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Aprahamian I, Coats AJ, Morley JE, Klompenhouwer T, Anker SD. Anorexia of aging: An international assessment of healthcare providers' knowledge and practice gaps. J Cachexia Sarcopenia Muscle 2023; 14:2779-2792. [PMID: 37897129 PMCID: PMC10751437 DOI: 10.1002/jcsm.13355] [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: 05/30/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Anorexia of aging is a common geriatric syndrome that includes loss of appetite and/or reduced food intake, with associated undernutrition, unintended weight loss, sarcopenia, functional decline, loss of independence and other adverse health outcomes. Anorexia of aging can have multiple and severe consequences and is often overlooked by healthcare professionals (HCPs). Even more concerningly, clinicians commonly accept anorexia of aging as an inevitable part of 'normal' aging. The aim of this assessment was to identify current gaps in professional knowledge and practice in identifying and managing older persons with anorexia. Results may guide educational programmes to fill the gaps identified and therefore improve patient outcomes. METHODS This international assessment was conducted using a mixed-methods approach, including focus group interviews with subject matter experts and an electronic survey of practicing HCPs. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations. RESULTS A quantitative survey of 26 multiple-choice questions was completed by physicians, dietitians and other HCPs (n = 1545). Most HCPs (56.8%) recognize a consistent definition of anorexia of aging as a loss of appetite and/or low food intake. Cognitive changes/dementia (91%) and dysphagia (87%) are seen as the biggest risk factors. Most respondents were confident to give nutritional (62%) and physical activity (59.4%) recommendations and engaged caregivers such as family members in supporting older adults with anorexia (80.6%). Most clinicians assessed appetite at each visit (66.7%), although weight is not measured at every visit (41.5%). Apart from the Mini-Nutritional Assessment Short Form (39%), other tools to screen for appetite loss are not frequently used or no tools are used at all (29.4%). A high number of respondents (38.7%) believe that anorexia is a normal part of aging. Results show that treatment is focused on swallowing disorders (78%), dentition issues (76%) and increasing oral intake (fortified foods [75%] and oral nutritional supplements [74%]). Nevertheless, the lack of high-quality evidence is perceived as a barrier to optimal treatment (49.2%). CONCLUSIONS Findings from this international assessment highlight the challenges in the care of older adults with or at risk for anorexia of aging. Identifying professional practice gaps between individual HCPs and team-based gaps can provide a basis for healthcare education that is addressed at root causes, targeted to specific audiences and developed to improve individual and team practices that contribute to improving patient outcomes.
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Affiliation(s)
- Ivan Aprahamian
- Division of Geriatrics, Department of Internal MedicineJundiaí Medical SchoolJundiaíBrazil
| | | | - John E. Morley
- Division of Geriatrics, Department of MedicineSaint Louis UniversitySt. LouisMissouriUSA
| | | | - Stefan D. Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT)German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité UniversitätsmedizinBerlinGermany
- Institute of Heart DiseasesWroclaw Medical UniversityWroclawPoland
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de Oliveira VP, Ferriolli E, Lourenço RA, González-Bautista E, de Souto Barreto P, de Mello RGB. The sensitivity and specificity of the WHO's ICOPE screening tool, and the prevalence of loss of intrinsic capacity in older adults: A scoping review. Maturitas 2023; 177:107818. [PMID: 37542782 DOI: 10.1016/j.maturitas.2023.107818] [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: 02/14/2023] [Revised: 05/26/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND The World Health Organization has developed the Integrated Care for Older People (ICOPE) program, a public health strategy to maintain older adults' functional abilities and promote healthier aging. The approach comprises a 5-step pathway. Step 1 is the screening for impairment in functions, and Step 2 is an in-depth evaluation to confirm the presence and severity of functional impairment. These initial two steps are crucial to determine the subsequent plan of care (Step 3) and follow-up (Step 4). The fifth step encompasses actions to support families and caregivers and to engage communities. This review gathers data from the literature on the prevalence of positive screenings regarding intrinsic capacity detected by the program's first-step screening tool, and on currently available results regarding the instrument's sensitivity and specificity. METHODS AND FINDINGS Electronic searches were conducted in the PubMed, Cochrane, Embase, and SciElo databases, the medRxiv platform, and recent human aging scientific events, looking for research analyzing the ICOPE screening instrument. Studies reporting data on the prevalence of positive screenings for loss of intrinsic capacity using the proposed screening tool and/or findings on the instrument's sensitivity and specificity were included. A total of 7 publications with participants aged 50 years or more were selected. The prevalence of at least one impairment in intrinsic capacity detected by the instrument varied among the studies from 17.1 % to 94.3 %. Sensitivity ranged from 26.4 % to 100 % and specificity from 22 % to 96 %, depending on the setting and the assessed domain. CONCLUSION Currently available data are heterogeneous, and different results were found among the studies due to diverse settings and methodologies. The evidence on the ICOPE screening tool's performance in different populations is still scarce and reinforces the need for further research worldwide.
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Affiliation(s)
- Vitor Pelegrim de Oliveira
- Geriatric Unit - Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 5° andar, sala C 5006, Bloco C, Porto Alegre, RS CEP 90035-903, Brazil; Post Graduation Program in Medical Sciences: Endocrinology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, RS CEP 90035-000, Brazil; Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France.
| | - Eduardo Ferriolli
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Enéas de Carvalho Aguiar, 155, 8° andar, Bloco 8A, Setor Azul, São Paulo, SP CEP 05003-900, Brazil.
| | - Roberto Alves Lourenço
- Faculty of Health Sciences, Internal Medicine Department, Human Aging Research Laboratory, Universidade do Estado do Rio de Janeiro, Av. Mal. Rondon, 381, Rio de Janeiro, RJ CEP 20950-003, Brazil.
| | - Emmanuel González-Bautista
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalier-Universitaire de Toulouse, 37 Allés Jules Guesdes, Toulouse, CP 31000, France
| | - Renato Gorga Bandeira de Mello
- Geriatric Unit - Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 5° andar, sala C 5006, Bloco C, Porto Alegre, RS CEP 90035-903, Brazil; Post Graduation Program in Medical Sciences: Endocrinology, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, RS CEP 90035-000, Brazil.
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Lach HW, Berg-Weger M, Washington S, Malmstrom TK, Morley JE. Falls across Health Care Settings: Findings from a Geriatric Screening Program. J Appl Gerontol 2023; 42:67-75. [PMID: 36121797 DOI: 10.1177/07334648221124912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Falls are a major public health problem for older adults, resulting in injuries and mortality. Screening is recommended to identify the multifactorial fall risks that can be addressed with interventions to prevent future falls. This study examined the utility of using the Rapid Geriatric Assessment (RGA) tool to identify fall risks across multiple settings. RGA data was collected at primary care sites, hospitals, long-term care settings, and community events (n = 8686, 65% female, mean age 77.6). Multinomial logistic regression was used to determine predictors of falls using the RGA. The FRAIL, SARC-F, Rapid Cognitive Screen and SNAQ measures all significantly predicted history of falls. The RGA provides a brief screening that can be used in any setting by multiple providers to identify fall risk.
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Affiliation(s)
- Helen W Lach
- Trudy Busch Valentine School of Nursing40272 Saint Louis University, Saint Louis, MO, USA
| | - Marla Berg-Weger
- School of Social Work, 40272Saint Louis University, Saint Louis, MO, USA
| | - Selena Washington
- Doisy College of Health Sciences, of Occupational Science and Occupational Therapy, 40272Saint Louis University, Saint Louis, MO, USA
| | | | - John E Morley
- School of Medicine, 40272Saint Louis University, Saint Louis, MO, USA
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Frailty inclusive care in acute and community-based settings: a systematic review protocol. Syst Rev 2021; 10:83. [PMID: 33771224 PMCID: PMC8004471 DOI: 10.1186/s13643-021-01638-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/12/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Frailty is a known risk factor for an array of adverse outcomes including more frequent and prolonged health services use and high health care costs. Aging of the population has implications for care provision across the care continuum, particularly for people living with frailty. Despite known risks associated with frailty, there has been limited research on care pathways that address the needs of persons living with frailty. Our study aims to review and examine, in a rigorous way, the quality of evidence for multi-component interventions and care pathways focused on frailty. METHODS A comprehensive electronic search strategy will be used to identify studies that evaluate multi-component interventions or care pathways for persons living with frailty. The search strategy will include terms for frailty, multi-component interventions, effectiveness, and cost effectiveness applied to the following databases: MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews. An adapted search for Google Scholar and gray literature databases will also be used. References of included studies will be hand-searched for additional citations of frailty-inclusive care. Known experts and corresponding authors of identified articles will be contacted by email to identify further eligible studies. Risk of bias will be assessed using the Effective Public Health Practice Project Quality Assessment tool. Data will be extracted from eligible studies and it is anticipated that narrative analysis will be used. If studies with sufficient homogeneity are found, then pooled effects will be reported using meta-analysis. DISCUSSION This review will appraise the evidence currently available on multi-component frailty interventions. Results will inform on clinical pathway development for people living with frailty across the care continuum and will guide future research to address gaps in the literature and areas in need of further development. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020166733.
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Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, De Souto Barreto P, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won Won C, Woo J, Vellas B. Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2021; 24:920-927. [PMID: 33155616 PMCID: PMC7568453 DOI: 10.1007/s12603-020-1492-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J G Ruiz
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
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Alex D, Fauzi AB, Mohan D. Online Multi-Domain Geriatric Health Screening in Urban Community Dwelling Older Malaysians: A Pilot Study. Front Public Health 2021; 8:612154. [PMID: 33520920 PMCID: PMC7841455 DOI: 10.3389/fpubh.2020.612154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: With a rapidly aging population, the Malaysian health care system needs to develop solutions to address the lack of resources that are required for the assessment of the older person. The complex nature of geriatric syndromes coupled with the occurrence of multiple comorbid illnesses with aging, make geriatric assessment a resource intensive process. Digital health solutions could play an important role in supporting existing health care systems, especially in low and middle income countries, with limited speciality services in geriatrics. Objective: This is a pilot study aimed at screening for geriatric syndromes through self-administered online surveys in urban community dwelling older Malaysians and assessing the pattern of geriatric syndromes in relation to the frailty status of the study participants. Methods: This is a cross-sectional pilot study conducted between July-September 2020. Community dwelling adults aged 60 years and over were invited to take part in an online survey. Information on sociodemographic variables, comorbidities, and the self-reported results of geriatric syndromes (frailty, sarcopenia, anorexia of aging, urinary incontinence, falls, and cognitive impairment), were collected through the survey. Results: Data was collected for 162 participants over a period of 2 months. The mean (SD) age of the respondents was 66.42 (5.25) years with 64.9% females. Majority of the respondents were of Chinese ethnic origin (67.9%) and had tertiary level of education (75.9%). The average time taken by participants to complete the survey was 16.86 min. Urinary incontinence was the highest reported geriatric syndrome (55.1%) followed by falls (37.6%), anorexia of aging (32.8%), cognitive impairment (27.8%), and sarcopenia (8.3%). Frailty was detected in 4.5% of the study population. Loss of weight in the previous year was the highest reported component of the frailty assessment tool. The presence of sarcopenia, anorexia of aging, poor/fair self-rated health, urinary incontinence, and multimorbidity were significantly higher in older adults who were frail or prefrail. Conclusion: Screening for geriatric syndromes through online surveys is a feasible approach to identify older adults in the community who are likely to benefit from geriatric assessment. However, the demographic profile of the older population that are accessible through such digital platforms is limited.
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Affiliation(s)
- Deepa Alex
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Adhhani Binti Fauzi
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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Merchant RA, Morley JE. Editorial: Rapid Geriatric Assessment in Primary Care Practice. J Nutr Health Aging 2021; 25:1034-1036. [PMID: 34725656 DOI: 10.1007/s12603-021-1681-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Reshma A Merchant
- Dr. J. E. Morley, Dammert Professor of Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110 USA,
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Bahat Öztürk G, Kılıç C, Bozkurt ME, Karan MA. Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults. J Nutr Health Aging 2021; 25:433-439. [PMID: 33786559 DOI: 10.1007/s12603-020-1535-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We aimed to study the prevalence of fear of falling (FOF), and its association with physical performance, functionality, frailty, sarcopenia, and a variety of geriatric syndromes including cognitive impairment, depression, quality of life and hearing. DESIGN Retrospective, cross-sectional study. SETTING Community-dwelling older adults applied to the geriatric outpatient clinic of a university hospital. PARTICIPANTS A total of 1021community-dwelling older adults >= 60 years of age applying to the geriatric outpatient clinic of a university hospital. MEASUREMENTS We screened for falls and FOF by single close-ended questions. We performed screening and assessment of probable sarcopenia by SARC-F test and handgrip strength evaluation according to EWGSOP2. We used timed up and go test (TUG), usual gait speed (UGS) for physical performance, and Katz- activities of daily living (ADL) and Lawton-Brody instrumental activities of daily living (IADL) for functional evaluation. We screened anxiety with the Generalized Anxiety Disorder-7 scale. RESULTS The prevalence of FOF was 44.6% and falls, 37.7%. Prevalence of FOF in sarcopenia screening positive participants was 30.1%; in probable sarcopenic (35/20 kg) participants, 43.9%; in those with undernutrition, 45.7%; in fallers, 51.1%; in females, 80.4%; and in prefrail/frail was 74.7% Multivariate regression analyses revealed that female sex (OR=4.1, 95%CI= 2.0-8.4, p<0.001), anxiety (OR=2.7, 95%CI= 1.1-6.5, p=0.03) and ADL limitation (OR=2.5, 95%CI= 1.03-6.3, p=0.04) were independent associates of FOF. CONCLUSION FOF accompanied by fall experience or not is prevalent in community-dwelling older adults. It is associated with anxiety and ADL limitations apart from the female sex.
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Affiliation(s)
- G Bahat Öztürk
- Prof.Dr. Gülistan Bahat Öztürk, Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University Capa, Istanbul, Turkey, , +90532 796 9748
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Lundy J, Hayden D, Pyland S, Berg-Weger M, Malmstrom TK, Morley JE. An Age-Friendly Health System. J Am Geriatr Soc 2020; 69:806-812. [PMID: 33275785 DOI: 10.1111/jgs.16959] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/07/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES To describe a screening and intervention program for geriatric syndromes instituted at a rural healthcare system that utilizes the 4Ms of an age-friendly health system, and to provide exercise and cognitive stimulation therapy (CST) as part of an age-friendly health program. DESIGN Retrospective evaluation of clinical data. SETTING Rural primary healthcare system. PARTICIPANTS Older adults aged 65 years and older in Perry County, Missouri. MEASUREMENTS Screening for geriatric syndromes was done using the Rapid Geriatric Assessment (RGA), which includes the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS). Outcomes for exercise and CST included the Five Times Sit to Stand (FTSS) and Timed Up and Go (TUG) tests, Cornell Scale for Depression in Dementia (CSDD), Saint Louis University Mental Status Examination (SLUMS), and Quality of Life in Alzheimer's Disease (QoL-AD) measures. RESULTS The RGA was administered to 1,326 individuals of which 36.5% were frail, 42.1% were sarcopenic, 26.1% were at risk for anorexia, and 20.8% had dementia. Of these receiving exercise therapy, both the FTSS and the TUG were improved at 3 months and 12 to 24 months. In the CST group, SLUMS, QoL-AD, and CSDD were improved at 7 weeks and 6 to 12 months. CONCLUSION It is feasible to introduce a screening program for geriatric syndromes and respond to the results with successful exercise and cognitive stimulation therapy programs.
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Affiliation(s)
- Janice Lundy
- Department of Social Work and Geriatric Care Management, Perry County Memorial Hospital, Perryville, Missouri, USA
| | - Deborah Hayden
- Department of Occupational Therapy, Perry County Memorial Hospital, Perryville, MO, USA
| | - Stephanie Pyland
- Department of Social Work and Geriatric Care Management, Perry County Memorial Hospital, Perryville, Missouri, USA
| | - Marla Berg-Weger
- School of Social Work, Saint Louis University, St. Louis, Missouri, USA
| | - Theodore K Malmstrom
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - John E Morley
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Lau S, Pek K, Chew J, Lim JP, Ismail NH, Ding YY, Cesari M, Lim WS. The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults. Nutrients 2020; 12:nu12092885. [PMID: 32967354 PMCID: PMC7551805 DOI: 10.3390/nu12092885] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Malnutrition is an independent marker of adverse outcomes in older adults. While the Simplified Nutritional Appetite Questionnaire (SNAQ) for anorexia has been validated as a nutritional screening tool, its optimal cutoff and validity in healthy older adults is unclear. This study aims to determine the optimal cutoff for SNAQ in healthy community-dwelling older adults, and to examine its factor structure and validity. We studied 230 community-dwelling older adults (mean age 67.2 years) who were nonfrail (defined by Fatigue, Resistance, Ambulation, Illnesses & Loss (FRAIL) criteria). When compared against the risk of malnutrition using the Mini Nutritional Assessment (MNA), the optimal cutoff for SNAQ was ≤15 (area under receiver operating characteristic (ROC) curve: 0.706, sensitivity: 69.2%, specificity: 61.3%). Using exploratory factor analysis, we found a two-factor structure (Factor 1: Appetite Perception; Factor 2: Satiety and Intake) which accounted for 61.5% variance. SNAQ showed good convergent, discriminant and concurrent validity. In logistic regression adjusted for age, gender, education and MNA, SNAQ ≤15 was significantly associated with social frailty, unlike SNAQ ≤4 (odds ratio (OR) 1.99, p = 0.025 vs. OR 1.05, p = 0.890). Our study validates a higher cutoff of ≤15 to increase sensitivity of SNAQ for anorexia detection as a marker of malnutrition risk in healthy community-dwelling older adults, and explicates a novel two-factor structure which warrants further research.
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Affiliation(s)
- Sabrina Lau
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
- Correspondence: ; Tel.: +65-6359-6474
| | - Kalene Pek
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Justin Chew
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Jun Pei Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Noor Hafizah Ismail
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20122 Milan, Italy
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.C.); (J.P.L.); (Y.Y.D.); (W.S.L.)
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore; (K.P.); (N.H.I.)
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Nishida Y, Tanaka S, Nakae S, Yamada Y, Shirato H, Hirano H, Sasaki S, Katsukawa F. Energy Gap between Doubly Labeled Water-Based Energy Expenditure and Calculated Energy Intake from Recipes and Plate Waste, and Subsequent Weight Changes in Elderly Residents in Japanese Long-Term Care Facilities: CLEVER Study. Nutrients 2020; 12:nu12092677. [PMID: 32887378 PMCID: PMC7551170 DOI: 10.3390/nu12092677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/28/2022] Open
Abstract
Unintentional weight loss is a major frailty component; thus, assessing energy imbalance is essential for institutionalized elderly residents. This study examined prediction errors of the observed energy intake (OEI) against the actual energy intake obtained from the doubly labeled water (DLW) method and clarified the relationship between the energy gap obtained by subtracting total energy expenditure (TEE) from OEI and subsequent weight changes in elderly residents in long-term care facilities. Overall, 46 participants were recruited in Japan. TEE was measured using the DLW method, and OEI was calculated from recipes and plate waste simultaneously over a 14–15-day period at baseline. The total energy intake (TEIDLW) was determined on the basis of DLW and weight changes during the DLW period. The weight was longitudinally tracked monthly for 12 months in the 28 residents who still lived at the facilities. OEI was higher than TEIDLW by a mean of 232 kcal/day (15.3%) among 46 residents at baseline. The longitudinal data of 28 residents showed that the energy gap tended to be correlated with the slope of weight change (ρ = 0.337, p = 0.080) and the median value was significantly lower in the weight loss group (152 kcal/day) than in the weight gain group (350 kcal/day) (p < 0.05). In conclusion, weight loss could occur at Japanese long-term care facilities even if the difference obtained by subtracting TEE from OEI was positive because OEI was overestimated by more than 200 kcal/day.
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Affiliation(s)
- Yuki Nishida
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Sports Medicine Research Center, Keio University, Yokohama 223-8521, Japan;
| | - Shigeho Tanaka
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Faculty of Nutrition, Kagawa Nutrition University, Saitama 350-0288, Japan
- Correspondence: ; Tel.: +81-49-282-3722
| | - Satoshi Nakae
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Division of Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka 560-8531, Japan
| | - Yosuke Yamada
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan; (Y.N.); (S.N.); (Y.Y.)
- Institute for Active Health, Kyoto University of Advanced Science, Kyoto 615-8577, Japan
| | - Hiroyuki Shirato
- Silverpia-Kaga Long-Term Care Health Facility, Tokyo 173-0003, Japan;
| | - Hirohiko Hirano
- Dentistry and Oral Surgery, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan;
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Fuminori Katsukawa
- Sports Medicine Research Center, Keio University, Yokohama 223-8521, Japan;
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Merchant RA, Chen MZ, Wong BLL, Ng SE, Shirooka H, Lim JY, Sandrasageran S, Morley JE. Relationship Between Fear of Falling, Fear‐Related Activity Restriction, Frailty, and Sarcopenia. J Am Geriatr Soc 2020; 68:2602-2608. [DOI: 10.1111/jgs.16719] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine National University Hospital Singapore Singapore
- Department of Medicine Yong Loo Lin School of Medicine, National University of Singapore Singapore Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine National University Hospital Singapore Singapore
| | - Beatrix Ling Ling Wong
- Division of Geriatric Medicine, Department of Medicine National University Hospital Singapore Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine National University Hospital Singapore Singapore
| | - Hidehiko Shirooka
- Division of Geriatric Medicine, Department of Medicine National University Hospital Singapore Singapore
| | - Jia Yi Lim
- Department of Medicine Yong Loo Lin School of Medicine, National University of Singapore Singapore Singapore
| | - Surein Sandrasageran
- Division of Geriatric Medicine, Department of Medicine National University Hospital Singapore Singapore
| | - John E. Morley
- Division of Geriatric Medicine Saint Louis University School of Medicine St Louis Missouri USA
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Merchant RA, Hui RJY, Kwek SC, Sundram M, Tay A, Jayasundram J, Chen MZ, Ng SE, Tan LF, Morley JE. Rapid Geriatric Assessment Using Mobile App in Primary Care: Prevalence of Geriatric Syndromes and Review of Its Feasibility. Front Med (Lausanne) 2020; 7:261. [PMID: 32733901 PMCID: PMC7360669 DOI: 10.3389/fmed.2020.00261] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
With the aging population and consequent increase in associated prevalence of frailty, dementia, and multimorbidity, primary care physicians will be overwhelmed with the complexity of the psychosocial and clinical presentation. Geriatric syndromes including frailty, sarcopenia, cognitive impairment, and anorexia of aging (AA) either in isolation or in combination are associated with an increased risk of adverse outcomes and if recognized early, and appropriately managed, will lead to decreased disability. Primary care practices are often located in residential settings and are in an ideal position to incorporate preventive screening and geriatric assessment with personalized management. However, primary care physicians lack the time, multidisciplinary resources, or skills to conduct geriatric assessment, and the limited number of geriatricians worldwide further complicates the matter. There is no one effective strategy to implement geriatric assessment in primary care which is rapid, cost-effective, and do not require geriatricians. Rapid Geriatric Assessment (RGA) takes <5 min to complete. It screens for frailty, sarcopenia, AA, and cognition with assisted management pathway without the need of a geriatrician. We developed RGA iPad application for screening with assisted management in two primary care practices and explored the feasibility and overall prevalence of frailty, sarcopenia, and AA. The assessment was conducted by trained nurses and coordinators. Among 2,589 older patients ≥65 years old, the prevalence of frailty was 5.9%, pre-frail 31.2%, and robust 62.9%. Fatigue was present in 17.8%, and among them, the prevalence of undiagnosed depression as assessed by the Patient Health Questionnaire (PHQ)-9 was 76.4% and 13.5% of total. The prevalence of sarcopenia was 15.4%, and 13.9% experienced at least one fall in the past year. AA was prevalent in 10.9%. The time taken to do the assessment with defined algorithm was on average 5 min or less per patient, and 96% managed to complete the assessment prior to seeing their doctor in the same session. The RGA app is a rapid and feasible tool to be used by any healthcare professional in primary care for identification of geriatric syndrome with assisted management.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Richard Jor Yeong Hui
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Sing Cheer Kwek
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Meena Sundram
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Arthur Tay
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Jerome Jayasundram
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Li Feng Tan
- Healthy Ageing Program, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
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Sanford AM, Morley JE, Berg-Weger M, Lundy J, Little MO, Leonard K, Malmstrom TK. High prevalence of geriatric syndromes in older adults. PLoS One 2020; 15:e0233857. [PMID: 32502177 PMCID: PMC7274399 DOI: 10.1371/journal.pone.0233857] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The geriatric syndromes of frailty, sarcopenia, weight loss, and dementia are highly prevalent in elderly individuals across all care continuums. Despite their deleterious impact on quality of life, disability, and mortality in older adults, they are frequently under-recognized. At Saint Louis University, the Rapid Geriatric Assessment (RGA) was developed as a brief screening tool to identify these four geriatric syndromes. MATERIALS AND METHODS From 2015-2019, the RGA, comprised of the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS) tools and a question on Advance Directives, was administered to 11,344 individuals ≥ 65 years of age across Missouri in community, office-based, hospital, Programs of All-Inclusive Care for the Elderly (PACE), and nursing home care settings. Standard statistical methods were used to calculate the prevalence of frailty, sarcopenia, weight loss, and dementia across the sample. RESULTS Among the 11,344 individuals screened by the RGA, 41.0% and 30.4% met the screening criteria for pre-frailty and frailty respectively, 42.9% met the screening criteria for sarcopenia, 29.3% were anorectic and at risk for weight loss, and 28.1% screened positive for dementia. The prevalence of frailty, risk for weight loss, sarcopenia, and dementia increased with age and decreased when hospitalized patients and those in the PACE program or nursing home were excluded. CONCLUSIONS Using the RGA as a valid screening tool, the prevalence of one or more of the geriatric syndromes of frailty, sarcopenia, weight loss, and dementia in older adults across all care continuums is quite high. Management approaches exist for each of these syndromes that can improve outcomes. It is suggested that the brief RGA screening tool be administered to persons 65 and older yearly as part of the Medicare Annual Wellness Visit.
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Affiliation(s)
- Angela M. Sanford
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - John E. Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - Marla Berg-Weger
- School of Social Work, Saint Louis University, St. Louis, MO, United States of America
| | - Janice Lundy
- Department of Social Work and Geriatric Care Management, Perry County Memorial Hospital, Perryville, MO, United States of America
| | - Milta O. Little
- Division of Geriatric Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Kathleen Leonard
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - Theodore K. Malmstrom
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, United States of America
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16
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Gade J, Beck AM, Rønholt F, Andersen HE, Munk T, Vinther A. Validation of the Danish SARC-F in Hospitalized, Geriatric Medical Patients. J Nutr Health Aging 2020; 24:1120-1127. [PMID: 33244571 DOI: 10.1007/s12603-020-1453-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Validation of the Danish version of the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) for hospitalized geriatric medical patients, compared against the original EWGSOP (European Working Group on Sarcopenia in Older People) and revised EWGSOP2 definition for sarcopenia. Additionally, investigation of the ability of SARC-F to individually identify low strength/function and muscle mass. DESIGN Cross-sectional analysis of data from an RCT. SETTING Hospital, Medical Department. PARTICIPANTS 122 geriatric medical patients (65.6% women) ≥ 70 years of age with mixed medical conditions. MEASUREMENTS SARC-F screening, diagnostic assessment of sarcopenia (hand-grip strength, muscle mass measured by dual-frequency bio-impedance analysis, and 4-m usual gait speed). RESULTS The prevalence of risk of sarcopenia (SARC-F ≥ 4) was 48.3%, while it was diagnosed in 65.8% and 21.7%, with EWGSOP and EWGSOP2, respectively. The sensitivity, specificity, positive predictive value, negative predictive value according to EWGSOP were 50.0 %, 53.7 %, 67.2% and 36.1%, while they were 53.8 %, 53.2 %, 24.1% and 80.6%, according to EWGSOP2 (all participants). The ability of SARC-F to predict reduced strength, function, and muscle mass was modest. There was a significant negative linear, yet weak, relationship between total SARC-F score and hand-grip strength (R2=0.033) and 4-m gait speed (R2=0.111), but not muscle mass (R2=0.004). CONCLUSION SARC-F does not seem to be a suitable screening tool for identifying and excluding non-sarcopenic geriatric patients. Furthermore, the SARC-F score was more strongly correlated with reduced muscle strength and physical function than with low muscle mass.
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Affiliation(s)
- J Gade
- Anders Vinther, Dept. Physiotherapy and Occupational therapy, Borgmester Ib Juuls Vej 29, DK-2730 Herlev, Denmark, Phone: +45-26808710 and E-mail:
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17
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Warnier RMJ, van Rossum E, van Kuijk SMJ, Magdelijns F, Schols JMGA, Kempen GIJM. Frailty screening in hospitalised older adults: How does the brief Dutch National Safety Management Program perform compared to a more extensive approach? J Clin Nurs 2019; 29:1064-1073. [PMID: 31856316 DOI: 10.1111/jocn.15148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/23/2019] [Accepted: 10/20/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the predictive properties of the brief Dutch National Safety Management Program for the screening of frail hospitalised older patients (VMS) and to compare these with the more extensive Maastricht Frailty Screening Tool for Hospitalised Patients (MFST-HP). BACKGROUND Screening of older patients during admission may help to detect frailty and underlying geriatric conditions. The VMS screening assesses patients on four domains (i.e. functional decline, delirium risk, fall risk and nutrition). The 15-item MFST-HP assesses patients on three domains of frailty (physical, social and psychological). DESIGN Retrospective cohort study. METHODS Data of 2,573 hospitalised patients (70+) admitted in 2013 were included, and relative risks, sensitivity and specificity and area under the receiver operating characteristic (AUC) curve of the two tools were calculated for discharge destination, readmissions and mortality. The data were derived from the patients nursing files. A STARD checklist was completed. RESULTS Different proportions of frail patients were identified by means of both tools: 1,369 (53.2%) based on the VMS and 414 (16.1%) based on the MFST-HP. The specificity was low for the VMS, and the sensitivity was low for the MFST-HP. The overall AUC for the VMS varied from 0.50 to 0.76 and from 0.49 to 0.69 for the MFST-HP. CONCLUSION The predictive properties of the VMS and the more extended MFST-HP on the screening of frailty among older hospitalised patients are poor to moderate and not very promising. RELEVANCE TO CLINICAL PRACTICE The VMS labels a high proportion of older patients as potentially frail, while the MFST-HP labels over 80% as nonfrail. An extended tool did not increase the predictive ability of the VMS. However, information derived from the individual items of the screening tools may help nurses in daily practice to intervene on potential geriatric risks such as delirium risk or fall risk.
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Affiliation(s)
- Ron M J Warnier
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Geriatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Integrated Care, Elderly Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Erik van Rossum
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Sander M J van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Fabienne Magdelijns
- Department of Internal Medicine, Geriatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Morley JE, Vellas B. Patient-Centered (P4) Medicine and the Older Person. J Am Med Dir Assoc 2019; 18:455-459. [PMID: 28549701 DOI: 10.1016/j.jamda.2017.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Bruno Vellas
- Gérontopôle, CHU Toulouse University Hospital and INSERM U1027, Toulouse, France
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19
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Morley JE. Cognition and Chronic Disease. J Am Med Dir Assoc 2019; 18:369-371. [PMID: 28433119 DOI: 10.1016/j.jamda.2017.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 02/07/2023]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
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20
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Tay LBG, Chua MPW, Tay EL, Chan HN, Mah SM, Latib A, Wong CQY, Ng YS. Multidomain Geriatric Screen and Physical Fitness Assessment Identify Prefrailty/Frailty and Potentially Modifiable Risk Factors in Community-Dwelling Older Adults. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2019. [DOI: 10.47102/annals-acadmedsg.v48n6p171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Frailty begins in middle life and manifests as a decline in functional fitness. We described a model for community frailty screening and factors associated with prefrailty and frailty and fitness measures to distinguish prefrail/frail from robust older adults. We also compared the Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) scale against Fried frailty phenotype and Frailty Index (FI). Materials and Methods: Community-dwelling adults >55 years old were designated robust, prefrail or frail using FRAIL. The multidomain geriatric screen included social profiling and cognitive, psychological and nutritional assessments. Physical fitness assessments included flexibility, grip strength, upper limb dexterity, lower body strength and power, tandem and dynamic balance and cardiorespiratory endurance. Results: In 135 subjects, 99 (73.3%) were robust, 34 (25.2%) were prefrail and 2 (1.5%) were frail. After adjusting for age and sex, depression (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.05-7.90; P = 0.040) and malnutrition (OR, 6.07; 95% CI, 2.52-14.64; P<0.001) were independently associated with prefrailty/frailty. Prefrail/frail participants had significantly poorer performance in upper limb dexterity (P = 0.030), lower limb power (P = 0.003), tandem and dynamic balance (P = 0.031) and endurance (P = 0.006). Except for balance and flexibility, all fitness measures differentiated prefrail/frail from robust women. In men, only lower body strength was significantly associated with frailty. Area under receiver operating characteristic curves for FRAIL against FI and Fried were 0.808 (0.688-0.927, P <0.001) and 0.645 (0.546-0.744, P = 0.005), respectively. Conclusion: Mood and nutrition are targets in frailty prevention. Physical fitness declines early in frailty and manifests differentially in both genders.
Key words: Elderly, Frail, Function
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Affiliation(s)
| | | | | | | | | | - Aisyah Latib
- Health Services Research and Evaluation, SingHealth, Singapore
| | - Cheryl QY Wong
- Health Services Research and Evaluation, SingHealth, Singapore
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Abstract
The anorexia of aging affects approximately a quarter of older people and is a major contributor to the development of under-nutrition and many other adverse health outcomes in older people. Despite the high prevalence, the anorexia of aging is frequently overlooked by clinicians and, of even more concern, it is commonly accepted as inevitable and a part of 'normal' aging. Early identification of risk coupled with efforts to mitigate these risks through appropriate interventions might stem the deleterious consequences of the anorexia of aging. This review aims to provide an update on the current knowledge base whilst making some practical suggestions that may be of use in clinical practice. Interventions such as exercise and good nutrition remain the preferred treatment while pharmacological options, whilst they continue to be trialed, are not currently recommended for routine clinical use.
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Affiliation(s)
- A D Jadczak
- Agathe Daria Jadczak, University of Adelaide, South Australia, Australia,
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22
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Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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23
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Affiliation(s)
- John E. Morley
- Division of Geriatric MedicineSaint Louis University School of MedicineSt. LouisUSA
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24
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Rogerson A, Stacey S. Successful Ageing in Singapore. Geriatrics (Basel) 2018; 3:E81. [PMID: 31011116 PMCID: PMC6371086 DOI: 10.3390/geriatrics3040081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 11/16/2022] Open
Abstract
Singapore has experienced rapid development in the past 50 years. This has presented unique challenges with regard to land space and a rapidly ageing population. The role of extrinsic factors in successful ageing is well documented, and places a degree of responsibility on the state and healthcare systems. Singapore has taken many proactive measures to meet this responsibility by implementing policy changes across multiple domains including housing, transport, education and research. One hospital in the north east of Singapore has undertaken a frailty screening program that aims to identify, prevent and reverse frailty at an early stage. This paper provides a review of these national and regional measures.
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Affiliation(s)
- Andrew Rogerson
- Department of General Medicine, Medical Centre Level 9, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore.
| | - Simon Stacey
- Department of General Medicine, Medical Centre Level 9, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore.
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RETRACTED ARTICLE: Rapid Screening for Frailty and Sarcopenia in Daily Clinical Practice. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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26
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Fougère B. RETRACTED ARTICLE: Management of Frailty: Screening and Interventions. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cao L, Morley JE. Sarcopenia Is Recognized as an Independent Condition by an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) Code. J Am Med Dir Assoc 2018; 17:675-7. [PMID: 27470918 DOI: 10.1016/j.jamda.2016.06.001] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Li Cao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - John E Morley
- Division of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, Missouri.
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29
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, Room M238, St Louis, MO 63104, USA.
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30
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Woo J. Challenges of population ageing: putting frailty as a cornerstone of health and social care systems. Eur Geriatr Med 2018; 9:273-276. [DOI: 10.1007/s41999-018-0056-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
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Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc 2018. [PMID: 28648901 DOI: 10.1016/j.jamda.2017.04.018] [Citation(s) in RCA: 370] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. METHODS An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RECOMMENDATIONS Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. CONCLUSIONS The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
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Affiliation(s)
- Elsa Dent
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Christopher Lien
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Chin Wong
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jean Woo
- The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Birong Dong
- Geriatrics Center Huaxi Hospital, Sichuan University, Chengdu, China
| | - Shelley de la Vega
- University of the Philippines College of Medicine, Manila, Philippines; Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Philip Jun Hua Poi
- Division of Geriatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Chang Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Li Cao
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Piu Chan
- Department of Geriatrics, Neurology, and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Edward Leung
- Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | | | - Linda P Fried
- Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University, St. Louis, MO
| | | | - Leon Flicker
- Western Australia Center for Health and Aging, University of Western Australia, Perth, Australia
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Amblàs-Novellas J, Martori JC, Espaulella J, Oller R, Molist-Brunet N, Inzitari M, Romero-Ortuno R. Frail-VIG index: a concise frailty evaluation tool for rapid geriatric assessment. BMC Geriatr 2018; 18:29. [PMID: 29373968 PMCID: PMC5787254 DOI: 10.1186/s12877-018-0718-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/14/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)-the Frail-VIG index ("VIG" is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months. METHODS Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n = 590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0-0.15; 0.16-0.25; 0.26-0.35; 0.36-0.45; 0.46-0.55; 0.56-0.65; and 0.66-1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index's capacity to predict mortality at 24 months. RESULTS Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p < 0.05) were observed for most index variables. Survival curves for the seven Frail-VIG groups differed significantly (X2 = 433.4, p < 0.001), with an area under the ROC curve (confidence interval) of 0.90 (0.88-0.92) at 12 months and 0.85 (0.82-0.88) at 24 months. Administration time for the Frail-VIG index ranged from 5 to 10 min. CONCLUSIONS The Frail-VIG index, which requires less time to administer than previously validated FIs, presents a good discriminative capacity for the degree of frailty and a high predictive capacity for mortality in the present cohort. Although more research is needed to confirm the validity of this instrument in other populations and settings, the Frail-VIG may provide clinicians with a RGA method and also a reliable tool to assess frailty in routine practice.
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Affiliation(s)
- Jordi Amblàs-Novellas
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu / Hospital Universitari de Vic, Rambla Hospital 52, 08500, Vic, Barcelona, Spain. .,Department of Palliative Care, University of Vic / Central University of Catalonia, Barcelona, Spain. .,Programme for the Prevention and Care of Patients with Chronic Conditions, Department of Health, Government of Catalonia, Barcelona, Spain.
| | - Joan Carles Martori
- Data Analysis and Modeling Research Group. Department of Economics and Business, University of Vic / Central University of Catalonia, Barcelona, Spain
| | - Joan Espaulella
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu / Hospital Universitari de Vic, Rambla Hospital 52, 08500, Vic, Barcelona, Spain.,Department of Palliative Care, University of Vic / Central University of Catalonia, Barcelona, Spain
| | - Ramon Oller
- Data Analysis and Modeling Research Group. Department of Economics and Business, University of Vic / Central University of Catalonia, Barcelona, Spain
| | - Núria Molist-Brunet
- Geriatric and Palliative Care Department, Hospital Universitari de la Santa Creu / Hospital Universitari de Vic, Rambla Hospital 52, 08500, Vic, Barcelona, Spain
| | - Marco Inzitari
- Parc Sanitari Pere Virgili. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roman Romero-Ortuno
- Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK.,Department of Public Health and Primary Care, Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
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Fougère B, Cesari M, Arai H, Woo J, Merchant RA, Flicker L, Cherubini A, Bauer JM, Vellas B, Morley JE. Editorial: Involving Primary Care Health Professionals in Geriatric Assessment. J Nutr Health Aging 2018; 22:566-568. [PMID: 29717754 DOI: 10.1007/s12603-018-1001-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- B Fougère
- B. Fougère, Institut du Vieillissement, Gérontopôle, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000 Toulouse, France, Tel: +33561145657 ; fax: +33561145640, E-mail:
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de Souza Orlandi F, Brochine Lanzotti R, Gomes Duarte J, Novais Mansur H, Zazzetta MS, Iost Pavarini SC, Cominetti MR, Matumoto S. Translation, Adaptation and Validation of Rapid Geriatric Assessment to the Brazilian context. J Nutr Health Aging 2018; 22:1115-1121. [PMID: 30379312 DOI: 10.1007/s12603-018-1078-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Translate, cross-culturally adapt and validate the Rapid Geriatric Assessment (RGA) for Brazilian community-dwelling adults. DESIGN Cross-sectional study, using a quantitative approach. SETTING Urban population from the city of São Carlos, located in the interior of São Paulo State, Brazil. PARTICIPANTS 148 individuals aged 60 or over. MEASUREMENTS Participants were assessed using the RGA, Fried Frailty Phenotype, International Physical Activity Questionnaire - long version, Addenbrooke´s Cognitive Exam - Revised Version, Mini Nutritional Assessment, short Form - 36, EuroQol 5-Dimension, Geriatric Depression Scale - short version, in addition to performing Dual Energy X-ray Absorptiometry to diagnose sarcopenia, according to the criteria established by the European Working Group on Sarcopenia in Older People. RESULTS In the translation and adaption process of the RGA, steps recommended by the literature were followed: initial translation, synthesis of translations, backward translation, evaluation from the panel of judges, and pre-test. When evaluating the psychometric properties of the scale, satisfactory reliability (internal consistency and stability) and validity (content, concurrent criterion and convergent, divergent and discriminant construct) were verified. CONCLUSION The Brazilian version of the RGA is reliable and valid, and can be used in the Brazilian context to evaluate the elderly population.
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Affiliation(s)
- F de Souza Orlandi
- Fabiana de Souza Orlandi, Rod. Washington Luis, km 235 CEP: 13565-905 São Carlos, São Paulo, Brazil (+55) 16 3306-6673/
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Pitkälä KH, Martin FC, Maggi S, Jyväkorpi SK, Strandberg TE. Status of Geriatrics in 22 Countries. J Nutr Health Aging 2018; 22:627-631. [PMID: 29717764 DOI: 10.1007/s12603-018-1023-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this article is to describe the current status of geriatrics and position of geriatricians in 22 countries of three continents, and to portray their attitudes towards and resources allocated to geriatrics. METHODS An electronic survey was delivered to a convenience sample of 22 geriatricians in leading positions of their countries. RESULTS The time required in post graduation specialist training to become a geriatrician varied from one year (subspecialty in the USA) to six years (independent specialty in Belgium). The number in the population aged 80+ per geriatrician varied from 450 (Austria) to 25,000 (Turkey). Of respondents, 55% reported that geriatrics is not a popular specialty in their country. Acute geriatric wards, rehabilitation and outpatient clinics were the most common working places for geriatricians. Nearly half of the respondents had an opinion that older patients who were acutely ill, were receiving subacute rehabilitation or had dementia should be cared for by geriatricians whereas half of the respondents would place geriatricians also in charge of nursing home and orthogeriatric patients. The biggest problems affecting older people's clinical care in their countries were: lack of geriatric knowledge, lack of geriatricians, and attitudes towards older people. Half of respondents thought that older people's health promotion and comprehensive geriatric assessment were not well implemented in their countries, although a majority felt that they could promote good geriatric care in their present position as a geriatrician. CONCLUSION The position of geriatric, geriatricians' training and contents of work has wide international variety.
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Affiliation(s)
- K H Pitkälä
- Kaisu Pitkälä, Faculty of Medicine, Department of General Practice and Primary Health Care, PO BOX 20, 00014 University of Helsinki, Finland,
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Morley JE. A Decade of JAMDA. J Am Med Dir Assoc 2017; 18:993-997. [PMID: 29169742 DOI: 10.1016/j.jamda.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO.
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2016. J Am Med Dir Assoc 2017; 17:978-993. [PMID: 27780573 DOI: 10.1016/j.jamda.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 12/31/2022]
Abstract
This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polypharmacy, rapid geriatric assessment, and transitional care.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Morley JE, Sanford A, Bourey R. Sleep Apnea: A Geriatric Syndrome. J Am Med Dir Assoc 2017; 18:899-904. [DOI: 10.1016/j.jamda.2017.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/25/2022]
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2017. J Am Med Dir Assoc 2017; 18:928-940. [PMID: 29080572 DOI: 10.1016/j.jamda.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023]
Abstract
This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Mena-Madrazo JA, Mariscal-Martinez BE, Leon-Quintero M, Lupercio Macias SM. Use of the Spanish Version of the Rapid Geriatric Assessment in Mexican Patients in Long-Term Care. J Am Med Dir Assoc 2017; 18:891-892. [DOI: 10.1016/j.jamda.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 06/28/2017] [Accepted: 07/18/2017] [Indexed: 11/27/2022]
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Morley JE. JAMDA Maintains Excellent Impact Factor. J Am Med Dir Assoc 2017; 18:737-740. [PMID: 28859817 DOI: 10.1016/j.jamda.2017.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 01/06/2023]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
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Warnier RMJ, van Rossum E, van Kuijk SMJ, Mulder WJ, Schols JMGA, Kempen GIJM. The Maastricht Frailty Screening Tool for Hospitalised Patients (MFST-HP) to Identify Non-Frail Patients. Int J Clin Pract 2017; 71. [PMID: 28885763 DOI: 10.1111/ijcp.13003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Maastricht frailty screening tool for hospitalised patients (MFST-HP) is a frailty screening tool that is fully integrated in the nursing assessment at admission. This study aims to determine the predictive value of the MFST-HP for the health outcomes length of hospital stay, discharge destination, readmission and mortality. METHODS Data of 2691 hospitalised patients (70+), admitted between 01-01-2013 and 31-12-2013, were included in the study. The predictive value of the MFST-HP was analysed by means of receiver operating characteristics curves. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for different MFST-HP cut-off scores were examined. RESULTS Mean age of the population was 78.9 years (SD 6.4) and their average length of stay was 10.2 days (SD 9.7). Nearly 75.0% of the patients were discharged to their home and around. Approximately 25% of the patients were readmitted within 120 days. Mortality rates were 4.3% and 9.5% (within 30 or 120 days postdischarge, respectively). The area under the curve was moderate and varied from 0.50 to 0.69 for the different outcomes. As a result of high values on negative predictive value (between 73.5% and 96.7%) the MFST-HP is able to rule out a large proportion of non-frail patients. In this study 84% of the patients had a MFST-HP score of ≥ 6, suggested as most favourable cut off. CONCLUSIONS The MFST-HP seems to operate more strongly as a non-frailty indicator than as a frailty indicator and may in this respect help professionals to decide upon subsequent care. The MFST-HP is able to rule out 84% of the non-frail population in this study. The remaining 16% need to be assessed by means of a comprehensive geriatric assessment or rapid geriatric assessment, to gain more insight in the level of vulnerability in the frail-group.
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Affiliation(s)
- Ron M J Warnier
- Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Geriatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Integrated Care, Division of Elderly care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Erik van Rossum
- Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Sander M J van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wubbo J Mulder
- Department of Internal Medicine, Division of Geriatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos M G A Schols
- Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Care and Public Health Research Institute (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri
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Panza F, Solfrizzi V, Lozupone M, Barulli MR, D'Urso F, Stallone R, Dibello V, Noia A, Di Dio C, Daniele A, Bellomo A, Seripa D, Greco A, Logroscino G. An Old Challenge with New Promises: A Systematic Review on Comprehensive Geriatric Assessment in Long-Term Care Facilities. Rejuvenation Res 2017. [PMID: 28635539 DOI: 10.1089/rej.2017.1964] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic process focused on determining the clinical profile, pathological risk, residual skills, short- and long-term prognosis, and personalized therapeutic and care plan of the functionally compromised and frail older subjects. Previous evidence suggested that the effectiveness of CGA programs may be influenced by settings where the CGA is performed [i.e., hospital, posthospital discharge/long-term care facilities (LTCFs), or community/home] as well as the specific clinical conditions of older frail individuals. In this scenario, CGA and quality of care in LTCFs have been a challenge for decades. In the present article, we systematically reviewed evidence from the last three decades of clinical research devoted to systematic implementation of CGA programs in LTCFs, that is, nursing homes, care homes, residential homes, and rehabilitation facilities. In the United States, all LTC residents must undergo a CGA on a regular basis on admission to a facility, prompting the development of the Resident Assessment Instrument (RAI) Minimum Data Set, a specific CGA-based assessment tool in this population. In the LTCF setting, the present reviewed evidence suggested that most complex older subjects may benefit from a CGA in terms of improved quality of care and reduced hospitalization events and that CGA must be standardized across healthcare settings to promote greater health system integration and coordination. In the LTCF setting, particularly in nursing homes, other new and promising CGA programs have also been proposed to develop rapid screening CGA-based tools to enhance in the future the ability of primary care physicians to recognize and treat geriatric syndromes in this setting. However, at present, the interRAI suite of instruments represented an integrated health information system that has the potential to provide person-centered information transcending healthcare settings.
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Affiliation(s)
- Francesco Panza
- 1 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,2 Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy .,3 Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- 4 Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro , Bari, Italy
| | - Madia Lozupone
- 1 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy
| | - Maria Rosaria Barulli
- 2 Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy
| | - Francesca D'Urso
- 5 Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia , Foggia, Italy
| | - Roberta Stallone
- 1 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy
| | - Vittorio Dibello
- 6 Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari Aldo Moro , Bari, Italy
| | - Alessia Noia
- 4 Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro , Bari, Italy
| | - Cristina Di Dio
- 2 Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy
| | - Antonio Daniele
- 7 Institute of Neurology, Catholic University of Sacred Heart , Rome, Italy
| | - Antonello Bellomo
- 5 Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia , Foggia, Italy
| | - Davide Seripa
- 3 Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo, Foggia, Italy
| | - Antonio Greco
- 3 Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo, Foggia, Italy
| | - Giancarlo Logroscino
- 1 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,2 Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy
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Tan LF, Lim ZY, Choe R, Seetharaman S, Merchant R. Screening for Frailty and Sarcopenia Among Older Persons in Medical Outpatient Clinics and its Associations With Healthcare Burden. J Am Med Dir Assoc 2017; 18:583-587. [DOI: 10.1016/j.jamda.2017.01.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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Integrated Care: Enhancing the Role of the Primary Health Care Professional in Preventing Functional Decline: A Systematic Review. J Am Med Dir Assoc 2017; 18:489-494. [DOI: 10.1016/j.jamda.2017.03.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
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Morley JE. Rapid Geriatric Assessment: Secondary Prevention to Stop Age-Associated Disability. Clin Geriatr Med 2017; 33:431-440. [PMID: 28689573 DOI: 10.1016/j.cger.2017.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Rapid Geriatric Assessment (RGA) measures frailty, sarcopenia, anorexia, cognition, and advanced directives. The RGA is a screen for primary care physicians to be able to detect geriatric syndromes. Early intervention when geriatric syndromes are recognized can decrease disability, hospitalization, and mortality.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA; Division of Endocrinology, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
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Laffon de Mazières C, Morley JE, Levy C, Agenes F, Barbagallo M, Cesari M, De Souto Barreto P, Donini LM, Fitten J, Franco A, Izquierdo M, Kane RA, Martin FC, Onder G, Ouslander J, Pitkälä K, Saliba D, Sinclair A, Manas LR, Vellas B, Rolland Y. Prevention of Functional Decline by Reframing the Role of Nursing Homes? J Am Med Dir Assoc 2017; 18:105-110. [PMID: 28126135 DOI: 10.1016/j.jamda.2016.11.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023]
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