Assessment of Frailty in Elderly Individuals with Heart Failure

Year 2025, Volume: 12 Issue: 2, 132 - 140, 17.07.2025

Sema Aytaç , Özlem Ovayolu , Sibel Serçe , Alpaslan Açıkgöz

https://doi.org/10.31125/globnursinsights.1743962

Abstract

Aim: This descriptive and cross-sectional study assessed the frailty levels of geriatric individuals with heart failure.
Material and Methods: The study was conducted in the emergency department, cardiology polyclinic, and clinic at a State Hospital between June and August 2023. Power analysis was performed to determine the sample size, and the study was completed with 115 geriatric individuals willing to participate and meeting the inclusion criteria. Before the study, necessary permissions were obtained from the institution, the ethics committee, and participants. A questionnaire prepared by the researchers, the Standardized Mini Mental Test (SMMT), and the Edmonton Frail Scale (EFS) were used for data collection. The scores obtained from the EFS range between 0 and 17. A score of 0-4 indicates 'not frail', 5-6 indicates 'vulnerable', 7-8 indicates 'mildly frail,' 9-10 indicates 'moderately frail', and a score of 11 and above indicates 'severely frail'. Descriptive statistics, Mann-Whitney U, and Kruskal-Wallis tests were used for data analysis.
Results: The mean age of the individuals was 73.12±6.48 years, 54.8% were female, 37.4% were primary school graduates, 52.2% had a disease duration of 1-5 years, and 49.6% had stage II heart failure. The mean EFS score among geriatric individuals was 8.60±4.53, with 36.5% classified in the 'severely frail' group. It was found that female, single individuals living alone, with comorbid diabetes, stage IV heart failure, and not monitoring their weight had a higher mean EFS score (p<0.05).
Conclusion: It was determined that the frailty score of geriatric individuals with heart failure was at a moderate level, with 36.5% classified in the 'severely frail' group. Among geriatric individuals with heart failure, frailty levels and the affecting factors should be considered during follow-up.

Keywords

Frailty , Geriatrics , Heart failure , Nursing , Patient

References

• Aşiret, D. G., & Çetinkaya, F. (2018). The relationship between frailty and sleep quality in the elderly hospitalized patients. Fırat Tıp Dergisi, 23(4), 184–188.
• Aygör, H. E., Fadıloğlu, Ç., Şahin, S., Aykar, F. Ş., & Akçiçek, F. (2018). Validation of Edmonton frail scale into elderly Turkish population. Archives of Gerontology and Geriatrics, 76, 133–137. https://doi.org/10.1016/j.archger.2018.02.00
• Chalise, H. N. (2019). Aging: basic concept. American Journal of Biomedical Science & Research, 1(1), 8–10.
• Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381(9868), 752–762. https://doi.org/10.1016/S0140-6736(13)60696-8
• Çavuşoğlu, Y., Altay, H., Ekmekçi, A., Eren, M., Küçükoğlu, M. S., Nalbantgil, S., ... & Tokgözoğlu, L. (2016). Kronik kalp yetersizliği tedavisinde pratik yaklaşımlar: güncel uygulamada sık sorulanlar, gözden kaçanlar, tartışmalı durumlar. Anatolian Journal of Cardiology, 15, 1–65.
• Degertekin, M., Erol, Ç., Ergene, O., Tokgözoğlu, L., Aksoy, M., Erol, M. K., ... & Kozan, Ö. (2012). Heart failure prevalence and predictors in Turkey: HAPPY study. Archives of the Turkish Society of Cardiology, 40(4), 298–308. https://doi.org/10.5543/tkda.2012.65031
• Dovjak, P. (2022). Frailty in older adults with heart disease. Zeitschrift für Gerontologie und Geriatrie, 55(6), 465–470. https://doi.org/10.1007/s00391-022-02079-7
• Dunlay, S. M., Manemann, S. M., Chamberlain, A. M., Cheville, A. L., Jiang, R., Weston, S. A., & Roger, V. L. (2015). Activities of daily living and outcomes in heart failure. Circulation: Heart Failure, 8(2), 261–267. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001542
• Enç, N., & Öz Alkan, H. (2012). Nursing care of patients with chronic heart failure in the hospital. Turkish Journal of Cardiovascular Nursing, 3(4), 85–100.
• Finn, M., & Green, P. (2015). The influence of frailty on outcomes in cardiovascular disease. Revista Española de Cardiología (English Edition), 68(8), 653–656. https://doi.org/10.1016/j.rec.2015.04.005
• Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Minimental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.
• Gastelurrutia, P., Lupón, J., Altimir, S., De Antonio, M., González, B., Cabanes, R., ... & Bayes-Genis, A. (2013). Effect of fragility on quality of life in patients with heart failure. The American Journal of Cardiology, 112(11), 1785–1789. https://doi.org/10.1016/j.amjcard.2013.08.002
• Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., ... & Turner, M. B. (2014). Heart disease and stroke statistics—2014 update: A report from the American Heart Association. Circulation, 129(3), e28–e292.
• Güngen, C., Ertan, T., Eker, E., et al. (2002). Reliability and validity of the standardized mini mental state examination in the diagnosis of mild dementia in the Turkish population. Türk Psikiyatri Dergisi, 13, 273–281.
• Hoch, C. R., Klinedinst, N. J., Larimer, K., Renn, C., Fiskum, G., & Gottlieb, S. S. (2023). Fatigue in heart failure: a scoping review using the theory of unpleasant symptoms. The Journal of Cardiovascular Nursing, 38(4), E141–E164. https://doi.org/10.1097/JCN.0000000000000940
• Jankowska-Polańska, B., Uchmanowicz, B., Kujawska-Danecka, H., Nowicka-Sauer, K., Chudiak, A., Dudek, K., & Rosińczuk, J. (2019). Assessment of frailty syndrome using Edmonton frailty scale in Polish elderly sample. The Aging Male, 22(3), 177–186. https://doi.org/10.1080/13685538.2018.1450376
• Jha, S. R., Ha, H. S., Hickman, L. D., Hannu, M., Davidson, P. M., Macdonald, P. S., & Newton, P. J. (2015). Frailty in advanced heart failure: a systematic review. Heart Failure Reviews, 20, 553–560. https://doi.org/10.1007/s10741-015-9493-8
• Kalyoncuo, S. (2023). Frailty and nursing care, one of the geriatric syndromes in the elderly. BSJ Health Sciences, 6(3), 521–527. https://doi.org/10.19127/bshealthscience.1289615
• Kilic, S. (2014). Etki büyüklüğü. Journal of Mood Disorders, 4(1), 44–46. https://doi.org/10.5455/jmood.20140228012836
• Lee, C. S., Chien, C. V., & Bidwell, J. T. (2014). Comorbidity profiles and inpatient outcomes during hospitalization for heart failure: an analysis of the US Nationwide inpatient sample. BMC Cardiovascular Disorders, 14, 73. https://doi.org/10.1186/1471-2261-14-73
• Leong, D. P., Joseph, P., McMurray, J. J., Rouleau, J., Maggioni, A. P., Lanas, F., ... & Yusuf, S. (2023). Frailty and outcomes in heart failure patients from high-, middle-, and low-income countries. European Heart Journal, 44(42), 4435–4444. https://doi.org/10.1093/eurheartj/ehad595
• Major, K., Bodys-Pełka, A., Grabowski, M., & Lelonek, M. (2024). Quality of life in heart failure: new data, new drugs and devices. Cardiology Journal, 31(1), 156–167. https://doi.org/10.5603/cj.92243
• McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ... & ESC Committee for Practice Guidelines. (2012). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal, 33(14), 1787–1847. https://doi.org/10.1093/eurheartj/ehs104
• Mehrabi, F., & Béland, F. (2020). Effects of social isolation, loneliness and frailty on health outcomes and their possible mediators and moderators in community-dwelling older adults: A scoping review. Archives of Gerontology and Geriatrics, 90, 104119. https://doi.org/10.1016/j.archger.2020.104119
• 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. https://doi.org/10.1093/ageing/afl041
• Salmon, T., Essa, H., Tajik, B., Isanejad, M., Akpan, A., & Sankaranarayanan, R. (2022). The impact of frailty and comorbidities on heart failure outcomes. Cardiac Failure Review, 8. https://doi.org/
• Schjoedt, I., Sommer, I., & Bjerrum, M. B. (2016). Experiences and management of fatigue in everyday life among adult patients living with heart failure: a systematic review of qualitative evidence. JBI Database of Systematic Reviews and Implementation Reports, 14(3), 681–715. https://doi.org/10.11124/jbisrir-2016-002752
• Shinmura, K. (2016). Cardiac senescence, heart failure, and frailty: a triangle in elderly people. Keio Journal of Medicine, 65(2), 25–32. https://doi.org/10.2302/kjm.65.25
• Singh, M., Stewart, R., & White, H. (2014). Importance of frailty in patients with cardiovascular disease. European Heart Journal, 35(26), 1726–1731. https://doi.org/10.1093/eurheartj/ehu163
• Size, S., Pellicori, P., Zhang, J., Weston, J., & Clark, A. L. (2019). Identification of frailty in chronic heart failure. JACC: Heart Failure, 7(4), 291–302. https://doi.org/10.1016/j.jchf.2019.01.009
• Tokgözoğlu, L., Yılmaz, M. B., Abacı, A., Altay, H., & Atalar, E. (2015). Türkiye’de kalp yetersizliği yol haritası: Kalp yetersizliğinin ve buna bağlı ölümlerin önlenmesi amacıyla geliştirilebilecek politikalara ilişkin öneriler. Türk Kardiyoloji Derneği Yayını, 1–31.
• Uchmanowicz, I., & Gobbens, R. J. J. (2015). The relationship between frailty, anxiety and depression, and health-related quality of life in elderly patients with heart failure. Clinical Interventions in Aging, 10, 1595–1600. https://doi.org/10.2147/CIA.S90077
• Uchmanowicz, I., Młynarska, A., Lisiak, M., Kałużna-Oleksy, M., Wleklik, M., Chudiak, A., … Gobbens, R. (2019). Heart failure and problems with frailty syndrome: why it is time to care about frailty syndrome in heart failure. Cardiac Failure Review, 5(1), 37.
• Uchmanowicz, I., Lee, C. S., Vitale, C., Manulik, S., Denfeld, Q. E., Uchmanowicz, B., … Jankowska, E. A. (2020). Frailty and the risk of all‐cause mortality and hospitalization in chronic heart failure: A meta‐analysis. ESC Heart Failure, 7(6), 3427–3437. https://doi.org/10.15420/cfr.2018.37.1
• Unlu, O., Levitan, E. B., Reshetnyak, E., Kneifati-Hayek, J., Diaz, I., Archambault, A., … others. (2020). Polypharmacy in older adults hospitalized for heart failure. Circulation: Heart Failure, 13(11), e006977. https://doi.org/10.1161/CIRCHEARTFAILURE.120.006977
• Yalınkılıç, M., Kılıçaslan, K., Uysal, H., Bilgin, S., & Enç, N. (2020). Determination of frailty status of elderly individuals with heart failure. Turkish Journal of Cardiovascular Nursing, 11(25), 51–59. https://dx.doi.org/10.5543/khd.2020.06025
• Zengin, N., Ören, B., Yıldız, H., & Çil Akıncı, H. (2012). An investigation on the quality of life of heart failure patients as per socio-demographic and disease related characteristics. Journal of Intensive Care Nursing, 16(2), 41–48.