The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty

Elsa Dent; Christopher Lien; Wee Shiong Lim; Wei Chin Wong; Chek Hooi Wong; Tze Pin Ng; Jean Woo; Birong Dong; Shelley de la Vega; Philip Jun Hua Poi; Shahrul Bahyah Binti Kamaruzzaman; Chang Won; Liang-Kung Chen; Kenneth Rockwood; Hidenori Arai; Leocadio Rodriguez-Mañas; Li Cao; Matteo Cesari; Piu Chan; Edward Leung; Francesco Landi; Linda P Fried; John E Morley; Bruno Vellas; Leon Flicker

doi:10.1016/j.jamda.2017.04.018

The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty

J Am Med Dir Assoc. 2017 Jul 1;18(7):564-575. doi: 10.1016/j.jamda.2017.04.018.

Authors

Elsa Dent¹, Christopher Lien², Wee Shiong Lim³, Wei Chin Wong³, Chek Hooi Wong⁴, Tze Pin Ng⁵, Jean Woo⁶, Birong Dong⁷, Shelley de la Vega⁸, Philip Jun Hua Poi⁹, Shahrul Bahyah Binti Kamaruzzaman⁹, Chang Won¹⁰, Liang-Kung Chen¹¹, Kenneth Rockwood¹², Hidenori Arai¹³, Leocadio Rodriguez-Mañas¹⁴, Li Cao¹⁵, Matteo Cesari¹⁶, Piu Chan¹⁷, Edward Leung¹⁸, Francesco Landi¹⁹, Linda P Fried²⁰, John E Morley²¹, Bruno Vellas¹⁶, Leon Flicker²²

Affiliations

¹ Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia. Electronic address: [email protected].
² Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore.
³ Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
⁴ Geriatric Education and Research Institute, Singapore, Singapore.
⁵ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁶ The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China.
⁷ Geriatrics Center Huaxi Hospital, Sichuan University, Chengdu, China.
⁸ University of the Philippines College of Medicine, Manila, Philippines; Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines.
⁹ Division of Geriatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
¹⁰ Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea.
¹¹ Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
¹² Dalhousie University, Halifax, Nova Scotia, Canada.
¹³ National Center for Geriatrics and Gerontology, Obu, Japan.
¹⁴ Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain.
¹⁵ Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
¹⁶ CHU Toulouse, Toulouse, France.
¹⁷ Department of Geriatrics, Neurology, and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
¹⁸ Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong.
¹⁹ Catholic University of Sacred Heart, Rome, Italy.
²⁰ Mailman School of Public Health, Columbia University Medical Center, New York, NY.
²¹ Divisions of Geriatric Medicine and Endocrinology, Saint Louis University, St. Louis, MO.
²² Western Australia Center for Health and Aging, University of Western Australia, Perth, Australia.

PMID: 28648901
DOI: 10.1016/j.jamda.2017.04.018

Abstract

Objective: To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty.

Methods: An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation.

Recommendations: Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan.

Conclusions: The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.

Keywords: Frail elderly; Practice Guidelines as Topic*; aged; disease management; evidence-based medicine/standards*; patient care management.

Publication types

Practice Guideline

MeSH terms

Aged
Asia
Disease Management
Evidence-Based Medicine
Female
Frail Elderly / statistics & numerical data*
Frailty / diagnosis
Frailty / therapy*
Geriatric Assessment / statistics & numerical data*
Humans
Male
Middle Aged
Patient Care Planning / standards*