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Article ; Online: Preoperative Frailty Evaluation: A Promising Risk-stratification Tool in Older Adults Undergoing General Surgery.

Ko, Fred C

2019 Volume 41, Issue 3, Page(s) 387–399

Abstract: Purpose: General surgical procedures are among the most commonly performed operations in the United States. Despite advances in surgical and anesthetic techniques and perioperative care, complications after general surgery in older adults remain a ... ...

Abstract	Purpose: General surgical procedures are among the most commonly performed operations in the United States. Despite advances in surgical and anesthetic techniques and perioperative care, complications after general surgery in older adults remain a significant cause of increased morbidity, mortality, and health care costs. Frailty, a geriatric syndrome characterized by multisystem physiologic decline and increased vulnerability to stressors and adverse clinical outcomes, has emerged as a plausible predictor of adverse outcomes after surgery in older patients. Thus, the goal of this topical review is to evaluate the evidence on the association between preoperative frailty and clinical outcomes after general surgery and whether frailty evaluation may have a role in surgical risk-stratification in vulnerable older patients. Methods: A PubMed database search was conducted between September and October 2018 to identify relevant studies evaluating the association between frailty and clinical outcomes after general surgery. Key words (frailty and surgery) and Medical Subject Heading term (general surgery) were used, and specific inclusion and exclusion criteria were applied. Findings: The available evidence from meta-analyses and cohort studies suggest that preoperative frailty is significantly associated with adverse clinical outcomes after emergent or nonemergent general surgery in older patients. Although these studies are limited by a high degree of heterogeneity of frailty assessments, types of surgery, and primary outcomes, baseline frailty appears to increase risk of postoperative complications and morbidity, hospital length of stay, 30-day mortality, and long-term mortality after general surgical procedures in older adults. Implications: Evidence supports the further development of preoperative frailty evaluation as a risk-stratification tool in older adults undergoing general surgery. Research is urgently needed to quantify and differentiate the predictive ability of validated frailty instruments in the context of different general surgical procedures and medical acuity and in conjunction with existing surgical risk indices widely used in clinical practice. Practical applicability of frailty instrument as well as geriatrics-centered outcomes need to be incorporated in future studies in this line of research. Furthermore, clinical care pathways that integrate frailty assessment, geriatric medicine focused perioperative and postoperative management, and patient-centered interdisciplinary care models should be investigated as a comprehensive intervention approach in older adults undergoing general surgery. Finally, early implementation of palliative care should occur at the outset of hospital encounter in frail older patients who present with indications for emergent general surgery.
MeSH term(s)	Aged ; Frailty ; General Surgery ; Geriatric Assessment ; Humans ; Preoperative Care ; Risk Assessment
Language	English
Publishing date	2019-02-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	603113-4
ISSN	1879-114X ; 0149-2918
ISSN (online)	1879-114X
ISSN	0149-2918
DOI	10.1016/j.clinthera.2019.01.014
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Article ; Online: The Science of Frailty: Sex Differences.

Park, Caroline / Ko, Fred C

Clinics in geriatric medicine

2021 Volume 37, Issue 4, Page(s) 625–638

Abstract: Frailty is an important clinical syndrome of age-related decline in physiologic reserve and increased vulnerability. In older adults, frailty leads to progressive multisystem decline and increased adverse clinical outcomes. The pathophysiology of frailty ...

Abstract	Frailty is an important clinical syndrome of age-related decline in physiologic reserve and increased vulnerability. In older adults, frailty leads to progressive multisystem decline and increased adverse clinical outcomes. The pathophysiology of frailty is hypothesized to be driven by dysregulation of neuroendocrine, inflammatory, and metabolic pathways. Sex-specific differences in the prevalence of frailty have been observed. Treatment interventions of geriatric care can be applied to the care of frail older women with these differences in mind. As additional evidence regarding sex-specific differences in frailty emerges, research efforts should encompass the development of screening tools and therapeutic interventions that optimize outcomes.
MeSH term(s)	Aged ; Female ; Frail Elderly ; Frailty/diagnosis ; Frailty/epidemiology ; Geriatric Assessment ; Humans ; Male ; Prevalence ; Sex Characteristics
Language	English
Publishing date	2021-09-30
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	1064151-8
ISSN	1879-8853 ; 0749-0690
ISSN (online)	1879-8853
ISSN	0749-0690
DOI	10.1016/j.cger.2021.05.008
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Article: HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV.

Sangarlangkarn, Aroonsiri / Yamada, Yuji / Ko, Fred C

Pathogens (Basel, Switzerland)

2021 Volume 10, Issue 10

Abstract: With advances in antiretroviral therapy and subsequent increase in life expectancy, People with HIV (PWH) now experience multiple geriatric syndromes in the setting of advanced aging and increased multimorbidity. HIV clinicians bear the responsibility of ...

Abstract	With advances in antiretroviral therapy and subsequent increase in life expectancy, People with HIV (PWH) now experience multiple geriatric syndromes in the setting of advanced aging and increased multimorbidity. HIV clinicians bear the responsibility of delivering geriatric care to this vulnerable population, despite limited geriatric medicine training and limited support from HIV service networks that were not traditionally designed to care for an aging population. Although HIV clinicians reported formal guidelines specific to older PWH to be among the most helpful interventions, current HIV guidelines present multiple issues in their applicability to the care of older PWH, including multifactorial nature of conditions in older adults, difficulty measuring patient-centered outcomes, lack of representation of older PWH in clinical trials, limited guidelines addressing geriatric syndromes, and the use of chronological age as criteria for inclusion despite advanced aging in PWH. Understanding that updated guidelines addressing above challenges may take many years to develop, we offer strategies on the application of current guidelines, including using baseline attributes, time to benefit, and the Geriatrics 5M model to aid in shared decision making and improve outcomes among older PWH.
Language	English
Publishing date	2021-10-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens10101332
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Article: HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV

Sangarlangkarn, Aroonsiri / Yamada, Yuji / Ko, Fred C.

Pathogens. 2021 Oct. 15, v. 10, no. 10

2021

Abstract	With advances in antiretroviral therapy and subsequent increase in life expectancy, People with HIV (PWH) now experience multiple geriatric syndromes in the setting of advanced aging and increased multimorbidity. HIV clinicians bear the responsibility of delivering geriatric care to this vulnerable population, despite limited geriatric medicine training and limited support from HIV service networks that were not traditionally designed to care for an aging population. Although HIV clinicians reported formal guidelines specific to older PWH to be among the most helpful interventions, current HIV guidelines present multiple issues in their applicability to the care of older PWH, including multifactorial nature of conditions in older adults, difficulty measuring patient-centered outcomes, lack of representation of older PWH in clinical trials, limited guidelines addressing geriatric syndromes, and the use of chronological age as criteria for inclusion despite advanced aging in PWH. Understanding that updated guidelines addressing above challenges may take many years to develop, we offer strategies on the application of current guidelines, including using baseline attributes, time to benefit, and the Geriatrics 5M model to aid in shared decision making and improve outcomes among older PWH.
Keywords	antiretroviral agents ; at-risk population ; gerontology ; longevity ; models ; people ; therapeutics
Language	English
Dates of publication	2021-1015
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
ZDB-ID	2695572-6
ISSN	2076-0817
ISSN	2076-0817
DOI	10.3390/pathogens10101332
Database	NAL-Catalogue (AGRICOLA)

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Article: Prevalence of Frailty and Prefrailty in People With Human Immunodeficiency Virus Aged 50 or Older: A Systematic Review and Meta-Analysis.

Yamada, Yuji / Kobayashi, Takaaki / Condo, Angela / Sangarlangkarn, Aroonsiri / Ko, Fred / Taniguchi, Yu / Kojima, Gotaro

Open forum infectious diseases

2022 Volume 9, Issue 5, Page(s) ofac129

Abstract: Background: With effective antiretroviral therapy, there is an emerging population of adults aged 50 years or older with human immunodeficiency virus (HIV). Frailty is an increasingly recognized clinical state of vulnerability associated with disability, ...

Abstract	Background: With effective antiretroviral therapy, there is an emerging population of adults aged 50 years or older with human immunodeficiency virus (HIV). Frailty is an increasingly recognized clinical state of vulnerability associated with disability, hospitalization, and mortality. However, there is a paucity of large studies assessing its prevalence in people with HIV (PWH) aged 50 or older. Methods: PubMed was systematically searched for studies published between January 2000 and August 2020 reporting the prevalence of frailty in PWH aged 50 or older. The pooled prevalence of frailty and prefrailty was synthesized using a random-effects meta-analysis. Results: Of the 425 studies identified, 26 studies were included in the analysis, with a total of 6584 PWH aged 50 or older. The included studies were published between 2012 and 2020, and all studies used the Fried frailty phenotype to define frailty. The overall pooled prevalence of frailty and prefrailty was 10.9% (95% confidence interval [CI], 8.1%-14.2%) and 47.2% (95% CI, 40.1%-54.4%), respectively. A high degree of heterogeneity was observed (I Conclusions: The pooled prevalence of frailty and prefrailty defined by the Fried frailty phenotype was assessed in PWH aged 50 or older. Findings from this study quantified the proportion of this specific population with this common geriatric syndrome. Future studies identifying effective strategies for frailty screening and intervention are required for this vulnerable population.
Language	English
Publishing date	2022-04-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac129
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Article ; Online: Decision making in frail patients at risk of postoperative delirium: A case study and literature review.

English-Cremeans, Maureen K / Wholihan, Dorothy J / Olson, Ellen / Zhu, Carolyn / Ko, Fred C

Geriatric nursing (New York, N.Y.)

2022 Volume 48, Page(s) 356–359

Abstract: Preoperative frailty is strongly associated with risks of postoperative delirium. However, gaps exist in targeted recommendations for clinical decision making related to surgical interventions in frail older patients. A case study is presented involving ... ...

Abstract	Preoperative frailty is strongly associated with risks of postoperative delirium. However, gaps exist in targeted recommendations for clinical decision making related to surgical interventions in frail older patients. A case study is presented involving a frail 74-year-old referred to the palliative care team for assistance with clinical decision making and in weighing risks and benefits of a surgical intervention. A literature review on the quantification of postoperative delirium risk and how this information might inform medical decision making in frail surgical patients did not identify clear clinical guidelines. In the absence of practice guidelines, the Patient Priorities Care model is proposed as a framework to help providers working with patients and caregivers facing complex medical decisions to better align interventions with patient values.
Language	English
Publishing date	2022-06-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	632559-2
ISSN	1528-3984 ; 0197-4572
ISSN (online)	1528-3984
ISSN	0197-4572
DOI	10.1016/j.gerinurse.2022.05.009
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Article ; Online: Chronic Post-Surgical Pain in the Frail Older Adult.

Esses, Gary / Deiner, Stacie / Ko, Fred / Khelemsky, Yury

Drugs & aging

2018 Volume 37, Issue 5, Page(s) 321–329

Abstract: Older adults are the fastest growing segment of the population and surgical procedures in this group increase each year. Chronic post-surgical pain is an important consideration in the older adult as it affects recovery, physical functioning, and overall ...

Abstract	Older adults are the fastest growing segment of the population and surgical procedures in this group increase each year. Chronic post-surgical pain is an important consideration in the older adult as it affects recovery, physical functioning, and overall quality of life. It is increasingly recognized as a public health issue but there is a need to improve our understanding of the disease process as well as the appropriate treatment and prevention. Frailty, delirium, and cognition influence post-operative outcomes in older adults and have been implicated in the development of chronic post-surgical pain. Further research must be conducted to fully understand the role they play in the occurrence of chronic post-surgical pain in the older adult. Additionally, careful attention must be given to the physiologic, cognitive, and comorbidity differences between the older adult and the general population. This is critical for elucidating the proper chronic post-surgical pain treatment and prevention strategies to ensure that the older adult undergoing surgical intervention will have an appropriate and desirable post-operative outcome.
MeSH term(s)	Aged ; Aged, 80 and over ; Chronic Pain/complications ; Chronic Pain/drug therapy ; Chronic Pain/psychology ; Cognition Disorders/etiology ; Cognition Disorders/prevention & control ; Delirium/etiology ; Delirium/prevention & control ; Female ; Frail Elderly ; Frailty/complications ; Frailty/psychology ; Humans ; Male ; Pain, Postoperative/complications ; Pain, Postoperative/drug therapy ; Pain, Postoperative/psychology ; Quality of Life
Language	English
Publishing date	2018-09-28
Publishing country	New Zealand
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1075770-3
ISSN	1179-1969 ; 1170-229X
ISSN (online)	1179-1969
ISSN	1170-229X
DOI	10.1007/s40266-020-00761-2
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Article ; Online: Hip fracture: a trigger for palliative care in vulnerable older adults.

Ko, Fred C / Morrison, R Sean

JAMA internal medicine

2014 Volume 174, Issue 8, Page(s) 1281–1282

MeSH term(s)	Activities of Daily Living ; Female ; Hip Fractures/therapy ; Humans ; Male ; Mobility Limitation ; Nursing Homes
Language	English
Publishing date	2014-08
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2014.999
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Article ; Online: The clinical care of frail, older adults.

Ko, Fred Chau-Yang

Clinics in geriatric medicine

2011 Volume 27, Issue 1, Page(s) 89–100

Abstract: Frailty and its management represent an emerging area of clinical care in older adults. Geriatricians have long recognized a syndrome of multiple comorbid conditions, immobility, weakness, and poor tolerance of physiologic stressors in older adults. ... ...

Abstract	Frailty and its management represent an emerging area of clinical care in older adults. Geriatricians have long recognized a syndrome of multiple comorbid conditions, immobility, weakness, and poor tolerance of physiologic stressors in older adults. Patients with these characteristics are described as frail and suffer increased adverse clinical outcomes. This article reviews the clinical spectrum of frailty in older adults, its biologic etiology, and potential clinical interventions. Several operational definitions of frailty and the associated clinical signs, symptoms, and outcomes are outlined. The biologic mechanisms hypothesized to underlie frailty are explored, particularly in the musculoskeletal, endocrine, and immune systems. Treatment options for frail, older adults are discussed, including physiologic system-targeted interventions and geriatric models of care.
MeSH term(s)	Activities of Daily Living ; Aged ; Aged, 80 and over ; Aging/physiology ; Disability Evaluation ; Exercise ; Female ; Frail Elderly ; Geriatric Assessment ; Geriatric Nursing ; Hormones/therapeutic use ; Humans ; Inflammation ; Male ; Models, Theoretical ; Muscle Weakness/physiopathology ; Muscle Weakness/therapy ; Patient Care Team/organization & administration ; Syndrome
Chemical Substances	Hormones
Language	English
Publishing date	2011-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1064151-8
ISSN	1879-8853 ; 0749-0690
ISSN (online)	1879-8853
ISSN	0749-0690
DOI	10.1016/j.cger.2010.08.007
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Article ; Online: Barriers to implementation of STRIDE, a national study to prevent fall-related injuries.

Reckrey, Jennifer M / Gazarian, Priscilla / Reuben, David B / Latham, Nancy K / McMahon, Siobhan K / Siu, Albert L / Ko, Fred C

Journal of the American Geriatrics Society

2021 Volume 69, Issue 5, Page(s) 1334–1342

Abstract: Background/objectives: Evaluations of complex models of care for older adults may benefit from simultaneous assessment of intervention implementation. The STRIDE (Strategies To Reduce Injuries and Develop confidence in Elders) pragmatic trial evaluated ... ...

Abstract	Background/objectives: Evaluations of complex models of care for older adults may benefit from simultaneous assessment of intervention implementation. The STRIDE (Strategies To Reduce Injuries and Develop confidence in Elders) pragmatic trial evaluated the effectiveness of a multifactorial intervention to reduce serious fall injuries in older adults. We conducted multi-level stakeholder interviews to identify barriers to STRIDE intervention implementation and understand efforts taken to mitigate these barriers. Design: Qualitative interviews with key informants. Setting: Ten clinical trial sites affiliated with practices that provided primary care for persons at increased risk for fall injuries. Participants: Specially trained registered nurses working as Falls Care Managers (FCMs) who delivered the intervention (n = 13 individual interviews), Research Staff who supervised trial implementation locally (n = 10 group interviews, 23 included individuals), and members of Central Project Management and the National Patient Stakeholder Council who oversaw national implementation (n = 2 group interviews, six included individuals). Measurements: A semi-structured interview guide derived from the consolidated framework for implementation research (CFIR). Results: We identified eight key barriers to STRIDE intervention implementation. FCMs navigated complex relationships with patients and families while working with Research Staff to implement the intervention in primary care practices with limited clinical space, variable provider buy-in, and significant primary care practice staff and provider turnover. The costs of the intervention to individual patients and medical practices amplified these barriers. Efforts to mitigate these barriers varied depending on the needs and opportunities of each primary care setting. Conclusion: The many barriers to implementation and the variability in how stakeholders addressed these locally may have affected the overall STRIDE intervention's effectiveness. Future pragmatic trials should incorporate simultaneous implementation aims to better understand how research interventions translate into clinical care that improves the lives of older adults.
MeSH term(s)	Accidental Falls/prevention & control ; Adult ; Aged ; Female ; Health Personnel/psychology ; Health Plan Implementation/statistics & numerical data ; Humans ; Male ; Middle Aged ; Patient Outcome Assessment ; Primary Health Care/methods ; Primary Health Care/statistics & numerical data ; Program Evaluation ; Qualitative Research ; Stakeholder Participation/psychology
Language	English
Publishing date	2021-02-13
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.17056
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