Screening for Frailty in Canada's Health Care System: A Time for Action

Canadian Journal on Aging

Volumn 35, Issue 3, 2016, Pages 281-297

  Muscedere, John ^a   Andrew, Melissa K ^b   Bagshaw, Sean M ^c   Estabrooks, Carole ^c   Hogan, David ^d   Holroyd Leduc, Jayna ^e   Howlett, Susan ^f   Lahey, William ^b   Maxwell, Colleen ^g   McNally, Mary ^f   Moorhouse, Paige ^b   Rockwood, Kenneth ^b   Rolfson, Darryl ^c   Sinha, Samir ^h   Tholl, Bill ⁱ  

^a QUEEN S UNIVERSITY   (Canada)

^b DALHOUSIE UNIVERSITY   (Canada)

^c UNIVERSITY OF ALBERTA   (Canada)

^d UNIVERSITY OF CALGARY   (Canada)

^e UNIVERSITY OF CALGARY   (Canada)

^f DALHOUSIE UNIVERSITY   (Canada)

^g UNIVERSITY OF WATERLOO   (Canada)

^h UNIVERSITY OF TORONTO   (Canada)

ⁱ President and CEO of HealthCareCAN   (Canada)

Author keywords

de d pistage; fragilit ; Mots cl s : vieillissement; r sultats; syst me de sant ; valuation

Indexed keywords

AGING; AWARENESS; HEALTH CARE SYSTEM; HUMAN; LIFESPAN; MODEL; ORGAN SYSTEMS; SCREENING; AGED; ASSISTED LIVING FACILITY; CANADA; FRAIL ELDERLY; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH STATUS; HOSPITALIZATION; INTENSIVE CARE; MASS SCREENING; NURSING HOME; PRIMARY HEALTH CARE; TRANSLATIONAL RESEARCH; VERY ELDERLY;

AGED; AGED, 80 AND OVER; ASSISTED LIVING FACILITIES; CANADA; CRITICAL CARE; DELIVERY OF HEALTH CARE; FRAIL ELDERLY; HEALTH POLICY; HEALTH STATUS; HOSPITALIZATION; HUMANS; MASS SCREENING; NURSING HOMES; PRIMARY HEALTH CARE; TRANSLATIONAL MEDICAL RESEARCH;

EID: 84969835134     PISSN: 07149808     EISSN: 17101107     Source Type: Journal    
DOI: 10.1017/S0714980816000301     Document Type: Article

References (163)

1. Abellan van Kan, G., Rolland, Y., Andrieu, S., Bauer, J., Beauchet, O., Bonnefoy, M., ... & Vellas, B. (2009). Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. The Journal of Nutrition Health and Aging, 13 (10), 881-889.
2. Afilalo, J., Mottillo, S., Eisenberg, M. J., Alexander, K. P., Noiseux, N., Perrault, L. P., ... Bergman, H. (2012). Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circulation: Cardiovascular Quality Outcomes, 5 (2), 222-228.
3. Akki, A., Yang, H., Gupta, A., Chacko, V. P., Yano, T., Leppo, M. K., ... & Weiss, R. G. (2014). Skeletal muscle ATP kinetics are impaired in frail mice. Age, 36 (1), 21-30.
4. Alon-Shenker, P. (2012). The unequal right to equality: Towards a dignified lives approach to age discrimination. The Canadian Journal of Law & Jurisprudence, 25 (2), 243-282.
5. Andrew, M., & Keefe, J. (2014). Social vulnerability among older adults: A social ecology perspective from the National Population Health Survey of Canada. BMC Geriatrics, 14 (90), 1-14.
6. Andrew, M., Mitnitski, A., Kirkland, S. A., & Rockwood, K. (2012). The impact of social vulnerability on the survival of the fittest older adults. Age and Ageing, 41 (2), 161-165.
7. Andrew, M. K., Mitnitski, A., & Rockwood, K. (2008). Social vulnerability, frailty, and mortality in elderly people. PLoS One, 3 (5), e2232.
8. Andrew, M. K., & Rockwood, K. (2010). Social vulnerability predicts cognitive decline in a prospective cohort of older Canadians. Alzheimers & Dementia, 6 (4), 319-325.
9. Armstrong, J. J., Stolee, P., Hirdes, J. P., & Poss, J. W. (2010). Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients. Age and Ageing, 39 (6), 755-758.
10. Bagshaw, S. M., Stelfox, H. T., Johnson, J. A., McDermid, R. C., Rolfson, D. B., Tsuyuki, R. T., ... Majumbar, S. R. (2015). Long-term association between frailty and health-related quality-of-life among survivors of critical illness: A prospective multicenter cohort study. Critical Care Medicine, 43 (5), 973-982.
11. Bagshaw, S. M., Stelfox, H. T., McDermid, R. C., Rolfson, D. B., Tsuyuki, R. T., Baig, N., ... et al. (2014). Association between frailty and short- and long-term outcomes among critically ill patients: A multicentre prospective cohort study. Canadian Medical Association Journal, 186 (2), E95-E102.
12. Bennett, K. M. (2005). Social engagement as a longitudinal predictor of objective and subjective health. European Journal of Ageing, 2 (1), 48-55.
13. Bergman, H., Ferrucci, L., Guralnik, J., Hogan, D. B., Hummel, S., Karunananthan, S., & Wolfson, C. (2007). Frailty: An emerging research and clinical paradigm-Issues and controversies. Journal of Gerontology, 62A (7), 731-737.
14. Berkman, L. F. (2000). Social support, social networks, social cohesion and health. Social Work in Health Care, 31 (2), 3-14.
15. Brault, M. E., Ohayon, S. M., Kwan, R., Bergman, H., Eisenberg, M. J., Boivin, J. F., ... & Afilalo, J. (2014). Telomere length and the clinical phenotype of frailty in older adults undergoing cardiac surgery. Journal of the American Geriatrics Society, 62 (11), 2205-2207.
16. Brennan, T. A., Leape, L. L., Laird, N. M., Herbert, L., Localio, A. R., Lawthers, A. G., ... & Hiatt, H. H. (1991). Incidence of adverse events and negligence in hospitalized patients-Results of the Harvard Medical Practice Study I. New England Journal of Medicine, 7 (324), 370-376.
17. Brothers, T. D., Kirkland, S., Guaraldi, G., Falutz, J., Theou, O., Johnston, B. L., & Rockwood, K. (2014). Frailty in people aging with human immunodeficiency virus (HIV) infection. Journal of Infectious Diseases, 210 (8), 1170-1179.
18. Brownie, S., & Nancarrow, S. (2013). Effects of personcentered care on residents and staff in aged-care facilities: A systematic review. Clinical Interventions in Aging, 8, 1-10.
19. Buckinx, F., Rolland, Y., Reginster, J. Y., Ricour, C., Petermans, J., & Bruyère, O. (2015). Burden of frailty in the elderly population: Perspectives for a public health challenge. Archives of Public Health, 73 (1), 19.
20. Buth, K. J., Gainer, R. A., Legare, J. F., & Hirsch, G. M. (2014). The changing face of cardiac surgery: Practice patterns and outcomes 2001-2010. Canadian Journal of Cardiology, 30 (2), 224-230.
21. Canadian Institute for Health Information. (2011). A focus on seniors and aging. Ottawa, ON: Health Care in Canada.
22. Canadian Study of Health and Aging Working Group. (1994). Canadian study of health and aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150 (6), 899-913.
23. Cane, J., O'Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7, 37.
24. Capital Health. (2015). Palliative & therapeutic harmonization clinic. Retrieved from http://www.cdha.nshealth.ca/ geriatric-medicine/palliative-therapeutic-harmonizationclinic
25. Carlson, C., Merel, S. E., & Yukawa, M. (2015). Geriatric syndromes and geriatric assessment for the generalist. Medical Clinics of North America, 99 (2), 263-279.
26. Carpenter, C. R., Shelton, E., Fowler, S., Suffoletto, B., Platts- Mills, T. F., Rothman, R. E., & Hogan, T. M. (2015). Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: A systematic review and meta-analysis. Academic Emergency Medicine, 22 (1), 1-21.
27. Chow, W. B., Rosenthal, R. A., Merkow, R. P., Ko, C., & Esnaola, N. F. (2012). Optimal preoperative assessment of the geriatric surgical patient: A best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. Journal of the American College of Surgeons, 215 (4), 453-466.
28. Clegg, A., Rogers, L., & Young, J. (2015). Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: A systematic review. Age and Ageing, 44 (1), 148-152.
29. Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. Lancet, 381 (9868), 752-762.
30. Collerton, J., Martin-Ruiz, C., Davies, K., Hilkens, C. M., Isaacs, J., Kolenda, C., ... & Kirkwood, T. B. (2012). Frailty and the role of inflammation, immunosenescence and cellular ageing in the very old: Cross-sectional findings from the Newcastle 85+ study. Mechanisms of Ageing and Development, 133 (6), 456-466.
31. Conference Board of Canada (2013). Future care for Canadian seniors - Why it matters. Ottawa, ON: Author.
32. Costa, A. P., & Hirdes, J. P. (2010). Clinical characteristics and service needs of alternate-level-of-care patients waiting for long-term care in Ontario hospitals. Healthcare Policy, 6 (1), 32.
33. Costa, A. P., Hirdes, J. P., Heckman, G. A., Dey, A. B. Jonsson, P. V., Lakhan, P., ... Gray, L. C. (2014). Geriatric syndromes predict postdischarge outcomes among older emergency department patients: Findings from the interRAI Multinational Emergency Department Study. Academic Emergency Medicine, 21 (4), 422-433.
34. Covinsky, K. E., Pierluissi, E., & Johnston, C. B. (2011). Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure". Journal of the American Medical Association, 306 (16), 1782-1793.
35. Debettignies, B., Mahurin, R., & Pirozzolo, F. (1990). Insight for impairment in independent living skills in Alzheimer's disease and multi-infarct dementia. Journal of Clinical and Experimental Neuropsychology, 12 (2), 355-363.
36. de Vries, N. M., Staal, J. B., van Ravensberg, C. D., Hobbelen, J. S., Olde Rikkert, M. G., & Nijhuis-van der Sanden, M. W. (2011). Outcome instruments to measure frailty: A systematic review. Ageing Research Reviews, 10 (1), 104-114.
37. Dickson, G., Lindstrom, R., Black, C., & Van der Gucht, D. (2012). Evidence-informed change management in Canadian healthcare organizations. Ottawa, ON: Canadian Health Services Research Foundation.
38. Doupe, M., Brownell, M., Kozyrskyj, A., Dik, N., Burchill, C., Dahl, M., ... Bodnarchuk, J. (2006). Using administrative data to develop indicators of quality care in personal care homes. Winnipeg, MB: Manitoba Centre for Health Policy, Department of Community Health Sciences.
39. Doupe, M., Brownell, M., St. John, P., Strang, D. G., Chateau, D., & Dik, N. (2011). Nursing home adverse events: Further insight into highest risk periods. Journal of the American Medical Directors Association, 12 (6), 467-474.
40. Doupe, M. B., St. John, P., Chateau, D., Strang, D., Smele, S., Bozat-Emre, S., ... & Dik, N. (2012). Profiling the multidimensional needs of new nursing home residents: Evidence to support planning. Journal of the American Medical Directors Association, 13 (5), e9-e17.
41. Drubbel, I., Numans, M. E., Kranenburg, G., Bleijenberg, N., de Wit, N. J., & Schuurmans, M. J. (2014). Screening for frailty in primary care: A systematic review of the psychometric properties of the frailty index in community- dwelling older people. BMC Geriatrics, 14 (27), 1-13.
42. Entwistle, V. A., Carter, S. M., Cribb, A., & McCaffery, K. (2010). Supporting patient autonomy: The importance of clinician-patient relationships. Journal of General Internal Medicine, 25 (7), 741-745.
43. Feridooni, H. A., Sun, M. H., Rockwood, K., & Howlett, S. E. (2014). Reliability of a frailty index based on the clinical assessment of health deficits in male C57BL/6J mice. The Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 70 (6), 686-693.
44. Ferrucci, L., Guralnik, J. M., Studenski, S., Fried, L. P., Cutler, G. B., & Walston, J. D. (2004). Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report. Journal of the American Geriatrics Society, 52 (4), 625-634.
45. Freiheit, E. A., Hogan, D. B., Strain, L. A., Schmaltz, H. N., Patten, S. B., Eliasziw, M., & Maxwell, C. J. (2011). Operationalizing frailty among older residents of assisted living facilities. BMC Geriatrics, 11 (23), 1-11.
46. Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsh, C., Gottdiener, J., ... & McBurnie, M. A. (2001). Frailty in older adults: Evidence for a phenotype. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56 (3), M146-M157.
47. Garrouste-Orgeas, M., Boumendil, A., Pateron, D., Aergerter, P., Somme, D., Simon, T., & Goudet, B. (2009). Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational, multicenter, prospective study. Critical Care Medicine, 37 (11), 2919-2928.
48. Giordano, S. (2005). Respect for equality and the treatment of the elderly: Declarations of human rights and age-based rationing. Cambridge Quarterly of Healthcare Ethics, 14 (1), 83-92.
49. Gobbens, R. J. J., van Assen, M. A. L. M., Luijkx, K. G., Wijnen-Sponselee, M. T., & Schols, J. M. (2010). The Tilburg Frailty Indicator: Psychometric properties. Journal of the American Medical Directors Association, 11 (5), 344-355.
50. Goldstein, J., Hubbard, R. E., Moorhouse, P., Andrew, M. K., Mitnitski, A., & Rockwood, K. (2015). The validation of a care partner-derived frailty index based upon comprehensive geriatric assessment (CP-FI-CGA) in emergency medical services and geriatric ambulatory care. Age and Ageing, 44 (2), 327-330.
51. Gonzalez-Vaca, J., de la Rica-Escuin, M., Silva-Iglesias, M., Arjonilla-García, M. D., Varela-Pérez, R., Oliver-Carbonell, J. L., & Abizanda, P. (2014). Frailty in institutionalized older adults from Albacete. The FINAL study: Rationale, design, methodology, prevalence and attributes. Maturitas, 77 (1), 78-84.
52. Gordon, A., & Oliver, D. (2015). Commentary: Frameworks for long term conditions must take account of needs of frail older people. British Medical Journal, 10, 350-370.
53. Gray, L. C., Peel, N. M., Costa, A. P., Burkett, E., Dey, A. B., Jonsson, P. V., ... Hirdes, J. (2013). Profiles of older patients in the emergency department: Findings from the interRAI Multinational Emergency Department Study. Annals of emergency medicine, 62 (5), 467-474.
54. Gruber-Baldini, A., Stuart, B., Zuckerman, I., Van Doren, H., Boockvar, K., Zimmerman, S., & Magaziner, J. (2009). Sensitivity of nursing home cost comparisons to method of dementia diagnosis ascertainment. International Journal of Alzheimer's Disease, 2009, 1-10. doi: 10.4061/2009/ 780720
55. Handforth, C., Clegg, A., Young, C., Simpkins, S., Seymour, M. T., Selby, P. J., & Young, J. (2014). The prevalence and outcomes of frailty in older cancer patients: A systematic review. Annals of Oncology, 26 (6), 1091-1101.
56. Harris, J. R., Cheadle, A., Hannon, P. A., Forehand, M., Lichiello, P., Mahoney, E., ... Yarrow, J. (2012). A framework for disseminating evidence-based health promotion practices. CDC - Preventing Chronic Disease, 9. http://dx.doi.org/10.5888/pcd9.110081
57. Herrara, A. P., Snipes, S. A., King, D. W., Torres-Vigil, I., Goldberg, D. S., & Weinberg, A. D. (2010). Disparate inclusion of older adults in clinical trials: Priorities and opportunities for policy and practice change. American Journal of Public Health, 100 (S1), S105-S112.
58. Heyland, D., Cook, D., Bagshaw, S., Garland, A., Stelfox, T., Mehta, S., ... Canadian Critical Care Trials Group and Canadian Researchers at the End of Life Network. (2015). The very elderly admitted to ICU: A quality finish? Critical Care Medicine, 41 (11), 1911-1920.
59. Hirdes, J. P., Curtin-Telegdi, N., Poss, J. W., Gray, L., Berg, K. O., Stolee, P., ... & Szczerbinska, K. (2010). interRAI contact assessment (CA) form and user's manual: A screening level assessment for emergency department and intake from community/hospital. Version 9.2. Washington, DC: interRAI.
60. Hirdes, J. P., Frijters, D. H., & Teare, G. F. (2003). The MDSCHESS Scale: A new measure to predict mortality in institutionalized older people. Journal of the American Geriatrics Society, 51 (1), 96-100.
61. Hirdes, J. P., Mitchell, L., Maxwell, C. J., & White, N. (2011). Beyond the 'iron lungs of gerontology': Using evidence to shape the future of nursing homes in Canada. Canadian Journal on Aging, 30 (3), 371-390.
62. Hirdes, J. P., Poss, J., Mitchell, L., Korngut, L., & Heckman, G. (2014). Use of the interRAI CHESS Scale to predict mortality among persons with neurological conditions in three care settings. PLoS ONE, 9 (6), e99066.
63. Hogan, D. B., Freiheit, E. A., Strain, L. A., Patten, S. B., Schmaltz, H. N., Rolfson, D., & Maxwell, C. J. (2012). Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living. BMC Geriatrics, 12 (56), 1-11.
64. Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7 (7), e1000316.
65. Hoogendijk, E. O., van der Horst, H. E., Deeg, D. J., Frijters, D. H., Prins, B. A., Jansen, A. P., ... van Hout, H. P. (2013). The identification of frail older adults in primary care: Comparing the accuracy of five simple instruments. Age and Ageing, 42 (2), 262-265.
66. Hoover, M., Roterman, M., Sanmartin, C., & Bernier, J. (2013). Validation of an index to estimate the prevalence of frailty among community-dwelling seniors. Health Reports, 24 (9), 10-17.
67. Howlett, S. E., Rockwood, M. R., Mitnitski, A., & Rockwood, K. (2014). Standard laboratory tests to identify older adults at increased risk of death. BMC Medicine, 12 (171), 1-8.
68. Hubbard, R. E., Peel, N. M., Samanta, M., Gray, L. C., Fries, B. E., Mitnitski, A., & Rockwood, K. (2015). Derivation of a frailty index from the interRAI acute care instrument. BMC Geriatrics, 15 (27), 1-8.
69. Jones, D., Song, X., Mitnitski, A., & Rockwood, K. (2005). Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians. Aging Clinical and Experimental Research, 17 (6), 465-471.
70. Jones, D. M., Song, X., & Rockwood, K. (2004). Operationalizing a frailty index from a standardized comprehensive geriatric assessment. Journal of the American Geriatrics Society, 52 (11), 1929-1933.
71. Joosten, E. L., Demuynck, M., Detroyer, E., & Milisen, K. (2014). Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatrics, 14 (1), 1-9.
72. Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Hashmi, A., Green, D. J., O'Keeffe, T., ... & Rhee, P. (2014). Superiority of frailty over age in predicting outcomes among geriatric trauma patients: A prospective analysis. Journal of the American Medical Association Surgery, 149 (8), 766-772.
73. Jung, H. W., Kim, S. W., Ahn, S., Lim, J. Y., Han, J. W., Kim, T. H., ... & Kim, C. H. (2014). Prevalence and outcomes of frailty in Korean elderly population: Comparisons of a multidimensional frailty index with two phenotype models. PLoS One, 9 (2), e87958.
74. Kaehr, E., Visvanathan, R., Malmstrom, T. K., & Morley, J. E. (2015). Frailty in nursing homes: The FRAIL-NH scale. Journal of the American Medical Directors Association, 16 (2), 87-89.
75. Kane, A. E., Hilmer, S. N., Boyer, D., Gavin, K., Nines, D., Howlett, S. E., ... & Mitchell, S. J. (2015). Impact of longevity interventions on a validated mouse clinical frailty index. The Journal of Gerontology Series A: Biological Sciences and Medical Sciences. doi: 10.1093/gerona/ glu315 (First published online: February 22, 2015).
76. Kanwar, A., Singh, M., Lennon, R., Ghanta, K., McNallan, S. M., & Roger, V. L. (2013). Frailty and health-related quality of life among residents of long-term care facilities. Journal of Aging and Health, 25 (5), 792-802.
77. Kelaiditi, E., Cesari, M., Canevelli, M., van Kan, G. A., Ousset, P. J., Gillette-Guyonnet, S., ... & Vellas, B. (2013). Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. The Journal of Nutrition Health and Aging, 17 (9), 726-734.
78. Kenig, J., Zychiewicz, B., Olszewska, U., & Richter, P. (2015). Screening for frailty among older patients with cancer that qualify for abdominal surgery. Journal of Geriatric Oncology, 6 (1), 52-59.
79. Krueger, K. R., Wilson, R. S., Kamenetsky, J. M., Barnes, L. L., Bienias, J. L., & Bennett, D. A. (2009). Social engagement and cognitive function in old age. Experimental Aging Research, 35 (1), 45-60.
80. Lee, D. H., Buth, K. J., Martin, B. J., Yip, A. M., & Hirsch, G. M. (2010). Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation, 121 (8), 973-978.
81. Lee, L., Heckman, G., & Molnar, F. (2015). Frailty: Identifying elderly patients at high risk of poor outcomes. Canadian Family Physician, 61 (3), 227-231.
82. Le Maguet, P., Roquilly, A., Lasocki, S., Asehnoune, K., Carise, E., Saint Martin, M., ... Seguin, P. (2014). Prevalence and impact of frailty on mortality in elderly ICU patients: A prospective, multicenter, observational study. Intensive Care Medicine, 40 (5), 674-682.
83. Liu, H., Graber, T. G., Ferguson-Stegall, L., & Thompson, L.V. (2014). Clinically relevant frailty index for mice. The Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 69 (12), 1485-1491.
84. Lomas, J. (1993). Diffusion, dissemination, and implementation: Who should do what? Annals of the New York Academy of Sciences, 703, 226-237.
85. López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2013). The hallmarks of aging. Cell, 153 (6), 1194-1217.
86. Lurie, I., Myers, V., Goldbourt, U., & Gerber, Y. (2014). Perceived social support following myocardial infarction and long-term development of frailty. European Journal of Preventative Cardiology, 22 (10), 1346-1353.
87. Mallery, L., Allen, M., Fleming, I., Kelly, K., Bowless, S., Duncan, J., & Moorhouse, P. (2014). Promoting higher blood pressure targets for frail older adults: A consensus guideline from Canada. Cleveland Clinic Journal of Medicine, 81 (7), 427-437.
88. Mallery, L. H., & Moorhouse, P. (2011). Respecting frailty. Journal of Medical Ethics, 37 (2), 126-128.
89. Marcantonio, E. R. (2012). Postoperative delirium: A 76-yearold woman with delirium following surgery. Journal of the American Medical Association, 308 (1), 73-81.
90. Marcantonio, E. R., Lee, G., Mangione, C. M., Ludwig, L. E., Muraca, B., Haslauer, C. M., ... Lee, T. H. (1994). A clinical prediction rule for delirium after elective noncardiac surgery. Journal of the American Medical Association, 271 (2), 134-139.
91. Marmot, M. (2004). Status syndrome: How your social standing directly affects your health and life expectancy. London, England: Bloomsbury.
92. Marmot, M. G., & Shipley, M. J. (1996). Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study. British Medical Journal, 313 (7066), 1177-1180.
93. Marshall, E. G., Clarke, B. S., Varatharasan, N., & Andrew, M. K. (2015). A Long-Term Care-Comprehensive Geriatric Assessment (LTC-CGA) tool: Improving care for frail older adults? Canadian Geriatrics Journal, 18 (1), 2-10.
94. Matusik, P., Tomaszewski, K., Chmielowska, K., Nowak, J., Parnicka, A., Dubiel, M., ... Grodzicki, T. (2012). Severe frailty and cognitive impairment are related to higher mortality in 12-month follow-up of nursing home residents. Archives of Gerontology and Geriatrics, 55 (1), 22-24.
95. McCusker, J., Bellavance, F., Cardin, S., Trepanier, S., Verdon, J., & Ardman, O. (1999). Detection of older people at increased risk of adverse health outcomes after an emergency visit: The ISAR screening tool. Journal of the American Geriatrics Society, 47 (10), 1229-1237.
96. McDermid, R. C., Stelfox, H. T., & Bagshaw, S. M. (2011). Frailty in the critically ill: A novel concept. Critical Care, 15 (1), 301.
97. McNally, M. E., & Lahey, W. (2014). Frailty's place in ethics and law: Some thoughts on equality, autonomy and limits and possibilities for ageing citizens. In K. Rockwood & O. Theou (Eds.), Frailty in ageing: Biological, clinical and social implications (pp. 174-185). Halifax, NS: Karger Medical and Scientific Publishers.
98. Minister of Employment and Immigration. (1999). Law v. Canada: 1 SCR 497. Ottawa, ON: Author.
99. Mitnitski, A., Collerton, J., Martin-Ruiz, C., Jagger, C., von Zglinicki, T., Rockwood, K., & Kirkwood, T. B. (2015). Age-related frailty and its association with biological markers of ageing. BMC Medicine, 13 (161), 1-9.
100. Mitnitski, A. B., Mogilner, A. J., MacKnight, C., & Rockwood, K. (2002). The mortality rate as a function of accumulated deficits in a frailty index. Mechanisms of Ageing and Development, 123 (11), 1457-1460.
101. Moorhouse, P., & Mallery, L. H. (2012). Palliative and therapeutic harmonization: A model for appropriate decisionmaking in frail older adults. Journal of the American Geriatrics Society, 60 (12), 2326-2332.
102. Morley, J. E., Vellas, B., van Kan, G. A., Anker, S. D., Bauer, J. M., Bernabei, R., ... & Waltson, J. (2013). Frailty consensus: A call to action. Journal of the American Medical Directors Association, 14 (6), 392-397.
103. Nichols, B. G., Varadarajan, V., Bock, J. M., & Blumin, J. H. (2015). Dysphonia in nursing home and assisted living residents: Prevalence and association with frailty. Journal of Voice, 29 (1), 79-82.
104. Oliver, D. (2014). Making health and care systems fit for an ageing population. Why we wrote it, who we wrote it for, and how relevant it might be to Canada. Canadian Geriatrics Journal, 17 (4), 136-139.
105. Parks, R. J., Fares, E., Macdonald, J. K., Ernst, M. C., Sinal, C. J., Rockwood, K., & Howlett, S. E. (2012). A procedure for creating a frailty index based on deficit accumulation in aging mice. The Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 67 (3), 217-227.
106. Patel, K. V., Brennan, K. L., Brennan, M. L., Jupiter, D. C., Shar, A., & Davis, M. L. (2014). Association of a modified frailty index with mortality after femoral neck fracture in patients aged 60 years and older. Clinical Orthopaedics and Related Research, 472 (3), 1010-1017.
107. Peek, M. K., Howrey, B. T., Ternent, R. S., Ray, L. A., & Ottenbacher, K. J. (2012). Social support, stressors, and frailty among older Mexican American adults. Journal of Gerontology Series B: Psychological Sciences and Social Sciences, 67 (6), 755-764.
108. Pilotto, A., Ferrucci, L., Franceschi, M., D'Ambrosio, L. P., Scarcelli, C., Cascavilla, L., ... & Leandro, G. (2008). Development and validation of a multidimensional prognostic index for 1-year mortality from the comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Research, 11 (1), 151-161.
109. Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. New York, NY: Simon & Schuster.
110. Ramage-Morin, P. L. (2006). Successful aging in health care institutions. H ealth Reports (Statistics Canada, Catalogue 82-003), 16 (Suppl), 47-56.
111. Rennick, D. M., & Fort, M. M. (2000). Lessons from genetically engineered animal models. XII. IL-10-deficient (IL-10(-/-) mice and intestinal inflammation. American Journal of Physiology: Gastrointestinal and Liver Physiology, 278 (6), G829-G833.
112. Robertson, D. A., Savva, G. M., & Kenny, R. A. (2013). Frailty and cognitive impairment - A review of the evidence and causal mechanisms. Ageing Research Reviews, 12 (4), 840-851.
113. Rockwood, K. (2005a). An unsuitable old age: The paradoxes of elder care. Canadian Medical Association Journal, 173 (12), 1500-1501.
114. Rockwood, K. (2005b). Frailty and its definition: A worthy challenge. Journal of the American Geriatrics Society, 53 (6), 1069-1070.
115. Rockwood, K. (2005c). What would make a definition of frailty successful? Age and Ageing, 34 (5), 432-434.
116. Rockwood, K., Abeysundera, M. J., & Mitnitski, A. (2007). How should we grade frailty in nursing home patients? Journal of the American Medical Directors Association, 8 (9), 595-603.
117. Rockwood, K., MacMillan, M., Mitnitski, A., & Howlett, S. E. (2015). A frailty index based on common laboratory tests in comparison with a clinical frailty index for older adults in long-term care facilities. Journal of the American Medical Directors Association, 16 (10), 842-847.
118. Rockwood, K., Silvius, J. L., & Fox, R. A. (1998). Comprehensive geriatric assessment. Helping your elderly patients maintain functional well-being. Postgraduate Medicine, 103 (3), 247-249.
119. Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., & Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173 (5), 489-495.
120. Rockwood, K., Song, X., & Mitnitski, A. (2011). Changes in relative fitness and frailty across the adult lifespan: Evidence from the Canadian National Population Health Survey. Canadian Medical Association Journal, 183 (8), E487-E494.
121. Rockwood, M. R., MacDonald, E., Sutton, E., Rockwood, K., Baron, M. & Canadian Scleroderma Research Group. (2014). Frailty index to measure health status in people with systemic sclerosis. The Journal of Rheumatology, 41 (4), 698-705.
122. Rodríguez-Mañas, L., Féart, C., Mann, G., Viña, J., Chatterji, S., Chodzko-Zajko, W., ... & Vega, E. (2013). Searching for an operational definition of frailty: A Delphi method based consensus statement. The frailty operative definition-consensus conference project. The Journal of Gerontology A. Biological Sciences & Medical Sciences, 68 (1), 62-67.
123. Rolfson, D. B., Majumdar, S. R., Tsuyuki, R. T., Tahir, A., & Rockwood, K. (2006). Validity and reliability of the Edmonton Frail Scale. Age and Ageing, 35 (5), 526-529.
124. Romero-Ortuno, R., & Soraghan, C. A. (2014). Frailty instrument for primary care for those aged 75 years or more: Findings from the Survey of Health, Ageing and Retirement in Europe, a longitudinal populationbased cohort study (SHARE-FI75+). BMJ Open, 4 (12), e006645.
125. Rudolph, J. L., Jones, R. N., Levkoff, S. E., Rockett, C., Inouye, S. K., Sellke, F. W., ... Marcantonio, E. R. (2009). Derivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation, 119 (2), 229-236.
126. Sabia, S., Singh-Manoux, A., Hagger-Johnson, G., Cambois, E., Brunner, E. J., & Kivimaki, M. (2012). Influence of individual and combined healthy behaviours on successful aging. Canadian Medical Association Journal, 184 (18), 1985-1992.
127. Salem, B. E., Nyamathi, A. M., Brecht, M. L., Phillips, L. R., Mentes, J. C., Sarkisian, C., & Leake, B. (2013). Correlates of frailty among homeless adults. Western Journal of Nursing Research, 35 (9), 1128-1152.
128. Saum, K. U., Dieffenbach, A. K., Müezzinler, A., Müller, H., Holleczek, B., Stegmaier, C., ... & Brenner, H. (2014). Frailty and telomere length: Cross-sectional analysis in 3537 older adults from the ESTHER cohort. Experimental Gerontology, 58, 250-255.
129. Schoufour, J. D., Evenhuis, H. M., & Echteld, M. A. (2014). The impact of frailty on care intensity in older people with intellectual disabilities. Research in Developmental Disabilities, 35 (12), 3455-3461.
130. Searle, S., Mitnitski, A., Gahbauer, E., Gill, T., & Rockwood, K. (2008). A standard procedure for creating a frailty index. BMC Geriatrics, 8 (24), 1-10.
131. Sepehri, A., Beggs, T., Hassan, A., Rigatto, C., Shaw-Daigle, C., Tangri, N., & Arora, R. C. (2014). The impact of frailty on outcomes after cardiac surgery: A systematic review. The Journal of Thoracic and Cardiovascular Surgery, 148 (6), 3110-3117.
132. Shim, J. K., Russ, A. J., & Kaufman, S. R. (2006). Risk, life extension and the pursuit of medical possibility. Sociology Health Illness, 28 (4), 479-502.
133. Silvester, K. M., Mohammed, M. A., Harriman, P., Girolami, A., & Downes, T. W. (2014). Timely care for frail older people referred to hospital improves efficiency and reduces mortality without the need for extra resources. Age and Ageing, 43 (4), 472-477.
134. Sinha, M. (2012). Portrait of caregivers, 2012. Retrieved from http://www.statcan.gc.ca/pub/89-652-x/89-652- x2013001-eng.htm
135. Sinha, S. K., Bessman, E. S., Flomenbaum, N., & Leff, B. (2011). A systematic review and qualitative analysis to inform the development of a new emergency department-based geriatric case management model. Annals of Emergency Medicine, 57 (6), 672-682.
136. Sinha, S. K., Oakes, S. L., Suh, T., & Chaudhry, S. (2014). How to use the ACE unit to improve hospital safety and quality for older patients: From ACE units to elderfriendly hospitals. In M. L. Malone, E. A. Capezuti, & R. M. Palmer (Eds.), Acute care for elders: A model for interdisciplinary care (pp. 131-156). New York, NY: Humana Press.
137. Sligl, W. I., Eurich, D. T., Marrie, T. J., & Majumdar, S. R. (2011). Only severely limited, premorbid functional status is associated with short- and long-term mortality in patients with pneumonia who are critically ill: A prospective observational study. Chest, 139 (1), 88-94.
138. Special Senate Committee on Aging (2009). Canada's aging population: Seizing the opportunity. Ottawa, ON: Senate of Canada.
139. Statistics Canada. (2001). 2001 Census of Canada. Ottawa, ON: Author.
140. Statistics Canada. (2011). Living arrangements of seniors: Families, households and marital status. Structural type of dwelling and collectives, 2011 census of population. Ottawa, ON: Author.
141. Steverink, N., Slaets, J. P. J., Schuurmans, H., & van Lis, M. (2001). Measuring frailty. Development and testing of the Groningen Frailty Indicator (GFI). Gerontologist, 41 (1), 236-237.
142. St. John, P. D., Montgomery, P. R., & Tyas, S. L. (2013). Social position and frailty. Canadian Journal on Aging, 32 (3), 250-259.
143. Strain, L. A., Maxwell, C. J., Wanless, D., Gilbart, E., & Alberta Continuing Care Epidemiological Studies (ACCES) Research Group. (2015). Designated Assisted Living (DAL) and long-term care in Alberta: Selected highlights from the Alberta Continuing Care Epidemiological Studies (ACCES). Retrieved from http://www.ab-cca.ca/uploads/files/ Documents/ACCES%20Final%20Report%202011.pdf
144. Stuck, A. E., Siu, A. L., Wieland, G. D., Adams, J., & Rubenstein, L. Z. (1993). Comprehensive geriatric assessment: A meta-analysis of controlled trials. Lancet, 342 (8878), 1032-1036.
145. Subra, J., Gillette-Guyonnet, S., Cesari, M., Oustric, S., & Vellas, B. (2012). The integration of frailty into clinical practice: Preliminary results from the Gérontopôle. The Journal of Nutrition Health and Aging, 16 (8), 714-720.
146. Subramanian, S. V., Kim, D. J., & Kawachi, I. (2002). Social trust and self-rated health in US communities: A multilevel analysis. Journal of Urban Health, 79 (Suppl 1), S21-S34.
147. Tabue-Teguo, M., Kelaiditi, E., Demougeot, L., Dartigues, J. F., Vellas, B., & Cesari, M. (2015, July 1). Frailty index and mortality in nursing home residents in France: Results from the INCUR study. Journal of the American Medical Directors Association, 16 (7), 603-606. doi: 10.1016/j.jamda.2015.02.002 (Epub 2015 Mar 10)
148. Tjam, E. Y., Heckman, G. A., Smith, S., Arai, B., Hirdes, J., Poss, J., & McKelvie, R. S. (2012). Predicting heart failure mortality in frail seniors: Comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0. International Journal of Cardiology, 155 (1), 75-80.
149. Theou, O., Brothers, T. D., Mitnitski, A., & Rockwood, K. (2013). Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. Journal of the American Geriatrics Society, 61 (9), 1537-1551.
150. Theou, O., Brothers, T. D., Peña, F. G., Mitnitski, A., & Rockwood, K. (2014). Identifying common characteristics of frailty across seven scales. Journal of the American Geriatrics Society, 62 (5), 901-906.
151. Theou, O., Brothers, T. D., Rockwood, M. R., Haardt, D., Mitnitski, A., & Rockwood, K. (2013). Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans. Age and Ageing, 42 (5), 614-619.
152. Tricco, A. C., Antony, J., Ivers, N. M., Ashoor, H., Khan, P., Blondal, E., ... Straus, S. (2014). Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: A systematic review and meta-analysis. Canadian Medical Association Journal, 186 (15), E568-E578.
153. Turner, G., & Clegg, A. (2014). Best practice guidelines for the management of frailty: A British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age and Ageing, 43 (6), 744-747.
154. Wallis, S. J., Wall, J., Biram, R. W., & Romero-Ortuno, R. (2015). Association of the clinical frailty scale with hospital outcomes. QJM: An International Journal of Medicine. http://dx.doi.org/10.1093/qjmed/hcv066 (First published online: March 15, 2015)
155. Walsh, T. S., Salisbury, L. G., Merriweather, J. L., Boyd, J. A., Griffith, D. M., Huby, G., ... Ramsay, P. (2015). Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: The RECOVER randomized clinical trial. Journal of the American Medical Association: Internal Medicine, 175 (6), 901-910.
156. Walston, J., Fedarko, N., Yang, H., Leng, S., Beamer, B., Espinoza, S., ... & Becker, K. (2008). The physical and biological characterization of a frail mouse model. The Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 63A (4), 391-398.
157. Whitehead, J. C., Hildebrand, B. A., Sun, M., Rockwood, M. R., Rose, R. A., Rockwood, K., & Howlett, S. E. (2014). A clinical frailty index in aging mice: Comparisons with frailty index data in humans. The Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 69 (6), 621-632.
158. Winograd, C. H., Gerety, M. B., Chung, M., Goldstein, M. K., Dominguez, F., & Vallone, R. (1991). Screening for frailty: Criteria and predictors of outcomes. Journal of the American Geriatrics Society, 39 (8), 778-784.
159. Wolinsky, F. D., Stump, T. E., & Johnson, R. J. (1995). Hospital utilization profiles among older adults over time: Consistency and volume among survivors and decedents. Journal of Gerontology Series B: Psychological Sciences and Social Sciences, 50 (2), S88-S100.
160. Woo, J., Goggins, W., Sham, A., & Ho, S. C. (2005). Social determinants of frailty. Gerontology, 51 (6), 402-408.
161. Woo, J., Tang, N. L., Suen, E., Leung, J. C., & Leung, P. C. (2008). Telomeres and frailty. Mechanisms of Ageing and Development, 129 (11), 642-648.
162. You, J. J., Fowler, R. A., & Heyland, D. K. (2014). Just ask: Discussing goals of care with patients in hospital with serious illness. Canadian Medical Association Journal, 186 (6), 425-432.
163. Zaslavsky, O., Cochrane, B. B., Thompson, H. J., Woods, N. F., Herting, J. R., & LaCroix, A. (2013). Frailty: A review of the first decade of research. Biological Research for Nursing, 15 (4), 422-432.