The integration of frailty into clinical practice: preliminary results from the Gérontopôle

J Subra, S Gillette-Guyonnet, M Cesari, S Oustric, B Vellas
Journal of Nutrition, Health & Aging 2012, 16 (8): 714-20

BACKGROUND: Disability is commonly considered as an irreversible condition of advanced age. Therefore, preventive actions need to be taken before the disabling cascade is fully established, that is in the pre-disability phase defined "frailty syndrome". The complexity and heterogeneity of frailty requires a clinical approach based on multidimensionality and multidisciplinary. In this paper, we present the main characteristics of the newborn Platform for Evaluation of Frailty and Prevention of Disability (Toulouse, France).

INTERVENTION: Persons aged 65 years and older screened for frailty by general practitioners in the Toulouse area are invited to undergo a multidisciplinary evaluation at the Platform. Here, the individual is multidimensionality assessed in order to preventively detect potential risk factors for disability. At the end of the comprehensive evaluation, the team members propose the patient (in agreement with the general practitioner) a preventive intervention program specifically tailored to the his/her needs and resources.

RESULTS: Mean age of our population is 82.7 years, with a large majority aged 75 years and older. Most patients are women (61.9%) Approximately two thirds of patients received any kind of regular help. Regarding level of frailty, 65 patients (41.4%) were pre-frail, and 83 (52.9%) frail. For what concerns the functional status, 83.9% of patients presented slow gait speed, 53.8% were sedentary, and 57.7% had poor muscle strength. Only 27.2% of patients had a SPPB score equal to or higher than 10. Autonomy in ADL was quite well preserved (mean ADL score 5.6 ± 0.8) as expected, suggesting that the patients of the platform have not yet developed disability. Consistently, IADL showed a marginal loss of autonomy reporting a mean score of 6.0 ± 2.3. About one third of patients (33.1%) presented a MMSE score lower than 25. Dementia (measured by the CDR scale) was observed in 11.6% of the platform population, whereas subjects with mild cognitive impairment (that is CDR equal to 0.5) were 65.8%. New diagnosed depressive disorders were relatively rare with only 3.2% of patients showing signs of depression but some people were already treated. Numerous patients presented vision problems with 10.4% having abnormal findings at the Amsler grid. Finally, it is noteworthy that 9% of the platform population presented an objective state of protein-energy malnutrition, 34% an early alteration of nutritional status, while almost everyone (94.9%) had a vitamin D deficiency (partially explained by the period of the year, that is winter-spring, of most of the measurements).

CONCLUSION: The Platform clinically evaluates and intervenes on frailty for the first time at the general population-level. This model may serve as preliminary step towards a wider identification of early signs of the disabling cascade in order to develop more effective preventive interventions.

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