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  1. Article ; Online: Frailty Screening and Detection of Geriatric Syndromes in Acute Inpatient Care: Impact on Hospital Length of Stay and 30-Day Readmissions.

    Chew, Justin / Chia, Jia Qian / Kyaw, Kay Khine / Fu, Katrielle Joy / Lim, Celestine / Chua, Shiyun / Tan, Huei Nuo

    Annals of geriatric medicine and research

    2023  Volume 27, Issue 4, Page(s) 315–323

    Abstract: Background: Frailty is prevalent in acute care and is associated with negative outcomes. While a comprehensive geriatric assessment to identify geriatric syndromes is recommended after identifying frailty, more evidence is needed to support this ... ...

    Abstract Background: Frailty is prevalent in acute care and is associated with negative outcomes. While a comprehensive geriatric assessment to identify geriatric syndromes is recommended after identifying frailty, more evidence is needed to support this approach in the inpatient setting. This study examined the association between frailty and geriatric syndromes and their impact on outcomes in acutely admitted older adults.
    Methods: A total of 733 individuals aged ≥65 years admitted to the General Surgery Service of a tertiary hospital were assessed for frailty using the Clinical Frailty Scale (CFS) and for geriatric syndromes using routine nursing admission assessments, including cognitive impairment, falls, incontinence, malnutrition, and poor oral health. Multinomial logistic regression and Cox regression were used to evaluate the associations between frailty and geriatric syndromes and their concomitant impact on hospital length of stay (LOS) and 30-day readmissions.
    Results: Greater frailty severity was associated with an increased likelihood of geriatric syndromes. Individuals categorized as CFS 4-6 and CFS 7-8 with concomitant geriatric syndromes had 29% and 35% increased risks of a longer LOS, respectively. CFS 4-6 was significantly associated with functional decline (relative risk ratio =1.46; 95% confidence interval [CI], 1.03-2.07) and 30-day readmission (hazare ratio=1.78; 95% CI, 1.04-3.04), whereas these associations were not significant for CFS 7-8.
    Conclusion: Geriatric syndromes in frail individuals can be identified from routine nursing assessments and represent a potential approach for targeted interventions following frailty identification. Tailored interventions may be necessary to achieve optimal outcomes at different stages of frailty. Further research is required to evaluate interventions for older adults with frailty in a wider hospital context.
    Language English
    Publishing date 2023-09-25
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 3035056-6
    ISSN 2508-4909 ; 2508-4798
    ISSN (online) 2508-4909
    ISSN 2508-4798
    DOI 10.4235/agmr.23.0124
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  2. Article ; Online: Novel Clinical Frailty Scale Scoring Tools for Community-Dwelling Older Persons: An Interim Analysis.

    Chong, Edward / Tham, Audrey / Chew, Justin / Chen, Wei Ting / Tan, Huei Nuo / Chan, Mark / Goh, Hern Yee / Lim, Wee Shiong

    Journal of the American Medical Directors Association

    2023  Volume 24, Issue 7, Page(s) 1007–1009.e2

    MeSH term(s) Humans ; Aged ; Frailty/diagnosis ; Independent Living ; Frail Elderly ; Geriatric Assessment
    Language English
    Publishing date 2023-05-12
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2023.03.039
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  3. Article: Heterogeneity in functional status among moderately frail older adults: improving predictive performance using a modified approach of subgrouping the Clinical Frailty Scale.

    Chong, Edward / Chan, Mark / Tan, Huei Nuo / Lim, Wee Shiong

    European geriatric medicine

    2020  Volume 12, Issue 2, Page(s) 275–284

    Abstract: Purpose: Moderately frail individuals [Clinical Frailty Scale (CFS) 6] demonstrate heterogeneity in basic activities of daily living (bADL). We aimed to establish whether functional dependency in moderate frailty predicts poorer outcomes and examined ... ...

    Abstract Purpose: Moderately frail individuals [Clinical Frailty Scale (CFS) 6] demonstrate heterogeneity in basic activities of daily living (bADL). We aimed to establish whether functional dependency in moderate frailty predicts poorer outcomes and examined the utility of subgrouping the CFS in predicting mortality and institutionalisation.
    Methods: We prospectively studied 201 hospitalised frail patients (89.5 ± 4.7 years, female 70.1%). We examined Katz Index (KI) against adverse outcomes in CFS6 (n = 106). We then compared predictive performances of a modified CFS version 1 (mCFS-1; category 6A: CFS6 and KI ≥ 2; 6B: CFS6 and KI ≤ 1) and modified CFS version 2 (mCFS-2; category 6A: CFS6 and KI ≥ 2; 6B1: CFS6, KI ≤ 1 and feeding independent; 6B2: CFS6, KI ≤ 1 and feeding dependent) against the CFS. Multivariate analysis was used to compare each tool against mortality and institutionalisation. Receiver operator characteristic analysis was performed to determine area under curve and optimal cut-points for each tool.
    Results: KI ≤ 1 in CFS6 was associated with higher 12-month mortality (39.3% vs. 15.6%, p = 0.01); amongst KI items, feeding dependent predicted 12-month mortality (p < 0.05). Using mCFS-1, category 6A did not increase 12-month mortality compared with category 5 (OR 1.83, 95% CI 0.52-6.47), unlike category 6B (OR 6.33, 95% CI 2.07-19.33). mCFS-2 produced higher mortality in category 6B1 (OR 5.19, 95% CI 1.30-20.69) and 6B2 (OR 6.92, 95% CI 2.14-22.35). Similar observations were seen for institutionalisation. Optimal cut-point for 12-month mortality was category 6 for CFS, and 6B and 6B1 for mCFS-1 and mCFS-2, respectively.
    Conclusion: This study corroborates the heterogeneity of functional status in moderately frail individuals and validates the use of a modified approach to subgrouping the CFS6 via bADL functional status for improved predictive performance.
    MeSH term(s) Activities of Daily Living ; Aged ; Female ; Frail Elderly ; Frailty/diagnosis ; Functional Status ; Geriatric Assessment ; Humans
    Keywords covid19
    Language English
    Publishing date 2020-10-23
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2556794-9
    ISSN 1878-7657 ; 1878-7649
    ISSN (online) 1878-7657
    ISSN 1878-7649
    DOI 10.1007/s41999-020-00418-8
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  4. Article ; Online: COVID-19: Use of the Clinical Frailty Scale for Critical Care Decisions.

    Chong, Edward / Chan, Mark / Tan, Huei Nuo / Lim, Wee Shiong

    Journal of the American Geriatrics Society

    2020  Volume 68, Issue 6, Page(s) E30–E32

    MeSH term(s) Aged ; Betacoronavirus ; COVID-19 ; Clinical Decision Rules ; Coronavirus Infections/mortality ; Coronavirus Infections/virology ; Critical Care/ethics ; Critical Care/methods ; Critical Illness/mortality ; Female ; Frailty/diagnosis ; Frailty/mortality ; Frailty/virology ; Humans ; Male ; Pandemics ; Pneumonia, Viral/mortality ; Pneumonia, Viral/virology ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-05-13
    Publishing country United States
    Document type Letter
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.16528
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  5. Article ; Online: Concurrent and Predictive Validity of FRAIL-NH in Hospitalized Older Persons: An Exploratory Study.

    Chong, Edward / Huang, Yufang / Chan, Mark / Tan, Huei Nuo / Lim, Wee Shiong

    Journal of the American Medical Directors Association

    2021  Volume 22, Issue 8, Page(s) 1664–1669.e4

    Abstract: Objectives: The FRAIL-NH was originally developed for frailty assessment of nursing home (NH) residents. We aimed to compare concurrent, predictive, and known-groups validity between FRAIL-NH and FRAIL, using the Frailty Index (FI) as gold standard ... ...

    Abstract Objectives: The FRAIL-NH was originally developed for frailty assessment of nursing home (NH) residents. We aimed to compare concurrent, predictive, and known-groups validity between FRAIL-NH and FRAIL, using the Frailty Index (FI) as gold standard reference. We also examined for ceiling effect of both measures in the detection of severe frailty.
    Design: A secondary analysis of a prospective cohort study.
    Setting & participants: Older adults (mean age 89.4 years) hospitalized for an acute medical illness in a 1300-bed tertiary hospital.
    Measurements: Baseline data on demographics, comorbidities, severity of illness, functional status, and cognitive status were gathered. We also captured outcomes of mortality, length of stay (LOS), institutionalization, and functional decline. For concurrent validity, we compared areas under the operating characteristic curves (AUCs) for both measures against the FI. For predictive validity, univariate analyses and multiple logistic regression were used to compare both measures against the adverse outcomes of interest. For known-groups validity, we compared both measures against comorbidities and functional status via 1-way analysis of variance, and dementia diagnosis via independent t test. Box plots were also derived to investigate for possible ceiling effect.
    Results: Both measures had good concurrent validity (both AUC > 0.8 and P < .001), with FRAIL-NH detecting more frailty cases (79.5% vs 50.0%). Although FRAIL-frail was superior for in-hospital mortality [6.7% vs 1.0%, P = .031, odds ratio (OR) 9.29, 95% confidence interval (CI) 1.09-79.20, P < .042] and LOS (10 vs 8 days, P = .043), FRAIL-NH-frail better predicted mortality (OR 6.62, 95% CI 1.91-22.94, P = .003) and institutionalization (OR 6.03, 95% CI 2.01-18.09, P = .001) up to 12 months postenrollment. Known-groups validity was good for both measures with FRAIL-NH yielding greater F values for functional status and dementia. Lastly, box plots revealed a ceiling effect for FRAIL in the severely frail group.
    Conclusions and implications: This exploratory study highlights the potential for expanding the role of FRAIL-NH beyond NH to acute care settings. Contrasted to FRAIL, FRAIL-NH had better overall validity with less ceiling effect in discrimination of severe frailty.
    MeSH term(s) Aged ; Aged, 80 and over ; Frail Elderly ; Frailty/diagnosis ; Frailty/epidemiology ; Geriatric Assessment ; Humans ; Institutionalization ; Prospective Studies
    Language English
    Publishing date 2021-05-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2021.04.017
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  6. Article ; Online: Brief Aids to Guide Clinical Frailty Scale Scoring at the Front Door of Acute Hospitals.

    Chong, Edward / Tham, Audrey / Chew, Justin / Lim, Wee Shiong / Tan, Huei Nuo / Ang, Hou / Chan, Mark

    Journal of the American Medical Directors Association

    2021  Volume 22, Issue 5, Page(s) 1116–1117.e2

    MeSH term(s) Aged ; Frail Elderly ; Frailty/diagnosis ; Geriatric Assessment ; Hospitals ; Humans
    Language English
    Publishing date 2021-03-11
    Publishing country United States
    Document type Letter
    ZDB-ID 2171030-2
    ISSN 1538-9375 ; 1525-8610
    ISSN (online) 1538-9375
    ISSN 1525-8610
    DOI 10.1016/j.jamda.2021.02.005
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  8. Article ; Online: COVID ‐19

    Chong, Edward / Chan, Mark / Tan, Huei Nuo / Lim, Wee Shiong

    Journal of the American Geriatrics Society

    Use of the Clinical Frailty Scale for Critical Care Decisions

    2020  Volume 68, Issue 6

    Keywords Geriatrics and Gerontology ; covid19
    Language English
    Publisher Wiley
    Publishing country us
    Document type Article ; Online
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.16528
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  9. Article: Epidemiological, Clinical, and Phylogenetic Characteristics of the First SARS-CoV-2 Transmission in a Nursing Home of Singapore: A Prospective Observational Investigation.

    Pang, Junxiong / Tan, Huei Nuo / Mak, Tze Minn / Octavia, Sophie / Maurer-Stroh, Sebastian / Sirota, Fernanda L / Chan, Mark Peng Chew / Leong, Ian Yi Onn / Koh, Valerie T J / Ooi, Peng Lim / Vasoo, Shawn / Fisher, Dale / Cui, Lin / Rafman, Heidi / Cutter, Jeffery / Lee, Vernon J

    Frontiers in medicine

    2022  Volume 8, Page(s) 790177

    Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has resulted in a significant burden among nursing home facilities globally. This prospective observational cohort study aims to define the potential sources of introduction and ... ...

    Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has resulted in a significant burden among nursing home facilities globally. This prospective observational cohort study aims to define the potential sources of introduction and characteristics of SARS-CoV-2 transmission of the first nursing home facility in Singapore. An epidemiological serial point-prevalence survey of SARS-CoV-2 was conducted among 108 residents and 56 healthcare staff (HCS). In the current study, 14 (13%) residents and two (3.6%) HCS were diagnosed with coronavirus disease 2019 (COVID-19), with a case fatality rate (CFR) of 28.6% (4/14) among the residents. The median age of the infected residents was 86.5 [interquartile range (IQR) 78.5-88] and 85.7% were women. Five residents were symptomatic (35.7%) and the others were asymptomatic (64.3%). A higher proportion of residents who succumbed to COVID-19 had hypertension than those who recovered. The SARS-CoV-2 whole-genome sequencing showed lineage B.6 which is rare globally but common regionally during the early phase of the pandemic. Household transmission is a potential source of introduction into the nursing home, with at least six epidemiologically linked secondary cases. Male residents were less implicated due to the staff segregation plan by block. Among residents, a higher proportion of the non-survivors were asymptomatic and had hypertension compared with survivors.
    Language English
    Publishing date 2022-01-28
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2775999-4
    ISSN 2296-858X
    ISSN 2296-858X
    DOI 10.3389/fmed.2021.790177
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  10. Article ; Online: Atypical COVID-19: Preventing transmission from unexpected cases.

    Chow, Angela / Htun, Htet Lin / Kyaw, Win Mar / Ang, Hou / Tan, Glenn / Tan, Huei Nuo / Koh, Li Wearn / Thong, Bernard Yu-Hor / Ang, Brenda

    Infection control and hospital epidemiology

    2020  Volume 42, Issue 9, Page(s) 1146–1148

    MeSH term(s) COVID-19 ; Humans ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-08-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2020.419
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