The assessment of frailty in older people in acute care
Notice bibliographique
Résumé
Today in Australia we face an ageing population; this will lead to increasing pressure on an already overtaxed health system. It is imperative that we set in place a refined and unified method to assess and predict health outcomes in frail older people As a person ages there is an accumulation of stressors and lifetime risk factors that combine with multi-organ physiological change to give rise to an increased risk of poor outcomes (e.g. death, institutionalisation, falls and iatrogenic disease). This vulnerability can be quantified by a frailty scale. Frailty can be seen as a measurement of the level of support that is required by a person. This measurement is useful as a predictive tool to determine the health services needed by the patient and for research purposes to assist in public health planning. In recent years effort has been made to determine the predictive strength of these scales and their efficacy in improving patients’ final outcomes. There are a number of different frailty scales currently in use, each with different emphases and measuring different outcomes. The majority of studies looking at frailty to date have been conducted in the community [1,2]. Of those that have looked at patients in a hospital setting [3,4], there has been a trend to use scales that are multifaceted, taking into account the complex nature of frailty, such as the Reported Edmonton Scale reported by Hilmer et al. in this edition of the Journal. The Reported Edmonton Scale has several attractive features: it can be assessed by interviewers without medical training, making it easier to use for larger studies; it has been designed to capture the pre-morbid frailty despite being collected in a hospital setting; and it correlated well with a global assessment of frailty as assessed by a geriatrician involved in comprehensive geriatric assessment. Given that the Reported Edmonton Scale incorporates components of cognition, independence, polypharmacy and comorbidity, it is no surprise that the scale correlated well with established methods of measurement for these domains. However, this finding does emphasise that the scale reflects the complex multi-faceted nature of frailty. Where to next? The challenge for the Geriatric Medicine research community is to identify which frailty measure will be the most useful in our clinical trial, epidemiology and observational research practice. At this stage it is unclear which measure will survive. However, incorporation of frailty measures into routine research must be a good thing, as it implicitly acknowledges that medical research should and must include the frail older person.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».