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Li W, Wu Z, Liao X, Geng D, Yang J, Dai M, Talipti M. Nutritional management interventions and multi-dimensional outcomes in frail and pre-frail older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 125:105480. [PMID: 38776700 DOI: 10.1016/j.archger.2024.105480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/27/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Frailty, a prevalent geriatric syndrome, presents challenges exacerbated by malnutrition. Nutritional Management Interventions (NMIs) offer hope in frailty reversal, necessitating exploration of their multi-dimensional outcomes. OBJECTIVES Assess NMIs' impact on frail and pre-frail older adults across diverse outcomes. METHODS A systematic review and meta-analysis of 13 studies (2012-2023) evaluated NMIs' effects on physical, dietary, psychological, and frailty aspects. Literature quality was assessed, and data analyzed with Review Manager 5.3. RESULTS A total of 13 studies involving participants were included in the analysis. Participants numbered 968, with the intervention group averaging 77.05±0.77 years and the control group 78.75±0.8 years. Compared to control groups,NMIs significantly increased body weight (SMD = 0.26, P = 0.03) and improved gait speed (SMD = 0.18, P = 0.03). Protein intake showed significance for interventions≤12 weeks (SMD = 1.04, P < 0.001). No significant differences in energy intake (SMD = 0.20, P = 0.60), but >12 weeks NMIs reduced energy intake (SMD = -0.73, P = 0.006). No significant differences in depressive symptoms, frailty scores, BMI, TUG, Handgrip Strength, or SPPB. CONCLUSION This meta-analysis underscores NMIs' potential benefits for frail and pre-frail older adults. Personalized, multidimensional interventions are recommended despite study limitations, emphasizing extended interventions and diverse assessments for holistic care.
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Affiliation(s)
- Weina Li
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| | | | - Xiaoqin Liao
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China.
| | - Dandan Geng
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| | - Jiechao Yang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| | - Mengqiao Dai
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
| | - Muksar Talipti
- School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong, Shanghai 56 Mailbox, China
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Wang L, Wang Y, Luo Y, Li Y, Li J. The mediating and moderating effect of health-promoting lifestyle on frailty and depressive symptoms for Chinese community-dwelling older adults: A cross-sectional study. J Affect Disord 2024; 361:91-96. [PMID: 38857627 DOI: 10.1016/j.jad.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND This study aims to explore the mediating and moderating effect of health-promoting lifestyles on the relationship between frailty and depressive symptoms to provide a practical reference for effectively promoting the mental health of older adults. METHODS A cross-sectional survey of community-dwelling older adults (n = 3107) was conducted in three cities of Ningxia Province, China. Depressive symptoms, frailty, and health-promoting lifestyles were assessed through the 30-item Geriatric Depression Scale, frailty scale, and health-promoting Lifestyle profile-II, respectively. The Bootstrap methods PROCESS program is employed to test the mediation and moderation model. RESULTS The findings indicated that health-promoting lifestyles are negatively related to depressive symptoms and frailty, while frailty is positively associated with depressive symptoms. Health-promoting lifestyles have mediated the relationship between frailty and depressive symptoms. Besides, the health-promoting lifestyles weakened the positive relationship between frailty and depression symptoms; there existed a moderating effect of health-promoting lifestyles on the relationship between frailty and depression symptoms among older adults. LIMITATIONS Given the cross-sectional study, it is impossible to make causal inferences. CONCLUSIONS A health-promoting lifestyle might be a protective factor for older adults' health in China. The mediating and moderating effect of a health-promoting lifestyle on the relationship between frailty and depression symptoms among older adults should be integrated to achieve maximum utility. Healthcare practitioners and medical service personnel are recommended to advance health education and publicity, encouraging healthy lifestyles among community-dwelling older adults with frailty to prevent depressive symptoms and promote healthy aging.
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Affiliation(s)
- Liqun Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Yali Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan 750004, China
| | - Yiling Luo
- Department of Health Management Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, China
| | - Yan Li
- The Center for Disease Control and Prevention of Yinchuan City, Yinchuan 750011, China
| | - Jiangping Li
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China.
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Sanchez-Garcia E, Cruz-Jentoft AJ, Ravasco P, Suominen M, Pitkälä PK. Nutritional care in older adults: are we doing everything? An expert opinion review. Curr Med Res Opin 2024; 40:1563-1576. [PMID: 39044672 DOI: 10.1080/03007995.2024.2380007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
Malnutrition is a prevalent, yet often underdiagnosed and undertreated, condition in older adults. It is characterized by weight loss and/or reduced muscle mass due to diminished caloric intake, inflammation, and/or disease burden. In return, malnutrition can lead to diminished skeletal muscle functionality and disability, among others. Malnutrition plays a crucial role in the pathogenesis of two prevalent geriatric syndromes, namely sarcopenia and frailty. The complex interplay between malnutrition, sarcopenia, and frailty significantly impacts the older population, leading to increased morbidity, mortality, hospitalization rates, quality-of-life, and healthcare costs. Given the prognostic significance of malnutrition in geriatric care, recent guidelines emphasized the role of nutritional support in vulnerable populations. A group of vulnerable populations to malnutrition, sarcopenia, and frailty are older patients with hip fractures, cancer patients, and those with sarcopenic dysphagia. This article highlights the importance of individualized nutritional assessment and treatment in the management of vulnerable populations such as older patients with hip fractures, cancer, and those suffering from sarcopenic dysphagia. It presents practical protocols and guidelines that can be instrumental in enhancing the nutritional care of these groups, thereby improving their overall health outcomes.
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Affiliation(s)
- Elisabet Sanchez-Garcia
- Consultant in Geriatric Medicine, Mater Private Network, Cork, Ireland
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paula Ravasco
- Universidade Católica Portuguesa, Faculty of Medicine and Centre for Interdisciplinary Research in Health, Centre for Interdisciplinary Research Egas Moniz (CiiEM), Lisbon, Portugal
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Prof Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
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Duan L, Xiao M, Liu S, Wu Z, Chen R, Zeng R, Xie F, Ye D, Zhu W, Zhao Y, Li W, Wang J. Associations between modifiable risk factors and frailty progression among individuals with pre-frailty. Exp Gerontol 2024; 194:112494. [PMID: 38880184 DOI: 10.1016/j.exger.2024.112494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND In the context of the present global aging phenomenon, the senior population and pace of aging in China have emerged as prominent issues on the worldwide stage. Frailty, a complicated condition that is closely linked to the clinical syndrome of advancing age, poses a considerable health risk to older individuals. Frailty status was assessed by the frailty index (FI) ranging from 0 to 1, pre-frailty was defined as >0.10 to <0.25, and frailty was defined as ≥0.25. To look at the connection between modifiable risk factors and frailty progression among individuals in the pre-frailty population. METHODS Using pre-frailty patients as characterized by the 32-frailty index, the study focused on middle-aged and elderly persons from China and ultimately recruited 5,411 participants for analysis. The relationship between modifiable factors and changes in pre-frailty status throughout follow-up was investigated. Modifiable factors were body mass index (BMI), abdominal obesity, smoking status, alcohol use, and sleep status. We employed logistic regression to examine the relationships between modifiable risk factors and changes in pre-frailty status, as well as the associations between modifiable factors scores and the corresponding pre-frailty progression. Additionally, we generated the modifiable factors scores and examined how these related to modifications in the pre-frailty stage. RESULTS In this study, after a mean follow-up of 6 years, (OR = 0.59, 95%CI: 0.48-0.71) for BMI ≥ 25 kg/m2 and (OR = 0.74, 95%CI: 0.63-0.89) for concomitant abdominal obesity were significantly associated with lower reversal to a healthy state; (OR = 1.24, 95%CI:1.07-1.44) and (OR = 1.25, 95%CI: 1.10-1.42) for the group that negatively progressed further to frailty were significantly associated with increased frailty progression profile. Subsequently, investigation of modifiable factor scores and changes of pre-frailty status found that as scores increased further, frailty developed (OR = 1.12, 95%CI:1.05-1.18), with scores of 3 and 4 of (OR = 1.38, 95%CI: 1.08-1.77) and (OR = 1.52, 95%CI:1.09-2.14). Finally, we also performed a series of stratified analyses and found that rural unmarried men aged 45 to 60 years with less than a high school degree were more likely to develop a frailty state once they developed abdominal obesity. CONCLUSION In pre-frailty individuals, maintaining more favorable controllable variables considerably enhances the chance of return to normal and, conversely, increase the risk of progressing to the frailty.
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Affiliation(s)
- Lanzhi Duan
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Mengmeng Xiao
- School of Public Health of Southeast University, Nanjing 210009, China
| | - Sijia Liu
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Zhigang Wu
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Ruzhao Chen
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China
| | - Rui Zeng
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Fayi Xie
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Dongmei Ye
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Wan Zhu
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Yueyue Zhao
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Wei Li
- School of Clinical Medicine, Jinggangshan University, Ji'an, Jiangxi Province, China
| | - Jiang Wang
- School of Basic Medicine, JingGangshan University, Ji'an, Jiangxi Province, China; Online Collaborative Research Center for Evidence-Based Medicine Ministry of Education, JingGangshan Univesity Branch, China; Affiliated Hospital of Jinggangshan University, Center for Clinical Medicine Research of Jinggangshan University, Ji'an 343000, China.
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Fons AB, Asscher VER, Stuyt RJL, Baven-Pronk AMC, van der Marel S, Jacobs RJ, Mooijaart SP, Eikelenboom P, van der Meulen-de Jong AE, Kalisvaart KJ, Jeroen Maljaars PW. Deficits in geriatric assessment are important in relation to fatigue in older patients with Inflammatory Bowel Disease. Dig Liver Dis 2024; 56:1490-1496. [PMID: 38369409 DOI: 10.1016/j.dld.2024.01.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND No previous study has investigated fatigue in older patients with Inflammatory Bowel Disease (IBD). AIMS To describe the prevalence of fatigue in older patients and compare it to the prevalence in younger patients with IBD, and to determine factors associated with fatigue. METHODS A prospective, multicenter cohort study, including older- (≥ 65 years) and younger patients with IBD (18-64 years). A geriatric assessment was performed in older patients to measure deficits in geriatric assessment (DiG). Fatigue was defined by one item from the short Inflammatory Bowel Disease Questionnaire. Active disease was defined as the presence of clinical or biochemical disease activity. RESULTS Fatigue prevalence in the 405 older patients varied between 45.4% (71/155) in active disease to 23.6% (60/250) in remission. Fatigue prevalence in 155 younger patients was 59.5% (47/79) and 57.4% (89/155), respectively. Female sex, clinical disease activity, use of immunomodulators and presence of DiG were associated with fatigue in older patients with IBD. CONCLUSIONS Fatigue prevalence is lower in older patients with IBD compared to younger patients with IBD, but increases when active disease is present. Clinicians should be aware that fatigue is a relevant symptom in older patients with IBD, as it is associated with DiG.
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Affiliation(s)
- Anne B Fons
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands; Department of Geriatric Medicine, Spaarne Gasthuis, Haarlem, Boerhaavelaan 2035RC, the Netherlands.
| | - Vera E R Asscher
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Rogier J L Stuyt
- Department of Gastroenterology and Hepatology, HagaZiekenhuis, Els Borst-Eilersplein 275, The Hague 2545AA, the Netherlands
| | - A Martine C Baven-Pronk
- Department of Gastroenterology and Hepatology, Groene Hart Ziekenhuis, Bleulandweg 10, Gouda 2803 HH, the Netherlands
| | - Sander van der Marel
- Department of Gastroenterology and Hepatology, Haaglanden Medical Centre, Lijnbaan 32, The Hague 2512VA, the Netherlands
| | - Rutger J Jacobs
- Department of Gastroenterology and Hepatology, Alrijne Hospital, Houtlaan 55, Leiden and Leiderdorp 2334CK, the Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Piet Eikelenboom
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC location, Amsterdam, The Netherlands
| | - Andrea E van der Meulen-de Jong
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
| | - Kees J Kalisvaart
- Department of Geriatric Medicine, Spaarne Gasthuis, Haarlem, Boerhaavelaan 2035RC, the Netherlands
| | - P W Jeroen Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, the Netherlands
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Yong K, Chew J, Low K, Yeo A, Tan CN, Lim JP, Ding YY, Lim WS. Predictive Validity of Intrinsic Capacity Composite Scores for Risk of Frailty at 2 Years: A Comparison of 4 Scales. J Am Med Dir Assoc 2024; 25:105146. [PMID: 39002555 DOI: 10.1016/j.jamda.2024.105146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE Intrinsic capacity (IC) and frailty are complementary constructs that encapsulate functional capacities of older adults. Although earlier studies suggest the utility of composite IC scores in predicting risk of frailty, key gaps remain with the lack of direct comparative studies between different IC scales and lack of a composite score based on the World Health Organization Integrated Care for Older People (ICOPE) tool. We aimed to compare different IC scales, including an ICOPE-based scale, in their predictive ability for risk of frailty at 2 years in healthy community-dwelling older adults. DESIGN Cohort study. SETTING AND PARTICIPANTS A total of 230 participants (age: 67.2 ± 7.4 years) from the GeriLABS-2 cohort study. METHODS We derived composite scores by summing 4 IC domains (locomotion, cognition, vitality, and psychological). We compared composite scores of 4 scales: IC1-Chew 2021, range: 0-8; IC2-Liu 2021, range: 0-4; IC3-ICOPE, range: 0-4; IC4-modified ICOPE, range: 0-8. The primary outcome was risk of frailty using the modified Fried Frailty Phenotype. We performed logistic regression to examine the association of baseline composite IC with risk of frailty. We also examined the impact of individual domains and number of impaired domains on risk of frailty. RESULTS Among 193 (83.9%) older adults who completed 2-year follow-up, 20 (10.4%) met criteria for risk of frailty. When adjusted for covariates, 2-point per domain scales (IC1/IC4) predicted increased risk of frailty (OR, 4.31; 95% CI, 1.55-11.96; OR, 5.00; 95% CI, 1.75-14.26). When further adjusted for baseline frailty, only IC4 remained significant (OR, 4.28; 95% CI, 1.45-12.60). Among the domains, impaired locomotion and vitality were associated with risk of frailty. Greater number of impaired domains predicted increased risk of frailty (IC1/IC2: β = 0.18-0.19, P < .05). CONCLUSIONS AND IMPLICATIONS Baseline composite IC score using 2-point per domain scales better predicted risk of frailty at 2 years, predicated on impaired locomotion/vitality and greater number of impaired domains. For early identification of healthy older adults at risk of frailty, an ICOPE-based scale should be considered, as it is effective and accessible.
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Affiliation(s)
- Kenneth Yong
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Justin Chew
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kristabella Low
- Department of Geriatric Medicine, Woodlands Health, Singapore, Singapore
| | - Audrey Yeo
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Cai Ning Tan
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jun Pei Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Imaoka Y, Hataji O. Factors associated with presbyphagia in patients with community-acquired pneumonia: A cross-sectional study. Respir Investig 2024; 62:976-979. [PMID: 39197379 DOI: 10.1016/j.resinv.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/20/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Presbyphagia, an age-related decline in swallowing function, is considered a precursor stage of dysphagia and a risk state that can lead to aspiration pneumonia and malnutrition. We examined factors associated with presbyphagia in patients with community-acquired pneumonia (CAP). METHODS A cross-sectional study was conducted with 80 patients with CAP aged ≥65 years admitted to an acute care hospital between June 2021 and April 2024. Presbyphagia was assessed using the 10-item Eating Assessment Tool. The survey items included grip strength, body mass index, the Mini-Cog©, repetitive saliva swallowing test, tongue pressure, and evaluations for sarcopenia and frailty. Logistic regression analysis was performed to examine the factors associated with presbyphagia after adjusting for age and sex. RESULTS Of 80 patients, 44 (55%) had presbyphagia. The presbyphagia group was older, had lower Barthel Index scores, and had a higher proportion of history of cerebrovascular accident, sarcopenia and frailty than the non-presbyphagia group. Logistic regression analysis revealed frailty (adjusted odds ratio: 3.106, 95% confidence interval: 1.161-8.313, p = 0.024) was significantly associated with presbyphagia. CONCLUSIONS Our results revealed a significant association between presbyphagia and frailty in patients with CAP. The relationship between presbyphagia and frailty suggests that these conditions are not caused by a single functional decline or structural change but by a combination of factors. Therefore, it is crucial to comprehensively evaluate presbyphagia in patients with CAP to provide appropriate interventions.
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Affiliation(s)
- Yasunori Imaoka
- Department of Rehabilitation, Matsusaka Municipal Hospital, Tonomachi, 1550, Matsusaka, Mie, 515-8544, Japan.
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Tonomachi, 1550, Matsusaka, Mie, 515-8544, Japan
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Nishimura A, Masuda C, Murauchi C, Ishii M, Murata Y, Kawasaki T, Azuma M, Arai H, Harashima SI. Regional differences in frailty among older adults with type 2 diabetes: a multicenter cross-sectional study in Japan. BMC Geriatr 2024; 24:688. [PMID: 39154001 PMCID: PMC11330035 DOI: 10.1186/s12877-024-05223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/15/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Social environment may broadly impact multifaceted frailty; however, how environmental differences influence frailty in older adults with diabetes remains unclear. This study aimed to investigate regional differences in frailty in urban and rural areas among older adults with diabetes. METHODS This cross-sectional study was conducted as part of the frailty prevention program for older adults with diabetes study. Older adults aged 60-80 years who could independently perform basic activities of daily living (ADLs) were enrolled sequentially. Trained nurses obtained patient background, complications, body weight, body composition, blood tests, grip strength, frailty assessment, and self-care score results. Regional differences in frailty were evaluated using logistic and multiple linear regression analyses. RESULTS This study included 417 participants (269 urban and 148 rural). The prevalence of robustness was significantly lower in rural areas than in urban areas (29.7% vs. 43.9%, p = 0.018). Living in rural areas was associated with frailty (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.38-4.71) and pre-frailty (OR 2.10, 95%CI 1.30-3.41). Lower instrumental ADL (B 0.28, standard error [SE] 0.073) and social ADL (B 0.265, SE 0.097) were characteristics of rural residents. CONCLUSIONS Regional differences in frailty were observed. Older adults with diabetes living in rural areas have a higher risk of frailty owing to a decline in instrumental and social ADLs. Social environment assessment and intervention programs that include communication strategies to enable care and social participation across environments are crucial to the effective and early prevention of frailty.
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Affiliation(s)
- Akiko Nishimura
- Department of Chronic Care Nursing, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan.
- Department of Internal Medicine and Diabetes, Goshominami Harashima Clinic, 630 Heinouchi-cho, Nakagyo-ku, Kyoto City, Kyoto, 604-0884, Japan.
| | - Chie Masuda
- Department of Nursing, Asahikawa City Hospital, 1-1-65 Kinsei-cho, Asahikawa City, Hokkaido, 070-8610, Japan
| | - Chiyo Murauchi
- Faculty of Nursing and Graduate School of Nursing, Kansai Medical University, 2-3-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Miho Ishii
- Jonan branch, Town Home-visit Medical Care Clinic, Gardenia Kamiikedai 101, 1-40-6 Kamiikedai, Ota-ku, Tokyo, 145-0064, Japan
| | - Yuko Murata
- Department of Nursing, Takashima Municipal Hospital, 1667 Katsuno, Takashima City, Shiga, 520-1121, Japan
| | - Terumi Kawasaki
- Department of Nursing, Sapporo City General Hospital, 1-1 Kita, 11-jo Nishi, 13-chome, Chuo- ku, Sapporo City, Hokkaido, 064-0064, Japan
| | - Mayumi Azuma
- Department of Chronic Care Nursing, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu- cho, Miyazaki City, Miyazaki, 880-8510, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, Aichi, 474-8511, Japan
| | - Shin-Ichi Harashima
- Department of Chronic Care Nursing, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan.
- Department of Internal Medicine and Diabetes, Goshominami Harashima Clinic, 630 Heinouchi-cho, Nakagyo-ku, Kyoto City, Kyoto, 604-0884, Japan.
- Clinical Research Planning and Administration Division, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa Mukabatake-cho, Fushimi-ku, Kyoto City, Kyoto, 611-8555, Japan.
- Research Center for Healthcare, Nagahama City Hospital, 313 Ohinui-cho, Nagahama City, Shiga, 526-8580, Japan.
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Zhao L, Deng X, Ding N, Liu Y, Ma Y, Li J, Wang S, Ji X, Wang J, Wang D, Li Y, Dou D, Zhu X, Zhu L, Zhang S. Diminished representation of vitamin-B12-producing bacteria in constipated elders with frailty. iScience 2024; 27:110403. [PMID: 39091462 PMCID: PMC11292359 DOI: 10.1016/j.isci.2024.110403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/24/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
Constipation and frailty are associated with intestinal dysbiosis. This study aims to identify intestinal microbial signatures that can differentiate between constipated elders accompanied by frailty and those without frailty. We collected stool samples from 61 participants and conducted 16S rRNA gene sequencing. Constipated patients with frailty (Constipation_F) exhibited reduced gut microbial diversities compared to constipated patients without frailty (Constipation_NF) and healthy individuals (C). From differential genera, random forest models identified 14, 8, and 5 biomarkers for distinguishing Constipation_F from Constipation_NF, Constipation_F from C, and Constipation_NF from C, respectively. Functional analysis revealed that pathways (P381-PWY and PWY-5507) related to vitamin B12 synthesis were reduced in Constipation_F, which aligns with the decreased abundances of vitamin-B12-producing Actinomyces and Akkermansia in this group. Our study unveils substantial differences in gut microbiota between constipated elders with frailty and those without, underscoring the diagnostic and therapeutic potential of genera involved in vitamin B12 synthesis.
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Affiliation(s)
- Luqing Zhao
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Xin Deng
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Ning Ding
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Yanzhen Liu
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Yun Ma
- Beijing University of Chinese Medicine, Beijing 100105, China
| | - Jiake Li
- Beijing University of Chinese Medicine, Beijing 100105, China
| | - Shuqing Wang
- Beijing University of Chinese Medicine, Beijing 100105, China
| | - Xingyu Ji
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Jinjuan Wang
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing 100081, China
| | - Dianpeng Wang
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing 100081, China
| | - Yanhui Li
- School of Mathematics and Statistics, Beijing Institute of Technology, Beijing 100081, China
| | - Dan Dou
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Xihan Zhu
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Lixin Zhu
- Department of General Surgery (Colorectal Surgery), Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Shengsheng Zhang
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
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10
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Dlima SD, Hall A, Aminu AQ, Akpan A, Todd C, Vardy ERLC. Frailty: a global health challenge in need of local action. BMJ Glob Health 2024; 9:e015173. [PMID: 39122463 PMCID: PMC11331888 DOI: 10.1136/bmjgh-2024-015173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/24/2024] [Indexed: 08/12/2024] Open
Abstract
Frailty is a complex, age-related clinical condition that involves multiple contributing factors and raises the risk of adverse outcomes in older people. Given global population ageing trends, the growing prevalence and incidence of frailty pose significant challenges to health and social care systems in both high-income and lower-income countries. In this review, we highlight the disproportionate representation of research on frailty screening and management from high-income countries, despite how lower-income countries are projected to have a larger share of older people aged ≥60. However, more frailty research has been emerging from lower-income countries in recent years, paving the way for more context-specific guidelines and studies that validate frailty assessment tools and evaluate frailty interventions in the population. We then present further considerations for contextualising frailty in research and practice in lower-income countries. First, the heterogeneous manifestations of frailty call for research that reflects different geographies, populations, health systems, community settings and policy priorities; this can be driven by supportive collaborative systems between high-income and lower-income countries. Second, the global narrative around frailty and ageing needs re-evaluation, given the negative connotations linked with frailty and the introduction of intrinsic capacity by the World Health Organization as a measure of functional reserves throughout the life course. Finally, the social determinants of health as possible risk factors for frailty in lower-income countries and global majority populations, and potential socioeconomic threats of frailty to national economies warrant proactive frailty screening in these populations.
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Affiliation(s)
- Schenelle Dayna Dlima
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alex Hall
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Abodunrin Quadri Aminu
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Asangaedem Akpan
- Bunbury Regional Hospital, Bunbury, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research Policy Research Unit in Older People and Frailty / Healthy Ageing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma R L C Vardy
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research, Applied Research Collaboration - Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Oldham Care Organisation, Northern Care Alliance NHS Foundation Trust, Rochdale Road, Oldham, UK
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11
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Vazquez-Guajardo M, Rivas D, Duque G. Exercise as a Therapeutic Tool in Age-Related Frailty and Cardiovascular Disease: Challenges and Strategies. Can J Cardiol 2024; 40:1458-1467. [PMID: 38215969 DOI: 10.1016/j.cjca.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/12/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024] Open
Abstract
Understanding the link between heart disease and frailty in older adults is crucial. Although medical progress has extended life, it has not fully addressed the decline in function and quality of life in frail older people. Frailty is a state of vulnerability to health stressors that needs comprehensive solutions. Its assessment within health care, especially in cardiology, is important owing to its association with worse clinical outcomes. Recent evidence and guidelines suggest that the prescription of a comprehensive exercise regimen, tailored to progressively include strength, balance, mobility, and endurance training improves adherence, functionality, and health-related quality of life, in both acute and chronic cardiovascular diseases. In addition, exercise is a vital tool that improves function, targets frailty, and holistically affects the body's systems. Still, many frail people do not exercise enough, and when they do, they usually do not follow an appropriate plan tailored for better functional outcomes. Overcoming barriers and limitations in exercise enrollment and adherence through strategies such as automated cardiac rehabilitation referral, patient education, and eHealth tools can notably improve clinical outcomes.
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Affiliation(s)
| | - Daniel Rivas
- Bone, Muscle and Geroscience Research Group, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Gustavo Duque
- Bone, Muscle and Geroscience Research Group, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; Geriatric Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada.
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12
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Veloso MP, Coelho VA, Sekercioglu N, Moyses RMA, Elias RM. Phosphate is associated with frailty in older patients with chronic kidney disease not on dialysis. Int Urol Nephrol 2024; 56:2725-2731. [PMID: 38498271 DOI: 10.1007/s11255-024-03985-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Frailty is common in older patients with chronic kidney disease (CKD) and has been considered an independent risk factor for adverse clinical outcomes in this population. CKD-associated mineral and bone metabolism (CKD-MBD) increases energy expenditure and causes malnutrition and inflammation leading to frailty. We investigated whether CKD-MBD markers and energy metabolism are associated with frailty in patients with advanced CKD on conservative management. METHODS In this cross-sectional study, we investigated factors associated with frailty in a sample of 75 patients ≥ 65 years, with stage 4 or 5 CKD. Collected data included age, sex, body mass index, physical activity status, educational level, Charlson Comorbidity Index, and laboratory markers. Frailty was evaluated according to Fried's classification. RESULTS Frailty was observed in 51.3% and pre-frailty in 47.3%. The frail population was significantly older, with a high proportion of females, more inactive, had lower educational levels, spent a long time sitting throughout the day, and had higher phosphate and fibroblast growth factor 21 (FGF-21). In the multivariate logistic analysis age (odds ratio 1.13, p = 0.026) and phosphate (odds ratio 3.38, p = 0.021) remained independently associated with frailty. CONCLUSION Serum phosphate seems to be a toxin associated with the frailty phenotype in older patients with CKD. Whether strategies to decrease serum phosphate would reduce the risk of frailty in this population deserves further evaluation.
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Affiliation(s)
- Mariana P Veloso
- Department of Medicine. Nephrology Service. Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo., São Paulo, Brazil
| | - Venceslau A Coelho
- Department of Medicine. Geriatric Division. Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Nigar Sekercioglu
- Department of Health Evidence and Impact, McMaster University, Hamilton, Canada
- Department of Medicine, Division of Nephrology, Health Sciences University, Istanbul, Turkey
| | - Rosa M A Moyses
- Department of Medicine. Nephrology Service. Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo., São Paulo, Brazil
| | - Rosilene M Elias
- Department of Medicine. Nephrology Service. Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo., São Paulo, Brazil.
- Universidade Nove de Julho. UNINOVE, São Paulo, Brazil.
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13
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Castrejón-Pérez RC, Borges-Yáñez SA, Ramírez-Aldana R, Nasu I, Saito Y. Complete dentures associated with frailty among edentulous older Japanese people: A prospective analysis. Community Dent Oral Epidemiol 2024; 52:572-580. [PMID: 38509032 DOI: 10.1111/cdoe.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This study aimed to explore the cross-sectional and prospective associations between self-reported functionality of complete dentures (FCD), satisfaction with complete dentures (SCD) and the ability to chew hard food (ACHF) on the one hand and the frailty index (FI) on the other hand among edentulous community-dwelling older Japanese people. METHODS The study examined 770 edentulous participants of the Nihon University Japanese Longitudinal Study of Aging. The self-reported FCD, SCD and ability to chew six groups of food (from hardest to softest) with complete dentures were the independent variables at the baseline. The FI was computed including 40 deficits as the dependent variable at the baseline and 4 years later. Cross-sectional and prospective generalized linear regression models were fitted controlling for age, gender, marital status, education, working status and area of residence. RESULTS The use of non-functional complete dentures and dissatisfaction with complete dentures were both associated with a higher FI cross-sectionally (3.9% [95% CI 2.2-5.6] and 3.2% [95% CI 1.5-4.9], respectively) and prospectively (3.9% [95% CI 2.0-6.0] and 3.3% [95% CI 1.3-5.3], respectively). Regarding the ability to chew, a higher FI at baseline was observed among those able to chew food of Group 2 (1.9%, [95% CI 0.1-3.7]) and Groups 4-6 (1.9%, [95% CI 0.1-3.7]), and a progressive increment in the FI, as the participants reported being able to chew softer groups of food at the follow-up (Group 2: 2.2% [95% CI 0.05-4.3]; Group 3: 3.6% [95% CI 1.2-6.0]; and Groups 4-6: 3.4 [95% CI 0.7-6.1]). CONCLUSION Self-reported use of non-functional complete dentures, dissatisfaction with dentures and a reduced ACHF with complete dentures were associated with a higher FI both cross-sectionally and prospectively.
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Affiliation(s)
- Roberto C Castrejón-Pérez
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
| | - S Aída Borges-Yáñez
- Division of Postgraduate and Research Studies, School of Dentistry, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ricardo Ramírez-Aldana
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
- Escuela Superior de Ingeniería y Tecnología, Universidad Internacional de la Rioja, Logroño, Spain
- Departamento de Matemáticas, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ikuo Nasu
- Escuela Superior de Ingeniería y Tecnología, Universidad Internacional de la Rioja, Logroño, Spain
| | - Yasuhiko Saito
- School of Dentistry at Matsudo, Nihon University, Chiba, Japan
- College of Economics, Nihon University, Tokyo, Japan
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14
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Tey SL, Huynh DTT, Kong ST, Oliver J, Baggs G, Low YL, How CH, Cheong M, Chow WL, Tan NC, Aw TC, Chew STH. Effects of Oral Nutritional Supplement with β-Hydroxy-β-methylbutyrate (HMB) on Biochemical and Hematological Indices in Community-Dwelling Older Adults at Risk of Malnutrition: Findings from the SHIELD Study. Nutrients 2024; 16:2495. [PMID: 39125374 PMCID: PMC11313967 DOI: 10.3390/nu16152495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/18/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Malnutrition may result in abnormal biochemical and hematological indices. This planned prespecified analysis investigated the effects of a specialized oral nutritional supplement (ONS) on biochemical and hematological indices in community-dwelling older adults at risk of malnutrition. In the Strengthening Health in ELDerly through nutrition (SHIELD) study, 811 older adults aged 65 years and above took part in this randomized, double-blind, placebo-controlled, multi-center study. Participants were randomly allocated to either a complete and balanced specialized ONS (each serving provides 262 kcal, 10.5 g protein, 7.75 µg vitamin D3, and 0.74 g calcium β-hydroxy-β-methylbutyrate) and dietary counselling (intervention group) or a placebo and dietary counselling (placebo group). Both groups consumed study products twice a day for 180 days. Data were collected at baseline, day 90, and day 180. Blood analysis results at follow-up visits were analyzed using repeated measures analysis of covariance with adjustments for confounders. Overall, when compared with the placebo group, the intervention group showed significantly greater urea (6.0 mmol/L vs. 5.4 mmol/L, p < 0.001), urea to creatinine ratio (4.39 vs. 4.26, p < 0.001), prealbumin (24.9 mg/dL vs. 24.0 mg/dL, p < 0.001), vitamin B12 (480.0 pmol/L vs. 420.1 pmol/L, p < 0.001), and globulin levels (26.8 g/L vs. 26.5 g/L, p = 0.032). The intervention group also had a significantly higher absolute reticulocyte count (62.0 × 103/µL vs. 58.2 × 103/µL, overall p < 0.001) and mean platelet volume (10.0 fL vs. 9.9 fL, overall p = 0.003). Furthermore, significant improvements were seen in total protein at day 90 (71.7 g/L vs. 71.1 g/L, p = 0.017) and in absolute monocyte count at day 90 (0.50 × 103/µL vs. 0.47 × 103/µL, p = 0.009) in the intervention group. In conclusion, daily consumption of a specialized ONS for six months led to significant improvements in biochemical and hematological indices in community-dwelling older adults at risk of malnutrition.
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Affiliation(s)
- Siew Ling Tey
- Abbott Nutrition Research and Development, Singapore 138668, Singapore; (D.T.T.H.); (S.T.K.); (Y.L.L.)
| | - Dieu Thi Thu Huynh
- Abbott Nutrition Research and Development, Singapore 138668, Singapore; (D.T.T.H.); (S.T.K.); (Y.L.L.)
| | - Sing Teang Kong
- Abbott Nutrition Research and Development, Singapore 138668, Singapore; (D.T.T.H.); (S.T.K.); (Y.L.L.)
| | - Jeffery Oliver
- Abbott Nutrition Research and Development, Columbus, OH 43219, USA; (J.O.); (G.B.)
| | - Geraldine Baggs
- Abbott Nutrition Research and Development, Columbus, OH 43219, USA; (J.O.); (G.B.)
| | - Yen Ling Low
- Abbott Nutrition Research and Development, Singapore 138668, Singapore; (D.T.T.H.); (S.T.K.); (Y.L.L.)
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore 529889, Singapore;
| | - Magdalin Cheong
- Department of Dietetic & Food Services, Changi General Hospital, Singapore 529889, Singapore;
| | - Wai Leng Chow
- Health Services Research, Changi General Hospital, Singapore 529889, Singapore;
| | | | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore;
- Duke-NUS Graduate School of Medicine, 8 College Road, Singapore 169857, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Samuel Teong Huang Chew
- Duke-NUS Graduate School of Medicine, 8 College Road, Singapore 169857, Singapore;
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
- Department of Geriatric Medicine, Changi General Hospital, Singapore 529889, Singapore
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15
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Lameirinhas J, Gorostiaga A, Etxeberria I. Definition and assessment of psychological frailty in older adults: A scoping review. Ageing Res Rev 2024; 100:102442. [PMID: 39084321 DOI: 10.1016/j.arr.2024.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES The confusion surrounding psychological frailty and its components prompts the need for a standardized conceptual definition. To address this, we aimed to (1) identify the psychological variables included in multicomponent frailty assessment instruments used with older adults and examine their operationalization; and (2) formulate a thorough conceptualization of psychological frailty based on the variables identified. METHODS This study followed the most recent recommendations for conducting scoping reviews and is reported in accordance with PRISMA-ScR guidelines. We systematically searched the CINAHL, MEDLINE, PsycInfo, Scopus, and Web of Science databases, with additional searches in Google Scholar and reference lists. RESULTS Sixteen instruments were identified. The results suggested that: (1) In multicomponent frailty assessment instruments, psychological variables are poorly represented; (2) A wide variety of psychological variables are included in the instruments, the most frequent being cognitive functioning and affective functioning (e.g., depressive symptoms, emotional loneliness, anxiety symptoms, poor coping, and suicidal ideation); and (3) The way in which variables are referred to and operationalized varies across instruments. CONCLUSIONS Including both cognitive and affective variables in psychological frailty assessments may lead to inaccuracies. We suggest distinguishing between two separate dimensions within psychological frailty: cognitive frailty and affective frailty. A conceptual definition for each dimension is provided. This proposal aims to advance the debate regarding the conceptualization and assessment of psychological frailty, with further research and discussion needed to ensure its practical applicability.
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Affiliation(s)
- Joanes Lameirinhas
- Department of Clinical and Health Psychology and Research Methodology, Faculty of Psychology, University of the Basque Country UPV/EHU, Donostia/San Sebastián, Gipuzkoa, Spain.
| | - Arantxa Gorostiaga
- Department of Clinical and Health Psychology and Research Methodology, Faculty of Psychology, University of the Basque Country UPV/EHU, Donostia/San Sebastián, Gipuzkoa, Spain
| | - Igone Etxeberria
- Department of Clinical and Health Psychology and Research Methodology, Faculty of Psychology, University of the Basque Country UPV/EHU, Donostia/San Sebastián, Gipuzkoa, Spain
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16
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Luo J, Deng H, Wu Y, Zhang T, Cai Y, Yang Y. The weight-adjusted waist index and frailty: A cohort study from the China Health and Retirement Longitudinal Study. J Nutr Health Aging 2024; 28:100322. [PMID: 39067142 DOI: 10.1016/j.jnha.2024.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/10/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES This cohort study's aim was to assess the association between the weight-adjusted waist index (WWI) and frailty among middle-aged and elderly individuals in China. METHODS Seven-year complete follow-up data from 10,349 adults aged ≥45 years, initially surveyed in 2 011 in the China Health and Retirement Longitudinal Study, were analyzed, including clinical demographic characteristics, anthropometric indices, frailty scores, and relevant covariates. The WWI was calculated as waist circumference divided by the square root of the body weight. Frailty was evaluated using the Frailty Index. Relationships between the WWI and frailty were evaluated via Cox proportional hazards modeling. Receiver operating characteristic curve analyses assessed the effectiveness of obesity-related indicators in predicting frailty. RESULTS Over a median 84-month follow-up period, frailty occurred in 23.7% (2453/10,349) of participants. After potential confounder adjustment, the WWI positively correlated with frailty (adjusted hazard ratio: 1.14; 95% confidence interval: 1.08-1.20; p < 0.001). After WWI-stratification into quartiles based on frailty and covariate adjustment, regression analyses were conducted; the adjusted hazard ratios exhibited a significant upward trend (p < 0.001). The subgroup analyses revealed higher positive correlations between the WWI and frailty in males and those aged ≥65 years and lower correlations in those with a high school or higher educational level and in married or cohabiting individuals. The strong positive correlation was unaltered in the other subgroup analyses. The WWI outperformed all other obesity-related indicators as a frailty predictor. CONCLUSIONS The WWI is a dependable and innovative obesity-related predictor of frailty and could help in mitigating its development.
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Affiliation(s)
- Jinhua Luo
- Geriatrics Research Unit, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China; Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - Hailian Deng
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - Yueying Wu
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - Tuming Zhang
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - Yuying Cai
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - Yu Yang
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China.
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17
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Tuan SH, Chang LH, Sun SF, Li CH, Chen GB, Tsai YJ. Assessing the Clinical Effectiveness of an Exergame-Based Exercise Training Program Using Ring Fit Adventure to Prevent and Postpone Frailty and Sarcopenia Among Older Adults in Rural Long-Term Care Facilities: Randomized Controlled Trial. J Med Internet Res 2024; 26:e59468. [PMID: 39024000 PMCID: PMC11294767 DOI: 10.2196/59468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Frailty and sarcopenia are geriatric syndromes of increasing concern and are associated with adverse health outcomes. They are more prevalent among long-term care facility (LTCF) users than among community dwellers. Exercise, especially multicomponent and progressive resistance training, is essential for managing these conditions. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to health care professional shortages. Moreover, older adults often become bored with repetitive exercise training and may lose interest over time. The Nintendo Switch Ring Fit Adventure (RFA) exergame is a novel exergame that combines resistance, aerobic, and balance exercises and offers a potential solution by boosting motivation in an immersive manner and reducing staff intervention needs. OBJECTIVE We aimed to evaluate the clinical effectiveness of an exergame-based exercise training program delivered via RFA (exergame-RFA) in improving muscle mass and functional performance among older adult LTCF users. METHODS This was a randomized controlled trial conducted from August 2022 to September 2023 and involved older adult LTCF users (aged ≥60 y) in rural southern Taiwan. Participants were randomized into an intervention group (exergame-RFA plus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skills and trunk control exercises using the RFA, lasted 30 minutes twice weekly over 12 weeks. The primary outcomes measured were the Study of Osteoporotic Fractures index (serving as an indicator of frailty status) and the diagnostic criteria for sarcopenia (appendicular skeletal muscle mass index, handgrip strength, and gait speed). The secondary outcomes included functional performance (box and block test as well as maximum voluntary isometric contraction of the dominant upper extremity), muscle condition (muscle thickness measured using ultrasonography), activities of daily living (Kihon checklist), health-related quality of life (Short Form Health Survey-36), and cognitive function (brain health test). We used an intention-to-treat analysis, incorporating a simple imputation technique in statistical analysis. A mixed ANOVA, with time as a within-participant factor and intervention as a between-participant factor, was used to compare the training effects on outcomes. RESULTS We recruited 96 individuals, of whom 60 (62%) underwent randomization. Of these 60 participants, 55 (92%) completed the study. Significant group×time interactions were observed in the intervention group in all primary outcomes (all P<.001, except P=.01 for handgrip strength) and most secondary outcomes, including maximum voluntary isometric contraction of the biceps (P=.004) and triceps brachii (P<.001) muscles, biceps muscle thickness measured using ultrasonography (P<.001), box and block test (P<.001), Kihon checklist (physical function: P=.01, mood status: P=.003, and total: P=.003), and brain health test (P<.001). CONCLUSIONS The exergame-RFA intervention significantly improved muscle mass, strength, and functional performance among older adult users of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia. TRIAL REGISTRATION ClinicalTrials.gov NCT05360667; https://clinicaltrials.gov/study/NCT05360667. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3389/fmed.2022.1071409.
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Affiliation(s)
- Sheng-Hui Tuan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lin-Hui Chang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Fen Sun
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Hui Li
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, National Defense Medical Center, Kaohsiung, Taiwan
| | - Yi-Ju Tsai
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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18
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Barghouth MH, Klein J, Bothe T, Ebert N, Schaeffner E, Mielke N. Social support and frailty progression in community-dwelling older adults. Front Public Health 2024; 12:1408641. [PMID: 39086799 PMCID: PMC11288939 DOI: 10.3389/fpubh.2024.1408641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
Objectives Despite the growing evidence regarding the influence of social factors on frailty in older adults, the effect of social support remains unclear. This study aims to assess the association between social support and frailty progression (transition and incidence) in a sample of community-dwelling older adults. Methods Using a cohort study design, 1,059 older adults from the Berlin Initiative Study were followed up for 2.1 years. Multinomial and logistic regression analyses were performed to assess the association of social support using Oslo Social Support Scale-3 with frailty transition and incidence, respectively. Gender differences were explored using stratified analyses. Results At baseline, frailty prevalence in the study population [mean (SD) age 84.3 (5.6) years; 55.8% women] reached 33.1% with 47.0, 29.4 and 23.6% of the participants reporting moderate, strong and poor social support, respectively. Over the follow-up period, social support was not significantly associated with the frailty transition categories in the adjusted model. Conversely, the adjusted logistic regression analysis showed that participants with poor social support had twice the odds of becoming frail compared to those with strong social support (OR 2.07; 95% CI 1.08-3.95). Gender-stratified analyses showed comparable estimates to the main analysis but were statistically non-significant. Discussion Our study results underpin the role of social factors in frailty incidence and highlight social support as a potential target for frailty-preventing interventions in older adults. Therefore, it is important to adopt a biopsychosocial model rather than a purely biomedical model to understand and holistically improve the health of community-dwelling older adults.
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Affiliation(s)
- Muhammad Helmi Barghouth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Jessica Klein
- Department of Social Policy and Social Security Studies, Hochschule Bonn-Rhein-Sieg, Sankt Augustin, Germany
| | - Tim Bothe
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Elke Schaeffner
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Nina Mielke
- Institute of Public Health, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Chirap-Mitulschi IA, Antoniu S, Schreiner TG. The impact of palliative care on the frailty-stroke continuum: from theoretical concepts to practical aspects. Postgrad Med 2024:1-9. [PMID: 38954726 DOI: 10.1080/00325481.2024.2374701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
With a constant increase in prevalence and incidence worldwide, stroke remains a public health issue in the 21st century. Additionally, population aging inevitably leads to increased vulnerability in the general population, a clinical state known as frailty. While there are adequate guidelines on the treatment of stroke in the acute setting, there are a lot of gaps regarding the chronic management of stroke patients, particularly the frail ones. From the therapeutic point of view, palliative care could be the key to offering complex and individualized treatment to these frail chronic stroke patients. In the context of the heterogeneous data and incomplete therapeutic guidelines, this article provides a new and original perspective on the topic, aiming to increase awareness and understanding and improve palliative care management in stroke patients. Based on current knowledge, the authors describe a new concept called the frailty-stroke continuum and offer a detailed explanation of the intricate stroke-frailty connection in the first part. After understanding the role of palliative care in managing this kind of patients, the authors discuss the most relevant practical aspects aiming to offer an individualized framework for daily clinical practice. The novel approach consists of developing a four-step scale for characterizing frail stroke patients, with the final aim of providing personalized treatment and correctly evaluating prognosis. By pointing out the limitations of current guidelines and the challenges of new research directions, this article opens the pathway for the better evaluation of frail stroke patients, offering a better perception of patients' prognosis.
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Affiliation(s)
- Ioan-Alexandru Chirap-Mitulschi
- Department of Medicine II/Nursing-Palliative Care, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania
- Neurology Clinic, Clinical Rehabilitation Hospital, Iasi, Romania
| | - Sabina Antoniu
- Department of Medicine II/Nursing-Palliative Care, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania
| | - Thomas Gabriel Schreiner
- Department of Electrical Measurements and Materials, Faculty of Electrical Engineering and Information Technology, Gheorghe Asachi Technical University of Iasi, Iasi, Romania
- Department of Medicine III/Neurology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania
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20
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Chen CW, Lee MC, Liu KF, Lin LJ, Wu SFV. Frailty management in older patients: a best practice implementation project. JBI Evid Implement 2024:02205615-990000000-00111. [PMID: 38946495 DOI: 10.1097/xeb.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Frailty in older adults can lead to a gradual decline in organ function. Without timely diagnosis and intervention, this condition can progress rapidly, increasing the risk of disability and mortality. OBJECTIVES The aim of this project was to implement evidence-based practices for managing frailty in the medical ward to prevent disability in older patients. METHODS This project was conceptually informed by the JBI Evidence Implementation Framework. This framework uses an audit and feedback approach and a pre- and post-test design to measure baseline compliance, develop implementation strategies responsive to gaps in compliance, and conduct a final evaluation to measure changes in compliance. JBI PACES and JBI GRiP situational analysis software were used to support data collection and implementation planning. Ten audit criteria were used with a sample of 30 patients in a regional teaching hospital in southern Taiwan. RESULTS The baseline audit showed poor compliance, with rates below 30% for all ten audit criteria. Through strategies such as professional training and education, the implementation of evidence-based care guidelines, and interdisciplinary consensus-building, the follow-up audit revealed an increase in compliance to over 90% for each audit criterion. CONCLUSIONS Frailty management strategies based on evidence-based audit criteria were implemented and routinely measured. The most effective strategies for improving compliance included the development of a training course, a digitized assessment tool, team meetings, interdisciplinary collaboration, communication, and consensus-building. SPANISH ABSTRACT http://links.lww.com/IJEBH/A225.
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Affiliation(s)
- Chih Wen Chen
- Antai Medical Care Corporation, Antai Tian-Sheng Memorial Hospital, Department of Nursing, Taiwan
| | - Mei-Chen Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kuei Fen Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Ju Lin
- International and Cross-Strait Education Center, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Vivienne Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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21
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Chan GCK, Kalantar-Zadeh K, Ng JKC, Tian N, Burns A, Chow KM, Szeto CC, Li PKT. Frailty in patients on dialysis. Kidney Int 2024; 106:35-49. [PMID: 38705274 DOI: 10.1016/j.kint.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 05/07/2024]
Abstract
Frailty is a condition that is frequently observed among patients undergoing dialysis. Frailty is characterized by a decline in both physiological state and cognitive state, leading to a combination of symptoms, such as weight loss, exhaustion, low physical activity level, weakness, and slow walking speed. Frail patients not only experience a poor quality of life, but also are at higher risk of hospitalization, infection, cardiovascular events, dialysis-associated complications, and death. Frailty occurs as a result of a combination and interaction of various medical issues in patients who are on dialysis. Unfortunately, frailty has no cure. To address frailty, a multifaceted approach is necessary, involving coordinated efforts from nephrologists, geriatricians, nurses, allied health practitioners, and family members. Strategies such as optimizing nutrition and chronic kidney disease-related complications, reducing polypharmacy by deprescription, personalizing dialysis prescription, and considering home-based or assisted dialysis may help slow the decline of physical function over time in subjects with frailty. This review discusses the underlying causes of frailty in patients on dialysis and examines the methods and difficulties involved in managing frailty among this group.
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Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harbor-University of California, Los Angeles Medical Center, Torrance, California, USA
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Na Tian
- Department of Nephrology, General Hospital of Ning Xia Medical University, Yin Chuan, China
| | - Aine Burns
- Division of Nephrology, University College London, Royal Free Hospital, London, UK
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China; Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip Kam-Tao Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China.
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22
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Moshkovits Y, Chetrit A, Dankner R. The association between frailty biomarkers and 20-year all-cause and cardiovascular mortality among community-dwelling older adults. Postgrad Med 2024:1-10. [PMID: 38940517 DOI: 10.1080/00325481.2024.2374703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/27/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES While several biomarkers were previously associated with frailty and mortality, data are still contradicting. We aimed to evaluate the association between novel biomarkers and frailty among community-dwelling older adults to enhance understanding of the pathophysiology of frailty. METHODS Nine hundred and sixty-three older adults were screened during the third phase (1999-2008) of the Israel study on Glucose Intolerance, Obesity, and Hypertension (GOH). Frailty was defined as sedentary individuals, past 10 years hospitalizations, or at least one of the following: body mass index (BMI) <21 kg/m2; albumin <3.2 g/dl; ≥2 major baseline diseases. Biomarkers were evaluated for their association with frailty, all-cause, and cardiovascular mortality. RESULTS Mean baseline age was 72 ± 7 years, 471 (49%) were women, and 195 (20%) were classified as frail. Median follow-up for cardiovascular and all-cause mortality was 11 and 13 years, with 179 (18.6%) and 466 (48.4%) deaths recorded, respectively. Multivariable logistic regression showed greater odds for frailty with lower quartile of alanine aminotransferase (ALT) (OR = 1.8, 95%CI: 1.2-2.8, p = 0.01), and for each 5 µmol/L increment in homocysteine levels (OR = 1.3, 95%CI: 1.1-1.5, p = 0.001). Multivariate Cox regression showed greater all-cause and cardiovascular mortality risk for individuals with low ALT (HR = 1.6, 95%CI: 1.3-2.0, p < 0.001 and HR = 1.5, 95% CI: 1.0-2.2, p = 0.03, respectively), and high homocysteine (HR = 1.1, 95%CI: 1.1-1.3, p = 0.003 and HR = 1.2, 95%CI: 1.0-1.3, p = 0.04, respectively). Homocysteine association with mortality was more pronounced in those with baseline ischemic heart disease (IHD) compared with subjects free of IHD (P for interaction = 0.01). CONCLUSIONS Lower ALT and higher homocysteine were associated with frailty, all-cause and cardiovascular mortality. These available and low-cost biomarkers underscore the nutritional and metabolic aspects of frailty when screening high-risk older adults, especially those with IHD, and may be considered as preferable screening biomarkers to be tested among these individuals for frailty and mortality risk.
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Affiliation(s)
| | - Angela Chetrit
- Public Health Research Center, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Rachel Dankner
- Public Health Research Center, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rakisheva A, Soloveva A, Shchendrygina A, Giverts I. Heart Failure With Preserved Ejection Fraction and Frailty: From Young to Superaged Coexisting HFpEF and Frailty. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:93-106. [PMID: 39081641 PMCID: PMC11284337 DOI: 10.36628/ijhf.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/01/2024] [Accepted: 06/14/2024] [Indexed: 08/02/2024]
Abstract
Being commonly diagnosed in elderly women and associated with comorbidities as well as ageing-related cardio-vascular changes, heart failure with preserved ejection fraction (HFpEF) has been recently considered as a distinct cardiogeriatric syndrome. Frailty is another frequent geriatric syndrome. HFpEF and frailty share common underlying mechanisms, often co-exist, and represent each other's risk factors. A threshold of 65 years old is usually used to screen patients for both frailty and HFpEF in research and clinical settings. However, both HFpEF and frailty are very heterogenous conditions that may develop at younger ages. In this review we aim to provide a broader overview on the coexistence of HFpEF and frailty throughout the lifetime. We hypothesize that HFpEF and frailty patients' profiles (young, elderly, superaged) represent a continuum of the common ageing process modified by cumulative exposure to risk factors resulting to a presentation of HFpEF and frailty at different ages. We believe, that suggested approach might stimulate assessment of frailty in HFpEF assessment and vice versa regardless of age and early implementation of targeted interventions. Future studies of pathophysiology, clinical features, and outcomes of frailty in HFpEF by age are needed.
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Affiliation(s)
| | - Anzhela Soloveva
- Department of Cardiology, Almazov Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Ilya Giverts
- Maimonides Medical Center, Brooklyn, NY, USA
- Massachusetts General Hospital, Boston, MA, USA
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24
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DeMaria A. Frailty: A Nebulous Concept? STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100337. [PMID: 39100580 PMCID: PMC11294890 DOI: 10.1016/j.shj.2024.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Affiliation(s)
- Anthony DeMaria
- Judy and Jack White Chair in Cardiology, Sulpizio Cardiovascular Center, University of California, San Diego, La Jolla, California
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25
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Ye B, Li Y, Wang Y, Ji X, Wang J, Huang Y, Chen J, Bao Z. A Modified Frailty Phenotype Used for Identifying Frailty in Health Care Practice: Validation Among Chinese Older Adults. J Am Med Dir Assoc 2024; 25:105016. [PMID: 38750655 DOI: 10.1016/j.jamda.2024.105016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVES The study aimed to evaluate a simplified and practical frailty detection tool derived from the Fried frailty phenotype (FFP). This tool was developed to facilitate the identification of frail individuals in constrained settings, addressing the challenges posed by uncertain cutoffs of FFP indicators in prompt frailty assessment. DESIGN A longitudinal study and a cross-sectional study. SETTINGS AND PARTICIPANTS A total of 1978 older adults aged 67.4 ± 6.16 years from the China Health and Retirement Longitudinal Study (CHARLS), and 972 older adults aged 72.8 ± 6.75 years from a pilot cross-sectional study conducted in Shanghai communities. METHODS Frailty was assessed according to the FFP criterion. A Chinese modified frailty phenotype (CMFP) was developed, incorporating specific cutoffs for grip strength and an alternative test for walk speed. The internal consistency reliability, the criterion, and predictive validity of the CMFP were evaluated. RESULTS The 5-time chair stand test (5t-CST) was significantly associated with the 2.5-m walk test (r = 0.373 in the CHARLS and 0.423 in the pilot study). Each element of the CMFP showed moderate to strong correlations with the total CMFP score and showed Cronbach's alpha of 0.303 and 0.358 in both populations. The Spearman's r and kappa values between the CMFP and the FFP were 0.795 and 0.663 in the CHARLS, and 0.676 and 0.537 in the pilot study. The areas under the curve (AUC) were 0.936 and 0.928 in the 2 studies, respectively. In addition, frailty assessed by the CMFP significantly predicted future incidence of outcomes, including all-cause mortality, activities of daily living (ADL)/instrumental ADL disability, hospitalization, and depression. CONCLUSIONS AND IMPLICATIONS The study demonstrated the CMFP as a valid tool, particularly highlighting its excellent predictive ability on outcomes. The 5t-CST may act as a viable alternative test for assessing slowness. The CMFP can be systematically integrated into preclinical practice to identify frail individuals, especially within constrained spaces.
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Affiliation(s)
- Bo Ye
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yunxia Li
- Department of Preventive Medicine, Heqing Community Health Service Center, Shanghai, China
| | - Yu Wang
- Clinical Research Unit for Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xueying Ji
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Department of General Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiaofeng Wang
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yiqing Huang
- Department of General Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jie Chen
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China; Clinical Research Unit for Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
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Dowling L, Lynch DH, Batchek D, Sun C, Mark-Wagstaff C, Jones E, Prochaska M, Huisingh-Sheetz M, Batsis JA. Nutrition interventions for body composition, physical function, cognition in hospitalized older adults: A systematic review of individuals 75 years and older. J Am Geriatr Soc 2024; 72:2206-2218. [PMID: 38376064 PMCID: PMC11226365 DOI: 10.1111/jgs.18799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/01/2023] [Accepted: 01/21/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Globally, the oldest old population is expected to triple by 2050. Hospitalization and malnutrition can result in progressive functional decline in older adults. Minimizing the impact of hospitalization on functional status in older adults has the potential to maintain independence, reduce health and social care costs, and maximize years in a healthy state. This study aimed to systematically review the literature to identify nutritional interventions that target physical function, body composition, and cognition in the older population (≥ 75 years). METHODS A systematic review was conducted to evaluate the efficacy of nutritional interventions on physical function, body composition, and cognition in adults aged ≥ 75 years or mean age ≥80 years. Searches of PubMed (National Institutes of Health, National Library of Medicine), Scopus (Elsevier), EMBASE (Elsevier), Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text (EBSCOhost), and PsycInfo (EBSCOhost) were conducted. Screening, data extraction, and quality assessment were performed in duplicate and independently (CRD42022355984; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=355984). RESULTS Of 8311 citations identified, 2939 duplicates were excluded. From 5372 citations, 189 articles underwent full-text review leaving a total of 12 studies for inclusion. Interventions were food-based, protein-based, carbohydrate-based, personalized, or used parenteral nutrition. Ten studies monitored anthropometric or body composition changes with three showing maintenance or improvements in lean mass, body mass index, triceps skinfold, and mid-upper arm circumference compared with the control group. Six studies monitored physical function but only the largest study found a beneficial effect on activities of daily living. Two of three studies showed the beneficial effects of nutritional intervention on cognition. CONCLUSION There are few, high-quality, nutrition-based interventions in older adults ≥75 years. Despite heterogeneity, our findings suggest that large, longer-term (>2 weeks) nutritional interventions have the potential to maintain body composition, physical function, and cognition in adults aged 75 years and older during hospitalization.
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Affiliation(s)
- Lisa Dowling
- The Medical School, University of Sheffield, Sheffield, UK
| | - David H Lynch
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dakota Batchek
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chang Sun
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Emily Jones
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Micah Prochaska
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Megan Huisingh-Sheetz
- Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - John A Batsis
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Xu T, Soh SLH, Chua CP, Pearpilai J, Wee SL. Clinical effectiveness and cost-effectiveness of a multicomponent frailty management program "Say No To Frailty" in Singapore: A cluster-randomized controlled trial protocol. Contemp Clin Trials 2024; 142:107546. [PMID: 38697512 DOI: 10.1016/j.cct.2024.107546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND A 12-week multicomponent frailty management program - Say No To Frailty (SNTF) consisting of interactive talks and fitness exercises led by a trained program leader has shown feasibility and positive health outcomes in community-living older adults with frailty and pre-frailty in Singapore. This study aims to evaluate the clinical- and cost-effectiveness of SNTF on physical functions, self-confidence, community participation, quality of life and fall reduction in the local community setting. METHODS This study will use the cluster-randomization method to randomly allocate 12 participating centres into three arms. Centres under two intervention arms will conduct the same SNTF program but led by a program leader with different training backgrounds (an Allied Health Professional (AHP) v.s. a non-AHP), whereas centres under the control arm will continue their usual care without an additional intervention. Eligible participants at each participating centre will be recruited via the convenience sampling method in the community setting. Primary outcome measure (frailty level) and secondary outcome measures (e.g., physical functions, self-confidence, community participation, quality of life) will be conducted by the blinded assessors at baseline, immediate, 3 months and 9 months post-intervention. Fall data will be collected during the one-year study period. Outcomes between and within groups will be compared and analysed using STATA to evaluate the clinical effectiveness. Program costs and relevant healthcare costs during the follow-up phase will be recorded for cost-effectiveness analysis. CONCLUSION This study will provide significant insights into conducting SNTF for Singapore community-living older adults with frailty and pre-frailty on clinical- and cost-effectiveness. Australia New Zealand Clinical Trials Registry: ACTRN12621001673831.
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Affiliation(s)
- Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.
| | - Shawn Leng Hsien Soh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Chern-Pin Chua
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | | | - Shiou Liang Wee
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
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28
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Kempton H, Hall R, Hungerford SL, Hayward CS, Muller DWM. Frailty and transcatheter valve intervention: A narrative review. Catheter Cardiovasc Interv 2024; 104:155-166. [PMID: 38819861 DOI: 10.1002/ccd.31076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/27/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
Frailty is a common clinical syndrome that portends poor peri-procedural outcomes and increased mortality following transcatheter valve interventions. We reviewed frailty assessment tools in transcatheter intervention cohorts to recommend a pathway for preprocedural frailty assessment in patients referred for transcatheter valve procedures, and evaluated current evidence for frailty interventions and their efficacy in transcatheter intervention. We recommend the use of a frailty screening instrument to identify patients as frail, with subsequent referral for comprehensive geriatric assessment in these patients, to assist in selecting appropriate patients and then optimizing them for transcatheter valve interventions. Interventions to reduce preprocedural frailty are not well defined, however, data from limited cohort studies support exercise-based interventions to increase functional capacity and reduce frailty in parallel with preprocedural medical optimization.
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Affiliation(s)
- Hannah Kempton
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Rachael Hall
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sara L Hungerford
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher S Hayward
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
| | - David W M Muller
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Health and Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
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Deguchi N, Tanaka R, Akita T. Association Between Sarcopenic Obesity and Frailty Risk in Community-Dwelling Older Women With Locomotive Syndrome: A Cross-Sectional Survey. Cureus 2024; 16:e64612. [PMID: 39149641 PMCID: PMC11324806 DOI: 10.7759/cureus.64612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 08/17/2024] Open
Abstract
Background Concurrent sarcopenia and obesity in locomotive syndrome (LS) impair activities of daily living and decrease extremity muscle strength and motor function. However, the increased risk of frailty posed by sarcopenic obesity compared to either sarcopenia or obesity alone remains unclear. Objective To examine the association between sarcopenic obesity and frailty risk in community-dwelling older adult women with LS. Methods This cross-sectional study included 158 women aged ≥65 years with LS stage 1 (age, 74.0 yrs, body mass index, 22.7 kg/m2) according to the Japanese Orthopaedic Association criteria. Bioelectrical impedance analysis was used to measure the skeletal muscle mass index (SMI) and percent body fat (PBF). Participants were classified into four subtypes: normal (non-obesity, non-sarcopenia), sarcopenia (SMI < 5.7 kg/m2), obesity (PBF > 35%), and sarcopenic obesity (SMI < 5.7 kg/m2 and PBF > 35%). Logistic regression analysis was used to adjust for age, body mass index, back pain, knee pain, history of falls, and physical function. Results Among the participants, 52 individuals (32.9%) were classified as frailty risk. The percentage of body phenotypes was 30.4% normal, 32.9% were sarcopenia, 22.8% had obesity (RT1), and 13.9% had sarcopenic obesity. The odds ratios for frailty risk compared to normal were 3.97 (95% confidence interval (CI): 1.51 to 10.4), 1.71 (95% CI: 0.55 to 5.39), and 4.25 (95% CI: 1.34 to 13.5) for sarcopenia (RT2), obesity, and sarcopenic obesity subtypes, respectively, sarcopenia and sarcopenic obesity were significantly associated with frailty risk. Conclusion In older adult women with LS, the presence of sarcopenia or sarcopenic obesity may increase the risk of frailty; however, the addition of obesity does not always further increase this risk. Further investigation of the association between increased body fat and frailty in older adult women is warranted.
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Affiliation(s)
- Naoki Deguchi
- Geriatrics, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, JPN
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, JPN
| | - Ryo Tanaka
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, JPN
| | - Tomoyuki Akita
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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Rosario BH, Kwok KM, Sim SKR. The value of frailty assessments in older surgical patients undergoing emergency laparotomies in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:340-341. [PMID: 38979989 DOI: 10.47102/annals-acadmedsg.2024193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Mortality in emergency laparotomy (EL) far exceeds that of elective bowel surgery, and standards for the National Emergency Laparotomy Audit (NELA) in the UK were introduced due to the high mortality within 1 month of EL.1 In Singapore, 30-day mortality varies between 5.4% and 14.7% after EL.2,3 However, 30-day mortality in older patients has been reported to be as high as 31.5%.3
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Affiliation(s)
| | - Kah Meng Kwok
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
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Tan LF, Merchant RA. Prevalence of tight glycemic control based on frailty status and associated factors in community-dwelling older adults. Postgrad Med J 2024:qgae077. [PMID: 38924725 DOI: 10.1093/postmj/qgae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/01/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Tight control of type 2 diabetes (T2DM) in frail older adults has shown to be associated with adverse outcomes. The objective of this study is to determine the prevalence of tight glycemic control based on underlying frailty status and its association with functional and cognitive measures in community-dwelling older adults. METHODOLOGY Ancillary study of the Singapore Population Health Studies on older adults aged ≥65 years with T2DM. Tight glycemic control cut-offs were based on the 2019 Endocrine Society guideline using HbA1c target range based on a patient's overall health status measured by the FRAIL scale. Data on basic demographics, frailty, cognitive, and functional statuses were collected. Multivariable regression was used to assess potential factors associated with tight glycemic control. RESULTS Of 172 community-dwelling older adults with diabetes mellitus and HbA1c done, frail (65%) and pre-frail (64.4%) participants were more likely to have tight glycemic control than robust participants (31.6%, P < 0.001). In multi-variate analysis, frailty (OR 6.43, 95% CI 1.08-38.1, P = 0.041), better cognition (OR 1.15, 95% CI 1.02-1.32, P = 0.028), and multi-morbidity (OR 7.36, 95% CI 1.07-50.4, P = 0.042) were found to be significantly associated with increased odds of tight glycemic control. CONCLUSION Tight glycemic control was highly prevalent in frail and pre-frail older adults, especially in those with multi-morbidity and better cognition. Future prospective longitudinal studies are required to evaluate effectiveness of frailty screening in making treatment decisions and long-term outcomes. Key messages What is already known on this topic: There is growing recognition that glycemic targets should be adjusted based on health or frailty status. However, there is no consensus on how health status or frailty should be defined when determining glycemic control targets. What this study adds: Our study found that tight glycemic control was highly prevalent in frail and pre-frail older adults. Our findings highlight the importance of assessing for tight glycemic control based on frailty status and further work is needed to aid implementation of screening and intervention policies to avoid the attendant harms of tight glycemic control.
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Affiliation(s)
- Li Feng Tan
- Healthy Ageing Programme, Alexandra Hospital, National University Health System, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Reshma Aziz Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
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Chen L, Liu C, Deng A, Zhang A, Zhu M, Xi H. Association between nutritional risk and fatigue in frailty conditions for older adult patients: a multicentre cross-sectional survey study. BMJ Open 2024; 14:e079139. [PMID: 38851231 PMCID: PMC11163610 DOI: 10.1136/bmjopen-2023-079139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND AND AIMS Frailty is widespread in the elderly, while there is a bi-directional relationship between frailty and malnutrition. The objectives of this study were to investigate the prevalence and correlation of frailty and nutritional risk in older adult patients and to analyse the factors associated with fatigue which is one indicator of frailty. METHODS This cross-sectional multicentre survey study was conducted in five hospitals in the same city from 01 January 2021 to 01 December 2021. We collected information on gender, age, diseases, medication and dietary status. Frailty status was diagnosed using the FRAIL scale, and Nutritional Risk Screening-2002 was used to screen the nutritional risk. Spearman rank correlation was used to analyse the correlation between frailty and nutritional risk. Univariate and multivariate logistic regression analyses were used to analyse the risk factors related to fatigue in all patients and inpatients. RESULTS Among 2016 older adult patients, the prevalence of frailty was 15.1% (305/2016), the prevalence of nutritional risk was 16.2% (327/2016) and the overlap prevalence of frailty and nutritional risk was 7.3% (147/2016). Multivariate analysis showed that nutritional risk (OR 3.109, 95% CI 2.384 to 4.056, p<0.001) was an independent risk factor for fatigue in all patients; similar results were found for nutritional risk (OR 2.717, 95% CI 2.068 to 3.571, p<0.001) in hospitalised patients. CONCLUSIONS Frailty and nutritional risk are prevalent among older adult patients, and nutritional risk is associated with the occurrence of fatigue in older adult patients and older adult inpatients. TRIAL REGISTRATION NUMBER China Clinical Trial Registry (Registered No. ChiCTR-EPC-14005253).
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Affiliation(s)
- Liru Chen
- Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chengyu Liu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - An Deng
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Anqi Zhang
- Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingwei Zhu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Xi
- Department of Geriatric, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Zhu L, Shen X, Shi X, Ouyang X. Factors associated with intrinsic capacity impairment in hospitalized older adults: a latent class analysis. BMC Geriatr 2024; 24:494. [PMID: 38840051 PMCID: PMC11151595 DOI: 10.1186/s12877-024-05093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/17/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Intrinsic capacity (IC) is proposed by the World Health Organization (WHO) to promote healthy aging. Although some studies have examined the factors influencing IC, few studies have comprehensively confirmed lifestyle factors on IC, especially IC impairment patterns. The present study aimed to identify the patterns of IC impairment and explore the lifestyle and other factors associated with different patterns of IC impairment. METHODS This cross-sectional study was conducted in a Chinese geriatric hospital. IC was evaluated in five domains according to the recommendations of WHO: cognition, locomotion, vitality, sensory and psychological domains. The sociodemographic and health-related characteristics of participants were assessed.The health promoting lifestyle was evaluated using the Health-Promoting Lifestyle Profile-II scale, including nutrition, health responsibility, interpersonal relationships, physical activity, spiritual growth and stress management. We applied latent class analysis to identify IC impairment patterns and compared basic activities of daily living, instrumental activities of daily living, frailty, quality of life and falls among different IC impairment patterns. Multinomial logistic regression analysis was conducted to identify factors influencing the IC impairment patterns. RESULTS Among 237 participants included, the latent class analysis identified three patterns of IC impairment: 44.7% high IC (Class 1), 31.2% intermediate IC mainly locomotor impairment (Class 2) and 24.1% low IC mainly cognitive impairment (Class 3). Older adults in class 1 had the best function ability and quality of life, while class 3 had the highest levels of disability and frailty, the poorest quality of life and a higher prevalence of falls. Compared with class 1, older adults with advanced age (OR = 22.046, 95%CI:1.735-280.149), osteoporosis (OR = 3.377, 95%CI:1.161-9.825), and lower scores in physical activity (OR = 0.842, 95%CI:0.749-0.945), stress management (OR = 0.762, 95%CI:0.585-0.993) and social support (OR = 0.897, 95%CI:0.833-0.965) were more likely to belong to the class 2. Simultaneously, compared with class 1, older adults with advanced age (OR = 104.435, 95%CI:6.038-1806.410), stroke (OR = 3.877, 95%CI:1.172-12.823) and lower scores in physical activity (OR = 0.784, 95%CI:0.667-0.922) and social support (OR = 0.909, 95%CI:0.828-0.998) were more likely to be class 3. In addition, compared with class 2, older adults with a lower score in nutrition (OR = 0.764, 95%CI:0.615-0.950) were more likely to belong to the class 3. CONCLUSIONS This study provides evidence that there are heterogeneous IC impairment patterns in older adults and identifies various associated factors in each pattern, including age, stroke, osteoporosis, social support and lifestyle behaviors such as nutrition, physical activity and stress management. It informs stakeholders on which modifiable factors should be targeted through public health policy or early intervention to promote IC and healthy aging in older adults.
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Affiliation(s)
- Lingzhi Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xiaoxing Shen
- Department of Geriatrics, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaolan Shi
- Department of Geriatrics, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaojun Ouyang
- Department of Geriatrics, Geriatric Hospital of Nanjing Medical University, Nanjing, China.
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Azevedo PS, de Melo RC, de Souza JT, Frost R, Gavin JP, Robinson K, Boas PJFV, Minicucci MF, Aprahamian I, Wachholz PA, Hinslif-Smith K, Gordon AL. Frailty identification and management among Brazilian healthcare professionals: a survey. BMC Geriatr 2024; 24:486. [PMID: 38831274 PMCID: PMC11149253 DOI: 10.1186/s12877-024-05020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND National and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice. METHODS An anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil. RESULTS Most of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011). CONCLUSION Frailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people.
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Affiliation(s)
- Paula Schmidt Azevedo
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | | | - Juli Thomaz de Souza
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Rachael Frost
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - James P Gavin
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Katie Robinson
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK
| | - Paulo José Fortes Villas Boas
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Marcos Ferreira Minicucci
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | | | - Patrick Alexander Wachholz
- Botucatu Medical School, São Paulo State University (Unesp), District of Rubião Junior, no number, Botucatu, SP, 18618-970, Brazil
| | - Kathryn Hinslif-Smith
- Leicester School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Adam Lee Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK.
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Nottingham, UK.
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Hayashi T, Sato R, Tamura K. Relationships among tooth loss, prefrailty, and dietary patterns in community-dwelling older Japanese females: a cross-sectional study. Nutr Res Pract 2024; 18:387-399. [PMID: 38854469 PMCID: PMC11156762 DOI: 10.4162/nrp.2024.18.3.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND/OBJECTIVES Poor oral health has been predicted the development of frailty and sarcopenia as well as the subsequent need for long-term care. This cross-sectional study examined the relationships among tooth loss, prefrailty, and dietary patterns in community-dwelling older Japanese females. SUBJECTS/METHODS Information on the number of teeth, food consumption, and lifestyle factors was collected from 271 participants aged ≥ 65 yrs using a questionnaire. The number of teeth was self-reported and classified into 2 groups: natural teeth ≥ 20 and natural teeth < 20. Prefrailty was assessed using the Japanese version of the Cardiovascular Health Study. Three dietary patterns ("vegetables and dairy products" [VD], "rice and fish and shellfish" [RF], and "bread and beverages") were adopted from a cluster analysis of the intakes of 20 foods evaluated using the Food Frequency Questionnaire. The odds ratios (ORs) for prefrailty and dietary patterns were calculated using a binary logistic regression analysis. RESULTS A total of 267 participants were analyzed, excluding those with frailty (n = 4). The rates of natural teeth < 20 and prefrailty were 57.3 and 37.4%, respectively. Natural teeth < 20 was positively correlated with prefrailty (OR, 4.66; 95% confidence interval [CI], 2.54-8.52) and inversely correlated with VD pattern (OR, 0.43; 95% CI, 0.27-0.69). Furthermore, both VD (OR, 0.38; 95% CI, 0.16-0.91) and RF (OR, 0.26; 95% CI, 0.11-0.62) patterns were inversely correlated with prefrailty. CONCLUSIONS Maintaining the number of natural teeth ≥ 20 into old age plays an important role in preventing a prefrailty. The promotion of VD and RF dietary patterns has potential as an effective nutritional strategy for preventing tooth loss and prefrailty.
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Affiliation(s)
- Tatsumi Hayashi
- Faculty of Economics, Shimonoseki City University, Shimonoseki 751-8510, Japan
- Faculty of Food and Nutrition, Kyushu Nutrition Welfare University, Kitakyushu 803-8511, Japan
| | - Rumi Sato
- Community Health Division, Council of Social Welfare, Bungo Ono City 879-7153, Japan
| | - Kazuo Tamura
- Research Promotion Division, Fukuoka University, Fukuoka 814-0180, Japan
- NPO Clinical Hematology Oncology Treatment Study Group, Fukuoka 819-0030, Japan
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Antoniadou E, Giusti E, Capodaglio P, Han DS, Gimigliano F, Guzman JM, Oh-Park M, Frontera W. Frailty recommendations and guidelines: an evaluation of the implementability and a critical appraisal of clinical applicability by the ISPRM Frailty Focus Group. Eur J Phys Rehabil Med 2024; 60:530-539. [PMID: 38656081 PMCID: PMC11258911 DOI: 10.23736/s1973-9087.24.08486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Aging is associated with an increased burden of multi-morbidity and disease related functional loss and disability, widely impacting patients and health care systems. Frailty is a major actor in age-related disability and is an important target for rehabilitation interventions, considering that is a reversible condition. EVIDENCE ACQUISITION A working group of members of the ISPRM, responding to WHO 2030 call for action to strengthen rehabilitation, was established to assess the quality and implementability of the existing guidelines for the rehabilitation of frailty. Guidelines were retrieved using a systematic search on Pubmed, Scopus and Web of Science and from the reference lists of screened articles. The included guidelines were evaluated using the AGREE II to assess their quality and using the AGREE-REX to assess their clinical credibility and implementability. Guidelines with a score >4 in the AGREE II item evaluating the overall quality of the guideline were considered for endorsement. Finally, nine external reviewers evaluated the applicability of each recommendation from the endorsed guidelines, providing comments about the barriers and facilitators for their implementation in their country. EVIDENCE SYNTHESIS Ten guidelines were retrieved and evaluated by the working group, of which four guidelines, i.e. the WHO Guidelines on Integrated Care for Older People, the FOCUS guidelines, the Asia-Pacific Clinical Practice Guidelines for the Management of Frailty and the ICFSR International Clinical Practice Guidelines for Identification and Management of Frailty, were considered for endorsement. All these guidelines were rated as of adequate quality and implementability. CONCLUSIONS The WHO Guidelines on Integrated Care for Older people (24) the ICFSR International Clinical Practice Guidelines for Identification and management of Frailty (15), the FOCUS guidelines (25) and the Asia Pacific Clinical Practice Guidelines (14) for the Management of Frailty have the best quality and applicability of the existing guidelines on the management of frailty, we suggest that should be employed to define the standards of care for patients with frailty. There are barriers for their implementation, as stated by our experts, to take into account, and some of them are country- or region-specific. Screening for frailty, exercise, nutrition, pharmacological management, social and psychological support, management of incontinence, and an overall comprehensive clinical management are the best tools to face upon frailty.
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Affiliation(s)
- Eleftheria Antoniadou
- Geriatric Rehabilitation Clinic Centre Hospitalier du Nord, Ettelbruck, Luxembourg -
| | - Emanuele Giusti
- EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Paolo Capodaglio
- Unit of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University of Turin, Turin, Italy
- Unit of Rehabilitation, Istituto Auxologico Italiano IRCCS, Piancavallo, Verbania, Italy
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan (R.O.C.)
| | - Francesca Gimigliano
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva Università Vanvitelli Campania, Naples, Italy
| | | | - Mooyeon Oh-Park
- Burke Rehabilitation Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System, New York, NY, USA
| | - Walter Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Kobayashi S, Morino K, Okamoto T, Tanaka M, Ida S, Ohashi N, Murata K, Yanagimachi T, Sakai J, Maegawa H, Fujita Y, Kume S. Acetate derived from the intestinal tract has a critical role in maintaining skeletal muscle mass and strength in mice. Physiol Rep 2024; 12:e16047. [PMID: 38837588 PMCID: PMC11150057 DOI: 10.14814/phy2.16047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Acetate is a short-chain fatty acid (SCFA) that is produced by microbiota in the intestinal tract. It is an important nutrient for the intestinal epithelium, but also has a high plasma concentration and is used in the various tissues. Acetate is involved in endurance exercise, but its role in resistance exercise remains unclear. To investigate this, mice were administered either multiple antibiotics with and without oral acetate supplementation or fed a low-fiber diet. Antibiotic treatment for 2 weeks significantly reduced grip strength and the cross-sectional area (CSA) of muscle fiber compared with the control group. Intestinal concentrations of SCFAs were reduced in the antibiotic-treated group. Oral administration of acetate with antibiotics prevented antibiotic-induced weakness of skeletal muscle and reduced CSA of muscle fiber. Similarly, a low-fiber diet for 1 year significantly reduced the CSA of muscle fiber and fecal and plasma acetate concentrations. To investigate the role of acetate as an energy source, acetyl-CoA synthase 2 knockout mice were used. These mice had a shorter lifespan, reduced skeletal muscle mass and smaller CSA of muscle fiber than their wild type littermates. In conclusion, acetate derived from the intestinal microbiome can contribute to maintaining skeletal muscle performance.
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Affiliation(s)
- Saki Kobayashi
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Katsutaro Morino
- Institutional Research Office, Shiga University of Medical ScienceOtsuJapan
- Present address:
Department of Diabetes and Endocrine MedicineKagoshima University Graduate School of Medical and Dental SciencesKagoshima‐cityJapan
| | - Takuya Okamoto
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Mitsumi Tanaka
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
- CMIC Pharma ScienceNishiwakiJapan
| | - Shogo Ida
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Natsuko Ohashi
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Koichiro Murata
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
| | - Tsuyoshi Yanagimachi
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
- Present address:
Department of Endocrinology and Metabolism, Graduate School of MedicineHirosaki UniversityHirosaki‐sityJapan
| | - Juro Sakai
- Division of Molecular Physiology and MetabolismTohoku University Graduate School of MedicineSendaiJapan
- Division of Metabolic Medicine, Research Center for Advanced Science and TechnologyThe University of TokyoTokyoJapan
| | - Hiroshi Maegawa
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
- Present address:
Yasu City HospitalYasu‐cityJapan
| | - Yukihiro Fujita
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
- Present address:
Department of Endocrinology and Metabolism, Graduate School of MedicineHirosaki UniversityHirosaki‐sityJapan
| | - Shinji Kume
- Division of Endocrinology and Metabolism, Department of MedicineShiga University of Medical ScienceOtsuJapan
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Kawamura K, Wakayama S, Osawa A, Ishino S, Iwase T, Tanimoto M, Itoh N, Maeshima S. Effectiveness of Home Exercise Program for Older People approach for frailty: A preliminary study. Geriatr Gerontol Int 2024; 24:649-651. [PMID: 38690759 DOI: 10.1111/ggi.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Koki Kawamura
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi, Medical University, Nagakute, Japan
| | - Satomu Wakayama
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Aiko Osawa
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shota Ishino
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Taku Iwase
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masanori Tanimoto
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Itoh
- Department of Rehabilitation, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shinichiro Maeshima
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
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Sawada Y, Tanaka E, Tomisaki E, Watanabe T, Okumura R, Kinoshita H, Ito S, Anme T. Active use of local exercise facilities can improve physical performance of community-dwelling older adults. J Phys Ther Sci 2024; 36:325-329. [PMID: 38832221 PMCID: PMC11144473 DOI: 10.1589/jpts.36.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/04/2024] [Indexed: 06/05/2024] Open
Abstract
[Purpose] In this study, we investigated the effects of local exercise facility use on physical function of Japanese community-dwelling older adults. [Participants and Methods] We analyzed data obtained from a cohort project initiated in 1991. The study included approximately 4,800 individuals from suburban areas of central Japan; we investigated 322 older individuals residing in Municipality A, who underwent physical fitness assessments in 2018 and 2019. We recorded participants' exercise facility use frequency and physical performance, based on handgrip strength, open-eye single-leg standing, timed up-and-go, and walking speed tests. [Results] Baseline values in the open-eye single-leg standing test were significantly higher in the no-use than in the low- and high-use groups. Follow-up assessments revealed that grip strength was significantly higher in the high-use than in the no- and low-use groups. [Conclusion] Active use of exercise facilities was positively correlated with maintenance and improvement in physical fitness among participants, which highlights the benefits of easily accessible exercise facilities in maintaining long-term physical function. Future studies should focus on functions that extend beyond physical fitness to develop effective support programs that address the evolving health needs of the aging population.
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Affiliation(s)
- Yuko Sawada
- Department of Physical Therapy, Morinomiya University of
Medical Sciences: 1-26-16 Nanko-kita, Suminoe-ku, Osaka 559-8611, Japan
| | | | | | - Taeko Watanabe
- Faculty of Nursing Sciences and Nutrition, Shukutoku
University, Japan
| | - Rika Okumura
- Department of Public Welfare, Tobishima Village, Aichi
Prefecture, Japan
| | - Hiroshi Kinoshita
- Department of Public Welfare, Tobishima Village, Aichi
Prefecture, Japan
| | - Sumio Ito
- Department of Public Welfare, Tobishima Village, Aichi
Prefecture, Japan
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Japan
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Coelho-Júnior HJ, Araújo EM, Uchida MC, Marzetti E, Aguiar SDS. Effects of resistance training associated with a verbal fluency task on physical performance and cognitive function in frail nursing home residents. Arch Gerontol Geriatr 2024; 121:105353. [PMID: 38340589 DOI: 10.1016/j.archger.2024.105353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Studies examining the effects of dual-task resistance training (RT) on nursing-home residents are still scarce. To add knowledge to this field, the present study compared the effects of 12-week RT and RT plus cognitive task (COG) programs on physical performance and cognitive function in a sample of frail nursing home residents. METHODS This is an experimental study that combined data from two studies that examined older adults living in nursing home residences in Brazil. Exercise groups performed a 12-week RT protocol that included four exercises, with 3-4 times (sets) of 8-10 repetitions at 70 %-75 % of 1-repetition maximum (1RM), twice a week. The RT+COG group evoked as many words was possible for specific categories during concentric actions of the squat on the chair (until 90° knee flexion) and seated unilateral knee extension exercises. Global cognitive function and physical performance were evaluated using the Mini-Mental State Examination (MMSE) and Short Physical Performance Battery (SPPB) tests, respectively. RESULTS After interventions, participants in the RT+COG and RT groups had significantly greater lower-limb muscle strength compared with the control group (CG). Those in the RT+COG group had greater tandem performance in comparison to RT and CG groups. CONCLUSIONS Our findings indicate that RT preserves lower-limb muscle strength in frail nursing home residents, regardless of performance of cognitive tasks. Better balance was exclusively observed in the RT+COG, whereas significant improvements in mobility status were only found in the RT group. The present investigation was based on a small sample of nursing home residents. Larger and more structured studies are necessary to confirm our results.
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Affiliation(s)
- Hélio José Coelho-Júnior
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | | | - Marco Carlos Uchida
- Applied Kinesiology Laboratory-AKL, School of Physical Education, University of Campinas, Campinas, SP 13083-851, Brazil
| | - Emanuele Marzetti
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, 00168, Italy; Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, 00168, Italy.
| | - Samuel da Silva Aguiar
- Federal University of Mato Grosso, Mato Grosso, Brazil; University Centre UDF, Faculty of Physical Education, Brasília, Brazil.
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Caldiroli L, De Mauri A, Sabatino A. Editorial: Personalized nutrition in chronic kidney disease. Front Nutr 2024; 11:1422149. [PMID: 38873564 PMCID: PMC11173966 DOI: 10.3389/fnut.2024.1422149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Lara Caldiroli
- Department of Nephrology, Dialysis and Kidney Transplants, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Andreana De Mauri
- Nephrology and Dialysis Unit, Maggiore della Carità University Hospital, Novara, Italy
| | - Alice Sabatino
- Division of Renal Medicine, Baxter Novum, Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
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de Nóbrega T, da Silva M, Rampani E, Curi R, Bazotte R. Tolerability of glutamine supplementation in older adults: a double-blind placebo-controlled randomized clinical trial. Braz J Med Biol Res 2024; 57:e13468. [PMID: 38808890 PMCID: PMC11136481 DOI: 10.1590/1414-431x2024e13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/16/2024] [Indexed: 05/30/2024] Open
Abstract
In this double-blind placebo-controlled randomized investigation, we assessed the tolerability of glutamine in older adults recruited from three daycare centers. The relevance of studying glutamine supplementation in elderly patients lies in its potential to provide a well-tolerated intervention. Glutamine, a crucial amino acid, plays a vital role in various physiological processes, including immune function and protein synthesis. Understanding its impact on older adults is essential, given the potential implications for their health and well-being. Participants received a daily dose of 12.4 g of oral effervescent glutamine (EGln group) or maltodextrin (placebo group) for 60 days. Fifteen patients from each group completed the study. The mean ages were 77.0±9.1 and 79.0±6.9 years for the EGln and placebo groups, respectively. We evaluated body mass index, aminogram, hemogram, plasma levels of glucose, prealbumin, albumin, urea, creatinine, uric acid, C-reactive protein, vitamin D, calcium, sodium, potassium, and the plasma activities of aspartate aminotransferase and alanine aminotransferase. Notably, we quantified a broad array of inflammatory markers and growth factors providing a holistic understanding of the potential effects of glutamine supplementation. The results demonstrated that oral glutamine did not induce significant changes in any evaluated parameters, and no adverse effects were reported. This finding suggested that the dosage of glutamine used in this study was well-tolerated and safe. This information contributes to the broader understanding of glutamine supplementation, emphasizing its safety and supporting its potential as a viable intervention for maintaining health in aging individuals.
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Affiliation(s)
- T.C.M. de Nóbrega
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, SP, Brasil
| | - M.A.R.C.P. da Silva
- Departamento de Farmacologia e Terapêutica, Universidade Estadual de Maringá, Maringá, PR, Brasil
| | - E.M. Rampani
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Maringá, Maringá, PR, Brasil
| | - R. Curi
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, SP, Brasil
- Seção de Produção de Imunobiológicos, Centro Bioindustrial, Instituto Butantan, São Paulo, SP, Brasil
| | - R.B. Bazotte
- Programa de Pós-graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, SP, Brasil
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Maringá, Maringá, PR, Brasil
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Hou D, Sun Y, Liu Z, Sun H, Li Y, Wang R. A longitudinal study of factors associated with cognitive frailty in middle-aged and elderly population based on the health ecology model. J Affect Disord 2024; 352:410-418. [PMID: 38367710 DOI: 10.1016/j.jad.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Cognitive frailty (CF) is an important geriatric syndrome and is reversible. It is crucial to develop preventive interventions for CF. We aimed to explore the associations between CF and its associated factors in Chinese aged 45 years and above. METHODS Based on the available data of 3 waves in China Health and Retirement Longitudinal Study from 2011 to 2015, 16,071 individuals aged 45 years and above from 3 waves were included. Based on the health ecology model, the associated factors were classified as downstream, midstream and upstream factors. Generalized hierarchical linear model including time level, individual level, and province level was applied to analyze the associations between factors and CF. RESULTS Multilevel factors have different effects on physical and cognitive function. In the downstream, old age, female, underweight, chronic diseases, and depression were risk factors of reversible CF and potentially reversible CF, and overweight was their protective factor. In the midstream, short or long night sleep duration was their risk factor, and > 30 and ≤ 60 min afternoon naps, alcohol drinking, and participation in social activities were their protective factors. In the upstream, living in rural areas was their risk factor, and high educational level, household consumption and GDP per capita were their protective factors. CONCLUSIONS Physical function and cognitive function are affected differently by multiple factors. The occurrence and development of physical frailty and cognitive impairment may have some common mechanisms. CF can be influenced by multilevel factors, and multilevel and comprehensive management of CF should be achieved. KEY POINTS Cognitive frailty was correlated with multilevel factors, including downstream, midstream, and upstream factors. It is crucial to focus on individual interventions such as physiological factors, psychological factors and health behaviors, especially the elderly, women and those with depression. Socioeconomic status was associated with the lower prevalence of cognitive frailty.
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Affiliation(s)
- Dingchun Hou
- School of Nursing, Peking University, Beijing 100191, China
| | - Yumei Sun
- School of Nursing, Peking University, Beijing 100191, China
| | - Zhike Liu
- School of Public Health, Peking University, Beijing 100191, China
| | - Hongyu Sun
- School of Nursing, Peking University, Beijing 100191, China.
| | - Yi Li
- School of Public Health, Peking University, Beijing 100191, China.
| | - Rui Wang
- School of Nursing, Peking University, Beijing 100191, China
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Tanimura C, Oba K, Noguchi Y, Itamochi T. A Concept Analysis of Self-Management of Physical Frailty. Yonago Acta Med 2024; 67:80-92. [PMID: 38803587 PMCID: PMC11128080 DOI: 10.33160/yam.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/09/2024] [Indexed: 05/29/2024]
Abstract
This review aimed to clarify the concept of self-management in the context of physical frailty and to provide insights that support the development of interventions to prevent physical frailty. A concept analysis using thirty-three studies was performed, six attributes of the concept "self-management of physical frailty" were identified: {Cooperating with healthcare professionals or familiar persons}, {Investing and managing in resources}, {Acquisition and maintenance of individualized self-management strategies}, {Self-directed process}, {Goal setting and personalized action planning} and {Living with one's own health condition with a positive attitude}. Self-management of physical frailty can be defined as a process in which an individual independently sets goals and action plans, engages in strategies such as exercise and nutritional management, and lives with one's own health condition with a positive attitude by collaborating with healthcare professionals and others, in addition to utilizing resources. To support the process in which an individual independently sets goals and action plans, engages in strategies, self-management support based on learning theories that lead to cognitive, emotional, and behavioral changes is necessary.
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Affiliation(s)
- Chika Tanimura
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Keiko Oba
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Yoshimi Noguchi
- School of Health Science, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Tomoyuki Itamochi
- Department of Nursing Science, Faculty of Nursing and Nutrition, The University of Shimane, Izumo 693-8550, Japan
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Russell ML, Justice A. Human Immunodeficiency Virus in Older Adults. Clin Geriatr Med 2024; 40:285-298. [PMID: 38521599 DOI: 10.1016/j.cger.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
As people with HIV live longer, they can experience increased incidence and earlier onset of chronic conditions and geriatric syndromes. Older people are also at substantially increased risk of delayed diagnosis and treatment for HIV. Increasing provider awareness of this is pivotal in ensuring adequate consideration of HIV testing and earlier screening for chronic conditions. In addition, evaluating patients for common geriatric syndromes such as polypharmacy, frailty, falls, and cognitive impairment should be contextualized based on how they present.
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Affiliation(s)
- Matthew L Russell
- Harvard University, Massachusetts General Hospital, 55 Fruit Street, Yawkey 2C, Boston, MA 02114, USA.
| | - Amy Justice
- Department of General Internal Medicine, Yale School of Medicine, Yale University, 950 Campbell Avenue, West Haven, CT 06516, USA
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Appukkuttan S, Ko G, Fu C, Bannister B, Kong SX, Jhaveri J, Freedland SJ. Drug-drug interaction potential among patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) treated with novel androgen receptor inhibitors. Expert Rev Anticancer Ther 2024; 24:325-333. [PMID: 38469875 DOI: 10.1080/14737140.2024.2328778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Nonmetastatic castration-resistant prostate cancer (nmCRPC) patients are often older and use concurrent medications that increase the potential for drug-drug interactions (pDDIs). This study assessed pDDI prevalence in real-world nmCRPC patients treated with apalutamide, darolutamide, or enzalutamide. RESEARCH DESIGN AND METHODS Castrated prostate cancer patients without metastases prior to androgen receptor inhibitor initiation were identified retrospectively via Optum Clinformatics Data Mart claims data (8/2019-3/2021). The top 100 concomitant medications were assessed for pDDIs. RESULTS Among 1,515 patients (mean age: 77 ± 8 years; mean Charlson Comorbidity Index: 3 ± 3), 340 initiated apalutamide, 112 darolutamide, and 1,063 enzalutamide. Common concomitant medication classes were cardiovascular (80%) and central nervous system (52%). Two-thirds of the patients received ≥5 concomitant medications; 30 (30/100 medications) pDDIs were identified for apalutamide and enzalutamide each and 2 (2/100 medications) for darolutamide. Most pDDIs had risk ratings of C or D, but four for apalutamide were rated X. Approximately 58% of the patients on apalutamide, 5% on darolutamide, and 54% on enzalutamide had ≥1 identified pDDI. CONCLUSIONS Results showed a higher frequency of pDDIs in patients receiving apalutamide and enzalutamide vs darolutamide. The impact of these could not be determined retrospectively. DDI risk should be carefully evaluated when discussing optimal therapy for patients with nmCRPC.
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Affiliation(s)
| | - Gilbert Ko
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Chunmay Fu
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | | | - Sheldon X Kong
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Jay Jhaveri
- Data Generation and Observational Studies, Bayer Healthcare, Whippany, NJ, USA
| | - Stephen J Freedland
- Center for Integrated Research in Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
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Zhu Y, Huang C, Zheng L, Li Q, Ge J, Geng S, Zhai M, Chen X, Yuan H, Li Y, Jia W, Sun K, Li Y, Ye T, Zhao Z, Liu H, Liu Z, Jiang H. Safety and efficacy of umbilical cord tissue-derived mesenchymal stem cells in the treatment of patients with aging frailty: a phase I/II randomized, double-blind, placebo-controlled study. Stem Cell Res Ther 2024; 15:122. [PMID: 38679727 PMCID: PMC11057094 DOI: 10.1186/s13287-024-03707-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/24/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Mesenchymal stem cells (MSCs) hold a great promise for cell-based therapy in the field of regenerative medicine. In this study, we aimed to evaluate the safety and efficacy of intravenous infusion of human umbilical cord-derived MSCs (HUC-MSCs) in patients with aging frailty. METHODS In this randomized, double-blind, placebo-controlled trial, participants diagnosed with aging frailty were randomly assigned to receive intravenous administrations of HUC-MSCs or placebo. All of serious adverse events and AEs were monitored to evaluate the safety of treatment during the 6-month follow-up. The primary efficacy endpoint was alteration of physical component scores (PCS) of SF-36 qualities of life at 6 months. The secondary outcomes including physical performance tests and pro-inflammatory cytokines, were also observed and compared at each follow-up visits. All evaluations were performed at 1 week, 1, 2, 3 and 6 months following the first intravenous infusion of HUC-MSCs. RESULTS In the MSCs group, significant improvements in PCS of SF-36 were observed from first post-treatment visit and sustained throughout the follow-up period, with greater changes compared to the placebo group (p = 0.042). EQ-VAS scores of MSCs group improved significantly at 2 month (p = 0.023) and continued until the end of the 6-month visit (p = 0.002) in comparison to the placebo group. The timed up and go (TUG) physical performance test revealed significant group difference and showed continual enhancements over 6 months (p < 0.05). MSC transplantation improved the function of 4-m walking test (4MWT) compared with the placebo group with a decrease of 2.05 s at 6 months of follow-up (p = 0.21). The measurement of grip strength revealed group difference with MSCs group demonstrating better performance, particularly at 6 months (p = 0.002). Inflammatory cytokines (TNF-α, IL-17) exhibited declines in MSCs group at 6 months compared to the placebo group (p = 0.034 and 0.033, respectively). There was no difference of incidence of AEs between the two groups. CONCLUSION Intravenous transplantation of HUC-MSCs is a safe and effective therapeutic approach on aging frailty. The positive outcomes observed in improving quality of life, physical performance, and reducing chronic inflammation, suggest that HUC-MSC therapy may be a promising potential treatment option for aging frailty. TRIAL REGISTRATION Clinicaltrial.gov; NCT04314011; https://clinicaltrials.gov/ct2/show/NCT04314011 .
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Affiliation(s)
- Yingqian Zhu
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Ce Huang
- Institute for Regenerative Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai Municipality, 200032, China
| | - Liang Zheng
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Qingqing Li
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Jianli Ge
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - ShaSha Geng
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Miaomiao Zhai
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Xin Chen
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Huixiao Yuan
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Yang Li
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Wenwen Jia
- Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, 200120, China
| | - Keping Sun
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Yan Li
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Tong Ye
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Zhengmei Zhao
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Hailiang Liu
- Institute for Regenerative Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
| | - Zhongmin Liu
- Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, 200120, China.
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
- Translational Medical Center for Stem Cell Therapy, Shanghai East Hospital, Tongji University, Shanghai, 200120, China.
| | - Hua Jiang
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
- Department of General Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
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Kwok VKY, Reid N, Hubbard RE, Thavarajah H, Gordon EH. Multicomponent perioperative interventions to improve outcomes for frail patients: a systematic review. BMC Geriatr 2024; 24:376. [PMID: 38671345 PMCID: PMC11055226 DOI: 10.1186/s12877-024-04985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Preoperative frailty is associated with increased risk of adverse outcomes. In 2017, McIsaac and colleagues' systematic review found that few interventions improved outcomes in this population and evidence was low-quality. We aimed to systematically review the evidence for multicomponent perioperative interventions in frail patients that has emerged since McIsaac et al.'s review. METHODS PUBMED, EMBASE, Cochrane, and CINAHL databases were searched for English-language studies published since January 1, 2016, that evaluated multicomponent perioperative interventions in patients identified as frail. Quality was assessed using the National Institute of Health Quality Assessment Tool. A narrative synthesis of the extracted data was conducted. RESULTS Of 2835 articles screened, five studies were included, all of which were conducted in elective oncologic gastrointestinal surgical populations. Four hundred and thirteen patients were included across the five studies and the mean/median age ranged from 70.1 to 87.0 years. Multicomponent interventions were all applied in the preoperative period. Two studies also applied interventions postoperatively. All interventions addressed exercise and nutritional domains with variability in timing, delivery, and adherence. Multicomponent interventions were associated with reduced postoperative complications, functional deterioration, length of stay, and mortality. Four studies reported on patient-centred outcomes. The quality of evidence was fair. CONCLUSIONS This systematic review provides evidence that frail surgical patients undergoing elective oncologic gastrointestinal surgery may benefit from targeted multicomponent perioperative interventions. Yet methodological issues and substantial heterogeneity of the interventions precludes drawing clear conclusions regarding the optimal model of care. Larger, low risk of bias studies are needed to evaluate optimal intervention delivery, effectiveness in other populations, implementation in health care settings and ascertain outcomes of importance for frail patients and their carers.
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Affiliation(s)
- Vivian Ka-Yan Kwok
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia.
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
| | - Natasha Reid
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Ruth E Hubbard
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Emily H Gordon
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Dong S, Zeng Q, He W, Cheng W, Zhang L, Zhong R, He W, Fang X, Wei H. Effect of Lactobacillus plantarum BFS1243 on a female frailty model induced by fecal microbiota transplantation in germ-free mice. Food Funct 2024; 15:3993-4009. [PMID: 38516869 DOI: 10.1039/d3fo05282f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Frailty, a complex geriatric syndrome, significantly impedes the goal of achieving 'healthy aging'. Increasing evidence suggests a connection between gut microbiota, systemic inflammation, and disease. However, it remains to be determined whether interventions targeting the intestinal flora can effectively ameliorate frailty. Our research involved fecal microbiota transplantation (FMT) experiments on germ-free (GF) mice, dividing these mice into three groups: a group receiving transplants from healthy elderly individuals (HF group), a group of frailty patients (FF group), and the FF group supplemented with Lactobacillus plantarum BFS1243 (FFL group). Our findings indicated a significant shift in the gut microbiota of the FF group, in contrast to the HF group, characterized by decreased Akkermansia and increased Enterocloster, Parabacteroides, and Eisenbergiella. Concurrently, there was a reduction in amino acids and SCFAs, with BFS1243 partially mitigating these changes. The FF group exhibited an upregulation of inflammatory markers, including PGE2, CRP, and TNF-α, and a downregulation of irisin, all of which were moderated by BFS1243 treatment. Furthermore, BFS1243 improved intestinal barrier integrity and physical endurance in the FF mice. Correlation analysis revealed a negative association between SCFA-producing species and metabolites like lysine and butyric acid with pro-inflammatory factors. In conclusion, our study conclusively demonstrated that alterations in the gut microbiota of elderly individuals can lead to physical frailty, likely due to detrimental effects on the intestinal barrier and a pro-inflammatory state. These findings underscore the potential of gut microbiome modulation as a clinical strategy for treating frailty.
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Affiliation(s)
- Sashuang Dong
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
- College of Food Science, South China Agricultural University, Guangzhou, Guangdong, 510630, P. R. China.
- Guangdong Provincial Key Laboratory of Utilization and Conservation of Food and Medicinal Resources in Northern Region, Shaoguan University, Shaoguan, 512000, P. R. China
| | - Qi Zeng
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
| | - Weimin He
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
- College of Food Science, South China Agricultural University, Guangzhou, Guangdong, 510630, P. R. China.
| | - Wei Cheng
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
| | - Ling Zhang
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
| | - Ruimin Zhong
- Guangdong Provincial Key Laboratory of Utilization and Conservation of Food and Medicinal Resources in Northern Region, Shaoguan University, Shaoguan, 512000, P. R. China
| | - Wen He
- Department of Geriatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
| | - Xiang Fang
- College of Food Science, South China Agricultural University, Guangzhou, Guangdong, 510630, P. R. China.
| | - Hong Wei
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510030, P. R. China.
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Silva SLAD, Brito GEGD, Ygnatios NTM, Mambrini JVDM, Lima-Costa MF, Torres JL. [Differences between men and women in the prevalence of frailty and associated factors among older adults: evidence from ELSI-Brazil]. CAD SAUDE PUBLICA 2024; 40:e00144923. [PMID: 38656069 PMCID: PMC11034629 DOI: 10.1590/0102-311xpt144923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 04/26/2024] Open
Abstract
Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.
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Affiliation(s)
| | | | - Nair Tavares Milhem Ygnatios
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Maria Fernanda Lima-Costa
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Programa de Pós-graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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