S1.4 Once frail – always frail? Frailty prevalence and possible intervention against frailty
Once frail - always frail? Frailty prevalence and possible interventions against frailty
Chair: Anette Hylen Ranhoff
Introduction to the symposium: Frailty, defined as reduction of physiological reserves, is partly a result of biological ageing, but also of lifestyle and diseases. Frailty is a predictor of functional decline and death and interventions targeting frailty is an important issue in geriatric medicine. ADVANTAGE is a EU Joint Action project, with aim to find prevalence and develop a road-map for prevention and management of frailty to diminish functional decline in older adults. In this line, this symposium will present prevalence of frailty at a population level and discuss three different strategies to counteract frailty; general life-style and health at a population level, invasive cardiac intervention and systematic targeted intervention before chemotherapy against colorectal cancer. The frailty phenotype as a predictor of all-cause mortality in community-living women and men aged 70 years and older: The Tromsø Study 2001-2016 (Laila Arnesdatter Hopstock, Norway).
S1.4.1 The frailty phenotype as a predictor of all-cause mortality in community-living women and men aged 70 years and older: The Tromsø Study 2001-2016
Petja Lyn Langholz1, Bjørn Heine Strand2,3, Sarah Cook4, Laila Arnesdatter Hopstock1
1 UiT The Arctic University of Norway, Tromsø, Norway, 2Norwegian Institute of Public Health,
3University of Oslo, Norway, 4London School of Hygiene & Tropical Medicine, UK, London, UK
Background: An important and challenging manifestation of the aging population is the clinical condition of frailty. There is a lack of data on frailty prevalence and studies of the association between frailty and mortality in a Norwegian general population. The aim of this study was to investigate the ability of the frailty phenotype to predict all-cause mortality in a Norwegian population. Methods: We followed 712 participants (52% women) 70+ years in the population-based Tromsø 5 Study in 2001-02 for all-cause mortality up to 2016. The frailty status at baseline was defined by a modified version of Fried’s frailty criteria. Cox regression models were used to analyse the association between frailty and mortality with adjustment for age, disability, comorbidity, smoking status and years of education. Results: In total, 4% (n=27) of participants were frail and 38% (n=271) were pre-frail. During follow-up (mean 10.1 years), 501 (70%) participants died. We found an increased risk of mortality for frail elderly (multivariate-adjusted HR 3.72 (95% CI 2.12, 6.54)) compared to non-frail elderly. In sex-stratified analysis the adjusted HR was 6.33 (95% CI 2.68, 14.94) for frail men and 2.79 (95% CI 1.29, 6.03) for frail women. The results for pre-frailty showed an overall weaker association with mortality. Conclusion: Frailty was strongly associated with mortality. The findings suggest that the risk is higher for frail men than frail women.
S1.4.2. On behalf of the CARDELIR Investigators: Change in frailty status in octogenarians after cardiac intervention (aortic valve implantation)
Astri Frantzen1, Bengt Fridlund1, 2, Lesley S. P. Eide3, Rune Haaverstad1, 3, Karl Ove. Hufthammer1, Karel K. J. Kuiper1, Anette Hylen Ranhoff3, Tone M. Norekval1, 3
1 Haukeland University Hospital, Bergen, Norway, 2 Jönköping University, Sweden, 3 University of Bergen, Norway
Background: As the number of octogenarians being referred to cardiac interventions is growing, assessing for frailty has received increased attention in terms of predicting outcome and defining clinical utility. The aim of the study was to investigate if frailty is amenable to change after transcatheter aortic valve implantation (TAVI) or surgical replacement (SAVR). Methods: In this observational prospective cohort study including octogenarians (80+ years) with symptomatic aortic stenosis (AS) accepted for TAVI or SAVR, frailty status was assessed one day prior to and six months after valve therapy using the Study of Osteoporotic Fracture (SOF) frailty index. Patients were categorized as robust, pre-frail and frail according to the specific criteria. Results: In all, 143 patients were included, mean age 83 years (SD 2.7). At baseline 34% were robust, 27% pre-frail and 39% frail. There was no change in overall frailty status after six months compared to baseline (p = .16), but changes in frailty status at an individual level. Frailty status improved in 40 patients, deteriorated in 25, and remained the same in 54 patients. Conclusion: One third of patients improved in frailty status, showing that cardiac intervention has potential to improve frailty-status, but also to aggravate frailty. Further research is required to determine characteristics of patients who are likely to benefit, as well as to have increased risk of increasing frailty before cardiac interventions.
S1.4.3 The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomized trial (GERICO)
Cecilia M. Lund1, Kirsten K. Vistisen1, Christian Dehlendorff2, Finn Rønholt1, J.S. Johansen1, 3, Dorte L Nielsen1, 3
1 Herlev and Gentofte Hospital, Denmark, 2Danish Cancer Society Research Center, Denmark,
3University of Copenhagen, Denmark
Background: Older patients with colorectal cancer (CRC) are at high risk of severe chemotherapy toxicity. The older patients are a very heterogeneous group, ranging from fit to frail with various comorbidities. With the increasing CRC incidence throughout life, and as populations are aging, the number of older patients needing chemotherapy for CRC is rapidly growing. The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary evaluation of an older individual’s health status. In cancer patients, CGA can predict survival, chemotherapy toxicity and morbidity. Research is limited on the effect of CGA based interventions in frail older cancer patients. Methods: This randomized controlled trial (GERICO) investigates whether CGA based interventions before and during chemotherapy in frail older patients with stages II–IV CRC will increase number of patients completing scheduled chemotherapy at start dose (primary endpoint). Patients ? 70 years are screened for frailty using the G8 questionnaire. Frail patients are offered inclusion and are randomized into the intervention and the control group. Patients in the intervention group receive CGA of comorbidity, medication, nutritional status, psycho-cognitive and physical function with interventions on identified health issues. Simultaneously, all patients receive chemotherapy according to international guidelines. Patients in the control group receive standard supportive care. Secondary outcomes are dose reductions, toxicity, time to recurrence/progression, survival, mortality and quality of life. Results: 90 of 140 patients are included in this ongoing trial (median age 75 years (70-88). In the intervention group (N=38), following interventions has been initiated: change in medications (20 patients (53%)), nutritional therapy (28 patients (74%)), physiotherapy (25 patients (66%)) and 13 patients (34%) needed other referrals. Conclusion: The GERICO study will provide knowledge about whether it is beneficial for older frail patients undergoing chemotherapy for CRC to be treated simultaneously by a geriatrician. Presentation will contain updated data about included patients.