A prospective, multicentre study to assess frailty in elderly patients with leg ulcers (GERAS study)

Abstract

Background: Although leg ulcers are a burdensome disease most common in those aged 65 years and older, frailty in this population has not yet been well established.

Objectives: The aim of this study was to prospectively explore and compare the presence of frailty in elderly patients with chronic leg or foot ulcers by applying different validated frailty screening methods in three healthcare settings and to assess the feasibility of frailty screening.

Methods: We compared frailty of leg ulcer patients referred to an academic hospital with a non-academic hospital, leg ulcer patients receiving (primary) homecare, and a dermato-oncology patient population (control group). Frailty and quality of life were assessed using four validated questionnaires: the Groninger Frailty Indicator, Geriatric-8, Mini-Cog and Wound Quality of Life. To analyse data multiple (non)-parametric tests were performed.

Results: Fifty of 60 included leg ulcer patients (83%) scored "frail" on at least one frailty questionnaire (GFI, G8 or Mini-Cog). The number of patients scoring "frail" on two or three out of three applied frailty questionnaires were significantly higher in the academic and homecare ulcer population compared with the non-academic ulcer population and control group (p = 0.002). In the academic ulcer population mean Wound Quality of Life scores were 30.2 (SD 17.6), compared with 17.7 (SD 13.1) in the non-academic and 15.0 (SD 10.4) in the homecare ulcer population (p = 0.002).

Conclusion: The majority of patients suffering from leg ulcers in this study was frail. The highest frailty prevalence was observed in the academic and homecare ulcer populations. The largest impaired quality of life was reported in the academic ulcer population. In dermatology practice, implementing frailty screening and initiating appropriate (paramedical) supportive care should be considered to improve patient outcomes.

FIGURE 1

Diagnoses per population

FIGURE 2

Number of patients with 0, 1, 2 or 3 positive frailty scores. p = 0.002.

FIGURE 3

GFI total score per population. Scoring ranges from 0 to 14 (≥4 = frail). Error bar: ±SD. Mean scores: Academic ulcer 4.7 (SD 2.5), non‐academic ulcer 3.9 (SD 2.4), homecare ulcer population 5.7 (SD 2.5), control group 2.5 (SD 1.8) (p = 0.001). Number of patients scoring positive (n [%]): Academic ulcer 14 (70), non‐academic ulcer 9 (45), homecare ulcer population 17 (85), control group 5 (25) (p = 0.001). ***Significantly higher mean scores (p < 0.001) **significantly higher mean scores (p < 0.01).

FIGURE 4

G8 total score per population. Scoring ranges from 0 to 17 (≤14 = frail). Error bar: ±SD. Mean scores: Academic ulcer 11.3 (SD 2.9), non‐academic ulcer 13.0 (SD 2.0), homecare ulcer population 10.3 (SD 2.0), control group 14.3 (SD 1.2) (p = 0.001). Number of patients scoring positive (n [%]): Academic ulcer 17 (85), non‐academic ulcer 14 (70), homecare ulcer population 20 (100), control group 11 (55) (p = 0.002). ***Significantly lower mean scores (p < 0.001).