A simple arm test that employs a novel wearable technology can rapidly and accurately identify physiological frailty in older adults, according to new study results.
Older adults undergo 35.3% of inpatient procedures and 32.1% of outpatient procedures in the US, according to the National Hospital Discharge Survey. As the population continues to age, and the rate of surgical procedures in older adults is likely to increase, accurate tools to assess risk of adverse outcomes are more necessary than ever.
Frailty – a condition characterised by weight loss, weakness, and lack of physical resiliency – is how a physician tells whether an ageing patient is healthy and could probably recover from an operation.
Although frailty is one indicator of post-operative complications and disability, a quick and simple frailty assessment tool is not yet available for trauma settings. The aim of this study was to find out if a biotechnology-based test was a reliable and practical tool when used on bed-bound trauma patients.
Researchers at Baylor College of Medicine, Houston, and University of Arizona, Tucson, developed a 20-second upper arm extension test (called upper extremity frailty: UEF system) to assess biomarkers of frailty such as slowness of motion, weakness, and exhaustion. The research team previously validated this novel wearable technology, which uses sensors found in cell phones in community-dwelling older adults.
“This test provides valuable information to help trauma surgeons decide whether a patient can tolerate an operation, how long they should keep a patient in the hospital, how they should manage the discharge process, specifically, whether the patient should go home or to a nursing facility,” said study investigator Dr Bijan Najafi, professor of surgery and director of the Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) at Baylor College of Medicine.
The study involved 101 patients, 65 years and older, who had been admitted to the hospital due to traumatic falls. Frailty was measured using the Trauma-Specific Frailty Index (TSFI), a questionnaire that is considered the gold standard for assessing this disabling condition. (The downside of the TSFI is that it is a subjective and time-consuming tool that is difficult to use for routine care in busy hospitals).
The patients then performed the 20-second arm extension test while wearing the UEF system. The agreement between UEF score and TSFI was quantified using the Pearson Correlation test, which yields a correlation score (r-value) with a range from -1.0 to 1.0, whereby the value closer to one equals perfect agreement with the TSFI, meaning that both measures are exactly the same.
The data showed a high agreement (r=0.72; an r value greater than 0.7 is considered to be high agreement) between the TSFI score and UEF system. The second research goal was to evaluate the traditional patient who cannot undergo the standard walking test, by using this technology as an alternative measure. The timed walking test (gait assessment) involves instructing a patient to stand from a chair, walk 10 feet, then return to the chair and sit. In the study, 57% of the patients were not able to walk at the time the measurements were taken.
“The study demonstrated that we can get the similar results as gait assessment by testing the kinematic and kinetic of the upper arm and elbow flexion extension,” Najafi said. “This finding is very valuable because gait assessment is often not practical in a busy hospital setting. Even if patients can stand up and walk, usually there is often no adequate space in a hospital that can be used for gait assessment without distraction. Therefore, having an alternate modality that can deliver similar results could be very important for the evaluation of frailty, moving ability and the prediction of adverse events.”
The researchers also performed the test to predict the moving ability of patients before admission to the hospital. The data showed significant correlations between UEF markers and the number of falls patients had within a prior year. The highest correlation was seen for elbow flexion slowness (r=0.41; this value shows the correlation is significant).
“Despite the fact that the test is very simple and convenient, we have demonstrated very promising results compared to other conventional tests that have been used,” Najafi said. “We are using bio sensors in an innovative way. There is a big gap in the medical field for this type of tool, and we hope to close this gap.”
Background: Despite increasing evidence that assessing frailty facilitates medical decision-making, a quick and clinically simple frailty assessment tool is not available for trauma settings.
Study Design: This study examined accuracy and acceptability of a novel wearable technology (upper-extremity frailty [UEF]) to objectively assess frailty status in older adults (65 years or older) admitted to the hospital due to traumatic ground-level falls. Frailty was measured using a validated modified Rockwood questionnaire, the Trauma-Specific Frailty Index (TSFI), as the gold standard. Participants performed a 20-second trial of rapid elbow flexion with the dominant elbow in a supine posture while wearing the UEF system.
Results: We recruited 101 eligible older adults (age 79 ± 9 years). Parameters of the UEF indicative of slowness, weakness, and exhaustion during elbow flexion were independent predictors of the TSFI score, while adjusted for age, sex, and body mass index. A high agreement (r = 0.72, p < 0.0001) was observed between TSFI score and the UEF model; sensitivity and specificity for predicting the frailty status were 78% and 82%, respectively. Of recruited participants, 57% were not able to walk at the time of measurements, suggesting a limitation for walking-based frailty assessments. Significant correlations were observed between UEF parameters and number of falls within a previous year, with highest correlation observed for elbow flexion slowness (r = −0.41).
Conclusions: The results suggest that a simple test of 20-second elbow flexion may be practical and sensitive to identify frailty among hospitalized older adults. The UEF test is independent of walking assessments, reflects several frailty markers, and it is practical for bed-bound patients.