Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology.

Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and biomarker panels for frailty screening and diagnosis, using artificial intelligence to identify frailty, and investigating the altered response to medications by older adults with frailty. Other areas with novel developments included exercise (including technology-based exercise), multidimensional interventions, person-centred and integrated care, assistive technologies, analysis of frailty transitions, risk-factors, clinical guidelines, COVID-19, and potential future treatments. This review identified a strong need for the implementation and evaluation of cost-effective, community-based interventions to manage and prevent frailty. Our findings highlight the need to better identify and support older adults with frailty and involve those with frailty in shared decision-making regarding their care.

An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis.

BACKGROUND: The eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment. METHODS: A cost-minimisation analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a hospital system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations. RESULTS: The traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach. CONCLUSIONS: The eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.

Work Productivity Loss in Young Workers Is Substantial and Is Associated With Spinal Pain and Mental Ill-health Conditions.

OBJECTIVE: The aim of this study was to estimate the effect of spinal pain and mental ill-health conditions on work productivity in 22-year-old workers. METHODS: A cross-sectional design using data from the Raine Study cohort (n = 867) including self-reported work productivity and self-report of health practitioner diagnosed medical conditions. RESULT: Mean (median, 25th-percentile, 75th-percentile) annualized cost of health-related absenteeism was $AUD1899 ($0, $0, $1738) per worker. Annualized cost of presenteeism was $AUD10,674 ($6573, $4003, $13,087) per worker. Spinal pain and mental ill-health conditions were associated with increased health-related absenteeism, but not presenteeism. CONCLUSION: Work productivity loss in young workers is a substantial problem needing priority attention. Addressing spinal pain and mental ill-health may improve productivity of this important sector of the workforce.

Occupational safety and health enforcement tools for preventing occupational diseases and injuries.

BACKGROUND: There is uncertainty as to whether and what extent occupational safety and health regulation and legislation enforcement activities, such as inspections, are effective and efficient to improve workers' health and safety. We use the term regulation to refer both to regulation and legislation. OBJECTIVES: To assess the effects of occupational safety and health regulation enforcement tools for preventing occupational diseases and injuries. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE (embase.com), CINAHL (EBSCO), PsycINFO (Ovid), OSH update, HeinOnline, Westlaw International, EconLit and Scopus from the inception of each database until January 2013. We also checked reference lists of included articles and contacted study authors to identify additional published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), controlled before-after studies (CBAs), interrupted time series (ITS) and econometric panel studies of firms or workplaces evaluating inspections, warnings or orders, citations or fines, prosecution or firm closure by governmental representatives and if the outcomes were injuries, diseases or exposures.In addition, we included qualitative studies of workers' or employers' attitudes or beliefs towards enforcement tools. DATA COLLECTION AND ANALYSIS: Pairs of authors independently extracted data on the main characteristics, the risk of bias and the effects of the interventions. We expressed intervention effects as risk ratios (RR) or mean differences (MD). We recalculated other effect measures into RRs or MDs. We combined the results of similar studies in a meta-analysis. MAIN RESULTS: We located 23 studies: two RCTs with 1414 workplaces, two CBAs with 9903 workplaces, one ITS with six outcome measurements, 12 panel studies and six qualitative studies with 310 participants. Studies evaluated the effects of inspections in general and the effects of their consequences, such as penalties. Studies on the effects of prosecution, warnings or closure were not available or were of such quality that we could not include their results. The effect was measured on injury rates, on exposure to physical workload and on compliance with regulation, with a follow-up varying from one to four years. All studies had serious limitations and therefore the quality of the evidence was low to very low. The injury rates in the control groups varied across studies from 1 to 23 injuries per 100 person-years and compliance rates varied from 40% to 75% being compliant.The effects of inspections were inconsistent in seven studies: injury rates decreased or stayed at a similar level compared to no intervention at short and medium-term follow-up. In studies that found a decrease the effect was small with a 10% decrease of the injury rate. At long-term follow-up, in one study there was a significant decrease of 23% (95% confidence interval 8% to 23%) in injury rates and in another study a substantial decrease in accident rates, both compared to no intervention.First inspections, follow-up inspections, complaint and accident inspections resulted in higher compliance rates compared to the average effect of any other type of inspections.In small firms, inspections with citations or with more penalties could result in fewer injuries or more compliance in the short term but not in the medium term.Longer inspections and more frequent inspections probably do not result in more compliance.In two studies, there was no adverse effect of inspections on firm survival, employment or sales.Qualitative studies show that there is support for enforcement among workers. However, workers doubt if the inspections are effective because inspections are rare and violations can be temporarily fixed to mislead inspectors. AUTHORS' CONCLUSIONS: There is evidence that inspections decrease injuries in the long term but not in the short term. The magnitude of the effect is uncertain. There are no studies that used chemical or physical exposures as outcome. Specific, focused inspections could have larger effects than inspections in general. The effect of fines and penalties is uncertain. The quality of the evidence is low to very low and therefore these conclusions are tentative and can be easily changed by better future studies. There is an urgent need for better designed evaluations, such as pragmatic randomised trials, to establish the effects of existing and novel enforcement methods, especially on exposure and disorders.