Comprehensive geriatric assessment

The nurse measured functional status, physical activity, disability, mood, nutritional status, and frailty status using validated instruments as described follows: 1) We administered the Korean version of the Mini-Mental State Examination (K-MMSE) (range: 0-30). Cognitive dysfunction was defined if K-MMSE score < 24 (15). 2) We used the Korean version of the Physical Activity Scale for the Elderly (K-PASE) (16). 3) As a physical function test, we measured handgrip strength (kg) using a dynamometer (T.K.K. 5401 Grip-D; Takei, Tokyo, Japan) and averaged two measurements from the dominant hand. Usual gait speed (m/second) was calculated from the time taken to walk four meters following one meter of unmeasured acceleration space. Slow gait was defined as < 0.8 m/second (17). Dismobility, a very slow gait, was defined as < 0.6 m/second (18). 4) To evaluate disability, using the validated scales for Koreans, we assessed dependence (i.e. requiring assistance from another person) in the following seven activities of daily living (ADL): bathing, continence, dressing, eating, toileting, transfer, and washing face and hands; and in the following ten instrumental activities of daily living (IADL): food preparation, household chores, going out short distance, grooming, handling finances, laundry, taking personal medication, shopping, using public transportation, and using the telephone (19). 5) We assessed depressive symptoms using the Korean version of the Center for Epidemiological Studies depression (CES-D) scale (range: 0-60) (20). Depression was defined if CES-D score ≥ 21 (21). 6) We defined malnutrition if the Mini-Nutritional Assessment Short Form (MNA-SF) score was < 8 points, and at risk for malnutrition if the MNA-SF score was 8 to 11 points (22). 7) We used two different validated frailty scales: Cardiovascular Health Study (CHS) frailty criteria (exhaustion, low activity, slowness, weakness, and weight loss) (4) and the Korean version of the FRAIL scale (K-FRAIL, an acronym for fatigue, resistance, ambulation, illnesses, and loss of weight) (23,24). Each scale assigns scores from 0 to 5 and classifies participants as robust if a score of 0, prefrail if a score of 1-2, and frail if a score ≥ 3. Although both scales are validated and widely used in clinical practice and research, the K-FRAIL scale that relies on self-reported response is relatively easier to obtain compared to the CHS criteria which requires a lengthy physical activity questionnaire and a measurement of physical performance.