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Sheshadri A, Elia JR. Physical Resilience in Older Patients Incident to Hemodialysis: Can Following Trajectories Improve Our Ability to Intervene on Functional Decline? Kidney Int Rep 2022; 7:1927-1929. [PMID: 36090497 PMCID: PMC9459025 DOI: 10.1016/j.ekir.2022.07.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anoop Sheshadri
- University of California San Francisco, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
- Kidney Health Research Collaborative, University of California, San Francisco, San Francisco, California, USA
- Correspondence: Anoop Sheshadri, Division of Nephrology, Department of Medicine, University of California, San Francisco San Francisco, California 94131-3204, USA.
| | - Jessica R. Elia
- University of California San Francisco, San Francisco, California, USA
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Mutz J, Choudhury U, Zhao J, Dregan A. Frailty in individuals with depression, bipolar disorder and anxiety disorders: longitudinal analyses of all-cause mortality. BMC Med 2022; 20:274. [PMID: 36038880 PMCID: PMC9425946 DOI: 10.1186/s12916-022-02474-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome that is strongly associated with mortality risk and an emerging global health burden. Mental disorders are associated with reduced life expectancy and elevated levels of frailty. In this study, we examined the mortality risk associated with frailty in individuals with a lifetime history of mental disorders compared to individuals without a history of mental disorders. METHODS The UK Biobank study recruited > 500,000 adults, aged 37-73, between 2006 and 2010. We derived the two most common albeit distinctive measures of frailty, the frailty phenotype and the frailty index. Individuals with lifetime depression, bipolar disorder or anxiety disorders were identified from multiple data sources. The primary outcome was all-cause mortality. We have also examined differences in frailty, separately by sex and age. RESULTS Analyses included up to 297,380 middle-aged and older adults with a median follow-up of 12.19 (interquartile range = 1.31) years, yielding 3,516,706 person-years of follow-up. We observed higher levels of frailty in individuals with mental disorders for both frailty measures. Standardised mean differences in the frailty index ranged from 0.66 (95% confidence interval [CI] 0.65-0.67) in individuals with anxiety disorders to 0.94 (95% CI 0.90-0.97) in individuals with bipolar disorder, compared to people without mental disorders. For key comparisons, individuals with a mental disorder had greater all-cause mortality hazards than the comparison group without mental disorders. The highest hazard ratio (3.65, 95% CI 2.40-5.54) was observed among individuals with bipolar disorder and frailty, relative to non-frail individuals without mental disorders. CONCLUSIONS Our findings highlight elevated levels of frailty across three common mental disorders. Frailty and mental disorders represent potentially modifiable targets for prevention and treatment to improve population health and life expectancy, especially where both conditions coexist.
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Affiliation(s)
- Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK.
| | - Umamah Choudhury
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK
| | - Jinlong Zhao
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandru Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Effect of the GERAS DANcing for Cognition and Exercise Program on Physical Function in Older Adults. J Aging Phys Act 2022; 31:182-190. [PMID: 35985648 DOI: 10.1123/japa.2021-0504] [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: 12/26/2021] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022]
Abstract
GERAS DANcing for Cognition and Exercise is a therapeutic dance program for older adults with cognitive or mobility impairments. Using a pre-/posttest study design, we investigated the effect of 12 weeks of dance on the short performance physical battery (SPPB). In 107 participants aged 61-93 (mean 76.1, SD = 7.0; 20% men), over 90% had multifrailty and/or cognitive impairment. The mean attendance rate was 18/24 classes (75%). A substantial minimal clinically important difference (>0.4) occurred for SPPB total (+0.53, SD = 2.04, p = .002) and chair stands (+0.45, SD = 0.92, p < .001). Individuals with baseline SPPB ≤8 points (n = 38)-indicative of sarcopenia and physical frailty-had the most marked improvement (SPPB total: +1.45, SD = 1.97, p < .001; balance: +0.65, SD = 1.27, p = .006; chair stands: +0.68, SD = 0.97, p < .001). GERAS DANcing for Cognition and Exercise may be a promising rehabilitation intervention to improve daily physical function.
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154
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Suikkanen S, Soukkio P, Kautiainen H, Kääriä S, Hupli MT, Sipilä S, Pitkälä K, Aartolahti E, Kukkonen-Harjula K. Changes in the Severity of Frailty Among Older Adults After 12 Months of Supervised Home-Based Physical Exercise: A Randomized Clinical Trial. J Am Med Dir Assoc 2022; 23:1717.e9-1717.e15. [PMID: 35985418 DOI: 10.1016/j.jamda.2022.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To investigate the effects of 12 months of physiotherapist-supervised, home-based physical exercise on the severity of frailty and on the prevalence of the 5 frailty phenotype criteria, using secondary analyses. DESIGN Randomized clinical trial, with 1:1 allocation into 12-month home-based physical exercise, or usual care. The multicomponent exercise sessions (60 minutes) were supervised by the physiotherapist and included strength, balance, functional, and flexibility exercises twice a week at participants' homes. SETTING AND PARTICIPANTS Home-dwelling older adults aged ≥65 years who were frail (meeting 3-5 criteria) or prefrail (1-2 criteria) according to frailty phenotype criteria. METHODS The severity of frailty (nonfrail, prefrail, or frail) was assessed using frailty phenotype criteria, and the prevalence of each frailty criterion (weight loss, low physical activity, exhaustion, weakness, and slowness) were assessed at baseline and at 12 months. RESULTS Two hundred ninety-nine persons were included in the analyses, of whom 184 were prefrail and 115 were frail at baseline. Their mean age was 82.5 (SD 6.3) years, and 75% were women. There was a significant difference between the exercise and usual care groups' transitions to different frailty states from baseline to 12 months among those who at baseline were prefrail (P = .032) and frail (P = .009). At 12 months, the mean number of frailty criteria had decreased in the exercise group (-0.27, 95% CI -0.47, -0.08) and remained unchanged in the usual care group (0.01, 95% CI -0.16, 0.18; P = .042). The prevalence of the exhaustion (P = .009) and the low physical activity (P < .001) criteria were lower at 12 months in the exercise group than in the usual care group. CONCLUSIONS AND IMPLICATIONS The severity of frailty can be reduced through 12-month supervised home-based exercise training. Exercise should be included in the care of older adults with signs of frailty.
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Affiliation(s)
- Sara Suikkanen
- Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Finland.
| | - Paula Soukkio
- Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Finland
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | | | - Markku T Hupli
- Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Sarianna Sipilä
- Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Kaisu Pitkälä
- Department of General Practice, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Eeva Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
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Carter B, Short R, Bouamra O, Parry F, Shipway D, Thompson J, Baxter M, Lecky F, Braude P. A national study of 23 major trauma centres to investigate the effect of frailty on clinical outcomes in older people admitted with serious injury in England (FiTR 1): a multicentre observational study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e540-e548. [PMID: 36102763 DOI: 10.1016/s2666-7568(22)00122-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Older people are the largest group admitted to hospital with serious injuries. Many older people are living with frailty, a risk factor for poor recovery. We aimed to examine the effect of preinjury frailty on outcomes. METHODS In this multicentre observational study (FiTR 1), we extracted prospectively collected data from all 23 adult major trauma centres in England on older people (aged ≥65 years) admitted with serious injuries over a 2·5 year period from the Trauma Audit and Research Network (TARN) database. Geriatricians assessed the preinjury Clinical Frailty Scale (CFS), a 9-point scale of fitness and frailty, with a score of 1 indicating a patient is very fit and a score of 9 indicating they are terminally ill. The primary outcome was inpatient mortality, with patients censored at hospital discharge. We used a multi-level Cox regression model fitted with adjusted hazards ratios (aHRs) to assess the association between CFS and mortality, with CFS scores being grouped as follows: a score of 1-2 indicated patients were fit; a score of 3 indicated patients were managing well; and a score of 4-8 indicated patients were living with frailty (4 being very mild, 5 being mild, 6 being moderate, and 7-8 being severe). FINDINGS Between March 31, 2019, and Oct 31, 2021, 193 156 patients had records were held by TARN, of whom 16 504 had eligible records. Median age was 81·9 years (IQR 74·7-88·0), 9200 (55·7%) were women, and 7304 (44·3%) were men. Of 16 438 patients with a CFS score of 1-8, 11 114 (67·6%) were living with frailty (CFS of 4-8). 1660 (10·1%) patients died during their hospital stay, with a median time from admission to death of 9 days (IQR 4-18). Compared in patients with a CFS score of 1-2, risk of inpatient death was increased in those managing well (CFS score of 3; aHR 1·82 [95% CI 1·39-2·40]), living with very mild frailty (CFS score of 4: 1·99 [1·51-2·62]), living with mild frailty (CFS score of 5: 2·61 [1·99-3·43]), living with moderate frailty (CFS score of 6: 2·97 [2·26-3·90]), and living with severe frailty (CFS score of 7-8: 4·03 [3·04-5·34]). INTERPRETATION Our findings support inclusion of the CFS in trauma pathways to aid patient management. Additionally, people who exercise regularly (CFS of 1-2) have better outcomes than those with lower activity levels (CFS of ≥3), supporting exercise as an intervention to improve trauma outcomes. FUNDING None.
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Affiliation(s)
- Ben Carter
- CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Roxanna Short
- CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Omar Bouamra
- The Trauma Audit and Research Network, The University of Manchester, Salford Royal - Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Frances Parry
- CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David Shipway
- CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Julian Thompson
- CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Severn Major Trauma Network, UK
| | - Mark Baxter
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fiona Lecky
- The Trauma Audit and Research Network, The University of Manchester, Salford Royal - Northern Care Alliance NHS Foundation Trust, Salford, UK; Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK; Emergency Department, Salford Royal Hospital, Salford, UK
| | - Philip Braude
- CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Southmead Hospital, Bristol, UK; Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK.
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156
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Teh R, Barnett D, Edlin R, Kerse N, Waters DL, Hale L, Tay E, Leilua E, Pillai A. Effectiveness of a complex intervention of group-based nutrition and physical activity to prevent frailty in pre-frail older adults (SUPER): a randomised controlled trial. THE LANCET. HEALTHY LONGEVITY 2022; 3:e519-e530. [PMID: 36102762 DOI: 10.1016/s2666-7568(22)00124-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The increasing prevalence of frailty with age is becoming a public health priority in countries with ageing populations. Pre-frailty presents a window of opportunity to prevent the development of frailty in community-dwelling older adults. This study aimed to examine the effectiveness of a complex intervention that combined a nutrition-based intervention and a physical activity intervention, along with the effectiveness of each intervention individually, to reduce physical frailty in pre-frail older adults over 2 years. METHODS In this single-blind, 2 x 2 factorial, randomised, controlled trial, we recruited pre-frail community-dwelling older adults in Aotearoa New Zealand via mail through general medical practices. To be eligible, participants had to be pre-frail according to self-reported FRAIL scores of 1 or 2, aged 75 years or older (or 60 years or older for Māori and Pacific Peoples), not terminally ill or with advanced dementia as judged by a general practitioner, able to stand, medically safe to participate in low-intensity exercise, and able to use kitchen utensils safely. Participants were randomly allocated to receive an 8-week Senior Chef programme (SC group), a 10-week Steady As You Go programme (SAYGO group), a 10-week combined SC and SAYGO intervention (combined group), or a 10-week social programme (control group), using computer-generated block randomisation administered through an electronic data capture system by local study coordinators. Assessors were masked to group allocation for all assessments. SC is a group-based nutrition education and cooking class programme (3 h weekly), SAYGO is a group-based strength and balance exercise programme (1 h weekly), and the social control programme was a seated, group socialising activity (once a week). Masked assessors ascertained Fried frailty scores at baseline, end of intervention, and at 6, 12, and 24 months after the programme. The primary outcome was change in Fried frailty score at 2 years. Intention-to-treat analyses were completed for all randomised participants, and all participants who had a high (≥75%) adherence were analysed per protocol. This study is registered at ANZCTR, ACTRN12614000827639. FINDINGS Between May 12, 2016 and April 9, 2018, we assessed 2678 older adults for eligibility, of whom 468 (17%) consented and completed baseline assessment, with a mean age of 80·3 years (SD 5·1) and a mean Fried score of 1·9 (1·2); 59% were women. We randomly allocated these participants into the four groups: 117 in the SC group, 118 in the SAYGO group, 118 in the combined group, and 115 in the control group; 318 participants attended the 24-month follow-up: 89 in the SC group, 78 in the SAYGO group, 73 in the combined group, and 78 in the control group. At the 24-month follow-up, there were no differences in mean Fried scores between the intervention groups and the control group. No adverse events were reported. INTERPRETATION The study did not find that the combined SC and SAYGO programme was effective in reducing frailty in pre-frail older adults. Although some short-term benefits were observed in each individual programme, there was no clear evidence of long-term impact. Further research is needed to evaluate combinations of group-based programmes for community-dwelling older adults to optimise their physical function. FUNDING Health Research Council New Zealand and Ageing Well Challenge (Ministry of Business Innovation and Employment).
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Affiliation(s)
- Ruth Teh
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
| | - Daniel Barnett
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Richard Edlin
- Department of Health Systems, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Debra L Waters
- Department of Medicine, University of Otago, Otago, New Zealand; School of Physiotherapy, University of Otago, Otago, New Zealand
| | - Leigh Hale
- School of Physiotherapy, University of Otago, Otago, New Zealand
| | - Esther Tay
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Evelingi Leilua
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Avinesh Pillai
- Department of Statistics, University of Auckland, Auckland, New Zealand
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Biomarkers of Frailty: miRNAs as Common Signatures of Impairment in Cognitive and Physical Domains. BIOLOGY 2022; 11:biology11081151. [PMID: 36009778 PMCID: PMC9405439 DOI: 10.3390/biology11081151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
The past years have seen an increasing concern about frailty, owing to the growing number of elderly people and the major impact of this syndrome on health and social care. The identification of frail people passes through the use of different tests and biomarkers, whose concerted analysis helps to stratify the populations of patients according to their risk profile. However, their efficiency in prognosis and their capability to reflect the multisystemic impairment of frailty is discussed. Recent works propose the use of miRNAs as biological hallmarks of physiological impairment in different organismal districts. Changes in miRNAs expression have been described in biological processes associated with phenotypic outcomes of frailty, opening intriguing possibilities for their use as biomarkers of fragility. Here, with the aim of finding reliable biomarkers of frailty, while considering its complex nature, we revised the current literature on the field, for uncovering miRNAs shared across physical and cognitive frailty domains. By applying in silico analyses, we retrieved the top-ranked shared miRNAs and their targets, finally prioritizing the most significant ones. From this analysis, ten miRNAs emerged which converge into two main biological processes: inflammation and energy homeostasis. Such markers, if validated, may offer promising capabilities for early diagnosis of frailty in the elderly population.
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158
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Kim JY, Kim NY, Jung HW, Yim JJ, Kwak N. Old age is associated with worse treatment outcome and frequent adverse drug reaction in Mycobacterium avium complex pulmonary disease. BMC Pulm Med 2022; 22:269. [PMID: 35836160 PMCID: PMC9284708 DOI: 10.1186/s12890-022-02063-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/07/2022] [Indexed: 12/20/2022] Open
Abstract
Background The number of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is rapidly increasing globally, especially in the older population. However, there is a dearth of evidence regarding the impact of aging on the treatment outcomes of NTM-PD.
Methods We analyzed consecutive patients who satisfied the diagnostic criteria for Mycobacterium avium complex (MAC)-PD and received antibiotic treatment between January 2009 and December 2020 at a tertiary referral hospital in Korea. The main outcomes were (1) long-term treatment success, defined by negative culture conversion for more than 12 months; and (2) adverse drug reactions (ADRs). Multivariable logistic regression model was used to evaluate the association between age and main outcomes.
Results A total of 614 patients (median age, 65 years, interquartile range [IQR] 57–73 years; men, 35.3%) were included. Median treatment duration (530 days, IQR 290–678 days; P for trend < 0.001) and long-term treatment success (P for trend = 0.026) decreased, whereas ADRs (P for trend < 0.001) increased significantly with age. Multivariable analyses demonstrated that age ≥ 80 years was an independent factor associated with ADRs (adjusted odds ratio [aOR] 3.29; 95% confidence interval [CI] 1.05–10.28) and worse treatment outcome (aOR 0.42; 95% CI 0.19–0.91). Conclusions Aging is associated with worse treatment outcome and frequent ADRs of patients with MAC-PD. Individualized treatment with reduced-intensity may be a reasonable alternative for older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02063-2.
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Affiliation(s)
- Joong-Yub Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Na Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Cong T, Hall AJ, Jia Z, Christiano A, Elsevier HCK, Cheung ZB, Wellman D, Forsh D, Lane JM. Conceptualizing Biological Aging and Frailty in Orthopaedics: A Framework for Clinical Practice. J Bone Joint Surg Am 2022; 104:1212-1222. [PMID: 35275895 DOI: 10.2106/jbjs.21.01053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Biological aging can best be conceptualized clinically as a combination of 3 components: frailty, comorbidity, and disability. ➤ Despite advancements in the understanding of senescence, chronological age remains the best estimate of biological age. However, a useful exercise for practitioners is to look beyond chronological age in clinical and surgical decision-making. ➤ A chronologically aging person does not age biologically at the same rate. ➤ The best way to understand frailty is to consider it as a physical phenotype. ➤ Physical optimization should parallel medical optimization before elective surgery. ➤ The poorer the host (both in terms of bone quality and propensity for healing), the more robust the implant construct must be to minimize reliance on host biology.
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Affiliation(s)
- Ting Cong
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
| | - Arielle J Hall
- Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anthony Christiano
- Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Hannah C K Elsevier
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Zoe B Cheung
- Department of Orthopaedic Surgery, University of California Davis, Davis, California
| | - David Wellman
- Department of Orthopaedic Surgery, Westchester Medical Center, Westchester, New York
| | - David Forsh
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
| | - Joseph M Lane
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Jung HW, Baek JY, Kwon YH, Jang IY, Kim DY, Kwon HS, Lee SH, Oh HJ, Lee E, Koh Y. At-Point Clinical Frailty Scale as a Universal Risk Tool for Older Inpatients in Acute Hospital: A Cohort Study. Front Med (Lausanne) 2022; 9:929555. [PMID: 35879923 PMCID: PMC9307996 DOI: 10.3389/fmed.2022.929555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background While the Clinical Frailty Scale (CFS) has been extensively validated for predicting health outcomes in older adults, the role of the at-point CFS at the time of examination is unclear. We aimed to examine the ability of the at-point CFS for predicting clinical outcomes of older inpatients. Methods As a single-center and prospective cohort study, we enrolled 1,016 older adults who were 65 years or older and were admitted to one of 9 medical or surgical units from May 2021 to September 2021. The associations of the at-point CFS with outcomes of falls, delirium, pressure ulcers, 30-day unplanned readmission and/or emergency department (ED) visits, institutionalization, and a composite outcome were analyzed. Results In the study population (n = 1,016), 26 patients had incident pressure ulcers, 6 patients had falls, 50 patients experienced delirium, and 13 patients died during hospitalization. Also, 37 patients experienced an ED visit and 22 patients had an unplanned readmission within 30 days after discharge. The composite outcome was 1.7% among patients with the CFS < 5 and 28.5% among patients with the CFS ≥ 5. The higher CFS was associated with an increased risk of a fall [odds ratio (OR) 1.74 (1.01–3.01)], pressure ulcers [OR 3.02 (2.15–4.23)], delirium [OR 2.72 (2.13–3.46)], 30-day readmission [OR 1.94 (1.44–2.62)], ED visit [OR 1.81 (1.47–2.23)], death [OR 3.27 (2.02–5.29)], and institutionalization after discharge [OR 1.88 (1.62–2.18)]. Conclusion The at-point CFS assessed in older inpatients can screen high-risk individuals who might experience adverse geriatric conditions and in-hospital outcomes.
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Affiliation(s)
- Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Hee-Won Jung
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young hye Kwon
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyouk-Soo Kwon
- Department of Internal Medicine, Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun hee Lee
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Hyun jin Oh
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Health Screening and Promotion Center, Asan Medical Center, Seoul, South Korea
- Younsuck Koh
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Cohen AA, Ferrucci L, Fülöp T, Gravel D, Hao N, Kriete A, Levine ME, Lipsitz LA, Olde Rikkert MGM, Rutenberg A, Stroustrup N, Varadhan R. A complex systems approach to aging biology. NATURE AGING 2022; 2:580-591. [PMID: 37117782 DOI: 10.1038/s43587-022-00252-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/08/2022] [Indexed: 04/30/2023]
Abstract
Having made substantial progress understanding molecules, cells, genes and pathways, aging biology research is now moving toward integration of these parts, attempting to understand how their joint dynamics may contribute to aging. Such a shift of perspective requires the adoption of a formal complex systems framework, a transition being facilitated by large-scale data collection and new analytical tools. Here, we provide a theoretical framework to orient researchers around key concepts for this transition, notably emergence, interaction networks and resilience. Drawing on evolutionary theory, network theory and principles of homeostasis, we propose that organismal function is accomplished by the integration of regulatory mechanisms at multiple hierarchical scales, and that the disruption of this ensemble causes the phenotypic and functional manifestations of aging. We present key examples at scales ranging from sub-organismal biology to clinical geriatrics, outlining how this approach can potentially enrich our understanding of aging.
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Affiliation(s)
- Alan A Cohen
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada.
- Research Center on Aging and Research Center of Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
- Butler Columbia Aging Center and Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Luigi Ferrucci
- Intramural Research Program of the National Institute on Aging, Baltimore, MD, USA
| | - Tamàs Fülöp
- Research Center on Aging and Research Center of Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Geriatric Division, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dominique Gravel
- Department of Biology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nan Hao
- Section of Molecular Biology, Division of Biological Sciences, University of California, San Diego, San Diego, CA, USA
| | - Andres Kriete
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Morgan E Levine
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center, Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, and Harvard Medical School, Boston, MA, USA
| | | | - Andrew Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicholas Stroustrup
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Ravi Varadhan
- Department of Oncology, Quantitative Sciences Division, Johns Hopkins University, Baltimore, MD, USA
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Diniz BS, Lima-Costa MF, Peixoto SV, Firmino JO, Torres KC, Martins-Filho OA, Teixeira-Carvalho A, Grady J, Kuchel GA, Castro-Costa E. Cognitive Frailty is Associated With Elevated Proinflammatory Markers and a Higher Risk of Mortality. Am J Geriatr Psychiatry 2022; 30:825-833. [PMID: 35227616 PMCID: PMC9177532 DOI: 10.1016/j.jagp.2022.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive impairment and physical frailty are common among older adults and associated with a higher likelihood of adverse health outcomes. These two conditions frequently coexist in the same individual as cognitive frailty, yet few studies have examined the impact of such comorbidity on clinical outcomes or underlying biological mechanisms. METHODS A total of 1,340 older adults (age ≥60 years old) from the Bambui Cohort Study of Ageing, with a total follow-up of 10 years, were included in this study. Frailty was defined by the accumulation of deficit framework and cognitive impairment based on scores on the MMSE less than 22. In addition, serum IL-6 levels were measured by cytometric bead array assay. RESULTS Individuals classified with cognitive frailty had significantly higher serum IL-6 levels compared to the robust, cognitively unimpaired group. Those with cognitive frailty (aOR = 1.97 [1.18-3.27] and prefrailty and cognitive impairment (aOR = 1.83 [1.24-2.69]) had the highest mortality risk over 10 years of follow-up. Higher IL-6 levels were also independently associated with a higher mortality rate (aOR = 1.37 [1.23-1.54]). CONCLUSION Our study shows that cognitive Frailty indicates a vulnerability state and of increasing mortality risk. Our findings also suggested that proinflammatory abnormalities can be viewed as a central phenomenon underlying common age-related problems (e.g., cognitive impairment and Frailty) and outcomes (e.g., mortality).
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Affiliation(s)
- Breno S. Diniz
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT,Department of Psychiatry, School of Medicine, University of Connecticut Health
| | | | - Sérgio Viana Peixoto
- Center for Studies in Public Health and Aging (NESPE), Rene Rachou Research,Nursing School, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | | | - Karen C.L. Torres
- Integrated Research Group on Biomarkers, Rene Rachou Research Center, Oswaldo,Faculty of Medicine, University José do Rosário Vellano, UNIFENAS, Belo Horizonte, MG Brazil
| | | | | | - James Grady
- Department of Public Health Sciences, School of Medicine, University of Connecticut Health Center, Farmington, CT USA
| | - George A. Kuchel
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT
| | - Erico Castro-Costa
- Center for Studies in Public Health and Aging (NESPE), Rene Rachou Research
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163
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164
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Jung HW, Baek JY, Jang IY, Lee E. Operationalization of the Clinical Frailty Scale in Korean Community-Dwelling Older People. Front Med (Lausanne) 2022; 9:880511. [PMID: 35755053 PMCID: PMC9226398 DOI: 10.3389/fmed.2022.880511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background The Clinical Frailty Scale (CFS) is a simple measure of global fitness validated in various populations in real-world settings. In this study, we aimed to assess the characteristics and validities of the CFS in community-dwelling older people in Korea, with the original classification tree (oCFS) and a culturally modified tree (mCFS). Methods The comprehensive geriatric assessment records of 1,064 individuals of the Aging Study of the Pyeongchang Rural Area were used for this study. For mCFS, we considered the dependency of the food preparations and household chores not to be deficits in the male population. The frailty index was used as a reference for construct validity. We used a composite outcome of death and institutionalization for outcome validity. Results The correlation coefficients with frailty index were higher in mCFS (.535) than in oCFS (.468). The mean frailty index was lower in individuals reclassified by mCFS (5 to 4) than people who stayed in mCFS 5. The classification coefficient of mCFS was significantly higher than that of oCFS (p <0.001) in determining people with frailty (frailty index.25 or higher). Trends of a higher incidence of the composite outcome were observed in both higher oCFS and mCFS, in which oCFS and mCFS did not differ significantly in predicting the risk of the outcome. Conclusion The classification tree of CFS could be culturally adopted in a community-dwelling population of Korea and considered valid in detecting the vulnerable population.
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Affiliation(s)
- Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Cohen AA, Leung DL, Legault V, Gravel D, Blanchet FG, Côté AM, Fülöp T, Lee J, Dufour F, Liu M, Nakazato Y. Synchrony of biomarker variability indicates a critical transition: Application to mortality prediction in hemodialysis. iScience 2022; 25:104385. [PMID: 35620427 PMCID: PMC9127602 DOI: 10.1016/j.isci.2022.104385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
Critical transition theory suggests that complex systems should experience increased temporal variability just before abrupt state changes. We tested this hypothesis in 763 patients on long-term hemodialysis, using 11 biomarkers collected every two weeks and all-cause mortality as a proxy for critical transitions. We find that variability-measured by coefficients of variation (CVs)-increases before death for all 11 clinical biomarkers, and is strikingly synchronized across all biomarkers: the first axis of a principal component analysis on all CVs explains 49% of the variance. This axis then generates powerful predictions of mortality (HR95 = 9.7, p < 0.0001, where HR95 is a scale-invariant metric of hazard ratio; AUC up to 0.82) and starts to increase markedly ∼3 months prior to death. Our results provide an early warning sign of physiological collapse and, more broadly, a quantification of joint system dynamics that opens questions of how system modularity may break down before critical transitions.
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Affiliation(s)
- Alan A. Cohen
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
- Research Center on Aging, Sherbrooke, Quebec J1H 4C4, Canada
- Research Center of Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Diana L. Leung
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Véronique Legault
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Dominique Gravel
- Département de Biologie, Université de Sherbrooke, Sherbrooke, Quebec J1K 2R1, Canada
| | - F. Guillaume Blanchet
- Research Center on Aging, Sherbrooke, Quebec J1H 4C4, Canada
- Département de Biologie, Université de Sherbrooke, Sherbrooke, Quebec J1K 2R1, Canada
- Département de mathématique, Université de Sherbrooke, Sherbrooke, Québec J1K 2R1, Canada
- Département des Sciences de la Santé Communautaires, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Anne-Marie Côté
- Department of Medicine, Nephrology Division, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Tamàs Fülöp
- Research Center on Aging, Sherbrooke, Quebec J1H 4C4, Canada
- Department of Medicine, Geriatric Division, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Juhong Lee
- InfoCentre, Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Frédérik Dufour
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
- Département de Biologie, Université de Sherbrooke, Sherbrooke, Quebec J1K 2R1, Canada
| | - Mingxin Liu
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Yuichi Nakazato
- Division of Nephrology, Hakuyukai Medical Corporation, Yuai Nisshin Clinic, 2-1914-6 Nisshin-cho, Kita-ku, Saitama-City, Saitama 331-0823, Japan
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Assessment of Physical Fitness and Risk Factors for the Occurrence of the Frailty Syndrome among Social Welfare Homes' Residents over 60 Years of Age in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127449. [PMID: 35742694 PMCID: PMC9223572 DOI: 10.3390/ijerph19127449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022]
Abstract
The study aimed at assessing physical fitness and occurrence of the frailty syndrome among social welfare homes’ residents as well as defining factors which determine the level of frailty and its occurrence. The examination included 198 residents (115 females and 83 males of average age 75.5 ± 10.21) and was carried out with the use of the Short Physical Performance Battery (SPPB) test with the following cut-off points: 0−6—frail, 7−9—pre-frail, 10−12—non-frail. The research additionally collected data regarding age, gender, number of chronic diseases, education level, type of prior work and current physical activity. In addition, the height and weight of the respondents were measured. The frailty syndrome was found in more than a half of the examinees (104; 52.53%), the pre-frailty state in 30.30% (n = 60) and 17.17% (n = 34) were non-frail. The average result of the SPPB test was 6.52 ± 2.73, which proves a moderate limitation of the sample group’s fitness. No significant differences were noted between female and male respondents (p = 0.27). The multifactorial linear regression model showed that independent and direct frailty syndrome predicators included age, number of chronic diseases and regular physical activity (p < 0.05). In conclusion, promoting and encouraging regular, age and interest-related forms of physical activity among seniors might foster the maintenance of their physiological reservoir and functional efficiency.
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167
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Melchiorre MG, D’Amen B, Quattrini S, Lamura G, Socci M. Caring for Frail Older People Living Alone in Italy: Future Housing Solutions and Responsibilities of Family and Public Services, a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127413. [PMID: 35742664 PMCID: PMC9223601 DOI: 10.3390/ijerph19127413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/20/2022]
Abstract
When frail older people age alone in place, with increasing functional limitations, they require support in performing daily living activities. In this respect, it is important to assess their preferences in terms of future housing solutions, and their opinions/orientations on the care responsibilities of both family and public services. The present study aimed to explore these aspects in Italy. Qualitative interviews were carried out in 2019 within the “Inclusive ageing in place” (IN-AGE) research project, involving 120 frail older people who lived at home in three Italian regions (Lombardy, Marche, and Calabria). A content analysis was conducted, and some quantifications of interviewees’ statements were provided. The results revealed that the majority of seniors prefer ageing at home, at least with a personal care assistant (PCA), whereas moving to a nursing home is typically deemed as a last option. Moreover, they considered the family to be primarily responsible for taking care of them, even with the support of public services. In addition, some territorial differences emerged. Strengthening an integrated model of long-term care (LTC) for older people, where both formal and informal supports allow frail older people to age at home, seems thus a good overall policy solution to pursue, with interventions based also on the needs and preferences of both seniors and their respective families.
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168
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Frailty in rodents: Models, underlying mechanisms, and management. Ageing Res Rev 2022; 79:101659. [PMID: 35660004 DOI: 10.1016/j.arr.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/24/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022]
Abstract
Frailty is a clinical geriatric syndrome characterized by decreased multisystem function and increased vulnerability to adverse outcomes. Although numerous studies have been conducted on frailty, the underlying mechanisms and management strategies remain unclear. As rodents share homology with humans, they are used extensively as animal models to study human diseases. Rodent frailty models can be classified broadly into the genetic modification and non-genetic modification models, the latter of which include frailty assessment models (based on the Fried frailty phenotype and frailty index methods) and induced frailty models. Such models were developed for use in investigating frailty-related physiological changes at the gene, cellular, molecular, and system levels, including the organ system level. Furthermore, exercise, diet, and medication interventions, in addition to their combinations, could improve frailty status in rodents. Rodent frailty models provide novel and effective tools for frailty research. In the present paper, we review research progress in rodent frailty models, mechanisms, and management, which could facilitate and guide further clinical research on frailty in older adults.
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169
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Picard M. Why Do We Care More About Disease than Health? PHENOMICS (CHAM, SWITZERLAND) 2022; 2:145-155. [PMID: 36939781 PMCID: PMC9590501 DOI: 10.1007/s43657-021-00037-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 04/30/2023]
Abstract
Modern Western biomedical research and clinical practice are primarily focused on disease. This disease-centric approach has yielded an impressive amount of knowledge around what goes wrong in illness. However, in comparison, researchers and physicians know little about health. What is health? How do we quantify it? And how do we improve it? We currently do not have good answers to these questions. Our lack of fundamental knowledge about health is partly driven by three main factors: (i) a lack of understanding of the dynamic processes that cause variations in health/disease states over time, (ii) an excessive focus on genes, and (iii) a pervasive psychological bias towards additive solutions. Here I briefly discuss potential reasons why scientists and funders have generally adopted a gene- and disease-centric framework, how medicine has ended up practicing "diseasecare" rather than healthcare, and present cursory evidence that points towards an alternative energetic view of health. Understanding the basis of human health with a similar degree of precision that has been deployed towards mapping disease processes could bring us to a point where we can actively support and promote human health across the lifespan, before disease shows up on a scan or in bloodwork.
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Affiliation(s)
- Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Irving Medical Center, New York, NY 10032 USA
- Department of Neurology, Merritt Center, Columbia Translational Neuroscience Initiative, Columbia University Irving Medical Center, New York, NY 10032 USA
- New York State Psychiatric Institute, New York, NY 10032 USA
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170
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Hladek MD, Zhu J, Crews DC, McAdams-DeMarco MA, Buta B, Varadhan R, Shafi T, Walston JD, Bandeen-Roche K. Physical Resilience Phenotype Trajectories in Incident Hemodialysis: Characterization and Mortality Risk Assessment. Kidney Int Rep 2022; 7:2006-2015. [PMID: 36090502 PMCID: PMC9459128 DOI: 10.1016/j.ekir.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/13/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction Methods Results Conclusion
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171
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Struijk EA, Fung TT, Rodríguez-Artalejo F, Bischoff-Ferrari HA, Hu FB, Willett WC, Lopez-Garcia E. Protein intake and risk of frailty among older women in the Nurses' Health Study. J Cachexia Sarcopenia Muscle 2022; 13:1752-1761. [PMID: 35318829 PMCID: PMC9178161 DOI: 10.1002/jcsm.12972] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/21/2022] [Accepted: 02/15/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is evidence that an overall healthy diet is associated with lower risk of frailty. However, the effect of diet composition, specifically the role of protein intake on frailty, is mostly unclear. The aim of this study was to evaluate the intake of protein, including total, plant, animal, and dairy protein, in relation to frailty incidence in a large cohort of older women. METHODS We analysed data from 85 871 women aged ≥60 participating in the Nurses' Health Study. Intake of protein was measured nine times during follow-up from 1980 until 2010. Frailty was defined as having at least three of the following five criteria from the Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale: fatigue, low strength, reduced aerobic capacity, having ≥5 illnesses, and weight loss of ≥5%. The occurrence of frailty was assessed every 4 years from 1992 up to 2014. RESULTS During follow-up, we identified 13 279 incident cases of frailty. Women with a higher intake of plant protein had a lower risk of developing frailty after adjustment for all relevant confounders [relative risks across quintiles of consumption: 1.00, 0.94, 0.89, 0.86, and 0.86; P-trend < 0.001]. In contrast, those with a higher intake of animal protein intake had a higher risk of frailty [relative risks across quintiles of consumption: 1.00, 0.98, 0.99, 1.00, and 1.07; P-trend 0.04]. The intake of total and dairy protein showed no significant association with frailty in the full model. Substituting 5% of energy from plant protein intake at the expense of animal protein, dairy protein, or non-dairy animal protein was associated with 38% (29%, 47%), 32% (21%, 42%), and 42% (33%, 50%) reduced risk of frailty. CONCLUSIONS A higher intake of plant protein, but not animal or dairy protein, was associated with a lower risk of frailty. Substitution of plant protein for animal protein, especially non-dairy animal protein, was associated with lower risk of frailty.
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Affiliation(s)
- Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA/Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Heike A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Centre on Aging and Mobility, University Hospital Zurich and Waid City Hospital, Zurich, Switzerland
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA/Food Institute, CEI UAM+CSIC, Madrid, Spain
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172
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Ekramzadeh M, Santoro D, Kopple JD. The Effect of Nutrition and Exercise on Body Composition, Exercise Capacity, and Physical Functioning in Advanced CKD Patients. Nutrients 2022; 14:nu14102129. [PMID: 35631270 PMCID: PMC9143955 DOI: 10.3390/nu14102129] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with stages 4 and 5 chronic kidney disease (CKD), and particularly chronic dialysis patients, commonly are found to have substantially reduced daily physical activity in comparison to age- and sex-matched normal adults. This reduction in physical activity is associated with a major decrease in physical exercise capacity and physical performance. The CKD patients are often physically deconditioned, and protein energy wasting (PEW) and frailty are commonly present. These disorders are of major concern because physical dysfunction, muscle atrophy, and reduced muscle strength are associated with poor quality of life and increased morbidity and mortality in CKD and chronic dialysis patients. Many randomized controlled clinical trials indicate that when CKD and chronic dialysis are provided nutritional supplements or undergo exercise training their skeletal muscle mass and exercise capacity often increase. It is not known whether the rise in skeletal muscle mass and exercise capacity associated with nutritional support or exercise training will reduce morbidity or mortality rates. A limitation of these clinical trials is that the sample sizes of the different treatment groups were small. The aim of this review is to discuss the effects of nutrition and exercise on body composition, exercise capacity, and physical functioning in advanced CKD patients.
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Affiliation(s)
- Maryam Ekramzadeh
- Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran;
- Division of Nephrology and Hypertension, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, Nephrology and Dialysis, University of Messina, 98100 Messina, Italy;
| | - Joel D. Kopple
- Division of Nephrology and Hypertension, Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- David Geffen School of Medicine, University of California, Los Angeles UCLA, Los Angeles, CA 90095, USA
- Fielding School of Public Health, University of California, Los Angeles UCLA, Los Angeles, CA 90095, USA
- Correspondence: ; Tel.: +1-310-968-5668
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Brown PJ, Ciarleglio A, Roose SP, Montes Garcia C, Chung S, Fernandes S, Rutherford BR. Frailty and Depression in Late Life: A High-Risk Comorbidity With Distinctive Clinical Presentation and Poor Antidepressant Response. J Gerontol A Biol Sci Med Sci 2022; 77:1055-1062. [PMID: 34758065 PMCID: PMC9071391 DOI: 10.1093/gerona/glab338] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To investigate the longitudinal relationship between physical frailty, the clinical representation of accelerated biological aging, and antidepressant medication response in older adults with depressive illness. METHODS An 8-week randomized placebo-controlled trial (escitalopram or duloxetine) followed by 10 months of open antidepressant medication treatment (augmentation, switch strategies) was conducted in an outpatient research clinic. 121 adults aged 60 years or older with major depressive disorder (MDD) or persistent depressive disorder and a 24-item Hamilton Rating Scale for Depression (HRSD) ≥16 were enrolled. Primary measures assessed serially over 12 months include response (50% reduction from baseline HRSD score), remission (HRSD score <10), and frailty (non/intermediate frail [0-2 deficits] vs frail [≥3 deficits]); latent class analysis was used to classify longitudinal frailty trajectories. RESULTS A 2-class model best fit the data, identifying a consistently low frailty risk (63% of the sample) and consistently high frailty risk (37% of the sample) trajectory. Response and remission rates (ps ≤ .002) for adults in the high-risk frailty class were at least 21 percentage points worse than those in the low-risk class over 12 months. Furthermore, subsequent frailty was associated with previous frailty (ps ≤ .01) but not previous response or remission (ps ≥ .10). CONCLUSIONS Antidepressant medication is poorly effective for MDD occurring in the context of frailty in older adults. Furthermore, even when an antidepressant response is achieved, this response does little to improve their frailty. These data suggest that standard psychiatric assessment of depressed older adults should include frailty measures and that novel therapeutic strategies to address comorbid frailty and depression are needed.
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Affiliation(s)
- Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Adam Ciarleglio
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Carolina Montes Garcia
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Sarah Chung
- Albert Einstein College of Medicine, New York, New York, USA
| | - Sara Fernandes
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
| | - Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York, USA
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174
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Picca A, Calvani R, Marzetti E. Multisystem derangements in frailty and sarcopenia: a source for biomarker discovery. Curr Opin Clin Nutr Metab Care 2022; 25:173-177. [PMID: 35238804 DOI: 10.1097/mco.0000000000000828] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Multisystem derangements, encompassing metabolic, musculoskeletal and stress-response systems, occur during aging and are associated with the development of physical frailty and sarcopenia. These modular changes are relevant sources for the identification of biomarkers for the two conditions. Here, we provide an up-to-date overview on existing biomarkers of physical frailty and sarcopenia and discuss emerging approaches for biomarker discovery. RECENT FINDINGS Inflammatory, metabolic and hematologic markers are shared between physical frailty and sarcopenia. Gut microbial derivatives and damage-associated molecular patterns transferred via extracellular vesicles have been indicated as possible gut-muscle axis regulators and candidate markers of physical frailty and sarcopenia. SUMMARY Mediators of metabolic, musculoskeletal and stress-response system dysregulation are shared by physical frailty and sarcopenia and indicate the existence of common pathophysiological pathways. Multiplatform biomarker analyses have been proposed as an innovating approach for tracking the multifaceted and dynamic nature of physical frailty and sarcopenia. Upon validation, the identified biomarkers may support diagnostic makeup and tracking of the two conditions in both research and clinical settings.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS
| | | | - Emanuele Marzetti
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS
- Università Cattolica del Sacro Cuore, Department of Geriatrics and Orthopedics, Rome, Italy
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175
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Perazza LR, Brown-Borg HM, Thompson LV. Physiological Systems in Promoting Frailty. Compr Physiol 2022; 12:3575-3620. [PMID: 35578945 DOI: 10.1002/cphy.c210034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.
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Affiliation(s)
- Laís R Perazza
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Holly M Brown-Borg
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - LaDora V Thompson
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
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176
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McKenzie BA, Chen FL, Gruen ME, Olby NJ. Canine Geriatric Syndrome: A Framework for Advancing Research in Veterinary Geroscience. Front Vet Sci 2022; 9:853743. [PMID: 35529834 PMCID: PMC9069128 DOI: 10.3389/fvets.2022.853743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/23/2022] [Indexed: 12/26/2022] Open
Abstract
Biological aging is the single most important risk factor for disease, disability, and ultimately death in geriatric dogs. The effects of aging in companion dogs also impose significant financial and psychological burdens on their human caregivers. The underlying physiologic processes of canine aging may be occult, or early signs of aging may be ignored because of the misconception that biological aging is natural and therefore inevitable. The ability to detect, quantify, and mitigate the deleterious processes of canine aging would greatly enhance veterinary preventative medicine and animal welfare. In this paper we propose a new conceptual framework for aging in dogs, the Canine Geriatric Syndrome (CGS). CGS consists of the multiple, interrelated physical, functional, behavioral, and metabolic changes that characterize canine aging as well as the resulting clinical manifestations, including frailty, diminished quality of life, and age-associated disease. We also identify potential key components of a CGS assessment tool, a clinical instrument that would enable veterinarians to diagnose CGS and would facilitate the development and testing of interventions to prolong healthspan and lifespan in dogs by directly targeting the biological mechanisms of aging. There are many gaps in our knowledge of the mechanisms and phenotype of aging in dogs that must be bridged before a CGS assessment tool can be deployed. The conceptual framework of CGS should facilitate identifying these gaps and should stimulate research to better characterize the processes and effects of aging in dogs and to identify the most promising preventative strategies to target these.
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Affiliation(s)
| | - Frances L. Chen
- Cellular Longevity Inc., dba Loyal, San Francisco, CA, United States
| | - Margaret E. Gruen
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Natasha J. Olby
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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177
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Different profiles among older adults with HIV according to their chronological age and the year of HIV diagnosis: The FUNCFRAIL cohort study (GeSIDA 9817). PLoS One 2022; 17:e0266191. [PMID: 35353855 PMCID: PMC8967027 DOI: 10.1371/journal.pone.0266191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/15/2022] [Indexed: 01/08/2023] Open
Abstract
Background People in their fifties with HIV are considered older adults, but they appear not to be a homogeneous group. Objective To evaluate the differences among older adults with HIV according to their chronological age and the year of HIV diagnosis. Methods Cross-sectional study of the FUNCFRAIL cohort. Patients 50 or over with HIV were included and were stratified by both chronological age and the year of HIV diagnosis: before 1996 (long-term HIV survivors [LTHS]) and after 1996. We recorded sociodemographic data, HIV-related factors, comorbidities, frailty, physical function, other geriatric syndromes, and quality of life (QOL). Results We evaluated 801 patients. Of these, 24.7% were women, 47.0% were LTHS, and 14.7% were 65 or over. Of the 65 or over patients, 73% were diagnosed after 1996. Higher rates of comorbidities among LTHS were found, being the more prevalent: COPD, history of cancer, osteoarthritis, depression, and other psychiatric disorders while the more prevalent among the 65 or over patients were: hypertension, diabetes, dyslipidemia, cancer, and osteoarthritis. LTHS showed a significantly worse QOL. There were no differences by the year of HIV diagnosis regarding frailty and functional impairment (SPPB <10) but they were more than twice as prevalent in the 65 or over patients compared to the other chronological age groups. Conclusions A LTHS and a 65 or over person are both “older adults with HIV,” but their characteristics and requirements differ markedly. It is mandatory to design specific approaches focused on the real needs of the different profiles.
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178
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Wieland J, Jordan BL, Jatoi A. Equity. Cancer 2022; 128:2240-2242. [PMID: 35403209 DOI: 10.1002/cncr.34179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Jana Wieland
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Barbara L Jordan
- Office of Education Diversity, Equity, and Inclusion, Mayo Clinic, Rochester, Minnesota
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
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179
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Cai Y, Wanigatunga AA, Mitchell CM, Urbanek JK, Miller ER, Juraschek SP, Michos ED, Kalyani RR, Roth DL, Appel LJ, Schrack JA. The effects of vitamin D supplementation on frailty in older adults at risk for falls. BMC Geriatr 2022; 22:312. [PMID: 35399053 PMCID: PMC8994906 DOI: 10.1186/s12877-022-02888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Low serum 25-hydroxyvitamin D [25(OH)D] level is associated with a greater risk of frailty, but the effects of daily vitamin D supplementation on frailty are uncertain. This secondary analysis aimed to examine the effects of vitamin D supplementation on frailty using data from the Study To Understand Fall Reduction and Vitamin D in You (STURDY).
Methods
The STURDY trial, a two-stage Bayesian, response-adaptive, randomized controlled trial, enrolled 688 community-dwelling adults aged ≥ 70 years with a low serum 25(OH)D level (10–29 ng/mL) and elevated fall risk. Participants were initially randomized to 200 IU/d (control dose; n = 339) or a higher dose (1000 IU/d, 2000 IU/d, or 4000 IU/d; n = 349) of vitamin D3. Once the 1000 IU/d was selected as the best higher dose, other higher dose groups were reassigned to the 1000 IU/d group and new enrollees were randomized 1:1 to 1000 IU/d or control group. Data were collected at baseline, 3, 12, and 24 months. Frailty phenotype was based on number of the following conditions: unintentional weight loss, exhaustion, slowness, low activity, and weakness (≥ 3 conditions as frail, 1 or 2 as pre-frail, and 0 as robust). Cox proportional hazard models estimated the risk of developing frailty, or improving or worsening frailty status at follow-up. All models were adjusted for demographics, health conditions, and further stratified by baseline serum 25(OH)D level (insufficiency (20–29 ng/mL) vs. deficiency (10–19 ng/mL)).
Results
Among 687 participants (mean age 77.1 ± 5.4, 44% women) with frailty assessment at baseline, 208 (30%) were robust, 402 (59%) were pre-frail, and 77 (11%) were frail. Overall, there was no significant difference in risk of frailty outcomes comparing the pooled higher doses (PHD; ≥ 1000 IU/d) vs. 200 IU/d. When comparing each higher dose vs. 200 IU/d, the 2000 IU/d group had nearly double the risk of worsening frailty status (HR = 1.89, 95% CI: 1.13–3.16), while the 4000 IU/d group had a lower risk of developing frailty (HR = 0.22, 95% CI: 0.05–0.97). There were no significant associations between vitamin D doses and frailty status in the analyses stratified by baseline serum 25(OH)D level.
Conclusions
High dose vitamin D supplementation did not prevent frailty. Significant subgroup findings might be the results of type 1 error.
Trial registration
ClinicalTrials.gov: NCT02166333.
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180
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Negrete-Najar JP, Sehovic M, Rodriquenz MG, Garcia-Martinez J, Extermann M. Development of a health data derived frailty index as a predictor of adverse outcomes in older patients with pancreatic cancer. J Geriatr Oncol 2022; 13:308-314. [PMID: 34740560 DOI: 10.1016/j.jgo.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/01/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
Pancreatic cancer is a prevalent disease among older adults. Well-selected patients, based on a geriatric assessment for risk stratification, could be good candidates for chemotherapy and/or curative resection. Deficits accumulation frailty indices (FI) utilize readily available clinical data and easily obtained patient-reported information to predict hospitalization and mortality of older individuals. Retrospective data from 440 older adults (median age 76 years) with pancreatic cancer, obtained from electronic health records, was used to develop a FI and its ability to predict mortality and other geriatric and cancer related outcomes was tested. Fatigue (n = 45), infection (n = 40) and neutropenia (n = 36) were the most common registered adverse events of treatment; 153 subjects had no adverse events. The mean FI score was 0.26, 112 subjects were fit (0.0 < 0.2), 255 pre-frail (0.2 < 0.35), and 73 frail (≥ 0.35). Median survival was twelve months for the whole sample; at one year 62.5% of fit patients, 46.3% of pre-frail, and 26% of frail patients were alive. The FI categories correlated with institutionalization (p < 0.001) and non-planned hospitalization (p < 0.001). The FI categories did not correlate with the presence of Common Terminology Criteria for Adverse Events (CTCAE) grade 3-4 adverse events (p = 0.377). We conclude that patients with pancreatic cancer classified as frail with our FI had worse survival than those fit and pre-frail. Non-fit patients were also more prone to be institutionalized and have non-planned hospitalizations. The items used for this FI can be usually acquired from electronic health records and could be automated in the future, which could simplify its use as a helping tool for decisions in older patients with pancreatic cancer.
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Affiliation(s)
| | | | - Maria Grazia Rodriquenz
- Oncology Unit, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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181
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Ji S, Baek JY, Jin T, Lee E, Jang IY, Jung HW. Association Between Changes in Frailty Index and Clinical Outcomes: An Observational Cohort Study. Clin Interv Aging 2022; 17:627-636. [PMID: 35509347 PMCID: PMC9057903 DOI: 10.2147/cia.s358512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Although the association between a single assessment of frailty index (FI) and clinical outcomes has been revealed in prior studies, there is a lack of knowledge about the prognostic value of FI at different time points and the changes in repeated measurements of FI. Hence, we sought to determine the clinically meaningful changes in FI and reveal the association with the changes and a composite outcome of mortality and institutionalization. Participants and Methods This study was based on a longitudinal study of the Pyeongchang Rural Area cohort that included people aged 65 years or older, ambulatory and living at home. Individuals were divided into the worsened group (changes in FI ≥ 0.03 during 2 years) and the stable group (changes in FI < 0.03 during 2 years). The incidence of a composite outcome was compared between the two groups and the relationship was adjusted for age, sex, baseline FI, and follow-up FI. Results Of the 953 participants, 403 (42.3%) and 550 (57.7%) were included in the worsened group and the stable group, respectively. The worsened group had a significantly higher risk of the composite outcome than the stable group (HR, 2.37 [95% CI, 1.54–3.67]; p < 0.001). Although the higher risk remained significant after adjusting for age, sex, and baseline FI, the statistical significance disappeared after adjusting for follow-up FI (p = 0.614). The aggravation of FI in the worsened group was predominantly due to aggravation of FI domains, such as activities in daily living, cognitive function and mood, and mobility rather than comorbidity burden. Conclusion Aggravation of FI was associated with a composite outcome regardless of baseline FI, and the association was significantly reflected in the follow-up measurement of FI. The worsening FI was mainly attributable to functional geriatric domains.
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Affiliation(s)
- Sunghwan Ji
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Yeon Baek
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Correspondence: Ji Yeon Baek, Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, Tel +82-2-3010-0020, Email
| | - Taeyang Jin
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eunju Lee
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Il-Young Jang
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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de Sousa Neto IV, da Cunha Nascimento D, Prestes J, da Fonseca EF, Celes RS, Rolnick N, de Sousa Barbalho YG, Silva ADO, Stival MM, de Lima LR, Funghetto SS. Initial Muscle Quality Affects Individual Responsiveness of Interleukin-6 and Creatine Kinase following Acute Eccentric Exercise in Sedentary Obese Older Women. BIOLOGY 2022; 11:biology11040537. [PMID: 35453736 PMCID: PMC9026080 DOI: 10.3390/biology11040537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/18/2022]
Abstract
This study aimed to evaluate the time course and responsiveness of plasma interleukin-6 (IL-6) and creatine kinase (CK) levels following acute eccentric resistance exercise in sedentary obese older women with a different muscle quality index (MQI). Eighty-eight participants (69.4 ± 6.06 years) completed an acute eccentric resistance exercise (7 sets of 10 repetitions at 110% of 10-repetition maximum with 3 min rest interval). Participants were divided into two groups: high or low MQI according to 50th percentile cut-off. The responsiveness was based on minimal clinical important difference. There were no differences between groups and time on IL-6 and CK levels (p > 0.05). However, the high MQI group displayed a lower proportion of low responders (1 for laboratory and 2 for field-based vs. 5 and 4) and a higher proportion of high responders for IL-6 (7 for laboratory and 6 for field-based vs. 4 and 5) compared to low MQI group. In addition, the high MQI group showed a higher proportion of high responders for CK (11 for laboratory and 9 for field-based vs. 6 and 6) compared to low MQI. A prior MQI screening can provide feedback to understand the magnitude response. Individual responsiveness should be taken into consideration for maximizing eccentric exercise prescription.
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Affiliation(s)
- Ivo Vieira de Sousa Neto
- Laboratory of Molecular Analysis, Faculty of Ceilândia, Universidade de Brasília, Brasilia 70910-900, Brazil
- Graduate Program of Sciences and Technology of Health, Faculty of Ceilândia, Universidade de Brasília, Brasilia 70910-900, Brazil; (Y.G.d.S.B.); (M.M.S.); (S.S.F.)
- Correspondence:
| | - Dahan da Cunha Nascimento
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasilia 70910-900, Brazil; (D.d.C.N.); (J.P.); (E.F.d.F.); (R.S.C.)
| | - Jonato Prestes
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasilia 70910-900, Brazil; (D.d.C.N.); (J.P.); (E.F.d.F.); (R.S.C.)
| | - Eduardo Fernandes da Fonseca
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasilia 70910-900, Brazil; (D.d.C.N.); (J.P.); (E.F.d.F.); (R.S.C.)
| | - Rodrigo Souza Celes
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasilia 70910-900, Brazil; (D.d.C.N.); (J.P.); (E.F.d.F.); (R.S.C.)
| | - Nicholas Rolnick
- The Human Performance Mechanic, Lehman College, New York, NY 10468, USA;
| | - Yuri Gustavo de Sousa Barbalho
- Graduate Program of Sciences and Technology of Health, Faculty of Ceilândia, Universidade de Brasília, Brasilia 70910-900, Brazil; (Y.G.d.S.B.); (M.M.S.); (S.S.F.)
| | | | - Marina Morato Stival
- Graduate Program of Sciences and Technology of Health, Faculty of Ceilândia, Universidade de Brasília, Brasilia 70910-900, Brazil; (Y.G.d.S.B.); (M.M.S.); (S.S.F.)
- Department of Nursing, Faculty of Ceilândia, Universidade de Brasília, Brasilia 70910-900, Brazil;
| | - Luciano Ramos de Lima
- Department of Nursing, Faculty of Ceilândia, Universidade de Brasília, Brasilia 70910-900, Brazil;
| | - Silvana Schwerz Funghetto
- Graduate Program of Sciences and Technology of Health, Faculty of Ceilândia, Universidade de Brasília, Brasilia 70910-900, Brazil; (Y.G.d.S.B.); (M.M.S.); (S.S.F.)
- Department of Nursing, Faculty of Ceilândia, Universidade de Brasília, Brasilia 70910-900, Brazil;
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183
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Lynch DH, Spangler HB, Franz JR, Krupenevich RL, Kim H, Nissman D, Zhang J, Li YY, Sumner S, Batsis JA. Multimodal Diagnostic Approaches to Advance Precision Medicine in Sarcopenia and Frailty. Nutrients 2022; 14:1384. [PMID: 35405997 PMCID: PMC9003228 DOI: 10.3390/nu14071384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia, defined as the loss of muscle mass, strength, and function with aging, is a geriatric syndrome with important implications for patients and healthcare systems. Sarcopenia increases the risk of clinical decompensation when faced with physiological stressors and increases vulnerability, termed frailty. Sarcopenia develops due to inflammatory, hormonal, and myocellular changes in response to physiological and pathological aging, which promote progressive gains in fat mass and loss of lean mass and muscle strength. Progression of these pathophysiological changes can lead to sarcopenic obesity and physical frailty. These syndromes independently increase the risk of adverse patient outcomes including hospitalizations, long-term care placement, mortality, and decreased quality of life. This risk increases substantially when these syndromes co-exist. While there is evidence suggesting that the progression of sarcopenia, sarcopenic obesity, and frailty can be slowed or reversed, the adoption of broad-based screening or interventions has been slow to implement. Factors contributing to slow implementation include the lack of cost-effective, timely bedside diagnostics and interventions that target fundamental biological processes. This paper describes how clinical, radiographic, and biological data can be used to evaluate older adults with sarcopenia and sarcopenic obesity and to further the understanding of the mechanisms leading to declines in physical function and frailty.
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Affiliation(s)
- David H. Lynch
- Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Hillary B. Spangler
- Division of Medicine and Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Rebecca L. Krupenevich
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Hoon Kim
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, North Carolina State University, Chapel Hill, NC 27599, USA; (J.R.F.); (R.L.K.); (H.K.)
| | - Daniel Nissman
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; (D.N.); (J.Z.)
| | - Janet Zhang
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA; (D.N.); (J.Z.)
| | - Yuan-Yuan Li
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
| | - Susan Sumner
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
| | - John A. Batsis
- Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina, Chapel Hill, NC 27599, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (Y.-Y.L.); (S.S.)
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184
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Guillotin S, Vallet A, Lorthois S, Cestac P, Schmidt E, Delcourt N. Association between Homocysteine, Frailty and Biomechanical Response of the CNS in NPH-suspected Patients. J Gerontol A Biol Sci Med Sci 2022; 77:1335-1343. [PMID: 35325129 DOI: 10.1093/gerona/glac074] [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: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
Frailty is a geriatric syndrome that combines physiological decline, disruptions of homeostatic mechanisms across multiple physiologic systems and thus, strong vulnerability to further pathological stress. Previously, we provided the first evidence that increased risk of poor health outcomes, as quantified by a frailty index, is associated with an alteration of the central nervous system (CNS) biomechanical response to blood pulsatility. In this study, we explored correlation between fourteen biological parameters, the CNS elastance coefficient and frailty index. We included 60 adults (52-92 years) suspected of normal pressure hydrocephalus (NPH) and presenting with markers of multiple co-existing brain pathologies, including Parkinson disease (PD), Alzheimer disease (AD) and vascular dementia. We showed that the homocysteine (Hcy) level was independently and positively associated with both frailty index and the CNS elastance coefficient (adjusted R² of 10% and 6%). We also demonstrated that creatinine clearance and folate level were independently associated with Hcy level. Based on previous literature results describing the involvement of Hcy in endothelial dysfunction, glial activation and neurodegeneration, we discuss how Hcy could contribute to the altered biomechanical response of the CNS and frailty.
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Affiliation(s)
- Sophie Guillotin
- Center for Epidemiology and Research in POPulation health (CERPOP), University of Toulouse, Toulouse, France.,Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France
| | - Alexandra Vallet
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Sylvie Lorthois
- Institut de Mécanique des Fluides de Toulouse (IMFT), University of Toulouse, CNRS, Toulouse, France
| | - Philippe Cestac
- Center for Epidemiology and Research in POPulation health (CERPOP), University of Toulouse, Toulouse, France
| | - Eric Schmidt
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse, INSERM, UPS, Toulouse, France.,Department of Neurosurgery, Toulouse-Purpan University Hospital, Toulouse, France
| | - Nicolas Delcourt
- Poison Control Center, Toulouse-Purpan University Hospital, Toulouse, France.,Toulouse NeuroImaging Center (ToNIC), University of Toulouse, INSERM, UPS, Toulouse, France
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185
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Christon LM, Smith PJ. Psychosocial Evaluation for Lung Transplantation: an Empirically Informed Update. CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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186
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Association of Frailty with Perioperative Outcomes Following Hepatic Resection: A National Study. J Am Med Dir Assoc 2022; 23:684-689.e1. [PMID: 35304129 DOI: 10.1016/j.jamda.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Risk of mortality and major comorbidity remains high following hepatic resection. Given recent advancements in nonsurgical techniques to control hepatic malignancy, accurate assessment of surgical candidates, especially those considered frail, has become imperative. The present study aimed to characterize the impact of frailty on clinical and financial outcomes following hepatic resection in older individuals. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS All older adults (≥65 years) undergoing elective hepatic resection were identified from the 2012 to 2019 National Inpatient Sample. METHODS Frailty was defined by using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Multivariable regression models were developed to assess the independent association of frailty with mortality, perioperative complications, and resource utilization. Marginal effects were tabulated to assess the impact of hospital volume on frailty-associated mortality. RESULTS Of an estimated 40,735 patients undergoing major hepatic resection, 9.0% were considered frail. After multivariable adjustment, frailty was associated with increased odds of mortality (adjusted odds ratio [AOR] 2.9; 95% confidence interval [CI] 2.0-4.3; P < .001) and perioperative complication (AOR 2.9; 95% CI 2.4-3.4; P < .001). Furthermore, frail patients incurred longer risk-adjusted length of stay (14.2 vs 6.7 days, P < .001) and greater hospitalization costs ($55,100 vs $29,300, P < .001). In assessing the impact of institutional expertise on perioperative outcomes, the marginal effect of frailty on mortality became less pronounced with increasing operative volume. CONCLUSIONS AND IMPLICATIONS As the population of the United States continues to age, surgeons are increasingly likely to encounter candidates for major hepatic resection who are frail. The present study associated frailty with inferior clinical and financial outcomes; however, frailty-associated mortality became less pronounced at centers with high hepatic resection operative volume. Coding-based instruments, such as the Johns Hopkins Adjusted Clinical Groups, may identify patients from electronic medical records who may benefit from further geriatric assessment and targeted treatments.
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187
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Zhang W, Li H, Bream JH, Nilles TL, Leng SX, Margolick JB. Longitudinal association of cytokine-producing CMV-specific T cells with frailty in HIV-infected and -uninfected men who have sex with men. Immun Ageing 2022; 19:13. [PMID: 35255947 PMCID: PMC8900335 DOI: 10.1186/s12979-022-00270-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/13/2022] [Indexed: 12/13/2022]
Abstract
Background Chronic cytomegalovirus (CMV) infection has been postulated as a driver of chronic inflammation that has been associated with frailty and other age-related conditions in both HIV-infected (HIV+) and -uninfected (HIV-) people. Methods To study the T cell response to CMV as a predictor of onset and maintenance of frailty, baseline CMV-specific T cell responses of 42 men (20 HIV-, 22 HIV+; 21 frail, 21 nonfrail) in the Multicenter AIDS Cohort Study (MACS) were assessed by flow cytometric analysis of cytokine production (IFN-γ, TNF-⍺, and IL-2) in response to overlapping peptide pools spanning 19 CMV open reading frames. The Fried frailty phenotype was assessed at baseline and semiannually thereafter. Times to transition into or out of frailty were compared by tertiles of percentages of cytokine-producing T cells using Kaplan-Meier estimators and the exact log-rank test. Results Over a median follow-up of 6.5 (interquartile range: 2) years, faster onset of frailty was significantly predicted by higher (HIV- men) or lower (HIV+ men) percentages of CD4 T cells producing only IFN-γ (IFN-γ-single-producing (SP)), and by lower percentages of IFN-γ-, TNF-⍺-, and IL-2-triple-producing CD8 T cells (HIV- men). Greater maintenance of frailty was significantly predicted by lower percentages of both these T cell subsets in HIV- men, and by lower percentages of IFN-γ-SP CD4 T cells in HIV+ men. The antigenic specificity of IFN-γ-SP CD4 T cells was different between HIV- and HIV+ nonfrail men, as were the correlations between these cells and serum inflammatory markers. Conclusions In this pilot study, percentages of CMV-specific T cells predicted the onset and maintenance of frailty in HIV- and HIV+ men. Predictive responses differed by HIV status, which may relate to differential control of CMV reactivation and inflammation by anti-CMV T cell responses. Supplementary Information The online version contains supplementary material available at 10.1186/s12979-022-00270-3.
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Affiliation(s)
- Weiying Zhang
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Rm E5153, Baltimore, MD, 21205, USA
| | - Huifen Li
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jay H Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Rm E5153, Baltimore, MD, 21205, USA.,Graduate Program in Immunology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tricia L Nilles
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Rm E5153, Baltimore, MD, 21205, USA
| | - Sean X Leng
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Rm E5153, Baltimore, MD, 21205, USA.,Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Johns Hopkins Center on Aging and Immune Remodeling, Baltimore, MD, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Rm E5153, Baltimore, MD, 21205, USA.
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188
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Hanlon P, Morton F, Siebert S, Jani BD, Nicholl BI, Lewsey J, McAllister D, Mair FS. Frailty in rheumatoidrmdopen-2021-002111 arthritis and its relationship with disease activity, hospitalisation and mortality: a longitudinal analysis of the Scottish Early Rheumatoid Arthritis cohort and UK Biobank. RMD Open 2022; 8:e002111. [PMID: 35292529 PMCID: PMC8928366 DOI: 10.1136/rmdopen-2021-002111] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/17/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess the prevalence of frailty in rheumatoid arthritis (RA) and its association with baseline and longitudinal disease activity, all-cause mortality and hospitalisation. PARTICIPANTS People with RA identified from the Scottish Early Rheumatoid Arthritis (SERA) inception cohort (newly diagnosed, mean age 58.2 years) and UK Biobank (established disease identified using diagnostic codes, mean age 59 years). Frailty was quantified using the frailty index (both datasets) and frailty phenotype (UK Biobank only). Disease activity was assessed using Disease Activity Score in 28 joints (DAS28) in SERA. Associations between baseline frailty and all-cause mortality and hospitalisation was estimated after adjusting for age, sex, socioeconomic status, smoking and alcohol, plus DAS28 in SERA. RESULTS Based on the frailty index, frailty was common in SERA (12% moderate, 0.2% severe) and UK Biobank (20% moderate, 3% severe). In UK Biobank, 23% were frail using frailty phenotype. Frailty index was associated with DAS28 in SERA, as well as age and female sex in both cohorts. In SERA, as DAS28 lessened over time with treatment, mean frailty index also decreased. The frailty index was associated with all-cause mortality (HR moderate/severe frailty vs robust 4.14 (95% CI 1.49 to 11.51) SERA, 1.68 (95% CI 1.26 to 2.13) UK Biobank) and unscheduled hospitalisation (incidence rate ratio 2.27 (95% CI 1.45 to 3.57) SERA 2.74 (95% CI 2.29 to 3.29) UK Biobank). In UK Biobank, frailty phenotype also associated with mortality and hospitalisation. CONCLUSION Frailty is common in early and established RA and associated with hospitalisation and mortality. Frailty in RA is dynamic and, for some, may be ameliorated through controlling disease activity in early disease.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Fraser Morton
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Bhautesh D Jani
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Barbara I Nicholl
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Jim Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - David McAllister
- Public Health, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
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189
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Polidori MC, Mecocci P. Modeling the dynamics of energy imbalance: The free radical theory of aging and frailty revisited. Free Radic Biol Med 2022; 181:235-240. [PMID: 35151828 DOI: 10.1016/j.freeradbiomed.2022.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/15/2022] [Accepted: 02/08/2022] [Indexed: 12/12/2022]
Abstract
The role of oxidative stress in aging and the newly conceptualized vision of frailty is of great interest for the possibility to define a framework able to explain the several modifications observed in all biological molecules along with age. In this review, the impact of oxidative stress is considered in aging processes as well as in frailty, the geriatric concept of declined capacity to cope with any stressor, leading to a status of reduced ability to maintain the homeostatic balance. Although some pharmacological and behavioral approaches have been proposed, we are still lacking efficacious management able to prevent and avoid frailty. This represents a fundamental challenge for future research in this field.
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Affiliation(s)
- Maria Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, Perugia Hospital, Building C Floor 4, Piazzale Menghini, 1 - 06132, Perugia, Italy.
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190
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Brown PJ. Evidence for a Geroscience Approach to Late Life Depression: Bioenergetics and the Frail-Depressed. Am J Geriatr Psychiatry 2022; 30:338-341. [PMID: 34879973 DOI: 10.1016/j.jagp.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Patrick J Brown
- New York State Psychiatric Institute (PJB), Columbia University College of Physicians and Surgeons, New York, NY.
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191
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Raffington L, Belsky DW. Integrating DNA Methylation Measures of Biological Aging into Social Determinants of Health Research. Curr Environ Health Rep 2022; 9:196-210. [PMID: 35181865 DOI: 10.1007/s40572-022-00338-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Acceleration of biological processes of aging is hypothesized to drive excess morbidity and mortality in socially disadvantaged populations. DNA methylation measures of biological aging provide tools for testing this hypothesis. RECENT FINDINGS Next-generation DNA methylation measures of biological aging developed to predict mortality risk and physiological decline are more predictive of morbidity and mortality than the original epigenetic clocks developed to predict chronological age. These new measures show consistent evidence of more advanced and faster biological aging in people exposed to socioeconomic disadvantage and may be able to record the emergence of socially determined health inequalities as early as childhood. Next-generation DNA methylation measures of biological aging also indicate race/ethnic disparities in biological aging. More research is needed on these measures in samples of non-Western and non-White populations. New DNA methylation measures of biological aging open opportunities for refining inference about the causes of social disparities in health and devising policies to eliminate them. Further refining measures of biological aging by including more diversity in samples used for measurement development is a critical priority for the field.
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Affiliation(s)
- Laurel Raffington
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
- Population Research Center, The University of Texas at Austin, Austin, TX, USA
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St. Rm 413, New York, NY, 10032, USA.
- Robert N Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA.
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192
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Jiang X, Cai Y, Wu X, Huang B, Chen Y, Zhong L, Gao X, Guo Y, Zhou J. The Multiscale Dynamics of Beat-to-Beat Blood Pressure Fluctuation Mediated the Relationship Between Frailty and Arterial Stiffness in Older Adults. J Gerontol A Biol Sci Med Sci 2022; 77:2482-2488. [PMID: 35143675 PMCID: PMC9799215 DOI: 10.1093/gerona/glac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Beat-to-beat blood pressure (BP) is an important cardiovascular output and regulated by neurophysiological elements over multiple temporal scales. The multiscale dynamics of beat-to-beat BP fluctuation can be characterized by "BP complexity" and has been linked to age-related adverse health outcomes. We here aimed to examine whether BP complexity mediates the association between arterial stiffness and frailty. METHOD This cross-sectional study was completed between January and October 2021. A total of 350 older adults completed assessments for frailty, arterial stiffness (ie, average brachial-ankle pulse wave velocity), and beat-to-beat finger BP. The complexity of beat-to-beat systolic blood pressure (SBP) and diastolic blood pressure (DBP) BP series was measured using multiscale entropy. The relationships between frailty, BP complexity, and arterial stiffness were examined using analysis of variance and linear regression models. The effects of BP complexity on the association between arterial stiffness and frailty were examined using mediation analyses. RESULTS Compared with non-frail, prefrail, and frail groups had significantly elevated lower SBP and DBP complexity (F > 11, p < .001) and greater arterial stiffness (F = 16, p < .001). Greater arterial stiffness was associated with lower BP complexity (β < -0.42, p < .001). Beat-to-beat SBP and DBP complexity mediated the association between arterial stiffness and frailty (indirect effects >0.28), accounting for at least 47% of its total effects on frailty (mediated proportion: SBP: 50%, DBP: 47%). CONCLUSION This study demonstrates the association between BP complexity and frailty in older adults, and BP complexity mediates the association between arterial stiffness and frailty, suggesting that this metric would serve as a marker to help characterize important functions in the older adults.
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Affiliation(s)
- Xin Jiang
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China,The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, People’s Republic of China,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China
| | - Yurun Cai
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaoyan Wu
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China,The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, People’s Republic of China
| | - Baofeng Huang
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China,The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, People’s Republic of China,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China
| | - Yurong Chen
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Lilian Zhong
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China,The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, People’s Republic of China,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China
| | - Xia Gao
- Department of Geriatrics, Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China,The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, People’s Republic of China,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China
| | - Yi Guo
- Address correspondence to: Yi Guo, MD, Department of Neurology, Shenzhen People’s Hospital, 1017 Dongmen Rd N, Luohu District, Shenzhen, Guangdong 518020, People’s Republic of China. E-mail:
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Maryland, USA,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA
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193
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Le Pogam MA, Seematter-Bagnoud L, Niemi T, Assouline D, Gross N, Trächsel B, Rousson V, Peytremann-Bridevaux I, Burnand B, Santos-Eggimann B. Development and validation of a knowledge-based score to predict Fried's frailty phenotype across multiple settings using one-year hospital discharge data: The electronic frailty score. EClinicalMedicine 2022; 44:101260. [PMID: 35059615 PMCID: PMC8760435 DOI: 10.1016/j.eclinm.2021.101260] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Most claims-based frailty instruments have been designed for group stratification of older populations according to the risk of adverse health outcomes and not frailty itself. We aimed to develop and validate a tool based on one-year hospital discharge data for stratification on Fried's frailty phenotype (FP). METHODS We used a three-stage development/validation approach. First, we created a clinical knowledge-driven electronic frailty score (eFS) calculated as the number of deficient organs/systems among 18 critical ones identified from the International Statistical Classification of Diseases and Related Problems, 10th Revision (ICD-10) diagnoses coded in the year before FP assessment. Second, for eFS development and internal validation, we linked individual records from the Lc65+ cohort database to inpatient discharge data from Lausanne University Hospital (CHUV) for the period 2004-2015. The development/internal validation sample included community-dwelling, non-institutionalised residents of Lausanne (Switzerland) recruited in the Lc65+ cohort in three waves (2004, 2009, and 2014), aged 65-70 years at enrolment, and hospitalised at the CHUV at least once in the year preceding the FP assessment. Using this sample, we selected the best performing model for predicting the dichotomised FP, with the eFS or ICD-10-based variables as predictors. Third, we conducted an external validation using 2016 Swiss nationwide hospital discharge data and compared the performance of the eFS model in predicting 13 adverse outcomes to three models relying on well-designed and validated claims-based scores (Claims-based Frailty Index, Hospital Frailty Risk Score, Dr Foster Global Frailty Score). FINDINGS In the development/internal validation sample (n = 469), 14·3% of participants (n = 67) were frail. Among 34 models tested, the best-subsets logistic regression model with four predictors (age and sex at FP assessment, time since last hospital discharge, eFS) performed best in predicting the dichotomised FP (area under the curve=0·71; F1 score=0·39) and one-year adverse health outcomes. On the external validation sample (n = 54,815; 153 acute care hospitals), the eFS model demonstrated a similar performance to the three other claims-based scoring models. According to the eFS model, the external validation sample showed an estimated prevalence of 56·8% (n = 31,135) of frail older inpatients at admission. INTERPRETATION The eFS model is an inexpensive, transportable and valid tool allowing reliable group stratification and individual prioritisation for comprehensive frailty assessment and may be applied to both hospitalised and community-dwelling older adults. FUNDING The study received no external funding.
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Affiliation(s)
- Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
- Corresponding author.
| | - Laurence Seematter-Bagnoud
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Tapio Niemi
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Dan Assouline
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Nathan Gross
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Bastien Trächsel
- Department of Training, Research and Innovation, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 113 Route de Berne, Lausanne 1010, Switzerland
| | - Valentin Rousson
- Department of Training, Research and Innovation, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 113 Route de Berne, Lausanne 1010, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Bernard Burnand
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
| | - Brigitte Santos-Eggimann
- Department of Epidemiology and Health Systems, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 10 Route de la Corniche, Lausanne 1010, Switzerland
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194
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miRNome Profiling Detects miR-101-3p and miR-142-5p as Putative Blood Biomarkers of Frailty Syndrome. Genes (Basel) 2022; 13:genes13020231. [PMID: 35205276 PMCID: PMC8872439 DOI: 10.3390/genes13020231] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 01/27/2023] Open
Abstract
Frailty is an aging-related pathology, defined as a state of increased vulnerability to stressors, leading to a limited capacity to meet homeostatic demands. Extracellular microRNAs (miRNAs) were proposed as potential biomarkers of various disease conditions, including age-related pathologies. The primary objective of this study was to identify blood miRNAs that could serve as potential biomarkers and candidate mechanisms of frailty. Using the Fried index, we enrolled 22 robust and 19 frail subjects. Blood and urine samples were analysed for several biochemical parameters. We observed that sTNF-R was robustly upregulated in the frail group, indicating the presence of an inflammatory state. Further, by RNA-seq, we profiled 2654 mature miRNAs in the whole blood of the two groups. Expression levels of selected differentially expressed miRNAs were validated by qPCR, and target prediction analyses were performed for the dysregulated miRNAs. We identified 2 miRNAs able to significantly differentiate frail patients from robust subjects. Both miR-101-3p and miR-142-5p were found to be downregulated in the frail vs. robust group. Finally, using bioinformatics targets prediction tools, we explored the potential molecular mechanisms and cellular pathways regulated by the two miRNAs and potentially involved in frailty.
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195
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Wang B, Wang L, Gasek NS, Zhou Y, Kim T, Guo C, Jellison ER, Haynes L, Yadav S, Tchkonia T, Kuchel GA, Kirkland JL, Xu M. An inducible p21-Cre mouse model to monitor and manipulate p21-highly-expressing senescent cells in vivo. NATURE AGING 2022; 1:962-973. [PMID: 35024619 DOI: 10.1038/s43587-021-00107-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The role of senescent cells has been implicated in various tissue dysfunction associated with aging, obesity, and other pathological conditions. Currently, most transgenic mouse models only target p16 Ink4a-highly-expressing (p16 high) cells. Here, we generated a p21-Cre mouse model, containing a p21 promoter driving inducible Cre, enabling us to examine p21 Cip1-highly-expressing (p21 high) cells, a previously unexplored cell population exhibiting several characteristics typical of senescent cells. By crossing p21-Cre mice with different floxed mice, we managed to monitor, sort, image, eliminate, or modulate p21 high cells in vivo. We showed p21 high cells can be induced by various conditions, and percentages of p21 high cells varied from 1.5 to 10% across different tissues in 23-month-old mice. Intermittent clearance of p21 high cells improved physical function in 23-month-old mice. Our study demonstrates that the p21-Cre mouse model is a valuable and powerful tool for studying p21 high cells to further understand the biology of senescent cells.
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Affiliation(s)
- Binsheng Wang
- UConn Center on Aging, UConn Health, Farmington, CT.,Department of Genetics and Genome Sciences, UConn Health, Farmington, CT.,These authors contributed equally
| | - Lichao Wang
- UConn Center on Aging, UConn Health, Farmington, CT.,Department of Genetics and Genome Sciences, UConn Health, Farmington, CT.,These authors contributed equally
| | - Nathan S Gasek
- UConn Center on Aging, UConn Health, Farmington, CT.,Department of Genetics and Genome Sciences, UConn Health, Farmington, CT.,These authors contributed equally
| | - Yueying Zhou
- Xiangya Stomatological Hospital, Central South University, Changsha, China.,Center for Regenerative Medicine and Skeletal Development, UConn Health, Farmington, CT
| | - Taewan Kim
- UConn Center on Aging, UConn Health, Farmington, CT.,Department of Genetics and Genome Sciences, UConn Health, Farmington, CT.,Biomedical Science Graduate Program, UConn Health, Farmington, CT
| | - Chun Guo
- UConn Center on Aging, UConn Health, Farmington, CT
| | | | - Laura Haynes
- UConn Center on Aging, UConn Health, Farmington, CT.,Department of Immunology, UConn Health, Farmington, CT
| | - Sumit Yadav
- Division of Orthodontics, UConn Health, Farmington, CT
| | - Tamar Tchkonia
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN
| | | | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN
| | - Ming Xu
- UConn Center on Aging, UConn Health, Farmington, CT.,Department of Genetics and Genome Sciences, UConn Health, Farmington, CT
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196
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Faye AS, Colombel JF. Aging and IBD: A New Challenge for Clinicians and Researchers. Inflamm Bowel Dis 2022; 28:126-132. [PMID: 33904578 DOI: 10.1093/ibd/izab039] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Indexed: 12/12/2022]
Abstract
Evidence from recent epidemiological data suggests that the patient population with inflammatory bowel disease (IBD) is chronologically aging. As these individuals become older, cellular senescence leads to a state of chronic inflammation. This process, known as inflammaging, is thought to be closely linked with biological aging and may be upregulated within IBD. As a consequence, we see an increased risk of aging-related disorders within IBD. In addition, we see that frailty, which results from physiologic decline, is increasing in prevalence and is associated with adverse clinical outcomes in IBD. As such, in this review we explore the potential overlapping biology of IBD and aging, discuss the risk of aging-related disorders in IBD, and describe frailty and its relation to clinical outcomes within IBD. Finally, we discuss current considerations for clinical care and potential research avenues for further investigation.
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Affiliation(s)
- Adam S Faye
- Department of Medicine, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jean-Frederic Colombel
- Department of Medicine, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Frailty in kidney transplant candidates: a comparison between physical frailty phenotype and FRAIL scales. J Nephrol 2022; 35:1841-1849. [PMID: 34978704 DOI: 10.1007/s40620-021-01234-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Frailty is common among advanced chronic kidney disease (CKD) patients who are kidney transplant (KT) candidates, and predisposes to poor outcomes after transplantation. However, frailty is not routinely measured during pretransplant work-up and it is unknown which metric should be used in this specific population. Our aim was to establish frailty prevalence in KT candidates according to different frailty scales. METHODS Prospective longitudinal study of 451 KT candidates evaluated for frailty by both Physical Frailty Phenotype (PFP) and FRAIL scale at the time of inclusion on the KT waiting list. Clinical and functional characteristics including sociodemographics, comorbidities, disability and nutritional status were recorded. Agreement between PFP and FRAIL scales as well as dissonant patients were analyzed. RESULTS Mean age was 60.9 years and 31.7% were female. Comorbidity burden among patients was high, with 36.9% and 16.2% presenting with diabetes and ischemic coronary disease, respectively. Disabilities were also frequent. More than 70% of patients presented with ≥ 1 PFP criteria while this percentage for ≥ 1 FRAIL criteria was 45.4%. Agreement between PFP and FRAIL was not good (kappa index 0.317). There were 132 patients who were pre-frail or frail according to PFP but non-frail according to the FRAIL scale and they presented with fewer comorbidities and less disability. CONCLUSIONS Frailty is frequent in advanced CKD patients, although its prevalence may vary according to different scales. Agreement between PFP and FRAIL scale is not good, and FRAIL scale might misclassify as robust patients those frail/prefrail patients who are in better health conditions.
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de Aquino MPM, de Oliveira Cirino NT, Lima CA, de Miranda Ventura M, Hill K, Perracini MR. The Four Square Step Test is a useful mobility tool for discriminating older persons with frailty syndrome. Exp Gerontol 2022; 161:111699. [DOI: 10.1016/j.exger.2022.111699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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Schoenborn NL, Blackford AL, Joshu CE, Boyd C, Varadhan R. Life expectancy estimates based on comorbidities and frailty to inform preventive care. J Am Geriatr Soc 2022; 70:99-109. [PMID: 34536287 PMCID: PMC8742754 DOI: 10.1111/jgs.17468] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Long-term prognostication is important to inform preventive care in older adults. Existing prediction indices incorporate age and comorbidities. Frailty is another important factor in prognostication. In this project, we aimed at developing life expectancy estimates that incorporate both comorbidities and frailty. METHODS In this retrospective cohort study, we used data from a 5% sample of Medicare beneficiaries with and without history of cancer from Surveillance, Epidemiology, and End Results (SEER) cancer registry areas. We included adults aged 66-95 years who were continuously enrolled in fee-for-service Medicare for ≥1 year from 1998 to 2014. Participants were followed for survival until 12/31/2015, death, or disenrollment. Comorbidity (none, low/medium, high) and frailty categories (low, high) were defined using established methods for claims. We estimated 5- and 10-year survival probabilities and median life expectancies by age, sex, comorbidities, and frailty. RESULTS The study included 479,646 individuals (4,128,316 person-years), of whom most were women (58.7%). Frailty scores varied widely among participants in the same comorbidity category. In Cox models, both comorbidities and frailty were independent predictors of mortality. Individuals with high comorbidities (HR, 3.24; 95% CI, 3.20-3.28) and low/medium comorbidities (HR, 1.36; 95% CI, 1.34-1.39) had higher risks of death than those with no comorbidities. Compared to low frailty, high frailty was associated with higher risk of death (HR, 1.55; 95% CI, 1.52-1.58). Frailty affected life expectancy estimates in ways relevant to preventive care (i.e., distinguishing <10-year versus >10-year life expectancy) in multiple subgroups. CONCLUSION Incorporating both comorbidities and frailty may be important in estimating long-term life expectancies of older adults. Our life expectancy tables can aid clinicians' prognostication and inform simulation models and population health management.
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Affiliation(s)
- Nancy L. Schoenborn
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD
| | - Amanda L. Blackford
- Johns Hopkins University School of Medicine, Department of Oncology, Division of Biostatistics and Bioinformatics, Baltimore, MD
| | - Corinne E. Joshu
- Johns Hopkins University School of Public Health, Department of Epidemiology, Baltimore, MD
| | - Cynthia Boyd
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD
| | - Ravi Varadhan
- Johns Hopkins University School of Medicine, Department of Oncology, Division of Biostatistics and Bioinformatics, Baltimore, MD
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Yu R, Leung J, Leung G, Woo J. Towards Healthy Ageing: Using the Concept of Intrinsic Capacity in Frailty Prevention. J Nutr Health Aging 2022; 26:30-36. [PMID: 35067700 DOI: 10.1007/s12603-021-1715-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine whether intrinsic capacity (IC) could predict frailty, whether declines in specific domains of IC could lead to frailty, and whether different combinations of domains could represent different risks of developing frailty. SETTING Community. PARTICIPANTS Chinese people aged 65 years and older. MEASUREMENTS Using data from a prospective cohort study, we derived a summary score for IC and scores for the five domains (cognitive, locomotor, vitality, sensory, psychological) for each participant at baseline. Frailty was assessed according to the Fried's frailty phenotype at baseline, 2- and 4-year follow-ups. Participants were classified as frail if they had ≥3 of the following criteria: weight loss, self-rated exhaustion, weakness, slow walking speed, and low physical activity. RESULTS Four thousand participants were interviewed at baseline. Overall mean age was 72.5 years; 50% were women. Between baseline and the 2-year follow-up, 5.7% of non-frail participants developed frailty; between 2- and 4-year follow-ups, 5.7% of non-frail participants developed frailty. The average annual incidence rate of frailty was 2.9%. Higher scores on IC at baseline were associated with a lower risk of incident frailty at both follow-ups (year 2, odds ratio (OR)=0.64, 95% confidence interval (CI)=0.59-0.71); year 4, OR=0.64, 95%CI=0.58-0.71) after adjustment for age, sex, educational level, and chronic diseases. Across the five domains, vitality was the strongest predictor of incident frailty at each follow-up (year 2, OR=0.33, 95%CI=0.24-0.45; year 4, OR=0.33, 95%CI=0.23-0.46). Compared to other combinations of any two domains, having 'high' scores on both vitality and locomotor domains was associated with the lowest risk of incident frailty (year 2, OR=0.11, 95%CI=0.06-0.22, area under the curve (AUC)=0.770; year 4, OR=0.18, 95%CI=0.10-0.32, AUC=0.782). CONCLUSION This study provides evidence that IC was independently associated with incident frailty. It also finds that vitality was the domain most strongly associated with incident frailty. Finally, it suggests that optimizing multiple domains of IC, particularly vitality and locomotor, may prevent frailty.
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Affiliation(s)
- R Yu
- Ruby Yu, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China,
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