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Young HML, Yates T, Dempsey PC, Herring LY, Henson J, Sargeant J, Curtis F, Sathanapally H, Highton PJ, Hadjiconstantinou M, Pritchard R, Lock S, Singh SJ, Davies MJ. Physical activity and sedentary behaviour interventions for people living with both frailty and multiple long-term conditions: a scoping review protocol. BMJ Open 2022; 12:e061104. [PMID: 35508347 PMCID: PMC9073409 DOI: 10.1136/bmjopen-2022-061104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The number of people living with multiple long-term conditions (MLTCs) is predicted to rise. Within this population, those also living with frailty are particularly vulnerable to poor outcomes, including decreased function. Increased physical activity, including exercise, has the potential to improve function in those living with both MLTCs and frailty but, to date, the focus has remained on older people and may not reflect outcomes for the growing number of younger people living with MLTCs and frailty. For those with higher burdens of frailty and MLTCs, physical activity may be challenging. Tailoring physical activity in response to symptoms and periods of ill-health, involving family and reducing sedentary behaviour may be important in this population. How the tailoring of interventions has been approached within existing studies is currently unclear. This scoping review aims to map the available evidence regarding these interventions in people living with both frailty and MLTCs. METHODS AND ANALYSIS We will use a six-stage process: (1) identifying the research questions; (2) identifying relevant studies (via database searches); (3) selecting studies; (4) charting the data; (5) collating and summarising and (6) stakeholder consultation. Studies will be critically appraised using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION All data in this project will be gathered through database searches. Stakeholder consultation will be undertaken with an established patient and public involvement group. We will disseminate our findings via social media, publication and engagement meetings.
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Affiliation(s)
- Hannah M L Young
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Paddy C Dempsey
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louisa Y Herring
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joseph Henson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jack Sargeant
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Ffion Curtis
- NIHR Applied Research Collaboration East Midlands, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harini Sathanapally
- NIHR Applied Research Collaboration East Midlands, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Patrick J Highton
- NIHR Applied Research Collaboration East Midlands, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Rebecca Pritchard
- NIHR Leicester BRC, University Hospitals of Leicester NHS Trust, Leicester, UK
- Medical School, University of Edinburgh, Edinburgh, UK
| | - Selina Lock
- Library Research Services, University of Leicester, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Unit, Leicester, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
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Evaluating a frailty education program implemented through barbershops/salons in Japan: A preliminary study. SN SOCIAL SCIENCES 2022; 2:55. [PMID: 35499069 PMCID: PMC9034965 DOI: 10.1007/s43545-022-00361-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/12/2022] [Indexed: 10/27/2022]
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Mariam NBG, Dunnett-Kane V, Herdman MT, Seers T, Aldcroft D, Balasegaram S, Davenport R, Redmond A, Ng C, Wentworth L. Experience of using a regional network of hospitals in the care of older inpatients with COVID-19 in spring 2020. Future Healthc J 2022; 9:45-50. [DOI: 10.7861/fhj.2021-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fazal MS, Gordon EJ, Humbyrd CJ. Current Bioethical Issues in Geriatric Organ Transplantation. CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00364-3] [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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Hanlon P, Morton F, Siebert S, Jani BD, Nicholl BI, Lewsey J, McAllister D, Mair FS. Frailty in rheumatoidrmdopen-2021-002111 arthritis and its relationship with disease activity, hospitalisation and mortality: a longitudinal analysis of the Scottish Early Rheumatoid Arthritis cohort and UK Biobank. RMD Open 2022; 8:e002111. [PMID: 35292529 PMCID: PMC8928366 DOI: 10.1136/rmdopen-2021-002111] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/17/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess the prevalence of frailty in rheumatoid arthritis (RA) and its association with baseline and longitudinal disease activity, all-cause mortality and hospitalisation. PARTICIPANTS People with RA identified from the Scottish Early Rheumatoid Arthritis (SERA) inception cohort (newly diagnosed, mean age 58.2 years) and UK Biobank (established disease identified using diagnostic codes, mean age 59 years). Frailty was quantified using the frailty index (both datasets) and frailty phenotype (UK Biobank only). Disease activity was assessed using Disease Activity Score in 28 joints (DAS28) in SERA. Associations between baseline frailty and all-cause mortality and hospitalisation was estimated after adjusting for age, sex, socioeconomic status, smoking and alcohol, plus DAS28 in SERA. RESULTS Based on the frailty index, frailty was common in SERA (12% moderate, 0.2% severe) and UK Biobank (20% moderate, 3% severe). In UK Biobank, 23% were frail using frailty phenotype. Frailty index was associated with DAS28 in SERA, as well as age and female sex in both cohorts. In SERA, as DAS28 lessened over time with treatment, mean frailty index also decreased. The frailty index was associated with all-cause mortality (HR moderate/severe frailty vs robust 4.14 (95% CI 1.49 to 11.51) SERA, 1.68 (95% CI 1.26 to 2.13) UK Biobank) and unscheduled hospitalisation (incidence rate ratio 2.27 (95% CI 1.45 to 3.57) SERA 2.74 (95% CI 2.29 to 3.29) UK Biobank). In UK Biobank, frailty phenotype also associated with mortality and hospitalisation. CONCLUSION Frailty is common in early and established RA and associated with hospitalisation and mortality. Frailty in RA is dynamic and, for some, may be ameliorated through controlling disease activity in early disease.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Fraser Morton
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Jim Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - David McAllister
- Public Health, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
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Shovel L, Morkane C. Prehabilitation for Vascular Surgery Patients: Challenges and Opportunities. Can J Cardiol 2022; 38:645-653. [PMID: 35240251 DOI: 10.1016/j.cjca.2022.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 11/02/2022] Open
Abstract
Global demand for major surgery is rising as a consequence of a growing, ageing population and clinically applicable approaches to perioperative risk reduction have never been needed more. Prehabilitation aims to optimise aerobic capacity and address modifiable risk factors prior to surgery to improve postoperative outcomes. Given the inherently high-risk nature of vascular surgery and the frequently high-acuity, frail, vascular surgical population, the potential to introduce an intervention into the surgical pathway that may reduce postoperative complications cannot be overlooked. The aim of this article is to examine the current evidence base for prehabilitation in patients awaiting vascular surgery, and to summarise the potential benefits, pitfalls, and practicalities of this emerging perioperative intervention. There is a paucity of high-quality research specifically aimed at prehabilitation for patients undergoing vascular surgery, both peripheral and aortic, making it difficult to draw definitive conclusions upon which to base a change in practice. Currently, evidence is taken from small, often single-centre heterogenous studies that vary significantly from each other, meaning that the optimal exercise regimen for patients awaiting vascular surgery has yet to be defined. Establishing the impact of prehabilitation on outcomes for vascular patients is important as the effectiveness of preoperative exercise training is likely to vary between surgical interventions and patient populations. However, extrapolation from other cohorts is possible and indeed forms the basis of many current prehabilitation programmes. Given the success of prehabilitation in other surgical groups, it has potential to become an important future research target for patients awaiting vascular surgery.
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Affiliation(s)
- Louisa Shovel
- Royal Free Perioperative Research, Department of Anaesthesia, Royal Free Hospital, Pond Street, London, UK, NW3 2QG.
| | - Clare Morkane
- Royal Free Perioperative Research, Department of Anaesthesia, Royal Free Hospital, Pond Street, London, UK, NW3 2QG
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Jung Y, Lyu J, Kim G. Multi-group frailty trajectories among older Koreans: Results from the Korean Longitudinal Study of Aging. Arch Gerontol Geriatr 2022; 98:104533. [DOI: 10.1016/j.archger.2021.104533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/15/2022]
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Highly Variable Paracetamol Pharmacokinetics After Multiple Oral Dosing in Frail Older People: A Population Pharmacokinetic Analysis. Drugs Aging 2021; 39:83-95. [PMID: 34918212 DOI: 10.1007/s40266-021-00912-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Paracetamol pharmacokinetics (PK) is highly variable in older fit adults after intravenous administration. Frailty and oral administration likely result in additional variability. The aim was to determine oral paracetamol PK and variability in geriatric inpatients. METHODS A population PK analysis, using NONMEM 7.2, was performed on 245 paracetamol samples in 40 geriatric inpatients (median age 87 [range 80-95] years, bodyweight 66.4 [49.3-110] kg, 92.5% frail [Edmonton Frail Scale]). All subjects received paracetamol 1000 mg as tablet (72.5%) or granulate (27.5%) three times daily. Simulations of dosing regimens (1000 mg every 6 hours [q6h] or q8h) were performed to determine target attainment, using mean steady-state concentration (Css-mean) of 10 mg/L as target. RESULTS A one-compartment model with first order absorption and lag time best described the data. The inter-individual variability was high, with absorption rate constant containing the highest variability. The inter-individual variability could not be explained by covariates. Simulations of 1000 mg q6h and q8h resulted in a Css-mean of 10.8 [25-75th percentiles 8.2-12.7] and 8.13 [6.3-9.6] mg/L, respectively, for the average geriatric inpatient. The majority of the population remained off-target (22.2% [q6h] and 52.2% [q8h] <8 mg/L; 31.3 [q6h] and 7.6% [q8h] >12 mg/L). CONCLUSION A population of average geriatric inpatients achieved target Css-mean with paracetamol 1000 mg q6h, while q8h resulted in underexposure for the majority of them. Due to high unexplained variability, a relevant proportion remained either above or below the target concentration of 10 mg/L. Research focusing on PK, efficacy and safety is needed to recommend dosing regimens.
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Harvey AR. Integrated neuroimmune processing of threat, injury, and illness: An ecological framework mapping social alienation onto lifetime health vulnerability. Brain Behav Immun Health 2021; 18:100349. [PMID: 34723222 PMCID: PMC8531850 DOI: 10.1016/j.bbih.2021.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022] Open
Abstract
Social alienation is a pre-eminent ecological threat for humans. In clinical and social care settings its impact is acknowledged in conditions as diverse as severe mood disturbance, chronic pain, and metabolic non-communicable diseases. An integrated psychoneuroimmune perspective shows how threat, injury, healing, and recovery follow through as a continuous process, but accepted cultural and clinical paradigms separating mental from physical illness provide little common ground on which to analyse and apply this continuum in practice. By reviewing the ecological relationships between emotional threat, tissue dyshomeostasis and injury, infection, pain, and mood this article explores not only how primeval somatic responses underpin the evolutionary foundations of depression and somatisation, but also links them to escalating physical non-communicable disease through archived socioeconomic adversity (allostatic load). Social alienation (in the absence of trauma) may prime and activate this ancient repertoire in which sensitised responses lay the foundation for persistent maladaptive states of aversive sensory misinterpretation, behavioural avoidance, anhedonia, and neuroinflammation presenting as widespread non-nociceptive pain, non-pain somatisation, and severe depression. The ecological perspective illuminates perverse clinical presentations, shows how some approaches to care may facilitate self-reinforcement in maladaptive syndromes, and offers pointers for inclusive rehabilitative clinical and social care.
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Affiliation(s)
- Andrew R. Harvey
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, LS2 9JT, UK
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Abstract
PURPOSE OF REVIEW To review available data on the relationship of MDS and aging and to address the question if biological changes of (premature) aging are a prerequisite for the development of MDS. RECENT FINDINGS Whereas the association of MDS with advanced age and some common biologic features of aging and MDS are well established, additional evidence for both, especially on the role of stem cells, the stem cell niche, and inflammation, has been recently described. Biologically, many but not all drivers of aging also play a role in the development and propagation of MDS and vice versa. As a consequence, aging contributes to the development of MDS which can be seen as an interplay of clonal disease and normal and premature aging. The impact of aging may be different in specific MDS subtypes and risk groups.
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Affiliation(s)
- Sonja Heibl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
- Paracelsus Medical University, Salzburg, Austria
| | - Reinhard Stauder
- Department of Internal Medicine V, Hematology and Oncology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Pfeilstöcker
- 3rd Medical Department, Hanusch Hospital, H.Collinstr 30, 1140, Vienna, Austria.
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Oude Voshaar RC, Dimitriadis M, vandenBrink RHS, Aprahamian I, Borges MK, Marijnissen RM, Hoogendijk EO, Rhebergen D, Jeuring HW. A 6-year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder. Int J Geriatr Psychiatry 2021; 36:1699-1707. [PMID: 34130356 PMCID: PMC8596411 DOI: 10.1002/gps.5588] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Depressive disorder has been conceptualised as a condition of accelerated biological ageing. We operationalised a frailty index (FI) as marker for biological ageing aimed to explore the bidirectional, longitudinal association between frailty and either depressive symptoms or depressive disorder. METHODS A cohort study with 6-year follow-up including 377 older (≥60 years) outpatients with a DSM-IV-defined depressive disorder and 132 never-depressed controls. Site visits at baseline, 2 and 6-year follow-up were conducted and included the CIDI 2.0 to assess depressive disorder and relevant covariates. Depressive symptom severity and mortality were assessed every 6 months by mail and telephone. A 41-item FI was operationalised and validated against the 6-year morality rate by Cox regression (HRFI = 1.04 [95% CI: 1.02-1.06]). RESULTS Cox regression showed that a higher FI was associated with a lower chance of remission among depressed patients (HRFI = 0.98 [95% CI: 0.97-0.99]). Nonetheless, this latter effect disappeared after adjustment for baseline depressive symptom severity. Linear mixed models showed that the FI increased over time in the whole sample (B[SE] = 0.94 (0.12), p < .001) with a differential impact of depressive symptom severity and depressive disorder. Higher baseline depressive symptom severity was associated with an attenuated and depressive disorder with an accelerated increase of the FI over time. CONCLUSIONS The sum score of depression rating scales is likely confounded by frailty. Depressive disorder, according to DSM-IV criteria, is associated with accelerated biological ageing. This argues for the development of multidisciplinary geriatric care models incorporating frailty to improve the overall outcome of late-life depression.
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Affiliation(s)
- Richard C. Oude Voshaar
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Menelaos Dimitriadis
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Rob H. S. vandenBrink
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Ivan Aprahamian
- Department of Internal MedicineGeriatrics DivisionFaculty of Medicine of JundiaíJundiaíBrazil
| | - Marcus K. Borges
- Department and Institute of PsychiatrySão PauloUniversity of São PauloBrazil
| | - Radboud M. Marijnissen
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Emiel O. Hoogendijk
- Department of Epidemiology and BiostatisticsAmsterdam UMC – Location VU University Medical CenterAmsterdamThe Netherlands
| | - Didi Rhebergen
- Department of PsychiatryNetherlands & GGZ Ingeest Specialized Mental Health CareAmsterdam UMC – Location VU University Medical CenterAmsterdamThe Netherlands
| | - Hans W. Jeuring
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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The prevalence of frailty among breast cancer patients: a systematic review and meta-analysis. Support Care Cancer 2021; 30:2993-3006. [PMID: 34694496 DOI: 10.1007/s00520-021-06641-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Coexistence of frailty and breast cancer (BC) is related to a higher risk of hospitalization, mortality, and falls. Given the potential reversibility of frailty, investigating its epidemiology in BC is of great importance. However, estimates of the prevalence of frailty in BC patients vary considerably. We synthesized the existing body of literature on the prevalence of frailty among BC patients. METHODS We searched English databases (Cochrane Library, PubMed, Medline, CINAHL, Embase, Scopus, and Web of Science) and Chinese databases (CNKI, WanFang, CBM, and VIP database) from the inception to April 15, 2021, and collected observational studies about the prevalence of frailty among BC patients. The robustness of the pooled estimates was validated by analysis of different subgroups, meta-regression, and sensitivity. All data were analyzed using Stata 15.1. RESULTS In total, 4645 articles were screened and data from 24 studies involving 13,510 subjects were used in the meta-analysis. The prevalence of frailty among BC patients in individual studies varied from 5 to 71%. The pooled prevalence of frailty was 43% (95% confidence intervals (CI): 36% to 50%, I2 = 98.4%, P < 0.05). Subgroup analyses revealed that the therapeutic method, frailty scales, age, frailty stage, regions, publication years, and study quality were associated with the prevalence of frailty among BC patients. CONCLUSIONS The prevalence of frailty among BC patients was relatively high, and the conditions of BC treatment can increase the risk of frailty. Understanding the effects of frailty on BC, especially in elderly patients, can provide the healthcare personnel with the theoretical basis for patients' management and treatment.
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Cole JA, Kehmeier MN, Bedell BR, Krishna Kumaran S, Henson GD, Walker AE. Sex Differences in the Relation Between Frailty and Endothelial Dysfunction in Old Mice. J Gerontol A Biol Sci Med Sci 2021; 77:416-423. [PMID: 34664649 DOI: 10.1093/gerona/glab317] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 11/14/2022] Open
Abstract
Vascular endothelial function declines with age on average, but there is high variability in the magnitude of this decline within populations. Measurements of frailty, known as frailty index (FI), can be used as surrogates for biological age, but it is unknown if frailty relates to the age-related decline in vascular function. To examine this relation, we studied young (4-9 months) and old (23-32 months) C57BL6 mice of both sexes. We found that FI was greater in old compared with young mice, but did not differ between old male and female mice. Middle cerebral artery (MCA) and mesenteric artery endothelium-dependent dilation (EDD) also did not differ between old male and female mice; however, there were sex differences in the relations between FI and EDD. For the MCA, FI was inversely related to EDD among old female mice, but not old male mice. In contrast, for the mesenteric artery, FI was inversely related to EDD among old male mice, but not old female mice. A higher FI was related to a greater improvement in EDD with the superoxide scavenger TEMPOL in the MCAs for old female mice and in the mesenteric arteries for old male mice. FI related to mesenteric artery gene expression negatively for extracellular superoxide dismutase (Sod3) and positively for interleukin-1β (Il1b). In summary, we found that the relation between frailty and endothelial function is dependent on sex and the artery examined. Arterial oxidative stress and pro-inflammatory signaling are potential mediators of the relations of frailty and endothelial function.
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Affiliation(s)
- Jazmin A Cole
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | | | - Bradley R Bedell
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | | | - Grant D Henson
- Department of Human Physiology, University of Oregon, Eugene, Oregon
| | - Ashley E Walker
- Department of Human Physiology, University of Oregon, Eugene, Oregon
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Liang YD, Xie YB, Du MH, Shi J, Yang JF, Wang H. Development and Validation of an Electronic Frailty Index Using Routine Electronic Health Records: An Observational Study From a General Hospital in China. Front Med (Lausanne) 2021; 8:731445. [PMID: 34650997 PMCID: PMC8505669 DOI: 10.3389/fmed.2021.731445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/02/2021] [Indexed: 02/03/2023] Open
Abstract
Background: This study aimed to develop and validate an electronic frailty index (eFI) based on routine electronic health records (EHR) for older adult inpatients and to analyze the correlations between frailty and hospitalized events and costs. Methods: We created an eFI from routine EHR and validated the effectiveness by the consistency of the comprehensive geriatric assessment-frailty index (CGA-FI) with an independent prospective cohort. Then, we analyzed the correlations between frailty and hospitalized events and costs by regressions. Results: During the study period, 49,226 inpatients were included in the analysis, 42,821 (87.0%) of which had enough data to calculate an eFI. A strong correlation between the CGA-FI and eFI was shown in the validation cohort of 685 subjects (Pearson's r = 0.716, P < 0.001). The sensitivity and specificity for an eFI≥0.15, the upper tertile, to identify frailty, defined as a CGA-FI≥0.25, were 64.8 and 88.7%, respectively. After adjusting for age, sex, and operation, an eFI≥0.15 showed an independent association with long hospital stay (odds ratio [OR] = 2.889, P < 0.001) and death in hospital (OR = 19.97, P < 0.001). Moreover, eFI values (per 0.1) were positively associated with total costs (β = 0.453, P < 0.001), examination costs (β = 0.269, P < 0.001), treatment costs (β = 0.414, P < 0.001), nursing costs (β = 0.381, P < 0.001), pharmacy costs (β = 0.524, P < 0.001), and material costs (β = 0.578, P < 0.001) after adjusting aforementioned factors. Conclusions: We successfully developed an effective eFI from routine EHR from a general hospital in China. Frailty is an independent risk factor for long hospital stay and death in hospital. As the degree of frailty increases, the hospitalized costs increase accordingly.
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Affiliation(s)
- Yao-Dan Liang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Bo Xie
- Information Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming-Hui Du
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Shi
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie-Fu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Aminu AQ, Wondergem R, Van Zaalen Y, Pisters M. Self-Efficacy Is a Modifiable Factor Associated with Frailty in Those with Minor Stroke: Secondary Analysis of 200 Cohort Respondents. Cerebrovasc Dis Extra 2021; 11:99-105. [PMID: 34628411 PMCID: PMC8543288 DOI: 10.1159/000519311] [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: 05/22/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Owing to the improvement in acute care, there has been an increase in the number of people surviving stroke and living with its impairments. Frailty is common in people with stroke and has a significant impact on the prognosis after stroke. To reduce frailty progression, potentially modifiable factors should be identified. Increasing levels of self-efficacy influence both behaviour and physical functioning, and therefore it could be a potential target to prevent frailty. METHODS This is a prospective cohort study that involved the secondary analysis of the RISE data to examine the relationship between self-efficacy and frailty. The RISE study is a longitudinal study that consists of 200 adults aged 18+ years after their first stroke event. Data were collected from the respondents at 3 weeks, 6 months, 12 months, and 24 months after their discharge from the hospital. Frailty was assessed using the multidimensional frailty index with scores ranging from 0 to 1, and self-efficacy was assessed using the SESx scale, which was dichotomized as low/moderate or high. Frailty trajectories were examined using the repeated linear model. The generalized estimating equation was used to examine the relationship between self-efficacy and frailty at baseline and in the future (6-24 months). The B coefficients were reported at 95% CI before and after adjusting for potential confounders (age, gender, stroke severity, education, and social support). RESULTS A total of 200 responses were analysed, and the mean age of the respondents was 67.78 ± 11.53. Females made up 64% of the sample, and the mean frailty score at baseline was 0.17 ± 0.09. After adjusting for confounders, respondents with low self-efficacy had an approximately 5% increase in their frailty scores at baseline and in the 24-month follow-up period compared to those with high self-efficacy. CONCLUSION The result from this study showed that self-efficacy was significantly associated with frailty after stroke. Our findings suggest that self-efficacy may play a role in frailty progression among stroke survivors.
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Affiliation(s)
- Abodunrin Quadri Aminu
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, United Kingdom
| | - Roderick Wondergem
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,The Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne Van Zaalen
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Martijn Pisters
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,The Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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66
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Strom JB, Xu J, Orkaby AR, Shen C, Charest BR, Kim DH, Cohen DJ, Kramer DB, Spertus JA, Gerszten RE, Yeh RW. Identification of Frailty Using a Claims-Based Frailty Index in the CoreValve Studies: Findings from the EXTEND-FRAILTY Study. J Am Heart Assoc 2021; 10:e022150. [PMID: 34585597 PMCID: PMC8649149 DOI: 10.1161/jaha.121.022150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background In aortic valve disease, the relationship between claims‐based frailty indices (CFIs) and validated measures of frailty constructed from in‐person assessments is unclear but may be relevant for retrospective ascertainment of frailty status when otherwise unmeasured. Methods and Results We linked adults aged ≥65 years in the US CoreValve Studies (linkage rate, 67%; mean age, 82.7±6.2 years, 43.1% women), to Medicare inpatient claims, 2011 to 2015. The Johns Hopkins CFI, validated on the basis of the Fried index, was generated for each study participant, and the association between CFI tertile and trial outcomes was evaluated as part of the EXTEND‐FRAILTY substudy. Among 2357 participants (64.9% frail), higher CFI tertile was associated with greater impairments in nutrition, disability, cognition, and self‐rated health. The primary outcome of all‐cause mortality at 1 year occurred in 19.3%, 23.1%, and 31.3% of those in tertiles 1 to 3, respectively (tertile 2 versus 1: hazard ratio, 1.22; 95% CI, 0.98–1.51; P=0.07; tertile 3 versus 1: hazard ratio, 1.73; 95% CI, 1.41–2.12; P<0.001). Secondary outcomes (bleeding, major adverse cardiovascular and cerebrovascular events, and hospitalization) were more frequent with increasing CFI tertile and persisted despite adjustment for age, sex, New York Heart Association class, and Society of Thoracic Surgeons risk score. Conclusions In linked Medicare and CoreValve study data, a CFI based on the Fried index consistently identified individuals with worse impairments in frailty, disability, cognitive dysfunction, and nutrition and a higher risk of death, hospitalization, bleeding, and major adverse cardiovascular and cerebrovascular events, independent of age and risk category. While not a surrogate for validated metrics of frailty using in‐person assessments, use of this CFI to ascertain frailty status among patients with aortic valve disease may be valid and prognostically relevant information when otherwise not measured.
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Affiliation(s)
- Jordan B Strom
- Department of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.,Harvard Medical School Boston MA
| | - Jiaman Xu
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.,Harvard Medical School Boston MA
| | - Ariela R Orkaby
- Harvard Medical School Boston MA.,Department of Medicine Veterans Affairs Healthcare System Boston MA
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.,Harvard Medical School Boston MA
| | - Brian R Charest
- Harvard Medical School Boston MA.,Department of Medicine Veterans Affairs Healthcare System Boston MA
| | - Dae H Kim
- Harvard Medical School Boston MA.,Division of Gerontology Beth Israel Deaconess Medical Center Boston MA
| | | | - Daniel B Kramer
- Department of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.,Harvard Medical School Boston MA
| | - John A Spertus
- Section of Cardiovascular Disease University of Missouri-Kansas City School of Medicine Kansas City MO
| | - Robert E Gerszten
- Department of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MA.,Harvard Medical School Boston MA
| | - Robert W Yeh
- Department of Medicine Cardiovascular Division Beth Israel Deaconess Medical Center Boston MA.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology Beth Israel Deaconess Medical Center Boston MA.,Harvard Medical School Boston MA
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Fleyshman DI, Wakshlag JJ, Huson HJ, Loftus JP, Olby NJ, Brodsky L, Gudkov AV, Andrianova EL. Development of infrastructure for a systemic multidisciplinary approach to study aging in retired sled dogs. Aging (Albany NY) 2021; 13:21814-21837. [PMID: 34587118 PMCID: PMC8507265 DOI: 10.18632/aging.203600] [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: 08/17/2021] [Accepted: 09/25/2021] [Indexed: 12/14/2022]
Abstract
Canines represent a valuable model for mammalian aging studies as large animals with short lifespans, allowing longitudinal analyses within a reasonable time frame. Moreover, they develop a spectrum of aging-related diseases resembling that of humans, are exposed to similar environments, and have been reasonably well studied in terms of physiology and genetics. To overcome substantial variables that complicate studies of privately-owned household dogs, we have focused on a more uniform population composed of retired Alaskan sled dogs that shared similar lifestyles, including exposure to natural stresses, and are less prone to breed-specific biases than a pure breed population. To reduce variability even further, we have collected a population of 103 retired (8-11 years-old) sled dogs from multiple North American kennels in a specialized research facility named Vaika. Vaika dogs are maintained under standardized conditions with professional veterinary care and participate in a multidisciplinary program to assess the longitudinal dynamics of aging. The established Vaika infrastructure enables periodic gathering of quantitative data reflecting physical, physiological, immunological, neurological, and cognitive decline, as well as monitoring of aging-associated genetic and epigenetic alterations occurring in somatic cells. In addition, we assess the development of age-related diseases such as arthritis and cancer. In-depth data analysis, including artificial intelligence-based approaches, will build a comprehensive, integrated model of canine aging and potentially identify aging biomarkers that will allow use of this model for future testing of antiaging therapies.
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Affiliation(s)
| | - Joseph J Wakshlag
- Cornell University College of Veterinary Medicine, Ithaca, NY 14853, USA
| | - Heather J Huson
- Cornell University College of Agriculture and Life Sciences, Ithaca, NY 14853, USA
| | - John P Loftus
- Cornell University College of Veterinary Medicine, Ithaca, NY 14853, USA
| | - Natasha J Olby
- North Carolina State University College of Veterinary Medicine, Raleigh, NC 27606, USA
| | - Leonid Brodsky
- Tauber Bioinformatic Research Center, University of Haifa, Haifa, Israel
| | - Andrei V Gudkov
- Vaika, Inc., East Aurora, NY 14052, USA.,Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
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Soto-Añari M, Camargo L, Ramos-Henderson M, Rivera-Fernández C, Denegri-Solís L, Calle U, Mori N, Ocampo-Barbá N, López F, Porto M, Caldichoury-Obando N, Saldías C, Gargiulo P, Castellanos C, Shelach-Bellido S, López N. Prevalence of Dementia and Associated Factors among Older Adults in Latin America during the COVID-19 Pandemic. Dement Geriatr Cogn Dis Extra 2021; 11:213-221. [PMID: 34721498 PMCID: PMC8543347 DOI: 10.1159/000518922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a great impact on cognitive health in Latin American older adults, increasing the risk of cognitive impairment and dementia. Our objective was to analyze the prevalence of dementia and the associated factors in Latin American older adults during SARS-CoV-2 pandemic. METHODS A multicentric first phase cross-sectional observational study was conducted during the SARS-CoV-2 pandemic. Five thousand two hundred and forty-five Latin American adults over 60 years of age were studied in 10 countries: Argentina, Bolivia, Chile, Colombia, Ecuador, Guatemala, Mexico, Peru, the Dominican Republic, and Venezuela. We used the telephone version of Montreal Cognitive Assessment, the "Alzheimer Disease 8" scale for functional and cognitive changes, and the abbreviated version of the Yesavage depression scale. We also asked for sociodemographic and lockdown data. All the evaluation was made by telephone. Cross-tabulations and χ2 tests were used to determine the variability of the prevalence of impairment by sociodemographic characteristics and binary logistic regression to assess the association between dementia and sociodemographic factors. RESULTS We observed that the prevalence of dementia in Latin America is 15.6%, varying depending on the country (Argentine = 7.83 and Bolivia = 28.5%). The variables most associated with dementia were race and age. It does not seem to be associated with the pandemic but with social and socio-health factors. CONCLUSION The prevalence of dementia shows a significant increase in Latin America, attributable to a constellation of ethnic, demographic, and socioeconomic factors.
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Affiliation(s)
- Marcio Soto-Añari
- Laboratorio de Neurociencia, Departamento de Psicología, Universidad Católica San Pablo, Arequipa, Peru
| | - Loida Camargo
- Escuela de Medicina, Universidad del Sinú, Cartagena de Indias, Colombia
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas Jaime Fandiño Franky (FIRE), Cartagena de Indias, Colombia
| | - Miguel Ramos-Henderson
- Centro de Investigación e Innovación en Gerontología Aplicada (CIGAP), Facultad de Salud, Universidad Santo Tomás, Santiago, Chile
| | | | | | | | | | - Ninoska Ocampo-Barbá
- Instituto de Neurociencias Comportamentales (INCC), Universidad Autónoma Gabriel René Moreno (UAGRM), Santa Cruz de la Sierra, Bolivia
| | - Fernanda López
- Hospital Nacional Dr. Alejandro Posadas, Buenos Aires, Argentina
| | - Maria Porto
- Universidad de La Costa, Barranquilla, Colombia
| | | | - Carol Saldías
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Valdivia, Chile
| | - Pascual Gargiulo
- Laboratorio de Neurociencias y Psicología Experimental, CONICET, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Cesar Castellanos
- Instituto Dominicano para el estudio de la Salud Integral y la Psicología Aplicada (IDESIP), Santo Domingo, Dominican Republic
| | - Salomon Shelach-Bellido
- Laboratorio de Neurociencia, Departamento de Psicología, Universidad Católica San Pablo, Arequipa, Peru
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Frailty Assessment in Heart Failure and Ventricular Assist Device Populations: A Review from the United States. Heart Lung 2021; 50:941-952. [PMID: 34433112 DOI: 10.1016/j.hrtlng.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Post-operative risk is increased with frail individuals undergoing cardiac surgery. Yet, there is no consensus for frailty assessment prior to durable left ventricular assist device (dLVAD) evaluation. OBJECTIVE The objectives of this integrative review were to describe frailty measures, examine psychometrics of measures used, and identify variables related to frailty in heart failure with reduced ejection fraction (HFrEF) and dLVAD populations. DESIGN, SETTING, PARTICIPANTS PubMed, CINAHL, and Embase databases were searched for terms related to frailty, HFrEF and dLVAD that met inclusion criteria. RESULTS Fourteen articles met inclusion criteria. Frailty was inconsistently defined. The Fried Phenotype Criteria was the most widely used approach to measurement. Validity was reported in all articles. Variables related to frailty included readmissions, higher mortality and increased adverse events. CONCLUSION There was variability in frailty definition and frailty measurement across studies. Further research in HFrEF and dLVAD populations is needed for frailty evaluation.
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Mandelblatt JS, Ahles TA, Lippman ME, Isaacs C, Adams-Campbell L, Saykin AJ, Cohen HJ, Carroll J. Applying a Life Course Biological Age Framework to Improving the Care of Individuals With Adult Cancers: Review and Research Recommendations. JAMA Oncol 2021; 7:1692-1699. [PMID: 34351358 PMCID: PMC8602673 DOI: 10.1001/jamaoncol.2021.1160] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The practice of oncology will increasingly involve the care of a growing population of individuals with midlife and late-life cancers. Managing cancer in these individuals is complex, based on differences in biological age at diagnosis. Biological age is a measure of accumulated life course damage to biological systems, loss of reserve, and vulnerability to functional deterioration and death. Biological age is important because it affects the ability to manage the rigors of cancer therapy, survivors' function, and cancer progression. However, biological age is not always clinically apparent. This review presents a conceptual framework of life course biological aging, summarizes candidate measures, and describes a research agenda to facilitate clinical translation to oncology practice. Observations Midlife and late-life cancers are chronic diseases that may arise from cumulative patterns of biological aging occurring over the life course. Before diagnosis, each new patient was on a distinct course of biological aging related to past exposures, life experiences, genetics, and noncancer chronic disease. Cancer and its treatments may also be associated with biological aging. Several measures of biological age, including p16INK4a, epigenetic age, telomere length, and inflammatory and body composition markers, have been used in oncology research. One or more of these measures may be useful in cancer care, either alone or in combination with clinical history and geriatric assessments. However, further research will be needed before biological age assessment can be recommended in routine practice, including determination of situations in which knowledge about biological age would change treatment, ascertaining whether treatment effects on biological aging are short-lived or persistent, and testing interventions to modify biological age, decrease treatment toxic effects, and maintain functional abilities. Conclusions and Relevance Understanding differences in biological aging could ultimately allow clinicians to better personalize treatment and supportive care, develop tailored survivorship care plans, and prescribe preventive or ameliorative therapies and behaviors informed by aging mechanisms.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.,Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Marc E Lippman
- Department of Medicine, Georgetown University Medical Center, Washington, DC.,Department of Oncology, Breast Cancer Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Claudine Isaacs
- Department of Medicine, Georgetown University Medical Center, Washington, DC.,Department of Oncology, Breast Cancer Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Lucile Adams-Campbell
- Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Andrew J Saykin
- Radiology and Imaging Sciences, Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana Alzheimer's Disease Research Center and the Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Judith Carroll
- UCLA Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, and Cousins Center for Psychoneuroimmunology, Los Angeles, California
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Abstract
There is growing interest in conceptualizing and diagnosing frailty. Less is understood, however, about older adults' perceptions of the term "frail", and the implications of being classified as "frail". The purpose of this scoping review was to map the breadth of primary studies; and describe the meaning, perceptions, and perceived implications of frailty language amongst community-dwelling older adults. Eight studies were included in the review and three core themes were identified: (1) understanding frailty as inevitable age-related decline in multiple domains, (2) perceiving frailty as a generalizing label, and (3) perceiving impacts of language on health and health care utilization. Clinical practice recommendations for health care professionals working with individuals with frailty include: (1) maintaining a holistic view of frailty that extends beyond physical function to include psychosocial and environmental constructs, (2) using person-first language, and (3) using a strengths-based approach to discuss aspects of frailty.
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Cruz AM, Monsalve L, Ladurner AM, Jaime LF, Wang D, Quiroga DA. Information and Communication Technologies for Managing Frailty: A Systematic Literature Review. Aging Dis 2021; 12:914-933. [PMID: 34094651 PMCID: PMC8139198 DOI: 10.14336/ad.2020.1114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022] Open
Abstract
Frailty is a prevalent condition among Canadians; over one million are diagnosed as medically frail, and in the next ten years this number will double. Information and telecommunication technologies can provide a low-cost method for managing frailty more proactively. This study aims to examine the range and extent of information and telecommunication technologies for managing frailty in older adults, their technology readiness level, the evidence, and the associated outcomes. A systematic literature review was conducted. Four databases were searched for studies: Medline, EMBASE, CINAHL, and Web of Science. In total, we included 19 studies (out of 9,930) for the data abstraction. Overall, our findings indicate that (1) the proposed frailty phenotype is the most common ground truth to be used for assessing frailty; (2) the most common uses of information and telecommunication technologies for managing frailty are detection, and monitoring and detection, while interventional studies on frailty are very rare; (3) the five main types of information and telecommunication technologies for managing frailty in older adults are information and telecommunication technology-based platforms, smartphones, telemonitoring (home monitoring), wearable sensors and devices (commercial off-the-shelf), and multimedia formats for online access; (4) the technology readiness level of information and telecommunication technologies for managing frailty in older adults is the “Technology Demonstration” level, i.e., not yet ready to be operated in an actual operating environment; and (5) the level of evidence is still low for information and telecommunication technology studies that manage frailty in older adults. In conclusion, information and telecommunication technologies for managing frailty in the older adult population are not yet ready to be full-fledged technologies for this purpose.
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Affiliation(s)
- Antonio Miguel Cruz
- 1Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,2Glenrose Rehabilitation Research, Innovation & Technology (GRRIT) Hub, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada.,3Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Laura Monsalve
- 4School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Anna-Maria Ladurner
- 1Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Luisa Fernanda Jaime
- 4School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Daniel Wang
- 1Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Gracie TJ, Caufield-Noll C, Wang NY, Sieber FE. The Association of Preoperative Frailty and Postoperative Delirium: A Meta-analysis. Anesth Analg 2021; 133:314-323. [PMID: 34257192 DOI: 10.1213/ane.0000000000005609] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Both frailty and postoperative delirium (POD) are common in elective surgical patients 65 years of age and older. However, the association between preoperative frailty and POD remains difficult to characterize owing to the large number of frailty and POD assessment tools used in the literature, only a few of which are validated. Furthermore, some validated frailty tools fail to provide clear score cutoffs for distinguishing frail and nonfrail patients. We performed a meta-analysis to estimate the relationship between preoperative frailty and POD. METHODS We searched several major databases for articles that investigated the relationship between preoperative frailty and POD in patients with mean age ≥65 years who were undergoing elective, nonemergent inpatient surgery. Inclusion criteria included articles published in English no earlier than 1999. Both preoperative frailty and POD must have been measured with validated tools using clear cutoff scores for frailty and delirium. Articles were selected and data extracted independently by 2 researchers. Risk of bias (ROBINS-I) and presence of confounders were summarized. Odds ratios (ORs) for POD associated with frailty relative to nonfrailty were computed with adjusted ORs when available. Original estimates were pooled by random effects analysis. Statistical significance was set at 2-sided P < .05. RESULTS Nine studies qualified for meta-analysis. The Fried score or a modified version of it was used in 5 studies. Frailty prevalence ranged from 18.6% to 56%. Delirium was assessed with the Confusion Assessment Method (CAM) or Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in 7 studies, Delirium Observation Scale in 1 study, and Intensive Care Delirium Screening Checklist in 1 study. The incidence of POD ranged from 7% to 56%. ROBINS-I risk of bias was low in 1 study, moderate in 4 studies, serious in 3 studies, and critical in 1 study. Random effects analysis (n = 794) of the OR for POD in frail versus nonfrail patients based on adjusted OR estimates was significant with an OR of 2.14 and a 95% confidence interval of 1.43-3.19. The I2 value was in the low range at 5.5, suggesting small variability from random effects. Funnel-plot analysis did not definitively support either the presence or absence of publication bias. CONCLUSIONS This meta-analysis provides evidence for a significant association between preoperative frailty and POD in elective surgical patients age 65 years or older.
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Affiliation(s)
- Thomas J Gracie
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine Caufield-Noll
- Library Services, Harrison Library, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Nae-Yuh Wang
- Departments of Medicine (General Internal Medicine), Biostatistics, and Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Frederick E Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cluley V, Martin G, Radnor Z, Banerjee J. Frailty as biographical disruption. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:948-965. [PMID: 33969903 DOI: 10.1111/1467-9566.13269] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
Biographical disruption positions the onset of chronic illness as a major life disruption in which changes to body, self and resources occur (Sociology of Health & Illness, 4, 1982, 167-182). The concept has been used widely in medical sociology. It has also been subject to critique and development by numerous scholars. In this paper, we build on recent developments of the concept, particularly those taking a phenomenological approach, to argue that it can also help in understanding other disruptive health-related experiences across the life course, in this case the onset of frailty. We draw on the findings of 30 situated interviews with frail older people, relating their experiences of frailty to the concept of biographical disruption. We show that frailty shares many similarities with the experience of chronic illness. Using the lens of biographical disruption to understand frailty also offers insights relevant to recent debates around both concepts, and on the continued relevance of the idea of biographical disruption given changing experiences of health and illness, including the circumstances in which biographical disruption is more and less likely to be experienced. Finally, we reflect on the potentials and limitations of applying the concept to a health-related condition that cannot be categorised as a disease.
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Affiliation(s)
- Victoria Cluley
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Graham Martin
- THIS Institute, University of Cambridge, Cambridge, UK
| | - Zoe Radnor
- The Business School (formerly Cass), City, University of London, London, UK
| | - Jay Banerjee
- University Hospitals of Leicester, NHS Trust, Leicester, UK
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Spiers GF, Kunonga TP, Hall A, Beyer F, Boulton E, Parker S, Bower P, Craig D, Todd C, Hanratty B. Measuring frailty in younger populations: a rapid review of evidence. BMJ Open 2021; 11:e047051. [PMID: 33753447 PMCID: PMC7986767 DOI: 10.1136/bmjopen-2020-047051] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/11/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Frailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care. DESIGN A rapid review of primary studies was conducted. DATA SOURCES Four databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020. ELIGIBILITY CRITERIA Eligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English. DATA EXTRACTION AND SYNTHESIS Records were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach. RESULTS We identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18-59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care. CONCLUSIONS Limited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.
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Affiliation(s)
- Gemma F Spiers
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tafadzwa Patience Kunonga
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Hall
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fiona Beyer
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Boulton
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stuart Parker
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Craig
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Barbara Hanratty
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Efthymiou A, Hersberger L, Reber E, Schönenberger KA, Kägi-Braun N, Tribolet P, Mueller B, Schuetz P, Stanga Z. Nutritional risk is a predictor for long-term mortality: 5-Year follow-up of the EFFORT trial. Clin Nutr 2021; 40:1546-1554. [PMID: 33743290 DOI: 10.1016/j.clnu.2021.02.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The nutritional risk screening (NRS 2002) is a validated screening tool for malnutrition. This study aims to investigate the prognostic value of the NRS 2002 and its individual components regarding long-term mortality and adverse outcomes in a well-characterized cohort of medical inpatients. METHODS We performed a 5-year follow-up investigation of patients included in the investigator-initiated, prospective, randomized controlled multicenter EFFORT trial that evaluated the effects of individualized nutritional intervention vs. standard hospital food. We used multivariable cox regression analyses adjusted for randomisation arm, study centre, comorbidities and main admission diagnosis to investigate associations between NRS 2002 total scores at time of hospital admission and several long-term outcomes. RESULTS We had confirmed mortality data over the mean follow-up time of 3.2 years in 1874 from the initial cohort of 2028 EFFORT patients. Mortality showed a step-wise increase in patients with NRS 3 (289/565 [51.2%]) and NRS 4 (355/717 [49.6%]) to 59.5% (353/593) in patient with NRS≥5 corresponding to an adjusted Hazard Ratio (HR) of 1.28 (95%CI 1.15 to 1.42, p ≤ 0.001) for mortality after one year and 1.13 (95%CI 1.05 to 1.23, p = 0.002) for the overall time period. All individual components of NRS including disease severity, food intake, weight loss and BMI provided prognostic information regarding long-term mortality risk. CONCLUSION Nutritional risk mirrored by a NRS 2002 total score is a strong and independent predictor of long-term mortality and morbidity in polymorbid medical inpatients particularly in patients with high nutritional risk with an NRS ≥5 points.
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Affiliation(s)
- Andriana Efthymiou
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lara Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emilie Reber
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | | | | | | | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Association between Phthalate Exposure and Frailty among Community-Dwelling Older Adults: A Repeated Panel Data Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041985. [PMID: 33670787 PMCID: PMC7922338 DOI: 10.3390/ijerph18041985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
Only a few studies have examined the impacts of environmental exposure on frailty. This study investigated the association between phthalates and frailty among community-dwelling older adults. The Korean Elderly Environmental Panel II (KEEP II) study is a repeated panel data study of 800 community-dwelling older adults in South Korea. Frailty was measured with five items defined by Fried and colleagues. Environmental pollutants in the form of two types of metabolites for Di-ethylhexyl phthalate (DEHPs)-Mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and Mono (2-ethyl-5-oxohexyl) phthalate (MEOHP)-were obtained from urine specimens. Analyses were performed using repeated linear mixed models. The concentration levels of both MEOHP and MEHHP in urine were significantly higher in the pre-frail or frail group than its counterparts. While adjusting for covariates, MEOHP level was positively associated with the likelihood of being pre-frail or frail in both males and females; the concentration level of MEHHP also had a positive impact on the likelihood of being pre-frail or frail in females. The DEHP metabolite concentrations were significantly lower among adults with daily fruit consumption in both males and females. DEHPs, measured by metabolite concentrations, may increase the risk of frailty among older men and women; further studies are necessary. The preventive effects of nutrition on DEHP risk should also be further investigated.
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Liu J, Palmgren T, Ponzer S, Masiello I, Farrokhnia N. Can dedicated emergency team and area for older people reduce the hospital admission rate? - An observational pre- and post-intervention study. BMC Geriatr 2021; 21:115. [PMID: 33568087 PMCID: PMC7877031 DOI: 10.1186/s12877-021-02044-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Emergency department (ED) care of older patients is often complex. Geriatric ED guidelines can help to meet this challenge. However, training requirements, the use of time-consuming tools for comprehensive geriatric assessment (CGA), a lack of golden standard to identify the frail patients, and the weak evidence of positive outcomes of using CGA in EDs pose barriers to introduce the guidelines. Dedicating an interprofessional team of regular ED medical and nursing staff and an older-friendly ED area can be another approach. Previous studies of geriatrician-led CGA in EDs have reported a reduced hospital admission rate. The aim of this study was to investigate whether a dedicated interprofessional emergency team also can reduce the hospital admission rate without the resources required by the formal use of CGA. METHODS An observational pre-post study at a large adult ED, where all patients 80 years or older arriving on weekdays in the intervention period from 2016.09.26 to 2016.11.28 and the corresponding weekdays in the previous year from 2015.09.28 to 2015.11.30 were included. In the intervention period, older patients either received care in the geriatric module by the dedicated team or in the regular team modules for patients of mixed ages. In 2015, all patients received care in regular team modules. The primary outcome measure was the total hospital admission rate and the ED length of stay was the secondary outcome measure. RESULTS We included 2377 arrivals in the intervention period, when 26.7% (N = 634) received care in the geriatric module, and 2207 arrivals in the 2015 period. The total hospital admission rate was 61.7% (N = 1466/2377) in the intervention period compared to 64.8% (N = 1431/2207) in 2015 (p = 0.03). The difference was larger for patients treated in the geriatric module, 51.1% compared to 62.1% (95% CI: 56.3 to 68.0%) for patients who would have been eligible in 2015. The ED length of stay was longer in the intervention period. CONCLUSIONS An interprofessional team and area dedicated to older patients was associated to a lower hospital admission rate. Further studies are needed to confirm the results.
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Affiliation(s)
- Jenny Liu
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖS, Sjukhusbacken 10, 118 83, Stockholm, Sweden.
| | - Therese Palmgren
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖS, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖS, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Italo Masiello
- Department of Computer Science and Media Technology, Linnaeus University, Växjö, Sweden
| | - Nasim Farrokhnia
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset AB, KI SÖS, Sjukhusbacken 10, 118 83, Stockholm, Sweden
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Davies K, Maharani A, Chandola T, Todd C, Pendleton N. The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: a prospective analysis. THE LANCET HEALTHY LONGEVITY 2021; 2:e70-e77. [DOI: 10.1016/s2666-7568(20)30038-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
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80
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Blodgett JM, Rockwood K, Theou O. Changes in the severity and lethality of age-related health deficit accumulation in the USA between 1999 and 2018: a population-based cohort study. LANCET HEALTHY LONGEVITY 2021; 2:e96-e104. [DOI: 10.1016/s2666-7568(20)30059-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
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81
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Mandelblatt JS, Zhou X, Small BJ, Ahn J, Zhai W, Ahles T, Extermann M, Graham D, Jacobsen PB, Jim H, McDonald BC, Patel SJ, Root JC, Saykin AJ, Cohen HJ, Carroll JE. Deficit Accumulation Frailty Trajectories of Older Breast Cancer Survivors and Non-Cancer Controls: The Thinking and Living With Cancer Study. J Natl Cancer Inst 2021; 113:1053-1064. [PMID: 33484565 DOI: 10.1093/jnci/djab003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/27/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We evaluated deficit accumulation and how deficits affected cognition and physical activity among breast cancer survivors and non-cancer controls. METHODS Newly diagnosed nonmetastatic survivors (n = 353) and matched non-cancer controls (n = 355) ages 60-98 years without neurological impairments were assessed presystemic therapy (or at enrollment for controls) from August 2010 to December 2016 and followed for 36 months. Scores on a 42-item index were analyzed in growth-mixture models to determine deficit accumulation trajectories separately and combined for survivors and controls. Multilevel models tested associations between trajectory and cognition (FACT-Cog and neuropsychological tests) and physical activity (IPAQ-SF) for survivors and controls. RESULTS Deficit accumulation scores were in the robust range, but survivors had higher scores (95% confidence intervals [CI]) than controls at 36 months (0.18, 95% CI = 0.16 to 0.19, vs 0.16, 95% CI = 0.14 to 0.17; P = .001), and averages included diverse deficit trajectories. Survivors who were robust but became frailer (8.8%) had similar baseline characteristics to those remaining robust (76.2%) but experienced a 9.6-point decline self-reported cognition (decline of 9.6 vs 3.2 points; P = .04) and a 769 MET minutes per week decline in physical activity (P < .001). Survivors who started and remained prefrail (15.0%) had self-reported and objective cognitive problems. At baseline, frail controls (9.5%) differed from robust controls (83.7%) on deficits and self-reported cognition (P < .001). Within combined trajectories, frail survivors had more sleep disturbances than frail controls (48.6% [SD = 17.4%] vs 25.0% [SD = 8.2%]; P = .05). CONCLUSIONS Most survivors and controls remained robust, and there were similar proportions on a frail trajectory. However, there were differences in deficit patterns between survivors and controls. Survivor deficit accumulation trajectory was associated with patient-reported outcomes. Additional research is needed to understand how breast cancer and its treatments affect deficit accumulation.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | | | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunita J Patel
- Departments of Population Sciences and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Departments of Psychiatry and Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Harvey Jay Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Judith E Carroll
- UCLA Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, and Cousins Center for Psychoneuroimmunology, Los Angeles, CA, USA
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Wilkinson C, Wu J, Searle SD, Todd O, Hall M, Kunadian V, Clegg A, Rockwood K, Gale CP. Clinical outcomes in patients with atrial fibrillation and frailty: insights from the ENGAGE AF-TIMI 48 trial. BMC Med 2020; 18:401. [PMID: 33357217 PMCID: PMC7758931 DOI: 10.1186/s12916-020-01870-w] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/25/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is common in older people with frailty and is associated with an increased risk of stroke and systemic embolism. Whilst oral anticoagulation is associated with a reduction in this risk, there is a lack of data on the safety and efficacy of direct oral anticoagulants (DOACs) in people with frailty. This study aims to report clinical outcomes of patients with AF in the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48 (ENGAGE AF-TIMI 48) trial by frailty status. METHODS Post hoc analysis of 20,867 participants in the ENGAGE AF-TIMI 48 trial, representing 98.8% of those randomised. This double-blinded double-dummy trial compared two once-daily regimens of edoxaban (a DOAC) with warfarin. Participants were categorised as fit, living with pre-frailty, mild-moderate, or severe frailty according to a standardised index, based upon the cumulative deficit model. The primary efficacy endpoint was stroke or systemic embolism and the safety endpoint was major bleeding. RESULTS A fifth (19.6%) of the study population had frailty (fit: n = 4459, pre-frailty: n = 12,326, mild-moderate frailty: n = 3722, severe frailty: n = 360). On average over the follow-up period, the risk of stroke or systemic embolism increased by 37% (adjusted HR 1.37, 95% CI 1.19-1.58) and major bleeding by 42% (adjusted HR 1.42, 1.27-1.59) for each 0.1 increase in the frailty index (four additional health deficits). Edoxaban was associated with similar efficacy to warfarin in every frailty category, and a lower risk of bleeding than warfarin in all but those living with severe frailty. CONCLUSIONS Edoxaban was similarly efficacious to warfarin across the frailty spectrum and was associated with lower rates of bleeding except in those with severe frailty. Overall, with increasing frailty, there was an increase in stroke and bleeding risk. There is a need for high-quality, frailty-specific population randomised control trials to guide therapy in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov NCT00781391 . First registered on 28 October 2008.
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Affiliation(s)
- Chris Wilkinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - Jianhua Wu
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Samuel D Searle
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Oliver Todd
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kenneth Rockwood
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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83
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Cross-sectoral inter-rater reliability of the clinical frailty scale - a Danish translation and validation study. BMC Geriatr 2020; 20:443. [PMID: 33143651 PMCID: PMC7640648 DOI: 10.1186/s12877-020-01850-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Focus on frailty status has become increasingly important when determining care plans within and across health care sectors. A standardized frailty measure applicable for both primary and secondary health care sectors is needed to provide a common reference point. The aim of this study was to translate the Clinical Frailty Scale (CFS) into Danish (CFS-DK) and test inter-rater reliability for key health care professionals in the primary and secondary sectors using the CFS-DK. METHODS The Clinical Frailty Scale was translated into Danish using the ISPOR principles for translation and cultural adaptation that included forward and back translation, review by the original developer, and cognitive debriefing. For the validation exercise, 40 participants were asked to rate 15 clinical case vignettes using the CFS-DK. The raters were distributed across several health care professions: primary care physicians (n = 10), community nurses (n = 10), hospital doctors from internal medicine (n = 10) and intensive care (n = 10). Inter-rater reliability was assessed using intraclass correlation coefficients (ICC), and sensitivity analysis was performed using multilevel random effects linear regression. RESULTS The Clinical Frailty Scale was translated and culturally adapted into Danish and is presented in this paper in its final form. Inter-rater reliability in the four professional groups ranged from ICC 0.81 to 0.90. Sensitivity analysis showed no significant impact of professional group or length of clinical experience. The health care professionals considered the CFS-DK to be relevant for their own area of work and for cross-sectoral collaboration. CONCLUSION The Clinical Frailty Scale was translated and culturally adapted into Danish. The inter-rater reliability was high in all four groups of health care professionals involved in cross-sectoral collaborations. However, the use of case vignettes may reduce the generalizability of the reliability findings to real-life settings. The CFS has the potential to serve as a common reference tool when treating and rehabilitating older patients.
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84
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Sillner AY, McConeghy RO, Madrigal C, Culley DJ, Arora RC, Rudolph JL. The Association of a Frailty Index and Incident Delirium in Older Hospitalized Patients: An Observational Cohort Study. Clin Interv Aging 2020; 15:2053-2061. [PMID: 33173286 PMCID: PMC7646464 DOI: 10.2147/cia.s249284] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/12/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction/Background Frailty identifies patients that have vulnerability to stress. Acute illness and hospitalization are stressors that may result in delirium and further accelerate the negative consequences of frailty. Purpose The purpose of this study was to determine whether frailty, identified at hospital admission and as measured by a frailty index, is associated with incident delirium. Methods A retrospective, observational, cohort study was done at a Veterans hospital between January 2013 and March 2014. English-speaking patients over 55 years were eligible. Exclusion criteria included inability to complete baseline assessments due to pre-existing cognitive impairment, emergent surgery; and/or admission from a nursing home, pre-existing delirium, and those with psychiatric disease or substance use disorder. Main Outcomes and Measures Frailty index (FI) variables included cognitive screening, physical function and comorbidities. The FI was calculated as a proportion of possible deficits (range 0 to 1; higher scores indicate increased frailty). Incident delirium was measured daily by an expert clinician interview. Results A total of 247 patients were admitted and 218 met inclusion/exclusion criteria, with a mean age of 71.54 years (SD = 9.53 years) and were predominantly white (92.7%) and male (91.7%). Participants were grouped using FI ranges as non-frail (FI <0.25, n=56 (26%)), pre-frail (FI =0.25–0.35, n=86 (39%)), and frail (FI >0.35, n=76 (35%)). Pre-frailty and frailty were associated with incident delirium (non-frail: 3.6% vs pre-frail: 20.9% vs frail: 29.3%, p=0.001) and total delirium days (mean day =non-frail 0.04 vs pre-frail 0.35 vs frail 0.57, p=0.003). After adjustment for sociodemographic factors, pre-frail (adjusted OR=5.64, 95% CI: 1.23, 25.99) and frail status (adjusted OR=6.80, 95% CI: 1.38, 33.45) were independently associated with delirium. Conclusion This study demonstrates that a frailty index is independently associated with incident delirium and suggests that admission assessments for frailty may identify patients at high risk of developing delirium.
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Affiliation(s)
- Andrea Yevchak Sillner
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA.,College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Robert Owens McConeghy
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Caroline Madrigal
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Deborah J Culley
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rakesh C Arora
- Max Rady College of Medicine, Department of Surgery, University of Manitoba, Manitoba, ON, Canada.,Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, ON, Canada
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA.,Warren Alpert Medical School and School of Public Health, Brown University, Providence, RI, USA
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Nutritional Assessment: A Primary Component of the Multidimensional Geriatric Assessment in the Intensive Care Unit. Crit Care Clin 2020; 37:205-219. [PMID: 33190771 DOI: 10.1016/j.ccc.2020.08.011] [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: 11/23/2022]
Abstract
The importance of evaluating and adjusting the nutritional state of critically ill patients has become a core principle of care. This article focuses on tools for the nutritional assessment of geriatric intensive care unit patients, including a review of imaging and other standardized techniques for evaluation of muscle mass, an indicator of malnutrition and sarcopenia. It concludes with a discussion of the interplay of malnutrition, reduced muscle mass/sarcopenia, and frailty. The goal of this multidimensional assessment is to identify those at risk and thereby initiate interventions to improve outcomes.
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86
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Gillis C, Fenton TR, Gramlich L, Sajobi TT, Culos-Reed SN, Bousquet-Dion G, Elsherbini N, Fiore JF, Minnella EM, Awasthi R, Liberman AS, Boutros M, Carli F. Older frail prehabilitated patients who cannot attain a 400 m 6-min walking distance before colorectal surgery suffer more postoperative complications. Eur J Surg Oncol 2020; 47:874-881. [PMID: 33041092 DOI: 10.1016/j.ejso.2020.09.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Recent efforts to prehabilitate intermediately frail and frail (Fried frailty criteria ≥2) elective colorectal cancer patients did not influence clinical nor functional outcomes. The objective of this secondary analysis was to describe the subset of intermediately frail and frail prehabilitated patients who could not attain a minimum 400 m (a prognostic cut-point used in other patient populations) 6-min walking distance (6MWD) before elective surgery. MATERIALS AND METHODS Secondary analysis of a randomized controlled trial. Patients participated in multimodal prehabilitation at home and in-hospital for approximately four weeks before colorectal surgery. Primary outcome was incidence of postoperative complications within 30 days of hospital discharge. RESULTS Sixty percent of the patients who participated in prehabilitation did not reach a minimum walking distance of 400 m in 6 min before surgery. Compared to the group that attained ≥400 m 6MWD (n = 19), the <400 m group (n = 28) were older, had higher percent body fat, lower physical function, lower self-reported physical activity, higher American Society of Anesthesiologists (ASA) classification, and twice as many were in critical need of a nutrition intervention at baseline. No group differences were observed regarding frailty status (P = 0.775). Sixty-one percent of the <400 m 6MWD group experienced at least one complication within 30 days of surgery compared to 21% in the ≥400 m group (P = 0.009). CONCLUSION Several preoperative characteristics were identified in the <400 m 6MWD group that could be useful in screening and targeting future prehabilitative treatments. Future trials should investigate use of a 400 m standard for the 6MWD as a minimal treatment target for prehabilitation.
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Affiliation(s)
- Chelsia Gillis
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Canada; Nutrition Lead, Peri Operative Program, McGill University, Montreal, Calgary, Alberta, Canada
| | - Tanis R Fenton
- Department of Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Nutrition Services, Alberta Health Services, Calgary, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tolulope T Sajobi
- Cumming School of Medicine, Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology and Department of Oncology, Cumming School of Medicine, University of Calgary. Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Noha Elsherbini
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Enrico M Minnella
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada
| | - Rashami Awasthi
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada
| | - A Sender Liberman
- Department of Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Marylise Boutros
- Department of Surgery, McGill University Health Center, Montreal, QC, Canada
| | - F Carli
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada.
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Oliveira JS, Pinheiro MB, Fairhall N, Walsh S, Chesterfield Franks T, Kwok W, Bauman A, Sherrington C. Evidence on Physical Activity and the Prevention of Frailty and Sarcopenia Among Older People: A Systematic Review to Inform the World Health Organization Physical Activity Guidelines. J Phys Act Health 2020; 17:1247-1258. [PMID: 32781432 DOI: 10.1123/jpah.2020-0323] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Frailty and sarcopenia are common age-related conditions associated with adverse outcomes. Physical activity has been identified as a potential preventive strategy for both frailty and sarcopenia. The authors aimed to investigate the association between physical activity and prevention of frailty and sarcopenia in people aged 65 years and older. METHODS The authors searched for systematic reviews (January 2008 to November 2019) and individual studies (January 2010 to March 2020) in PubMed. Eligible studies were randomized controlled trials and longitudinal studies that investigated the effect of physical activity on frailty and/or sarcopenia in people aged 65 years and older. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate certainty of evidence. RESULTS Meta-analysis showed that physical activity probably prevents frailty (4 studies; frailty score pooled standardized mean difference, 0.24; 95% confidence interval, 0.04-0.43; P = .017, I2 = 57%, moderate certainty evidence). Only one trial investigated physical activity for sarcopenia prevention and did not provide conclusive evidence (risk ratio 1.08; 95% confidence interval, 0.10-12.19). Five observational studies showed positive associations between physical activity and frailty or sarcopenia prevention. CONCLUSIONS Physical activity probably prevents frailty among people aged 65 years and older. The impact of physical activity on the prevention of sarcopenia remains unknown, but observational studies indicate the preventive role of physical activity.
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Abstract
Patients with frailty experience substantial physical and emotional distress related to their condition and face increased morbidity and mortality compared with their nonfrail peers. Palliative care is an interdisciplinary medical specialty focused on improving quality of life for patients with serious illness, including those with frailty, throughout their disease course. Anesthesiology providers will frequently encounter frail patients in the perioperative period and in the intensive care unit (ICU) and can contribute to improving the quality of life for these patients through the provision of palliative care. We highlight the opportunities to incorporate primary palliative care, including basic symptom management and straightforward goals-of-care discussions, provided by the primary clinicians, and when necessary, timely consultation by a specialty palliative care team to assist with complex symptom management and goals-of-care discussions in the face of team and/or family conflict. In this review, we apply the principles of palliative care to patients with frailty and synthesize the evidence regarding methods to integrate palliative care into the perioperative and ICU settings.
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Affiliation(s)
- Rita C. Crooms
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura P. Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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89
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The Muller’s Ratchet and Aging. Trends Genet 2020; 36:395-402. [DOI: 10.1016/j.tig.2020.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022]
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Haren A, Lal R, Walker D, Nair R, Partridge J, Dhesi J. Frailty assessment in older urological patients prior to surgery: a systematic review and narrative synthesis. Ther Adv Urol 2020; 12:1756287220916614. [PMID: 32435276 PMCID: PMC7225795 DOI: 10.1177/1756287220916614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/07/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Radical cystectomy (RC) and urinary diversion are the recommended treatment for patients with muscle invasive bladder cancer. This is complex surgery, associated with significant patient morbidity and mortality. Frailty has been shown to be an independent risk factor for adverse outcomes in several surgical populations. Preoperative assessment of frailty is advocated in current guidelines but is not yet standard clinical practice. Aims: This systematic review and narrative synthesis aims to examine whether patients undergoing RC are assessed for frailty, what tools are used, and whether an association is found between frailty and adverse outcomes in this population. Results: Nine studies, published within the last 4 years, describe the use of tools reporting to measure frailty in the RC population. All demonstrate increased risk of adverse postoperative outcomes with higher frailty levels. Only one study used a validated frailty tool. The majority of studies measure frailty using variations on a tool derived from a large database (ACS-NSQIP) effectively counting co-morbidities, rather than assessing the multidomain nature of the frailty syndrome. Conclusion: The recognition of frailty as an important consideration in the perioperative period is welcome. This systematic review and narrative synthesis demonstrates the need for collaboration in research and delivery of clinical care for older surgical patients. Such collaboration may provide clarity regarding terms such as frailty and multimorbidity, preventing the development of assessment tools inaccurately measuring these discreet syndromes interchangeably. More accurate assessment of patients in terms of frailty, multimorbidity and functional status may allow better modification and shared decision making leading to improved postoperative outcomes in older patients undergoing RC.
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Affiliation(s)
- Andrea Haren
- Perioperative Medicine Fellow, Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK
| | - Rajni Lal
- Perioperative Care of Older People undergoing Surgery (POPS) Fellow, Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Walker
- Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK
| | - Rajesh Nair
- Consultant Urological Surgeon, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Judith Partridge
- Perioperative Care of Older People undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jugdeep Dhesi
- Perioperative Care of Older People undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
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Abstract
Thanks to advances in modern medicine over the past century, the world’s population has experienced a marked increase in longevity. However, disparities exist that lead to groups with both shorter lifespan and significantly diminished health, especially in the aged. Unequal access to proper nutrition, healthcare services, and information to make informed health and nutrition decisions all contribute to these concerns. This in turn has hastened the ageing process in some and adversely affected others’ ability to age healthfully. Many in developing as well as developed societies are plagued with the dichotomy of simultaneous calorie excess and nutrient inadequacy. This has resulted in mental and physical deterioration, increased non-communicable disease rates, lost productivity and quality of life, and increased medical costs. While adequate nutrition is fundamental to good health, it remains unclear what impact various dietary interventions may have on improving healthspan and quality of life with age. With a rapidly ageing global population, there is an urgent need for innovative approaches to health promotion as individual’s age. Successful research, education, and interventions should include the development of both qualitative and quantitative biomarkers and other tools which can measure improvements in physiological integrity throughout life. Data-driven health policy shifts should be aimed at reducing the socio-economic inequalities that lead to premature ageing. A framework for progress has been proposed and published by the World Health Organization in its Global Strategy and Action Plan on Ageing and Health. This symposium focused on the impact of nutrition on this framework, stressing the need to better understand an individual’s balance of intrinsic capacity and functional abilities at various life stages, and the impact this balance has on their mental and physical health in the environments they inhabit.
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92
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Cytokine signaling in the modulation of post-acute and chronic systemic inflammation: a review of the influence of exercise and certain drugs. AIMS ALLERGY AND IMMUNOLOGY 2020. [DOI: 10.3934/allergy.2020009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cubitt M, Downie E, Shakerian R, Lange PW, Cole E. Timing and methods of frailty assessments in geriatric trauma patients: A systematic review. Injury 2019; 50:1795-1808. [PMID: 31376920 DOI: 10.1016/j.injury.2019.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The trauma population is aging and better prognostic measures for geriatric trauma patients are required. Frailty rather than age appears to be associated with poor outcomes. This systematic review aimed to identify the optimum frailty assessment instrument and timing of assessment in patients aged over 65 years admitted to hospital after traumatic injury. The secondary aim was to evaluate outcomes associated with frailty in elderly trauma populations. METHODS This systematic review was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42018090620). A MEDLINE and EMBASE literature search was conducted from inception to June 2019 combining the concepts of injury, geriatric, frailty, assessment and prognosis. Included studies were in patients 65 years or older hospitalised after injury and exposed to an instrument meeting consensus definition for frailty assessment. Study quality was assessed using criteria for review of prognostic studies combined with a GRADE approach. RESULTS Twenty-eight papers met inclusion criteria. Twenty-eight frailty or component instruments were reported, and assessments of pre-injury frailty were made up to 1-year post injury. Pre-injury frailty prevalence varied from 13% (13/100) to 94% (17/18), with in-hospital mortality rates from 2% (5/250) to 33% (6/18). Eleven studies found an association between frailty and mortality. Eleven studies reported an association between frailty and a composite outcome of mortality and adverse discharge destination. Generalisability and assessment of strength of associations was limited by single centre studies with inconsistent findings and overlapping cohorts. CONCLUSIONS Associations between frailty and adverse outcomes including mortality in geriatric trauma patients were demonstrated despite a range of frailty instruments, administering clinicians, time of assessment and data sources. Although evidence gaps remain, incorporating frailty assessment into trauma systems is likely to identify geriatric patients at risk of adverse outcomes. Consistency in frailty instruments and long-term geriatric specific outcome measures will improve research relevance. LEVEL OF EVIDENCE Level III prognostic.
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Affiliation(s)
- Mya Cubitt
- Department of Emergency Medicine, The Royal Melbourne Hospital, VIC, Australia.
| | - Emma Downie
- Trauma Service, The Royal Melbourne Hospital, VIC, Australia
| | - Rose Shakerian
- Trauma Service, The Royal Melbourne Hospital, VIC, Australia
| | - Peter W Lange
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, VIC, Australia
| | - Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, England
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Hegendörfer E, Vaes B, Van Pottelbergh G, Matheï C, Verbakel J, Degryse JM. Predictive Accuracy of Frailty Tools for Adverse Outcomes in a Cohort of Adults 80 Years and Older: A Decision Curve Analysis. J Am Med Dir Assoc 2019; 21:440.e1-440.e8. [PMID: 31678074 DOI: 10.1016/j.jamda.2019.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the predictive performance of 3 frailty identification tools for mortality, hospitalization, and functional decline in adults aged ≥80 years using risk reclassification statistics and decision curve analysis. DESIGN Population-based, prospective cohort. SETTING BELFRAIL study, Belgium. PARTICIPANTS 560 community-dwelling adults aged ≥80 years. MEASUREMENTS Frailty by Cardiovascular Health Study (CHS) phenotype, Longitudinal Aging Study Amsterdam (LASA) markers, and Groeningen Frailty Indicator (GFI); mortality until 5.1 ± 0.25 years from baseline and hospitalization until 3.0 ± 0.25 years; and functional status assessed by activities of daily living at baseline and after 1.7 ± 0.21 years. RESULTS Frailty prevalence was 7.3% by CHS phenotype, 21.6% by LASA markers, and 22% by GFI. Participants determined to be frail by each tool had a significantly higher risk for all-cause mortality and first hospitalization. For functional decline, only frail by GFI had a higher adjusted odds ratio. Harrell 's C-statistic for mortality and hospitalization and area under receiver operating characteristic curve for functional decline were similar for all tools and <0.70. Reclassification statistics showed improvement only by LASA markers for hospitalization and mortality. In decision curve analysis, all tools had higher net benefit than the 2 default strategies of "treat all" and "treat none" for mortality risk ≥20%, hospitalization risk ≥35%, and functional decline probability ≥10%, but their curves overlapped across all relevant risk thresholds for these outcomes. CONCLUSIONS AND IMPLICATIONS In a cohort of adults aged ≥80 years, 3 frailty tools based on different conceptualizations and assessment sources had comparable but unsatisfactory discrimination for predicting mortality, hospitalization, and functional decline. All showed clinical utility for predicting these outcomes over relevant risk thresholds, but none was significantly superior. Future research on frailty tools should include a focus on the specific group of adults aged ≥80 years, and the predictive accuracy for adverse outcomes of different tools needs a comprehensive assessment that includes decision curve analysis.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain, Belgium.
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Catharina Matheï
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Jan Verbakel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain, Belgium
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Niederstrasser NG, Rogers NT, Bandelow S. Determinants of frailty development and progression using a multidimensional frailty index: Evidence from the English Longitudinal Study of Ageing. PLoS One 2019; 14:e0223799. [PMID: 31665163 PMCID: PMC6821067 DOI: 10.1371/journal.pone.0223799] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/28/2019] [Indexed: 01/10/2023] Open
Abstract
Objective To identify modifiable risk factors for development and progression of frailty in older adults living in England, as conceptualised by a multidimensional frailty index (FI). Methods Data from participants aged 50 and over from the English Longitudinal Study of Ageing (ELSA) was used to examine potential determinants of frailty, using a 56-item FI comprised of self-reported health conditions, disabilities, cognitive function, hearing, eyesight, depressive symptoms and ability to carry out activities of daily living. Cox proportional hazards regression models were used to measure frailty development (n = 7420) and linear regression models to measure frailty progression over 12 years follow-up (n = 8780). Results Increasing age (HR: 1.08 (CI: 1.08–1.09)), being in the lowest wealth quintile (HR: 1.79 (CI: 1.54–2.08)), lack of educational qualifications (HR: 1.19 (CI: 1.09–1.30)), obesity (HR: 1.33 (CI: 1.18–1.50) and a high waist-hip ratio (HR: 1.25 (CI: 1.13–1.38)), being a current or previous smoker (HR: 1.29 (CI: 1.18–1.41)), pain (HR: 1.39 (CI: 1.34–1.45)), sedentary behaviour (HR: 2.17 (CI: 1.76–2.78) and lower body strength (HR: 1.07 (CI: 1.06–1.08)), were all significant risk factors for frailty progression and incidence after simultaneous adjustment for all examined factors. Conclusion The findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation tools. Furthermore, improving educational outcomes and reducing poverty may also reduce inequalities in frailty.
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Affiliation(s)
- Nils Georg Niederstrasser
- School of Applied Social Sciences, De Montfort University, Leicester, England, United Kingdom
- * E-mail:
| | - Nina Trivedy Rogers
- Department of Epidemiology and Public Health, University College London, London, England, United Kingdom
| | - Stephan Bandelow
- Department of Physiology, Neuroscience and Behavioural Sciences, St. George’s University, St. George’s, Grenada
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Rusanova I, Fernández-Martínez J, Fernández-Ortiz M, Aranda-Martínez P, Escames G, García-García FJ, Mañas L, Acuña-Castroviejo D. Involvement of plasma miRNAs, muscle miRNAs and mitochondrial miRNAs in the pathophysiology of frailty. Exp Gerontol 2019; 124:110637. [PMID: 31199979 DOI: 10.1016/j.exger.2019.110637] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 02/08/2023]
Abstract
Frailty is a geriatric syndrome that leads not only to the loss of physical functions, but also to a generalized decline of the organism and a high risk of disability and dependency. Frailty's detection and management represent important goals for current gerontology. The advance in its rapid diagnosis could play a relevant role in taking measures to reduce the negative consequences it exerts on the body and to take preventive measures. microRNAs are the one of multiple epigenetic biomarkers that reflect functional changes in aged subject. In this review we analyze microRNAs as molecules involved in the control of the pathways leading to the development of frailty. miRNAs can be present in different body fluids, including plasma/serum and saliva, can be associated with organelles like the mitochondria, and can be expressed in tissues. Based on the multifactorial physiopathology of frailty, we analyzed here the microRNAs linked to "inflammaging" (inflamma-miRs), to musculoskeletal health (myomiRs), and microRNAs that can directly or indirectly affect the mitochondria (mitomiRs). Subsequently, we analyze those microRNAs that can be modified by physical exercise. In this review we will analyze the latest experimental studies carried out in animals, cell cultures, and human samples, with the aim to identify gaps in the research and in order to try to dazzle the information about the pathways regulated by each miRNA. Multiple studies revised here suggest that several miRs can be considered as possible markers of frailty, including miR-1, miR-21, miR-34a, miR-146a, miR-185, and miR-206, miR-223, among others. Normalization of miRNAs data and standardization of the protocols used for their measurement to avoid confounding variables influencing the results, are important to use miRNAs as disease biomarkers.
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Affiliation(s)
- Iryna Rusanova
- Departamento de Fisiología, Facultad de Medicina, Centro de Investigación Biomédica, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, Granada, Spain; CIBERfes, Ibs.Granada, and UGC de Laboratorios Clínicos, Complejo Hospitalario de Granada, Granada, Spain.
| | - José Fernández-Martínez
- Departamento de Fisiología, Facultad de Medicina, Centro de Investigación Biomédica, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, Granada, Spain
| | - Marisol Fernández-Ortiz
- Departamento de Fisiología, Facultad de Medicina, Centro de Investigación Biomédica, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, Granada, Spain
| | - Paula Aranda-Martínez
- Departamento de Fisiología, Facultad de Medicina, Centro de Investigación Biomédica, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, Granada, Spain
| | - Germaine Escames
- Departamento de Fisiología, Facultad de Medicina, Centro de Investigación Biomédica, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, Granada, Spain; CIBERfes, Ibs.Granada, and UGC de Laboratorios Clínicos, Complejo Hospitalario de Granada, Granada, Spain
| | - Francisco J García-García
- CIBERfes, División de Medicina Geriátrica, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Leocadio Mañas
- CIBERfes, Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain
| | - Darío Acuña-Castroviejo
- Departamento de Fisiología, Facultad de Medicina, Centro de Investigación Biomédica, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, Granada, Spain; CIBERfes, Ibs.Granada, and UGC de Laboratorios Clínicos, Complejo Hospitalario de Granada, Granada, Spain.
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97
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Age-related deficit accumulation and the diseases of ageing. Mech Ageing Dev 2019; 180:107-116. [DOI: 10.1016/j.mad.2019.04.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
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98
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Mitchell SJ, Mitchell GJ, Mitchell JR. Modulation of frailty syndrome by diet: A review of evidence from mouse studies. Mech Ageing Dev 2019; 180:82-88. [DOI: 10.1016/j.mad.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
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Affiliation(s)
- Kenneth Rockwood
- Department of Aging Medicine and Geriatric MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Experimental Medicine and Population SciencesUniversity College LondonLondonUK
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100
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Blodgett JM, Theou O, Mitnitski A, Howlett SE, Rockwood K. Associations between a laboratory frailty index and adverse health outcomes across age and sex. Aging Med (Milton) 2019; 2:11-17. [PMID: 31942508 PMCID: PMC6880698 DOI: 10.1002/agm2.12055] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Early frailty may be captured by a frailty index (FI) based entirely on vital signs and laboratory tests. Our aim was to examine associations between a laboratory-based FI (FI-Lab) and adverse health outcomes, and investigate how this changed with age. METHODS Up to 8988 individuals aged 20+ years from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey cohorts were included. Characteristics of the FI-Lab were compared to those of a self-reported clinical FI. Associations between each FI and health care use, self-reported health, and disability were examined in the full sample and across age groups. RESULTS Laboratory-based FI scores increased with age but did not demonstrate expected sex differences. Women aged 20-39 years had higher FI scores than men; this pattern reversed after age 60 years. FI-Lab scores were associated with poor self-reported health (odds ratio[95% confidence interval]: 1.46[1.39-1.54]), high health care use (1.35[1.29-1.42]), and high disability (1.41[1.32-1.50]), even among those aged 20-39 years. CONCLUSION Higher FI-Lab scores were associated with poor health outcomes at all ages. Associations in the youngest group support the notion that deficit accumulation occurs across the lifespan. FI-Lab scores could be utilized as an early screening tool to identify deficit accumulation at the cellular and molecular level before they become clinically visible.
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Affiliation(s)
| | - Olga Theou
- Geriatric MedicineDepartment of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Arnold Mitnitski
- Geriatric MedicineDepartment of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Susan E. Howlett
- Geriatric MedicineDepartment of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- Department of PharmacologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Kenneth Rockwood
- Geriatric MedicineDepartment of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
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