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Background:Timely recognition of the end of life allows patients to discuss preferences and make advance plans,and clinicians to introduce appropriate care. We examined changes in frailty over 1 year, with the aim of identifyingtrajectories that could indicate where an individual is at increased risk of all-cause mortality and may requirepalliative care.Methods:Electronic health records from 13,149 adults (cases) age 75 and over who died during a 1-year period(1 January 2015 to 1 January 2016) were age, sex and general practice matched to 13,149 individuals with no recordof death over the same period (controls). Monthly frailty scores were obtained for 1 year prior to death for cases, andfrom 1 January 2015 to 1 January 2016 for controls using the electronic frailty index (eFI; a cumulative deficit measureof frailty, available in most English primary care electronic health records, and ranging in value from 0 to 1). Latentgrowth mixture models were used to investigate longitudinal patterns of change and associated impact on mortality.Cases were reweighted to the population level for tests of diagnostic accuracy.Results:Three distinct frailty trajectories were identified. Rapidly rising frailty (initial increase of 0.022 eFI per monthbefore slowing from a baseline eFI of 0.21) was associated with a 180% increase in mortality (OR 2.84, 95% CI 2.34–3.45)for 2.2% of the sample. Moderately increasing frailty (eFI increase of 0.007 per month, with baseline of 0.26) wasassociated with a 65% increase in mortality (OR 1.65, 95% CI 1.54–1.76) for 21.2% of the sample. The largest (76.6%)class was stable frailty (eFI increase of 0.001 from a baseline of 0.26). When cases were reweighted to population level,rapidly rising frailty had 99.1% specificity and 3.2% sensitivity (positive predictive value 19.8%, negative predictive value93.3%) for predicting individual risk of mortality.Conclusions:People aged over 75 with frailty who are at highest risk of death have a distinctive frailty trajectory in thelast 12 months of life, with a rapid initial rise from a low baseline, followed by a plateau. Routine measurement of frailtycan be useful to support clinicians to identify people with frailty who are potential candidates for palliative care, andallow time for intervention.

More information Original publication

DOI

10.1186/s12916-018-1148-x

Type

Journal article

Journal

Bmc medicine

Issue

17

Publication Date

21/09/2018

Volume

161

Addresses

SPCR PhD: Daniel Stow

Keywords

Frailty, Geriatrics, Palliative care, Primary care, End of life