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Deacutetection de la fragiliteacute Quels outils
Prof Didier Schoevaerdts MD PhD
23032018
2
Deacutepistage
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
3
Les 10 critegraveres de lrsquoOMS pour un deacutepistage
bull Problegraveme majeur de santeacute publique
bull Histoire naturelle connue
bull Diagnostic possible des stades preacutecoces
bull Reacutesultats des traitements preacutecoces supeacuterieurs
bull Bonne performance du test
bull Test acceptable pour la population
bull Moyens pour diagnostic et traitement acceptables
bull Test pouvant ecirctre reacutepeacuteteacute agrave intervalles reacuteguliers
bull Nuisances du deacutepistages lt beacuteneacutefices
bull Coucirct deacutepasseacute par les beacuteneacutefices
Wilson et Junger WHO 1970
4
Fragiliteacute
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
5
La fragiliteacute un concept en cours de deacutefinition
bull Etat de vulneacuterabiliteacute lors drsquoune situation de stresso Etat stable ou situation aigue
bull Diffeacuterent de lrsquoacircge chronologique des incapaciteacutes et de la poly-pathologie
bull Touche plusieurs domaines de la santeacute
bull Atteinte multi-systeacutemique
bull Origine multiple
bull Physiopathologie complexe (nutrition sarcopeacutenie inflammation)
bull Associeacutee agrave des conseacutequences neacutegativeso Syndromes G deacuteclin fonctionnel institutionnalisation mortaliteacute
bull Transition dynamique o Niveaux de seacuteveacuteriteacutes et bascules brutales ou progressives
Clegg A Lancet 2013
6
Facteurs de risques de deacuteclin fonctionnel
bull Mauvaise perception de son eacutetat de santeacute
bull Tr cognitifs Anxieacuteteacute Deacutepression
bull Tr sensoriels
bull BMI faible
bull Faiblesse musculaire
bull Niveau drsquoactiviteacute faible
bull Co-morbiditeacutes
bull Polymeacutedication
bull Alcoolisme et tabagisme
bull Isolement social
Stuck AE Social Science amp Medicine 199948445-469
7
Quels outils
8
Pour quels objectifs bull Preacutedire mieux que le jugement clinique
o Des conseacutequences neacutegatives
o Etablir un pronostic
o Une reacuteponse agrave un traitement
bull Mesurer
o Stades de seacuteveacuteriteacutes
o Effets drsquoune intervention
o Recherche clinique (eacutepideacutemiologie interventionshellip)
bull Orienter et agir
o Le plan de soins (preacuteventif ou curatif)
o Dans la filiegravere de soins
bull Comprendre la physiopathologie
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
2
Deacutepistage
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
3
Les 10 critegraveres de lrsquoOMS pour un deacutepistage
bull Problegraveme majeur de santeacute publique
bull Histoire naturelle connue
bull Diagnostic possible des stades preacutecoces
bull Reacutesultats des traitements preacutecoces supeacuterieurs
bull Bonne performance du test
bull Test acceptable pour la population
bull Moyens pour diagnostic et traitement acceptables
bull Test pouvant ecirctre reacutepeacuteteacute agrave intervalles reacuteguliers
bull Nuisances du deacutepistages lt beacuteneacutefices
bull Coucirct deacutepasseacute par les beacuteneacutefices
Wilson et Junger WHO 1970
4
Fragiliteacute
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
5
La fragiliteacute un concept en cours de deacutefinition
bull Etat de vulneacuterabiliteacute lors drsquoune situation de stresso Etat stable ou situation aigue
bull Diffeacuterent de lrsquoacircge chronologique des incapaciteacutes et de la poly-pathologie
bull Touche plusieurs domaines de la santeacute
bull Atteinte multi-systeacutemique
bull Origine multiple
bull Physiopathologie complexe (nutrition sarcopeacutenie inflammation)
bull Associeacutee agrave des conseacutequences neacutegativeso Syndromes G deacuteclin fonctionnel institutionnalisation mortaliteacute
bull Transition dynamique o Niveaux de seacuteveacuteriteacutes et bascules brutales ou progressives
Clegg A Lancet 2013
6
Facteurs de risques de deacuteclin fonctionnel
bull Mauvaise perception de son eacutetat de santeacute
bull Tr cognitifs Anxieacuteteacute Deacutepression
bull Tr sensoriels
bull BMI faible
bull Faiblesse musculaire
bull Niveau drsquoactiviteacute faible
bull Co-morbiditeacutes
bull Polymeacutedication
bull Alcoolisme et tabagisme
bull Isolement social
Stuck AE Social Science amp Medicine 199948445-469
7
Quels outils
8
Pour quels objectifs bull Preacutedire mieux que le jugement clinique
o Des conseacutequences neacutegatives
o Etablir un pronostic
o Une reacuteponse agrave un traitement
bull Mesurer
o Stades de seacuteveacuteriteacutes
o Effets drsquoune intervention
o Recherche clinique (eacutepideacutemiologie interventionshellip)
bull Orienter et agir
o Le plan de soins (preacuteventif ou curatif)
o Dans la filiegravere de soins
bull Comprendre la physiopathologie
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
3
Les 10 critegraveres de lrsquoOMS pour un deacutepistage
bull Problegraveme majeur de santeacute publique
bull Histoire naturelle connue
bull Diagnostic possible des stades preacutecoces
bull Reacutesultats des traitements preacutecoces supeacuterieurs
bull Bonne performance du test
bull Test acceptable pour la population
bull Moyens pour diagnostic et traitement acceptables
bull Test pouvant ecirctre reacutepeacuteteacute agrave intervalles reacuteguliers
bull Nuisances du deacutepistages lt beacuteneacutefices
bull Coucirct deacutepasseacute par les beacuteneacutefices
Wilson et Junger WHO 1970
4
Fragiliteacute
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
5
La fragiliteacute un concept en cours de deacutefinition
bull Etat de vulneacuterabiliteacute lors drsquoune situation de stresso Etat stable ou situation aigue
bull Diffeacuterent de lrsquoacircge chronologique des incapaciteacutes et de la poly-pathologie
bull Touche plusieurs domaines de la santeacute
bull Atteinte multi-systeacutemique
bull Origine multiple
bull Physiopathologie complexe (nutrition sarcopeacutenie inflammation)
bull Associeacutee agrave des conseacutequences neacutegativeso Syndromes G deacuteclin fonctionnel institutionnalisation mortaliteacute
bull Transition dynamique o Niveaux de seacuteveacuteriteacutes et bascules brutales ou progressives
Clegg A Lancet 2013
6
Facteurs de risques de deacuteclin fonctionnel
bull Mauvaise perception de son eacutetat de santeacute
bull Tr cognitifs Anxieacuteteacute Deacutepression
bull Tr sensoriels
bull BMI faible
bull Faiblesse musculaire
bull Niveau drsquoactiviteacute faible
bull Co-morbiditeacutes
bull Polymeacutedication
bull Alcoolisme et tabagisme
bull Isolement social
Stuck AE Social Science amp Medicine 199948445-469
7
Quels outils
8
Pour quels objectifs bull Preacutedire mieux que le jugement clinique
o Des conseacutequences neacutegatives
o Etablir un pronostic
o Une reacuteponse agrave un traitement
bull Mesurer
o Stades de seacuteveacuteriteacutes
o Effets drsquoune intervention
o Recherche clinique (eacutepideacutemiologie interventionshellip)
bull Orienter et agir
o Le plan de soins (preacuteventif ou curatif)
o Dans la filiegravere de soins
bull Comprendre la physiopathologie
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
4
Fragiliteacute
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
5
La fragiliteacute un concept en cours de deacutefinition
bull Etat de vulneacuterabiliteacute lors drsquoune situation de stresso Etat stable ou situation aigue
bull Diffeacuterent de lrsquoacircge chronologique des incapaciteacutes et de la poly-pathologie
bull Touche plusieurs domaines de la santeacute
bull Atteinte multi-systeacutemique
bull Origine multiple
bull Physiopathologie complexe (nutrition sarcopeacutenie inflammation)
bull Associeacutee agrave des conseacutequences neacutegativeso Syndromes G deacuteclin fonctionnel institutionnalisation mortaliteacute
bull Transition dynamique o Niveaux de seacuteveacuteriteacutes et bascules brutales ou progressives
Clegg A Lancet 2013
6
Facteurs de risques de deacuteclin fonctionnel
bull Mauvaise perception de son eacutetat de santeacute
bull Tr cognitifs Anxieacuteteacute Deacutepression
bull Tr sensoriels
bull BMI faible
bull Faiblesse musculaire
bull Niveau drsquoactiviteacute faible
bull Co-morbiditeacutes
bull Polymeacutedication
bull Alcoolisme et tabagisme
bull Isolement social
Stuck AE Social Science amp Medicine 199948445-469
7
Quels outils
8
Pour quels objectifs bull Preacutedire mieux que le jugement clinique
o Des conseacutequences neacutegatives
o Etablir un pronostic
o Une reacuteponse agrave un traitement
bull Mesurer
o Stades de seacuteveacuteriteacutes
o Effets drsquoune intervention
o Recherche clinique (eacutepideacutemiologie interventionshellip)
bull Orienter et agir
o Le plan de soins (preacuteventif ou curatif)
o Dans la filiegravere de soins
bull Comprendre la physiopathologie
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
5
La fragiliteacute un concept en cours de deacutefinition
bull Etat de vulneacuterabiliteacute lors drsquoune situation de stresso Etat stable ou situation aigue
bull Diffeacuterent de lrsquoacircge chronologique des incapaciteacutes et de la poly-pathologie
bull Touche plusieurs domaines de la santeacute
bull Atteinte multi-systeacutemique
bull Origine multiple
bull Physiopathologie complexe (nutrition sarcopeacutenie inflammation)
bull Associeacutee agrave des conseacutequences neacutegativeso Syndromes G deacuteclin fonctionnel institutionnalisation mortaliteacute
bull Transition dynamique o Niveaux de seacuteveacuteriteacutes et bascules brutales ou progressives
Clegg A Lancet 2013
6
Facteurs de risques de deacuteclin fonctionnel
bull Mauvaise perception de son eacutetat de santeacute
bull Tr cognitifs Anxieacuteteacute Deacutepression
bull Tr sensoriels
bull BMI faible
bull Faiblesse musculaire
bull Niveau drsquoactiviteacute faible
bull Co-morbiditeacutes
bull Polymeacutedication
bull Alcoolisme et tabagisme
bull Isolement social
Stuck AE Social Science amp Medicine 199948445-469
7
Quels outils
8
Pour quels objectifs bull Preacutedire mieux que le jugement clinique
o Des conseacutequences neacutegatives
o Etablir un pronostic
o Une reacuteponse agrave un traitement
bull Mesurer
o Stades de seacuteveacuteriteacutes
o Effets drsquoune intervention
o Recherche clinique (eacutepideacutemiologie interventionshellip)
bull Orienter et agir
o Le plan de soins (preacuteventif ou curatif)
o Dans la filiegravere de soins
bull Comprendre la physiopathologie
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
6
Facteurs de risques de deacuteclin fonctionnel
bull Mauvaise perception de son eacutetat de santeacute
bull Tr cognitifs Anxieacuteteacute Deacutepression
bull Tr sensoriels
bull BMI faible
bull Faiblesse musculaire
bull Niveau drsquoactiviteacute faible
bull Co-morbiditeacutes
bull Polymeacutedication
bull Alcoolisme et tabagisme
bull Isolement social
Stuck AE Social Science amp Medicine 199948445-469
7
Quels outils
8
Pour quels objectifs bull Preacutedire mieux que le jugement clinique
o Des conseacutequences neacutegatives
o Etablir un pronostic
o Une reacuteponse agrave un traitement
bull Mesurer
o Stades de seacuteveacuteriteacutes
o Effets drsquoune intervention
o Recherche clinique (eacutepideacutemiologie interventionshellip)
bull Orienter et agir
o Le plan de soins (preacuteventif ou curatif)
o Dans la filiegravere de soins
bull Comprendre la physiopathologie
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
7
Quels outils
8
Pour quels objectifs bull Preacutedire mieux que le jugement clinique
o Des conseacutequences neacutegatives
o Etablir un pronostic
o Une reacuteponse agrave un traitement
bull Mesurer
o Stades de seacuteveacuteriteacutes
o Effets drsquoune intervention
o Recherche clinique (eacutepideacutemiologie interventionshellip)
bull Orienter et agir
o Le plan de soins (preacuteventif ou curatif)
o Dans la filiegravere de soins
bull Comprendre la physiopathologie
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
8
Pour quels objectifs bull Preacutedire mieux que le jugement clinique
o Des conseacutequences neacutegatives
o Etablir un pronostic
o Une reacuteponse agrave un traitement
bull Mesurer
o Stades de seacuteveacuteriteacutes
o Effets drsquoune intervention
o Recherche clinique (eacutepideacutemiologie interventionshellip)
bull Orienter et agir
o Le plan de soins (preacuteventif ou curatif)
o Dans la filiegravere de soins
bull Comprendre la physiopathologie
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
9
Un concept utilehellip
Clinique
Cibler
Preacutevenir
Orienter
Deacutecider
Santeacute publique
Expliquer
Preacutevoir
Scientifique
Inclure
Preacutevenir
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
10
Measurement properties of instrumentsThe COSMIN CHECKLIST
Exemple Measurement
Reliability-Internal consistency-Reliability-Measurement error
Inter-relatedness of itemsInter-intra and test retestSystematic or random error
Cronbach alphaCohenrsquos Kappa
Validity- Content validity
- Construct validity
- Criterion validity
Adequate reflexion of the constructFace validity (a good look)Score consistent with hypothesisHypothesis testing
Structural validity (adequate reflexion of
dimensionality of construct)
Cross-cultural validity
Adequate reflexion of a gold standard
Delphy method
Relation with other instrumentsDifferences between groupsOdds ratio Se SpExploratory factor analysis
Translation in other countries
Responsiveness Detect a change over time
Interpretability To assign qualitative meaning
Mokking LB J of Clinical Epidemiology 2010 63 737-745
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
11
Preacutediction des conseacutequences neacutegatives
Clegg A Lancet 2013
Quid des autres syndromes geacuteriatriques
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
12Kim SW Archives of Gerontology and Geriatrics 2017
N=365gt65years Geriatric Center Seoul
Frailty indexlt0202-035gt035
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
13Kim SW Archives of Gerontology and Geriatrics 2017
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
14
361 high and extreme-risk patients2011-2015 Atlanta Georgia
Composite outcomes 2830 days mortality 58365 days mortality 125
Frailty markers1 Albumin le 35 gdl2 Grip strength 247 kg or 147 kg3 ADL le 65 5m Walk test le61 or 93 sec
Forcillo j Ann Thorac Surg 2017
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
15Forcillo j Ann Thorac Surg 2017
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
16
mCGA n=288 Oncologist n=286
Frail 49 36
FrailFrail 25
FitFit 40
FrailFit 23 (colorectal cancer localised disease curative treatment)
Kappa 030
Onco surv mCGA adj HR 161 (114-227)
Kirkhus L British Journal of Cancer 2017
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
17
Questions compleacutementaires au preacutealable
o Domicile structures de long seacutejours clinique ambulatoire hospitalisation
o Quel lieux o Quel public cible
o PA admise aux urgences
o En oncologie-heacutematologie
o En preacuteopeacuteratoire
o En cardiovasculaire
o En orthopeacutedie
o En neacutephrologie
o En heacutepatologie
o Temps souhaiteacute
o Avis objectif ou subjectif
o Auto ou heacuteteacutero-eacutevaluation
o Mateacuteriel ou formation speacutecifique
o Multi-domaine ou uni-domaine
o One step or two step approach
o Deacutepistage ou mini-eacutevaluation rapide
o Avant ou apregraves un CGA
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
18
La grande marmite
Outils multidimensionnels
o Friedrsquos Fraily Phenotype
o Frailty Index-CD or CGA
o Study of OsteoporoticFractures (SOF)
o Edmonton Frailty Scale
o FRAIL-index
o Gerontopocircle frailty Screening Tool (GFST)
o Groningen Frailty Indicator(GFI)
o Tilburg Frailty Indicator (TFI)
Outils uni-dimenionnels
o Gait Speed
o Handgrip
o Get-Up and Go test
o Short Physical Performance Score
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
19
Instruments citeacutes freacutequemment
Buta BJ Ageing Research Reviews 2016
Fried
MitniskiRockwood
Tinetti
Rockwood
Rockwood
Saliba
Vellas
Gill
Winograd
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
20Buta BJ Ageing Research Reviews 2016
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
21
Domaines inclus dans les outils
Buta BJ Ageing Research Reviews 2016
Et la thymie Et les facteurs contextuels Et lrsquoaidant proche
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
22
Usage des outils drsquoeacutevaluation
Buta BJ Ageing Research Reviews 2016
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
23
bull 29 outils diffeacuterents en 2015
bull Pas drsquooutil standard international
bull Usage clinique ou eacutepideacutemiologique
bull FI et FPP les plus robustes
o Fiabiliteacute
o Preacutediction
o Support theacuteorique biologique
bull Deacutefaut de validation interculturelle
Dent E European Journal of Internal Medicine 2016
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
24
Les deux grands modegraveles
Le Pheacutenotype Physique de Fried
o 2001
o Etude longitudinale CHS
o Analyse secondaire
o N=5210
o 5 mesures
o 3 cateacutegories
o Variable cateacutegorielle
o Mortaliteacute agrave 7 anso adj HR 163 (127-208)
Le Frailty Index de Rockwood et Mitnitski
o 2001
o Etude longitudinale CSHA
o Analyse secondaire
o N=10 263
o 92 deacuteficits
o Index (n deacuteficitsn domaines)
o Variable continue
o Mortaliteacute agrave 10 anso Adj HR 157 (141-174)
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
25
Le pheacutenotype physique de Fried 2001
Lower quintile at GRIP STRENGTH
Lower quintile at WALKING SPEED
WEIGHT LOSS more than 45 kg past year
EXHAUSTION criteria
Lower quartile for PHYSICAL ACTIVITY
Fried et al J Gerontol Med Sc 200156A M146ndashM156
gt=3 frail
1-2 intermediate
0 robust Cardiovascular Health Study
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
26Theou O Ageing research review 2015
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
27
Modegravele de fragiliteacute Le Frailty Index
Liste de deacuteficits (rapport deacuteficits nb max de deacuteficits)
Fonctionnel cognitif psychologique mobiliteacute morbiditeacutehellip
Via une eacutevaluation geacuteriatrique
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
282828
Frailty Index Rockwood et al
46 70 100 laquo deacuteficits raquo
Deacutependance
Pbm meacuted
Seuil de fragiliteacute 025
Neacutecessite une EGS
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
29
Modegraveles de fragiliteacute vers une convergencehellip
29 Whitson et al J Gerontol 200762A728-730
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
30Malmstrom TK JAGS 2014
Comorbidity
1
2
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
31Malmstrom TK JAGS 2014
ADL agrave 9ans iADL agrave 9ans
mortaliteacute agrave 9ans
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
32
bull 38 multi-component frailty assessment tools
bull Outils souvent deacuteveloppeacutes de faccedilon reacutetrospective comme objectif secondaire
bull Validiteacute et fideacuteliteacute disponibles dans 21 des cas
bull Validiteacute et fiabiliteacute suffisante dans 5 des cas
bull TFI et GFI avaient le plus drsquoeacutevaluation psychomeacutetriques
Sutton JL BMC Geriatrics 2016
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
33
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
ltlt Prev Table 12 Next gtgtPMC full text JBI Database System Rev Implement Rep 2017 Apr 15(4) 1154ndash1208
Published online 2017 May 25 doi 1011124JBISRIR-2016-003018
CopyrightLicense Request permission to reuse
Table 12
Summary of evidence for outcomes of reliability validity and diagnostic accuracy
Images in this article
JBI DATABASE OF SYSTEMATIC REVIEWS
AND IMPLEMENTATION REPORTS
Apostolo J JBI Database of Systematic Reviews and implementationReports 2017
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
34
Conclusions de cette revuebull Sur 5 revues soit 227 381 patients 26 instruments ou
questionnaires eacutevalueacutes et 8 indicateurs
bull Donneacutees surtout dans la communauteacute
bull Peu drsquoinstruments valides reproductibles et performants
bull Inteacuterecirct des outils multi-domaines dont le Frailty Index
bull Inteacuterecirct comme outils preacutedicteurs simples
o La vitesse de marche tregraves sensible et tregraves bon pouvoir preacutedictif mais speacutecificiteacute modeacutereacutee
o Perception subjective de santeacute
bull Faible performance des instruments en salle drsquourgence
bull TFI fidegravele valide mais discrimination agrave confirmerApostolo J JBI Database of Systematic Reviews and implementationReports 2017
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
35Theou O Age and Ageing 2015
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
36
Outils en oncologie
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
37
Hamaker ME The lancet oncology 2012
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
38
Outils en bilan preacute-opeacuteratoire
Auteur Date (Insertion gt En-tecirctePied de page gt Appliquer partout)
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
39Frontiers in Public Health 2016
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
40
Comment eacutevaluer la fragiliteacute dans le contexte preacuteopeacuteratoire
Edmonton Frail Scale
Recommandeacute par la BGS (consensus frailty 2014) ndash environ 5 minutes
Disponible sur appstore et google play
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
41
Outils en meacutedecine geacuteneacuterale
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
42Pialoux T Geriatr Gerontol Int 2012
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
43
Le Tilburg Frailty Indicator (14 minutes)bull Sex age marital status country level of education income
bull How healthy would you say your lifestyle is
bull gt two or more diseases andor chronic disorders
bull Have you experienced one or more of the following events during the pastyear
bull Do you feel physically healthy
bull Have you lost a lot of weight recently
bull Do you experience problems in your daily life
bull Do you have problems with your memory
bull Have you felt down during the last month
bull Have you felt nervous or anxious during the last month
bull Are you able to cope with problems well
bull Do you live alone
bull Do you sometimes miss having people around you
bull Do you receive enough support from other people
Gobbens RJJ et al J Am Med Dir Assoc 2010 11(5)344-355
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
44
Le PRISMA 7 (3 minutes auto-questionnaire)
ge 3 = Frail
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
45
Best practice guidelines for the management of frailty a British Geriatrics Society Age UK and Royal College of General Practitioners
report
bull RECOGNITION OF FRAILTY
o The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailtyo A gait speed lt08ms
o Timed-up-and-go test gt10s
o PRISMA 7 ge 3
o Common clinical presentations falls delirium sudden immobility
Turner G Clegg A Age Ageing 2014
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
46
Les outils aux urgences
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
47Dent E Age and Ageing 2014
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
48de Saint-hubert M J Nutr Health and Ageing 2010
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
49
SHERPAScore Hospitalier drsquoEacutevaluation du Risque de la Perte drsquoAutonomie
Items Score
Age lt75 ans 0
75-84 ans 15
gt84 ans 3
MMSE gt=1521 0
lt15 2
AIVJ 6-7 0
5 1
3-4 2
0-2 3
Chutes Non 0
Oui 2
Santeacute perccedilue Bonne = 0
Mauvaise 15
Cateacutegories de risque
Deacuteclin fonctionnel
agrave 3 mois
OR
Faible 0 ndash 3 13 1
Leacuteger 35 ndash 45 23 2
5 - 6 39 4
gt6 62 10
49
P Cornette et al Eur J Public Health 2006
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
50
ISAR
OUI NON
Hospitalisation reacutecent (6 mois)
1 point par item positifgt= 3 ISAR consideacutereacute +
Seacuterieux problegravemes de vue
Seacuterieux problegravemes de meacutemoire
3 meacutedicaments ou plus
Besoin drsquoaide AVJ avant lrsquoadmission
Besoin drsquoaide accru reacutecent
ATTENTION
MRMRS
Deacutemence
Chute dans le mois
McCusker J et al JAGS 1999 47Hoogerduin J et al Age Ageing 201443 ISAR-HP et DF
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
51
SEGA
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
52
Validation works
bull Excellent feasability and acceptability
bull Short time 5 - 8 minutes
bull Good internal consistency
bull Good test-retest reliability
bull Good discrimination
bull Good predictive validity (mortality and NH admission)
Screening for frailty in elderly subjects living at home validation of the Modified Short Emergency Geriatric Assessment (SEGAm) instrument Oubaya N et al J Nutr Health and Ageing 2014
External validation of the short emergency geriatric assessment (SEGA) instrument on the SAFES cohort Tardieu E et al Geriatr Psychol Neuropsychiatr Vieil 2016
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
53
Les indicateurs simples
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
54Clegg A Age and Ageing 2015
N= 3261Median frailty prevalence of 1057 index tests assessed
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
55Vermeulen BMC Geriatrics 2011
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
56
En pratique Two- step approach
1 Screening Outil rapide bonne sensibiliteacute
ISAR ou SHERPA pour patient acircgeacute aux urgences puis SEGA
EFS pour patients acircgeacutes avant chirurgie
G8 ou VES-13 pour patients acircgeacutes en oncologie
En meacutedecine geacuteneacuterale EFS SEGA
2 EGS des personnes identifieacutees laquo agrave risque de fragiliteacute raquo
Mise en place drsquointerventions
Suivi neacutecessiteacute drsquooutils sensibles aux changements
56
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
57
Conclusions
bull Pas drsquooutil consensuel
bull Rien ne remplacera lrsquoEGS
bull Proposer une approche en deux temps
o Test de deacutepistage tregraves sensible
o Test de reacutefeacuterence standard tregraves speacutecifique
bull Etudes neacutecessaires sur lrsquoeffet des deacutepistages sur les interventions proposeacutees
bull Etudes neacutecessaires sur lrsquoorientation theacuterapeutique qui suivra
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
59
Le Groningen FrailtyIndicator
ge415= moderateto severefrailty
GFI ( Groningen Frailty Index ) Circle the appropriate answer and add scores
YES NO Mobility Can the patient perform the following tasks without assistance from another person ( walking aids such as a can or a wheelchair are allowed)
1 Grocery shopping 0 1
2 Walk outside house ( around house or to neighbour) 0 1
3 Getting (un)dressed 0 1
4 Visiting restroom 0 1
Vision
5 Does the patient encounter problems in daily life because of impaired vision
1 0
Hearing
6 Does the patient encounter problems in daily life because of impaired hearing
1 0
Nutrition
7 Has the patient unintentionally lost a lot of weight in the past 6 months (6kg in 6 months or 3kg in 3 months)
1 0
Co-morbidity
8 Does the patient use 4 or more different types of medication 1 0
YES NO SOMETIMES
Cognition
9 Does the patient have any complaints on hisher memory (or diagnosed with dementia)
1 0 0
Psychosocial
10 Does the patient ever experience emptiness around him eg You feel so sad that you have no interest in your surroundings Or if someone you love no longer love you how do you feel
1 0 1
11 Does the patient ever miss the presence of other people around him Or do you miss anyone you love
1 0 1
12 Does the patient ever feel left alone eg You wish there is someone to go with you for something important
1 0 1
13 Has the patient been feeling down or depressed lately 1 0 1
14 Has the patient felt nervous or anxious lately 1 0 1
Physical Fitness
15 How would the patient rate hisher own physical fitness (0-10 0 is very bad 10 is very good) 0 ndash 6 = 1 7 ndash 10 = 0
1 0
TOTAL SCORE GFI
Appendix 6 ndash PS (Performance Status)
0 Normal activity without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable for all self-care unable to carry out any work and about gt50 of waking hours
3 Capable only limited self-care confined to bed or chair and about lt50 of waking hours
4 Completely disabled cannot carry on any self-care totally confined to bed or chair
Steverink N Gerontologist 200141236ndash237
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
60
ISAR Identification of Seniors At Risk Identification Systeacutematique des Aicircneacutes agrave Risque
bull Avez-vous eacuteteacute hospitaliseacute dans les 6 derniers mois ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de vue ON
bull En geacuteneacuteral avez-vous de seacuterieux problegravemes de meacutemoire ON
bull Prenez-vous de maniegravere reacuteguliegravere 3 meacutedicaments ou + ON
bull Avant la maladie qui vous amegravene aux urgences
aviez-vous de maniegravere reacuteguliegravere besoin de lrsquoaide drsquoune tierce personne pour prendre soin de vous ON
bull Depuis ce problegraveme de santeacute avez-vous ducirc augmenter cette aide ON
Mc Cusker J et al JAGS 1999 47 1229-1237
ge 3 oui fragileDeacutecegraves placement
deacuteclin AVJ agrave 6 mois
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
61Ritt M Clinical interventions in Aging 2017
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
62
Deacutepistage de la fragiliteacute en meacutedecine geacuteneacuterale (HAS geacuterontopocircle Toulouse)
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
63
Le G8 en oncogeacuteriatrie
Score le 14
Implique une EGS
64
Edmonton Frail Scale
64
64
Edmonton Frail Scale
64
