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Differences in health-related quality of life highlight the different emphases of three frailty instruments in older Australian men living with HIV ....13% had HCV coinfection
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Reported by Jules Levin
Durban 2016 July 18-22
Yeoh H1,2, Cherry C1,3, Cheng A1, Palmer C1,2, Crowe S1,2, Hoy J1
1 Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia. 2 Centre for Biomedical Research, Burnet Institute, Melbourne, Australia. 3 School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
"(double the reported rate in HIV negative older men)."
"Frailty is a condition of physical and psycho-social vulnerability1. A frail individual encountering a minor illness is at greater risk of unrecoverable decline compared to a robust counterpart"
Reported by Jules Levin
Durban 2016 July 18-22
Yeoh H1,2, Cherry C1,3, Cheng A1, Palmer C1,2, Crowe S1,2, Hoy J1
1 Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia. 2 Centre for Biomedical Research, Burnet Institute, Melbourne, Australia. 3 School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
ABSTRACT
Background: As the Australian HIV population ages, there is increasing recognition of the need to identify frailty, a condition of physical and psycho-social vulnerability. The prevalence of frailty in the Australian HIV population is unknown. Thus, the aim of this study was to compare three different frailty instruments and to measure health-related quality of life (HRQOL), in order to better characterise the utility of each tool in people living with HIV (PLHIV).
Methods: HIV+ men aged over 50-years, on ART for >6 months were enrolled between March and November 2015 in a Melbourne HIV referral centre. Frailty was assessed using the Frailty Phenotype (FP), the Frailty Index (FI), and the Edmonton Frail Scale (EFS). Participants were assessed on standard quality of life scales (RAND 36-Item Health Survey 1.0/SF-36). The distribution of frail subjects in relation to physical and mental component scores were visualised.
Results: Ninety three study participants were evaluated: median age 60 years; 95% Caucasian, 92% had undetectable viral load. Using the FP, 11% were frail, 53% pre-frail and 37% robust. Median FI score was 0.11, with 23% frail, 77% non-frail. Using the EFS, 12% were frail, 88% non-frail. All frailty instruments correlated with all subscales and components of HRQOL. The FP was skewed towards low physical component summary scores (PCS), but high mental component summary scores (MCS). The FI identified an equal number of participants who had high PCS but low MCS, and vice versa. Only the EFS identified frail participants who had equally-matched PCS and MCS.
Conclusions: This the first reported prevalence of frailty in Australian PLHIV. The FP conceptualises frailty in more physical terms, the FI frames frailty in varied terms, and the EFS describes a frailty that has a balanced impact on both physical and mental components quality of life, and is designed to be clinically implemented. Regardless of frailty instrument, frailty is associated with poor HRQOL. Each instrument is significantly different, however, consensus on the definition of frailty is required to adequately manage older PLHIV with chronic disease.
References:
(1) Fried L, Tangen C, Walston J et al. Frailty in Older Adults: Evidence for a Phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3): M146-56.
(2) Clegg A, Young J, Iliffe S, Old Rikkert M, Rockwood K. Frailty in Older People. Lancet 2003; 381(9868): 752-762.
(3) Searle S, Mitniski A, Gahbauer E et al. A standard procedure for creating a frailty index. BMC Geriatr. 2008; 8:24.
(4) Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing 2006; 35(5): 526-529.
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