Background
Frailty is an aging-associated vulnerability to poor health comes when challenged by physiologic stressors. Frailty is a common problem amongst the elderly and is associated with increased mortality and health care resource utilization. Frailty is common in recipients of cardiac devices. What is not known is whether interventions will improve frailty and if this changes patient outcomes.
Methods
There are four chapters in this thesis. In chapter 1, a review of the current state of frailty research, methods of measurement, biomarkers, imaging modalities and interventions are presented. In chapter 2, a pilot randomized controlled trial is proposed to determine if a supervised exercise program and nutritional supplement improves physical frailty in cardiac device patients. Chapter 3 presents the results of the pilot study to date. In chapter 4, we discuss the challenges faced during the COVID-19 pandemic with respect to recruitment and conducting the trial and changes to the protocol that could have improved the study and adapted to the current state of research.
Results
There are two conceptual models of frailty which include the frailty phenotype and frailty index. Frailty instruments are abundant and there is no gold standard measurement. Frailty biomarkers, imaging techniques in their current state are complementary measures and are not yet ready for clinical practice. The DEFINIT P trial is single centre RCT involving 24 cardiac device patients randomized to 12 month supervised exercise program and nutritional supplement. Recruitment was halted due to COVID-19 pandemic.
Conclusions
Frailty is common in cardiac device recipients. A gold standard frailty instrument is not yet established though efforts are currently underway. The DEFINIT P study is feasible with respect to recruitment and consent targets but whether the adherence target to the exercise intervention and nutritional supplement is achieved remains unknown due to stopping the pilot trial as a result of the COVID 19 pandemic. / Thesis / Master of Science (MSc) / Frailty is a state of vulnerability in elderly that makes them susceptible to large declines in health from minor illnesses. Frail elderly are more likely to be admitted to the hospital, nursing homes and have higher chance of dying. Old age and frailty are not the same. Frailty is common in patients with a pacemakers and defibrillators. The purpose of this study is to test whether a supervised exercise program and a nutritional supplement will help improve frailty. We planned to recruit 24 patients into the randomized control trial and 100 patients in the registry and follow them for a period of one year. We aimed to understand how common is frailty in elderly with pacemakers and defibrillators and what factors contribute to developing frailty.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/29568 |
| Date | January 2021 |
| Creators | Oqab, Zardasht |
| Contributors | Healey, Jeff, Whitlock, Richard, Mehta, Shamir |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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