Frailty is a multifaceted, geriatric syndrome that is associated with age-related declines in functional reserves resulting in increased risks of in-hospital death, readmissions and discharge to nursing homes. The risks associated with frailty highlights the need for providers to be able to quickly, and accurately, assess someone’s frailty level. Previous studies have shown that bedside clinician assessment is not a reliable or valid way to determine frailty, meaning that a more reliable, valid and concise method is needed. We developed a prediction model using discharge ICD-9/ICD-10 diagnostic codes and other demographic variables to predict Reported Edmonton Frail Scale scores. Participants were from the Baystate Frailty Study, a prospective cohort design study among elderly patients greater than 65 years old who were admitted to a single academic medical center between 2014 and 2016. Three different predictive models were completed utilizing the LASSO approach. The adjusted r-square increased across the three models indicating an increase in the predictive ability of the models. In this study of 762 hospitalized patients over the age of 65 years old, we found that a frailty prediction model that included ICD codes only had a poor prediction ability (adjusted r-square=0.10). The prediction ability improved 2-fold after adding demographic information, a comorbidity score and interaction terms (adjusted r-square=0.26). This study provided additional insights into the development of an automatic frailty assessment, something which is currently missing from clinical care.

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The purpose of this work was to further understand nutritional status, especially body weight and composition, during colorectal cancer progression. Population-based studies of colorectal cancer patients were conducted using administrative health data (primary and co-morbid diseases, demographics), and computed tomography (CT) imaging (body composition). In cohort 1, administrative health data was used to study comorbidities and nutritional status in 574 colorectal cancer patients referred for chemotherapy. Multivariate Cox regression revealed several comorbidities, performance status and weight loss 20% predicted survival. In cohort 2, a serial CT image analysis assessed longitudinal body composition changes during the last 12 months preceding death from colorectal cancer (n=34). Body composition changes were typified by exponential increases in liver metastases with concurrent accelerations of muscle and fat loss. These results have the potential to make a difference in how colorectal cancer patients are treated and researched by dietitians, oncologists, and health services researchers. / Nutrition and Metabolism