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Conroy A, Zhang V, Kaito M, Ramamoorthy V, Roy M, Ahmed MA, Zhang Z, McGranaghan P, Appunni S, Saxena A, Rubens M, Cristian A. Effect of Frailty on Hospital Outcomes Among Pediatric Cancer Patients in the United States: Results From the National Inpatient Sample. Am J Clin Oncol 2023; 46:381-386. [PMID: 37259194 DOI: 10.1097/coc.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Studies on frailty among pediatric patients with cancer are scarce. In this study, we sought to understand the effects of frailty on hospital outcomes in pediatric patients with cancer. METHODS This retrospective study used data collected and stored in the Nationwide Inpatient Sample (NIS) between 2005 and 2014. These were hospitalized patients and hence represented the sickest group of patients. Frailty was measured using the frailty definition diagnostic indicator by Johns Hopkins Adjusted Clinical Groups. RESULTS Of 187,835 pediatric cancer hospitalizations included in this analysis, 11,497 (6.1%) were frail. The average hospitalization costs were $86,910 among frail and $40,358 for nonfrail patients. In propensity score matching analysis, the odds of in-hospital mortality (odds ratio, 2.08; 95% CI, 1.71-2.52) and length of stay (odds ratio, 3.76; 95% CI, 3.46-4.09) were significantly greater for frail patients. The findings of our study suggest that frailty is a crucial clinical factor to be considered when treating pediatric cancer patients in a hospital setting. CONCLUSIONS These findings highlight the need for further research on frailty-based risk stratification and individualized interventions that could improve outcomes in frail pediatric cancer patients. The adaptation and validation of a frailty-defining diagnostic tool in the pediatric population is a high priority in the field.
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Affiliation(s)
- Abigail Conroy
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | - Vicky Zhang
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | - Max Kaito
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale
| | | | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida
| | | | | | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | | | - Anshul Saxena
- Center for Advanced Analytics
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
- Universidad Espíritu Santo, Guayaquil, Ecuador
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102
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Tenforde AS, Alexander JJ, Alexander M, Annaswamy TM, Carr CJ, Chang P, Díaz M, Iaccarino MA, Lewis SB, Millett C, Pandit S, Ramirez CP, Rinaldi R, Roop M, Slocum CS, Tekmyster G, Venesy D, Verduzco-Gutierrez M, Zorowitz RD, Rowland TR. Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research. PM R 2023; 15:1156-1174. [PMID: 37354209 DOI: 10.1002/pmrj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Joshua J Alexander
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Conley J Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Chang
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Stephen B Lewis
- Physiatry-Pharmacy Collaborative, NJ Institute for Successful Aging, Princeton, New Jersey, USA
| | - Carolyn Millett
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | | | | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Megan Roop
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Gene Tekmyster
- Department of Orthopedic Surgery, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network, Georgetown University, Washington, District of Columbia, USA
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103
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Bedard K, Taylor L, Rajabali N, Kroeker K, Halloran B, Meng G, Raman M, Tandon P, Abraldes JG, Peerani F. Handgrip strength and risk of malnutrition are associated with an increased risk of hospitalizations in inflammatory bowel disease patients. Therap Adv Gastroenterol 2023; 16:17562848231194395. [PMID: 37667803 PMCID: PMC10475242 DOI: 10.1177/17562848231194395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 09/06/2023] Open
Abstract
Background In patients with inflammatory bowel disease (IBD), frailty is independently associated with mortality and morbidity. Objectives This study aimed to extend this work to determine the association between the clinical frailty scale (CFS), handgrip strength (HGS), and malnutrition with IBD-related hospitalizations and surgeries. Design IBD patients ⩾18 years of age were prospectively enrolled from two ambulatory care clinics in Alberta, Canada. Methods Frailty was defined as a CFS score ⩾4, dynapenia as HGS < 16 kg for females and <27 kg for males, malnutrition using the subjective global assessment (SGA), and the risk of malnutrition using either the abridged patient-generated SGA (abPG-SGA), or the Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT). Logarithm relative hazard graphs and multivariable logistic regression models adjusting for relevant confounders were constructed. Results One hundred sixty-one patients (35% ulcerative colitis, 65% Crohn's disease) with a mean age of 42.2 (±15.9) years were followed over a mean period of 43.9 (±10.1) months. Twenty-seven patients were hospitalized, and 13 patients underwent IBD-related surgeries following baseline. While the CFS (aHR 1.34; p = 0.61) and SGA (aHR 0.81; p = 0.69) did not independently predict IBD-related hospitalizations, decreased HGS (aHR 3.96; p = 0.03), increased abPG-SGA score (aHR 1.07; p = 0.03) and a SaskIBD-NRT ⩾ 5 (aHR 4.49; p = 0.02) did. No variable was independently associated with IBD-related surgeries. Conclusion HGS, the abPG-SGA, and the SaskIBD-NRT were independently associated with an increased risk of IBD-related hospitalizations. Future studies should aim to validate other frailty assessments in the IBD population in order to better tailor care for all IBD patients.
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Affiliation(s)
- Katherine Bedard
- Department of Medicine, Faculty of Graduate Studies and Research, University of Alberta, Edmonton, AB, Canada
| | - Lorian Taylor
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Naheed Rajabali
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Brendan Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Guanmin Meng
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Juan G. Abraldes
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Farhad Peerani
- Division of Gastroenterology, University of Alberta, 1-59 Zeidler Ledcor Centre, 8540 – 112 Street NW, Edmonton AB T6G 2P8, Canada
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Forman DE, Kuchel GA, Newman JC, Kirkland JL, Volpi E, Taffet GE, Barzilai N, Pandey A, Kitzman DW, Libby P, Ferrucci L. Impact of Geroscience on Therapeutic Strategies for Older Adults With Cardiovascular Disease: JACC Scientific Statement. J Am Coll Cardiol 2023; 82:631-647. [PMID: 37389519 PMCID: PMC10414756 DOI: 10.1016/j.jacc.2023.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
Geroscience posits that cardiovascular disease (CVD) and other chronic diseases result from progressive erosion of the effectiveness of homeostatic mechanisms that oppose age-related accumulation of molecular damage. This hypothetical common root to chronic diseases explains why patients with CVD are often affected by multimorbidity and frailty and why older age negatively affects CVD prognosis and treatment response. Gerotherapeutics enhance resilience mechanisms that counter age-related molecular damage to prevent chronic diseases, frailty, and disability, thereby extending healthspan. Here, we describe the main resilience mechanisms of mammalian aging, with a focus on how they can affect CVD pathophysiology. We next present novel gerotherapeutic approaches, some of which are already used in management of CVD, and explore their potential to transform care and management of CVD. The geroscience paradigm is gaining traction broadly in medical specialties, with potential to mitigate premature aging, reduce health care disparities, and improve population healthspan.
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Affiliation(s)
- Daniel E Forman
- Department of Medicine (Geriatrics and Cardiology) University of Pittsburgh, Pittsburgh, Pennsylvania, USA; GRECC, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, UConn Health, Farmington, Connecticut, USA
| | - John C Newman
- Buck Institute for Research on Aging, Novato California, USA; Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - James L Kirkland
- Division of General Internal Medicine, Department of Medicine and Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - George E Taffet
- Department of Medicine (Geriatrics and Cardiovascular Sciences), Baylor College of Medicine, Houston, Texas, USA
| | - Nir Barzilai
- Einstein Institute for Aging Research, Bronx, New York, USA; Einstein-NSC and Glenn Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dalane W Kitzman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Libby
- Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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105
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Fonseca A, Nogueira CB, Borges EDO, Berkenbrock I, Duarte JE, Martins KRDS, Lopes MAAM, Duarte PDO, da Cruz RC. Frailty in older women. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S110. [PMID: 37556629 PMCID: PMC10411692 DOI: 10.1590/1806-9282.2023s110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Anelise Fonseca
- Sociedade Brasileira de Geriatria e Gerontologia – Rio de Janeiro (RJ), Brazil
| | | | | | - Ivete Berkenbrock
- Sociedade Brasileira de Geriatria e Gerontologia – Rio de Janeiro (RJ), Brazil
| | - Juliana Elias Duarte
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Hospital Orizonti de Oncologia e Longevidade, Faculdade de Ciências Médicas de Minas Gerais – Belo Horizonte (MG), Brazil
| | | | - Marina Alves Antonio Moreira Lopes
- Hospital Estadual de Dermatologia Sanitária Colônia Santa Marta – Goiânia (GO), Brazil
- Hospital Municipal de Aparecida de Goiânia – Aparecida de Goiânia (GO), Brazil
| | - Paulo de Oliveira Duarte
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Instituto de Geriatria e Gerontologia – São Paulo (SP), Brazil
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106
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Hu Y, Wang X, Lin L, Huan J, Li Y, Zhang L, Li Y. Association of remnant cholesterol with frailty: findings from observational and Mendelian randomization analyses. Lipids Health Dis 2023; 22:115. [PMID: 37537564 PMCID: PMC10399004 DOI: 10.1186/s12944-023-01882-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Recent insights suggest that remnant cholesterol (RC) plays a role in cellular senescence, yet its specific contribution to frailty remains indeterminate. Through the integration of observational and mendelian randomization (MR) studies, this research explores the impact of elevated serum RC levels on frailty susceptibility. METHODS A dual-method approach, combining an observational study with an MR study, was employed to investigate the connection between RC and frailty. The observational study included 11,838 participants from the National Health and Nutrition Examination Survey. Multivariable logistic regression and propensity score matching were employed to control for potential confounders. The non-linear relationship was assessed using restricted cubic splines. To circumvent observational study limitations, a two-sample MR analysis was conducted using the inverse-variance weighted method, leveraging genome-wide association studies (GWAS) data. RESULTS After adjusting for potential confounding variables, the observational study identified a significant association between high serum RC levels and frailty in middle-aged and older adults (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.20 to 2.33, P = 0.003), exhibiting a non-linear dose-response correlation (non-linear P = 0.011). This association persisted after propensity score matching (OR = 1.53, 95% CI = 1.14 to 2.06, P = 0.005). The MR study echoed these results, demonstrating a causal association of RC with the frailty index (β = 0.059, 95% CI = 0.033 to 0.085, P = 1.05E-05), consistent with the observational findings (β = 0.017, 95% CI = 0.008 to 0.026, P = 4.51E-04). CONCLUSION This study provides evidence that higher RC levels amplify frailty risk in middle-aged and older adults, implying that the reduction of RC levels may present a promising strategy for frailty prevention and management.
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Affiliation(s)
- Yuanlong Hu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaojie Wang
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau, China
| | - Lin Lin
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiaming Huan
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuan Li
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Key Laboratory of Traditional Chinese Medicine Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Provincial Key Laboratory of Traditional Chinese Medicine for Basic Research, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lei Zhang
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yunlun Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
- Shandong Province Engineering Laboratory of Traditional Chinese Medicine Precise Diagnosis and Treatment of Cardiovascular Disease, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
- Department of Cardiovascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
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107
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Homes RAP, Giddens F, Francis RS, Hubbard RE, Gordon EH, Midwinter MJ. The sublingual microcirculation and frailty index in chronic kidney disease patients. Microcirculation 2023; 30:e12819. [PMID: 37285445 PMCID: PMC10909441 DOI: 10.1111/micc.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine the relationship between sublingual microcirculatory measures and frailty index in those attending a kidney transplant assessment clinic. METHODS Patients recruited had their sublingual microcirculation taken using sidestream dark field videomicroscopy (MicroScan, Micro Vision Medical, Amsterdam, the Netherlands) and their frailty index score using a validated short form via interview. RESULTS A total of 44 patients were recruited with two being excluded due to microcirculatory image quality scores exceeding 10. The frailty index score indicated significant correlations with total vessel density (p < .0001, r = -.56), microvascular flow index (p = .004, r = -.43), portion of perfused vessels (p = .0004, r = -.52), heterogeneity index (p = .015, r = .32), and perfused vessel density (p < .0001, r = -.66). No correlation was shown between the frailty index and age (p = .08, r = .27). CONCLUSIONS There is a relationship between the frailty index and microcirculatory health in those attending a kidney transplant assessment clinic, that is not confounded by age. These findings suggest that the impaired microcirculation may be an underlying cause of frailty.
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Affiliation(s)
- Ryan A. P. Homes
- School of Biomedical Science, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Fiona Giddens
- Centre for Health Services Research, Faulty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Ross S. Francis
- Department of NephrologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Ruth E. Hubbard
- Centre for Health Services Research, Faulty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Emily H. Gordon
- Centre for Health Services Research, Faulty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Mark J. Midwinter
- School of Biomedical Science, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
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108
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Bandeen-Roche K, Tian J, Buta B, Walston J, Xue QL. Substitution of self-reported measures for objectively assessed grip strength and slow walk in the Physical Frailty Phenotype: ramifications for validity. BMC Geriatr 2023; 23:451. [PMID: 37481528 PMCID: PMC10362666 DOI: 10.1186/s12877-023-04105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/13/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Frailty assessment promises to identify older adults at risk for adverse consequences following stressors and target interventions to improve health outcomes. The Physical Frailty Phenotype (PFP) is a widely-studied, well validated assessment but incorporates performance-based slow walk and grip strength criteria that challenge its use in some clinical settings. Variants replacing performance-based elements with self-reported proxies have been proposed. Our study evaluated whether commonly available disability self-reports could be substituted for the performance-based criteria in the PFP while still identifying as "frail" the same subpopulations of individuals. METHODS Parallel analyses were conducted in 3393 female and 2495 male Cardiovascular Health Study, Round 2 participants assessed in 1989-90. Candidate self-reported proxies for the phenotype's "slowness" and "weakness" criteria were evaluated for comparable prevalence and agreement by mode of measurement. For best-performing candidates: Frailty status (3 + positive criteria out of 5) was compared for prevalence and agreement between the PFP and mostly self-reported versions. Personal characteristics were compared between those adjudicated as frail by (a) only a self-reported version; (b) only the PFP; (c) both, using bivariable analyses and multinomial logistic regression. RESULTS Self-reported difficulty walking ½ mile was selected as a proxy for the phenotype's slowness criterion. Two self-reported weakness proxies were examined: difficulty transferring from a bed or chair or gripping with hands, and difficulty as just defined or in lifting a 10-pound bag. Prevalences matched to within 4% between self-reported and performance-based criteria in the whole sample, but in all cases the self-reported prevalence for women exceeded that for men by 11% or more. Cross-modal agreement was moderate, with by-criterion and frailty-wide Kappa statistics of 0.55-0.60 in all cases. Frail subgroups (a), (b), (c) were independently discriminated (p < 0.05) by race, BMI, and depression in women; by age in men; and by self-reported health for both. CONCLUSIONS Commonly used self-reported disability items cannot be assumed to stand in for performance-based criteria in the PFP. We found subpopulations identified as frail by resultant phenotypes versus the original phenotype to systematically differ. Work to develop self-reported proxies that more closely replicate their objective phenotypic counterparts than standard disability self-reports is needed.
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Affiliation(s)
- Karen Bandeen-Roche
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Johns Hopkins Center On Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
| | - Jing Tian
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center On Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Brian Buta
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center On Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jeremy Walston
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center On Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - Qian-Li Xue
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center On Aging and Health, Johns Hopkins University, Baltimore, MD, USA
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109
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Álvarez-Bustos A, Carnicero JA, Rodríguez-Sánchez B, El-Assar M, Rueda R, Pereira SL, Sepúlveda-Loyola W, Garcia-Garcia FJ, Sulo S, Rodríguez-Mañas L. Association Between Pulse Wave Velocity and Frailty, Disability, and Mortality in Community-Dwelling Older Adults. JACC. ADVANCES 2023; 2:100423. [PMID: 38939008 PMCID: PMC11198582 DOI: 10.1016/j.jacadv.2023.100423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 06/29/2024]
Abstract
Background Arterial stiffness leads to several adverse events in the older population, but there is a lack of data on its association with frailty, disability, and mortality in the same population. Objectives The purpose of this study was to evaluate the role of arterial stiffness in the loss of functional ability (frailty and disability) and mortality. Methods Data were taken from community-dwelling aged 65 years participants without diabetes in the Toledo Study of Healthy Ageing cohort. Pulse wave velocity (PWV), assessed through SphygmoCor, was recorded at baseline. Median follow-up time were 2.99 years for frailty (frailty phenotype [FP] and Frailty Trait Scale-5 [FTS5]) and disability (Katz Index) and 6.2 for mortality. Logistic regressions models were built for disability and frailty and Cox proportional hazards model for death, adjusted by age and sex, comorbidity, cardiovascular risk factors, asymmetric dimethylarginine levels, and polypharmacy. Results Overall, 978 (mean age 74.5 ± 5.6 years, 56.7% female) participants were included. Different cut-off points were shown for each outcome. PWV >11.5 m/s was cross-sectionally associated with frailty (FP: OR fully-adjusted model: 1.69, 95% CI: 1.45-1.97; FTS5: OR: 1.51, 95% CI: 1.22-1.87) and disability (OR: 1.51, 95% CI: 1.26-1.79); PWV >10 m/s with incident frailty by FP (OR: 1.36, 95% CI: 1.10-1.68) and FTS5 (OR: 1.40, 95% CI: 1.12-1.75), and PWV >11 m/s with death (HR: 1.28, 95% CI: 1.09-1.50). For incident (OR: 1.28, 95% CI: 1.06-1.55) and worsening disability (OR: 1.21, 95% CI: 1.02-1.45) the threshold was 12.5 m/s. Below these cut-off points, age was the best predictor of adverse outcomes. Conclusions Arterial stiffness predicts frailty, disability, and mortality in older people, with different cut-off points, ie,severity degrees, for each of the assessed outcomes.
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Affiliation(s)
- Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose A. Carnicero
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Fundación de Investigación Biomédica, Hospital Universitario de Getafe, Getafe, Spain
| | - Beatriz Rodríguez-Sánchez
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Economía Aplicada, Economía Pública y Economía Política, Facultad de Derecho, Universidad Complutense de Madrid, Madrid, Spain
| | - Mariam El-Assar
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Fundación de Investigación Biomédica, Hospital Universitario de Getafe, Getafe, Spain
| | | | | | | | - Francisco J. Garcia-Garcia
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Geriatría, Hospital Virgen del Valle, Toledo, Spain
| | - Suela Sulo
- Abbott Nutrition, Chicago, Illinois, USA
| | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain
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Melvin RL, Ruple A, Pearson EB, Olby NJ, Fitzpatrick AL, Creevy KE. A review of frailty instruments in human medicine and proposal of a frailty instrument for dogs. Front Vet Sci 2023; 10:1139308. [PMID: 37441560 PMCID: PMC10333704 DOI: 10.3389/fvets.2023.1139308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Over the last few decades, frailty has become a pillar of research and clinical assessment in human gerontology. This complex syndrome, characterized by loss of physiologic reserves leading to decreased resilience to stressors, is of critical importance because it predicts higher risks of poor health outcomes, including mortality. Thus, identifying frailty among the elderly human population has become a key focus of gerontology. This narrative review presents current scientific literature on frailty in both humans and animals. The authors discuss the need for an accessible frailty instrument for companion dogs suitable for general use in veterinary medicine and the advances that would be facilitated by this instrument. A phenotypic frailty instrument for companion dogs, utilizing components that are easily collected by owners, or in the general practice setting, is proposed. The authors elaborate on the domains (physical condition, physical activity, mobility, strength, cognitive task performance, and social behavior), factors that will be included, and the data from the Dog Aging Project that inform each domain.
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Affiliation(s)
- Rachel L. Melvin
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, United States
| | - Audrey Ruple
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Elizabeth B. Pearson
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, United States
| | - Natasha J. Olby
- Department of Clinical Sciences, NC State University College of Veterinary Medicine, Raleigh, NC, United States
| | | | - Kate E. Creevy
- Department of Small Animal Clinical Sciences, Texas A&M University School of Veterinary Medicine & Biomedical Sciences, College Station, TX, United States
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Mazzone A, Del Turco S, Trianni G, Quadrelli P, Marotta M, Bastiani L, Gasbarri T, D'Agostino A, Mariani M, Basta G, Foffa I, Sbrana S, Vassalle C, Ravani M, Solinas M, Berti S. The Positive Impact of Early Frailty Levels on Mortality in Elderly Patients with Severe Aortic Stenosis Undergoing Transcatheter/Surgical Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10050212. [PMID: 37233180 DOI: 10.3390/jcdd10050212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Frailty is highly common in older patients (pts) undergoing transcatheter aortic valve replacement (TAVR), and it is associated with poor outcomes. The selection of patients who can benefit from this procedure is necessary and challenging. The aim of the present study is to evaluate outcomes in older severe aortic valve stenosis (AS) pts, selected by a multidisciplinary approach for surgical, clinical, and geriatric risk and referred to treatment, according to frailty levels. Methods: A total of 109 pts (83 ± 5 years; females, 68%) with AS were classified by Fried's score in pre-frail, early frail, and frail and underwent surgical aortic valve replacement SAVR/TAVR, balloon aortic valvuloplasty, or medical therapy. We evaluated geriatric, clinical, and surgical features and detected periprocedural complications. The outcome was all-cause mortality. Results: Increasing frailty was associated with the worst clinical, surgical, geriatric conditions. By using Kaplan-Meier analysis, the survival rate was higher in pre-frail and TAVR groups (p < 0.001) (median follow-up = 20 months). By using the Cox regression model, frailty (p = 0.004), heart failure (p = 0.007), EF% (p = 0.043), albumin (p = 0.018) were associated with all-cause mortality. Conclusions: According to tailored frailty management, elderly AS pts with early frailty levels seem to be the most suitable candidates for TAVR/SAVR for positive outcomes because advanced frailty would make each treatment futile or palliative.
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Affiliation(s)
- Annamaria Mazzone
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | | | - Giuseppe Trianni
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Paola Quadrelli
- Adult Cardiosurgery Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Marco Marotta
- Adult Cardiosurgery Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Luca Bastiani
- CNR Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Tommaso Gasbarri
- Adult Cardiosurgery Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Andreina D'Agostino
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Massimiliano Mariani
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | | | - Ilenia Foffa
- CNR Institute of Clinical Physiology, 54100 Massa, Italy
| | | | | | - Marcello Ravani
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Marco Solinas
- Adult Cardiosurgery Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Sergio Berti
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
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Szymkowicz SM, Gerlach AR, Homiack D, Taylor WD. Biological factors influencing depression in later life: role of aging processes and treatment implications. Transl Psychiatry 2023; 13:160. [PMID: 37160884 PMCID: PMC10169845 DOI: 10.1038/s41398-023-02464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Late-life depression occurring in older adults is common, recurrent, and malignant. It is characterized by affective symptoms, but also cognitive decline, medical comorbidity, and physical disability. This behavioral and cognitive presentation results from altered function of discrete functional brain networks and circuits. A wide range of factors across the lifespan contributes to fragility and vulnerability of those networks to dysfunction. In many cases, these factors occur earlier in life and contribute to adolescent or earlier adulthood depressive episodes, where the onset was related to adverse childhood events, maladaptive personality traits, reproductive events, or other factors. Other individuals exhibit a later-life onset characterized by medical comorbidity, pro-inflammatory processes, cerebrovascular disease, or developing neurodegenerative processes. These later-life processes may not only lead to vulnerability to the affective symptoms, but also contribute to the comorbid cognitive and physical symptoms. Importantly, repeated depressive episodes themselves may accelerate the aging process by shifting allostatic processes to dysfunctional states and increasing allostatic load through the hypothalamic-pituitary-adrenal axis and inflammatory processes. Over time, this may accelerate the path of biological aging, leading to greater brain atrophy, cognitive decline, and the development of physical decline and frailty. It is unclear whether successful treatment of depression and avoidance of recurrent episodes would shift biological aging processes back towards a more normative trajectory. However, current antidepressant treatments exhibit good efficacy for older adults, including pharmacotherapy, neuromodulation, and psychotherapy, with recent work in these areas providing new guidance on optimal treatment approaches. Moreover, there is a host of nonpharmacological treatment approaches being examined that take advantage of resiliency factors and decrease vulnerability to depression. Thus, while late-life depression is a recurrent yet highly heterogeneous disorder, better phenotypic characterization provides opportunities to better utilize a range of nonspecific and targeted interventions that can promote recovery, resilience, and maintenance of remission.
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Affiliation(s)
- Sarah M Szymkowicz
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew R Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Damek Homiack
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL, USA
| | - Warren D Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN, USA.
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA.
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113
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Debain A, Loosveldt FA, Knoop V, Costenoble A, Lieten S, Petrovic M, Bautmans I. Frail OLDER ADULTS are more likely TO have autonomic dysfunction: A systematic review and META-ANALYSIs. Ageing Res Rev 2023; 87:101925. [PMID: 37028604 DOI: 10.1016/j.arr.2023.101925] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/26/2023] [Accepted: 04/01/2023] [Indexed: 04/09/2023]
Abstract
Autonomic dysfunction and frailty are two common and complex geriatric syndromes. Their prevalence increases with age and they have similar negative health outcomes. In PubMed and Web of Science we screened studies identifying a relationship between autonomic function (AF) and frailty in adults aged ≥65 years. Twenty-two studies of which two prospective and 20 cross-sectional were included (n=8375). We performed a meta-analysis for the articles addressing orthostatic hypotension (OH). Frailty was associated with 1.6 higher odds of suffering from consensus OH (COH) {OR=1.607 95%CI [1.15-2.24]; 7 studies; n=3488}. When measured for each type of OH the largest trend was seen between initial OH (IOH) and frailty {OR=3.08; 95%CI [1.50-6.36]; 2 studies; n=497}. Fourteen studies reported other autonomic function alterations in frail older adults with 4-22% reduction in orthostatic heart rate increase, 6% reduction in systolic blood pressure recovery, 9-75% reduction in most common used heart rate variability (HRV) parameters. Frail older adults were more likely to have impaired AF. Diagnosis of frailty should promptly lead to orthostatic testing as OH implicates specific treatment modalities, which differ from frailty management. As IOH is most strongly correlated with frailty, continuous beat to beat blood pressure measurements should be performed when present at least until cut-off values for heart rate variability testing are defined.
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Affiliation(s)
- Aziz Debain
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Fien Ann Loosveldt
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Veerle Knoop
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Axelle Costenoble
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Siddhartha Lieten
- Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Department of Geriatrics, Universitair Ziekenhuis Gent (UZGent), Corneel Heymanslaan 10, 9000 Gent
| | - Mirko Petrovic
- Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Department of Geriatrics, Universitair Ziekenhuis Gent (UZGent), Corneel Heymanslaan 10, 9000 Gent
| | - Ivan Bautmans
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium.
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114
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Taylor JA, Greenhaff PL, Bartlett DB, Jackson TA, Duggal NA, Lord JM. Multisystem physiological perspective of human frailty and its modulation by physical activity. Physiol Rev 2023; 103:1137-1191. [PMID: 36239451 PMCID: PMC9886361 DOI: 10.1152/physrev.00037.2021] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
"Frailty" is a term used to refer to a state characterized by enhanced vulnerability to, and impaired recovery from, stressors compared with a nonfrail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given that age-related frailty manifests in the form of functional declines such as poor balance, falls, and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune, and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a nonfrail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targeted interventions to diminish frailty progression.
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Affiliation(s)
- Joseph A Taylor
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Paul L Greenhaff
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - David B Bartlett
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.,Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Thomas A Jackson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Niharika A Duggal
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
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115
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Singer JP, Calfee CS, Delucchi K, Diamond JM, Anderson MA, Benvenuto LA, Gao Y, Wang P, Arcasoy SM, Lederer DJ, Hays SR, Kukreja J, Venado A, Kolaitis NA, Leard LE, Shah RJ, Kleinhenz ME, Golden J, Betancourt L, Oyster M, Brown M, Zaleski D, Medikonda N, Kalman L, Balar P, Patel S, Calabrese DR, Greenland JR, Christie JD. Subphenotypes of frailty in lung transplant candidates. Am J Transplant 2023; 23:531-539. [PMID: 36740192 PMCID: PMC11005295 DOI: 10.1016/j.ajt.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023]
Abstract
Heterogeneous frailty pathobiology might explain the inconsistent associations observed between frailty and lung transplant outcomes. A Subphenotype analysis could refine frailty measurement. In a 3-center pilot cohort study, we measured frailty by the Short Physical Performance Battery, body composition, and serum biomarkers reflecting causes of frailty. We applied latent class modeling for these baseline data. Next, we tested class construct validity with disability, waitlist delisting/death, and early postoperative complications. Among 422 lung transplant candidates, 2 class model fit the best (P = .01). Compared with Subphenotype 1 (n = 333), Subphenotype 2 (n = 89) was characterized by systemic and innate inflammation (higher IL-6, CRP, PTX3, TNF-R1, and IL-1RA); mitochondrial stress (higher GDF-15 and FGF-21); sarcopenia; malnutrition; and lower hemoglobin and walk distance. Subphenotype 2 had a worse disability and higher risk of waitlist delisting or death (hazards ratio: 4.0; 95% confidence interval: 1.8-9.1). Of the total cohort, 257 underwent transplant (Subphenotype 1: 196; Subphenotype 2: 61). Subphenotype 2 had a higher need for take back to the operating room (48% vs 28%; P = .005) and longer posttransplant hospital length of stay (21 days [interquartile range: 14-33] vs 18 days [14-28]; P = .04). Subphenotype 2 trended toward fewer ventilator-free days, needing more postoperative extracorporeal membrane oxygenation and dialysis, and higher need for discharge to rehabilitation facilities (P ≤ .20). In this early phase study, we identified biological frailty Subphenotypes in lung transplant candidates. A hyperinflammatory, sarcopenic Subphenotype seems to be associated with worse clinical outcomes.
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Affiliation(s)
- Jonathan P Singer
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA.
| | - Carolyn S Calfee
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Joshua M Diamond
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michaela A Anderson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Luke A Benvenuto
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York City, New York, USA
| | - Ying Gao
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Ping Wang
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York City, New York, USA
| | | | - Steven R Hays
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Jasleen Kukreja
- Division of Cardiothoracic Surgery, University of California, San Francisco, California, USA
| | - Aida Venado
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Nicholas A Kolaitis
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Lorianna E Leard
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Rupal J Shah
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Mary Ellen Kleinhenz
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Jeffrey Golden
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Legna Betancourt
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Michelle Oyster
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melanie Brown
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Derek Zaleski
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikhila Medikonda
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Laurel Kalman
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Priya Balar
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shreena Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York City, New York, USA
| | - Daniel R Calabrese
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - John R Greenland
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA; San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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116
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Gu Y, Wu W, Kong C, Luo Q, Ran L, Tan X, Zhang Q. Development of Prognostic Prediction Model to Estimate Mortality for Frail Oldest Old: Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:711-717. [PMID: 36574506 PMCID: PMC10061936 DOI: 10.1093/gerona/glac256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study was performed to derive and validate a prognostic prediction model for individualized estimation of mortality risk among the frail oldest old (aged 80 years or older). METHODS This analysis was based on the prospective open cohort study from the Chinese Longevity and Health Longitudinal Survey. A total of 14 118 frail oldest old were included from the 2002 wave to 2014 waves; the study outcome was all-cause mortality. Available predictors included frailty, demographics, and social factors. Cox models were used to estimate the coefficients of the predictors and least absolute shrinkage and selection operator was used for selecting predictors. Model performance was measured by discrimination and calibration with internal validation by bootstrapping. We also developed a nomogram to visualize and predict the 3-year mortality risk based on the obtained prognostic prediction model. RESULTS During the 16-years follow-up, 10 410 (76.42%) deaths were identified. The final model comprises the following factors: frailty, age, sex, race, birthplace, education, occupation, marital status, residence, economic condition, number of children, and the question "who do you ask for help first when in trouble." The model has valid predictive ability as measured and validated by Harrell's C statistic (0.602) and calibration plots. CONCLUSIONS This study provides a basic prognostic prediction model to quantify absolute mortality risk for the frail oldest old. Future studies are needed, firstly, to update, adjust, and perform external validation of the present model by using phenotypic frailty, and secondly, to add biomarkers, environmental, and psychological factors to the prediction model.
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Affiliation(s)
- Yaohua Gu
- School of Nursing, Wuhan University, Wuhan, China
| | - Wenwen Wu
- School of Public Health and Management, Hubei University of Medicine, Hubei, China
| | - Chan Kong
- Tongji Hospital, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Qiaoqian Luo
- Department of General Medicine, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Li Ran
- School of Public Health, Wuhan University, Wuhan, China
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan, China
| | - Qing Zhang
- School of Nursing, Wuhan University, Wuhan, China
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117
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Jiang X, Zhou J, Yu C, Chen W, Huang B, Chen Y, Zhong L, Guo Y, Geng Q, Cai Y. The alterations in multiple neurophysiological procedures are associated with frailty phenotype in older adults. Front Aging Neurosci 2023; 15:1063322. [PMID: 37056686 PMCID: PMC10086197 DOI: 10.3389/fnagi.2023.1063322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundOlder adults oftentimes suffer from the conditions in multiple physiologic systems, interfering with their daily function and thus contributing to physical frailty. The contributions of such multisystem conditions to physical frailty have not been well characterized.MethodsIn this study, 442 (mean age = 71.4 ± 8.1 years, 235 women) participants completed the assessment of frailty syndromes, including unintentional weight loss, exhaustion, slowness, low activity, and weakness, and were categorized into frail (≥3 conditions), pre-frail (1 or 2 conditions), and robust (no condition) status. Multisystem conditions including cardiovascular diseases, vascular function, hypertension, diabetes, sleep disorders, sarcopenia, cognitive impairment, and chronic pain were assessed. Structural equation modeling examined the interrelationships between these conditions and their associations with frailty syndromes.ResultsFifty (11.3%) participants were frail, 212 (48.0%) were pre-frail, and 180 (40.7%) were robust. We observed that worse vascular function was directly associated with higher risk of slowness [standardized coefficient (SC) = −0.419, p < 0.001], weakness (SC = −0.367, p < 0.001), and exhaustion (SC = −0.347, p < 0.001). Sarcopenia was associated with both slowness (SC = 0.132, p = 0.011) and weakness (SC = 0.217, p = 0.001). Chronic pain, poor sleep quality, and cognitive impairment were associated with exhaustion (SC = 0.263, p < 0.001; SC = 0.143, p = 0.016; SC = 0.178, p = 0.004, respectively). The multinomial logistic regression showed that greater number of these conditions were associated with increased probability of being frail (odds ratio>1.23, p < 0.032).ConclusionThese findings in this pilot study provide novel insights into how multisystem conditions are associated with each other and with frailty in older adults. Future longitudinal studies are warranted to explore how the changes in these health conditions alter frailty status.
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Affiliation(s)
- Xin Jiang
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
- *Correspondence: Xin Jiang,
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Chengyuan Yu
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Wenbo Chen
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Baofeng Huang
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yurong Chen
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
| | - Lilian Zhong
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yi Guo
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Department of Neurology, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
- Yi Guo,
| | - Qingshan Geng
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, China
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Qingshan Geng,
| | - Yurun Cai
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States
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118
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Brach M, de Bruin ED, Levin O, Hinrichs T, Zijlstra W, Netz Y. Evidence-based yet still challenging! Research on physical activity in old age. Eur Rev Aging Phys Act 2023; 20:7. [PMID: 36932320 PMCID: PMC10022149 DOI: 10.1186/s11556-023-00318-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Preserving functional health and quality-of-life in old age is a major goal and global challenge in public health. The high rate of sedentary behavior that is characteristic of the older adult population exacerbates impairments of physiological and structural systems that are typically seen in the aging process. Achieving an understanding of the profound influence of physical activity on all aspects of health in old age is the driving force behind the emergence of "physical activity in old age" as a growing area of research. Accumulated evidence implies that being physically active and exercising is far superior to other optimal aging facilitators. Yet this area of research faces numerous constraints and obstacles. This commentary addresses some of these challenges, primarily the heterogeneity of the aging process, which induces both inter- and intra-individual differences among aged individuals, heterogeneity in assessment tools, unjustified inclusion/exclusion criteria and insufficient recruitment strategies, difficulties in implementing research results in real-world conditions, and rudimentary exploitation of innovative technology. We explain the importance of establishing a network of multidisciplinary scientists and stakeholders to propose consensus-based goals and scientifically evidenced wide-ranging plans for dealing with these challenges. In addition, we suggest work directions for this network.
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Affiliation(s)
- Michael Brach
- Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany
| | - Eling D. de Bruin
- Department of Health, OST – Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Oron Levin
- Movement Control and Neuroplasticity Research Group, Biomedical Sciences, KU Leuven, Louvain, Belgium
| | - Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Yael Netz
- Levinsky-Wingate Academic Center, The Academic College at Wingate, Netanya, Israel
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
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119
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Loewenthal J, Innes KE, Mitzner M, Mita C, Orkaby AR. Effect of Yoga on Frailty in Older Adults : A Systematic Review. Ann Intern Med 2023; 176:524-535. [PMID: 36913687 DOI: 10.7326/m22-2553] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Yoga, a multicomponent mind-body practice, improves several domains of physical and psychological health and may affect frailty in older adults. PURPOSE To evaluate the available trial evidence on the effect of yoga-based interventions on frailty in older adults. DATA SOURCES MEDLINE, EMBASE, and Cochrane Central from their inception to 12 December 2022. STUDY SELECTION Randomized controlled trials evaluating the effect of yoga-based interventions, including at least 1 session of physical postures, on a validated frailty scale or single-item markers of frailty in adults aged 65 years or older. DATA EXTRACTION Two authors independently screened articles and extracted data; 1 author assessed risk of bias with review from a second author. Disagreements were resolved through consensus and as-needed input from a third author. DATA SYNTHESIS Thirty-three studies (n = 2384 participants) were identified in varied populations, including community dwellers, nursing home residents, and those with chronic disease. Yoga styles were primarily based on Hatha yoga and most often included Iyengar or chair-based methods. Single-item frailty markers included measures of gait speed, handgrip strength, balance, lower-extremity strength and endurance, and multicomponent physical performance measures; no studies included a validated definition of frailty. When compared with education or inactive control, there was moderate-certainty evidence that yoga improved gait speed and lower-extremity strength and endurance, low-certainty evidence for balance and multicomponent physical function measures, and very low-certainty evidence for handgrip strength. LIMITATION Heterogeneity in study design and yoga style, small sample sizes, and reporting deficiencies leading to concerns for selection bias. CONCLUSION Yoga may affect frailty markers that are associated with clinically meaningful outcomes in older adult populations but may not offer benefit over active interventions (for example, exercise). PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42020130303).
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Affiliation(s)
- Julia Loewenthal
- Division of Aging, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (J.L.)
| | - Kim E Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia (K.E.I.)
| | - Margalit Mitzner
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York (M.M.)
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, Massachusetts (C.M.)
| | - Ariela R Orkaby
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, and New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts (A.R.O.)
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Custodero C, Agosti P, Anton SD, Manini TM, Lozupone M, Panza F, Pahor M, Sabbà C, Solfrizzi V. Effect of Physical Activity Intervention on Gait Speed by Frailty Condition: A Randomized Clinical Trial. J Am Med Dir Assoc 2023; 24:489-496. [PMID: 36878264 DOI: 10.1016/j.jamda.2023.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES There is uncertainty about effects of physical activity on physical performance, such as gait speed, among community-dwelling older adults according to their physical frailty status. We determined whether a long-term, moderate-intensity physical activity program was associated with different responses on gait speed over 4 m and 400 m based on physical frailty status. DESIGN Post hoc analysis from the Lifestyle Interventions and Independence for Elders (LIFE) (NCT01072500), a single-blind randomized clinical trial testing the effect of physical activity intervention compared with health education program. SETTING AND PARTICIPANTS We analyzed data on 1623 community-dwelling older adults (78.9 ± 5.2 years) at risk for mobility disability. METHODS Physical frailty was assessed at baseline using the Study of Osteoporotic Fractures frailty index. Gait speed over 4 m and 400 m was measured at baseline, and 6, 12, and 24 months. RESULTS We estimated significantly better 400-m gait speed at 6, 12, and 24 months for nonfrail older adults in the physical activity group, but not for frail participants. Among frail participants, physical activity showed a potentially clinically meaningful benefit on 400-m gait speed at 6 months (0.055; 95% CI 0.016-0.094; P = .005), compared with the healthy educational intervention, only in those who, at baseline, were able to rise from a chair 5 times without using their arms. CONCLUSIONS AND IMPLICATIONS A well-structured physical activity program produced a faster 400-m gait speed potentially able to prevent mobility disability among physically frail individuals with preserved muscle strength in lower limbs.
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Affiliation(s)
- Carlo Custodero
- Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy
| | - Pasquale Agosti
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, and Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Madia Lozupone
- Population Health Unit-"Salus In Apulia Study", National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Francesco Panza
- Population Health Unit-"Salus In Apulia Study", National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Carlo Sabbà
- Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Solfrizzi
- Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy.
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121
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Prefrailty subtypes differentially predict 5-year mortality in the functionally independent geriatric population. Arch Gerontol Geriatr 2023; 106:104897. [PMID: 36508848 DOI: 10.1016/j.archger.2022.104897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Both frailty and prefrailty (PF) are related to mortality. However, there is no consensus about the PF subtypes for prediction of the mortality risk. We aimed to compare the 5-year mortality of functionally independent geriatric outpatients with nonfrailty, different PF subtypes and frailty. METHODS This was a single-center, retrospective cohort study. Community-dwelling older adults who visited the geriatric outpatient clinic in a healthcare institution in Taiwan were enrolled. PF1 was defined based on exhaustion and/or body weight loss whereas PF2 was defined by one or two of the following criteria: weakness, slowness, and low physical activity. Frailty was defined by three or more above criteria. Demographics and results of comprehensive geriatric assessment were compared and Kaplan-Meier survival analysis was used to determine the 5-year survival among the nonfrail, PF1, PF2 and frail groups. RESULTS Of the 982 participants, the proportion of PF and frailty was high (PF 45.7% and frailty 24.5%). The cumulative 5-year survival rate of the nonfrail group, PF1, PF2 subgroups and frail group was 98.6%, 95.8%, 89.1% and 81.3% respectively. Age, male sex, PF2 subtype and frailty were significantly associated with 5-year mortality [hazard ratio (95% confidence interval) 1.05 (1.01-1.08), 1.96 (1.08-3.57), 5.18 (1.57-17.09), and 6.87 (2.05-23.04), respectively]. DISCUSSION AND CONCLUSION The proportion of PF and frailty was high in old outpatient population with functional independence. PF2 subtypes and frailty could influence the 5-year mortality risk in these participants. Identifying PF2 participants earlier and instituting prompt intervention may be beneficial in older patients.
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122
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Luo Y, Chen Y, Wang K, De Fries CM, Huang Z, Xu H, Yang Z, Hu Y, Xu B. Associations between multimorbidity and frailty transitions among older Americans. J Cachexia Sarcopenia Muscle 2023; 14:1075-1082. [PMID: 36852679 PMCID: PMC10067509 DOI: 10.1002/jcsm.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/02/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The associations of multimorbidity patterns with transitions between frailty states remain unclear in older individuals. METHODS We used data from the National Health and Aging Trends Study 2011-2019. Frailty was measured annually using the Fried frailty phenotype. Multimorbidity patterns at baseline were identified using latent class analysis based on 14 chronic conditions. We used the semi-Markov multi-state model to investigate the influences of multimorbidity characterized by condition counts and patterns on subsequent frailty transitions over follow-ups. RESULTS Among 9450 participants aged ≥65 years at baseline, 34.8% were non-frail, 48.1% were pre-frail and 17.0% were frail. Over a median follow-up of 4.0 years, 16 880 frailty transitions were observed, with 10 527 worsening and 6353 improving. For 7675 participants with multimorbidity, four multimorbidity patterns were identified: osteoarticular pattern (62.4%), neuropsychiatric-sensory pattern (17.2%), cardiometabolic pattern (10.3%) and complex multimorbidity pattern (10.1%). Compared with no disease, multimorbidity was significantly associated with an increased risk of worsening transitions, including from non-frail to pre-frail (hazard ratio [HR] = 1.35; 95% confidence interval [CI] = 1.21-1.52), from non-frail to frail (HR = 1.68; 95% CI = 1.04-2.73), from pre-frail to frail (HR = 2.19; 95% CI = 1.66-2.90) and from pre-frail to death (HR = 1.64; 95% CI = 1.11-2.41). Compared with the osteoarticular pattern, neuropsychiatric-sensory, cardiometabolic and complex multimorbidity patterns had a significantly higher risk of worsening frailty (all P < 0.05). CONCLUSIONS Multimorbidity was associated with dynamic transitions between frailty states and death among older American adults, and the associations varied across multimorbidity patterns. The findings could offer significant implications for public health policymakers in planning interventions and healthcare resources. They also might inform clinicians regarding providing targeted clinical treatment and health management based on multimorbidity patterns of older people.
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Affiliation(s)
- Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yuming Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Carson M De Fries
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Ziting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Huiwen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zhou Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, China
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Lv Y, Yang Z, Ye L, Jiang M, Zhou J, Guo Y, Qiu Y, Li X, Chen C, Ju A, Wang J, Li C, Li Y, Wang J, Zhang J, Ji JS, Li T, Baccarelli AA, Gao X, Shi X. Long-term fine particular exposure and incidence of frailty in older adults: findings from the Chinese Longitudinal Healthy Longevity Survey. Age Ageing 2023; 52:7036277. [PMID: 36794712 PMCID: PMC9933051 DOI: 10.1093/ageing/afad009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 10/31/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The association between fine particular matter (PM2.5) and frailty is less studied, and the national burden of PM2.5-related frailty in China is unknown. OBJECTIVE To explore the association between PM2.5 exposure and incident frailty in older adults, and estimate the corresponding disease burden. DESIGN Chinese Longitudinal Healthy Longevity Survey from 1998 to 2014. SETTING Twenty-three provinces in China. SUBJECTS A total of 25,047 participants aged ≥65-year-old. METHODS Cox proportional hazards models were performed to evaluate the association between PM2.5 and frailty in older adults. A method adapted from the Global Burden of Disease Study was used to calculate the PM2.5-related frailty disease burden. RESULTS A total of 5,733 incidents of frailty were observed during 107,814.8 person-years follow-up. A 10 μg/m3 increment of PM2.5 was associated with a 5.0% increase in the risk of frailty (Hazard Ratio = 1.05, 95% confidence interval = [1.03-1.07]). Monotonic, but non-linear exposure-response, relationships of PM2.5 with risk of frailty were observed, and slopes were steeper at concentrations >50 μg/m³. Considering the interaction between population ageing and mitigation of PM2.5, the PM2.5-related frailty cases were almost unchanged in 2010, 2020 and 2030, with estimations of 664,097, 730,858 and 665,169, respectively. CONCLUSIONS This nation-wide prospective cohort study showed a positive association between long-term PM2.5 exposure and frailty incidence. The estimated disease burden indicated that implementing clean air actions may prevent frailty and substantially offset the burden of population ageing worldwide.
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Affiliation(s)
- Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ze Yang
- Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lihong Ye
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China,School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Meijie Jiang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Jinhui Zhou
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanbo Guo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China,Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yidan Qiu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China,Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinwei Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China,Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Aipeng Ju
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China,Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jun Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chenfeng Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China,Department of Occupational Health and Environment Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yang Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiaonan Wang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - John S Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Andrea A Baccarelli
- Laboratory of Environmental Precision Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Xu Gao
- Author correspondence to: Xiaoming Shi, China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention; #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China. Tel: (+86) 1050930101; Fax: (+86) 1058900247.
| | - Xiaoming Shi
- Author correspondence to: Xiaoming Shi, China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention; #7 Panjiayuan Nanli, Chaoyang, Beijing 100021, China. Tel: (+86) 1050930101; Fax: (+86) 1058900247.
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Massari MC, Bimonte VM, Falcioni L, Moretti A, Baldari C, Iolascon G, Migliaccio S. Nutritional and physical activity issues in frailty syndrome during the COVID-19 pandemic. Ther Adv Musculoskelet Dis 2023; 15:1759720X231152648. [PMID: 36820002 PMCID: PMC9929193 DOI: 10.1177/1759720x231152648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/06/2023] [Indexed: 02/17/2023] Open
Abstract
'Frailty' has been described as 'a state of increased vulnerability of the individual caused by an impairment of homeostasis as a result of endogenous or exogenous stress'. Frail individuals are depicted by a dramatic change in health status following an apparently minor insult and a higher risk of adverse health-related outcomes such as osteoporosis and sarcopenia, falls and disability, and fragility fractures. Frailty is a condition of increasing importance due to the global ageing of the population during the last decades. Central to the pathophysiology of frailty is a mechanism that is partially independent of ageing, but most likely evolves with ageing: the cumulative level of molecular and cellular damage in every subject. Furthermore, an uncorrected nutrition and a sedentary behaviour play a pivotal role in worsening the syndrome. In January 2020, a cluster of a genus of the family Coronaviridae was isolated as the pathogen of the new coronavirus disease (COVID-19). Since then, this infection has spread worldwide causing one of the most dramatic pandemics of the modern era, with more than 500 million confirmed cases all over the world. The clinical spectrum of SARS-CoV-2 severity ranges from asymptomatic conditions to mild symptoms, such as fever, cough, ageusia, anosmia and asthenia, up to most severe conditions, such as acute respiratory distress syndrome (ARDS) and multi-organ failure leading to death. Primary evidence revealed that the elderly frail subjects were more susceptible to the disease in its most intense form and were at greater risk of developing severe COVID-19. Factors contributing to the severity of COVID-19, and the higher mortality rate, are a poor immune system activity and long-standing inflammatory status of the frail subjects compared with the general population. Further recent research also suggested a potential role of sedentary behaviour, metabolic chronic disorders linked to it and uncorrected nutritional status. Thus, the aim of this review was to evaluate the different studies and evidence related to COVID-19 pandemic, both nutritional status and physical activity, and, also, to provide further information on the correct nutritional approach in this peculiar pathological condition.
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Affiliation(s)
- Maria Chiara Massari
- Department of Experimental Medicine, Section of Medical Pathophysiology, Endocrinology and Food Sciences, University Sapienza of Rome, Rome, Italy
| | - Viviana Maria Bimonte
- Department of Movement, Human and Health Sciences, University Foro Italico of Rome, Rome, Italy
| | - Lavinia Falcioni
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Napoli, Italy
| | - Carlo Baldari
- Department of Theoretical and Applied Sciences, eCampus University, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Napoli, Italy
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Das S, Prasad J. Gender Differences in Determinants of the Components of the Frailty Phenotype among Older Adults in India: Findings from LASI Wave-1. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3055. [PMID: 36833748 PMCID: PMC9965095 DOI: 10.3390/ijerph20043055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
This study examines the gender-specific determinants of the components of frailty in a community-dwelling setting in India. Using data from the Longitudinal Ageing Study in India (LASI) Wave-1, this study employed 30,978 (14,885 male and 16,093 female) older adults (aged 60+) to fulfil the study objective. The modified Fried frailty phenotype criteria defines frailty by the five components: exhaustion, weak grip strength, slow walking speed, unintentional weight loss, and low physical activity. The result showed grip strength (79.1%) as the most discriminant component among males, and physical activity (81.6%) as the most discriminant component among females. The results also indicated that grip strength (male: 98.0%, female: 93.5%) and physical activity (male: 94.8%, female: 96.9%) showed a sensitivity of more than 90%, which appears to be a good indicator of frailty. Combining this dual marker increased the accuracy to 99.97% among male and 99.98% among female samples. The findings suggested adding grip strength and physical activity as a proxy measure of frailty, which can increase the precision of screening without a large additional investment of time, training, or cost.
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Affiliation(s)
- Sayani Das
- International Institute of Health Management Research, Delhi 110075, India
| | - Jitender Prasad
- International Institute for Population Sciences, Mumbai 400088, India
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Liu P, Pan Y, Song Y, Zhou Y, Zhang W, Li X, Li J, Li Y, Ma L. Association of metformin exposure with low risks of frailty and adverse outcomes in patients with diabetes. Eur J Med Res 2023; 28:65. [PMID: 36732827 PMCID: PMC9896807 DOI: 10.1186/s40001-023-01017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Diabetes is an independent risk factor of frailty, which increases adverse outcomes in patients with diabetes. Metformin is a common antidiabetic drug in clinical practice. Insulin resistance and chronic inflammation are the two common mechanisms of diabetes and frailty, as well as the main targets of metformin. Research suggested that metformin has anti-aging potential. However, few studies focus on the relationship between metformin and frailty. Thus, we aimed to explore whether metformin was associated with a low risk of frailty and other adverse outcomes in diabetic patients. METHODS A total of 422 patients (≥ 40 years old) with type 2 diabetes were recruited. Frailty was defined by the Fried phenotype. General information and metformin exposure data were collected, and comprehensive geriatric assessment and laboratory tests were performed. Follow-up was conducted after 4.5 years. The primary outcome was the combined endpoint of cardiovascular events, cerebrovascular events, readmission, and death. Binary logistic regression analysis was used to analyze the association of metformin with frailty. Survival analysis was performed using Cox proportional hazards models. RESULTS The total prevalence of frailty was 19.4% among the participants with diabetes. 13.1% of patients in the metformin group and 28.2% in the non-metformin group had frailty. Metformin was inversely associated with frailty after adjusting for age, sex, duration, blood glucose levels, target organ damage, comorbidities, and polypharmacy. Further longitudinal analysis showed that metformin was also independently associated with a low risk of combined primary outcomes after adjusting for multiple covariables, while frailty was related to an increased risk of the combined primary outcomes. In the non-frail group, metformin was associated with a decreased risk of combined primary outcomes after adjustment for age and sex. However, the protective effect of metformin on adverse outcomes was not found in frail participants with diabetes. CONCLUSIONS Metformin use is associated with a reduced risk of frailty. In addition, frailty may attenuate the protective effects of metformin on adverse outcomes in diabetic patients. The early identification and prevention of frailty progression may help enhance the benefits of metformin in patients with diabetes.
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Affiliation(s)
- Pan Liu
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yiming Pan
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yu Song
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yaru Zhou
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wanshu Zhang
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xiaojun Li
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jiatong Li
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yun Li
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Lina Ma
- grid.413259.80000 0004 0632 3337Department of Geriatrics, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital Capital Medical University, Beijing, China
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Wanigatunga AA, Chiu V, Cai Y, Urbanek JK, Mitchell CM, Miller ER, Christenson RH, Rebuck H, Michos ED, Juraschek SP, Walston J, Xue QL, Bandeen-Roche K, Appel LJ, Schrack JA. Patterns of Daily Physical Movement, Chronic Inflammation, and Frailty Incidence. Med Sci Sports Exerc 2023; 55:281-288. [PMID: 36170549 PMCID: PMC9840658 DOI: 10.1249/mss.0000000000003048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Low physical activity is a criterion of phenotypic frailty defined as an increased state of vulnerability to adverse health outcomes. Whether disengagement from daily all-purpose physical activity is prospectively associated with frailty and possibly modified by chronic inflammation-a pathway often underlying frailty-remains unexplored. METHODS Using the Study to Understand Fall Reduction and Vitamin D in You data from 477 robust/prefrail adults (mean age = 76 ± 5 yr; 42% women), we examined whether accelerometer patterns (activity counts per day, active minutes per day, and activity fragmentation [broken accumulation]) were associated with incident frailty using Cox proportional hazard regression. Baseline interactions between each accelerometer metric and markers of inflammation that include interleukin-6, C-reactive protein, and tumor necrosis factor-alpha receptor 1 were also examined. RESULTS Over an average of 1.3 yr, 42 participants (9%) developed frailty. In Cox regression models adjusted for demographics, medical conditions, and device wear days, every 30 min·d -1 higher baseline active time, 100,000 more activity counts per day, and 1% lower activity fragmentation was associated with a 16% ( P = 0.003), 13% ( P = 0.001), and 8% ( P < 0.001) lower risk of frailty, respectively. No interactions between accelerometer metrics and baseline interleukin-6, C-reactive protein, or tumor necrosis factor-alpha receptor 1 were detected (interaction P > 0.06 for all). CONCLUSIONS Among older adults who are either robust or prefrail, constricted patterns of daily physical activity (i.e., lower total activity minutes and counts, and higher activity fragmentation) were prospectively associated with higher risk of frailty but not modified by frailty-related chronic inflammation. Additional studies, particularly trials, are needed to understand if this association is causal.
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Affiliation(s)
- Amal A. Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD
| | - Venus Chiu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yurun Cai
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | | | - Christine M. Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD
| | - Edgar R. Miller
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Heather Rebuck
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | - Erin D. Michos
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen P. Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, MA
| | - Jeremy Walston
- Division of Geriatric Medicine, Johns Hopkins University and Medical Institutions, Baltimore, MD
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of Geriatric Medicine, Johns Hopkins University and Medical Institutions, Baltimore, MD
| | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of Geriatric Medicine, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University and Medical Institutions, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University and Medical Institutions, Baltimore, MD
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Robison R, (Focht) Garand KL, Affoo R, Yeh CK, Chin N, McArthur C, Pulia M, Rogus-Pulia N. New horizons in understanding oral health and swallowing function within the context of frailty. Age Ageing 2023; 52:afac276. [PMID: 36735843 PMCID: PMC9897303 DOI: 10.1093/ageing/afac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/15/2022] [Indexed: 02/05/2023] Open
Abstract
Frailty is a complex and multidimensional condition wherein declines in physiologic reserve and function place individuals in a state of heightened vulnerability and decreased resiliency. There has been growing interest in both research and clinical settings to understand how to best define, assess and characterise frailty in older adults. To this end, various models and clinical assessment tools have been used to define and measure frailty. While differences exist among these models and tools, a common unifying theme is a focus on physical function and activity. Notably absent across many available conceptual models and clinical tools are items directly related to oral and swallowing function. This is an important oversight as widespread changes to both oral and swallowing function are evident in older adults. Indeed, emerging evidence suggests many of the functional domains affected in frail older adults, such as nutrition and sarcopenia, have cyclical relationships with impairments in oral (oral hypofunction) and swallowing function (dysphagia) as well. The increasing appreciation for the interrelationships among oral hypofunction, dysphagia and frailty provides an opportunity for refinement of frailty assessment and characterisation in older adults to incorporate metrics specific to oral and swallowing function.
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Affiliation(s)
- Raele Robison
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Kendrea L (Focht) Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL 36688, USA
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Chih-Ko Yeh
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System (STVHCS), San Antonio, TX 78229, USA
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio (UTHSA), San Antonio, TX 78229, USA
| | - Nathaniel Chin
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Caitlin McArthur
- School of Physiotherapy, Faculty Health, Dalhousie University, Halifax, NS
| | - Michael Pulia
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI 53703, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
- Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI 53705, USA
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Wolff CA, Gutierrez-Monreal MA, Meng L, Zhang X, Douma LG, Costello HM, Douglas CM, Ebrahimi E, Pham A, Oliveira AC, Fu C, Nguyen A, Alava BR, Hesketh SJ, Morris AR, Endale MM, Crislip GR, Cheng KY, Schroder EA, Delisle BP, Bryant AJ, Gumz ML, Huo Z, Liu AC, Esser KA. Defining the age-dependent and tissue-specific circadian transcriptome in male mice. Cell Rep 2023; 42:111982. [PMID: 36640301 PMCID: PMC9929559 DOI: 10.1016/j.celrep.2022.111982] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/01/2022] [Accepted: 12/23/2022] [Indexed: 01/10/2023] Open
Abstract
Cellular circadian clocks direct a daily transcriptional program that supports homeostasis and resilience. Emerging evidence has demonstrated age-associated changes in circadian functions. To define age-dependent changes at the systems level, we profile the circadian transcriptome in the hypothalamus, lung, heart, kidney, skeletal muscle, and adrenal gland in three age groups. We find age-dependent and tissue-specific clock output changes. Aging reduces the number of rhythmically expressed genes (REGs), indicative of weakened circadian control. REGs are enriched for the hallmarks of aging, adding another dimension to our understanding of aging. Analyzing differential gene expression within a tissue at four different times of day identifies distinct clusters of differentially expressed genes (DEGs). Increased variability of gene expression across the day is a common feature of aged tissues. This analysis extends the landscape for understanding aging and highlights the impact of aging on circadian clock function and temporal changes in gene expression.
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Affiliation(s)
- Christopher A Wolff
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Myology Institute, University of Florida, Gainesville, FL 32610, USA
| | - Miguel A Gutierrez-Monreal
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Myology Institute, University of Florida, Gainesville, FL 32610, USA; Claude D. Pepper Older Americans Independence Center, University of Florida, Gainesville, FL 32610, USA
| | - Lingsong Meng
- Department of Biostatistics, University of Florida, Gainesville, FL 32610, USA
| | - Xiping Zhang
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Myology Institute, University of Florida, Gainesville, FL 32610, USA
| | - Lauren G Douma
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL 32610, USA
| | - Hannah M Costello
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL 32610, USA
| | - Collin M Douglas
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Myology Institute, University of Florida, Gainesville, FL 32610, USA
| | - Elnaz Ebrahimi
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ann Pham
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Aline C Oliveira
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Chunhua Fu
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Amy Nguyen
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Bryan R Alava
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Stuart J Hesketh
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Myology Institute, University of Florida, Gainesville, FL 32610, USA
| | - Andrew R Morris
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mehari M Endale
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - G Ryan Crislip
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Kit-Yan Cheng
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Elizabeth A Schroder
- Internal Medicine, Pulmonary, University of Kentucky, Lexington, KY 40506, USA; Department of Physiology, University of Kentucky, Lexington, KY 40506, USA
| | - Brian P Delisle
- Department of Physiology, University of Kentucky, Lexington, KY 40506, USA
| | - Andrew J Bryant
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL 32610, USA
| | - Michelle L Gumz
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL 32610, USA; Center for Integrative Cardiovascular and Metabolic Disease, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Zhiguang Huo
- Department of Biostatistics, University of Florida, Gainesville, FL 32610, USA.
| | - Andrew C Liu
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
| | - Karyn A Esser
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL 32610, USA; Myology Institute, University of Florida, Gainesville, FL 32610, USA; Claude D. Pepper Older Americans Independence Center, University of Florida, Gainesville, FL 32610, USA.
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130
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Chan CY, De Roza JG, Ding GTY, Koh HL, Lee ES. Psychosocial factors and caregiver burden among primary family caregivers of frail older adults with multimorbidity. BMC PRIMARY CARE 2023; 24:36. [PMID: 36717770 PMCID: PMC9885618 DOI: 10.1186/s12875-023-01985-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Provision of care for frail older adults with multiple chronic diseases (multimorbidity) poses increasing challenge for family caregivers. Our study aims to evaluate to what extent caregiving competence, social support and positive aspects of caregiving can mitigate the effect of burden experienced by family caregivers of frail older adults with multimorbidity. METHODS A descriptive cross-sectional study was conducted in 2 primary care clinics. Family caregivers of older adults aged 65 years and above were invited to complete interviewer-administered questionnaires. Descriptive statistics were used to describe sociodemographic and clinical data. Caregiver's burden was measured using the Zarit Burden Interview (ZBI). Mann-Whitney U test was used to compare differences in Caregiving Competence Scale (CCS), short Positive Aspects of Caregiving (S-PAC) and modified Medical Outcome Study Social support (mMOS-SS). Multivariable logistic regression was used to analyse factors associating with caregiver burden. RESULTS A total of 188 participants were recruited. 71.8% reported caregiver burden (ZBI score ≥ 10). Caregivers who perceived burden had significantly lower CCS, S-PAC and mMOS-SS scores than those who did not (10.0 vs 11.6; 26.8 vs 29.8; 24.8 vs 31.4, p < 0.001 respectively). Factors significantly associated with higher odds of perceived burden were presence of alternative caregivers (OR 3.3, 95% CI 1.09, 10.19, p = 0.04), use of community resources (OR 4.4, 95% CI 1.15, 16.83, p = 0.03) and time spent caregiving per week (OR 1.1, 95% CI 1.02, 1.10, p = 0.003). DISCUSSION AND CONCLUSION This study found that caregivers had high perception of burden as demand in caregiving may increase. Anticipating caregiver burden and social support needs may be important part of managing these frail older adults.
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Affiliation(s)
- Cheuk Ying Chan
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore
| | | | - Gabriel Teck Yong Ding
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore
| | - Hui Li Koh
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore
| | - Eng Sing Lee
- grid.466910.c0000 0004 0451 6215National Healthcare Group Polyclinics, Singapore, Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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131
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Efficient representations of binarized health deficit data: the frailty index and beyond. GeroScience 2023:10.1007/s11357-022-00723-z. [PMID: 36705846 PMCID: PMC10400752 DOI: 10.1007/s11357-022-00723-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/29/2022] [Indexed: 01/28/2023] Open
Abstract
We investigated efficient representations of binarized health deficit data using the 2001-2002 National Health and Nutrition Examination Survey (NHANES). We compared the abilities of features to compress health deficit data and to predict adverse outcomes. We used principal component analysis (PCA) and several other dimensionality reduction techniques, together with several varieties of the frailty index (FI). We observed that the FI approximates the first - primary - component obtained by PCA and other compression techniques. Most adverse outcomes were well predicted using only the FI. While the FI is therefore a useful technique for compressing binary deficits into a single variable, additional dimensions were needed for high-fidelity compression of health deficit data. Moreover, some outcomes - including inflammation and metabolic dysfunction - showed high-dimensional behaviour. We generally found that clinical data were easier to compress than lab data. Our results help to explain the success of the FI as a simple dimensionality reduction technique for binary health data. We demonstrate how PCA extends the FI, providing additional health information, and allows us to explore system dimensionality and complexity. PCA is a promising tool for determining and exploring collective health features from collections of binarized biomarkers.
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132
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Schmidle S, Gulde P, Koster R, Soaz C, Hermsdörfer J. The relationship between self-reported physical frailty and sensor-based physical activity measures in older adults - a multicentric cross-sectional study. BMC Geriatr 2023; 23:43. [PMID: 36694172 PMCID: PMC9875425 DOI: 10.1186/s12877-022-03711-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/20/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The decline in everyday life physical activity reflects and contributes to the frailty syndrome. While especially self-reported frailty assessments have the advantage of reaching large groups at low costs, little is known about the relationship between the self-report and objective measured daily physical activity behavior. The main objective was to evaluate whether and to what extent a self-reported assessment of frailty is associated with daily physical activity patterns. METHODS Daily activity data were obtained from 88 elderly participants (mean 80.6 ± 9.1 years) over up to 21 days. Acceleration data were collected via smartwatch. According to the results of a self-report frailty questionnaire, participants were retrospectively split up into three groups, F (frail, n = 43), P (pre-frail, n = 33), and R (robust, n = 12). Gait- and activity-related measures were derived from the built-in step detector and acceleration sensor and comprised, i.a., standard deviation of 5-s-mean amplitude deviation (MADstd), median MAD (MADmedian), and the 95th percentile of cadence (STEP95). Parameters were fed into a PCA and component scores were used to derive behavioral clusters. RESULTS The PCA suggested two components, one describing gait and one upper limb activity. Mainly gait related parameters showed meaningful associations with the self-reported frailty score (STEP95: R2 = 0.25), while measures of upper limb activity had lower coefficients (MADmedian: R2 = 0.07). Cluster analysis revealed two clusters with low and relatively high activity in both dimensions (cluster 2 and 3). Interestingly, a third cluster (cluster 1) was characterized by high activity and low extent of ambulation. Comparisons between the clusters showed significant differences between activity, gait, age, sex, number of chronic diseases, health status, and walking aid. Particularly, cluster 1 contained a higher number of female participants, whose self-reports tended towards a low health status, the frequent use of a walking aid, and a higher score related to frailty questions. CONCLUSIONS The results demonstrate that subjective frailty assessments may be a simple first screening approach. However, especially older women using walking aids may classify themselves as frail despite still being active. Therefore, the results of self-reports may be particularly biased in older women.
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Affiliation(s)
- Stephanie Schmidle
- grid.6936.a0000000123222966Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Philipp Gulde
- grid.6936.a0000000123222966Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Raphael Koster
- MADoPA, Centre Expert en Technologies et Service pour le Maintien en Autonomie á Domicile des Personnes Agées, Paris, France
| | | | - Joachim Hermsdörfer
- grid.6936.a0000000123222966Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Sirisegaram L, Owodunni OP, Ehrlich A, Qin CX, Bettick D, Gearhart SL. Validation of the self-reported domains of the Edmonton Frail Scale in patients 65 years of age and older. BMC Geriatr 2023; 23:15. [PMID: 36631769 PMCID: PMC9832416 DOI: 10.1186/s12877-022-03623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION In the era of virtual care, self-reported tools are beneficial for preoperative assessments and facilitating postoperative planning. We have previously reported the use of the Edmonton Frailty Scale (EFS) as a valid preoperative assessment tool. OBJECTIVE We wished to validate the self-reported domains of the EFS (srEFS) by examining its association with loss of independence (LOI) and mortality. METHODS This is a post-hoc analysis of a single-institution observational study of patients 65 years of age or older undergoing multi-specialty surgical procedures and assessed with the EFS in the preoperative setting. Exploratory data analysis was used to determine the threshold for identifying frailty using the srEFS. Procedures were classified using the Operative Stress Score (OSS) scored 1 to 5 (lowest to highest). Hierarchical Condition Category (HCC) was utilized to risk-adjust. LOI was described as requiring more support at discharge and mortality was defined as death occurring up to 30 days following surgery. Receiver operating characteristic (ROC) curves were used to determine the ability of the srEFS to predict the outcomes of interest in relation to the EFS. RESULTS Five hundred thirty-five patients were included. Exploratory analysis confirmed best positive predictive value for srEFS was greater or equal to 5. Overall, 113 (21 percent) patients were considered high risk for frailty (HRF) and 179 (33 percent) patients had an OSS greater or equal to 5. LOI occurred in 7 percent (38 patients) and the mortality rate was 4 percent (21 patients). ROC analysis showed that the srEFS performed similar to the standard EFS with no difference in discriminatory thresholds for predicting LOI and mortality. Examination of the domains of the EFS not included in the srEFS demonstrated a lack of association between cognitive decline and the outcomes of interest. However, functional status assessed with either the Get up and Go (EFS only) or self-reported ADLs was independently associated with increased risk for LOI. CONCLUSION This study shows that self-reported EFS may be an optional preoperative tool that can be used in the virtual setting to identify patients at HRF. Early identification of patients at risk for LOI and mortality provides an opportunity to implement targeted strategies to improve patient care.
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Affiliation(s)
- Luxey Sirisegaram
- grid.21107.350000 0001 2171 9311The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.39381.300000 0004 1936 8884Schulich School of Medicine, University of Western Ontario, London, ON Canada
| | - Oluwafemi P. Owodunni
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - April Ehrlich
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Caroline Xu Qin
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Dianne Bettick
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Susan L. Gearhart
- grid.21107.350000 0001 2171 9311Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD USA ,grid.411940.90000 0004 0442 9875Department of Surgery, Johns Hopkins Bayview Medical Center, A Building, 4940 Eastern Avenue, Baltimore, MD 21286 USA
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Fons A, Kalisvaart K, Maljaars J. Frailty and Inflammatory Bowel Disease: A Scoping Review of Current Evidence. J Clin Med 2023; 12:533. [PMID: 36675461 PMCID: PMC9860672 DOI: 10.3390/jcm12020533] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Frailty is increasingly recognized as an important concept in patients with Inflammatory Bowel Disease (IBD). The aim of this scoping review is to summarize the current literature on frailty in IBD. We will discuss the definition of frailty, frailty assessment methods, the prevalence of frailty, risk factors for frailty and the prognostic value of frailty in IBD. A scoping literature search was performed using the PubMed database. Frailty prevalence varied from 6% to 53.9%, depending on the population and frailty assessment method. Frailty was associated with a range of adverse outcomes, including an increased risk for all-cause hospitalization and readmission, mortality in non-surgical setting, IBD-related hospitalization and readmission. Therefore, frailty assessment should become integrated as part of routine clinical care for older patients with IBD.
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Affiliation(s)
- Anne Fons
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Geriatric Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands
| | - Kees Kalisvaart
- Department of Geriatric Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands
| | - Jeroen Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
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Hanlon P, Guo X, McGhee E, Lewsey J, McAllister D, Mair FS. Systematic review and meta-analysis of prevalence, trajectories, and clinical outcomes for frailty in COPD. NPJ Prim Care Respir Med 2023; 33:1. [PMID: 36604427 PMCID: PMC9816100 DOI: 10.1038/s41533-022-00324-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
This systematic review synthesised measurement and prevalence of frailty in COPD and associations between frailty and adverse health outcomes. We searched Medline, Embase and Web of Science (1 January 2001-8 September 2021) for observational studies in adults with COPD assessing frailty prevalence, trajectories, or association with health-related outcomes. We performed narrative synthesis and random-effects meta-analyses. We found 53 eligible studies using 11 different frailty measures. Most common were frailty phenotype (n = 32), frailty index (n = 5) and Kihon checklist (n = 4). Prevalence estimates varied by frailty definitions, setting, and age (2.6-80.9%). Frailty was associated with mortality (5/7 studies), COPD exacerbation (7/11), hospitalisation (3/4), airflow obstruction (11/14), dyspnoea (15/16), COPD severity (10/12), poorer quality of life (3/4) and disability (1/1). In conclusion, frailty is a common among people with COPD and associated with increased risk of adverse outcomes. Proactive identification of frailty may aid risk stratification and identify candidates for targeted intervention.
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Affiliation(s)
- Peter Hanlon
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Xuetong Guo
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Eveline McGhee
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jim Lewsey
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - David McAllister
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Nguyen DD, Arnold SV. Impact of frailty on disease-specific health status in cardiovascular disease. Heart 2023:heartjnl-2022-321631. [PMID: 36604164 DOI: 10.1136/heartjnl-2022-321631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
Frailty is a syndrome of older age that reflects an impaired physiological reserve and decreased ability to recover from medical stressors. While the impact of frailty on mortality in cardiovascular disease has been well described, its impact on cardiovascular disease-specific health status-cardiac symptoms, physical functioning and quality of life-has been less well studied. In this review, we summarise the impact of frailty on health status outcomes across different cardiovascular conditions. In heart failure, frail patients have markedly impaired disease-specific health status and are at risk for subsequent health status deteriorations. However, frail patients have similar or even greater health status improvements with interventions for heart failure, such as cardiac rehabilitation or guideline-directed medical therapy. In valvular heart disease, the impact of frailty on disease-specific health status is of even greater concern since management involves physiologically taxing procedures that can worsen health status. Frailty increases the risk of poor health status outcomes after transcatheter aortic valve intervention or surgical aortic valve replacement for aortic stenosis, but there is no evidence that frail patients benefit more from one procedure versus another. In both heart failure and valvular heart disease, health status improvements may reverse frailty, highlighting the overlap between cardiovascular disease and frailty and emphasising that treatment should typically not be withheld based on the presence of frailty alone. Meanwhile, data are limited on the impact of frailty on health status outcomes in the treatment of coronary artery disease, peripheral artery disease and atrial fibrillation, and requires further research.
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Affiliation(s)
- Dan D Nguyen
- Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Suzanne V Arnold
- Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA .,Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
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Brañas F, Torralba M, Antela A, Vergas J, Ramírez M, Ryan P, Dronda F, Galindo MJ, Machuca I, Bustinduy MJ, Cabello A, Montes ML, Sánchez-Conde M. Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV. BMC Geriatr 2023; 23:4. [PMID: 36597036 PMCID: PMC9809005 DOI: 10.1186/s12877-022-03719-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To understand the effects of frailty, geriatric syndromes, and comorbidity on quality of life and mortality in older adults with HIV (OAWH). METHODS Cross-sectional study of the FUNCFRAIL multicenter cohort. The setting was outpatient HIV-Clinic. OAWH, 50 year or over were included. We recorded sociodemographic data, HIV infection-related data, comorbidity, frailty, geriatric syndromes (depression, cognitive impairment, falls and malnutrition), quality of life (QOL) and the estimated risk of all-cause 5-year mortality by VACS Index. Association of frailty with geriatric syndromes and comorbidity was evaluated using the Cochran-Mantel-Haenszel test. RESULTS Seven hundred ninety six patients were included. 24.7% were women, mean age was 58.2 (6.3). 14.7% were 65 or over. 517 (65%) patients had ≥3 comorbidities, ≥ 1 geriatric syndrome and/or frailty. There were significant differences in the estimated risk of mortality [(frailty 10.8%) vs. (≥ 3 comorbidities 8.2%) vs. (≥ 1 geriatric syndrome 8.2%) vs. (nothing 6.2%); p = 0.01] and in the prevalence of fair or poor QOL [(frailty 71.7%) vs. (≥ 3 comorbidities 52%) vs. (≥ 1 geriatric syndrome 58.4%) vs. (nothing 51%); p = 0.01]. Cognitive impairment was significantly associated to mortality (8.7% vs. 6.2%; p = 0.02) and depression to poor QOL [76.5% vs. 50%; p = 0.01]. CONCLUSIONS Frailty, geriatric syndromes, and comorbidity had negative effects on mortality and QOL, but frailty had the greatest negative effect out of the three factors. Our results should be a wake-up call to standardize the screening for frailty and geriatric syndromes in OAWH in the clinical practice. TRIAL REGISTRATION NCT03558438.
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Affiliation(s)
- Fátima Brañas
- grid.414761.1Geriatrics Department, Hospital Universitario Infanta Leonor, Fundación para la Investigación e Innovación Biomédica H.U Infanta Leonor y H.U. Sureste. Universidad Complutense, Madrid, Spain
| | - Miguel Torralba
- grid.411098.50000 0004 1767 639XInternal Medicine Department, Hospital Universitario de Guadalajara. Universidad de Alcalá, Guadalajara, Spain
| | - Antonio Antela
- grid.411048.80000 0000 8816 6945Infectious Diseases Unit, Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Madrid, Spain
| | - Jorge Vergas
- grid.411068.a0000 0001 0671 5785Internal Medicine/ Infectious Diseases Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Margarita Ramírez
- grid.410526.40000 0001 0277 7938Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Ryan
- grid.414761.1HIV Clinic. Hospital Universitario Infanta Leonor, Fundación para la Investigación e Innovación Biomédica H.U Infanta Leonor y H.U. Sureste. Universidad Complutense. CIBERINFEC, Madrid, Spain
| | - Fernando Dronda
- grid.411347.40000 0000 9248 5770Infectious Diseases Department, Hospital Universitario Ramón y Cajal. IRYCIS. CIBERINFEC, Madrid, Spain
| | - María José Galindo
- grid.411308.fInternal Medicine/ Infectious Diseases Department, Hospital Universitario Clínico de Valencia, Valencia, Spain
| | - Isabel Machuca
- grid.411349.a0000 0004 1771 4667Infectious Diseases Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - María Jesús Bustinduy
- grid.414651.30000 0000 9920 5292Infectious Diseases Department, Hospital de Donostia, San Sebastián, Spain
| | - Alfonso Cabello
- grid.419651.e0000 0000 9538 1950Infectious Diseases Department, Fundación Jiménez Díaz, Madrid, Spain
| | - María Luisa Montes
- grid.81821.320000 0000 8970 9163HIV Unit/Internal Medicine Department, Hospital Universitario La Paz. IdiPAZ, Madrid, Spain
| | - Matilde Sánchez-Conde
- grid.411347.40000 0000 9248 5770Infectious Diseases Department, Hospital Universitario Ramón y Cajal. IRYCIS. CIBERINFEC, Madrid, Spain
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Hwang AC, Chen LY, Tang TC, Peng LN, Lin MH, Chou YJ, Hsiao FY, Chen LK. Transitions in Frailty and 4-Year Mortality Risk in Taiwan Longitudinal Study on Aging. J Am Med Dir Assoc 2023; 24:48-56.e5. [PMID: 36370752 DOI: 10.1016/j.jamda.2022.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To explore the associations of (1) the frailty phenotype or frailty index transition with cause-specific mortality, and (2) different combinations of transition in frailty phenotype and frailty index with all-cause mortality. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Data from 3529 respondents aged >50 years who completed the 1999 and 2003 surveys of the Taiwan Longitudinal Study on Aging were analyzed. METHODS Cox regression and subdistribution hazard models were constructed to investigate frailty phenotype or frailty index transitions (by categories of frailty phenotype, absolute and percentage changes in frailty index, and combined categories of the 2 measurements) and subsequent 4-year all-cause and cause-specific mortality, respectively. RESULTS Among the frailty phenotype transition groups, the improved frailty group had overall mortality risk comparable to that of the maintained robustness/prefrailty group [hazard ratio (HR): 0.9; 95% CI: 0.7-1.2] and lower risk of mortality due to organ failure (HR: 0.4; 95% CI: 0.2-0.8; P = .015), whereas the worsened frailty group had the highest risk of all-cause mortality and death from infection, malignancy, cardiometabolic/cerebrovascular diseases, and other causes (HR: 1.8-3.7; all P < .03). The rapidly increased frailty index group had significantly higher all-cause and every cause-specific mortality than the decreased frailty index group (HR: 1.8-7.7; all P < .05). When frailty phenotype and frailty index transition groups were combined, participants with worsened frailty/rapidly increased frailty index had increased risk under the same frailty index/frailty phenotype transition condition, particularly for large changes in each factor (HR: 1.5-2.2; P < .01 for worsened frailty; 1.7-4.5, P < .03 for rapidly increased frailty index). CONCLUSIONS AND IMPLICATIONS We found that considering both frailty phenotype and frailty index provided best mortality prediction. These associations were independent of baseline frailty status and comorbidities. Nevertheless, even capturing transitions in frailty phenotype or frailty index only can provide good mortality prediction, which supported adopting these approaches in different clinical settings.
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Affiliation(s)
- An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Ching Tang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan.
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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Yu X, Lobo JD, Sundermann E, Baker DJ, Tracy RP, Kuchel GA, Stephenson KE, Letendre SL, Brew B, Cysique LA, Dale SK, Wallen C, Kunisaki KM, Guaraldi G, Milic J, Winston A, Moore DJ, Margolick JB, Erlandson KM. Current Challenges and Solutions for Clinical Management and Care of People with HIV: Findings from the 12th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2023; 39:1-12. [PMID: 36322713 PMCID: PMC9889016 DOI: 10.1089/aid.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
People with HIV on combination antiretroviral therapy (ART) have longer life expectancy and are increasingly experiencing age-related comorbidities. Thus, aging with HIV has become a central issue in clinical care and research, which has been particularly challenging with the intersection of the ongoing coronavirus (COVID)-19 pandemic. Since 2009, the International Workshop on HIV and Aging has served as a multidisciplinary platform to share research findings from cross-disciplinary fields along with community advocates to address critical issues in HIV and aging. In this article, we summarize the key oral presentations from the 12th Annual International Workshop on HIV and Aging, held virtually on September 23rd and 24th, 2021. The topics ranged from basic science research on biological mechanisms of aging to quality of life and delivery of care under the COVID-19 pandemic. This workshop enriched our understanding of HIV and aging under the COVID-19 pandemic, identified challenges and opportunities to combat the impact of COVID-19 on HIV communities, and also provided updated research and future directions of the field to move HIV and aging research forward, with the ultimate goal of successful aging for older people with HIV.
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Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, Texas, USA
| | - Judith D. Lobo
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Erin Sundermann
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Darren J. Baker
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Colchester, Vermont, USA
| | - George A. Kuchel
- UConn Center on Aging, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Kathryn E. Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott L. Letendre
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Bruce Brew
- Department of Neurology and HIV Medicine, St. Vincent's Hospital, Sydney, Australia
- Department of Neurology, Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, Australia
- Faculty of Medicine, Department of Neurology, University of New South Wales Sydney, Sydney, Australia
- University of Notre Dame Australia, Sydney, Australia
| | - Lucette A. Cysique
- Faculty of Science, Department of Psychology, School of Psychology, University of New South Wales Sydney, Sydney, Australia
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Neuroscience Unit, St. Vincent's Hospital Centre for Applied Medical Research, Sydney, Australia
| | - Sannisha K. Dale
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Chelsie Wallen
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, Modena HIV Metabolic Clinic (MHMC), University of Modena and Reggio Emilia, Modena, Italy
| | - Alan Winston
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joseph B. Margolick
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristine M. Erlandson
- Divisions of Infectious Diseases, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
- Divisions of Geriatric Medicine, Department of Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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COVID-19 case and mortality rates lower in green houses compared to traditional nursing homes in New York state. Geriatr Nurs 2023; 50:132-137. [PMID: 36780710 PMCID: PMC9852308 DOI: 10.1016/j.gerinurse.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
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Watanabe D, Yoshida T, Nanri H, Watanabe Y, Itoi A, Goto C, Ishikawa-Takata K, Yamada Y, Fujita H, Miyachi M, Kimura M. Dose-Response Relationships between Diet Quality and Mortality among Frail and Non-Frail Older Adults: A Population-Based Kyoto-Kameoka Prospective Cohort Study. J Nutr Health Aging 2023; 27:1228-1237. [PMID: 38151874 DOI: 10.1007/s12603-023-2041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Although better diet quality is inversely associated with mortality risk, the association between diet quality and mortality remains unclear in frail and non-frail older adults. Thus, we aimed to examine this association in older Japanese adults. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS We used the data of 8,051 Japanese older adults aged ≥65 years in the Kyoto-Kameoka study. MESUREMENTS Dietary intake was estimated using a validated food frequency questionnaire. Diet quality was evaluated by calculating the adherence scores to the Japanese Food Guide Spinning Top (range, 0 [worst] to 80 [best]), which were stratified into quartiles. Frailty status was assessed using the validated self-administered Kihon Checklist (KCL) and the Fried phenotype (FP) model. Survival data were collected between February 15, 2012 and November 30, 2016. Statistical analysis was performed using the multivariate Cox proportional hazard analysis and the spline model. RESULTS During the median 4.75-year follow-up (36,552 person-years), we recorded 661 deaths. After adjusting for confounders, compared with the bottom adherence score quartile, the top quartile was associated with lower hazard ratio (HR) of mortality in frailty (HR, 0.73; 95% confidence interval [CI], 0.54-1.00) and non-frailty, as defined by the KCL (HR, 0.72; 95% CI, 0.52-1.01). In the spline model, regardless of frailty status defined by the KCL and FP model, adherence score showed a strongly dose-dependent inverse association with mortality up to approximately 55 points; however, no significant differences were observed thereafter. This association was similar to the results obtained in individuals with physical, cognitive, and depression as domains of KCL in the spline model. CONCLUSIONS Our findings demonstrate an L-shaped association between diet quality and mortality in both frail and non-frail individuals. This study may provide important knowledge for improving poor diet quality in older individuals with frailty or domains of frailty.
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Affiliation(s)
- D Watanabe
- Daiki Watanabe, RD, PhD, Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-city, Saitama 359-1192, Japan. Tel.: +81-4-2947-6936. E-mail:
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Lin TY, Hung SC. Frailty and Humoral Immune Responses Following COVID-19 Vaccination among Patients Undergoing Hemodialysis. J Nutr Health Aging 2023; 27:980-986. [PMID: 37997719 DOI: 10.1007/s12603-023-1994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/25/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Patients with end-stage kidney disease who are undergoing dialysis have reduced immune responses to COVID-19 vaccination. Frailty is extremely common among dialysis patients and may contribute to the impaired immunogenicity. This study aimed to determine the association between frailty and humoral immune responses following COVID-19 vaccination in hemodialysis patients. DESIGN, SETTING, PARTICIPANTS Adult hemodialysis patients without prior SARS-CoV-2 infection who received a priming dose of ChAdOx1 nCoV-19, an adenovirus-vectored vaccine, were assessed for eligibility. Participants were categorized as robust, pre-frail, or frail using the Fried frailty criteria. Humoral responses were assessed 28 days after vaccination by measuring titers of anti-spike IgG antibodies. The primary outcome was anti-spike antibody seroconversion, defined as antibody levels ≥50 AU/mL. Multivariable-adjusted logistic regression models were used to assess the association between frailty status and the primary outcome. RESULTS A total of 206 participants (mean age 67 ± 13 years, 50% women) were included in the study, of whom 50 (24%) were characterized as frail, 86 (42%) were characterized as pre-frail, and 70 (34%) were characterized as robust. Anti-spike antibody levels were progressively lower with more advanced stages of frailty (P <0.001). Compared with robust patients, a significantly smaller proportion of pre-frail and frail patients developed anti-spike antibody seroconversion (87%, 66%, and 40%, respectively; P <0.001). Frailty was associated with the absence of humoral responses after adjustment for age, sex, body mass index, diabetes, coronary artery disease, serum albumin, and lymphocyte count (OR=0.25; 95% CI, 0.08-0.80). CONCLUSIONS Frailty is independently associated with impaired humoral responses following COVID-19 vaccination among hemodialysis patients. Strategies aimed at preventing or attenuating frailty in the dialysis population are warranted.
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Affiliation(s)
- T-Y Lin
- Szu-Chun Hung, Division of Nephrology, Taipei Tzu Chi Hospital, 289, Jianguo Road, Xindian District, New Taipei City 231, Taiwan. E-mail:
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Galluzzo L, Noale M, Maggi S, Feraldi A, Baldereschi M, Di Carlo A, Onder G. Frailty Prevalence, Incidence, and Association with Incident Disability in the Italian Longitudinal Study on Aging. Gerontology 2023; 69:249-260. [PMID: 35871516 DOI: 10.1159/000525581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Data on frailty frequency are heterogeneous and mostly based on cross-sectional studies. Little is known about frailty development and progression over time. Our aim was to conduct a systematic analysis of frailty prevalence and incidence in a large cohort of older adults and to evaluate the association with incident disability, in order to tackle the current paucity and fragmentation of longitudinal data on frailty. METHODS As secondary analysis of the Italian Longitudinal Study on Aging (ILSA) population-based cohort (n = 5,632, 65-84), frailty status was operationalized according to Fried criteria (n = 2,457). Weighted prevalence and incidence rates were calculated at each ILSA wave (T0 1992-1993, T1 1995-1996, T2 2000-2001). The association with incident disability in Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL) was investigated through Cox proportional hazard models, controlling for possible confounders. RESULTS Prevalence of frailty and pre-frailty at baseline (mean age 71.6 years; women 58.9%) were 4.0% (95% confidence interval [CI]: 3.4-4.6) and 44.6% (95% CI: 43.1-46.1), respectively. Incidence rates per 1,000 person-years for the T0-T1 interval were 7.3 (95% CI: 5.2-9.3) for frailty and 83.7 (95% CI: 73.6-93.8) for pre-frailty. Prevalence and incidence of frailty, and to a lesser degree of pre-frailty, were overall higher for women and increased with age, yet no increasing trend with advancing age was detected for pre-frailty incidence. Frailty incidence rates were significantly higher among pre-frail than non-frail individuals at follow-up entry. After full adjustment, being frail markedly increased the risk of incident disability in ADL (hazard ratio [HR] 3.58, 95% CI: 1.97-6.52) and IADL (HR 2.56, 95% CI: 1.58-4.16) over a 4-year period. DISCUSSION/CONCLUSION According to our findings, frailty is common among older people and is a strong and independent predictor of disability. Further research on factors and characteristics related to frailty progression, and especially remission, over time is crucial to calibrate effective public health preventive measures.
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Affiliation(s)
- Lucia Galluzzo
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Marianna Noale
- Neuroscience Institute, Aging Branch, National Research Council (CNR), Padua, Italy
| | - Stefania Maggi
- Neuroscience Institute, Aging Branch, National Research Council (CNR), Padua, Italy
| | | | - Marzia Baldereschi
- Institute of Neuroscience, National Research Council (CNR), Florence, Italy
| | - Antonio Di Carlo
- Institute of Neuroscience, National Research Council (CNR), Florence, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
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Huynh NTH, Nguyen TTT, Pham HKT, Huynh NTH, Nguyen NT, Cao NT, Dung DV. Malnutrition, Frailty, and Health-Related Quality of Life Among Rural Older Adults in Vietnam: A Cross-Sectional Study. Clin Interv Aging 2023; 18:677-688. [PMID: 37138949 PMCID: PMC10149318 DOI: 10.2147/cia.s405847] [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: 01/24/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023] Open
Abstract
Purpose Rural older adults are more likely to be malnourished than urban older adults, particularly those living in lower-middle-income countries like Vietnam. Therefore, this study aimed to address the prevalence of malnutrition and its association with frailty and health-related quality of life in older rural Vietnamese adults. Participants and Methods This cross-sectional study was conducted on community-dwelling older adults (aged ≥ 60 years) living in a rural province in Vietnam. Nutritional status was determined using the Mini Nutritional Assessment Short Form (MNA-SF), and frailty was evaluated using the FRAIL scale. The 36-Item Short Form Survey (SF-36) was used to evaluate health-related quality of life. Results Among the 627 participants, 46 (7.3%) were malnourished (MNA-SF score <8), and 315 (50.2%) were at risk of malnutrition (MNA-SF score: 8-11). Individuals with malnutrition had significantly higher rates of impairments in instrumental activities of daily living and activities of daily living than those without malnutrition (47.8% vs 27.4% and 26.1% vs 8.7%, respectively). The prevalence of frailty was 13.5%. Risk of malnutrition and malnutrition were associated with high risks of frailty, with odds ratios of 2.14 (95% confidence interval [CI]: 1.16-3.93) and 4.78 (1.86-12.32), respectively. Furthermore, the MNA-SF score was positively correlated with eight domains of the health-related quality of life among rural older adults. Conclusion The prevalence rates of malnutrition, risk of malnutrition, and frailty were high among older adults in Vietnam. A strong association was observed between nutritional status and frailty. Therefore, this study reinforces the importance of screening for malnutrition and risk of malnutrition among older rural individuals. Further studies should explore whether early nutritional intervention reduces the risk of frailty among older adults and increase their health-related quality of life in the Vietnamese population.
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Affiliation(s)
- Nhung Thi Hong Huynh
- Faculty of Medicine and Pharmacy, Tra Vinh University, Tra Vinh, Tra Vinh Province, Vietnam
| | - Tran To Tran Nguyen
- Department of Geriatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Geriatrics, Gia Dinh People’s Hospital, Ho Chi Minh City, Vietnam
- Correspondence: Tran To Tran Nguyen, Department of Geriatrics, 1 Ly Thuong Kiet Street, Ward 7, Tan Binh District, Ho Chi Minh City, Vietnam, Tel +84 979635889, Email ;
| | - Huy Kien Tai Pham
- Department of Geriatrics, Gia Dinh People’s Hospital, Ho Chi Minh City, Vietnam
- Department of Oriental Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ngoc Thi Hong Huynh
- Faculty of Medicine and Pharmacy, Tra Vinh University, Tra Vinh, Tra Vinh Province, Vietnam
| | - Ngoan Thi Nguyen
- Faculty of Medicine and Pharmacy, Tra Vinh University, Tra Vinh, Tra Vinh Province, Vietnam
| | - Ngoc Thanh Cao
- Department of Geriatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Do Van Dung
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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145
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de Matos DG, de Santana JL, Mendelson AA, Duhamel TA, Villar R. Integrated Dynamic Autonomic and Cardiovascular Regulation during Postural Transitions in Older Adults Living with Frailty: A Systematic Review Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:566. [PMID: 36612888 PMCID: PMC9819247 DOI: 10.3390/ijerph20010566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/25/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Older adults often experience episodes of a sudden drop in blood pressure when standing, known as orthostatic hypotension (OH). OH is associated with an increased risk of life-threatening health problems, falls, and death. Although OH has been studied in older adults, the integrated dynamic autonomic and cardiovascular regulation during postural transitions in older adults with frailty remains scarce and poorly understood. The primary aim of this systematic review is to determine the association between how active (e.g., lie-to-stand) and passive (head-up tilt) postural transitions affect the dynamic integrated autonomic and cardiovascular regulatory responses, comparing older adults with different levels of frailty (non-frail, pre-frail, or frail). A second aim is to perform a meta-analysis to compare autonomic and cardiovascular responses during active postural transitions in non-frail, pre-frail, and frail older adults. The systematic review will be outlined according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The meta-analysis will generate estimates of the comparative autonomic and cardiovascular responses after active postural transitions in adults who are non-frail, pre-frail, and frail. This systematic review will provide critical information on how integrated dynamic autonomic and cardiovascular regulation occurs during postural transitions in older adults with different frailty statuses.
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Affiliation(s)
- Dihogo Gama de Matos
- Cardiorespiratory & Physiology of Exercise Research Laboratory, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Jefferson Lima de Santana
- Cardiorespiratory & Physiology of Exercise Research Laboratory, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Asher A. Mendelson
- Section of Critical Care, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W2, Canada
| | - Todd A. Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada
| | - Rodrigo Villar
- Cardiorespiratory & Physiology of Exercise Research Laboratory, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
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146
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Kang MG, Jung HW. Association Between Oral Health and Frailty in Older Korean Population: A Cross-Sectional Study. Clin Interv Aging 2022; 17:1863-1872. [PMID: 36575660 PMCID: PMC9790170 DOI: 10.2147/cia.s384417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Frailty is closely associated with biological age, concurrent medical conditions, morbidity, and decreased survival. Poor oral health is common in older individuals and is associated with frailty. Considering its potential importance, a study on the association between oral health and frailty is meaningful. Therefore, we aimed to analyze the association between major oral health factors and frailty using nationally representative samples of older adults. Patients and Methods This cross-sectional study included 3018 older adults (age ≥ 65 years) from the seventh Korea National Health and Nutrition Examination Survey. Oral examination results, laboratory data, handgrip strength, life style factors derived from questionnaires, and food intake survey results were analyzed. This study used the deficit accumulation model among the main operational definitions of frailty. We constructed a frailty index based on 36 items and classified participants as non-frail, pre-frail, or frail. Oral health factors included chewing difficulty, number of teeth, periodontal disease, and number of carious teeth. Logistic regression analysis was performed to determine significant factors. Results A total of 1222 (40.5%), 1014 (33.6%), and 782 (25.9%) individuals were classified as non-frail, pre-frail, and frail, respectively. Chewing difficulty was associated with increased risk of frailty after adjusting for age, sex, socioeconomic factors, and comorbidities (odds ratio 2.68, 95% confidence interval 2.08-3.44). Periodontal disease was positively associated with chewing difficulty (odds ratio 1.29, 95% confidence interval 1.07-1.56), and chewing difficulty decreased as the number of teeth increased (odds ratio 0.97, 95% confidence interval 0.96-0.99). Conclusion Chewing difficulty was significantly associated with frailty in the older population. Considering the negative effect of chewing difficulty on frailty, more attention should be focused on oral health.
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Affiliation(s)
- Min-gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence: Hee-Won Jung, Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea, Tel +82 10 2318 3490, Email
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147
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Newman AB. Introduction of Linda P. Fried, MD, MPH. J Clin Invest 2022; 132:162514. [PMID: 36519549 PMCID: PMC9754097 DOI: 10.1172/jci162514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Anne B. Newman
- Department of Epidemiology, Center for Aging and Population Health, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh, School of Medicine, Division of Geriatric Medicine, Pittsburgh, Pennsylvania, USA
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The Parallel Mediation Effects of Depression, Well-Being, and Social Activity on Physical Performance and Frailty in Community-Dwelling Middle-Aged and Older People. Curr Gerontol Geriatr Res 2022; 2022:7979006. [PMID: 36545342 PMCID: PMC9763010 DOI: 10.1155/2022/7979006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background Frailty refers to a decline in an elderly person's physical, psychological, and social functioning, making them sensitive to stressors. Because frailty is caused by a variety of factors, including certain demographic characteristics, understanding the mediating factors that affect frailty in the elderly is critical. Purpose To provide evidence about the relationship between depression, well-being, social activity, physical performance, and frailty among older adults. Materials and Methods The study used secondary data from Taiwan's Long-term Study of Aging (n = 7,622), excluding people with severe dementia. The chi-square test and Spearmen's coefficient correlation were used to assess the relationship between the demographic variables and frailty. Nonparametric bootstrapping analysis was used to test whether depression, well-being, and social activity are parallel mediators of the relationship between physical performance and frailty. This study was approved by Fu Jen Catholic University (FJU-IRB No. C110040). Results The overall frailty prevalence was 13.9%. We calculated a mean score and standard deviation for each measurement in this study. The correlation found low-to-moderate positive and negative statistically significant correlations between the variables. A significant, moderately negative relationship was found between physical performance and frailty that correlated with three potential mediating factors. The path indicated that lower physical performance scores and higher depression scores are more likely to be associated with frailty. Conclusion Older adults who are depressed are more likely to become frail. Adults who are more socially active and report greater well-being are less likely to become frail. Therefore, further research should design and test a comprehensive intervention for older adults in community settings that addresses all three factors, aimed at increasing well-being and social activity while also treating depression.
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149
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Doody P, Lord JM, Greig CA, Whittaker AC. Frailty: Pathophysiology, Theoretical and Operational Definition(s), Impact, Prevalence, Management and Prevention, in an Increasingly Economically Developed and Ageing World. Gerontology 2022; 69:927-945. [PMID: 36476630 PMCID: PMC10568610 DOI: 10.1159/000528561] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
The world's population is ageing, and most older adults experience a later life burdened with disease and disability. Frailty is a multidimensional and dynamic condition characterized by declines in reserve and function across multiple physiological systems, such that the ability to cope with every day or acute stressors becomes compromised. It is projected to become one of the most serious public health challenges economically developed societies will face in the coming century. This review provides a comprehensive overview of frailty, exploring its pathophysiology, theoretical and operational definition(s), impact, prevalence, management, and prevention, within the context of its emergence as a major public health challenge, in an increasingly economically developed and ageing world. Further, this review discusses the major limitations, deficiencies, and knowledge gaps presently within the field, and future research directions pertinent to the advancement of frailty research and the promotion of healthy longevity among the increasing global population of older adults.
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Affiliation(s)
- Paul Doody
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Janet M. Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham., Birmingham, UK
| | - Carolyn A. Greig
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham., Birmingham, UK
| | - Anna C. Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Picca A, Calvani R, Coelho-Júnior HJ, Landi F, Marzetti E. Anorexia of Aging: Metabolic Changes and Biomarker Discovery. Clin Interv Aging 2022; 17:1761-1767. [PMID: 36483084 PMCID: PMC9726216 DOI: 10.2147/cia.s325008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/24/2022] [Indexed: 08/04/2023] Open
Abstract
The age-associated decrease in appetite and food intake is referred to as "anorexia of aging". Older adults with anorexia show changes in the quantity/quality of energy supplied to the organism which eventually may cause a mismatch between ingested calories and physiological energy demands. Therefore, a state of malnutrition and impaired metabolism may ensue which renders older people more vulnerable to stressors and more prone to incur negative health outcomes. These latter cover a wide range of conditions including sarcopenia, low engagement in physical activity, and more severe consequences such as disability, loss of independence, hospitalization, nursing home placement, and mortality. Malnutrition has been recognized by the European Society of Clinical Nutrition (ESPEN) among the chief risk factors for the development of frailty. Frailty refers to a state of increased vulnerability to stressors stemming from reduced physiologic reserve, and according to ESPEN, is also nutrition-based. Alike frailty, anorexia is highly prevalent among older adults, and its multifactorial nature includes metabolic changes that develop in older age and possibly underly the condition. Circulating factors, including hormones (eg, cholecystokinin, ghrelin, leptin, and inflammatory and microbial mediators of gut dysbiosis), have been proposed as biomarkers for this condition to support early identification and develop personalized nutritional interventions. Additional studies are needed to untangle the interrelationship between gut microbiota and appetite regulation in older adults operating through brain-gut crosstalk. Furthermore, the contribution of the genetic background to appetite regulation and specific nutritional needs warrants investigation. Here, we provide an overview on anorexia of aging in the context of age-related metabolic changes. A special focus is placed on candidate biomarkers that may be used to assist in the early identification of anorexia of aging and in the development of personalized nutritional counseling.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | | | - Francesco Landi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, Italy
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