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Kohn JN, Lobo JD, Troyer EA, Ang G, Wilson KL, Walker AL, Spoon C, Pruitt C, Tibiriçá L, Pung MA, Redwine LS, Hong S. Tai Chi versus health education as a frailty intervention for community-dwelling older adults with hypertension. Aging Clin Exp Res 2023; 35:2051-2060. [PMID: 37458963 PMCID: PMC10826892 DOI: 10.1007/s40520-023-02504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/11/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Frailty is associated with poor outcomes among older adults with hypertension and complicates its pharmacological management. Here, we assessed whether 12-weeks of instructor-guided, group Tai Chi (TC) practice improved frailty relative to Healthy Aging Practice-centered Education (HAP-E) classes in older adults with hypertension. METHODS Secondary analysis of a randomized controlled trial in San Diego County, USA, of 167 community-dwelling individuals aged ≥ 60 yrs (70% female; 72.1 ± 7.5 yrs), defined as non-frail (66%) or frail (34%) based on 53-item deficit accumulation frailty index (FI). Linear mixed-effects models were used to assess pre-to-post intervention differences in FI and logistic regression to explore differential odds of clinically meaningful FI change. RESULTS One hundred thirty-one participants completed post-intervention assessments. Frailty decreased pre-to-post intervention in the TC (ΔFI = - 0.016, d = - 0.39, - 0.75 to - 0.03), but not the HAP-E arm (ΔFI = - 0.009, d = - 0.13, - 0.52-0.27), despite no significant group differences between the TC and HAP-E arms (d = - 0.11, - 0.46-0.23). Furthermore, greater odds of improved FI were observed for frail participants in the TC (OR = 3.84, 1.14-14.9), but not the HAP-E (OR = 1.34, 0.39-4.56) arm. Subgroup analysis indicated treatment effects in TC were attributed to frail participants (frail: ΔFI = - 0.035, d = - 0.68, -1.26 to - 0.08; non-frail: ΔFI = - 0.005, d = - 0.19, - 0.59-0.22), which was not the case in the HAP-E arm (frail: ΔFI = - 0.017, d = - 0.23, - 0.81-0.35; non-frail: ΔFI = - 0.003, d = - 0.07, - 0.47-0.33). Frail participants were no more likely to drop-out of the study than non-frail (71% vs. 69% retained). CONCLUSIONS Twelve weeks of twice-weekly guided TC practice was well-tolerated, associated with decreases in frailty, and increased odds of clinically meaningful FI improvement at post-intervention.
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Affiliation(s)
- Jordan N Kohn
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US.
- Sam and Rose Stein Institute for Research On Aging, University of California San Diego, La Jolla, CA, 92093, US.
| | - Judith D Lobo
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, US
| | - Emily A Troyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, US
| | - Gavrila Ang
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Kathleen L Wilson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Amanda L Walker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Chad Spoon
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Christopher Pruitt
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Lize Tibiriçá
- Sam and Rose Stein Institute for Research On Aging, University of California San Diego, La Jolla, CA, 92093, US
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, US
| | - Meredith A Pung
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
| | - Laura S Redwine
- Family Medicine and Community Health, Osher Center for Integrative Health, University of Miami, Miller School of Medicine, Miami, FL, 33136, US
| | - Suzi Hong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, 92093, US
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, US
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102
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Lovett M, Koto P, Shetty N. Assessing clinical frailty scale scoring by junior medical learners on an inpatient geriatrics consultation service. GERONTOLOGY & GERIATRICS EDUCATION 2023:1-10. [PMID: 37660357 DOI: 10.1080/02701960.2023.2253180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The Clinical Frailty Scale (CFS) is incorporated into our institution's comprehensive geriatric assessment (CGA). CGAs and CFS scoring are completed by junior medical trainees on the Geriatric consult service. The agreement between CFS score assignment by junior trainees and Geriatrics trained individuals in this setting is unknown. Importantly, these scores assign a frailty level that impacts care pathways. We conducted a retrospective chart review from April-June 2019. A Geriatric medicine subspecialty resident assigned retrospective CFS scores based on data from the CGA. We compared scores to determine the level of agreement using the Cohen and Conger's Kappa inter-rater agreement metric and assessed whether patient characteristics influenced the likelihood of agreement between raters using a generalized linear model. Medical students assessed 43% (46/108) of patients (n = 13), and 57% (62/108) were assessed by PGY1s (n = 10). Inter-rater agreement measures showed substantial agreement overall and for PGY1s, but dropped to a moderate agreement for medical students. The retrospective inter-rater agreement of the CFS showed substantial agreement overall and decreased when limited to medical students, highlighting the need for interventions to improve the understanding of frailty early in medical training.
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Affiliation(s)
- M Lovett
- Medicine, Dalhousie University, Halifax, Canada
| | - P Koto
- Medicine, Dalhousie University, Halifax, Canada
| | - N Shetty
- Medicine, Dalhousie University, Halifax, Canada
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Blackstone EH. Commentary: Frailty: I know it when I see it. J Thorac Cardiovasc Surg 2023; 166:879-880. [PMID: 35410690 DOI: 10.1016/j.jtcvs.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Eugene H Blackstone
- Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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104
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Si H, Yu J, Liu Q, Li Y, Jin Y, Bian Y, Qiao X, Wang W, Ji L, Wang Y, Du J, Wang C. Clinical practice guidelines for frailty vary in quality but guide primary health care: a systematic review. J Clin Epidemiol 2023; 161:28-38. [PMID: 37414366 DOI: 10.1016/j.jclinepi.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES To appraise the methodological quality, clinical applicability, and reporting quality of clinical practice guidelines (CPGs) for frailty in primary care and identify research gaps using evidence mapping. STUDY DESIGN AND SETTING We conducted a systematic literature search in PubMed, Web of Science, Embase, CINAHL, guideline databases, and frailty or geriatric society websites. Appraisal of Guidelines Research and Evaluation II, AGREE-Recommendations Excellence, and Reporting Items for Practice Guidelines in Healthcare checklist were used to evaluate overall quality for frailty CPGs as "high", "medium", or "low" quality. We used bubble plots to show recommendations in CPGs. RESULTS Twelve CPGs were identified. According to the overall quality evaluation, five CPGs were considered as high quality, six as medium quality, and one as low quality. The recommendations in CPGs were generally consistent and mainly focused on frailty prevention, identification, multidisciplinary, nonpharmacological, and other treatments. However, evidence was lacking in some areas, such as effective prevention strategies and implementation of recommendations. CONCLUSION The frailty CPGs vary in quality but have consistent recommendations that can guide clinical practice in primary care. This could point the way for future research to address existing gaps and facilitate the development of trustworthy CPGs for frailty.
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Affiliation(s)
- Huaxin Si
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jiaqi Yu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Qinqin Liu
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yanyan Li
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yaru Jin
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yanhui Bian
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Wenyu Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lili Ji
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yan Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jian Du
- National Institute of Health Data Science, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Cuili Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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105
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Nakashima H, Nagae M, Komiya H, Fujisawa C, Watanabe K, Yamada Y, Tajima T, Miyahara S, Sakai T, Umegaki H. Combined use of the Clinical Frailty Scale and laboratory tests in acutely hospitalized older patients. Aging Clin Exp Res 2023; 35:1927-1935. [PMID: 37378813 DOI: 10.1007/s40520-023-02477-w] [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: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
AIMS To evaluate the Clinical Frailty Scale (CFS) and a Frailty Index based on laboratory tests (FI-lab) in terms of what each assesses about frailty and to determine the appropriateness of combined use of these two frailty scales. METHODS This was a prospective observational cohort study in an acute geriatric ward of a university hospital. The FI-lab is the proportion of laboratory parameters that yield abnormal results from a total of 23. The FI-lab and CFS were assessed at admission. Data on activities of daily living (ADL), cognition, geriatric syndromes, and comorbidities were also collected. Main outcomes were in-hospital mortality and 90-day mortality after admission. RESULTS In total, 378 inpatients (mean age 85.2 ± 5.8 years, 59.3% female) were enrolled. ADL and cognition correlated strongly with the CFS (Spearman's |r|> 0.60) but weakly with the FI-lab (|r|< 0.30). Both the CFS and FI-lab correlated weakly with geriatric syndromes and comorbidities (|r|< 0.40). The correlation between the CFS and FI-lab was also weak (r = 0.28). The CFS and FI-lab were independently associated with in-hospital mortality and 90-day mortality after admission. The Akaike information criterion was lower for models using both the CFS and FI-lab than for models using either tool alone. CONCLUSIONS The CFS and FI-lab each reflected only some of the aspects of frailty in acutely hospitalized older patients. The model fit was better when the two frailty scales were used together to assess the mortality risk than when either was used alone.
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Affiliation(s)
- Hirotaka Nakashima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan.
| | - Masaaki Nagae
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Hitoshi Komiya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Chisato Fujisawa
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Kazuhisa Watanabe
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Yosuke Yamada
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Tomihiko Tajima
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Shuzo Miyahara
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Tomomichi Sakai
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8560, Japan
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106
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Greeley B, Low H, Kelly R, McDermid R, Song X. Preserving the discreteness of deficits during coding leads to a lower frailty index in individuals living in long-term care. Mech Ageing Dev 2023; 214:111851. [PMID: 37453658 DOI: 10.1016/j.mad.2023.111851] [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: 04/19/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
This study assesses two coding approaches on the frailty index (FI). Two FI were calculated using 43 variables from 29,758 older adults (84.6 ± 8 years old; 64 % female) in long-term care. Scores were coded as 0, 0.5, or 1 regardless of the number of levels (grouped), or preserved (e.g., a 4 level variable was coded as 0, 0.33, 0.67, or 1; discrete). Grouped and discrete FI were compared with each ordinal variable removed but all other ordinal variables included. This was repeated until 28 unique (14 grouped, 14 discrete) FI had been constructed each with one ordinal variable removed per FI. FI was correlated to age and mortality separated by sex. The median grouped (0.302 (0.221-0.372)) was higher relative to the discrete (0.237 (0.170-0.307)) FI. The discrete (r = 0.91, r = 0.87) and grouped (r = 0.93, r = 0.87) FI showed similar relationships to age and mortality. Removal of any ordinal variable reduced grouped FI by 0.004 or 0.016, whereas removal led to both increases (range: 0.003-0.001) and reductions (range: 0.002-0.008) for discrete FI. A grouped approach inflates FI. A discrete approach provides a more accurate measure of frailty.
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Affiliation(s)
- Brian Greeley
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Hilary Low
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Ronald Kelly
- Long-term Care and Assisted Living Access, Fraser Health, New Westminster, British Columbia, Canada
| | - Robert McDermid
- Critical Care, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada
| | - Xiaowei Song
- Clinical Research, Surrey Memorial Hospital, Fraser Health, Surrey, British Columbia, Canada.
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107
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Carr ZJ, Siller S, McDowell BJ. Perioperative Pulmonary Complications in the Elderly: The Forgotten System. Anesthesiol Clin 2023; 41:531-548. [PMID: 37516493 DOI: 10.1016/j.anclin.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.
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Affiliation(s)
- Zyad J Carr
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Saul Siller
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA
| | - Brittany J McDowell
- Department of Anesthesiology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT 84107, USA
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108
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Dogra P, Šambula L, Saini J, Thangamuthu K, Athimulam S, Delivanis DA, Baikousi DA, Nathani R, Zhang CD, Genere N, Salman Z, Turcu AF, Ambroziak U, Garcia RG, Achenbach SJ, Atkinson EJ, Singh S, LeBrasseur NK, Kastelan D, Bancos I. High prevalence of frailty in patients with adrenal adenomas and adrenocortical hormone excess: a cross-sectional multi-centre study with prospective enrolment. Eur J Endocrinol 2023; 189:318-326. [PMID: 37590964 PMCID: PMC10479159 DOI: 10.1093/ejendo/lvad113] [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: 03/16/2023] [Revised: 05/30/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Frailty, characterized by multi-system decline, increases vulnerability to adverse health outcomes and can be measured using Frailty Index (FI). We aimed to assess the prevalence of frailty in patients with adrenal disorders (based on hormonal sub-type) and examine association between FI and performance-based measures of physical function. DESIGN Multi-centre, cross-sectional study (March 2019-August 2022). METHODS Adult patients with adrenal disorders (non-functioning adrenal adenomas [NFA], mild autonomous cortisol secretion [MACS], Cushing syndrome [CS], primary aldosteronism [PA]) and referent subjects without adrenal disorders completed a questionnaire encompassing 47 health variables (comorbidities, symptoms, daily living activities). FI was calculated as the average score of all variables and frailty defined as FI ≥ 0.25. Physical function was assessed with hand grip, timed up-and-go test, chair rising test, 6-minute walk test, and gait speed. RESULTS Compared to referent subjects (n = 89), patients with adrenal disorders (n = 520) showed increased age, sex, and body mass index-adjusted prevalence of frailty (CS [odds ratio-OR 19.2, 95% confidence interval-CI 6.7-70], MACS [OR 12.5, 95% CI 4.8-42.9], PA [OR 8.4, 95% CI 2.9-30.4], NFA [OR 4.5, 95% CI 1.7-15.9]). Prevalence of frailty was similar to referent subjects when post-dexamethasone cortisol was <28 nmol/L and was higher when post-dexamethasone cortisol was 28-50 nmol/L (OR 4.6, 95% CI 1.7-16.5). FI correlated with all measures of physical function (P < .001). CONCLUSIONS Whilst frailty prevalence was highest in patients with adrenocortical hormone excess, even patients with NFA demonstrated an increased prevalence compared to the referent population. Future longitudinal studies are needed to evaluate the impact of various management strategies on frailty.
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Affiliation(s)
- Prerna Dogra
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
| | - Lana Šambula
- Department of Internal Medicine, General Hospital Koprivnica, Zeljka Selingera 1, 48000, Koprivnica, Croatia
| | - Jasmine Saini
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
| | - Karthik Thangamuthu
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
| | - Shobana Athimulam
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Health System, Detroit, MI 48202, United States
| | - Danae A Delivanis
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
| | - Dimitra A Baikousi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, 45 Ipsilantou Street, Athens 106 76, Greece
| | - Rohit Nathani
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
- Department of Interna Medicine, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Catherine D Zhang
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
- Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI 53210, United States
| | - Natalia Genere
- Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, MO 63130, United States
| | - Zara Salman
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI 48109, United States
| | - Adina F Turcu
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI 48109, United States
| | - Urszula Ambroziak
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland Banacha 1a, 02-097, Warsaw, Poland
| | - Raul G Garcia
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
| | - Sara J Achenbach
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Elizabeth J Atkinson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
| | - Sumitabh Singh
- Department of Interna Medicine, UT Southwestern Medical Center, Dallas, TX 75390, United States
| | - Nathan K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, United States
| | - Darko Kastelan
- Department of Endocrinology, University Hospital Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States
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Shafiee A, Bahri RA, Rafiei MA. Frailty among patients undergoing breast reconstruction surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 84:556-566. [PMID: 37422955 DOI: 10.1016/j.bjps.2023.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to evaluate the predictive value of frailty for predicting postsurgical complications in patients undergoing breast reconstruction surgery. METHODS MEDLINE (PubMed), Scopus, Web of Science, and Embase were searched for relevant studies up to September 13, 2022. A systematic review and meta-analysis of studies were performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement criteria. RESULTS Nine studies were included in this research. The rates of overall complications (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.17-1.97, I2 = 76%; p = 0.002), wound complications (OR 1.87, 95% CI 1.56-2.26, I2 = 16%; p < 0.0001), readmissions (OR 1.94, 95% CI 1.61-2.34, I2 = 15%; p < 0.0001), and reoperations (OR 1.41, 95% CI 1.12-1.77, I2 = 39%; p = 0.003) were significantly greater in frail patients than in nonfrail undergoing breast reconstruction surgery. Furthermore, compared with nonfrail patients, this difference remained significantly higher among prefrail individuals (overall complications: OR 1.27, 95% CI 1.13-1.41, I2 = 67%; p < 0.001, wound complications: OR 1.48, 95% CI 1.33-1.66, I2 = 24%; p < 0.0001, readmission: OR 1.47, 95% CI 1.34-1.61, I2 = 0%; p < 0.0001, reoperation: OR 1.32, 95% CI 1.23-1.42, I2 = 0%; p < 0.0001). We found that frail patients undergoing immediate autologous reconstruction surgery are the most vulnerable to experiencing overall postoperative complications. CONCLUSION Frailty is a strong predictor of postsurgical complications after breast reconstruction surgery in frail and prefrail patients. The most frailty index utilized was the modified five-item frailty index (mFI-5). More research is needed on this topic to assess the utility of frailty in practice, especially in countries other than the United States.
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110
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van der Ploeg MA, Poortvliet RKE, Bogaerts JMK, van der Klei VMGTH, Kerse N, Rolleston A, Teh R, Robinson L, Jagger C, Arai Y, Shikimoto R, Abe Y, Blom JW, Drewes YM, Gussekloo J. The Role of a Composite Fitness Score in the Association Between Low-Density Cholesterol and All-Cause Mortality in Older Adults: An Individual Patient Data Meta-Analysis. J Gerontol A Biol Sci Med Sci 2023; 78:1708-1716. [PMID: 37314150 PMCID: PMC10460558 DOI: 10.1093/gerona/glad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND In the general population, an increase in low-density lipoprotein cholesterol (LDL-C) predicts higher cardiovascular disease risk, and lowering LDL-C can prevent cardiovascular disease and reduces mortality risk. Interestingly, in cohort studies that include very old populations, no or inverse associations between LDL-C and mortality have been observed. This study aims to investigate whether the association between LDL-C and mortality in the very old is modified by a composite fitness score. METHODS A 2-stage meta-analysis of individual participant data from the 5 observational cohort studies. The composite fitness score was operationalized by performance on a combination of 4 markers: functional ability, cognitive function, grip strength, and morbidity. We pooled hazard ratios (HR) from Cox proportional-hazards models for 5-year mortality risk for a 1 mmol/L increase in LDL-C. Models were stratified by high/low composite fitness score. RESULTS Composite fitness scores were calculated for 2 317 participants (median 85 years, 60% females participants), of which 994 (42.9%) had a high composite fitness score, and 694 (30.0%) had a low-composite fitness score. There was an inverse association between LDL-C and 5-year mortality risk (HR 0.87 [95% CI: 0.80-0.94]; p < .01), most pronounced in participants with a low-composite fitness score (HR 0.85 [95% CI: 0.75-0.96]; p = .01), compared to those with a high composite fitness score (HR = 0.98 [95% CI: 0.83-1.15]; p = .78), the test for subgroups differences was not significant. CONCLUSIONS In this very old population, there was an inverse association between LDL-C and all-cause mortality, which was most pronounced in participants with a low-composite fitness scores.
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Affiliation(s)
- Milly A van der Ploeg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonathan M K Bogaerts
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Veerle M G T H van der Klei
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Ruth Teh
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Shikimoto
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne M Drewes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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111
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Watts P, Menon M, Netuveli G. Depression Earlier on in Life Predicts Frailty at 50 Years: Evidence from the 1958 British Birth Cohort Study. J Clin Med 2023; 12:5568. [PMID: 37685635 PMCID: PMC10487987 DOI: 10.3390/jcm12175568] [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: 07/28/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Frailty and depression in older ages have a bidirectional relationship, sharing some symptoms and characteristics. Most evidence for this has come from cross-sectional studies, or longitudinal studies with limited follow-up periods. We used data from the National Child Development Study (1958 Birth Cohort) to investigate the relationship between depression and early-onset frailty using a life course perspective. The primary outcome was frailty based on a 30-item inventory of physical health conditions, activities of daily living and cognitive function at 50 years. The main exposure was depression (based on a nine-item Malaise score ≥ 4) measured at 23, 33 and 42 years. We investigated this relationship using multiple logistic regression models adjusted for socio-demographic factors, early life circumstances and health behaviours. In fully adjusted models, when modelled separately, depression at each timepoint was associated with around twice the odds of frailty. An accumulated depression score showed increases in the odds of frailty with each unit increase (once: OR 1.92, 95%CI 1.65, 2.23; twice OR 2.33, 95%CI 1.85, 2.94; thrice: OR 2.95, 95%CI 2.11, 4.11). The public health significance of this finding is that it shows the potential to reduce the physical burden of disease later in life by paying attention to mental health at younger ages.
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Affiliation(s)
- Paul Watts
- School of Health, Sport and Bioscience, University of East London, London E16 2RD, UK;
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Ogata T, Sadakari Y, Nakane H, Koikawa K, Kanno H, Kohata R, Endo K, Tsukahara T, Shimonaga K, Kaneshiro K, Hirokata G, Aoyagi T, Tsutsumi C, Taniguchi M. The five-item modified frailty index predicts long-term outcomes in elderly patients undergoing colorectal cancer surgery. World J Surg Oncol 2023; 21:268. [PMID: 37626381 PMCID: PMC10463643 DOI: 10.1186/s12957-023-03150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Frailty has been globally recognized as a predictor of adverse postoperative outcomes. Frailty assessment using the five-factor modified frailty index (5-mFI) has recently gained traction; however, long-term outcomes are unknown in colorectal cancer (CRC) surgery. This study aimed to investigate whether the 5-mFI predicted long-term survival and cause of death on the basis of frailty severity in elderly patients who underwent CRC surgery and to determine the risk factors for mortality. METHODS A total of 299 patients underwent CRC surgery with curative intent between January 2013 and December 2017. Patients were divided into three groups by the 5-mFI score: group 1 (5-mFI: 0 or 1; n = 164): no frailty; group 2 (5-mFI: 2; n = 91): moderate frailty; and group 3 (5-mFI: ≥ 3; n = 44): severe frailty. Clinicopathological variables, namely comorbidities, 5-mFI, prognostic nutrition index, operative/postoperative data, and outcome, including cause of death, were compared between the three groups. To identify factors associated with death from CRC- and non-CRC-related causes, univariate and multivariate analyses using a Cox regression model were performed. RESULTS The immediate postoperative morbidity of patients with Clavien-Dindo grade ≥ III complications (9.1%) in group 3 was not significantly different from that in group 1 (9.1%) or group 2 (14.3%); however, the 30-day mortality rate (4.5%) in group 3 was significantly higher. Long-term disease-free survival was similar between frailty groups, suggesting that CRC surgery provides oncological benefit to patients irrespective of frailty. The 5-year survival rates in groups 1, 2, and 3 were 83.5%, 71.2%, and 47.9%, respectively, showing a significantly lower survival rate as frailty advanced. Sixty percent of the deaths in frail patients were due to respiratory failure and cardiovascular diseases. Multivariate analysis demonstrated that advanced age, higher 5-mFI score, and longer postoperative hospital stay were risk factors for mortality unrelated to CRC. Multivariate analysis also revealed that advanced tumor stage, carcinoembryonic antigen ≥ 5 ng/ml, undifferentiated tumor, and R1 resection were risk factors for CRC-related mortality. CONCLUSIONS The 5-mFI score can predict postoperative short- and long-term outcomes and risk factors for mortality unrelated to CRC. Additionally, long-term survival was negatively associated with the 5-mFI score.
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Affiliation(s)
- Toshiro Ogata
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan.
| | - Yoshihiko Sadakari
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Hiroyuki Nakane
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Kazuhiro Koikawa
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Hiroki Kanno
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Ryo Kohata
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Kayoko Endo
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Takao Tsukahara
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Koichiro Shimonaga
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Kazuhisa Kaneshiro
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Gentaro Hirokata
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Takeshi Aoyagi
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Chiyo Tsutsumi
- Department of Medical Biostatistics, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
| | - Masahiko Taniguchi
- Department of Surgery, St. Mary's Hospital, Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan
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Verduri A, Carter B, Rice C, Laraman J, Barton E, Clini E, Maskell NA, Hewitt J. Frailty Prevalence and Association with Clinical Outcomes in Interstitial Lung Disease, Asthma, and Pleural Disease. Geriatrics (Basel) 2023; 8:82. [PMID: 37623275 PMCID: PMC10454934 DOI: 10.3390/geriatrics8040082] [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: 07/19/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Frailty is a syndrome characterised by increased vulnerability to negative outcomes. Interstitial lung disease (ILD), asthma, and pleural disease are leading causes of morbidity and mortality. We aimed to investigate the prevalence and impact of frailty in adult patients with these diseases. METHODS We conducted a systematic review and meta-analysis, searching PubMed, Web of Science, The Cochrane Library, and EMBASE for studies reporting on frailty in ILD, asthma, and pleural disease. MeSH terms including interstitial lung disease, Idiopathic Pulmonary Fibrosis, Non-specific Interstitial Pneumonia, Chronic Hypersensitivity Pneumonitis, systemic sclerosis-associated ILD, connective tissue disease-associated ILD, and frailty were used as key words. The primary outcome was prevalence of frailty. Where enough contextually homogeneous studies were included, a pooled random-effects meta-analysis was performed with mortality and hospitalisation as the outcomes. RESULTS The review found three studies relating to frailty in asthma. No studies relating to pleural disease and frailty were identified. The median prevalence in asthma was 9.5% (IQR, 7.8-11.3). Six relevant studies incorporating 1471 ILD patients (age 68.3 ± SD2.38; 50% male) were identified, which were either cohort or cross-sectional design rated either good or fair. The median prevalence of frailty was 48% (IQR, 25-50). There was a positive association between frail ILD patients and increased risk of long-term mortality (pooled OR, 2.33 95%CI 1.31-4.15, I2 9%). One study reported a hospitalization rate of HR = 1.97(1.32-3.06) within 6 months in frail ILD patients. CONCLUSIONS Frailty is very common and associated with increased mortality in patients with ILD. There are still minimal data regarding the prevalence of frailty and its influence on the risk in this population.
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Affiliation(s)
- Alessia Verduri
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK; (A.V.); (C.R.); (J.L.)
- Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK;
| | - Ceara Rice
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK; (A.V.); (C.R.); (J.L.)
| | - James Laraman
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK; (A.V.); (C.R.); (J.L.)
| | - Eleanor Barton
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK; (E.B.); (N.A.M.)
| | - Enrico Clini
- Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Nick A. Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK; (E.B.); (N.A.M.)
| | - Jonathan Hewitt
- Department of Population Medicine, Cardiff University, Cardiff CF10 3XQ, UK; (A.V.); (C.R.); (J.L.)
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Tajik B, Voutilainen A, Lyytinen A, Kauhanen J, Lip GY, Tuomainen TP, Isanejad M. Frailty Predicts Incident Atrial Fibrillation in Women but Not in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study. Cardiology 2023; 148:574-580. [PMID: 37544295 PMCID: PMC10733937 DOI: 10.1159/000533361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Frailty and atrial fibrillation (AF) are common aging problems and increasing globally. The association(s) between frailty and AF has been inconclusive. The purpose of this prospective population-based cohort was to investigate the associations between frailty and incident AF in older men and women. METHODS In total 839 participants, women (n = 458) and men (n = 381), aged 61-74 years from the Kuopio Ischaemic Heart Disease Risk Factor Study were included (March 1, 1998, to December 31, 2001). At the baseline, frailty prevalence was 49.3% (n = 414), and non-frailty 50.7% (n = 425) of the total population. Frailty was ascertained with the presence of 3-5 and prefrailty 1-2 of the following criteria: weight loss (highest 20% over 7 years), self-reported tiredness, weakness (measured by handgrip strength), slow walking speed (walking pace), and low physical activity (lowest 20%). AF events were obtained by record linkages from the national computerized hospitalization registry in Finland up to December 31, 2019. Multivariate Cox proportional hazard regression estimated the hazard ratio (HR) of incident events, adjusted for potential confounders. RESULTS During the mean follow-up of 14.2 years, 288 AF cases (169 women; 119 men) occurred. After adjustment for possible confounders, the HRs (95% confidence intervals [CIs]) for AF was 1.46 (1.48-1.85) in the frail population, compared to the non-frail group. The association was observed only among older frail women (multivariable-adjusted HR 1.78, 95% CI [1.28-2.48]) (p for interaction = 0.04). No statistically significant associations were observed between frailty and future AF incident among men (multivariable-adjusted HRs 1.12, 95% CI (0.77-1.63)). CONCLUSIONS In this population-based epidemiological cohort, the risk of developing AF was increased in women affected by frailty at baseline but not in men.
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Affiliation(s)
- Behnam Tajik
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Arja Lyytinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Gregory Y.H. Lip
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Masoud Isanejad
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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Fan RR, Rudnick SB, Minami HR, Chen AM, Zemela MS, Wittgen CM, Williams MS, Smeds MR. Depression screening in patients with vascular disease. Vascular 2023; 31:758-766. [PMID: 35404707 DOI: 10.1177/17085381221084817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Major depression is associated with increased morbidity and mortality in vascular surgery patients. The US Preventive Services Task Force and American Heart Association recommend routine depression screening for adults, especially those with cardiovascular disease. Since routine depression screening has not been implemented in most vascular surgery clinics across the nation, we sought to determine the feasibility of depression screening and understand the prevalence and predictors of depression in patients presenting to a single institution's vascular surgery clinic over a 4 month period. METHODS From June to September 2020, vascular surgery clinic patients were administered a 26-item survey that included validated scales for depression (PHQ-9), pain, frailty, alcohol dependence, and nicotine dependence. Although not validated, the Rosenberg Self-Esteem Scale was also administered. Patient charts were reviewed for demographic information and medical history. 9-digit patient zip codes were used to determine Area Deprivation Index, a measure of socioeconomic status. Univariate and multivariate analyses were performed to understand the factors associated with increased depression prevalence in the study population. RESULTS A total of 140 (36.4%) of 385 patients met study inclusion criteria. 35.7% of them screened positive for mild to severe depression (PHQ-9 scores ≥5). On univariate analysis, major depression was significantly associated with lower socioeconomic status (p = 0.007), higher frailty (p < 0.001), lower self-esteem (p < 0.001), higher daily pain (p < 0.001), health problems that interfere with social activities (p < 0.001), fatigue (p < 0.001), unmarried status (p = 0.031), and lack of primary care provider (p = 0.048). Multivariate analyses significantly predicted higher frailty (B= 0.487, p = 0.007) and lower self-esteem (B= -0.413, p < 0.001) in patients with depression. Depression was not associated with gender, age, employment status, smoking status, alcohol use, or type of vascular disease. COCLUSIONS More than one-third of vascular surgery clinic patients have comorbid depression. Higher frailty and lower self-esteem are significant risk factors for depression. Prevention and early identification of frailty may improve outcomes. Depression screening in vascular surgery clinics is feasible and could be useful in determining which patients may benefit from more frequent follow-up and monitoring for associated comorbidities. Vascular surgeons may play an important role in screening for depression and referring patients for psychotherapy and/or pharmacotherapy.
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Affiliation(s)
- Rachel R Fan
- Saint Louis University School of Medicine, St Louis, MO, USA
| | | | - Hataka R Minami
- Saint Louis University School of Medicine, St Louis, MO, USA
| | - Amy M Chen
- Saint Louis University School of Medicine, St Louis, MO, USA
| | - Mark S Zemela
- Saint Louis University School of Medicine, St Louis, MO, USA
| | - Catherine M Wittgen
- Division of Vascular and Endovascular Surgery, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Michael S Williams
- Division of Vascular and Endovascular Surgery, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Matthew R Smeds
- Division of Vascular and Endovascular Surgery, Saint Louis University School of Medicine, St Louis, MO, USA
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Zeng XZ, Meng LB, Li YY, Jia N, Shi J, Zhang C, Hu X, Hu JB, Li JY, Wu DS, Li H, Qi X, Wang H, Zhang QX, Li J, Liu DP. Prevalence and factors associated with frailty and pre-frailty in the older adults in China: a national cross-sectional study. Front Public Health 2023; 11:1110648. [PMID: 37554734 PMCID: PMC10406229 DOI: 10.3389/fpubh.2023.1110648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
Objective Frailty increases poor clinical outcomes in older adults, the aim of this study was to investigate the prevalence and factors associated with frailty and pre-frailty in older adults in China. Research design and methods Data were obtained from the Sample Survey of the Aged Population in Urban and Rural China in 2015, which was a cross-sectional study involving a nationally representative sample of older adults aged 60 years or older from 31 provinces/autonomous regions/municipalities in mainland China. The frailty index (FI) based on 33 potential deficits was used to classify individuals as robust (FI < 0.12), pre-frail (FI ≧0.12 and <0.25) and frail (FI ≥0.25). Results A total of 208,386 older people were included in the study, and the age-sex standardised prevalence of frailty and pre-frailty among older adults in China was 9.5% (95% CI 9.4-9.7) and 46.1% (45.9-46.3) respectively. The prevalence of frailty and pre-frailty was higher in female than in male older adults, higher in rural than in urban older adults, and higher in northern China than in southern China. The multinomial analysis revealed similar risk factors for frailty and pre-frailty, including increased age, being female, living in a rural area, low educational attainment, poor marital status, living alone, difficult financial status, poor access to medical reimbursement, and living in northern China. Conclusion Frailty and pre-frailty are very common among older adults in China and differ significantly between southern and northern China, men and women, and rural and urban areas. Appropriate public health prevention strategies should be developed based on identified risk factors in frail and pre-frail populations. The management of frailty and pre-frailty should be optimised according to regional and gender differences in prevalence and associated factors, such as strengthening the integrated management of chronic diseases, increasing reimbursement rates for medical costs, and focusing on vulnerable groups such as the disabled, economically disadvantaged, living alone and those with low literacy levels, in order to reduce the burden of frailty among older adults in China.
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Affiliation(s)
- Xue-zhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ling-bing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying-ying Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Jia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Shi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chi Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Xing Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Jia-bin Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Jian-yi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Di-shan Wu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Qi
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Juan Li
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - De-ping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Li X, Wang Q, Guo L, Xue Y, Dang Y, Liu W, Yin T, Zhang Y, Zhao Y. Associations between Low-Carbohydrate Diets and Low-Fat Diets with Frailty in Community-Dwelling Aging Chinese Adults. Nutrients 2023; 15:3084. [PMID: 37513502 PMCID: PMC10383029 DOI: 10.3390/nu15143084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Frailty is a major health issue associated with aging. Diet affects frailty status; however, studies on the associations between the low-carbohydrate diet (LCD) score, low-fat diet (LFD) score and frailty in older Chinese adults are scarce. This study aimed to examine the associations between the LCD score, LFD score and risk of frailty in older Chinese adults. We analyzed data from 6414 participants aged ≥ 60 years from the China Northwest Natural Population Cohort: Ningxia Project. Frailty was measured using the frailty index (FI), calculated from 28 items comprising diseases, behavioral disorders and blood biochemistry and classified as robust, pre-frail and frail. LCD and LFD scores were calculated using a validated food frequency questionnaire (FFQ). Multiple logistic regression models were used to evaluate associations between LCD, LFD scores and frail or pre-frail status after adjusting for confounders. Participants' mean age was 66.60 ± 4.15 years, and 47.8% were male. After adjusting for age, sex, educational level, drinking, smoking, BMI, physical activity and total energy, compared to the lowest quartile (Q1: reference), the odds ratios (ORs) for pre-frail and frail status in the highest quartile (Q4) of LCD score were 0.73 (95% confidence intervals: 0.61-0.88; p for trend = 0.017) and 0.73 (95%CI: 0.55-0.95; p for trend = 0.035), respectively. No significant associations were observed between LFD score and either pre-frail or frail status. Our data support that lower-carbohydrate diets were associated with lower pre-frail or frail status, particularly in females, while diets lower in fat were not significantly associated with the risk of either pre-frail or frail status in older Chinese adults. Further intervention studies are needed to confirm these results.
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Affiliation(s)
- Xiaoxia Li
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Qingan Wang
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Linfeng Guo
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Yixuan Xue
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Yuanyuan Dang
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Wanlu Liu
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Ting Yin
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Yuhong Zhang
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
| | - Yi Zhao
- School of Public Health, Ningxia Medical University, Yinchuan 750004, China; (X.L.)
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan 750004, China
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Wu A, Setiawan VW, Stram D, Crimmins E, Tseng CC, Lim U, Park SY, White K, Cheng I, Haiman C, Wilkens L, Le Marchand L. Racial, Ethnic, and Socioeconomic Differences in a Deficit Accumulation Frailty Index in the Multiethnic Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:1246-1257. [PMID: 36255109 PMCID: PMC11255091 DOI: 10.1093/gerona/glac216] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frailty status has been sparsely studied in some groups including Native Hawaiians and Asian Americans. METHODS We developed a questionnaire-based deficit accumulation frailty index (FI) in the Multiethnic Cohort (MEC) and examined frailty status (robust, FI 0 to <0.2, prefrail, FI 0.2 to <0.35, and frail FI ≥ 0.35) among 29 026 men and 40 756 women. RESULTS After adjustment for age, demographic, lifestyle factors, and chronic conditions, relative to White men, odds of being frail was significantly higher (34%-54%) among African American, Native Hawaiian, and other Asian American men, whereas odds was significantly lower (36%) in Japanese American men and did not differ in Latino men. However, among men who had high school or less, none of the groups displayed significantly higher odds of prefrail or frail compared with White men. Relative to White women, odds of being frail were significantly higher (14%-33%) in African American and Latino women, did not differ for other Asian American women and lower (14%-36%) in Native Hawaiian and Japanese American women. These racial and ethnic differences in women were observed irrespective of education. Risk of all-cause mortality was higher in prefrail and frail men than robust men (adjusted hazard ratio [HR] = 1.69, 1.59-1.81; HR = 3.27, 3.03-3.53); results were similar in women. All-cause mortality was significantly positively associated with frailty status and frailty score across all sex, race, and ethnic groups. CONCLUSIONS Frailty status differed significantly by race and ethnicity and was consistently associated with all-cause mortality. The FI may be a useful tool for aging studies in this multiethnic population.
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Affiliation(s)
- Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - V Wendy Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel O Stram
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Chiu-Chen Tseng
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Unhee Lim
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Song-Yi Park
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Kami K White
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Christopher A Haiman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lynne R Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
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119
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Bergus KC, Gelbard RB, Scarlet S, Srinivas S, Tracy BM. Effect of Frailty on the Management of Suspected Choledocholithiasis. Am Surg 2023; 89:3104-3109. [PMID: 37501308 DOI: 10.1177/00031348231157896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The American Society for Gastrointestinal Endoscopy and The Society of American Gastrointestinal and Endoscopic Surgeons (ASGE-SAGES) guidelines for managing choledocholithiasis (CDL) omit patient-specific factors like frailty. We evaluated how frail patients with CDL undergoing same-admission cholecystectomy were managed within ASGE-SAGES guidelines. METHODS We analyzed patients undergoing same-admission cholecystectomy for CDL and/or acute biliary pancreatitis (ABP) from 2016 to 2019 at 12 US academic medical centers. Patients were grouped by Charlson comorbidity index into non-frail (NF), moderately frail (MF), and severely frail (SF). ASGE-SAGES guidelines stratified likelihood of CDL and were used to compare actual to suggested management. Rate of guideline deviation was our primary outcome. Secondary outcomes included rates of surgical site infections (SSIs), biliary leaks, and 30-day surgical readmissions. Rates are presented as NF, MF, and SF. RESULTS Among 844 patients, 43.3% (n = 365) were NF, 25.4% (n = 214) were MF, and 31.4% (n = 265) were SF. Frail patients were older (33y vs 56.7y vs 73.5y, P < .0001) and more likely to have ABP (32.6% vs 47.7% vs 43.8%, P = .0005). As frailty increased, guideline deviation increased (41.1% vs 43.5% vs 53.6%, P < .006). Severe frailty was predictive of guideline deviation compared to MF (aOR 1.47, 95% CI 1.02-2.12, P = .04) and NF (aOR 1.46, 95% CI 1.01-2.12, P = .04). There was no difference in SSIs (P = .2), biliary leaks (P = .7), or 30-day surgical readmission (P = .7). CONCLUSION Frail patients with common bile duct stones had more management deviating from guidelines yet no difference in complications. Future guidelines should consider including frailty to optimize detection and management of CDL in this population.
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Affiliation(s)
- Katherine C Bergus
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama Medical Center, Birmingham, AL, USA
| | - Sara Scarlet
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shruthi Srinivas
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brett M Tracy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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120
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Sang N, Li BH, Zhang MY, Wei M, Fang RX, Liu WJ, Huang LE, Zhang J, Wu GC. Bidirectional causal relationship between depression and frailty: a univariate and multivariate Mendelian randomisation study. Age Ageing 2023; 52:afad113. [PMID: 37392400 DOI: 10.1093/ageing/afad113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND cumulative evidence from cohort studies suggested that there were inconsistent conclusions as to whether there was a bidirectional association between depression and frailty. Therefore, this study used a bidirectional two-sample Mendelian randomisation (MR) study to investigate the causal relationship between depression and frailty. METHODS we performed univariate and multivariate bidirectional MR analyses to assess the causal association between depression and frailty. Independent genetic variants associated with depression and frailty were selected as instrumental variables. Inverse variance weighted (IVW), MR-Egger, weighted median and weighted mode were mainly used in univariate MR analysis. Multivariate MR (MVMR) analyses used multivariable inverse variance-weighted methods to individually and jointly adjust for three potential confounders, body mass index (BMI), age at menarche (AAM) and waist-to-hip ratio (WHR, adjusted for BMI). RESULTS univariate MR analysis showed a positive causal relationship between depression and risk of frailty (IVW, odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.23-1.37, P = 6.54E-22). Causal relationship between frailty and risk of depression (IVW, OR = 1.69, 95% CI = 1.33-2.16, P = 2.09E-05). MVMR analysis revealed that the bidirectional causal association between depression and frailty remained after adjusting for three potential confounders, BMI, AAM and WHR (adjusted for BMI), individually and in combination. CONCLUSIONS our findings supported a causal relationship between genetically predicted depression and frailty in both directions.
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Affiliation(s)
- Ni Sang
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Bo-Han Li
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Meng-Yao Zhang
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Meng Wei
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Ruo-Xuan Fang
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Wen-Jing Liu
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Li-E Huang
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Jing Zhang
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, 15 Feicui Road, Hefei 230032, Anhui, China
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121
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Wehrfritz A, Schmidt J, Bremer F, Lang A, Welzer J, Castellanos I. Ethical conflicts associated with COVID-19 pandemic, triage and frailty-unexpected positive disease progression in a 90-year-old patient: A case report. Clin Case Rep 2023; 11:e7710. [PMID: 37476601 PMCID: PMC10354352 DOI: 10.1002/ccr3.7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
During the COVID 19 pandemic, advanced age, scoring systems, and a shortage of ICU beds were used as cut-offs for ICU admission. This case report describes the epicrisis of an elderly patient who was almost mistakenly not treated in an ICU.
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Affiliation(s)
- Andreas Wehrfritz
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Joachim Schmidt
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Frank Bremer
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Anne‐Katharina Lang
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Jacob Welzer
- Department of AnaesthesiologyKlinikum FuerthFuerthGermany
| | - Ixchel Castellanos
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
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Trias-Llimós S, Barbieri M, Egidi V, Frova L, Grippo F, Meslé F, Pappagallo M, Désesquelles A. Frailty at death: An examination of multiple causes of death in four low mortality countries in 2017. DEMOGRAPHIC RESEARCH 2023; 49:13-30. [PMID: 38288270 PMCID: PMC10824539 DOI: 10.4054/demres.2023.49.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The increasing prevalence of frailty in aging populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process. OBJECTIVE To examine frailty-related mortality as reported on the death certificate in France, Italy, Spain and the United States in 2017. METHODS We identify frailty at death for the population aged 50 years and over in France, Italy, Spain and the United States. We estimate the proportions of deaths by sex, age group and country with specific frailty-related ICD-codes on the death certificate 1) as the underlying cause of death (UC), 2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and 3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). RESULTS The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0%), then in France (24.1%) and Spain (17.3%), and lowest in the United States (14.0%). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. CONCLUSIONS Notable cross-country differences were found in the prevalence and the type of frailty-related symptoms at death even after adjusting for differential age distributions.
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Affiliation(s)
| | - Magali Barbieri
- Institut National d’Études Démographiques (France) and University of California, Berkeley (United States)
| | - Viviana Egidi
- Dipartimento di Scienze Statistiche, Sapienza Università di Roma (Italy)
| | - Luisa Frova
- Istituto nazionale di statistica – ISTAT (Italy)
| | | | - France Meslé
- Institut National d’Études Démographiques (France)
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123
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Kawai M, Demura S, Kato S, Yokogawa N, Shimizu T, Kurokawa Y, Kobayashi M, Yamada Y, Nagatani S, Uto T, Murakami H. The Impact of Frailty on Postoperative Complications in Total En Bloc Spondylectomy for Spinal Tumors. J Clin Med 2023; 12:4168. [PMID: 37373861 DOI: 10.3390/jcm12124168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Total en bloc spondylectomy (TES) is an effective treatment for spinal tumors. However, its complication rate is high, and the corresponding risk factors remain unclear. This study aimed to clarify the risk factors for postoperative complications after TES, including the patient's general condition, such as frailty and their levels of inflammatory biomarkers. We included 169 patients who underwent TES at our hospital from January 2011-December 2021. The complication group comprised patients who experienced postoperative complications that required additional intensive treatments. We analyzed the relationship between early complications and the following factors: age, sex, body mass index, type of tumor, location of tumor, American Society of Anesthesiologists score, physical status, frailty (categorized by the 5-factor Modified Frailty Index [mFI-5]), neutrophil-to-lymphocyte ratio, C-reactive protein/albumin ratio, preoperative chemotherapy, preoperative radiotherapy, surgical approach, and the number of resected vertebrae. Of the 169 patients, 86 (50.1%) were included in the complication group. Multivariate analysis showed that high mFI-5 scores (odds ratio [OR] = 2.99, p < 0.001) and an increased number of resected vertebrae (OR = 1.87, p = 0.018) were risk factors for postoperative complications. Frailty and the number of resected vertebrae were independent risk factors for postoperative complications after TES for spinal tumors.
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Affiliation(s)
- Masafumi Kawai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yuki Kurokawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Motoya Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yohei Yamada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoshi Nagatani
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takaaki Uto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan
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Delgado-Velandia M, Maroto-Rodríguez J, Ortolá R, Rodríguez-Artalejo F, Sotos-Prieto M. The role of lifestyle in the association between frailty and all-cause mortality amongst older adults: a mediation analysis in the UK Biobank. Age Ageing 2023; 52:afad092. [PMID: 37368869 DOI: 10.1093/ageing/afad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE frailty is a syndrome characterised by increased vulnerability to stressors, which manifests as higher death risk. Whilst guidelines for frailty management usually entails lifestyle modifications (e.g. physical exercise, diet), the mediating role of lifestyle on the excess mortality associated with frailty is unclear. This study estimates the death risk due to frailty that could be avoided with a healthy lifestyle in older adults. SUBJECTS AND METHODS we analysed data from 91,906 British individuals aged ≥60 years recruited between 2006 and 2010. At baseline, frailty was identified according to Fried's phenotype, and a four-item Healthy Lifestyle Index (HLS) was calculated based on physical activity, diet, smoking and alcohol consumption. Mortality was ascertained from baseline through 2021. A mediation analysis under the counterfactual framework was performed adjusting for the main confounders. RESULTS during a median follow-up of 12.5 years, 9,383 deaths occurred. Frailty was directly associated with all-cause mortality (hazard ratio: 2.30 [95% confidence interval {CI} 2.07, 2.54]), and inversely associated with the HLS (ß: -0.45 points [-0.49, -0.40]). The hazard ratio [95%CI] for the direct effect of frailty on mortality was 2.12 [1.91, 2.34], whilst for the indirect effect (mediated by HLS) was 1.08 [1.07, 1.10]. The mediated proportion of HLS on mortality was 13.55% [11.26, 16.20], with physical activity having the highest proportion amongst the four HLS items (7.69% [5.00, 10.40]). CONCLUSIONS a healthy lifestyle partly mediates the association between frailty and mortality in British older adults. Since this was an exploratory mediation analysis, these results should be specifically tested in future research.
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Affiliation(s)
- Mario Delgado-Velandia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Javier Maroto-Rodríguez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
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125
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Logan B, Viecelli AK, Johnson DW, Aquino EM, Bailey J, Comans TA, Gray LC, Hawley CM, Hickey LE, Janda M, Jaure A, Jose MD, Kalaw E, Kiriwandeniya C, Matsuyama M, Mihala G, Nguyen KH, Pascoe E, Pole JD, Polkinghorne KR, Pond D, Raj R, Reidlinger DM, Scholes-Robertson N, Varghese J, Wong G, Hubbard RE. Study protocol for The GOAL Trial: comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals-a cluster randomised controlled trial. Trials 2023; 24:365. [PMID: 37254217 DOI: 10.1186/s13063-023-07363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. METHODS The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3-5/5D who are frail, measured by a Frailty Index (FI) of > 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index - Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. DISCUSSION This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial's findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. TRIAL REGISTRATION ClinicalTrials.gov NCT04538157. Registered on 3 September 2020.
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Affiliation(s)
- B Logan
- Centre for Health Services Research, University of Queensland, Brisbane, Australia.
| | - A K Viecelli
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - D W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - E M Aquino
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - J Bailey
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - T A Comans
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - L C Gray
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - C M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - L E Hickey
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - M Janda
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - A Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - M D Jose
- Renal Unit, Royal Hobart Hospital, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - E Kalaw
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - C Kiriwandeniya
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - M Matsuyama
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - G Mihala
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - K H Nguyen
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - E Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - J D Pole
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - K R Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - D Pond
- School of Rural Medicine, University of New England, Armidale, Australia
- Wicking Centre, University of Tasmania, Hobart, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - R Raj
- School of Medicine, University of Tasmania, Hobart, Australia
- Department of Nephrology, Launceston General Hospital, Launceston, Australia
| | - D M Reidlinger
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - N Scholes-Robertson
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - J Varghese
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
| | - G Wong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
| | - R E Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Department of Geriatric Medicine, Princess Alexandra Hospital, Brisbane, Australia
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Zhao H, Tu J, She Q, Li M, Wang K, Zhao W, Huang P, Chen B, Wu J. Prognostic significance of frailty in hospitalized elderly patients with community-acquired pneumonia: a retrospective cohort study. BMC Geriatr 2023; 23:308. [PMID: 37198576 DOI: 10.1186/s12877-023-04029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Frailty is associated with poor prognosis in a wide range of illnesses. However, its prognostic implications for older patients with community-acquired pneumonia (CAP) are not adequately addressed. METHODS In this study, patients were classified into 3 groups according to the frailty index based on standard laboratory tests (FI-Lab) score: robust (FI-Lab < 0.2), pre-frail (FI-Lab 0.2-0.35), and frail (FI-Lab ≥ 0.35). The relationships between frailty and all-cause mortality and short-term clinical outcomes (length of stay, duration of antibiotic therapy, in-hospital mortality) were examined. RESULTS Finally, 1164 patients were included, the median age was 75 years (interquartile range: 69, 82), and 438 patients (37.6%) were women. According to FI-Lab, 261(22.4%), 395(33.9%), and 508(43.6%) were robust, pre-frail, and frail. After adjustment for confounding variables, frailty was independently associated with prolonged antibiotic treatment (p = 0.037); pre-frailty and frailty were independently associated with longer inpatient days (p < 0.05 for both). The risk of in-hospital mortality was independently increased in frail patients (HR = 5.01, 95% CI = 1.51-16.57, p = 0.008) but not pre-frail patients (HR = 2.87, 95% CI = 0.86-9.63, p = 0.088) compared to robust patients. During a median follow-up of 33.9 months (interquartile range: 32.8 to 35.1 months), 408 (35.1%) patients died, of whom 29 (7.1%) were robust, 112 (27.5%) were pre-frail, and 267 (65.9%) were frail. Compared to robust patients, frail and pre-frail were significantly associated with increased risk for all-cause death (HR = 4.29, 95%CI: 1.78-10.35 and HR = 2.42 95%CI: 1.01-5.82, respectively). CONCLUSIONS Frailty is common among older patients with CAP and is strongly associated with increased mortality, longer length of stay, and duration of antibiotics. A routine frail assessment at the admission of elderly patients with CAP is necessary as the first step for appropriate multidisciplinary interventions.
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Affiliation(s)
- Hongye Zhao
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
- Department of General Practice, The First People's Hospital of Lianyungang, Lianyungang Clinical College of Nanjing Medical Unversity, Lianyungang, 222000, China
| | - Junlan Tu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Quan She
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Min Li
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Kai Wang
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Weihong Zhao
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China
| | - Peng Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Bo Chen
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China.
| | - Jianqing Wu
- Jiangsu Provincial Key Laboratory of Geriatrics, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Jiangsu, 210029, Nanjing, P.R. China.
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Shakya S, Silva SG, McConnell ES, McLaughlin SJ, Cary MP. Does cumulative psychosocial stress explain frailty disparities in community-dwelling older adults? Arch Gerontol Geriatr 2023; 113:105055. [PMID: 37167754 DOI: 10.1016/j.archger.2023.105055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Frailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential mediating role of psychosocial stress. METHODS This cross-sectional study included 7,679 community-dwelling older adults (≥ 65) from Health and Retirement Study in the US (2006 and 2008). We used six dichotomized psychosocial stressors: a) loneliness, b) discrimination, c) financial strain, d) low subjective status, e) poor neighborhood cohesion, and f) traumatic life events to compute cumulative psychosocial stress. The Fried frailty phenotype defined frailty based on three features: slowness, poor strength, weight loss, fatigue, and low physical activity. Multivariable regressions were used to examine the structural determinants (gender, education, race, and ethnicity) frailty relationship and test whether cumulative psychosocial stress has a mediating role. RESULTS The frailty prevalence was 22%. Females, Hispanics, Blacks, and those with less education had higher odds of frailty (p<.01). Race and ethnic minorities and non-college graduates experienced greater cumulative psychosocial stress relative to their White and college graduate counterparts (p<.05), respectively. Greater cumulative psychosocial stress was associated with increased odds of frailty (p < .001); however, it did not mediate the structural determinants and frailty relationship. CONCLUSION Contrary to expectations, cumulative psychosocial stress did not mediate the relationship between structural determinants and frailty. Rather, high cumulative psychosocial stress was independently associated with frailty. Further research should examine other psychosocial mediators to inform interventions to prevent/delay frailty.
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Affiliation(s)
| | | | - Eleanor S McConnell
- Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs Medical Center, Durham, NC, USA
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
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Chu WM, Tange C, Nishita Y, Tomida M, Shimokata H, Otsuka R, Lee MC, Arai H. Effect of different types of social support on physical frailty development among community-dwelling older adults in Japan: Evidence from a 10-year population-based cohort study. Arch Gerontol Geriatr 2023; 108:104928. [PMID: 36649669 DOI: 10.1016/j.archger.2023.104928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE Social support is associated with multiple positive health outcomes and is negatively associated with frailty in older adults. However, most evidence came from cross-sectional research. This study aimed to longitudinally explore the relationship between different types of social support and incident physical frailty. MATERIALS AND METHODS A 10-year prospective cohort study data from the National Institute for Longevity Sciences - Longitudinal Study of Aging (NILS-LSA) database, from 2000 to 2012 on older adults aged ≥65 years were analyzed excluding those with physical frailty at baseline, missing data, or not attending follow-up. We measured three kinds of social support, whether from within or outside family members, including emotional, instrumental, and negative support. The generalized estimating equation (GEE) model was used to examine the longitudinal relationships between social support and subsequent frailty. RESULTS The final analysis included 466 participants, with an average age of 71.3 (standard deviation [SD], 4.3) years and 7.33 years of follow-up (SD, 3.11). GEE analysis showed that emotional and instrumental supports from within and outside family members were associated with a significantly lower risk of physical frailty (odd ratio (OR) and 95% confidence interval (CI): 0.80 [0.64-1.00] and 0.74 [0.58-0.95]; 0.77 [0.60-0.99] and 0.79 [0.63-0.99], respectively). Both negative support from within or outside family members had no significant relationship with the risk of physical frailty. CONCLUSIONS This longitudinal study suggested that emotional, and instrumental support both from within or outside family members can reduce future physical frailty among older adults.
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Affiliation(s)
- Wei-Min Chu
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Aichi, Japan; Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chikako Tange
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Yukiko Nishita
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
| | - Makiko Tomida
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Graduate School of Humanities and Social Sciences, Nagoya City University, Aichi, Japan
| | - Hiroshi Shimokata
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Japan
| | - Rei Otsuka
- Department of Epidemiology of Aging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Institute of Population Sciences, National Health Research Institutes, Miaoli County, Taiwan; College of Management, Chaoyang University of Technology, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Aichi, Japan
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Chen LF, Chang HC, Cai ZC, Chen YJ, Hsu WL, Chuang YH, Lee SC, Huang HC. Community-based exercise and nutritional interventions to improve frailty syndrome among older adults: A quasi-experimental study. Geriatr Nurs 2023; 51:222-231. [PMID: 37018848 DOI: 10.1016/j.gerinurse.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023]
Abstract
This study aimed to explore the efficacy of single and combined effects of exercise and branched-chain amino acid (BCAA) supplements on improving frailty and quality of life in older adults. In total, 120 study participants were allocated into a combined exercise-and-BCAA supplementation group, an exercise-only group, a BCAA supplementation-only group, and a control group. Results showed that Fried's frailty score significantly decreased in the combined exercise-and-BCAA supplementation group (β= -1.73, p<0.001), exercise-only group (β= -1.68, p<0.001), and BCAA supplementation-only group (β= -0.73, p=0.005) compared to the control group. Moreover, the combination of exercise and BCAA supplements and the exercise-only program produced significant improvements in frailty compared to the BCAA supplement-only group and control group (p<0.05). Exercise should be a critical approach for older adults to improve frailty. Healthcare professionals in geriatric care should incorporate exercise programs as frailty management and prevention for older adults.
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Affiliation(s)
- Li-Fen Chen
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan; Lotung Poh-Ai Home Care Center, Lo-Hsu Medical Foundation, 61-8 Nanchang Street, Luodong Township, Yilan County, 265006, Taiwan; Department of Community Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, 83, Nanchang Street, Luodong Township, Yilan County, 265006, Taiwan.
| | - Hsien-Cheng Chang
- Department of Community Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, 83, Nanchang Street, Luodong Township, Yilan County, 265006, Taiwan; Department of Family Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, 83 Nanchang Street, Luodong Township, Yilan County, 265006, Taiwan.
| | - Zong-Ci Cai
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.
| | - Yan-Jen Chen
- Department of Rehabilitation Therapy, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, 83 Nanchang Street, Luodong Township, Yilan County, 265006, Taiwan.
| | - Wen-Ling Hsu
- Department of Community Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, 83, Nanchang Street, Luodong Township, Yilan County, 265006, Taiwan.
| | - Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan.
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Malik P, Nakhla N, Guo Y, Tadrous M, Duqoum A, Hogan DB, Maxwell CJ. Pharmacists' knowledge, perceptions and practices regarding frailty: A cross-sectional survey across practice settings in Canada. Can Pharm J (Ott) 2023; 156:159-171. [PMID: 37201168 PMCID: PMC10186872 DOI: 10.1177/17151635231164957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Data on Canadian pharmacists' knowledge and perceptions about frailty in older adults and its assessment in pharmacy practice are scarce. Methods A cross-sectional survey of 349 Canadian pharmacists was conducted to evaluate pharmacists' knowledge, perceptions and practices regarding frailty. Descriptive analyses summarized responses by practice setting, and a multivariable logistic regression model examined associations between respondent characteristics and the likelihood of assessing frailty. Results Most respondents were female (70%), aged ≤34 years (47%), Canadian graduates (83%), from Ontario/Quebec (51%) and from urban centres (58%). Although a significant proportion agreed it is important for pharmacists to know (80%) and assess (56%) patient frailty status, only 36% reported assessing frailty in practice. Respondents exclusively practising in a community pharmacy were significantly less likely to agree that it is important for a pharmacist to know or assess frailty status and to report assessing it. Factors associated with a greater likelihood of assessment included positive beliefs about the importance of knowing a patient's frailty status and having a greater proportion of older patients with cognitive or functional impairment in practice. Discussion Findings suggest that pharmacists generally agree with the importance of understanding frailty as it relates to the appropriate use of medications, but most do not assess it. Further research is needed to identify the barriers to assessing frailty, while guidance is needed on which of the available screening tools can best be integrated into a clinical pharmacy practice. Conclusion There is an opportunity to improve pharmaceutical care for older adults by providing pharmacists the means and resources to assess frailty in practice.
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Affiliation(s)
- Paul Malik
- Independent researcher in North Chicago,
Illinois
| | - Nardine Nakhla
- School of Pharmacy, University of Waterloo,
Waterloo, Ontario
| | - Yanling Guo
- School of Public Health Sciences, University of
Waterloo, Waterloo, Ontario
| | - Mina Tadrous
- Women’s College Research Institute, Women’s
College Hospital, Toronto
- Leslie Dan Faculty of Pharmacy, University of
Toronto
- ICES, Toronto, Ontario
| | - Areen Duqoum
- School of Pharmacy, University of Waterloo,
Waterloo, Ontario
| | - David B. Hogan
- Departments of Medicine & Community Health
Sciences, Cumming School of Medicine, University of Calgary, Calgary,
Alberta
| | - Colleen J. Maxwell
- School of Pharmacy, University of Waterloo,
Waterloo, Ontario
- School of Public Health Sciences, University
of Waterloo, Waterloo, Ontario
- ICES, Toronto, Ontario
- Departments of Medicine & Community Health
Sciences, Cumming School of Medicine, University of Calgary, Calgary,
Alberta
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Huang TY, Chou MY, Liang CK, Lin YT, Chen RY, Wu PF. Physical activity plays a crucial role in multidomain intervention for frailty prevention. Aging Clin Exp Res 2023; 35:1283-1292. [PMID: 37101084 PMCID: PMC10132799 DOI: 10.1007/s40520-023-02412-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND AND AIMS Taiwan is one of the most rapidly aging countries worldwide. Both physical activity and frailty affect older adults, and multidomain interventions prevent frailty. This study investigated the associations between physical activity, frailty, and the effects of multidomain intervention. METHODS This study enrolled individuals aged 65 years or older. The physical activity level was assessed using the Physical Activity Scale for the Elderly (PASE). Enrollees participated in a multidomain intervention program that consisted of twelve 120-min sessions administered over a 12-week period that included health education, cognitive training, and exercise programs. The effects of the intervention were evaluated using the instrumental activities of daily living scale (IADL), Mini Nutritional Assessment short form (MNA-SF), five-item Geriatric Depression Scale (GDS-5), Mini-Mental State Examination (MMSE), timed up and go test (TUGT), and Fried's frailty phenotype. RESULTS In total, 106 older adults (aged 65-96 years) were enrolled in this study. The mean age was 77.47 ± 7.19 years, and 70.8% of participants were women. PASE scores were significantly lower among participants who were of older age, frail, and had a history of falls in the last 12 months. Frailty could be improved by multidomain interventions and was significantly positively correlated with depression, and negatively correlated with physical activity, mobility, cognition and daily living skills. Moreover, daily living skills were significantly positively correlated with cognition, mobility and physical activity, and negatively correlated with age, sex, and frailty. However, multidomain interventions did not affect daily living skills suggesting daily living skills may need to be maintained from a young age. Finally, results from multiple regressions suggest that physical activity, mobility and depression may be predictors of frailty. CONCLUSIONS Physical activity has an important role in frailty, may be a predictor of frailty, and strongly contributes to reducing frailty through multidomain intervention. Policies that encourage healthy aging should focus on increasing physical activity, maintaining basic daily living skills and reducing frailty.
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Affiliation(s)
- Tzu-Ya Huang
- Department of Family Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, 700, Kaohsiung University Rd., Kaohsiung, 811726, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
| | - Ru-Yih Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Department of Business Management, Institute of Health Care Management, National Sun Yat-sen University, No.70 Lienhai Rd., Kaohsiung, 804201, Taiwan
| | - Pei-Fung Wu
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, 700, Kaohsiung University Rd., Kaohsiung, 811726, Taiwan.
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Cano-Escalera G, Graña M, Irazusta J, Labayen I, Gonzalez-Pinto A, Besga A. Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital. J Clin Med 2023; 12:jcm12093103. [PMID: 37176544 PMCID: PMC10179017 DOI: 10.3390/jcm12093103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. MATERIALS Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. METHODS Kaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. RESULTS Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)). CONCLUSIONS Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.
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Affiliation(s)
- Guillermo Cano-Escalera
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Manuel Graña
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain
- BioCruces Health Research Institute, 48903 Barakaldo, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain
| | - Ana Gonzalez-Pinto
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
| | - Ariadna Besga
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
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Bu F, Deng XH, Zhan NN, Cheng H, Wang ZL, Tang L, Zhao Y, Lyu QY. Development and validation of a risk prediction model for frailty in patients with diabetes. BMC Geriatr 2023; 23:172. [PMID: 36973658 PMCID: PMC10045211 DOI: 10.1186/s12877-023-03823-3] [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: 11/28/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Frailty is the third most common complication of diabetes after macrovascular and microvascular complications. The aim of this study was to develop a validated risk prediction model for frailty in patients with diabetes. METHODS The research used data from the China Health and Retirement Longitudinal Study (CHARLS), a dataset representative of the Chinese population. Twenty-five indicators, including socio-demographic variables, behavioral factors, health status, and mental health parameters, were analyzed in this study. The study cohort was randomly divided into a training set and a validation set at a ratio of 70 to 30%. LASSO regression analysis was used to screen the variables for the best predictors of the model based on a 10-fold cross-validation. The logistic regression model was applied to explore the associated factors of frailty in patients with diabetes. A nomogram was constructed to develop the prediction model. Calibration curves were applied to evaluate the accuracy of the nomogram model. The area under the receiver operating characteristic curve and decision curve analysis were conducted to assess predictive performance. RESULTS One thousand four hundred thirty-six patients with diabetes from the CHARLS database collected in 2013 (n = 793) and 2015 (n = 643) were included in the final analysis. A total of 145 (10.9%) had frailty symptoms. Multivariate logistic regression analysis showed that marital status, activities of daily living, waist circumference, cognitive function, grip strength, social activity, and depression as predictors of frailty in people with diabetes. These factors were used to construct the nomogram model, which showed good concordance and accuracy. The AUC values of the predictive model and the internal validation set were 0.912 (95%CI 0.887-0.937) and 0.881 (95% CI 0.829-0.934). Hosmer-Lemeshow test values were P = 0.824 and P = 0.608 (both > 0.05). Calibration curves showed significant agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had a good predictive performance. CONCLUSIONS Comprehensive nomogram constructed in this study was a promising and convenient tool to evaluate the risk of frailty in patients with diabetes, and contributed clinicians to screening the high-risk population.
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Affiliation(s)
- Fan Bu
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Xiao-Hui Deng
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Na-Ni Zhan
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Hongtao Cheng
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Zi-Lin Wang
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Li Tang
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Yu Zhao
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China
| | - Qi-Yuan Lyu
- School of Nursing, Jinan University, No. 601, West Huangpu Avenue, Guangzhou, People's Republic of China.
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Pua YH, Tay L, Clark RA, Thumboo J, Tay EL, Mah SM, Lee PY, Ng YS. Development and validation of a physical frailty phenotype index-based model to estimate the frailty index. Diagn Progn Res 2023; 7:5. [PMID: 36941719 PMCID: PMC10029224 DOI: 10.1186/s41512-023-00143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/23/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The conventional count-based physical frailty phenotype (PFP) dichotomizes its criterion predictors-an approach that creates information loss and depends on the availability of population-derived cut-points. This study proposes an alternative approach to computing the PFP by developing and validating a model that uses PFP components to predict the frailty index (FI) in community-dwelling older adults, without the need for predictor dichotomization. METHODS A sample of 998 community-dwelling older adults (mean [SD], 68 [7] years) participated in this prospective cohort study. Participants completed a multi-domain geriatric screen and a physical fitness assessment from which the count-based PFP and the 36-item FI were computed. One-year prospective falls and hospitalization rates were also measured. Bayesian beta regression analysis, allowing for nonlinear effects of the non-dichotomized PFP criterion predictors, was used to develop a model for FI ("model-based PFP"). Approximate leave-one-out (LOO) cross-validation was used to examine model overfitting. RESULTS The model-based PFP showed good calibration with the FI, and it had better out-of-sample predictive performance than the count-based PFP (LOO-R2, 0.35 vs 0.22). In clinical terms, the improvement in prediction (i) translated to improved classification agreement with the FI (Cohen's kw, 0.47 vs 0.36) and (ii) resulted primarily in a 23% (95%CI, 18-28%) net increase in FI-defined "prefrail/frail" participants correctly classified. The model-based PFP showed stronger prognostic performance for predicting falls and hospitalization than did the count-based PFP. CONCLUSION The developed model-based PFP predicted FI and clinical outcomes more strongly than did the count-based PFP in community-dwelling older adults. By not requiring predictor cut-points, the model-based PFP potentially facilitates usage and feasibility. Future validation studies should aim to obtain clear evidence on the benefits of this approach.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Laura Tay
- Department of General Medicine (Geriatric Medicine), Sengkang General Hospital, Singapore, Singapore
| | - Ross Allan Clark
- School of Health and Behavioural Science, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Health Services Research & Evaluation, SingHealth Office of Regional Health, Singapore, Singapore
| | - Ee-Ling Tay
- Department of Physiotherapy, Sengkang General Hospital, Singapore, Singapore
| | - Shi-Min Mah
- Department of Physiotherapy, Sengkang General Hospital, Singapore, Singapore
| | - Pei-Yueng Lee
- Organization Planning and Performance, Singapore General Hospital, Singapore, Singapore
| | - Yee-Sien Ng
- Geriatric Education and Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Rehabilitation Medicine, Singapore General Hospital and Sengkang General Hospital, Singapore, Singapore
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135
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Zhao X, Zhu R, Chen Q, He J. Effect of frailty status on mortality risk among Chinese community-dwelling older adults: a prospective cohort study. BMC Geriatr 2023; 23:150. [PMID: 36934220 PMCID: PMC10024402 DOI: 10.1186/s12877-023-03759-8] [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: 07/13/2022] [Accepted: 01/18/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Frailty is associated with mortality among older adults. We aimed to determine the appropriate time and frailty index (FI) threshold for frailty intervention in Chinese community-dwelling older adults. METHODS In this prospective cohort study, we used data from the 2011 wave of the Chinese Longitudinal Healthy Longevity Study. Follow-up was performed for seven years from baseline. Using the FI to evaluate frailty and define frailty status, we explored the best time point and FI score for frailty intervention, by comparing the relationships of FI and frailty status with mortality. RESULTS From 2011 to 2018, 8642 participants were included and followed-up. A total of 4458 participants died during the study period. After adjusting for variables such as age, sex, marital status, education level, and living conditions, the hazard ratio (HR) of mortality risk based on the FI at baseline was 37.484 (95% confidence interval [CI]: 30.217-46.498; P < 0.001); female sex, living in the city, being married, and living with spouse were found to be protective factors, whereas ageing was a risk factor for frailty. The mortality risk was higher in pre-frail than in frail participants (HR: 3.588, 95% CI: 3.212-4.009, P < 0.001). Piecewise linear regression analysis revealed an FI score threshold of 0.5. When the FI score was > 0.5, the HR of mortality based on the FI was 15.758 (95% CI: 3.656-67.924; P < 0.001); when the FI score was ≤ 0.5, the HR of mortality based on the FI was 48.944 (95% CI: 36.162-66.244; P < 0.001). CONCLUSION Using FI as a continuous variable to predict death is more accurate than frailty status. The advancement of early interventions for mortality risk reduction is more beneficial in pre-frail than in frail patients, and an FI score of 0.5 was found to be the threshold for mortality prediction using the FI.
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Affiliation(s)
- Xinxin Zhao
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, China
| | - Rui Zhu
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, China
- School of Medicine, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University, Shanghai, 200092, China
| | - Qi Chen
- Department of Health Statistics, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433, China.
| | - Jia He
- School of Medicine, Tongji University, 1239 Siping Road, Shanghai, 200092, China.
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136
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Kozela M, Pająk A, Szafraniec K, Ayuso-Mateos JL, Bobak M, Lu W, Pikhart H, Polak M, Sanchez-Niubo A, Stepaniak U, Haro JM. ATHLOS Healthy Aging Scale score as the predictor of all-cause mortality in Poland and Czechia. Front Public Health 2023; 11:1114497. [PMID: 37006584 PMCID: PMC10061126 DOI: 10.3389/fpubh.2023.1114497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundThe ATHLOS consortium (Aging Trajectories of Health–Longitudinal Opportunities and Synergies) used data from several aging cohorts to develop a novel scale measuring healthy aging comprehensively and globally (ATHLOS Healthy Aging Scale). In the present study, we assessed the predictive performance of the ATHLOS Healthy Aging Scale for all-cause mortality in middle-aged and older adults.MethodsData from the Polish and Czech HAPIEE (Health Alcohol and Psychosocial factors In Eastern Europe) prospective cohorts were used. There were 10,728 Poles and 8,857 Czechs recruited. The ATHLOS Healthy Aging Scale score was calculated for all participants using data from the baseline examination carried out from 2002 to 2005. The follow-up for all-cause mortality was completed over 14 years. The associations between quintiles of the ATHLOS Healthy Aging Scale and all-cause mortality were estimated using Cox proportional hazards models.ResultsA total of 9,922 Polish and 8,518 Czech participants contributed ATHLOS Healthy Aging Scale and mortality data with 1,828 and 1,700 deaths, respectively. After controlling for age, the ATHLOS Healthy Aging Scale score was strongly associated with mortality in a graded fashion for both genders and countries (hazard ratios for lowest vs. highest quintile were 2.98 and 1.96 for Czech and Polish women and 2.83 and 2.66 for Czech and Polish men, respectively). The associations were only modestly attenuated by controlling for education, economic activity, and smoking, and there was further modest attenuation after additional adjustment for self-rated health.ConclusionThe novel ATHLOS Healthy Aging Scale is a good predictor of all-cause mortality in Central European urban populations, suggesting that this comprehensive measure is a useful tool for the assessment of the future health trajectories of older persons.
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Affiliation(s)
- Magdalena Kozela
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
- *Correspondence: Magdalena Kozela
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Krystyna Szafraniec
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czechia
| | - Wentian Lu
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czechia
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Albert Sanchez-Niubo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Urszula Stepaniak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Josep Maria Haro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
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Cruz-Moreira K, Alvarez-Cordova L, González-Palacios Torres C, Chedraui P, Jouvin J, Jiménez-Moleón JJ, Barrios-Rodríguez R. Prevalence of frailty and its association with oral hypofunction in older adults: a gender perspective. BMC Oral Health 2023; 23:140. [PMID: 36899360 PMCID: PMC10007728 DOI: 10.1186/s12903-023-02824-3] [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: 12/29/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Previous studies have indicated an association between oral hypofunction and frailty in community-dwelling older adults. However, this issue has not been evaluated in institutionalized older patients. We aimed to determine the prevalence of physical frailty in this particularly vulnerable group and evaluate its association with oral hypofunction, analyzing possible differences by gender. METHODS This cross-sectional study was conducted in private and public care homes in Guayaquil (Ecuador) from January 2018 until December 2019. Participants were classified as robust, pre-frail, and frail according to the Fried's frailty phenotype. Oral hypofunction was defined as the presence of at least three positive items in the following list: poor oral hygiene, oral dryness, reduced occlusal force, decreased masticatory function, and deterioration of swallowing function. The relationships between frailty and oral hypofunction were analyzed using logistic regression models for the whole sample and stratified by gender. Statistical analyses were performed using STATA 15.0 software (Stata Corp. LP, College Station, TX, USA). RESULTS Among the 589 participants analyzed (65% women), the median age was 72 years (interquartile range: 66-82). Pre-frailty and frailty were presented in 66.7% and 28.9% of them respectively. Weakness was the most frequent item (84.6%). There was a significant relationship between frailty and oral hypofunction in women. In the overall sample, the frequency of frailty was 2.06 times higher (95% CI 1.30-3.29) in patients with oral hypofunction, and this association was maintained in women (ORa: 2.18; 95% CI 1.21-3.94). Reduced occlusal force and decreased swallowing function were items significantly associated with the presence of frailty (ORa: 1.95; 95% CI 1.18-3.22 and ORa: 2.11; 95% CI 1.39-3.19, respectively). CONCLUSION The prevalence of frailty and pre-frailty was high among institutionalized older people and was associated with the presence of hypofunction, especially in women. Decreased swallowing function was the most strongly item associated with frailty.
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Affiliation(s)
- Karla Cruz-Moreira
- Specialist in Oral Medicine, Dentistry degree, Catholic University of Santiago de Guayaquil, Guayaquil, Ecuador.,Instituto de Investigación e Innovación en Salud Integral, Catholic University of Santiago de Guayaquil, Guayaquil, Ecuador
| | - Ludwig Alvarez-Cordova
- Instituto de Investigación e Innovación en Salud Integral, Catholic University of Santiago de Guayaquil, Guayaquil, Ecuador.,Master in Clinical Nutrition, Nutrition and Dietetics degree, Catholic University of Santiago de Guayaquil, Guayaquil, Ecuador
| | | | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Catholic University of Santiago de Guayaquil, Guayaquil, Ecuador.,Medical degree, PhD, Catholic University of Santiago de Guayaquil, Guayaquil, Ecuador
| | - José Jouvin
- Master in Health Services Management. Medical degree, Catholic University of Santiago de Guayaquil, Guayaquil, Ecuador
| | - José Juan Jiménez-Moleón
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
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138
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Kim Y, Kim J, Kim M, Song K, Choi M. Association of Depressive Mood and Frailty With Mortality and Health Care Utilization: Korean National Cohort Study. J Am Med Dir Assoc 2023; 24:504-510. [PMID: 36878262 DOI: 10.1016/j.jamda.2023.01.025] [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: 09/11/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To investigate the association of depressive mood and frailty with mortality and health care utilization (HCU) and identify the coexisting effect of depressive mood and frailty in older adults. DESIGN A retrospective study using nationwide longitudinal cohort data. SETTING AND PARTICIPANTS A total of 27,818 older adults age 66 years from the National Screening Program for Transitional Ages between 2007 and 2008, part of the National Health Insurance Service-Senior cohort. METHODS Depressive mood and frailty were measured by the Geriatric Depression Scale and Timed Up and Go test, respectively. Outcomes were mortality and HCU, including long-term care services (LTCS), hospital admissions, and total length of stay (LOS) from the index date to December 31, 2015. Cox proportional hazards regression and zero-inflated negative binomial regression were performed to identify differences in outcomes by depressive mood and frailty. RESULTS Participants with depressive mood and frailty represented 50.9% and 2.4%, respectively. The prevalence of mortality and LTCS use in the overall participants was 7.1% and 3.0%, respectively. More than 3 hospital admissions (36.7%) and total LOS above 15 days (53.2%) were the most common. Depressive mood was associated with LTCS use [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.05-1.42] and hospital admissions [incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.08]. Frailty had associations with mortality risk (HR 1.96, 95% CI 1.44-2.68), LTCS use (HR 4.86, 95% CI 3.45-6.84), and LOS (IRR 1.30, 95% CI 1.06-1.60). The coexistence of depressive mood and frailty was associated with increased LOS (IRR 1.55, 95% CI 1.16-2.07). CONCLUSIONS AND IMPLICATIONS Our findings highlight the need to focus on depressive mood and frailty to reduce mortality and HCU. Identifying combined problems early in older adults may contribute to healthy aging by reducing adverse health outcomes and the burden of health care costs.
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Affiliation(s)
- Yesol Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Jeewuan Kim
- Department of Statistics and Data Science, Yonsei University, Seoul, Republic of Korea
| | - Mihui Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Kijun Song
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Mona Choi
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea.
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139
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Wang Y, Li R, Yuan L, Yang X, Lv J, Ye Z, Huang F, He T. Association between diabetes complicated with comorbidities and frailty in older adults: A cross-sectional study. J Clin Nurs 2023; 32:894-900. [PMID: 35934867 DOI: 10.1111/jocn.16442] [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: 03/09/2022] [Revised: 06/05/2022] [Accepted: 06/20/2022] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study investigated the relationship between frailty and diabetes complicated with comorbidities. BACKGROUND Frailty is a common geriatric syndrome, and older adults with diabetes are prone to frailty. Patients with diabetes and comorbidities might be at increased risk of developing frailty. DESIGN A multicenter cross-sectional study. METHODS A cross-sectional study was conducted to identify older patients with diabetes and comorbidities in the internal medicine departments of five tertiary general hospitals in Sichuan Province, China, from March 2020 to June 2021. We used the FRAIL scale to identify frailty, and multinomial logistic regression was used to compare sociodemographic characteristics and comorbidities of frail or pre-frail participants with robust participants. The STROBE checklist was used for this cross-sectional study. RESULTS A total of 1652 patients (883 males, 53.5%) were included, and the prevalence of frailty was 26.5%. Multinomial logistic regression analysis revealed that compared with robust patients, diabetic patients with hypertension, coronary heart disease, chronic cardiac failure, COPD, cerebrovascular diseases, osteoarticular diseases, chronic renal diseases, chronic gastrointestinal diseases and cancer were more likely to be frail. In addition, patients who engaged in less exercise, presented more comorbidities, were older and had lower education levels, were more prone to frailty. CONCLUSION There was a clear correlation between diabetes complicated with comorbidities and the development of frailty. Appropriate personalised care levels for patients with diabetes and comorbidities, and early screening for frailty might reduce the prevalence of frailty in these patients. RELEVANCE TO CLINICAL PRACTICE This study provided information for healthcare providers to identify circumstances that increase the risk of frailty and more effectively support patients with diabetes and comorbidities.
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Affiliation(s)
- Yi Wang
- West China School of Nursing, Sichuan University/Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Rao Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Li Yuan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoling Yang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Jing Lv
- West China School of Nursing, Sichuan University/Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Ziwei Ye
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Fengmei Huang
- West China School of Nursing, Sichuan University/Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Ting He
- West China School of Nursing, Sichuan University/Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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Wang R, Hannan MT, Wang M, Schwartz AW, Lopez-Garcia E, Grodstein F. Long-Term Consumption of Nuts (Including Peanuts, Peanut Butter, Walnuts, and Other Nuts) in Relation to Risk of Frailty in Older Women: Evidence from a Cohort Study. J Nutr 2023; 153:820-827. [PMID: 36931754 PMCID: PMC10196568 DOI: 10.1016/j.tjnut.2023.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Adherence to a healthy diet is inversely associated with frailty. However, the relationship between nuts, a key food group of Mediterranean diet, and frailty is unclear. OBJECTIVES This study aimed to evaluate the association between nut consumption and frailty in an aging female population. METHODS This population-based observational study included nonfrail women (≥60 y old) in the NHS from 11 states of the United States. Outcome was incident frailty, defined as having ≥3 of the FRAIL components (fatigue, lower strength, reduced aerobic capacity, multiple chronic conditions, and significant weight loss) and assessed every 4 y from 1992 to 2016. From 1990 to 2014, FFQs were used to assess the intakes of peanuts, peanut butter, walnuts (added in 1998), and other nuts at 4-y intervals. Exposure was total nut consumption, calculated as the sum of intakes of peanuts, peanut butter, walnuts, and other nuts and categorized into <1 serving/mo, 1-3 servings/mo, 1 serving/wk, 2-4 servings/wk, and ≥5 servings/wk. The relations of intakes of peanuts, peanut butter, and walnuts with frailty were also investigated separately. Cox proportional hazards models were used to assess the associations between nut consumption and frailty after adjusting for age, smoking, BMI, EI, diet quality, and medication use. RESULTS Among 71,704 participants, 14,195 incident frailty cases occurred over 1,165,290 person-years. The adjusted HR (95% CI) for consuming ≥5 servings/wk of nuts was 0.80 (0.73, 0.87), as compared with <1 serving/mo. Higher intakes of peanuts and walnuts, but not peanut butter, were also inversely associated with frailty. CONCLUSIONS This large prospective cohort study showed a strong and consistent inverse association between regular nut consumption and incident frailty. This suggests that nut consumption should be further tested as a convenient public health intervention for the preservation of health and well-being in older adults.
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Affiliation(s)
- Ruibin Wang
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Marian T Hannan
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea W Schwartz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; New England Geriatrics Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA Food Institute. CEI UAM + CSIC, Madrid, Spain
| | - Francine Grodstein
- Rush Alzheimer Disease Center, Rush University Medical Center, Chicago, IL, USA
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Quinn KJ, Ma Y, Carli M, Coelho DH. The Predictive Value of a Modified Frailty Index on Perioperative Morbidity and Mortality Following Otologic Surgery. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e029. [PMID: 38516323 PMCID: PMC10950125 DOI: 10.1097/ono.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/31/2022] [Indexed: 03/23/2024]
Abstract
Objectives Recently, determinants of frailty have become an increasingly recognized perioperative risk stratification tool. This study examines the predictive value of a 5-factor modified frailty index (mFI-5) on perioperative morbidity and mortality in patients undergoing otologic surgery, with a subgroup analysis based on surgery site. Study Design Cross-sectional analysis. Setting National surgical quality improvement program dataset 2005-2019. Patients Current procedural terminology (CPT) codes were used to identify patients undergoing all otologic surgeries. Interventions Otologic surgeries as indicated by CPT codes, including external ear, middle ear/mastoid, implants, and inner ear/facial nerve subgroups. Main Outcome Measures Primary outcomes examined in this study included rates of overall complications and life-threatening complications within 30 days after surgery. Overall complications included superficial surgical site infections (SSI), deep incisional SSI, readmission, deep vein thrombosis, life-threatening complications, and mortality. Life-threatening complications included those classified as Clavien-Dindo grade IV: cerebrovascular accident, mechanical ventilation for more than 48 hours, reintubation, pulmonary embolism, acute renal failure, cardiac arrest, and myocardial infarction. Results A total of 16,859 patients who underwent otologic surgery were identified, resulting in a cohort that was 47.5% male with an average age of 47.6 years (17.1 SD). Multivariable regression analysis of the entire cohort demonstrated a score of 3 or more on the mFI-5 was independently predictive of all postoperative complications (odds ratio (OR): 2.02, P < 0.0001). However, subgroup analysis showed that only "external ear" surgery correlated with mFi-5 (OR 8.03, P = 0.013). Conclusions Higher frailty scores as measured by the mFI-5 correlate with postoperative morbidity and mortality after otologic surgery, though subgroup analysis reveals an association only with cases performed on the external ear. These findings suggest that for most otologic surgery, the mFI-5 frailty score is not predictive of postoperative complications.
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Affiliation(s)
- Kevin J. Quinn
- Department of Otolaryngology – Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Yuchi Ma
- Department of Otolaryngology – Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Matthew Carli
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Daniel H. Coelho
- Department of Otolaryngology – Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Zhang B, Zhao P, Wang H, Wang S, Wei C, Gao F, Liu H. Factors associated with frailty in kidney transplant recipients: A cross-sectional study. J Ren Care 2023; 49:35-44. [PMID: 34860469 DOI: 10.1111/jorc.12407] [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: 07/20/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Frailty is prevalent in kidney transplant recipients and associated with multiple health care challenges. The association between frailty and outcomes has been extensively studied in kidney transplant recipients, but the status of frailty and its associated factors are not well studied, hindering efforts to develop strategies to improve care and reduce frailty. OBJECTIVES To identify the factors that are associated with frailty in kidney transplant recipients comprehensively. DESIGN AND PARTICIPANTS The associated factors of frailty were explored by a cross-sectional study of 185 kidney transplant recipients. MEASUREMENTS Data were collected using the general information questionnaire, the Charlson comorbidity index, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Connor-Davidson Resilience Scale, the Perceived Social Support Scale and the Tilburg Frailty Indicator. Data were analyzed using the multiple linear regression analysis. RESULTS A total of 75 (40.5%) kidney transplant recipients were assessed as frail by Chinese TFI. Age (β = 0.228), time post-transplant (β = 0.055), sleep quality (β = 0.224) and psychological resilience (β = -0.038) entered the final multiple regression equation and accounted for 41.8% of the total frailty variation (R2 = 0.418, F = 21.31, p < 0.05). CONCLUSIONS Frailty was common among kidney transplant recipients. Old age, long time after transplantation, poor sleep quality and low psychological resilience were main associated factors for frailty. Integrated care interventions are therefore needed for this vulnerable population to prevent or delay frailty.
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Affiliation(s)
- Bei Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Peiyu Zhao
- Nursing Department, China-Japan Friendship Hospital, Beijing, China
| | - Han Wang
- Department of Clinical Nursing, School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Shasha Wang
- Department of Clinical Nursing, School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Changyun Wei
- Department of Clinical Nursing, School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Fengli Gao
- Nursing Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hongxia Liu
- Department of Clinical Nursing, School of Nursing, Beijing University of Chinese Medicine, Beijing, China
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143
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Lima K, Legge A, Hanly JG, Lee J, Song J, Chung A, Ramsey-Goldman R. Association of the Systemic Lupus International Collaborating Clinics Frailty Index and Damage Accrual in Longstanding Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2023; 75:578-584. [PMID: 34590445 PMCID: PMC8964839 DOI: 10.1002/acr.24798] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/30/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To externally validate the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) in a prevalent systemic lupus erythematosus (SLE) cohort and to assess the ability of the SLICC-FI to predict organ damage accrual among individuals with longstanding SLE. METHODS This was a secondary analysis of data from the Study of Lupus Vascular and Bone Long-Term Endpoints (SOLVABLE) cohort, which consists of adult women from the Chicago Lupus Database who met the 1997 revised American College of Rheumatology (ACR) classification criteria for SLE. There were 185 patients with SLE enrolled, of whom 149 patients were included in a 5-year follow-up analysis. The SLICC-FI and SLICC/ACR Damage Index (SDI) scores were calculated at baseline and 5-year follow-up. Unadjusted and adjusted logistic regression models estimated the association of baseline SLICC-FI scores (per 0.05 increase) with damage accrual at 5-year follow-up. RESULTS At enrollment the mean ± SD age of the 149 patients was 43.30 ± 10.15 years, the mean ± SD disease duration was 11.93 ± 8.46 years, and the mean ± SD SDI score was 1.64 ± 1.83. At baseline, the mean ± SD SLICC-FI score was 0.18 ± 0.08, and 36% of participants were categorized as frail (SLICC-FI score >0.21). In a model adjusted for age, race, and disease duration, each 0.05-unit increase in the baseline SLICC-FI score was associated with 28% higher odds of subsequent damage accrual (odds ratio 1.28, 95% confidence interval 1.01-1.63). CONCLUSION In a prevalent cohort of women with established SLE, higher baseline SLICC-FI scores were associated with a higher risk of subsequent damage accrual at 5-year follow-up.
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Affiliation(s)
- Kaitlin Lima
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexandra Legge
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jing Song
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anh Chung
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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López-Sampalo A, Cobos-Palacios L, Vilches-Pérez A, Sanz-Cánovas J, Vargas-Candela A, Mancebo-Sevilla JJ, Hernández-Negrín H, Gómez-Huelgas R, Bernal-López MR. COVID-19 in Older Patients: Assessment of Post-COVID-19 Sarcopenia. Biomedicines 2023; 11:biomedicines11030733. [PMID: 36979712 PMCID: PMC10045496 DOI: 10.3390/biomedicines11030733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
(1) Background: Acute COVID-19 infections produce alterations in the skeletal muscle, leading to acute sarcopenia, but the medium- and long-term consequences are still unknown. The aim of this study was to evaluate: (1) body composition; (2) muscle strength and the prevalence of sarcopenia; and (3) the relationship between muscle strength with symptomatic and functional evolution in older patients affected by/recovered from COVID-19; (2) Methods: A prospective, longitudinal study of patients aged ≥65 years who had suffered from COVID-19 infection between 1 March and 31 May 2020, as confirmed by PCR or subsequent seroconversion. Persistent symptoms, as well as anthropometric, clinical, and analytical characteristics, were analyzed at 3 and 12 months after infection. The degree of sarcopenia was determined by dynamometry and with SARC-F; (3) Results: 106 participants, aged 76.8 ± 7 years, were included. At 3 months postinfection, a high percentage of sarcopenic patients was found, especially among women and in those with hospitalization. At 12 months postinfection, this percentage had decreased, coinciding with a functional and symptomatic recovery, and the normalization of inflammatory parameters, especially interleukin-6 (4.7 ± 11.6 pg/mL vs. 1.5 ± 2.4 pg/mL, p < 0.05). The improvement in muscle strength was accompanied by significant weight gain (71.9 ± 12.1 kg vs. 74.7 ± 12.7 kg, p < 0.001), but not by an increase in lean mass (49.6 ± 10 vs. 49.9 ± 10, p 0.29); (4) Conclusions: Older COVID-19 survivors presented a functional, clinical, and muscular recovery 12 months postinfection. Even so, it is necessary to carry out comprehensive follow-ups and assessments that include aspects of nutrition and physical activity.
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Affiliation(s)
- Almudena López-Sampalo
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), University of Málaga, Avda. Hospital Civil s/n, 29009 Málaga, Spain
| | - Lidia Cobos-Palacios
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), University of Málaga, Avda. Hospital Civil s/n, 29009 Málaga, Spain
| | - Alberto Vilches-Pérez
- Endocrinology and Nutrition Department, Virgen de la Victoria University Hospital, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29010 Málaga, Spain
| | - Jaime Sanz-Cánovas
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), University of Málaga, Avda. Hospital Civil s/n, 29009 Málaga, Spain
| | - Antonio Vargas-Candela
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), University of Málaga, Avda. Hospital Civil s/n, 29009 Málaga, Spain
| | - Juan José Mancebo-Sevilla
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), University of Málaga, Avda. Hospital Civil s/n, 29009 Málaga, Spain
| | - Halbert Hernández-Negrín
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), University of Málaga, Avda. Hospital Civil s/n, 29009 Málaga, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), University of Málaga, Avda. Hospital Civil s/n, 29009 Málaga, Spain
- Ciber Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.G.-H.); (M.R.B.-L.)
| | - María Rosa Bernal-López
- Internal Medicine Department, Regional University Hospital of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), University of Málaga, Avda. Hospital Civil s/n, 29009 Málaga, Spain
- Ciber Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.G.-H.); (M.R.B.-L.)
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145
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Low Dietary Variety Is Associated with Incident Frailty in Older Adults during the Coronavirus Disease 2019 Pandemic: A Prospective Cohort Study in Japan. Nutrients 2023; 15:nu15051145. [PMID: 36904144 PMCID: PMC10005648 DOI: 10.3390/nu15051145] [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: 01/27/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Stagnation of social activity due to the COVID-19 pandemic probably reduces motivation to maintain a healthy diet. It is important to report on the dietary changes observed in older adults during a period of restriction on outings and to clarify the relationship between dietary variety and frailty. This one-year follow-up study examined the association between frailty and dietary variety during the COVID-19 pandemic. METHODS Baseline and follow-up surveys were conducted in August 2020 and August 2021, respectively. The follow-up survey was distributed by mail to 1635 community-dwelling older adults aged ≥65 years. Of the 1235 respondents, 1008 respondents who were non-frail at baseline are included in this study. Dietary variety was examined using a dietary variety score developed for older adults. Frailty was assessed using a five-item frailty screening tool. The outcome was frailty incidence. RESULTS In our sample, 108 subjects developed frailty. A linear regression analysis revealed a significant association between dietary variety score and frailty score (β, -0.032; 95% CI, -0.064 to -0.001; p = 0.046). This association was also significant in Model 1, adjusted for sex and age, (β, -0.051; 95% CI, -0.083 to -0.019; p = 0.002) and in a multivariate analysis that added adjustments for living alone, smoking, alcohol use, BMI, and existing conditions to Model 1 (β, -0.045; 95% CI, -0.078 to -0.012; p = 0.015). CONCLUSIONS A low dietary variety score was associated with an increased frailty score during the COVID-19 pandemic. The restricted daily routine caused by the COVID-19 pandemic will probably continue to have a long-term effect in terms of reduced dietary variety. Thus, vulnerable populations, such as older adults, might require dietary support.
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146
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Yang G, Cao X, Yu J, Li X, Zhang L, Zhang J, Ma C, Zhang N, Lu Q, Wu C, Chen X, Hoogendijk EO, Gill TM, Liu Z. Association of childhood adversity with frailty and the mediating role of unhealthy lifestyle: Findings from the UK biobank. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.08.23285634. [PMID: 36798168 PMCID: PMC9934802 DOI: 10.1101/2023.02.08.23285634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Background Childhood adversity and lifestyle have been associated with frailty in later life, but not much is known about factors that may explain these associations. An unhealthy lifestyle may play an important role in the pathway from childhood adversity to frailty. Therefore, this study aims to investigate the association of childhood adversity with frailty, and the mediating role of unhealthy lifestyle in the association. Methods This lifespan analysis included 152914 adults aged 40-69 years old from the UK Biobank. We measured childhood adversity with five items: physical neglect, emotional neglect, sexual abuse, physical abuse, and emotional abuse through online mental health survey. Frailty was measured by the frailty index; an unhealthy lifestyle score (range: 0-5) was calculated based on unhealthy body mass index, smoking, drinking, physical inactivity, and unhealthy diet at the baseline survey. Multiple logistic regression and mediation analysis were performed. Results A total of 10078 participants (6.6%) were defined as having frailty. Participants with any childhood adversity had higher odds of frailty. For example, in the fully adjusted model, with a one-point increase in cumulative score of childhood adversity, the odds of frailty increased by 41% (Odds Ratio: 1.41; 95% Confidence Interval: 1.39, 1.44). Unhealthy lifestyle partially mediated the associations of childhood adversity with frailty (mediation proportion: 4.4%-7.0%). The mediation proportions were largest for physical (8.2%) and sexual (8.1%) abuse. Conclusions Among this large sample, childhood adversity was positively associated with frailty, and unhealthy lifestyle partially mediated the association. This newly identified pathway highlights the potential of lifestyle intervention strategies among those who experienced childhood adversity (in particular, physical and sexual abuse) to promote healthy aging.
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Affiliation(s)
- Gan Yang
- School of Public Health and Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Xingqi Cao
- School of Public Health and Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Jie Yu
- School of Public Health and Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Xueqin Li
- School of Public Health and Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Liming Zhang
- School of Public Health and Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Jingyun Zhang
- School of Public Health and Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Chao Ma
- School of Economics and Management, Southeast University, Nanjing 211189, Jiangsu, China
| | - Ning Zhang
- Department of Social Medicine School of Public Health and Center for Clinical Big Data and Analytics Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Qingyun Lu
- School of Public Health, Nantong University, Nantong 226007, JiangSu, China
| | - Chenkai Wu
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06520, United States of America
- Department of Economics, Yale University, New Haven, CT 06520, United States of America
| | - Emiel O. Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC – location VU University medical center, Amsterdam, the Netherlands
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, United States of America
| | - Zuyun Liu
- School of Public Health and Second Affiliated Hospital, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
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Kaskirbayeva D, West R, Jaafari H, King N, Howdon D, Shuweihdi F, Clegg A, Nikolova S. Progression of frailty as measured by a cumulative deficit index: A systematic review. Ageing Res Rev 2023; 84:101789. [PMID: 36396032 DOI: 10.1016/j.arr.2022.101789] [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: 03/29/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Frailty is a risk factor for adverse health outcomes. There is a paucity of literature on frailty progression defined by a cumulative deficit model among community dwelling older people. The objective of this review was to synthesise evidence on these changes in health and mortality among community-dwelling older people. METHODS Six databases (Medline, Embase, CINAHL, Cochrane, PsycInfo, Web of Science) and a clinical trials registry were searched in July 2021. The inclusion criteria were studies using a frailty index and providing information on transition between frailty states or to death in community-dwelling older people aged ≥ 50. Exclusion criteria were studies examining specific health conditions, conference abstracts and non-English studies. To standardise the follow-up period and facilitate comparison, we converted the transition probabilities to annual transition rates. RESULTS Two reviewers independently screened 5078 studies and 61 studies were included for analysis. Of these, only three used the same frailty state cut-points to facilitate cross-cohort comparison. This review found that frailty tends to increase with time, people who are frail at baseline have greater likelihood to progress in frailty and die, and the main factor that accelerates frailty progression is age. Other risk factors for progression are having chronic disease, smoking, obesity, low-income or/and low-education levels. A frailty index is an accurate predictor of adverse outcomes and death. DISCUSSION This systematic review demonstrated that worsening in frailty was a common frailty transition, and older people who are frail at baseline are more likely to die. A frailty index has significant power to predict adverse health outcomes. It is a useful tool for within-cohort comparison but there are challenges comparing different cohorts due to dependence of frailty progression on age and differences in how frailty index is defined and measured.
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Affiliation(s)
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hussain Jaafari
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Natalie King
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew Clegg
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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148
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Sun X, Liu W, Gao Y, Qin L, Feng H, Tan H, Chen Q, Peng L, Wu IXY. Comparative effectiveness of non-pharmacological interventions for frailty: a systematic review and network meta-analysis. Age Ageing 2023; 52:7028009. [PMID: 36746389 DOI: 10.1093/ageing/afad004] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Frailty endangers the health of older adults. Furthermore, the prevalence of frailty continues to increase as the global population ageing. OBJECTIVE To update evidence on the effectiveness of non-pharmacological interventions for frailty by conducting a network meta-analysis (NMA) of randomised controlled trials (RCTs). METHODS Eight databases were searched from January 1, 2000, until September 24, 2021. RCTs of interventions for frailty among participants aged ≥60 years were considered eligible. The primary outcome was frailty. Pairwise meta-analysis and NMA were performed, with the pooled standardised mean difference (SMD) and 95% confidence interval (CI) being reported. RESULTS A total of 69 RCTs were included after screening 16,058 retrieved citations. There were seven types of interventions (11 interventions) for frailty among the included RCTs. Physical activity (PA) (pooled SMD = 0.43, 95% CI: 0.34-0.51), multicomponent intervention (pooled SMD = 0.34, 95% CI: 0.23-0.45) and nutrition intervention (pooled SMD = 0.21, 95% CI: 0.06-0.35) were associated with reducing frailty compared to control, of which PA was the most effective type of intervention. In terms of specific types of PA, resistance training (pooled SMD = 0.58, 95% CI: 0.33-0.83), mind-body exercise (pooled SMD = 0.57, 95% CI: 0.24-0.90), mixed physical training (pooled SMD = 0.47, 95% CI: 0.37-0.57) and aerobic training (pooled SMD = 0.36, 95% CI: 0.09-0.62) were associated with a reduction in frailty compared to usual care. Resistance training was the most effective PA intervention. CONCLUSION Resistance training has the best potential to reduce frailty in older adults. This finding might be useful to clinicians in selecting interventions for older adults with frailty.
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Affiliation(s)
- Xuemei Sun
- Department of Epidemiology and Biostatistics, Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Wenqi Liu
- Department of Epidemiology and Biostatistics, Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Yinyan Gao
- Department of Epidemiology and Biostatistics, Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Lang Qin
- Department of Epidemiology and Biostatistics, Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Hui Feng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Hongzhuan Tan
- Department of Epidemiology and Biostatistics, Xiangya School of Public health, Central South University, Changsha, Hunan, China
| | - Qiong Chen
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Linlin Peng
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Irene X Y Wu
- Department of Epidemiology and Biostatistics, Xiangya School of Public health, Central South University, Changsha, Hunan, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China
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He D, Qiu Y, Yan M, Zhou T, Cheng Z, Li J, Wu Q, Liu Z, Zhu Y. Associations of metabolic heterogeneity of obesity with frailty progression: Results from two prospective cohorts. J Cachexia Sarcopenia Muscle 2023; 14:632-641. [PMID: 36575595 PMCID: PMC9891922 DOI: 10.1002/jcsm.13169] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Previous studies indicated that obesity would accelerate frailty progression. However, obesity is heterogeneous by different metabolic status. The associations of metabolic heterogeneity of obesity with frailty progression remain unclear. METHODS A total of 6730 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 4713 from the English Longitudinal Study of Ageing (ELSA) were included at baseline. Metabolic heterogeneity of obesity was evaluated based on four obesity and metabolic phenotypes as metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHOO), and metabolically unhealthy overweight/obesity (MUOO). Frailty status was assessed by the frailty index (FI) ranging from 0 to 100 and frailty was defined as FI ≥ 25. Linear mixed-effect models were used to analyse the associations of metabolic heterogeneity of obesity with frailty progression. RESULTS In the CHARLS, MUOO and MUNW presented the accelerated FI progression with additional annual increases of 0.284 (95% CI: 0.155 to 0.413, P < 0.001) and 0.169 (95% CI: 0.035 to 0.303, P = 0.013) as compared with MHNW. MHOO presented no accelerated FI progression (β: -0.011, 95% CI: -0.196 to 0.173, P = 0.904) as compared with MHNW. In the ELSA, the accelerated FI progression was marginally significant for MUOO (β: 0.103, 95% CI: -0.005 to 0.210, P = 0.061) and MUNW (β: 0.157, 95% CI: -0.011 to 0.324, P = 0.066), but not for MHOO (β: -0.047, 95% CI: -0.157 to 0.062, P = 0.396) in comparison with MHNW. The associations of MUOO and MUNW with the accelerated FI progression were stronger after excluding the baseline frail participants in both cohorts. The metabolic status changed over time. When compared with stable MHNW, participants who changed from MHNW to MUNW presented the accelerated FI progression with additional annual increases of 0.356 (95% CI: 0.113 to 0.599, P = 0.004) and 0.255 (95% CI: 0.033 to 0.477, P = 0.024) in the CHARLS and ELSA, respectively. The accelerated FI progression was also found in MHOO participants who transitioned to MUOO (CHARLS, β: 0.358, 95% CI: 0.053 to 0.663, P = 0.022; ELSA, β: 0.210, 95% CI: 0.049 to 0.370, P = 0.011). CONCLUSIONS Metabolically unhealthy overweight/obesity and normal weight, but not metabolically healthy overweight/obesity, accelerated frailty progression as compared with metabolically healthy normal weight. Regardless of obesity status, transitions from healthy metabolic status to unhealthy metabolic status accelerated frailty progression as compared with stable metabolically healthy normal weight. Our findings highlight the important role of metabolic status in frailty progression and recommend the stratified management of obesity based on metabolic status.
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Affiliation(s)
- Di He
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yiwen Qiu
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Mengsha Yan
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Tianjing Zhou
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Zongxue Cheng
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jun Li
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Qiong Wu
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Zuyun Liu
- Center for Clinical Big Data and Analytics, Second Affiliated Hospital and Department of Big Data in Health Science, School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Zhejiang, China
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China.,Cancer Center, Zhejiang University, Zhejiang, China
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Núñez-Cortés R, López-Bueno R, Torres-Castro R, Soto-Carmona C, Ortega-Palavecinos M, Pérez-Alenda S, Solis-Navarro L, Díaz-Cambronero Ó, Martinez-Arnau FM, Calatayud J. Risk Factors for One-Year Mortality in Hospitalized Adults with Severe COVID-19. Aging Dis 2023; 14:14-20. [PMID: 36818568 PMCID: PMC9937706 DOI: 10.14336/ad.2022.0424] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/24/2022] [Indexed: 11/18/2022] Open
Abstract
As the body's immunity declines with age, elderly-hospitalized patients due to COVID-19 might be at higher mortality risk. Therefore, the aim of this prospective study was to examine the possible risk factors (demographic, social or comorbidities) most associated with mortality one-year after diagnosis of COVID-19. Routine data were collected from a cohort of hospitalized adults with severe COVID-19. The primary endpoint was mortality at one-year after diagnosis of COVID-19. We used a Cox proportional hazard model to estimate the hazard ratios (HRs) for both all-cause and specific cardiorespiratory mortality. A fully adjusted model included sex, socioeconomic status, institutionalization status, disability, smoking habit, and comorbidities as confounders. A total of 368 severe cases hospitalized on average 67.3 ± 15.9 years old were included. Participants aged ≥ 71 years had significantly higher HRs for all-cause mortality (adjusted HRs = 2.86, 95%CI: 2.01-4.07) and cardiorespiratory mortality (adjusted HRs = 2.86, 95%CI: 1.99-4.12). The association between age and mortality after diagnosis of COVID-19 due to both all-causes and cardiorespiratory mortality showed a consistent dose-response fashion. Institutionalization, disability, and socioeconomic status also showed a significant association with mortality. In conclusion, aging itself was the most important risk factor associated with mortality one year after diagnosis of COVID-19. People with disabilities, institutionalized or low socioeconomic status are significantly more likely to die after COVID-19.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.,Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Hospital Clínico Dra. Eloisa Díaz de La Florida, Santiago, Chile.
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Spain.,National Research Centre for the Working Environment, Copenhagen, Denmark.
| | - Rodrigo Torres-Castro
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain.
| | | | | | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.
| | - Lilian Solis-Navarro
- Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Óscar Díaz-Cambronero
- Department Anesthesiology, Hospital Universitari i Politécnic la Fe, Valencia, Spain.,Perioperative Medicine Research Group. Biomedical Research Institute la Fe, Valencia, Spain.
| | - Francisco M. Martinez-Arnau
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.,Correspondence should be addressed to: Dr. Francisco M. Martinez-Arnau, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain. .
| | - Joaquín Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Spain.
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