AboutContactsEditorial StaffEditorial CouncilArchiveFor AuthorsFor Reviewers

Feasibility of Screening for Frailty in Elderly Patients with Arterial Hypertension: Age Is Not A Hindrance?

Journal «MEDICINA» ¹ 1, 2021, pp.36-57 (Research)

Authors

Bel'diev S. N.
MD, PhD, Associate Professor, Chair of therapy and cardiology1

Andreeva E. V.
MD, PhD, Associate Professor, Chair of therapy and cardiology1

Berezina E. I.
MD, PhD, Associate Professor, Chair of therapy and cardiology1

Egorova I. V.
MD, PhD, Associate Professor, Chair of therapy and cardiology1

Medvedeva I. V.
MD, PhD, Associate Professor, Chair of therapy and cardiology1

Platonov D. Yu.
MD, PhD, MPH, Head, Chair of therapy and cardiology1

1 - Tver State Medical University, Tver, Russia

Corresponding Author

Bel'diev Sergej; e-mail: sbeldiev@yandex.ru

Conflict of interest

Authors have no conflict of interest.

Funding

The study had no sponsorship.

Abstract

The Russian clinical guidelines «Arterial hypertension in adults» (2020) contain a statement according to which elderly (≥65 years) patients should be screened for frailty using «Vozrast ne pomeha» (verbatim – «Age is not a hindrance») questionnaire, since the identification of frailty can affect drug treatment strategy and level of target blood pressure. The paper presents a critical analysis of this statement, which shows that recommendation to use «Vozrast ne pomeha» questionnaire for frailty screening is insufficiently evidence based and does not fully take into account the problem of geriatric care availability.

Key words

frailty, senile asthenia syndrome, elderly, arterial hypertension, screening

DOI

References

1. Kobalava Z.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I., et al. Arterial'naja gipertenzija u vzroslyh. Klinicheskie rekomendacii 2020 [Arterial hypertension in adults. Clinical guidelines 2020]. Rossijskij kardiologicheskij zhurnal [Russian Journal of Cardiology] 2020; 25(3): 3786. doi: 10.15829/1560-4071-2020-3-3786. (In Russ.)

2. Chazova I.E., Oshchepkova E.V., Zhernakova Yu.V., Arkhipov M.V., Barbarash O.L., Galyavich A.S. et al. Arterial'naja gipertonija u vzroslyh. Klinicheskie rekomendacii 2016 [Arterial hypertension in adults. Clinical guidelines 2016]. Available at: https://minzdrav29.ru/health/normativnye-pravovye-dokumenty/klinical­_protokols/ŹŠ62.pdf. Accessed: 2021, Mar 22. (In Russ.)

3. Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39(33): 3021-3104. doi: 10.1093/eurheartj/ehy339.

4. Tkacheva O.N., Kotovskaya Yu.V., Runikhina N.K., Frolova E.V., Naumov A.V., Vorobyeva N.M., et al. Klinicheskie rekomendacii «Starcheskaja astenija» [Clinical guidelines on frailty]. Rossijskij zhurnal geriatricheskoj mediciny [Russian Journal of Geriatric Medicine] 2020; (1): 11-46. doi: 10.37586/2686-8636-1-2020-11-46. (In Russ.)

5. Fried L.P., Tangen C.M., Walston J., Newman A.B., Hirsch C., Gottdiener J., et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): M146-156. doi: 10.1093/gerona/56.3.m146.

6. Syddall H., Cooper C., Martin F., Briggs R., Aihie Sayer A. Is grip strength a useful single marker of frailty? Age Ageing 2003; 32(6): 650-656. doi: 10.1093/ageing/afg111.

7. Clegg A., Young J., Iliffe S., Rikkert M.O., Rockwood K. Frailty in elderly people. Lancet 2013; 381(9868): 752-62. doi: 10.1016/S0140-6736(12)62167-9.

8. Buta B.J., Walston J.D., Godino J.G., Park M., Kalyani R.R., Xue Q.L., et al. Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev 2016; (26): 53-61. doi: 10.1016/j.arr.2015.12.003.

9. Vermeiren S., Vella-Azzopardi R., Beckwée D., Habbig A.K., Scafoglieri A., Jansen B., et al. Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Dir Assoc 2016; 17(12): 1163.e1-1163.e17. doi: 10.1016/j.jamda.2016.09.010.

10. European Medicines Agency. Reflection paper on physical frailty: instruments for baseline characterisation of older populations in clinical trials (9 January 2018). Available at: https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-physical-frailty-instruments-baseline-characterisation-older-populations-clinical­_en.pdf. Accessed: 2021, Mar 22.

11. Ostapenko V.S. Rasprostranennost' i struktura geriatricheskih sindromov u pacientov ambulatorno-poliklinicheskih uchrezhdenij g. Moskvy [The prevalence and structure of geriatric syndromes in patients of outpatient clinics in Moscow]. Avtoreferat dissertacii na soiskanie uchenoj stepeni kandidata medicinskih nauk [Author’s abstract, PhD Thesis]. Moscow, 2017. 24 p. Available at: https://dlib.rsl.ru/viewer/01008712489#?page=1. Accessed: 22 March 2021. (In Russ.)

12. Ostapenko V.S. Rasprostranennost' i struktura geriatricheskih sindromov u pacientov ambulatorno-poliklinicheskih uchrezhdenij g. Moskvy [The prevalence and structure of geriatric syndromes in patients of outpatient clinics in Moscow]. Dissertacija na soiskanie uchenoj stepeni kandidata medicinskih nauk [PhD Thesis]. Moscow, 2017. 157 p. (In Russ.)

13. Tkacheva O.N., Runikhina N.K., Ostapenko V.S., Sharashkina N.V., Mkhitaryan E.A., Onuchina Yu.S., et al. Validacija oprosnika dlja skrininga sindroma starcheskoj astenii v ambulatornoj praktike [Validation of the questionnaire for screening frailty]. Uspehi gerontologii [Advances in gerontology] 2017; 30(2): 236-242. (In Russ.)

14. Tkacheva O.N., Runikhina N.K., Ostapenko V.S., Sharashkina N.V. Sem' voprosov dlja pozhilyh v praktike vracha pervichnogo zvena [Seven questions for elderly in the practice of primary care physicians]. Uspehi gerontologii [Advances in gerontology] 2017; 30(2): 231-235. (In Russ.)

15. Ostapenko V.S., Runikhina N.K., Sharashkina N.V. Rasprostranennost' sindroma starcheskoj astenii i ego vzaimosvjaz' s hronicheskimi neinfekcionnymi zabolevanijami u pacientov ambulatorno-poliklinicheskih uchrezhdenij g. Moskvy [Prevalence of frailty and its correlation with chronic non-infectious diseases in outpatients in Moscow]. Rossijskij zhurnal geriatricheskoj mediciny [Russian Journal of Geriatric Medicine] 2020; (2): 131-137. doi: 10.37586/2686-8636-2-2020-131-137. (In Russ.)

16. Bel'diev S.N., Medvedeva I.V., Platonov D.Yu. Lekarstvennye vzaimodejstvija novyh peroral'nyh antikoaguljantov: vnutri i vne jacheek tablicy [Drug interactions of new oral anticoagulants: inside and outside table cells]. Racional'naja farmakoterapija v kardiologii [Rational Pharmacotherapy in Cardiology] 2017; 13(5): 716-724. doi: 10.20996/1819-6446-2017-13-5-716-724. (In Russ.)

17. Platonov D.Yu., Bel'diev S.N. Lechenie arterial'noj gipertenzii u pacientov 80 let i starshe: kommentarii k soglasovannomu mneniju rossijskih jekspertov [Arterial hypertension management in patients over 80 years old: comment on the position agreement of the Russian experts]. Arterial'naja gipertenzija [Arterial Hypertension] 2018; 24(6): 646-653. doi: 10.18705/1607-419X-2018-24-6-646-653. (In Russ.)

18. Platonov D.Yu., Bel'diev S.N., Egorova I.V., Lazdin O.A., Berezina E.I., Andreeva E.V. et al. Pervye rossijskie klinicheskie rekomendacii po vedeniju bol'nyh s komorbidnoj patologiej: ocenivaem uroven' dokazatel'nosti [First Russian clinical recommendations for the management of patients with comorbid pathology: evaluate the evidence level]. Verhnevolzhskij medicinskij zhurnal [Upper Volga Medical Journal] 2018; 17(3): 23-32. (In Russ.)

19. Bel'diev S.N., Egorova I.V., Platonov D.Yu. Rekomendacii po primeneniju peroral'nyh antikoaguljantov u pacientov pozhilogo vozrasta: kriterii Birsa i dokazatel'naja medicina [Recommendations on the use of oral anticoagulants in elderly patients: Beers criteria and evidence-based medicine]. Medicina [Medicine] 2019; 7(4): 1-11. doi: 10.29234/2308-9113-2019-7-4-1-11. (In Russ.)

20. Tkacheva O.N., Kotovskaya Yu.V., Runikhina N.K., Milto A.S., Aleksanyan L.A., Frolova E.V. et al. Klinicheskie rekomendacii «Starcheskaja astenija» (2020) [Clinical guidelines on frailty (2020)]. Available at: http://cr.rosminzdrav.ru/recomend/613. Accessed: 2021, Mar 22. (In Russ.)

21. Vlassov V.V., Rebrova O.Yu. Ocenka populjacionnoj jeffektivnosti medicinskih tehnologij [Criteria for population efficacy of medical technologies]. Medicinskie tehnologii. Ocenka i vybor [Medical Technologies. Assessment and Choice] 2012; (3): 33-41. (In Russ.)

22. Geriatricheskaja sluzhba polnocenno zarabotaet v 68 regionah [The geriatric service will be fully operational in 68 regions]. Medvestnik: portal rossijskogo vracha [Medical bulletin: portal of a Russian doctor] 2020, May 21. Available at: https://medvestnik.ru/content/news/Geriatricheskaya-slujba-polnocenno-zarabotaet-v-68-regionah.html. Accessed: 2021, Mar 22. (In Russ.)

23. Memetov S.S., Sharkunov N.P. Nekotorye problemy sozdanija geriatricheskoj sluzhby v regionah [Some problems of creating a geriatric service in the regions]. Uspehi gerontologii [Advances in Gerontology] 2020; 33(1): 189-193. doi: 10.34922/AE.2020.33.1.025. (In Russ.).

24. Minzdrav: k 2024 godu chislo geriatrov v strane udvoitsja [Ministry of Health of Russia: by 2024, the number of geriatricians in the country will double]. Rossijskaja gazeta [Russian newspaper] 2020, Oct 29. Available at: https://rg.ru/2020/10/29/minzdrav-k-2024-godu-chislo-geriatrov-v-strane-udvoitsia.html. Accessed: 2021, Mar 22. (In Russ.).

25. Federal State Statistics Service. Demography: population distribution by age groups (2020, June 23). Available at: https://rosstat.gov.ru/folder/12781. Accessed: 2021, Mar 22. (In Russ.).

26. Federal State Statistics Service. Demographics: demographic forecast until 2035 (2020, Mar 26). Available at: https://rosstat.gov.ru/folder/12781. Accessed: 2021, Mar 22. (In Russ.).

27. Bel'diev S.N., Medvedeva I.V., Platonov D.Yu., Trufanova G.Yu. Issledovanija antikoaguljantnoj terapii u «hrupkih» pozhilyh pacientov: problemy terminologii i metodologii [Studies of anticoagulant therapy in frail elderly patients: problems of terminology and methodology]. Racional'naja farmakoterapija v kardiologii [Rational Pharmacotherapy in Cardiology] 2019; 15(2): 251-257. doi: 10.20996/1819-6446-2019-15-2-251-257. (In Russ.).

28. Polubichenko L.V. N. Polevoj – perevodchik shekspirovskogo «Gamleta»: sled v russkoj kul'ture. [Polevoy – translator of Shakespeare's «Hamlet»: a trace in Russian culture]. Materialy VIII Mezhdunarodnoj nauchnoj konferencii «Fenomen tvorcheskoj lichnosti v kul'ture: Fatjushhenkovskie chtenija» [Materials of the VIII International Scientific Conference «The Phenomenon of the Creative Personality in Culture: Fatyushchenko Readings»]. Moscow: Nauka, 2019. P. 419-426.

29. Benetos A., Bulpitt C.J., Petrovic M., Ungar A., Agabiti Rosei E., Cherubini A., et al. An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society working group on the management of hypertension in very old, frail subjects. Hypertension 2016; 67(5): 820-825. doi: 10.1161/HYPERTENSIONAHA.115.07020.

30. Beckett N.S., Peters R., Fletcher A.E., Staessen J.A., Liu L., Dumitrascu D., et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358(18): 1887-1898. doi: 10.1056/NEJMoa0801369.

31. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991; 265(24): 3255-3264. doi: 10.1001/jama.1991.03460240051027.

32. Staessen J.A., Fagard R., Thijs L., Celis H., Arabidze G.G., Birkenhäger W.H., et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997; 350(9080): 757-764. doi: 10.1016/s0140-6736(97)05381-6.

33. Gueyffier F., Bulpitt C., Boissel J.P., Schron E., Ekbom T., Fagard R., et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet 1999; 353(9155): 793-796. doi: 10.1016/s0140-6736(98)08127-6.

34. Bulpitt C.J., Beckett N.S., Cooke J., Dumitrascu D.L., Gil-Extremera B., Nachev C., et al. Results of the pilot study for the Hypertension in the Very Elderly Trial. J Hypertens 2003; 21(12): 2409-2417. doi: 10.1097/00004872-200312000-00030.

35. Mancia G., Fagard R., Narkiewicz K., Redón J., Zanchetti A., Böhm M., et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31(7): 1281-1357. doi: 10.1097/01.hjh.0000431740.32696.cc.

36. Warwick J., Falaschetti E., Rockwood K., Mitnitski A., Thijs L., Beckett N., et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med 2015; 13: 78. doi: 10.1186/s12916-015-0328-1.

37. Abellan van Kan G., Rolland Y., Bergman H., Morley J.E., Kritchevsky S.B., Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging 2008; 12(1): 29-37. doi: 10.1007/BF02982161.

38. Studenski S., Perera S., Patel K., Rosano C., Faulkner K., Inzitari M., et al. Gait speed and survival in older adults. JAMA 2011; 305(1): 50-58. doi: 10.1001/jama.2010.1923.

39. Romero-Ortuno R, Soraghan C. A 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 population-based cohort study (SHARE-FI75+). BMJ Open 2014; 4(12): e006645. doi: 10.1136/bmjopen-2014-006645.

40. Gale C.R., Cooper C., Sayer A.A. Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age Ageing 2015; 44(1): 162-165. doi: 10.1093/ageing/afu148.

41. Bulpitt C., Fletcher A., Beckett N., Coope J., Gil-Extremera B., Forette F., et al. Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial. Drugs Aging 2001; 18(3): 151-164. doi: 10.2165/00002512-200118030-00001.

42. Borhani N.O., Applegate W.B., Cutler J.A., Davis B.R., Furberg C.D., Lakatos E., et al. Systolic Hypertension in the Elderly Program (SHEP). Part 1: Rationale and design. Hypertension 1991; 17(3 Suppl): II2-15. doi: 10.1161/01.hyp.17.3­_suppl.ii2.

43. Amery A., Birkenhäger W., Bulpitt C.J., Clément D., De Leeuw P., Dollery C.T., et al. Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: objectives, protocol, and organization. Aging (Milano) 1991; 3(3): 287-302. doi: 10.1007/BF03324024.

44. Mancia G., Laurent S., Agabiti-Rosei E., Ambrosioni E., Burnier M., Caulfield M.J., et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2009; 18(6): 308-347. doi: 10.3109/08037050903450468.

45. SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373(22): 2103-2116. doi: 10.1056/NEJMoa1511939.

46. Pajewski N.M., Williamson J.D., Applegate W.B., Berlowitz D.R., Bolin L.P., Chertow G.M., et al. Characterizing frailty status in the systolic blood pressure intervention trial. J Gerontol A Biol Sci Med Sci 2016; 71(5): 649-655. doi: 10.1093/gerona/glv228.

47. Williamson J.D., Supiano M.A., Applegate W.B., Berlowitz D.R., Campbell R.C., Chertow G.M., et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA 2016; 315(24): 2673-2682. doi: 10.1001/jama.2016.7050.

48. Rockwood K., Andrew M., Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 2007; 62(7): 738-743. doi: 10.1093/gerona/62.7.738.

49. Song X., Mitnitski A., Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 2010; 58(4): 681-687. doi: 10.1111/j.1532-5415.2010.02764.x.

50. Hoover M., Rotermann M., Sanmartin C., Bernier J. Validation of an index to estimate the prevalence of frailty among community-dwelling seniors. Health Rep 2013; 24(9): 10-17. PMID: 24258362.

51. Blodgett J., Theou O., Kirkland S., Andreou P., Rockwood K. Frailty in NHANES: Comparing the frailty index and phenotype. Arch Gerontol Geriatr 2015; 60(3): 464-470. doi: 10.1016/j.archger.2015.01.016.

52. Kulminski A.M., Ukraintseva S.V., Kulminskaya I.V., Arbeev K.G., Land K., Yashin A.I. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 2008; 56(5): 898-903. doi: 10.1111/j.1532-5415.2008.01656.x.

53. Ambrosius W.T., Sink K.M., Foy C.G., Berlowitz D.R., Cheung A.K., Cushman W.C., et al. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials 2014; 11(5): 532-546. doi: 10.1177/1740774514537404.