Dansk Selskab for Almen Medicin logoDansk Selskab for Almen Medicin logo
Klinisk vejledning

Publiseret: 2023

Den ældre skrøbelige patient

Dansk Selskab for Almen Medicin 2023


  1. Rønholt F, Holm EA. Geriatri, Forlaget Munksgaard. 2016.

  2. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013;381:752–62. doi:10.1016/S0140-6736(12)62167-9.

  3. Hanlon P, Nicholl BI, Jani BD, et al. Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants. Lancet Public Heal 2018;3:e323-32.

  4. Puts MTE, Toubasi S, Andrew MK, et al. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: A scoping review of the literature and international policies. Age Ageing 2017;46:383–92. doi:10.1093/ageing/afw247.

  5. Sutorius FL, Hoogendijk EO, Prins BAH, et al. Comparison of 10 single and stepped methods to identify frail older persons in primary care: Diagnostic and prognostic accuracy. BMC Fam Pract 2016;17:1-12. doi:10.1186/s12875-016-0487-y.

  6. Fournaise A, Nissen SK, Lauridsen JT, et al. Translation of the updated clinical frailty scale 2.0 into Danish and implications for cross-sectoral reliability. BMC Geriatr 2021;21:1-3. doi:10.1186/s12877-021-02222-w.

  7. Ambagtsheer RC, Beilby JJ, Visvanathan R, et al. Should we screen for frailty in primary care settings? A fresh perspective on the frailty evidence base: A narrative review. Prev Med (Baltim) 2019;119:63-9. doi:10.1016/j.ypmed.2018.12.020.

  8. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Cmaj 2005;173:489-95. doi:10.1503/cmaj.050051.

  9. Sundhedsstyrelsen. National klinisk retningslinje for ernærings- og træningsindsatser til ældre med geriatriske problemstillinger. Sundhedsstyrrelsen. Lokaliseret 22. maj 2023 på: https://www.sst.dk/da/udgivelser/2016/~/media/316C3E23E56D4F2DB7BF9C14A70F364D.ashx.

  10. Travers J, Romero-Ortuno R, Bailey J, et al. Delaying and reversing frailty: A systematic review of primary care interventions. Br J Gen Pract 2019;69:E61-9. doi:10.3399/bjgp18X700241.

  11. Dedeyne L, Deschodt M, Verschueren S, et al. Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: A systematic review. Clin Interv Aging 2017;12:873-96. doi:10.2147/CIA.S130794.

  12. Sundhedsstyrelsen. Rehabilitering for ældre. Sundhedsstyrelsen. 2022. Lokaliseret 22. maj 2023 på: https://www.sst.dk/da/viden/aeldre/rehabilitering-af-aeldre

  13. Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: A systematic review. BMC Geriatr 2015;15. doi:10.1186/s12877-015-0029-9.

  14. Collamati A, Martone AM, Poscia A, et al. Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence. Aging Clin Exp Res 2016;28:25-35. doi:10.1007/s40520-015-0359-7.

  15. Reeve E, Gnjidic D, Long J, et al. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: Implications for future research and clinical practice. Br J Clin Pharmacol 2015;80:1254-68. doi:10.1111/bcp.12732.

  16. Sundhedsstyrelsen. Seponeringslisten. Lokaliseret 22. maj 2023 på: https://www.sst.dk/da/viden/laegemidler/medicingennemgang/seponeringslisten.

  17. Sundhedsstyrelsen. Kvalitetsstandarder for kommunale akutfunktioner i hjemmesygeplejen. 2017. Lokaliseret 22. maj 2023 på: https://www.sst.dk/da/udgivelser/2017/kvalitetsstandarder-for-kommunale-akutfunktioner-i-hjemmesygeplejen.

  18. Krogseth M, Watne LO, Juliebø V et al. Delirium is a risk factor for further cognitive decline in cognitively impaired hip fracture patients. Arch Gerontol Geriatr 2016;64:38-44.

  19. Sundhedsstyrelsen. National klinisk retningslinje for forebyggelse og behandling af organisk delirium. 2021. Lokaliseret 22. maj 2023 på: https://www.sst.dk/da/udgivelser/2016/~/media/2CEF8027049549D8AFE638651CAC9B49.ashx.

  20. RTLN, PLO. Vejledning i overenskomstens anvendelse: Udarbejdet af RLTN og PLO i henhold til § 69 i Overenskomst om almen praksis. 2022.

  21. Neergaard MA, Skorstengaard MH, Brogaard T, et al. Advance care planning and longer survival in the terminally ill: a randomised controlled trial unexpected finding. BMJ Support Palliat Care 2020;10:221–2. doi:10.1136/bmjspcare-2019-001906.

  22. Cardona-Morrell M, Lewis E, Suman S, et al. Recognising older frail patients near the end of life: What next? Eur J Intern Med 2017;45:84-90. doi:10.1016/j. ejim.2017.09.026.

  23. Glaudemans JJ, Van Charante EPM, Willems DL. Advance care planning in primary care, only for severely ill patients? A structured review. Fam Pract 2015;32:16-–26. doi:10.1093/fampra/cmu074.

  24. Zwakman M, Jabbarian LJ, van Delden JJM, et al. Advance care planning: A systematic review about experiences of patients with a life-threatening or life-limiting illness. Palliat Med 2018;32:1305-21. doi:10.1177/0269216318784474.

  25. Pape M, Rajan S, Hansen SM, et al. Survival after out-of-hospital cardiac arrest in nursing homes – A nationwide study. Resuscitation 2018;125:90-8. doi:10.1016/j. resuscitation.2018.02.004.

  26. Thomsen RW, Riis A, Nørgaard M, et al. Rising incidence and persistently high mortality of hospitalized pneumonia: A 10-year population-based study in Denmark. J Intern Med 2006;259:410-7. doi:10.1111/j.1365-2796.2006.01629.x.

  27. Faller JW, do Nascimento Pereira D, de Souza S, et al. Instruments for the detection of frailty syndrome in older adults: A systematic review. PLoS One 2019;14:1-23. doi:10.1371/journal.pone.0216166.

  28. Pialoux T, Goyard J, Lesourd B. Screening tools for frailty in primary health care: A systematic review. Geriatr Gerontol Int 2012;12:189-97. doi:10.1111/j.14470594.2011.00797.x.

  29. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. Journals Gerontol - Ser A Biol Sci Med Sci 2001;56:146-57. doi:10.1093/gerona/56.3.m146.

  30. Thompson MQ, Theou O, Tucker GR, et al. FRAIL scale: Predictive validity and diagnostic test accuracy. Australas J Ageing 2020;39:e529-36. doi:10.1111/ajag.12829.

  31. Ensrud KE, Ewing SK, Taylor BC, et al. Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures. Journals Gerontol - Ser A Biol Sci Med Sci 2007;62:744-51. doi:10.1093/gerona/62.7.744.

  32. 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. doi:10.1136/bmjopen-2014-006645.

  33. Gobbens RJJ, van Assen MALM, Augustijn H, et al. Prediction of Mortality by the Tilburg Frailty Indicator (TFI). J Am Med Dir Assoc 2021;22:607.e1-607.e6. doi:10.1016/j.jamda.2020.07.033.

  34. Petty DR, House A, Knapp P, et al. Validity and reliability of the Edmonton Frail Scale. Age Ageing 2006;35:526-9.

  35. Hoffmann S, Wiben A, Kruse M, et al. Predictive validity of PRISMA-7 as a screening instrument for frailty in a hospital setting. BMJ Open 2020;10:1-7. doi:10.1136/bmjopen-2020-038768.

  36. Lawless MT, Archibald MM, Ambagtsheer RC, et al. Factors influencing communication about frailty in primary care: A scoping review. Patient Educ Couns 2020;103:436–50. doi:10.1016/j.pec.2019.09.014.

  37. Jadczak AD, Dollard J, Mahajan N, et al. The perspectives of pre-frail and frail older people on being advised about exercise: A qualitative study. Fam Pract 2018;35:330–5. doi:10.1093/fampra/cmx108.

  38. Andreasen J, Sørensen EE, Gobbens RJJ, et al. Danish version of the Tilburg Frailty Indicator - Translation, cross-cultural adaption and validity pretest by cognitive interviewing. Arch Gerontol Geriatr 2014;59:32-8. doi:10.1016/j.archger.2014.02.007.

  39. Church S, Rogers E, Rockwood K, et al. A scoping review of the Clinical Frailty Scale. BMC Geriatr 2020;20:1–18. doi:10.1186/s12877-020-01801-7.

  40. Nissen SK, Fournaise A, Lauridsen JT, et al. Cross-sectoral inter-rater reliability of the clinical frailty scale – a Danish translation and validation study. BMC Geriatr 2020;20:1–8. doi:10.1186/s12877-020-01850-y.

  41. Ricchizzi E, Latour K, Kärki T, et al. Antimicrobial use in european long-term care facilities: Results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017. Eurosurveillance 2018;23. doi:10.2807/1560-7917.ES.2018.23.46.1800394.

  42. Sloane PD, Kistler CE, Reed D, et al. Urine Culture Testing in Community Nursing Homes: Gateway to Antibiotic Overprescribing. Infect Control Hosp Epidemiol 2017;38:524–31. doi:10.1017/ice.2016.326.

  43. Kistler CE, Zimmerman S, Scales K, et al. The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents. J Am Geriatr Soc 2017;65. doi:10.1111/jgs.14857.

  44. Daneman N, Bronskill SE, Gruneir A, et al. Variability in Antibiotic Use Across Nursing Homes and the Risk of Antibiotic-Related Adverse Outcomes for Individual Residents. JAMA Intern Med 2015;175:1331–9. doi:10.1001/jamainternmed.2015.2770 [doi].

  45. Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin. Infect. Dis. 2019;68:E83-E75.

  46. Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler MT, et al. Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst. Rev. 2015;2015:CD009534. doi:10.1002/14651858.CD009534.pub2.

  47. Sundhedsstyrelsen. National klinisk retningslinje for forebyggelse og behandling af adfærdsmæssige og psykiske symptomer hos personer med demens. 2019. Lokaliseret 22. maj 2023 på: https://www.sst.dk/da/udgivelser/2019/nkr-forebyggelse-og-behandling-af-adfaerdsmaessige-og-psykiske-symptomer-hos-personer-med-demens.

  48. Mayne S, Bowden A, Sundvall P, et al. The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review. BMC Geriatr 2019;19:1-15.

  49. Sundvall PD, Ulleryd P, Gunnarsson RK. Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: A cross-sectional study of 32 nursing homes. BMC Fam Pract 2011;12:36. doi:10.1186/1471-2296-12-36.

  50. Brown KA, Daneman N, Schwartz KL, et al. The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection. Clin Infect Dis 2020;70:1620-7. doi:10.1093/cid/ciz482.

  51. Arnold SH, Nygaard Jensen J, Bjerrum L, et al. Effectiveness of a tailored intervention to reduce antibiotics for urinary tract infections in nursing home residents: a cluster, randomised controlled trial. Lancet Infect Dis 2021;3099:1-3.

  52. Loeb M. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ 2005;331:669.