Frailty Syndrome in the Elderly: A Real Challenge for Our Society

A special issue of Medicines (ISSN 2305-6320).

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 34519

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Guest Editor
Internal Medicine Department, University Hospital Strasbourg, 67000 Strasbourg, France
Interests: frailty syndrome; telemonitoring; comprehensive geriatric assessment; telemedicine; hypervitaminosis B12 syn-drome; hematological disease in the elderly; vitamin B12-related diseases
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Dear Colleagues,

Described since the 1970s, the frailty syndrome is a dynamic and evolving geriatric concept, involving many dimensions of everyday life and leading to a risk of developing a loss of autonomy. It corresponds to a precarious state of equilibrium combined with a reduction of physiological reserves linked to aging and is responsible for an inability to respond to physical, psychological, or social stress. Its management requires medical, social, and psychological interventions. It is becoming increasingly important that we detect signs of frailty among individuals on the cusp of old age, not only to ensure this population ages “successfully” but also to avoid unnecessary health-related expenses. The main purpose of this call of paper is to study the frailty syndrome as much on the physiopathological mechanisms which govern it, its daily detection in ambulatory medicine (primary care) or in hospital environment by appropriate scales of identification, and the repercussions of this syndrome.

Dr. Abrar-Ahmad Zulfiqar
Guest Editor

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Keywords

  • frailty syndrome
  • scales
  • primary care
  • physiopathological mechanisms
  • inflammaging
  • geriatric risk

Published Papers (11 papers)

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Research

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10 pages, 556 KiB  
Article
Zulfiqar Frailty Scale (ZFS): Concordance Study with the Clinical Frailty Scale (CFS)
by Abrar-Ahmad Zulfiqar, Léo Martin, Perla Habchi, Delwende Noaga Damien Massimbo, Ibrahima Amadou Dembele and Emmanuel Andres
Medicines 2022, 9(11), 58; https://doi.org/10.3390/medicines9110058 - 18 Nov 2022
Cited by 1 | Viewed by 1540
Abstract
Introduction: We designed a new scale for the rapid detection of frailty for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). Objective: To evaluate the performance of the “ZFS” tool to screen for frailty as defined in the Clinical [...] Read more.
Introduction: We designed a new scale for the rapid detection of frailty for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). Objective: To evaluate the performance of the “ZFS” tool to screen for frailty as defined in the Clinical Frailty Scale (CFS) criteria in an ambulatory population of patients at least 75 years old. Method: A prospective study conducted in Alsace, France, for a duration of 6 months that included patients aged 75 and over was judged to be autonomous with an ADL (Activity of Daily Living) > 4/6. Results: In this ambulatory population of 124 patients with an average age of 79 years, the completion time for our scale was less than two minutes, and the staff required no training beforehand. Sensibility was 67%, while specificity was 87%. The positive predictive value was 80%, and the negative predictive value was 77%. The Youden index was 59.8%. In our study, we have a moderate correlation between CFS and ZFS (r = 0.674 with 95%CI = [0.565; 0.760]; p-value < 2.2 × 10−16 < 0.05). The Pearson correlations between these two geriatric scores were all strong and roughly equivalent to each other. The kappa of Cohen (k) = 0.46 (Unweighted), moderate concordance between the ZFS and CFS scales according to Fleiss classification. Conclusion: The “ZFS” tool makes it possible to screen for frailty with a high level of specificity and positive/negative predictive value. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
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9 pages, 1312 KiB  
Article
Magnetic Resonance Imaging of the Cervical Spine: Frequency of Abnormal Findings with Relation to Age
by Ali Alghamdi and Abeer Alqahtani
Medicines 2021, 8(12), 77; https://doi.org/10.3390/medicines8120077 - 14 Dec 2021
Cited by 2 | Viewed by 9459
Abstract
Background: Patients with neck pain are frequently encountered in cervical spine (C-spine) magnetic resonance imaging (MRI) practice. However, the exact distribution and prevalence of cervical abnormalities are not known. Aim: The aim of this study is to evaluate the association between age, gender, [...] Read more.
Background: Patients with neck pain are frequently encountered in cervical spine (C-spine) magnetic resonance imaging (MRI) practice. However, the exact distribution and prevalence of cervical abnormalities are not known. Aim: The aim of this study is to evaluate the association between age, gender, and prevalence of abnormal cervical MRI findings. Methods: Records of 111 cervical MRIs were collected in 12 months from January to December 2019 from adults aged 20–89 years who were referred from neurosurgery, neurology, and orthopedic clinics. Findings were classified and analyzed using the Statistical Package for Social Science (SPSS), version 24.0 (IBM, Armonk, NY, USA). The chi-square test was used to determine the association between demographics and abnormalities using a significance of p = 0.05. Results: The majority of patients were female (72.1%). The number of abnormal incidences increased with age until it reached a peak at ages 50–59. Spondylodegenerative changes were the most frequent finding, which was present in 52.2% of the total sample, and was followed by disc bulge (25.2%). Incidences increased in lower discs, with C5–C6 being the most frequent in 65% of the total sample. Younger males in their 20s had more injuries than females of the same age. However, this rate was reversed in patients over 40, as women were the dominant gender among patients in their 40s with cervical injuries, with a rate of 81.5%. Conclusion: In our study, we found that older patients developed more C-spine injuries. Gender may play a role in the rate of incidents. However, we did not find any significant differences between men and women or between different types of abnormalities. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
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8 pages, 281 KiB  
Article
Factors Affecting Dietary Improvements in Elderly Residents of Long-Term Care Institutions Receiving Domiciliary Dental Care
by Hitomi Kikuchi, Akira Komatsuzaki, Sachie Ono, Miwa Sirono, Shiho Motoi, Asami Iguchi and Mio Susuga
Medicines 2021, 8(11), 62; https://doi.org/10.3390/medicines8110062 - 21 Oct 2021
Cited by 1 | Viewed by 2568
Abstract
Background: Oral disabilities occur due to tooth loss. This study aimed to investigate oral and systemic factors related to diet in elderly residents receiving domiciliary dental care. Methods: The subjects were 74 consenting residents. Survey items included whether subjects could eat independently and [...] Read more.
Background: Oral disabilities occur due to tooth loss. This study aimed to investigate oral and systemic factors related to diet in elderly residents receiving domiciliary dental care. Methods: The subjects were 74 consenting residents. Survey items included whether subjects could eat independently and diet type. Subjects were examined by the dentist for the number of teeth, occlusal support index, and wearing dentures. Contingency table analysis was performed to determine what levels of decline in general and oral functions led to difficulties eating a normal diet. Results: There was a significant difference in the mean number of activities of daily living (ADL) requiring assistance evident between subjects eating a normal diet and those eating fluid boiled rice (p < 0.01). A comparison of occlusal support and diet type showed that most subjects who ate a soft diet or gruel had no occlusal support. Almost all subjects who ate a normal diet wore dentures. However, only 38% of subjects eating a soft diet and 40% of those eating gruel did wear dentures; both group differences were significant (p < 0.01). Conclusions: Future studies need to further investigate oral factors related to the type of diet and their relationships to domiciliary dental care in older adults. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)

Review

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16 pages, 1354 KiB  
Review
Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem
by Loredana Raciti, Gianfranco Raciti, Grazia Pulejo, Valeria Conti-Nibali and Rocco Salvatore Calabrò
Medicines 2022, 9(2), 16; https://doi.org/10.3390/medicines9020016 - 21 Feb 2022
Cited by 5 | Viewed by 5254
Abstract
Neurogenic dysphagia is a difficulty in swallowing food caused by disease or impairment of the nervous system, including stroke and traumatic brain injury. The most clinically apparent complication of neurogenic dysphagia is pulmonary aspiration, which may manifest itself acutely as choking or coughing, [...] Read more.
Neurogenic dysphagia is a difficulty in swallowing food caused by disease or impairment of the nervous system, including stroke and traumatic brain injury. The most clinically apparent complication of neurogenic dysphagia is pulmonary aspiration, which may manifest itself acutely as choking or coughing, respiratory distress, wheezing, gasping or gurgling, and tachycardia. However, chronic symptoms, including weight loss, production of excessive oral secretions and aspiration pneumonia, may be also present, especially in patients with a disorder of consciousness (DOC). Usually, patients with dysphagia after the acute phase need to be treated with enteral nutrition using a feeding tube. This avoids patient malnutrition and supports the rehabilitation program. This narrative review aims to investigate dysphagia and its complications and management in patients with DOC. Clinical indications and practical advice on how to assess and treat this complex problem are also provided. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
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Other

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11 pages, 311 KiB  
Brief Report
Evaluation of Nutritional Status in an Acute Geriatric Unit: Retrospective Study and Analysis of Frailty Syndrome
by Abrar-Ahmad Zulfiqar, Ibrahima Amadou Dembele and Emmanuel Andres
Medicines 2023, 10(3), 22; https://doi.org/10.3390/medicines10030022 - 8 Mar 2023
Viewed by 1216
Abstract
Introduction: The aim of our study is to evaluate the nutritional status of patients in an acute geriatric unit. Methods: Patients included in the study were hospitalized in an acute geriatric unit over a period of 6 months. The nutritional status of each [...] Read more.
Introduction: The aim of our study is to evaluate the nutritional status of patients in an acute geriatric unit. Methods: Patients included in the study were hospitalized in an acute geriatric unit over a period of 6 months. The nutritional status of each patient was evaluated with anthropometric measurements (the BMI and MNA scales), and biological measurements (albumin). Frailty was evaluated using three scales: the Fried scale, the CFS and the modified SEGA scale. Results: A total of 359 patients were included, comprising 251 women (70%) with an average age of 85.28 years. The study showed that 102 elderly subjects were considered undernourished according to the BMI scale, 52 subjects were undernourished according to the MNA scale, and 50 subjects were undernourished according to their albumin levels. The relationships between undernutrition and frailty syndrome studied in our work show that elderly subjects who are undernourished according to the BMI and MNA scales are significantly frail according to Fried and Rockwood, whereas those who are undernourished according to their albumin levels are significantly frail according to Fried and the modified SEGA scale. Conclusion: The relationship between undernutrition and the frailty syndrome is close, and their joint screening is necessary, whether on an outpatient or in-hospital basis, in order to prevent negative events related to comorbidities and geriatric syndromes. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
10 pages, 429 KiB  
Brief Report
Physical Activity in the Elderly and Frailty Syndrome: A Retrospective Study in Primary Care
by Abrar-Ahmad Zulfiqar, Habib Habchi, Perla Habchi, Ibrahima Amadou Dembele and Emmanuel Andres
Medicines 2022, 9(10), 51; https://doi.org/10.3390/medicines9100051 - 11 Oct 2022
Cited by 4 | Viewed by 1783
Abstract
Objectives: Physical activity carries numerous therapeutic benefits, and it is more effective when applied before the onset of symptoms. The objective of this study is to compare the correlation of the evaluation of physical activity carried out using the Ricci and Gagnon test [...] Read more.
Objectives: Physical activity carries numerous therapeutic benefits, and it is more effective when applied before the onset of symptoms. The objective of this study is to compare the correlation of the evaluation of physical activity carried out using the Ricci and Gagnon test and the frailty profile measured by the mSEGA scale in a population of patients consulting in general medicine. Methods: We conducted a retrospective study within a general practitioner clinic in Chaumont and Bologne (Haute-Marne department) during a 3-month period. Patients aged 65 years and up were screened for frailty using the modified SEGA (mSEGA) assessment, and physical activity was measured using the Ricci–Gagnon questionnaire. Results: A total of 44 patients were selected, with a slightly female predominance (59.1%). Of these, 21 patients reported having worked in manual labor. Seven patients were found to be frail using the SEGAm assessment, while 10 (22.73%) patients had an inactive profile according the Ricci–Gagnon score. Malnutrition was detected in six patients (13.64%) using the MNA survey. Frailty as defined by the mSEGA scale had no statistical correlation (p = 0.68) with the Ricci–Gagnon score. A Ricci–Gagnon inactive profile showed statistical correlations with fall indicators (unipedal balance test, p = 0.014) and malnutrition scores using the MNA (p = 0.0057) as well as with the Charlson Comorbidity Index (p = 0.027). Conclusion: A systematic survey of the elderly by a general practitioner implementing a regular and suitable physical activity regimen would allow a better screening of frailty, minimizing its complications. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
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9 pages, 309 KiB  
Brief Report
Association of Frailty Status with Risk of Fall among Hospitalized Elderly Patients: A Cross-Sectional Study in an Acute Geriatric Unit
by Abrar-Ahmad Zulfiqar, Perla Habchi, Ibrahima Amadou Dembele and Emmanuel Andres
Medicines 2022, 9(10), 48; https://doi.org/10.3390/medicines9100048 - 20 Sep 2022
Viewed by 1673
Abstract
Introduction: The objective was to study the association of frailty status in hospitalized elderly patients with risk of fall in an acute geriatric unit and to characterize elderly “fallers” using a comprehensive gerontological assessment. Patients and Methods: A cross-sectional study was conducted in [...] Read more.
Introduction: The objective was to study the association of frailty status in hospitalized elderly patients with risk of fall in an acute geriatric unit and to characterize elderly “fallers” using a comprehensive gerontological assessment. Patients and Methods: A cross-sectional study was conducted in patients over 65 years of age and hospitalized in an acute geriatric unit. This work was carried out in the Acute Geriatric Medicine Unit, Saint-Julien Hospital, Center Hospitalier Universitaire de Rouen from 1 June 2016 to 15 August 2016. Results: 172 patients were included during the collection period, with a female predominance of 115 patients (66.9%). The average age of the sample was 79.37 years old (65–85). The average CHARLSON score was 6.93 (3–16). Patients came from home in 81.4% of cases (i.e., 140 patients), and from a nursing home in 18.6% of cases (i.e., 32 patients). The risk of falling, as assessed by the Monopodal Support Test, returned as abnormal for 127 patients. In our series, there was a statistically strong link between the risk of falling and the presence of a dementia pathology (p = 0.009), the presence of a vitamin D deficiency (p = 0.03), the presence of frailty, as assessed by the three scales (modified SEGA scale, Fried scale and CFS/7 (<0.001), a high comorbidity score (p = 0.04), and a disturbed autonomy assessment according to IADL (p = 1.02 × 10−5) and according to ADL (p = 6.4 × 10−8). There was a statistically strong link between the risk of falling and the occurrence of death (p = 0.01). Conclusion: The consequences of the fall in terms of morbidity and mortality and the frequency of this event with advancing age and its impact on the quality of life as well as on health expenditure justify a systematic identification of the risk of falling in the elderly population. It is therefore important to have sensitive, specific, and reproducible tools available for identifying elderly people at high risk of falling. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
9 pages, 310 KiB  
Brief Report
Obesity and Frailty Syndrome in the Elderly: Prospective Study in Primary Care
by Abrar-Ahmad Zulfiqar, Perla Habchi and Ibrahima Amadou Dembele
Medicines 2022, 9(7), 38; https://doi.org/10.3390/medicines9070038 - 24 Jun 2022
Viewed by 1952
Abstract
Background: Obesity is a chronic pathology that affects people of all ages, from infants to the elderly, residing in both developed and developing countries. Objective: Our aim is to study the link between obesity and frailty in the elderly. Method: A prospective study [...] Read more.
Background: Obesity is a chronic pathology that affects people of all ages, from infants to the elderly, residing in both developed and developing countries. Objective: Our aim is to study the link between obesity and frailty in the elderly. Method: A prospective study was carried out in 12 General Medicine practices in Champagne-Ardenne, in the Departments of Marne and the Ardennes, France, for a period of 12 months (from 2 May 2019 through 30 April 2020). All patients included were aged 65 or older, in consultation with a general practitioner, and had an ADL (Activity of Daily Living) greater than or equal to 4. Frailty was measured using the Fried scale and the simplified ZULFIQAR frailty scale. Results: 268 patients aged 65 and over were included, with an average age of 77.5 years. A total of 100 were obese according to BMI. The mean Fried (/5) in the series was 1.57, and the mean sZFS (/5) was 0.91. Our study shows that obesity is not significantly correlated with frailty according to the FRIED sarcopenic scale, but is significantly correlated with frailty according to the sZFS scale. Conclusions: The link between obesity and frailty remains much debated, with the underlying emergence of sarcopenic obesity equally prevalent among the elderly. This is a preliminary study that should be followed by large-scale outpatient studies to better clarify the links between sarcopenia and obesity. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
4 pages, 279 KiB  
Brief Report
Zulfiqar Frailty Scale: Overview, Stakes, and Possibilities
by Abrar-Ahmad Zulfiqar and Ibrahima Dembélé
Medicines 2021, 8(12), 73; https://doi.org/10.3390/medicines8120073 - 23 Nov 2021
Cited by 2 | Viewed by 2360
Abstract
Very few frailty scales are used by general practitioners, as they are time consuming and cumbersome. We developed a frailty screening tool for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). This scale was tested in multiple general practitioners’ [...] Read more.
Very few frailty scales are used by general practitioners, as they are time consuming and cumbersome. We developed a frailty screening tool for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). This scale was tested in multiple general practitioners’ offices in France, and these studies were published. In this paper, we offer a summary of these results. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
7 pages, 550 KiB  
Brief Report
Concordance in mSEGA Tool to Frailty Diagnosis between Medical Doctors and Nurses
by Abrar-Ahmad Zulfiqar and Ibrahima Amadou Dembélé
Medicines 2021, 8(11), 63; https://doi.org/10.3390/medicines8110063 - 29 Oct 2021
Viewed by 2509
Abstract
Introduction: It is currently considered that screening for frailty in elderly subjects is a major public health issue. Methods: a cross-sectional pilot study involving elderly subjects (over 75 years of age) admitted at the emergency department of the hospital of Troyes, France in [...] Read more.
Introduction: It is currently considered that screening for frailty in elderly subjects is a major public health issue. Methods: a cross-sectional pilot study involving elderly subjects (over 75 years of age) admitted at the emergency department of the hospital of Troyes, France in the period from 24 August to 30 August 2017 was conducted. The patients were screened for frailty using the modified SEGA (Short Emergency Geriatric Assessment) (part A) grid (mSEGA), correlated with the subjective opinion of the triage nurse and the senior physician. Results: 100 patients were included during the pilot study period, the mean age was 84.34 years (range: 75–97), 56 patients (56%) were female, and the average CHARLSON score was 4.28 (range: 0–11). The patients’ previous medical histories were remarkable for cardiovascular diseases. The main reason for hospital admission was fall (26 subjects, 26%). Hospitalization was required for 52 subjects (52%). The average mSEGA score was 6.3 +/− 3.59. The completion time for the SEGAm (part A) score was about 5 minutes. According to Cohen’s kappa, the concordance between the subjective opinion of the triage nurse and the mSEGA grid was average, while the concordance between the subjective opinions of the senior physicians was good. Conclusion: The mSEGA score appears to be well-suited and useful in the emergency department. It is easy to use, allows an overall evaluation of the patient, and is not time-consuming. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
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11 pages, 496 KiB  
Brief Report
Validation of the Zulfiqar Frailty Scale (ZFS): A New Tool for General Practitioners
by Abrar-Ahmad Zulfiqar
Medicines 2021, 8(9), 52; https://doi.org/10.3390/medicines8090052 - 4 Sep 2021
Cited by 4 | Viewed by 2668
Abstract
Introduction: The early detection of frailty, a frequent transient state that can be reversible in the elderly and is responsible for significant morbidity and mortality, helps prevent complications from it. Objective: To evaluate the performance of the “ZFS” tool to screen for frailty [...] Read more.
Introduction: The early detection of frailty, a frequent transient state that can be reversible in the elderly and is responsible for significant morbidity and mortality, helps prevent complications from it. Objective: To evaluate the performance of the “ZFS” tool to screen for frailty as defined SEGA scale criteria in an ambulatory population of patients at least 65 years of age. Methods: A prospective non-interventional study conducted in Alsace for a duration of six months that included patients aged 65 and over, judged to be autonomous with an ADL > 4/6. Results: In this ambulatory population of 102 patients with an average age of 76 years, frailty, according to modified SEGA criteria grid A, had a prevalence of 19.6%. Frailty, according to the “ZFS” tool, had a prevalence of 35.0%, and all of its elements except weight loss were significantly associated with frailty. Its threshold for identifying frailty is three criteria out of six. It was rapid (average completion time: 87 s), had a sensitivity of 100%, and a negative predictive value of 100%. Conclusions: The “ZFS” tool makes it possible to screen for frailty with a high level of sensitivity and a negative predictive value. Full article
(This article belongs to the Special Issue Frailty Syndrome in the Elderly: A Real Challenge for Our Society)
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