September 3, 2013 Predicting Perioperative Complications:
Slow and Simple
- November 2013 Predicting Perioperative Complications:
Even Simpler!
- June 2014 Another Study Linking Frailty to
Surgical Complications
- September 2, 2014 Frailty and the Trauma Patient
- February 17, 2015 Functional Impairment and Hospital
Readmission, Surgical Outcomes
- June 2015 Get a Grip on It!
- January 26, 2016 More
on Frailty and Surgical Morbidity and Mortality
- May 2016 Guidelines
for Perioperative Geriatric Care
- May 31, 2016 More
Frailty Measures That Predict Surgical Outcomes
- May 16, 2017 Are
Surgeons Finally Ready to Screen for Frailty?
- February 2018 Global
Sensory Impairment and Patient Safety
- April 10, 2018 Prepping
the Geriatric Patient for Surgery
- January 15, 2019 Another Plus for Prehabilitation
- September 17, 2019 American College of
Surgeons Geriatric Surgery Verification Program
- April 7, 2020 From Preoperative
Assessment to Preoperative Optimization
- June 30, 2020 What Happens after
Hospitalization?
- July 2020 Getting a Grip on
Things
References:
Lee L, Patel T, Costa A, Bryce E,
Hillier LM, Slonim K, et al. Screening for frailty in primary care. Accuracy of
gait speed and hand-grip strength. Can Fam Physician 2017; 63: e51-57
https://www.cfp.ca/content/63/1/e51
Najafi B, Veranyan
N, Zulbaran-Rojas A, et al. Association Between
Wearable DeviceBased Measures of Physical Frailty and Major Adverse Events
Following Lower Extremity Revascularization. JAMA Netw
Open 2020; 3(11): e2020161
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773096
(Najafi
2020)
Print PDF version
http://www.patientsafetysolutions.com/
Home
Tip of the
Week Archive
Whats New in
the Patient Safety World Archive