Advanced search
1 file | 660.74 KB Add to list

A proposal for the retrospective identification and categorization of older people with functional impairments in scientific studies : recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) research group

Author
Organization
Abstract
When treating older adults, a main factor to consider is physical frailty. Because specific assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status given in clinical trials in older adults to allow for a retrospective characterization and indirect comparison of treatment evidence from these cohorts. We conducted 4 separate systematic reviews of randomized and nonrandomized controlled clinical trials in older people with hypertension, diabetes, depression, and dementia. All assessments identified that reflected functional status were analyzed. Assessments were categorized across 4 different functional status levels. These levels span from functionally not impaired, slightly impaired, significantly impaired, to severely impaired/disabled. If available from the literature, cut-offs for these 4 functioning levels were extracted. If not, or if the existing cut-offs did not match the predefined functional levels, cut-off points were defined by an expert group composed of geriatricians, pharmacists, pharmacologists, neurologists, psychiatrists, and epidemiologists using a patient-centered approach. We identified 51 instruments that included measures of functional status. Although some of the assessments had clearly defined cut-offs across our predefined categories, many others did not. In most cases, no cut-offs existed for slightly impaired or severely impaired older adults. Missing cut-offs or values to adjust were determined by the expert group and are presented as described. The functional status assessments that were identified and operationalized across 4 functional levels could now be used for a retrospective characterization of functional status in randomized controlled trials and observational studies. Allocated categories only serve as approximations and should be validated head-to-head in future studies. Moreover, as general standard, upcoming studies involving older adults should include and explicitly report functional impairment as a baseline characteristic of all participants enrolled.
Keywords
Functional status, frailty, concept paper, evidence-based medicine, assessment, MAINTENANCE SCALE PSMS, BLOOD-PRESSURE, SELF-MAINTENANCE, GAIT SPEED, ELDERLY ADULTS, MORTALITY, DISABILITY, HEALTH, RISK, TOOL

Downloads

  • BREFKA S et al JAMDA 2019.pdf
    • full text
    • |
    • open access
    • |
    • PDF
    • |
    • 660.74 KB

Citation

Please use this url to cite or link to this publication:

MLA
Brefka, Simone et al. “A Proposal for the Retrospective Identification and Categorization of Older People with Functional Impairments in Scientific Studies : Recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) Research Group.” JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION 20.2 (2019): 138–146. Print.
APA
Brefka, S., Dallmeier, D., Mühlbauer, V., von Arnim, C. A., Bollig, C., Onder, G., Petrovic, M., et al. (2019). A proposal for the retrospective identification and categorization of older people with functional impairments in scientific studies : recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) research group. JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 20(2), 138–146.
Chicago author-date
Brefka, Simone, Dhayana Dallmeier, Viktoria Mühlbauer, Christine AF von Arnim, Claudia Bollig, Graziano Onder, Mirko Petrovic, et al. 2019. “A Proposal for the Retrospective Identification and Categorization of Older People with Functional Impairments in Scientific Studies : Recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) Research Group.” Journal of the American Medical Directors Association 20 (2): 138–146.
Chicago author-date (all authors)
Brefka, Simone, Dhayana Dallmeier, Viktoria Mühlbauer, Christine AF von Arnim, Claudia Bollig, Graziano Onder, Mirko Petrovic, Carlos Schönfeldt-Lecuona, Moritz Seibert, Gabriel Torbahn, Sebastian Voigt-Radloff, Walter E Haefeli, Jürgen M Bauer, and Michael D Denkinger. 2019. “A Proposal for the Retrospective Identification and Categorization of Older People with Functional Impairments in Scientific Studies : Recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) Research Group.” Journal of the American Medical Directors Association 20 (2): 138–146.
Vancouver
1.
Brefka S, Dallmeier D, Mühlbauer V, von Arnim CA, Bollig C, Onder G, et al. A proposal for the retrospective identification and categorization of older people with functional impairments in scientific studies : recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) research group. JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION. 2019;20(2):138–46.
IEEE
[1]
S. Brefka et al., “A proposal for the retrospective identification and categorization of older people with functional impairments in scientific studies : recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) research group,” JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, vol. 20, no. 2, pp. 138–146, 2019.
@article{8588221,
  abstract     = {When treating older adults, a main factor to consider is physical frailty. Because specific assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status given in clinical trials in older adults to allow for a retrospective characterization and indirect comparison of treatment evidence from these cohorts. We conducted 4 separate systematic reviews of randomized and nonrandomized controlled clinical trials in older people with hypertension, diabetes, depression, and dementia. All assessments identified that reflected functional status were analyzed. Assessments were categorized across 4 different functional status levels. These levels span from functionally not impaired, slightly impaired, significantly impaired, to severely impaired/disabled. If available from the literature, cut-offs for these 4 functioning levels were extracted. If not, or if the existing cut-offs did not match the predefined functional levels, cut-off points were defined by an expert group composed of geriatricians, pharmacists, pharmacologists, neurologists, psychiatrists, and epidemiologists using a patient-centered approach. We identified 51 instruments that included measures of functional status. Although some of the assessments had clearly defined cut-offs across our predefined categories, many others did not. In most cases, no cut-offs existed for slightly impaired or severely impaired older adults. Missing cut-offs or values to adjust were determined by the expert group and are presented as described. The functional status assessments that were identified and operationalized across 4 functional levels could now be used for a retrospective characterization of functional status in randomized controlled trials and observational studies. Allocated categories only serve as approximations and should be validated head-to-head in future studies. Moreover, as general standard, upcoming studies involving older adults should include and explicitly report functional impairment as a baseline characteristic of all participants enrolled.},
  author       = {Brefka, Simone and Dallmeier, Dhayana and Mühlbauer, Viktoria and von Arnim, Christine AF and Bollig, Claudia and Onder, Graziano and Petrovic, Mirko and Schönfeldt-Lecuona, Carlos and Seibert, Moritz and Torbahn, Gabriel and Voigt-Radloff, Sebastian and Haefeli, Walter E and Bauer, Jürgen M and Denkinger, Michael D},
  issn         = {1525-8610},
  journal      = {JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION},
  keywords     = {Functional status,frailty,concept paper,evidence-based medicine,assessment,MAINTENANCE SCALE PSMS,BLOOD-PRESSURE,SELF-MAINTENANCE,GAIT SPEED,ELDERLY ADULTS,MORTALITY,DISABILITY,HEALTH,RISK,TOOL},
  language     = {eng},
  number       = {2},
  pages        = {138--146},
  title        = {A proposal for the retrospective identification and categorization of older people with functional impairments in scientific studies : recommendations of the Medication and Quality of Life in Frail Older Persons (MedQoL) research group},
  url          = {http://dx.doi.org/10.1016/j.jamda.2018.11.008},
  volume       = {20},
  year         = {2019},
}

Altmetric
View in Altmetric
Web of Science
Times cited: