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Lee YC, Chang SF, Kao CY, Tsai HC. Muscle Strength, Physical Fitness, Balance, and Walking Ability at Risk of Fall for Prefrail Older People. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4581126. [PMID: 36531652 PMCID: PMC9750769 DOI: 10.1155/2022/4581126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/08/2022] [Accepted: 09/10/2022] [Indexed: 12/24/2023]
Abstract
AIM This study was to explore the relationship of older adults' demographic information, physiological indices, and stages of frailty with their risk of falling. METHODS In the cross-sectional study, a total of 221 older adults with the mean age 74.9 (SD = 6.8) years old were surveyed by senior fitness test. RESULTS Results were observed in terms of participants' physical fitness, with significant differences being observed in the correlations of left-hand grip strength (t = 5.05, p < .000), right-hand grip strength (t = 6.03, p < .000), and total grip strength (t = 5.70, p < .000), time up and go test (t = -6.25, p < .000), and 30-sec chair stand test (t = 7.19, p < .000) with the risk of falling. According to the logistic regression analysis results, long-term medication (OR = 0.12, 95% CI =0.02-0.62, p < .01) and right-hand grip strength (OR = 0.86, 95% CI =0.76-0.97, p < .01) are the main predictors of older adults' risk of falling. CONCLUSIONS Older females with low education, history of falls, weaker grip strengths; taking longer to finish the TUG test; and standing fewer times during the 30-second chair stand test were at risk of fall. In prediction, older people using long-term medication were at lower risk of falling, and the greater the hand grip strength was, the lower the fall risk was. According to the research results, nursing personnel must develop care programs and improve older adults' risk of falls.
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Affiliation(s)
- Yan-Cheng Lee
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Chang
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ching-Yun Kao
- Saint Paul's Hospital, No. 123, Jianxin Street, Taoyuan District, Taoyuan City, Taiwan
| | - Hsiao Chi Tsai
- Cardinal Tien Hospital, No. 15, Chezi Rd., Xindian Dist., New Taipei City, 23155, Taiwan
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202
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Kim S, Won CW. Optimistic orientation and frailty in community-dwelling older adults: Results from KFACS study. Exp Gerontol 2022; 170:111963. [PMID: 36191834 DOI: 10.1016/j.exger.2022.111963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Optimistic orientation is linked to several benefits, including better-coping skills, lower stress levels, and better physical health. This study aimed to identify whether optimistic orientation is associated with physical frailty and whether it is related to each component of physical frailty. METHODS We conducted a cross-sectional analysis of 2019 survey data from the Korean Frailty and Aging Cohort Study, which included 1203 participants aged 70-84 years. Frailty was defined using the Fried frailty phenotype and optimistic orientation was assessed using the Life Orientation Test-Revised. RESULTS Optimistic orientation and frailty were negatively correlated (r = -0.214, p < 0.001). After adjusting for several variables, the relationship between optimistic orientation and physical frailty was only significant in women (odds ratio [OR] = 2.960, 95 % confidence interval [CI]:2 1.375-6.371). Regarding the relationship with the five components of the physical frailty phenotype, the least optimistic women were more exhausted (OR = 1.829, 95 % CI: 1.224-2.732) and weaker (OR = 1.955, 95 % CI: 1.197-3.192) after adjusting for age, body mass index, alcohol consumption, smoking, education, marital status, social activity, living alone, family income, cognitive state, nutritional status, comorbidity, and depression. DISCUSSION Optimistic orientation was negatively associated with physical frailty only in women. Among the components of physical frailty, exhaustion and weakness are associated with optimistic orientation in women.
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Affiliation(s)
- Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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203
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Hoogendijk EO, Dent E. Trajectories, Transitions, and Trends in Frailty among Older Adults: A Review. Ann Geriatr Med Res 2022; 26:289-295. [PMID: 36503183 PMCID: PMC9830071 DOI: 10.4235/agmr.22.0148] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Frailty is an age-related clinical state associated with deterioration across multiple physiological systems and a leading cause of morbidity and mortality later in life. To understand how frailty develops and what causes its progression, longitudinal data with repeated frailty measurements are required. This review summarizes evidence from longitudinal studies on frailty trajectories, transitions, and trends. We identified several consistent findings: frailty increases with aging and is a dynamic condition, and more recent generations of older adults have higher frailty levels. These findings have both clinical and public health relevance, including the provision of healthcare and aged care services in the coming years. Further studies are required, particularly those conducted in low- and middle-income countries and those investigating factors associated with changes in frailty. The latter may help develop better-targeted interventions to reverse or slow the progression of frailty.
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Affiliation(s)
- Emiel O. Hoogendijk
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life Research Program, Amsterdam, the Netherlands
| | - Elsa Dent
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
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204
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Kehler DS, Milic J, Guaraldi G, Fulop T, Falutz J. Frailty in older people living with HIV: current status and clinical management. BMC Geriatr 2022; 22:919. [PMID: 36447144 PMCID: PMC9708514 DOI: 10.1186/s12877-022-03477-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022] Open
Abstract
This paper will update care providers on the clinical and scientific aspects of frailty which affects an increasing proportion of older people living with HIV (PLWH). The successful use of combination antiretroviral therapy has improved long-term survival in PLWH. This has increased the proportion of PLWH older than 50 to more than 50% of the HIV population. Concurrently, there has been an increase in the premature development of age-related comorbidities as well as geriatric syndromes, especially frailty, which affects an important minority of older PLWH. As the number of frail older PLWH increases, this will have an important impact on their health care delivery. Frailty negatively affects a PLWH's clinical status, and increases their risk of adverse outcomes, impacting quality of life and health-span. The biologic constructs underlying the development of frailty integrate interrelated pathways which are affected by the process of aging and those factors which accelerate aging. The negative impact of sarcopenia in maintaining musculoskeletal integrity and thereby functional status may represent a bidirectional interaction with frailty in PLWH. Furthermore, there is a growing body of literature that frailty states may be transitional. The recognition and management of related risk factors will help to mitigate the development of frailty. The application of interdisciplinary geriatric management principles to the care of older PLWH allows reliable screening and care practices for frailty. Insight into frailty, increasingly recognized as an important marker of biologic age, will help to understand the diversity of clinical status occurring in PLWH, which therefore represents a fundamentally new and important aspect to be evaluated in their health care.
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Affiliation(s)
- D. Scott Kehler
- grid.55602.340000 0004 1936 8200Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS Canada ,grid.55602.340000 0004 1936 8200School of Physiotherapy, Faculty of Health, Dalhousie University, Room 402 Forrest Building 5869 University Ave, B3H 4R2, PO Box 15000 Halifax, NS Canada
| | - Jovana Milic
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- grid.7548.e0000000121697570Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tamas Fulop
- grid.86715.3d0000 0000 9064 6198Department of Medicine, Geriatric Division, Research Center On Aging, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Julian Falutz
- grid.63984.300000 0000 9064 4811Division of Geriatric Medicine, Division of Infectious Diseases, Comprehensive HIV Aging Initiative, McGill University Health Center, Montreal, QC Canada
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205
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Aung MN, Moolphate S, Aung TNN, Koyanagi Y, Kurusattra A, Chantaraksa S, Supakankunti S, Yuasa M. Effectiveness of a community-integrated intermediary care (CIIC) service model to enhance family-based long-term care for Thai older adults in Chiang Mai, Thailand: a cluster-randomized controlled trial TCTR20190412004. Health Res Policy Syst 2022; 20:110. [PMID: 36443788 PMCID: PMC9706835 DOI: 10.1186/s12961-022-00911-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Populations around the world are ageing faster, with the majority living in low- and middle-income countries where health and social care are yet to be universal and inclusive for the ageing population. This community-integrated intermediary care (CIIC) model is a novel prevention-based, long-term care model enhancing the family-based care system traditionally practised in Thailand and neighbouring Asian countries, and many low-and middle-income countries globally. This study assessed the effectiveness of the CIIC model in Chiang Mai, Thailand. METHODS The two-arm parallel intervention study was designed as a cluster-randomized controlled trial. The study population at randomization and analysis was 2788 participants: 1509 in six intervention clusters and 1279 in six control clusters. The research protocol was approved by the WHO Research Ethics Review Committee (WHO/ERC ID; ERC.0003064). The CIIC service intervention model is a combination of formal care and informal care in a subdistrict setting consisting of three components: (1) care prevention delivered as community group exercise and home exercise; (2) care capacity-building of the family caregiver; and (3) community respite service. The primary outcome was family caregivers' burden at 6-month follow-up, and secondary outcome was activities of daily living. Analysis applied the intention-to-treat approach using cluster-level analysis via STATA 16 SE. RESULTS Baseline characteristics did not differ between the two arms. Loss of follow up was 3.7%. Mean age of the participants was 69.53 years. Women constituted 60%. The COVID-19 pandemic caused delayed implementation. The proportion of families with reduced caregiver burden at 6-month follow-up was higher among the intervention clusters (mean 39.4%) than control clusters (mean 28.62%). The intervention clusters experienced less functional decline and fewer people with depression. CONCLUSIONS When communities are integrated for preventing care, and families are empowered for giving care, it is possible to secure universal access to health and social care for the older persons, with basic resources mobilized from communities. This study had shown the CIIC model as an effective and potential step to the realization of universal health and long-term care coverage being inclusive of ageing populations in Thailand and globally. TRIAL REGISTRATION This trial was registered at the Thailand Clinical Trial Registry-Trial registration number TCTR20190412004, https://www.thaiclinicaltrials.org/.
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Affiliation(s)
- Myo Nyein Aung
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan.
- Advanced Research Institute for Health Sciences, Juntendo University, Tokyo, 113-8421, Japan.
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan.
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai, 50300, Thailand.
| | - Saiyud Moolphate
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai, 50300, Thailand
| | - Thin Nyein Nyein Aung
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Yuka Koyanagi
- Department of Judo Therapy, Faculty of Medical and Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo, 135-0063, Japan
| | - Akrapon Kurusattra
- Department of Health Service Support, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Sutatip Chantaraksa
- Department of Health Service Support, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Siripen Supakankunti
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan
- Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Motoyuki Yuasa
- Department of Global Health Research, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan
- Faculty of International Liberal Arts, Juntendo University, Tokyo, 113-8421, Japan
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206
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Merchant RA, Chan YH, Aprahamian I, Morley JE. Patterns of participation restriction among older adults at risk of falls and relationship with intrinsic capacity: A latent cluster analysis. Front Med (Lausanne) 2022; 9:1023879. [PMID: 36507507 PMCID: PMC9732451 DOI: 10.3389/fmed.2022.1023879] [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: 08/20/2022] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction The concept of participation restriction was first described by the World Health Organization in 2001 as a component of The International Classification of Functioning, Disability and Health Framework. Both falls and fear of falling (FOF) are associated with social isolation, depression, anxiety, poor quality of life and cognitive impairment resulting in participation restriction. Life-space mobility (LSM) is an important indicator for participation restriction which depends on multiple inter-related factors. We aimed to determine participation patterns using latent cluster analysis (LCA) in older adults at risk of falls, its relationship with intrinsic capacity (IC) and its risk prediction. Methods Cross-sectional study of 154 community dwelling older adults ≥ 60 years with falls or risk of falls was conducted. Questionnaires were administered on demographics, hearing, LSM, frailty (FRAIL scale), anorexia of aging (SNAQ), cognition (Montreal Cognitive Assessment, MoCA), FOF (Falls Efficacy Scale-International), physical function, and assessment for handgrip strength (HGS), gait speed, 5-times sit to stand (STS), vision and times-up-and-go (TUG) were performed. Six IC domains (vision and hearing, cognition, nutrition, mobility and depression) were measured. Results Three pattern of participation cluster were identified, high (n = 63, 40.9%), moderate (n = 83, 53.9%) and low (n = 8, 33 5.2%). Individuals in the high participation cluster were significantly younger, had higher LSM scores and lower FES-I scores, more robust, fewer ADL and IADL limitations, lower prevalence of low HGS, higher gait speed and shorter TUG. In the fully adjusted model compared to the high participation cluster, moderate participation was significantly associated with low MoCA scores (OR 4.2, 95% CI 1.7-10.4, p = 0.02), poor STS (OR 7.1, 95% CI 3.0-17.0, p < 0.001) whereas low participation was associated with anorexia of aging (OR 9.9, 95% CI 1.6-60.9, p = 0.014), poor STS (OR 19.1, 95% CI 2.0-187.5, p = 0.011) and hearing impairment (OR 9.8, 95% CI 1.4-70.8, p = 0.024). Participants with 3 out of 6 IC decline had a probability of greater than 80% to belong to the low/moderate participation class. Discussion Physical function, cognition, hearing and nutrition were significantly associated with low and/or moderate participation class. Future studies are needed to evaluate improvement in participation of those with falls or at risk for falls through restoration of IC.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ivan Aprahamian
- Geriatrics Division, Department of Internal Medicine, Jundiai Medical School, Jundiai, São Paulo, Brazil
| | - John E Morley
- Division of Geriatric Medicine, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
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207
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Normann M, Ekerstad N, Angenete E, Prytz M. Effect of comprehensive geriatric assessment for frail elderly patients operated for colorectal cancer—the colorectal cancer frailty study: study protocol for a randomized, controlled, multicentre trial. Trials 2022; 23:948. [PMID: 36397083 PMCID: PMC9670054 DOI: 10.1186/s13063-022-06883-9] [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: 10/25/2021] [Accepted: 10/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Colorectal cancer (CRC) is the third most common cancer worldwide, with a median age of 72–75 years at diagnosis. Curative treatment usually involves surgery; if left untreated, symptoms may require emergency surgery. Therefore, most patients will be accepted for surgery, despite of high age or comorbidity. It is known that elderly patients suffer higher risks after surgery than younger patients, in terms of complications and mortality. Assessing frailty and offering frail elderly patients individualized treatment according to the comprehensive geriatric assessment (CGA) and care concept has been shown to improve the outcome for frail elderly patients in other clinical contexts. Methods This randomized controlled multicentre trial aims to investigate if CGA and care prior to curatively intended surgery for CRC in frail elderly patients will improve postoperative outcome. All patients ≥ 70 years with surgically curable CRC will be screened for frailty using the Clinical Frailty Scale (CFS-9). Frail patients will be offered inclusion. Randomization is stratified for colon or rectal cancer. Patients in the intervention group are, in addition to standard protocol, treated according to CGA and care. This consists of individualized assessments and interventions, established by a multiprofessional team. Patients in the control group are treated according to best known practice as stipulated by Swedish colorectal cancer treatment guidelines, within an enhanced recovery after surgery (ERAS) setting. The primary outcome is 90-day mortality. Secondary outcomes are the length of hospital stay and total number of hospital days within 3 months, discharge destination, 30-day readmission, ADL, safe medication assessment, CFS-9 score, complications, Health-Related Quality of Life (HRQoL) at 2-month follow-up in comparison to baseline measurements, health economical calculations including cost-effectiveness analysis based on costs of hospital care and primary care, mortality and HRQoL at baseline, 2- and 12-month follow-up and all-cause 1-year mortality. Discussion The trial is the first of its size and extent to investigate intervention with CGA and care prior to surgery for CRC in frail elderly patients. If this addition proves to be favourable, it could have implications on future care of frail elderly patients with CRC. Trial registration ClinicalTrials.gov NCT04358328. Registered on 4 February 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06883-9.
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Affiliation(s)
- Maria Normann
- grid.8761.80000 0000 9919 9582Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.459843.70000 0004 0624 0259Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - Niklas Ekerstad
- grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.459843.70000 0004 0624 0259Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - Eva Angenete
- grid.8761.80000 0000 9919 9582Department of Surgery, SSORG – Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Prytz
- grid.8761.80000 0000 9919 9582Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,grid.459843.70000 0004 0624 0259Department of Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden ,grid.459843.70000 0004 0624 0259Department of Research and Development, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
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Tan V, Chen C, Merchant RA. Association of social determinants of health with frailty, cognitive impairment, and self-rated health among older adults. PLoS One 2022; 17:e0277290. [PMID: 36367863 PMCID: PMC9651553 DOI: 10.1371/journal.pone.0277290] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Recently, the role of social determinants of health on frailty and dementia has received increased attention. The aim of the present study is to explore the association of social determinants on cognitive impairment, frailty, and self-rated health. As health is influenced by many factors, we also examine other health determinants including lifestyle, health seeking behaviour, socio-demographics, and multimorbidity in the analysis. Research design and methods Cross-sectional analysis of the Healthy Older People Everyday (HOPE) study in Singapore was carried out on 998 older adults above the age of 65. We used forward stepwise multivariable logistic and linear regression analyses to assess the association of five health determinants (social determinants, lifestyle, health seeking behaviour, socio-demographics and multimorbidity) on frailty, cognitive impairment, and self-rated health. Results Mean age of participants was 71.1 ± 0.2 years; 154 (15.4%) were cognitively impaired; 430 (43.1%) were pre-frail or frail; mean self-rated health was 80.4 ± 15.6. Social determinants contributed between 29% to 57% of the overall variation found in the full model with all five health determinants adjusted for. Participants with higher education had significantly lower odds of cognitive impairment and frailty. Leisure physical activity was significantly associated with lower odds of frailty and cognitive impairment, and better self-rated health. Discussion and implications Understanding the dynamics of different health determinants is crucial to protect the vulnerable in an ageing population. Our study highlights the need for a multidimensional, multidisciplinary and multisectoral approach in the prevention of frailty, cognitive impairment, and associated disability.
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Affiliation(s)
- Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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209
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Kiselev J, Schaller SJ, Schmidt K, Spies C. Prähabilitation als OP-Vorbereitung bei Patienten mit Frailty. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:697-708. [DOI: 10.1055/a-1760-8244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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210
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Abstract
OBJECTIVE We aimed to evaluate the prevalence, clinical determinants, and consequences (falls and hospitalization) of frailty in older adults with mental illness. DESIGN Retrospective clinical cohort study. SETTING We collected the data in a specialized psychogeriatric ward, in Boston, USA, between July 2018 and June 2019. PARTICIPANTS Two hundred and fourty-four inpatients aged 65 years old and over. MEASUREMENTS Psychiatric diagnosis was based on a multi-professional consensus meeting according to DSM-5 criteria. Frailty was assessed according to two common instruments, that is, the FRAIL questionnaire and the deficit accumulation model (aka Frailty Index [FI]). Multiple linear regression analyses were conducted to evaluate the association between frailty and sample demographics (age, female sex, and non-Caucasian ethnicity) and clinical characteristics (dementia, number of clinical diseases, current infection, number of psychotropic, and non-psychotropic medications in use). Multiple regression between frailty assessments and either falls or number of hospital admissions in the last 6 and 12 months, respectively, were analyzed and adjusted for covariates. RESULTS Prevalence of frailty was high, that is, 83.6% according to the FI and 55.3% according to the FRAIL questionnaire. Age, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty identified by the FRAIL. Dementia, current infection, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty according to the FI. Falls were significantly associated with both frailty instruments. However, we found only a significant association for the number of hospital admissions with the FI. CONCLUSION Frailty is highly prevalent among geriatric psychiatry inpatients. The FRAIL questionnaire and the FI may capture different forms of frailty dimensions, being the former probably more associated with the phenotype model and the latter more associated with multimorbidity.
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Lewis ET, Williamson M, Lewis LP, Ní Chróinín D, Dent E, Ticehurst M, Peters R, Macniven R, Cardona M. The Feasibility of Deriving the Electronic Frailty Index from Australian General Practice Records. Clin Interv Aging 2022; 17:1589-1598. [PMID: 36353269 PMCID: PMC9639370 DOI: 10.2147/cia.s384691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Frailty is a prevalent condition in older adults. Identification of frailty using an electronic Frailty Index (eFI) has been successfully implemented across general practices in the United Kingdom. However, in Australia, the eFI remains understudied. Therefore, we aimed to (i) examine the feasibility of deriving an eFI from Australian general practice records and (ii) describe the prevalence of frailty as measured by the eFI and the prevalence with socioeconomic status and geographic remoteness. Participants and Methods This retrospective analysis included patients (≥70 years) attending any one of >700 general practices utilizing the Australian MedicineInsight data platform, 2017–2018. A 36-item eFI was derived using standard methodology, with frailty classified as mild (scores 0.13–0.24); moderate (0.25–0.36) or severe (≥0.37). Socioeconomic status (Socio-Economic Indexes for Areas (SEIFA) index)) and geographic remoteness (Australian Statistical Geography Standard (ASGC) remoteness areas) were also examined. Results In total, 79,251 patients (56% female) were included, mean age 80.0 years (SD 6.5); 37.4% (95% CI 37.0–37.7) were mildly frail, 16.7% (95% CI 16.4–16.9) moderately frail, 4.8% (95% CI 4.7–5.0) severely frail. Median eFI score was 0.14 (IQR 0.08 to 0.22); maximum eFI score was 0.69. Across all age groups, moderate and severe frailty was significantly more prevalent in females (P < 0.001). Frailty severity increased with increasing age (P < 0.001) and was strongly associated with socioeconomic disadvantage (P < 0.001) but not with geographic remoteness. Conclusion Frailty was identifiable from routinely collected general practice data. Frailty was more prevalent in socioeconomically disadvantaged groups, women and older patients and existed in all levels of remoteness. Routine implementation of an eFI could inform interventions to prevent or reduce frailty in all older adults, regardless of location.
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Affiliation(s)
- Ebony T Lewis
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
- Correspondence: Ebony T Lewis, School of Population Health, Faculty of Medicine & Health, University of New South Wales, Level 3, Samuels Building, Gate 11, Botany Street, Sydney, NSW, 2052, Australia, Tel +612 9065 2068, Email
| | - Margaret Williamson
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Lou P Lewis
- Matraville Medical Centre, Sydney, NSW, Australia
| | - Danielle Ní Chróinín
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Elsa Dent
- Torrens University Australia, Adelaide, SA, Australia
| | - Maree Ticehurst
- Matraville Medical Centre, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruth Peters
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Rona Macniven
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
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Coelho-Júnior HJ, Picca A, Calvani R, Marzetti E. Prescription of resistance training for sarcopenic older adults: Does it require specific attention? Ageing Res Rev 2022; 81:101720. [PMID: 35987322 DOI: 10.1016/j.arr.2022.101720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/09/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
Sarcopenia is an age-related neuromuscular disease characterized by substantial muscle atrophy, dynapenia and/or loss of physical function. Sarcopenia progression increases the risk for numerous negative events, including falls, disability, hospitalization, nursing home placement, and death. As such, this condition is recognized as an important topic in gerontology and geriatrics. The best approach to counteract the development and progression of sarcopenia is actively debated. Resistance training (RT) has received special attention in this context, owing to the large number of studies showing its ability to produce significant improvements in sarcopenia-related parameters. Recommendations to guide RT prescription for older adults with different conditions, including people who have traits of sarcopenia, have been published. Some authors have argued that RT guidelines for older adults are similar to one another, which may indicate that the presence of sarcopenia does not require specific physical exercise programs. However, older people with sarcopenia might present with peculiar physical, biomechanical, physiological, and psychosocial characteristics that, in our view, are not taken into adequate consideration in existing exercise guidelines. Here, we present evidence to support the view that RT prescription for older adults with sarcopenia is complex, multifactorial, and still needs more evidence.
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Affiliation(s)
- Hélio José Coelho-Júnior
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Department of Geriatrics and Orthopedics, Rome, Italy.
| | - Anna Picca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Department of Geriatrics and Orthopedics, Rome, Italy
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Physical frailty as an important indicator of accelerated biological aging in serious mental illnesses. Int Psychogeriatr 2022; 34:955-957. [PMID: 34127170 DOI: 10.1017/s1041610220003713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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214
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Merchant RA, Vathsala A. Healthy aging and chronic kidney disease. Kidney Res Clin Pract 2022; 41:644-656. [PMID: 36328991 PMCID: PMC9731776 DOI: 10.23876/j.krcp.22.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/18/2022] [Accepted: 07/03/2022] [Indexed: 07/30/2023] Open
Abstract
The world population is aging and the prevalence of noncommunicable diseases such as diabetes, hypertension, and chronic kidney disease (CKD) will increase significantly. With advances in medical treatment and public health, the human lifespan continues to outpace the health span in such a way that the last decade of life is generally spent in poor health. In 2015, the World Health Organization defined healthy aging as 'the process of developing and maintaining the functional ability that enables wellbeing in older age.' CKD is increasingly being recognized as a model of accelerated aging and is associated with physical performance decline, cognitive decline, falls and fractures, poor quality of life, loss of appetite, and inflammation. Frailty and dementia are the final pathways and key determinants of disability and mortality independent of underlying disease. CKD, dementia, and frailty share a triangular relationship with synergistic actions and have common risk factors wherein CKD accelerates frailty and dementia through mechanisms such as uremic toxicity, metabolic acidosis and derangements, anorexia and malnutrition, dialysis-related hemodynamic instability, and sleep disturbance. Frailty accelerates glomerular filtration decline as well as dialysis induction in CKD and more than doubles the mortality risk. Anorexia is one of the major causes of protein-energy malnutrition, which is also prevalent in the aging population and warrants screening. Healthcare systems across the world need to have a system in place for the prevention of CKD amongst high-risk older adults, focusing on screening for poor prognostic factors amongst patients with CKD such as frailty, poor appetite, and cognitive impairment and providing necessary person-centered interventions to reverse underlying factors that may contribute to poor outcomes.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anantharaman Vathsala
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore, Singapore
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215
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Relação entre fragilidade física e síndromes geriátricas em idosos da assistência ambulatorial. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao01797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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216
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Cechinel C, Lenardt MH, Rodrigues JAM, Binotto MA, Aristides MM, Kraus R. Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3687. [PMID: 36287400 PMCID: PMC9580989 DOI: 10.1590/1518-8345.6120.3687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/17/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults. METHOD a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes. RESULTS initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01). CONCLUSION 34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.
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Affiliation(s)
- Clovis Cechinel
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Secretaria Municipal de Saúde, Hospital Municipal do Idoso Zilda Arns, Curitiba, PR, Brazil
| | | | | | - Maria Angélica Binotto
- Universidade Estadual do Centro-Oeste, Departamento de Educação Fisica, Irati, PR, Brazil
| | | | - Rosane Kraus
- Universidade Federal do Paraná, Curitiba, PR, Brazil., Fundação Estatal de Atencão a Saúde, Hospital Municipal do Idoso Zilda Arns, Curitiba, PR, Brazil
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217
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Wijnant SRA, Benz E, Luik AI, Rivadeneira F, Voortman T, Brusselle GG, Lahousse L. Frailty Transitions in Older Persons With Lung Function Impairment: A Population-Based Study. J Gerontol A Biol Sci Med Sci 2022; 78:349-356. [PMID: 36226677 PMCID: PMC9951055 DOI: 10.1093/gerona/glac202] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The aging population and its burden on health care systems warrant early detection of patients at risk of functional decline and mortality. We aimed to assess frailty transitions and its accuracy for mortality prediction in participants with impaired spirometry (Preserved Ratio Impaired Spirometry [PRISm] or chronic obstructive pulmonary disease [COPD]). METHODS In participants from the population-based Rotterdam Study (mean age 69.1 ± 8.9 years), we examined whether PRISm (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ≥ 70% and FEV1 < 80%) or COPD (FEV1/FVC < 70%) affected frailty transitions (progression/recovery between frailty states [robust, prefrailty, and frailty], lost to follow-up, or death) using age-, sex- and smoking state-adjusted multinomial regression models yielding odds ratios (OR). Second, we assessed the diagnostic accuracy of frailty score for predicting mortality in participants with COPD using c-statistics. RESULTS Compared to participants with normal spirometry, participants with PRISm were more likely to transit from robust (OR 2.2 [1.2-4.2], p < .05) or prefrailty (OR 2.6 [1.3-5.5], p < .01) toward frailty. Participants with PRISm (OR 0.4 [0.2-0.8], p < .05) and COPD (OR 0.6 [0.4-1.0], NS) were less likely to recover from their frail state, and were more likely to progress from any frailty state toward death (OR between 1.1 and 2.8, p < .01). Accuracy for predicting mortality in participants with COPD significantly improved when adding frailty score to age, sex, and smoking status (90.5 [82.3-89.8] vs 77.9 [67.2-88.6], p < .05). CONCLUSION Participants with PRISm or COPD more often developed frailty with poor reversibility. Assessing physical frailty improved risk stratification for participants with impaired spirometry for predicting increased life years.
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Affiliation(s)
- Sara R A Wijnant
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium,Department of Epidemiology, Erasmus MC―University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Elizabeth Benz
- Department of Epidemiology, Erasmus MC―University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Internal Medicine, Erasmus MC―University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC―University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC―University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC―University Medical Center Rotterdam, Rotterdam, the Netherlands,Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium,Department of Epidemiology, Erasmus MC―University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lies Lahousse
- Address correspondence to: Lies Lahousse, PhD, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium. E-mail:
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218
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de Nooijer K, Van Den Noortgate N, Pype P, Van den Block L, Pivodic L. Palliative care symptoms, concerns and well-being of older people with frailty and complex care needs upon hospital discharge: a cross-sectional study. Palliat Care 2022; 21:173. [PMID: 36203161 PMCID: PMC9540036 DOI: 10.1186/s12904-022-01065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the nature and intensity of palliative care needs of hospitalised older people. We aimed to describe the palliative care symptoms, concerns, and well-being of older people with frailty and complex care needs upon discharge from hospital to home, and to examine the relationship between palliative care symptoms and concerns, and well-being. Methods Cross-sectional study using baseline survey data of a pilot randomised controlled trial. Hospital staff identified patients (≥ 70 years) about to be discharged home, with a clinical frailty score of 5 to 7 and complex needs based on physician-assessment. Patients completed structured interviews, using the Integrated Palliative Care Outcome Scale (IPOS), ICEpop CAPability measure for supportive care (ICECAP-SCM) and IPOS Views on Care quality of life item. We calculated descriptive statistics. Results We assessed 37 older people with complex needs (49% women, mean age 84, standard deviation 6.1). Symptoms rated as causing severe problems were weakness (46%) and poor mobility (40%); 75% reported that their family felt anxious at least occasionally. Of the 17 IPOS items, 41% of patients rated five or more symptoms as causing severe problems, while 14% reported that they were not severely affected by any symptom. 87% expressed feeling supported. There was a negative correlation between symptoms (IPOS) and well-being (ICECAP); r = -0.41. Conclusion We identified a large variety of symptoms experienced by older people identified as having frailty and complex needs upon hospital discharge. Many were severely affected by multiple needs. This population should be considered for palliative care follow-up at home.
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Affiliation(s)
- Kim de Nooijer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, Belgium.
| | - Nele Van Den Noortgate
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Peter Pype
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Lara Pivodic
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
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Acosta Benito MÁ, García Pliego RA, Baena Díez JM, Gorroñogoitia Iturbe A, Herreros Herreros Y, De Hoyos Alonso MDC, Magán Tapia P, Martin Lesende I. [PAPPS update on older people 2022]. Aten Primaria 2022; 54 Suppl 1:102438. [PMID: 36435582 PMCID: PMC9705221 DOI: 10.1016/j.aprim.2022.102438] [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: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.
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220
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Wilkinson TJ, Miksza J, Zaccardi F, Lawson C, Nixon AC, Young HML, Khunti K, Smith AC. Associations between frailty trajectories and cardiovascular, renal, and mortality outcomes in chronic kidney disease. J Cachexia Sarcopenia Muscle 2022; 13:2426-2435. [PMID: 35851589 PMCID: PMC9530530 DOI: 10.1002/jcsm.13047] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/11/2022] [Accepted: 06/25/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Frailty is characterized by the loss of biological reserves and vulnerability to adverse outcomes. In individuals with chronic kidney disease (CKD), numerous pathophysiological factors may be responsible for frailty development including inflammation, physical inactivity, reduced energy intake, and metabolic acidosis. Given that both CKD and frailty incur a significant healthcare burden, it is important to understand the relationship of CKD and frailty in real-world routine clinical practice, and how simple frailty assessment methods (e.g. frailty indexes) may be useful. We investigated the risk of frailty development in CKD and the impact of frailty status on mortality and end-stage kidney disease (ESKD). METHODS A retrospective cohort study using primary care records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics and the UK Office for National Statistics was undertaken in 819 893 participants aged ≥40 years, of which 140 674 had CKD. Frailty was defined using an electronic frailty index, generated electronically from primary care records. Cox proportional hazard and flexible parametric survival models were used to investigate the risk of developing frailty and the effect of frailty on risk of all-cause and cardiovascular mortality, and ESKD. RESULTS The mean age of those with CKD was 77.5 (SD 9.7) years [61.0 (SD 12.1) years in no-CKD group]; 62.0% of the CKD group were female (compared with 53.3% in no-CKD group). The mean estimated glomerular filtration rate of those with CKD was 46.1 (SD 9.9) mL/min/1.73 m2 . The majority of those with CKD (75.3%) were frail [vs. 45.4% in those without CKD (no-CKD)]. Over 3 years (median), 69.5% of those with CKD developed frailty. Compared with no-CKD, those with CKD had increased rates of developing mild (hazard ratio: 1.02; 95% confidence interval: 1.01-1.04), moderate (1.30; 1.26-1.34), and severe (1.50; 1.37-1.65) frailty. Mild (1.22; 1.19-1.24), moderate (1.60; 1.56-1.63), and severe (2.16; 2.11-2.22) frailty was associated with increased rates of all-cause and cardiovascular-related mortality (mild 1.35; 1.31-1.39; moderate 1.96; 1.90-2.02; and severe 2.91; 2.81-3.02). All stages of frailty significantly increased ESKD rates. CONCLUSIONS Frailty is highly prevalent and associated with adverse outcomes in people with CKD, including mortality and risk of ESKD. Preventative interventions should be initiated to mitigate the development of frailty. The use of a simple frailty index, generated electronically from health records, can predict outcomes and may aid prioritization for management of people with frailty.
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Affiliation(s)
- Thomas J Wilkinson
- NIHR Applied Research Collaboration East Midlands, Leicester Diabetes Research Centre, Leicester, UK.,Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Joanne Miksza
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Claire Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Andrew C Nixon
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- NIHR Applied Research Collaboration East Midlands, Leicester Diabetes Research Centre, Leicester, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.,Leicester NIHR Biomedical Research Centre, Leicester, UK
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Savary-Auzeloux I, Jarzaguet M, Migné C, Kemeny JL, Novais-Gameiro L, de Azevedo M, Mathé V, Mariotti F, Langella P, Chatel JM, Dardevet D. Anti-inflammatory Streptococcus thermophilus CNRZ160 limits sarcopenia induced by low-grade inflammation in older adult rats. Front Nutr 2022; 9:986542. [PMID: 36245508 PMCID: PMC9559730 DOI: 10.3389/fnut.2022.986542] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aimsAging is characterized, at the systemic level, by the development of low-grade inflammation, which has been identified as determining sarcopenia by blunting postprandial muscle anabolism. The causes of this “inflammageing” is still not clearly defined. An increased intestinal permeability, a microbiota dysbiosis and subsequent generation of intestinal then generalized inflammation have been hypothesized. The objective of this study was to test in vivo during aging if (1) a chronic low-grade intestinal inflammation can lead to anabolic resistance and muscle loss and (2) if a bacterial strain presenting anti-inflammatory properties could prevent these adverse effects.MethodsYoung adult (6 m) and elderly rats (18 m) received Dextran Sodium Sulfate (DSS) for 28 days to generate low-grade intestinal inflammation, and received (PB1 or PB2 groups) or not (DSS group) one of the two S. Thermophilus strains (5 × 109 CFU/day) previously shown to present an anti-inflammatory potential in vitro. They were compared to pair fed control (PF). Muscle and colon weights and protein synthesis (using 13C Valine) were measured at slaughter. Muscle proteolysis, gut permeability and inflammatory markers were assessed only in old animals by RT-PCR or proteins quantifications (ELISA).ResultsIn both adult and old rats, DSS reduced absolute protein synthesis (ASR) in gastrocnemius muscle [−12.4% (PB1) and −9.5% (PB2) vs. PF, P < 0.05] and increased ASR in colon (+86% and +30.5%, respectively vs. PF, P < 0.05). PB1 (CNRZ160 strain) but not PB2 resulted in a higher muscle ASR as compared to DSS in adults (+18%, P < 0.05), a trend also observed for PB1 in old animals (+12%, P = 0.10). This was associated with a blunted increase in colon ASR. In old rats, PB1 also significantly decreased expression of markers of autophagy and ubiquitin-proteasome pathways vs. DSS groups and improved gut permeability (assessed by Occludin, Zonula Occludens 1 and Claudin 1 expression, P < 0.05) and alleviated systemic inflammation (A2M: −48% vs. DSS, P < 0.05).ConclusionThe loss of muscle anabolism associated with low-grade intestinal inflammation can be prevented by supplementation with anti-inflammatory CNRZ160 strain. We propose that the moderated gut inflammation by CNRZ160 may result in curtailed amino acids (AA) utilization by the gut, and subsequent restored AA systemic availability to support muscle protein accretion. Therefore, CNRZ160 could be considered as an efficient probiotic to modulate muscle mass loss and limit sarcopenia during aging.
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Affiliation(s)
- Isabelle Savary-Auzeloux
- Unité Nutrition Humaine, UMR1019, Université Clermont Auvergne, INRAE, Clermont-Ferrand, France
- *Correspondence: Isabelle Savary-Auzeloux
| | - Marianne Jarzaguet
- Unité Nutrition Humaine, UMR1019, Université Clermont Auvergne, INRAE, Clermont-Ferrand, France
| | - Carole Migné
- MetaboHUB Clermont, Plateforme d'Exploration du Métabolisme, Unité de Nutrition Humaine (UNH), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jean-Louis Kemeny
- Centre Imagerie cellulaire et Santé – CICS - Université Clermont Auvergne, Clermont-Ferrand, France
| | - Lorraine Novais-Gameiro
- Centre Imagerie cellulaire et Santé – CICS - Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marcela de Azevedo
- Université Paris Saclay, AgroParisTech, UMR1319 MICALIS, INRAE, Jouy en Josas, France
| | - Véronique Mathé
- Université Paris-Saclay, AgroParisTech, UMR PNCA, INRAE, Paris, France
| | - François Mariotti
- Université Paris-Saclay, AgroParisTech, UMR PNCA, INRAE, Paris, France
| | - Philippe Langella
- Université Paris Saclay, AgroParisTech, UMR1319 MICALIS, INRAE, Jouy en Josas, France
| | - Jean-Marc Chatel
- Université Paris Saclay, AgroParisTech, UMR1319 MICALIS, INRAE, Jouy en Josas, France
| | - Dominique Dardevet
- Unité Nutrition Humaine, UMR1019, Université Clermont Auvergne, INRAE, Clermont-Ferrand, France
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Lv C, Shi W, Pan T, Li H, Peng W, Xu J, Deng J. Exploration of Aging-Care Parameters to Predict Mortality of Patients Aged 80-Years and Above with Community-Acquired Pneumonia. Clin Interv Aging 2022; 17:1379-1391. [PMID: 36164658 PMCID: PMC9509012 DOI: 10.2147/cia.s382347] [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: 07/14/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The study explores a clinical model based on aging-care parameters to predict the mortality of hospitalized patients aged 80-year and above with community-acquired pneumonia (CAP). Patients and methods In this study, four hundred and thirty-five CAP patients aged 80-years and above were enrolled in the Central Hospital of Minhang District, Shanghai during 01,01,2018–31,12,2021. The clinical data were collected, including aging-care relevant factors (ALB, FRAIL, Barthel Index and age-adjusted Charlson Comorbidity Index) and other commonly used factors. The prognostic factors were screened by multivariable logistic regression analysis. Receiver operating characteristic (ROC) curves were used to predict the mortality risk. Results Univariate analysis demonstrated that several factors, including gender, platelet distribution width, NLR, ALB, CRP, pct, pre-albumin, CURB-65, low-density, lipoprotein, Barthel Index, FRAIL, leucocyte count, neutrophil count, lymphocyte count and aCCI, were associated with the prognosis of CAP. Multivariate model analyses further identified that CURB-65 (p < 0.0001, OR = 5.44, 95% CI = 3.021–10.700), FRAIL (p < 0.0001, OR = 5.441, 95% CI = 2.611–12.25) and aCCI (p = 0.003, OR = 1.551, 95% CI = 1.165–2.099) were independent risk factors, whereas ALB (p = 0.005, OR = 0.871, 95% CI = 0.788–0.957) and Barthel Index (p = 0.0007, OR = 0.958, 95% CI = 0.933–0.981) were independent protective factors. ROC curves were plotted to further predict the in-hospital mortality and revealed that combination of three parameters (Barthel Index+ FRAI +CURB-65) showed the best performance. Conclusion This study showed that CURB-65, frailty and aCCI were independent risk factors influencing prognosis. In addition, ALB and Barthel Index were protective factors for in CAP patients over 80-years old. AUC was calculated and revealed that combination of three parameters (Barthel Index+ FRAI +CURB-65) showed the best performance.
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Affiliation(s)
- Chunxin Lv
- Oncology Department, Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Wen Shi
- Department of Dermatology, Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Teng Pan
- The 3rd Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China.,Richard Dimbleby Laboratory of Cancer Research, School of Cancer & Pharmaceutical Sciences, King's College London, London, SE1 1UL, UK
| | - Houshen Li
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London, London, UK
| | - Weixiong Peng
- Hunan Zixing Artificial Intelligence Technology Group Co, Ltd, Changsha City, Hunan Province, People's Republic of China
| | - Jiayi Xu
- Geriatric Department, Fudan University, Minhang Hospital, Shanghai, People's Republic of China
| | - Jinhai Deng
- Richard Dimbleby Laboratory of Cancer Research, School of Cancer & Pharmaceutical Sciences, King's College London, London, SE1 1UL, UK.,Hunan Zixing Artificial Intelligence Technology Group Co, Ltd, Changsha City, Hunan Province, People's Republic of China
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Potential association between frailty and pTau in community-dwelling older adults. BMC Geriatr 2022; 22:770. [PMID: 36162981 PMCID: PMC9511781 DOI: 10.1186/s12877-022-03454-0] [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: 04/24/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Frailty is a geriatric syndrome characterized by a decline in physiological reserves, and multiple factors contribute to the occurrence and development of frailty. Growing evidence supports a strong link and overlap between frailty and cognitive impairment, but the mechanisms involved have not yet been fully elucidated. Aim To identify associations between 12 plasma cognition-related biomarkers and frailty in community-dwelling older adults. Methods A total of 375 participants (age 70.9 ± 5.8, 165 men and 210 women) were included in this study. Frailty was assessed using the modified Fried frailty phenotype. Participants were divided into not-frail group (n = 313) and frail group (n = 62). Twelve plasma cognitive biomarkers were detected by enzyme-linked immunosorbent assay (ELISA). Multinomial logistic regression was used to explore the association between different biomarkers and frailty status. Results Among the 12 biomarkers, only pTau was higher in frail individuals than in their not-frail peers (471.3 ± 58.1 pg/mL vs. 451.9 ± 61.1 pg/mL, p = 0.022). No other biomarkers had any significant association with frailty, including total-Tau (tTau), neurofilament light (NFL), amyloid-β 40 (Aβ40), amyloid-β 40 (Aβ42), S100 calcium binding protein B (S100B), visinin-like protein 1 (VLP-1), Alzheimer-associated neuronal thread protein (AD7cNTP), β-amyloid precursor protein (βAPP), chitinase-3-like-1 (CHI3L1), soluble complement receptor 1 (sCR1) and heart-type fatty acid binding protein (hFABP). Furthermore, pTau was compared between negative and positive subject groups for each individual criterion of frailty. Significantly higher levels of pTau were observed in those who were positive for the criteria of low grip strength (451.2 ± 61.4 pg/mL vs. 469.1 ± 57.6 pg/mL, p = 0.019), exhaustion (451.2 ± 61.6 pg/mL vs. 466.4 ± 58.4 pg/mL, p = 0.035) and low physical activity (451.1 ± 60.7 pg/mL vs. 465.7 ± 60.7 pg/mL, p = 0.034) when compared to those who were negative for each corresponding criterion. Finally, in the multivariable-adjusted analysis, the association between pTau and frailty was statistically significantly associated (OR: 1.40, 95% CI: 1.04–1.89), even after adjusting. Conclusions The present study found a potential association between pTau and frailty. Future works should monitor the longitudinal trajectory of changes of pTau concentrations in frailty older adults. A better understanding of the molecular mechanisms behind will contribute to biomarker research in frailty.
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Ye B, Wang Y, Chen H, Chen Y, Yan H, Fu H, Bao Z, Gao J. Development and Validation of the Chinese Frailty Screening Scale: A Study among Community-Dwelling Older Adults in Shanghai. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811811. [PMID: 36142085 PMCID: PMC9517433 DOI: 10.3390/ijerph191811811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Based on intrinsic capacity (IC) as defined by the World Health Organization, an accelerated decline may be an important precursor of frailty among older adults; however, there is a lack of validated instruments that both screen for frailty and monitor IC. This study aims to develop a comprehensive and acculturative frailty screening scale to determine healthy aging among older Chinese adults. SETTING AND PARTICIPANTS A cross-sectional and a cohort study both based on community-dwelling older adults aged 65 and older. METHODS This study mainly consisted of two parts. First, the selection and revision of 20 items related to frailty based on a literature review, expert consultation, and stakeholder analysis; second, a cross-sectional study was conducted to simplify the scale and test the reliability and validity of the new frailty screening tool. The fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale, the Tilburg frailty indictor (TFI), and a 49-item Frailty Index (FI) were investigated as criteria. Additionally, a cohort study in Shanghai was conducted to verify the predictive validity of the new screening scale. The disability measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and all-cause mortality were documented as outcomes. RESULTS A 10-item Chinese frailty screening scale (CFSS-10) was successfully developed and validated. It presented a Cronbach's α of 0.63 and an intraclass correlation coefficient of 0.73, which indicated good reliability. Taking the other frailty tools as criteria, Kappa values of 0.54-0.58 and an area under the curve of 0.87-0.91 showed good validity. The results of the log-binomial and Poisson models showed a high score, which predicted a higher risk of disability and all-cause mortality. An optimal cut-off point of 5 gave an excellent prediction of one-year disability. CONCLUSIONS The CFSS-10 has good validity and reliability as a quick and acculturative frailty screening scale for community-dwelling older adults in Shanghai. It may also supplement existing frailty screening tools.
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Affiliation(s)
- Bo Ye
- Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yi Wang
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Hao Chen
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Yingwei Chen
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Huihui Yan
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Hua Fu
- School of Public Health, Fudan University, Shanghai 200032, China
- Health Communication Institute, Fudan University, Shanghai 200032, China
| | - Zhijun Bao
- Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Shanghai 200040, China
| | - Junling Gao
- School of Public Health, Fudan University, Shanghai 200032, China
- Collaborative Innovation Cooperative Unit, National Clinical Research Center for Geriatric Diseases, Shanghai 200032, China
- Core Unit, Shanghai Clinical Research Center for Geriatric Diseases, Shanghai 200032, China
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225
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Álvarez-Bustos A, Rodríguez-Sánchez B, Carnicero-Carreño JA, Sepúlveda-Loyola W, Garcia-Garcia FJ, Rodríguez-Mañas L. Healthcare cost expenditures associated to frailty and sarcopenia. BMC Geriatr 2022; 22:747. [PMID: 36096728 PMCID: PMC9469617 DOI: 10.1186/s12877-022-03439-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Frailty and sarcopenia have been related with adverse events, including hospitalization. However, its combined effect with hospitalization-related outcomes, including costs, has not been previously investigated. Our purpose was to explore how frailty, sarcopenia and its interaction could impact on healthcare expenditures. Methods 1358 community-dwelling older adults from the Toledo Study of Healthy Ageing (TSHA) were included. Sarcopenia was measured using the Foundation for the National Institutes of Health criteria fitted to our cohort. Frailty was defined according to Frailty Trait Scale 5 (FTS5) and the Frailty Index fitted to the cut-off points of TSHA population. Hospitalization costs were taken from hospital records and costs were attributed according to Diagnostic-Related Groups, using as the cost base year 2015. Two-part regression models were used to analyze the relationship between frailty and sarcopenia and hospital admission, number of hospitalizations, length of stay and hospitalization costs. Results Sarcopenia was associated only with the probability of being admitted to hospital. Frailty was also associated with higher hospital use, regardless of the frailty tool used, but in addition increased hospital admission costs at follow-up by 23.72% per year and by 19.73% in the full model compared with non-frail individuals. The presence of sarcopenia did not increase the costs of frailty but, by opposite, frailty significantly increased the costs in people with sarcopenia, reaching by 46–56%/patient/year at follow-up. Older adults with frailty and sarcopenia had a higher risk of hospitalization, disregarding the tool used to assess frailty, and higher hospitalization costs (FTS5) in the full model, at the cross-sectional and at the follow-up level. Conclusions Frailty is associated with increased hospitalization costs and accounts for the potential effects of sarcopenia. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03439-z.
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Affiliation(s)
- Alejandro Álvarez-Bustos
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Beatriz Rodríguez-Sánchez
- Department of Applied Economics, Public Economics and Political Economy, Faculty of Law, University Complutense of Madrid, Madrid, Spain
| | - Jose A Carnicero-Carreño
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
| | - Walter Sepúlveda-Loyola
- Faculty of Health and Social Sciences, Universidad de Las Americas, Santiago, Chile.,Masters and PhD Programme in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil
| | - Francisco J Garcia-Garcia
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain.,Geriatrics Department, Virgen del Valle Hospital, Toledo, Spain
| | - Leocadio Rodríguez-Mañas
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain. .,Geriatrics Department, Hospital Universitario de Getafe, Getafe University Hospital, Ctra de Toledo km 12,500, 28905, Getafe, Spain.
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226
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Frailty in Nursing Homes-A Prospective Study Comparing the FRAIL-NH and the Clinical Frailty Scale. J Am Med Dir Assoc 2022; 23:1717.e1-1717.e8. [PMID: 36065096 DOI: 10.1016/j.jamda.2022.07.028] [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: 05/04/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Frailty is common in nursing home (NH) residents, but its prevalence in German institutions is unknown. Valid and easy-to-use screening tools are needed to identify frail residents. We used the FRAIL-NH scale and the Clinical Frailty Scale (CFS) to (1) obtain the prevalence of frailty, (2) investigate the agreement between both instruments, and (3) evaluate their predictive validity for adverse health events in German NH residents. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS German NH residents (n = 246, age 84 ± 8 years, 67% female). METHODS Frailty status was categorized according to FRAIL-NH (nonfrail, frail, most frail) and CFS (not frail, mild to moderately frail, severely frail). Agreement between instruments was examined by Spearman correlation, an area under the receiver operating characteristic curve (AUC) with 95% CI, and sensitivity and specificity using the "most frail" category of FRAIL-NH as reference standard. Adverse health events (death, hospital admissions, falls) were recorded for 12 months, and multivariate cox and logistic regression models calculated. RESULTS According to FRAIL-NH, 71.1% were most frail, 26.4% frail, and 2.5% nonfrail. According to CFS, 66.3% were severely frail, 26.8% mild to moderately frail, and 6.9% not frail. Both scales correlated significantly (r = 0.78; R2 = 60%). The AUC was 0.92 (95% CI 0.88-0.96). Using a CFS cutoff of 7 points, sensitivity was 0.90 and specificity 0.92. The frailest groups according to both instruments had an increased risk of death [FRAIL-NH hazard ratio (HR) 2.19, 95% CI 1.21-3.99; CFS HR 2.56, 95% CI 1.43-4.58] and hospital admission [FRAIL-NH odds ratio (OR) 1.95, 95% CI 1.06-3.58; CFS OR 1.79, 95% CI 1.01-3.20] compared to less frail residents. The FRAIL-NH predicted recurrent faller status (OR 2.57, 95% CI 1.23-5.39). CONCLUSIONS AND IMPLICATIONS Frailty is highly prevalent in German NH residents. Both instruments show good agreement despite different approaches and are able to predict adverse health outcomes. Based on our findings and because of its simple administration, CFS may be an alternative to FRAIL-NH for assessing frailty in NHs.
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227
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Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, Aguilar-Navarro S, Alexander NB, Becker C, Blain H, Bourke R, Cameron ID, Camicioli R, Clemson L, Close J, Delbaere K, Duan L, Duque G, Dyer SM, Freiberger E, Ganz DA, Gómez F, Hausdorff JM, Hogan DB, Hunter SMW, Jauregui JR, Kamkar N, Kenny RA, Lamb SE, Latham NK, Lipsitz LA, Liu-Ambrose T, Logan P, Lord SR, Mallet L, Marsh D, Milisen K, Moctezuma-Gallegos R, Morris ME, Nieuwboer A, Perracini MR, Pieruccini-Faria F, Pighills A, Said C, Sejdic E, Sherrington C, Skelton DA, Dsouza S, Speechley M, Stark S, Todd C, Troen BR, van der Cammen T, Verghese J, Vlaeyen E, Watt JA, Masud T. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022; 51:afac205. [PMID: 36178003 PMCID: PMC9523684 DOI: 10.1093/ageing/afac205] [Citation(s) in RCA: 351] [Impact Index Per Article: 175.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. OBJECTIVES to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. METHODS a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. RECOMMENDATIONS all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Nathalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maw Pin Tan
- Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sara Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neil B Alexander
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, MI, USA
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Hubert Blain
- Department of Geriatrics, Montpellier University hospital and MUSE, Montpellier, France
| | - Robbie Bourke
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney. Department of Medicine (Neurology) and Neuroscience and Mental Health, Sydney, NSW, Australia
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Lindy Clemson
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Leilei Duan
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Gustavo Duque
- Research Institute of the McGill University HealthCentre, Montreal, Quebec, Canada
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Ellen Freiberger
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Fernando Gómez
- Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Center, University Caldas, Manizales, Colombia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David B Hogan
- Brenda Strafford Centre on Aging, O’BrienInstitute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan M W Hunter
- School of Physical Therapy, Faculty of Health Sciences, Elborn College, University of Western Ontario, London, ON, Canada
| | - Jose R Jauregui
- Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nellie Kamkar
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Rose-Anne Kenny
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Sarah E Lamb
- Faculty of Health and Life Sciences, Mireille Gillings Professor of Health Innovation, Medical School Building, Exeter, England, UK
| | | | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, England, UK
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Louise Mallet
- Department of Pharmacy, Faculty of Pharmacy, McGill University Health Center, Université de Montréal, Montreal, QC, Canada
| | - David Marsh
- University College London, London, England, UK
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rogelio Moctezuma-Gallegos
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
- Geriatric Medicine Program, Tecnologico de Monterrey, School of Medicine and Health Sciences. Monterrey, Nuevo León, Mexico
| | - Meg E Morris
- Healthscope and Academic and Research Collaborative in Health (ARCH), La Trobe University, Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Monica R Perracini
- Master’s and Doctoral programs in Physical Therapy, Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, QLD, Australia
| | - Catherine Said
- Western Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- Melbourne School of Health Sciences The University of Melbourne, Parkville, Australia
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Dawn A Skelton
- School of Health and Life Sciences, Research Centre for Health (ReaCH), Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, UK
| | - Sabestina Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Susan Stark
- Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Bruce R Troen
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University of Buffalo; Research Service, Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
| | - Tischa van der Cammen
- Department of Human-Centred Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joe Verghese
- Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jennifer A Watt
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tahir Masud
- Department of Geriatric Medicine, The British Geriatrics Society, Nottingham University Hospitals NHS Trust, Nottingham, England, UK
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Irshad CV, Muhammad T, Balachandran A, Sekher TV, Dash U. Early life factors associated with old age physical frailty: evidence from India. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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229
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Canbolat Seyman C, Sara Y. What do orthopaedic nurses think about frailty? A qualitative analysis. Collegian 2022. [DOI: 10.1016/j.colegn.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fernandes IG, Macedo MCGS, Souza MA, Silveira-Nunes G, Barbosa MCSA, Queiroz ACC, Vieira ER, Barbosa AC. Does 8-Week Resistance Training with Slow Movement Cadenced by Pilates Breathing Affect Muscle Strength and Balance of Older Adults? An Age-Matched Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10849. [PMID: 36078566 PMCID: PMC9518437 DOI: 10.3390/ijerph191710849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
This study investigated the balance and dorsiflexion strength of older adults after eight weeks of resistance training, with the exercise velocity cadenced by the Pilates breathing technique and the volume modulated by the session duration. Forty-four older adults were divided into two groups: resistance training (TR; n = 22) and resistance training with the Pilates breathing technique cadencing all exercises (TR + P; n = 22), both during eight weeks. The total exercising volume was controlled by time of execution (50 min/session). The dorsiflexion strength and balance were assessed. The RT group showed higher dorsiflexion strength after the protocol: Right (RT = 29.1 ± 7.7 vs. RT + P = 22.9 ± 5.2, p = 0.001) and Left (RT = 29.5 ± 6.9 vs. RT + P = 24.0 ± 5.2, p = 0.001). All balance parameters were improved in RT + P group compared to its own baseline: Path Length (cm) (pre = 71.0 ± 14.3 vs. post = 59.7 ± 14.3, p = 0.003); Sway Velocity (cm/s) (pre = 3.6 ± 0.7; post = 2.9 ± 0.7; p = 0.001); Sway Area (cm2) (pre = 8.9 ± 5.3 vs. post = 5.7 ± 2.1, p = 0.003); Excursion Medio Lateral (cm) (pre = 3.0 ± 0.7 vs. post = 2.6 ± 0.5 cm, p = 0.002); and Excursion AP (cm) (pre = 3.6 ± 1.4 vs. post = 2.8 ± 0.7 cm, p = 0.010). Resistance training using slower velocity movement cadenced by Pilates breathing technique produced balance improvements compared to baseline (moderate to large effect sizes), but no between-group effect was observed at the end of the protocol. The dorsiflexion strength was higher in the RT group compared to RT + P group.
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Affiliation(s)
- Ilha G. Fernandes
- Postgraduate Program in Physical Education, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
- Musculoskeletal Research Group (NIME), Department of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
| | - Maria C. G. S. Macedo
- Musculoskeletal Research Group (NIME), Department of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
| | - Matheus A. Souza
- Postgraduate Program in Physical Education, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
- Musculoskeletal Research Group (NIME), Department of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
| | - Gabriela Silveira-Nunes
- Musculoskeletal Research Group (NIME), Department of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
| | - Michelle C. S. A. Barbosa
- Musculoskeletal Research Group (NIME), Department of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
| | - Andreia C. C. Queiroz
- Postgraduate Program in Physical Education, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
- Department of Physical Education, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
| | - Edgar R. Vieira
- Department of Physical Therapy, Florida International University, Miami, FL 33199, USA
| | - Alexandre C. Barbosa
- Postgraduate Program in Physical Education, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
- Musculoskeletal Research Group (NIME), Department of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora 35020-360, MG, Brazil
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Fernandes AL, Pereira RMR. Frailty in the context of COVID-19 pandemic: A life-threatening condition. Front Med (Lausanne) 2022; 9:965562. [PMID: 36091682 PMCID: PMC9451136 DOI: 10.3389/fmed.2022.965562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
The pandemic outbreak of coronavirus disease 2019 (COVID-19) has caused emerging challenges for healthcare systems regarding the assistance to the older adult population which, added to the increased life expectancy, may be exposing frail older adults to an increased risk of unfavorable health outcomes. Frailty has a pathogenesis of multifactorial etiology and is defined as a condition characterized by progressive decline in physiological function, weakness, decreased strength, and reduced resilience to stressors, leading to vulnerability and an increased risk of fractures, falls, institutionalization, and death. In the context of COVID-19, frail older adults accounted for approximately 51% of hospitalized patients with confirmed cases and elevated risk of mortality in-hospital. In addition, frailty may be associated with recent “excess mortality” reported by the World Health Organization (WHO) in terms of the full death toll associated directly (due to the disease) or indirectly (due to the pandemic's impact on health systems and society) to COVID-19. Therefore, this mini review aimed to provide a summarized discussion from meta-analyses data regarding the impact of frailty in community-dwelling older adults hospitalized with COVID-19 on short-term mortality risk.
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Swartz MC, Lewis ZH, Deer RR, Stahl AL, Swartz MD, Christopherson U, Basen-Engquist K, Wells SJ, Silva HC, Lyons EJ. Feasibility and Acceptability of an Active Video Game-Based Physical Activity Support Group (Pink Warrior) for Survivors of Breast Cancer: Randomized Controlled Pilot Trial. JMIR Cancer 2022; 8:e36889. [PMID: 35994321 PMCID: PMC9446134 DOI: 10.2196/36889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Survivors of breast cancer with functional limitations have a 40% higher mortality rate than those without. Despite the known benefits of physical activity (PA), <40% of survivors of breast cancer meet the recommendations for PA. The combination of active video games (AVGs) and group-based PA counseling may hold potential for motivating PA adoption and improving physical function. However, this method has not been widely studied in survivors of breast cancer. OBJECTIVE We aimed to determine the feasibility and acceptability of a group AVG-based multicomponent PA intervention and estimate its effect size and variability on PA and physical function in female survivors of breast cancer in a clinic setting. METHODS Female survivors of breast cancer (N=60) were recruited through the clinic and randomly assigned to the intervention group (12 weekly sessions) or the control group (existing support group). The intervention group received game-based pedometers and participated in weekly group AVG sessions, PA behavioral coaching, and survivorship navigation discussions. A participant manual with weekly reflection worksheets was provided to reinforce the coaching lessons and promote self-led PA. The control group received conventional pedometers and participated in an existing breast cancer support group. Feasibility was assessed by enrollment rate (≥50%), retention rate (≥80%), group attendance rate (75% attending ≥9 sessions [intervention group]), and the number of technological issues and adverse events. Acceptability was measured by participants' attitudes (from strongly disagree=1 to strongly agree=5) toward the use of AVGs and the overall program. The outcomes included PA (accelerometers) and physical function (Short Physical Performance Battery and gait speed). Analysis of covariance was used to determine differences in PA and physical function between the groups. The Cohen d and its 95% CI determined the effect size and variability, respectively. All the analyses followed the intention-to-treat principle. RESULTS Participants were an average of 57.4 (SD 10.5) years old, 70% (42/60) White, and 58% (35/60) off treatment. The enrollment rate was 55.9% (66/118). Despite substantial long-term hurricane-related disruptions, we achieved an 80% (48/60) retention. The intervention group's attendance rate was 78% (14/18), whereas the control group's attendance rate was 53% (9/17). Of the 26 game-based pedometers, 3 (12%) were damaged or lost. No study-related adverse events occurred. Acceptability items were highly rated. Steps (β=1621.64; P=.01; d=0.72), Short Physical Performance Battery (β=.47; P=.01; d=0.25), and gait speed (β=.12; P=.004; d=0.48) had a significant intervention effect. CONCLUSIONS The intervention was feasible and acceptable in this population despite the occurrence of a natural disaster. Pilot results indicate that group AVG sessions, PA coaching, and survivorship navigation produced moderate effects on PA and physical functioning. AVGs with PA counseling can potentially be used in existing breast cancer support groups to encourage PA and improve physical function. TRIAL REGISTRATION ClinicalTrials.gov NCT02750241; https://clinicaltrials.gov/ct2/show/NCT02750241.
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Affiliation(s)
- Maria C Swartz
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zakkoyya H Lewis
- Department of Kinesiology & Health Promotion, California State Polytechnic University, Pomona, Pomona, CA, United States
| | - Rachel R Deer
- Department of Nutrition, Metabolism and Rehabilitation Sciences, Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States
| | - Anna L Stahl
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Ursela Christopherson
- Department of Nutrition, Metabolism and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stephanie J Wells
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - H Colleen Silva
- Department of Surgery, The University of Texas Medical Branch, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism and Rehabilitation Sciences, Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States
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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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Liu C, Xu H, Chen L, Zhu M. Exercise and Nutritional Intervention for Physical Function of the Prefrail: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:1431.e1-1431.e19. [PMID: 35697124 DOI: 10.1016/j.jamda.2022.05.007] [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: 01/13/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function. DESIGN Systematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197). SETTING AND PARTICIPANTS Randomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions. METHODS Ovid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values). RESULTS We included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21‒1.42, I2 = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70‒2.34, I2 = 6%), and gait speed (n = 4, standard weighted mean difference -1.06, 95% CI -1.87 to -0.25, I2 = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index. CONCLUSIONS AND IMPLICATIONS Our systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults.
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Affiliation(s)
- Chengyu Liu
- Department of General Surgery, Department of Hepatobiliopancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Hongxuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Liru Chen
- Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Mingwei Zhu
- Department of General Surgery, Department of Hepatobiliopancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China; Department of Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China.
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235
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Daou T, Abi Kharma J, Daccache A, Bassil M, Naja F, Rahi B. Association between Lebanese Mediterranean Diet and Frailty in Community-Dwelling Lebanese Older Adults-A Preliminary Study. Nutrients 2022; 14:nu14153084. [PMID: 35956260 PMCID: PMC9370448 DOI: 10.3390/nu14153084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
Discrepancies in the characteristics of the food components of a Mediterranean diet exist based on the country of origin. In Lebanon, a traditional Mediterranean diet emphasizes the high intakes of fruits (including dried), vegetables, burghol, and dairy products. Therefore, this cross-sectional study aimed to explore the association between adherence to the Lebanese Mediterranean diet (LMD) and frailty among older adults in Lebanon. A total of 112 community-dwelling older adults aged ≥65 years were recruited. Demographic and clinical characteristics were collected through face-to-face interviews. A 61-item food frequency questionnaire (FFQ) was used to collect dietary intake data, and adherence to LMD was calculated. Physical frailty was defined by the presence of three out of the five criterion: weight loss, weakness, exhaustion, slowness, and low activity. Binary logistic regression was used to examine the relationship between LMD adherence and frailty while adjusting for several confounders. The participants’ mean age was 73 ± 12.8 and 65% were females. Sixteen (14.3%) individuals were identified as frail. Frail individuals were significantly older (p = 0.001), depressed (p < 0.001), at risk of cognitive impairment (p = 0.006), and reported polypharmacy (p = 0.003). No significant association was found between LMD adherence and frailty in fully adjusted models (OR = 0.195; 95% CI: 0.033−1.154; p = 0.071 when categorical and OR = 0.856; 95% CI: 0.668−1.097; p = 0.218 when continuous). We also performed additional analyses with a modified frailty index where house chores were not considered as part of leisure activities of the physical activity criterion. The results showed that a higher LMD adherence was associated with a significantly decreased frailty prevalence (OR = 0.123, 95% CI: 0.022−0.676, p = 0.016 when categorical and OR = 0.773, 95% CI 0.608−0.983, p = 0.036). Larger, longitudinal studies are needed to clarify the relationship between the adherence to the Lebanese Mediterranean diet and frailty in Lebanese older adults.
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Affiliation(s)
- Tracy Daou
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Joelle Abi Kharma
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Alexandra Daccache
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Maya Bassil
- Department of Human Nutrition, College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, Research Institute of Medical & Health Sciences (RIMHS), College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Berna Rahi
- Department of Family and Consumer Sciences, College of Health Sciences, Sam Houston State University, Huntsville, TX 77304, USA
- Correspondence: ; Tel.: +1-936-294-1986
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Venegas-Sanabria LC, Cavero-Redondo I, Martínez-Vizcaino V, Cano-Gutierrez CA, Álvarez-Bueno C. Effect of multicomponent exercise in cognitive impairment: a systematic review and meta-analysis. BMC Geriatr 2022; 22:617. [PMID: 35879665 PMCID: PMC9316334 DOI: 10.1186/s12877-022-03302-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multicomponent physical exercise is the most recommended type of physical intervention in older adults. Experimental data suggest the relevance of the muscle-brain axis and the relationship between muscle contraction and release of brain-derived neurotrophic factor, however, the impact of this relationship on cognition remains unclear, especially in people with diagnosis of cognitive impairment. This study assesses the effect of multicomponent physical exercise on global cognition in people with mild cognitive impairment or dementia. METHODS Randomized controlled trials published until January 2021 were searched across three electronic databases (PubMed, Scopus, and Cochrane Database). Data about exercises included in the multicomponent intervention (endurance, strength, balance, or flexibility), the inclusion of aerobic exercise, and the change in global cognition were extracted. The effect size was represented as a standardized mean difference. Risk of bias was assessed by the RoB2 tool. RESULTS A total of 8 studies were included. The overall effect size suggested an effect of multicomponent exercise on global cognition. However, the subgroup analysis showed an effect only when aerobic exercise was included in the intervention. No effect when mild cognitive impairment and dementia were assessed separately was found. CONCLUSION This study suggests that multicomponent physical exercise could have an effect on global cognition in people with mild cognitive impairment or dementia only when aerobic exercise is included in the intervention. Our results support the inclusion of structured physical exercise programs in the management of people with cognitive impairment.
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Affiliation(s)
- Luis Carlos Venegas-Sanabria
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Instituto Rosarista para el Estudio del Envejecimiento y la Longevidad, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Hospital Universitario Mayor, Méderi, Bogotá, Colombia
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.
- Rehabilitation in Health Research Center (CIRES), Universidad de Las Américas, Santiago, Chile.
- Facultad de Enfermería de Cuenca, C/ Santa Teresa Jornet, s/n. Cuenca, Spain.
| | - Vicente Martínez-Vizcaino
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - Carlos Alberto Cano-Gutierrez
- Aging Institute, Medicine School, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Internal Medicine, Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Politécnica Y Artística del Paraguay, Asunción, Paraguay
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Tan LF, Chan YH, Merchant RA. Association between dentition and frailty and cognitive function in community-dwelling older adults. BMC Geriatr 2022; 22:614. [PMID: 35879659 PMCID: PMC9310464 DOI: 10.1186/s12877-022-03305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To evaluate dentition status amongst community-dwelling older adults and its association with frailty and cognitive impairment. Methodology One thousand forty-seven community-dwelling older adults aged ≥65 years were surveyed in an epidemiologic population-based cohort study in Singapore between April 2015 and August 2016. Data on demographics, dentition status, chronic diseases, activities and instrumental activities on daily-living, cognition (age- and education-specific MMSE cut-offs), frailty (FRAIL scale), perceived health and functional status were collected. Multiple logistic regression was performed to examine the association between dentition, frailty and cognition. Results Mean age of participants was 71.2 ± 5.5 years. The prevalence of denture use was 70.7% and edentulism 7.9%. Compared to edentulousness, having teeth was associated with lower odds of cognitive impairment and higher odds of being robust or pre-frail. Denture-wearers compared with edentulous persons were less likely to be male, had higher education level and more likely be robust or pre-frail. Conclusion and implications There were significant associations between dentition status, frailty and cognition in our study where those with remining teeth and / or dentures had better overall outcomes. As oral health, frailty and cognitive impairments are all modifiable risk factors for healthy ageing, countries should consider population level screening for oral health, frailty and cognitive impairment.
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Affiliation(s)
- Li Feng Tan
- Healthy Ageing Programme, Alexandra Hospital, 378 Alexandra Rd, Singapore, 159964, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Reshma A Merchant
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Chang HC, Lu YY, Kao SL. Association of frailty and functional recovery in an Acute Care for Elders unit: a prospective observational study. BMC Geriatr 2022; 22:608. [PMID: 35864478 PMCID: PMC9306076 DOI: 10.1186/s12877-022-03290-2] [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: 10/24/2021] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background Evidence on the effects of Acute Care for Elders (ACE) units in frail older adults remains limited. Therefore, we aimed to evaluate the effects of the ACE unit on functional outcomes in frail older adults. Methods In this prospective observational study, we enrolled 114 consecutive patients aged 65 years and older admitted to the ACE unit for acute medical conditions between October 2019 and September 2020. The FRAIL scale (5-question assessment of fatigue, resistance, aerobic capacity, illnesses, and loss of weight) was used to classify the patients into three groups: robust (score = 0, n = 28), prefrail (score = 1–2, n = 57), and frail (score = 3–5, n = 29). The primary outcome was the activities of daily living (ADL) measured by the Barthel Index at admission and before discharge. Paired sample t-test was employed to determine the difference in ADL. Multiple linear regression analysis, with adjustment for covariates, was conducted to examine the association between frailty status and change in ADL. Results Among 114 patients enrolled (mean age, 79.8 ± 8.1 years; mean length of stay, 6.4 ± 5.6 days), 77 (67.5%) were female. ADL at admission (60.3 ± 31.9) and before discharge (83.7 ± 21.6) were significantly different (P < 0.001). After covariates adjustment, a significant association between frailty status and change in ADL was found (prefrail vs. robust: β = 9.0, 95% confidence interval [CI] 0.3–17.6, P = 0.04; frail vs. robust: β = 13.4, 95% CI 2.7–24.0, P = 0.01). Conclusions Older adults with frailty experienced functional improvement after admission to the ACE unit. Prefrail and frail groups were associated with a more significant change in ADL between admission and discharge compared to the robust group.
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Affiliation(s)
- Hsiao-Chen Chang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd, Hualien, 97002, Taiwan
| | - Yi-Yen Lu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sheng-Lun Kao
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung Yang Rd, Hualien, 97002, Taiwan. .,Department of Family Medicine, Tzu Chi University, Hualien, Taiwan. .,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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Oba K, Kagiwada Y, Kamada M, Miki R, Kondo Y, Kamakura T, Yamagami T, Fujita T, Tsuchida Y. Evaluating the feasibility of a remote-based training program supported by information and communications technology in the older adults living at home. BMC Geriatr 2022; 22:574. [PMID: 35831789 PMCID: PMC9277784 DOI: 10.1186/s12877-022-03273-3] [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: 10/28/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Exercise has been one of the key strategies for preventing frailty. While training programs for preventing frailty have been mainly developed in person, which have now become difficult to perform due to the coronavirus disease pandemic. It would be worthwhile to explore a feasibility of methods for a remote-based training with information and communications technology (ICT) in the pre-frail/robust older adults living at home. Methods We assessed the feasibility of a remote-based training with ICT device in terms of 1) a measurement accuracy and 2) whether it could be used for remote-based training of different intensities. To evaluate a measurement accuracy of the ICT device, we evaluated an inter-rater reliability between a true score and scores obtaining from the ICT device in 20 participants aged 65 years and older. Intraclass correlation was calculated. To evaluate a feasibility of remote-based training interventions of different intensities, we did a parallel, randomized, active controlled trial. Participants aged 65 years or older were randomly allocated to the two 3-month intervention programs with different intensity of exercise with the ICT (i.e., an Exercise-Intensive program and a Light-load exercise program). The primary outcome was 3-month scores of the 30-s chair-stand test (CS-30), which was compared between two groups using mixed models for repeated measures to account for within-person correlations. Results The ICT device showed a high intraclass correlation of over 0.99 for all outcomes including CS-30. Between Aug and Oct 2020, 70 participants (36 and 34 in the Exercise-Intensive and Light-load exercise programs, respectively) were randomized. After 3 months of intervention, CS-30 scores and other physical function improved in both groups. Difference in the 3-month CS-30 scores between two programs was found to be 0.08 (95% confidence interval: − 2.64, 2.79; p = 0.955), which was not statistically significant. No harmful incidents, such as falls, occurred in either group. Conclusion We showed a remote-based training with ICT device in the older adults living at home was feasible. Further studies are warranted to determine what kind of remote exercise intervention programs is more effective for maintaining a physical performance and, beyond that, preventing frailty. Trial registration number UMIN000041616 (05/09/2020) https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000047504&type=summary&language=E
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Affiliation(s)
- Koji Oba
- Department of Biostatistics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan. .,Interfaculty Initiative in Information Studies, the University of Tokyo, Tokyo, Japan.
| | - Yusuke Kagiwada
- Department of Biostatistics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masamitsu Kamada
- Department of Health Education and Health Sociology, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryusuke Miki
- Health Planning Division, Public Health Bureau, Kobe City Government, Kobe, Japan
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240
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Noublanche F, Simon R, Ben-Sadoun G, Annweiler C. Physical Activity and Fall Prevention in Geriatric Inpatients in an Acute Care Unit (AGIR Study): Protocol for a Usability Study. JMIR Res Protoc 2022; 11:e32288. [PMID: 35816381 PMCID: PMC9315880 DOI: 10.2196/32288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Falls are one of the world’s top 10 risks associated with disability in people older than 60 years. They also represent more than two-thirds of adverse events in hospitals, mainly affecting patients older than 65 years. Physical activity is a central intervention in fall prevention for older people. Whatever the details of the prevention strategy that is adopted (ie, how a mono- or multifactorial intervention is evaluated, the category of person the intervention targets, and where it is used), it is important to ensure that the proposed intervention is feasible and usable for the patient and the health care team. Objective The primary objective is to study the usability of carrying out a physical activity intervention, including 3 types of exercises, in older patients hospitalized in a geriatric acute care unit and categorized according to 3 fall risk levels: low, moderate, and high. The secondary objectives are to determine the difficulty of the physical exercise for patients with different fall risk levels, to study the health care team’s perceptions of the intervention’s feasibility, and to study the benefits for patients. Methods This is an open-label, unicenter, nonrandomized, usability prospective clinical trial. The intervention tested is a daily physical activity program. It consists of 3 types of physical exercise: staying out of bed for at least 3 hours, performing balance exercises while standing for 2 minutes, and the Five Times Sit to Stand transfer exercise. These exercises are carried out under the supervision of the health care team. Fall risk in the patients is classified with the Brief Geriatric Assessment tool. The exercise program starts on the second day of hospitalization after inclusion in the study. Patient assessment continues until the last day of hospitalization or the 20th day of hospitalization, whichever is earlier. For each fall-risk group and each type of exercise, the intervention will be defined as usable if at least 80% of the participants complete 75% or more of the exercises (ie, the ratio between the number of days when the patient completes a type of exercise and the total number of hospitalization days). The perceived feasibility by the health care team is measured with 2 scales, measuring perceived difficulty and time spent with the patient. The intervention benefit is evaluated using the performance of the Five Times Sit to Stand test before and after the intervention. Results The first patient was recruited on March 16, 2015. The study enrolled 266 patients, including 75 with low fall risk, 105 with moderate risk, and 85 with high risk. Conclusions We have not yet analyzed the results, but our observations suggest that the usability of each type of exercise for a given patient will depend on their fall risk level. Trial Registration ClinicalTrials.gov NCT02393014; https://clinicaltrials.gov/ct2/show/NCT02393014 International Registered Report Identifier (IRRID) DERR1-10.2196/32288
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Affiliation(s)
- Frédéric Noublanche
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, Angers, France.,Laboratoire de Psychologie des Pays de la Loire, Université Angers, Université de Nantes, EA 4638 LPPL, SFR Confluences, F-49000, Angers, France
| | - Romain Simon
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, Angers, France
| | - Grégory Ben-Sadoun
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, Angers, France.,Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, 14000, Caen, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital of Angers, Angers, France.,Laboratoire de Psychologie des Pays de la Loire, Université Angers, Université de Nantes, EA 4638 LPPL, SFR Confluences, F-49000, Angers, France.,Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Hax V, Tessari J, Pena E, Santo RCDE, dos Santos LP, Gasparin AA, Bredemeier M, Fighera TM, Spritzer PM, Xavier RM, Chakr RMDS. Physical frailty in patients with systemic sclerosis. Semin Arthritis Rheum 2022; 56:152077. [DOI: 10.1016/j.semarthrit.2022.152077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
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242
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Chang YS, Wang CJ, Wu CH, Wu YH, Lee HN. Frailty is Associated With Frontal Cortex-Related Cognitive Function in Patients With Alzheimer Disease. J Geriatr Psychiatry Neurol 2022; 35:544-549. [PMID: 33977812 DOI: 10.1177/08919887211016062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We compared the cognitive functions of Alzheimer disease (AD) patients who were robust, frail or pre-frail and hypothesized that declines in frontal cortex-related neuropsychological function would be associated with frailty. METHOD One hundred and sixty outpatients aged 65 years or older with mild AD were enrolled. Cognitive function was assessed using the Cognitive Ability Screening Instrument and further classified into 4 clusters (recent memory, frontal cortex cluster, posterior cortex cluster, and orientation). Other variables included depressive mood, daily activities, body mass index, handgrip strength (HGS), and normal gait speed (NGS). RESULTS Performance in daily activities, and slower NGS than robust group. Both the frail and pre-frail groups had lower HGS and more depressive symptoms than robust group. Generalized linear with ordinal logistic analysis showed that increment in age, slowing in NGS, and worse frontal cortex cluster function associated with being in a higher level of frailty. The patients with depression symptoms were the odds of being in a higher level of frailty compared to those without depression symptoms. CONCLUSIONS In addition to physical and psychological symptoms, frailty is associated with specific cognitive domains in patients with AD. A multidimensional approach should be used to assess the impact of intervention programs focusing on frail patients with AD.
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Affiliation(s)
- Yu San Chang
- Department of Psychiatry, 156931Catholic Mercy Hospital, Catholic Mercy Medical Foundation, Hukou Township, Hsinchu County
| | - Chin Jen Wang
- Department of Neuropsychiatry, 59082Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Ling-Ya District, Kaohsiung
| | - Chiu Hsiang Wu
- Department of Nursing, 59082Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Ling-Ya District, Kaohsiung
| | - Yu Hsuan Wu
- Department of Neuropsychiatry, 59082Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Ling-Ya District, Kaohsiung
| | - Hsin Ning Lee
- Department of Neuropsychiatry, 59082Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Ling-Ya District, Kaohsiung
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243
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Serra-Prat M, Lavado À, Cabré M, Burdoy E, Palomera E, Papiol M, Parera JM. Development and validation of the electronic screening index of frailty. Age Ageing 2022; 51:6637440. [PMID: 35810395 DOI: 10.1093/ageing/afac161] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND primary care screening for frailty status is recommended in clinical guidelines, but is impeded by doctor and nurse workloads and the lack of valid, easy-to-use and time-saving screening tools. AIM to develop and validate a new electronic tool (the electronic screening index of frailty, e-SIF) using routinely available electronic health data to automatically and massively identify frailty status in the population aged ≥65 years. METHODS the e-SIF was developed in three steps: selection of clinical conditions; establishment of ICD-10 codes, criteria and algorithms for their definition; and electronic tool design and data extraction, transformation and load processes. The validation phase included an observational cohort study with retrospective data collection from computerised primary care medical records. The study population included inhabitants aged ≥65 years corresponding to three primary care centres (n = 9,315). Evaluated was the relationship between baseline e-SIF categories and mortality, institutionalisation, hospitalisation and health resource consumption after 2 years. RESULTS according to the e-SIF, which includes 42 clinical conditions, frailty prevalence increases with age and is slightly greater in women. The 2-year adjusted hazard ratios for pre-frail, frail and very frail subjects, respectively, were as follows: 2.23 (95% CI: 1.74-2.85), 3.34 (2.44-4.56) and 6.49 (4.30-9.78) for mortality; 2.80 (2.39-3.27), 5.53 (4.59-6.65) and 9.14 (7.06-11.8) for hospitalisation; and 1.02 (0.70-1.49), 1.93 (1.21-3.08) and 2.69 (1.34-5.40) for institutionalisation. CONCLUSIONS the e-SIF shows good agreement with mortality, institutionalisation, hospitalisation and health resource consumption, indicating satisfactory validity. More studies in larger populations are needed to corroborate our findings.
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Affiliation(s)
- Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain.,CIBER Liver and Digestive Diseases (CIBEREHD), CIBEREHD, ISCIII, Madrid, Spain
| | - Àngel Lavado
- Information Management Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Mateu Cabré
- Internal Medicine Department, Hospital of Mataró, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Emili Burdoy
- Primary Care Department, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Elisabet Palomera
- Research Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Mònica Papiol
- Primary Care Department, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Joan Marc Parera
- Documentation Unit, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain)
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Treacy D, Hassett L, Schurr K, Fairhall NJ, Cameron ID, Sherrington C. Mobility training for increasing mobility and functioning in older people with frailty. Cochrane Database Syst Rev 2022; 6:CD010494. [PMID: 35771806 PMCID: PMC9245897 DOI: 10.1002/14651858.cd010494.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Frailty is common in older people and is characterised by decline across multiple body systems, causing decreased physiological reserve and increased vulnerability to adverse health outcomes. It is estimated that 21% of the community-dwelling population over 65 years are frail. Frailty is independently predictive of falls, worsening mobility, deteriorating functioning, impaired activities of daily living, and death. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) defines mobility as: changing and maintaining a body position, walking, and moving. Common interventions used to increase mobility include functional exercises, such as sit-to-stand, walking, or stepping practice. OBJECTIVES To summarise the evidence for the benefits and safety of mobility training on overall functioning and mobility in frail older people living in the community. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, AMED, PEDro, US National Institutes of Health Ongoing Trials Register, and the World Health Organization International Clinical Trials Registry Platform (June 2021). SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of mobility training on mobility and function in frail people aged 65+ years living in the community. We defined community as those residing either at home or in places that do not provide rehabilitative services or residential health-related care, for example, retirement villages, sheltered housing, or hostels. DATA COLLECTION AND ANALYSIS: We undertook an 'umbrella' comparison of all types of mobility training versus control. MAIN RESULTS This review included 12 RCTs, with 1317 participants, carried out in 9 countries. The median number of participants in the trials was 97. The mean age of the included participants was 82 years. The majority of trials had unclear or high risk of bias for one or more items. All trials compared mobility training with a control intervention (defined as one that is not thought to improve mobility, such as general health education, social visits, very gentle exercise, or "sham" exercise not expected to impact on mobility). High-certainty evidence showed that mobility training improves the level of mobility upon completion of the intervention period. The mean mobility score was 4.69 in the control group, and with mobility training, this score improved by 1.00 point (95% confidence interval (CI) 0.51 to 1.51) on the Short Physical Performance Battery (on a scale of 0 to 12; higher scores indicate better mobility levels) (12 studies, 1151 participants). This is a clinically significant change (minimum clinically important difference: 0.5 points; absolute improvement of 8% (4% higher to 13% higher); number needed to treat for an additional beneficial outcome (NNTB) 5 (95% CI 3.00 to 9.00)). This benefit was maintained at six months post-intervention. Moderate-certainty evidence (downgraded for inconsistency) showed that mobility training likely improves the level of functioning upon completion of the intervention. The mean function score was 86.1 in the control group, and with mobility training, this score improved by 8.58 points (95% CI 3.00 to 14.30) on the Barthel Index (on a scale of 0 to 100; higher scores indicate better functioning levels) (9 studies, 916 participants) (absolute improvement of 9% (3% higher to 14% higher)). This result did not reach clinical significance (9.8 points). This benefit did not appear to be maintained six months after the intervention. We are uncertain of the effect of mobility training on adverse events as we assessed the certainty of the evidence as very low (downgraded one level for imprecision and two levels for bias). The number of events was 771 per 1000 in the control group and 562 per 1000 in the group with mobility training (risk ratio (RR) 0.74, 95% CI 0.63 to 0.88; 2 studies, 225 participants) (absolute difference of 19% fewer (9% fewer to 26% fewer)). Mobility training may result in little to no difference in the number of people who are admitted to nursing care facilities at the end of the intervention period as the 95% confidence interval includes the possibility of both a reduced and increased number of admissions to nursing care facilities (low-certainty evidence, downgraded for imprecision and bias). The number of events was 248 per 1000 in the control group and 208 per 1000 in the group with mobility training (RR 0.84, 95% CI 0.53 to 1.34; 1 study, 241 participants) (absolute difference of 4% fewer (8% more to 12% fewer)). Mobility training may result in little to no difference in the number of people who fall as the 95% confidence interval includes the possibility of both a reduced and increased number of fallers (low-certainty evidence, downgraded for imprecision and study design limitations). The number of events was 573 per 1000 in the control group and 584 per 1000 in the group with mobility training (RR 1.02, 95% CI 0.87 to 1.20; 2 studies, 425 participants) (absolute improvement of 1% (12% more to 7% fewer)). Mobility training probably results in little to no difference in the death rate at the end of the intervention period as the 95% confidence interval includes the possibility of both a reduced and increased death rate (moderate-certainty evidence, downgraded for bias). The number of events was 51 per 1000 in the control group and 59 per 1000 in the group with mobility training (RR 1.16, 95% CI 0.64 to 2.10; 6 studies, 747 participants) (absolute improvement of 1% (6% more to 2% fewer)). AUTHORS' CONCLUSIONS The data in the review supports the use of mobility training for improving mobility in a frail community-dwelling older population. High-certainty evidence shows that compared to control, mobility training improves the level of mobility, and moderate-certainty evidence shows it may improve the level of functioning in frail community-dwelling older people. There is moderate-certainty evidence that the improvement in mobility continues six months post-intervention. Mobility training may make little to no difference to the number of people who fall or are admitted to nursing care facilities, or to the death rate. We are unsure of the effect on adverse events as the certainty of evidence was very low.
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Affiliation(s)
- Daniel Treacy
- Physiotherapy Department, Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, Australia
| | - Leanne Hassett
- Discipline of Physiotherapy, Faculty of Health Sciences and Musculoskeletal Health Sydney, School of Public Health, The University of Sydney, Sydney, Australia
| | - Karl Schurr
- Physiotherapy Department, Bankstown Hospital, Bankstown, Australia
| | - Nicola J Fairhall
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, St Leonards, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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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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Ambagtsheer RC, Casey MG, Lawless M, Archibald MM, Yu S, Kitson A, Beilby JJ. Practitioner perceptions of the feasibility of common frailty screening instruments within general practice settings: a mixed methods study. BMC PRIMARY CARE 2022; 23:160. [PMID: 35754037 PMCID: PMC9235102 DOI: 10.1186/s12875-022-01778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Frailty is a highly prevalent clinical syndrome increasing older people's vulnerability to risk of adverse outcomes. Better frailty identification through expanded screening implementation has been advocated within general practice settings, both internationally and within Australia. However, little is known about practitioner perceptions of the feasibility of specific instruments, and the underlying motivations behind those perceptions. Consequently, the purpose of this study was to explore the attitudes and perceptions of a convenience and volunteer sample of Australian general practitioners (GPs) and practice nurses (PNs) towards common frailty screening instruments. METHODS The feasibility of several frailty screening instruments (PRISMA-7 [P7], Edmonton Frail Scale [EFS], FRAIL Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC] and Timed Up and Go [TUG]) to 43 Australian GPs and PNs was assessed. The study adopted a concurrent embedded mixed-methods design incorporating quantitative (ranking exercise) and qualitative (content analysis) data collection integrated during the analysis phase. RESULTS Practitioners assessed multi-dimensional instruments (EFS, GFI, KC) as having relatively higher clinical utility, better integration into existing assessment processes and stronger links to intervention over uni-dimensional (GST, TUG) and simple (FQ, P7) instruments. CONCLUSIONS While existing frailty screening instruments show promise as an initial step in supporting better care for older people, all the included instruments were associated with perceived advantages and disadvantages. Ultimately, clinicians will need to weigh several factors in their selection of the optimal screening instrument. Further translational research, with a focus on contextual fit, is needed to support clinical decision-making on the selection of instruments for frailty screening.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia.
- Torrens University Australia, Adelaide, Australia.
| | - Mavourneen G Casey
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Michael Lawless
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Mandy M Archibald
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Solomon Yu
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Alison Kitson
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Justin J Beilby
- National Health and Medical Research Council Centre of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Ageing, GPO Box 2025, Adelaide, SA, 5000, Australia
- Torrens University Australia, Adelaide, Australia
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Bloeckl J, Raps S, Weineck M, Kob R, Bertsch T, Kemmler W, Schoene D. Feasibility and Safety of Whole-Body Electromyostimulation in Frail Older People—A Pilot Trial. Front Physiol 2022; 13:856681. [PMID: 35812334 PMCID: PMC9263209 DOI: 10.3389/fphys.2022.856681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/30/2022] [Indexed: 01/04/2023] Open
Abstract
Whole-body electromyostimulation (WB-EMS) induces high-intense stimuli to skeletal muscles with low strain on joints and the autonomic nervous system and may thus be suitable for frail, older people. However, if trained at very high intensities, WB-EMS may damage muscles and kidneys (rhabdomyolysis). This study aimed at investigating the feasibility, safety and preliminary efficacy of WB-EMS in frail, older people. Seven frail (81.3 ± 3.5 years), 11 robust (79.5 ± 3.6 years), 10 young (29.1 ± 6.4 years) participants completed an eight-week WB-EMS training (week 1–4: 1x/week; week 5–8: 1.5x/week) consisting of functional exercises addressing lower extremity strength and balance. Feasibility was assessed using recruitment, adherence, retention, and dropout rates. The satisfaction with WB-EMS was measured using the Physical Activity Enjoyment Scale for older adults (PACES-8). In week 1, 3, and 8 creatine kinase (CK) was assessed immediately before, 48 and 72 h after WB-EMS. Symptoms of rhabdomyolysis (muscle pain, muscle weakness, myoglobinuria) and adverse events were recorded. Functional capacity was assessed at baseline and after 8 weeks using the Short Physical Performance Battery (SPPB), Timed Up-and-Go Test (TUG), Choice Stepping Reaction Time Test (CSRT), 30-second Chair-Stand Test (30-STS), maximum isometric leg strength and handgrip strength. The recruitment rate of frail individuals was 46.2%, adherence 88.3% and the dropout rate 16.7%. All groups indicated a high satisfaction with WB-EMS. CK activity was more pronounced in young individuals with significant changes over time. Within older people CK increased borderline-significantly in the frail group from baseline to week 1 but not afterwards. In robust individuals CK increased significantly from baseline to week 1 and 3. No participant reached CK elevations close to the threshold of ≥5,000 U/l and no symptoms of rhabdomyolysis were observed. With the exception of the TUG (p = 0.173), frail individuals improved in all tests of functional capacity. Compared to the young and robust groups, frail individuals showed the greater improvements in the SPPB, handgrip strength, maximum isokinetic hip-/knee extension and flexion strength. WB-EMS is feasible for frail older people. There were no clinical signs of exertional rhabdomyolysis. WB-EMS proved to be sufficiently intense to induce meaningful changes in functional capacity with frail individuals showing greater improvements for several measures.
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Affiliation(s)
- Joerg Bloeckl
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Joerg Bloeckl,
| | - Sebastian Raps
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weineck
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Kemmler
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Institute of Exercise and Public Health, University of Leipzig, Leipzig, Germany
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Luo J, Liao X, Zou C, Zhao Q, Yao Y, Fang X, Spicer J. Identifying Frail Patients by Using Electronic Health Records in Primary Care: Current Status and Future Directions. Front Public Health 2022; 10:901068. [PMID: 35812471 PMCID: PMC9256951 DOI: 10.3389/fpubh.2022.901068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
With the rapidly aging population, frailty, characterized by an increased risk of adverse outcomes, has become a major public health problem globally. Several frailty guidelines or consensuses recommend screening for frailty, especially in primary care settings. However, most of the frailty assessment tools are based on questionnaires or physical examinations, adding to the clinical workload, which is the major obstacle to converting frailty research into clinical practice. Medical data naturally generated by routine clinical work containing frailty indicators are stored in electronic health records (EHRs) (also called electronic health record (EHR) data), which provide resources and possibilities for frailty assessment. We reviewed several frailty assessment tools based on primary care EHRs and summarized the features and novel usage of these tools, as well as challenges and trends. Further research is needed to develop and validate frailty assessment tools based on EHRs in primary care in other parts of the world.
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Affiliation(s)
- Jianzhao Luo
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiaoyang Liao ; orcid.org/0000000344099674
| | - Chuan Zou
- Department of General Practice, Chengdu Fifth People's Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qian Zhao
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Qian Zhao ; orcid.org/0000000295405726
| | - Yi Yao
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Fang
- International Medical Centre/Ward of General Practice and National Clinical Research Centre for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - John Spicer
- GP and Senior Lecturer in Medical Law and Clinical Ethics, Institute of Medical and Biomedical Education, St George's University of London, London, United Kingdom
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Acosta-Benito MÁ, Martín-Lesende I. [Frailty in primary care: Diagnosis and multidisciplinary management]. Aten Primaria 2022; 54:102395. [PMID: 35700618 PMCID: PMC9198324 DOI: 10.1016/j.aprim.2022.102395] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
El envejecimiento poblacional se asocia a un mayor uso de recursos sociales sanitarios, asociados a la mayor morbimortalidad y discapacidad de este grupo etario. La fragilidad es un síndrome geriátrico previo a la aparición de la dependencia funcional, que permite la identificación de individuos de mayor riesgo de dependencia, institucionalización, efectos adversos de fármacos, mortalidad y otros eventos negativos de salud. Este síndrome es potencialmente reversible con una intervención multicomponente. La atención primaria de salud es el lugar preferente para el diagnóstico y seguimiento de la fragilidad, a través de escalas como la FRAIL scale, el fenotipo de Fried o modelos de acumulación de déficits. Para el seguimiento se precisa la intervención multidimensional y coordinada de diferentes profesionales sanitarios y sociales, con la implicación del paciente y su familia. Se debe fomentar la investigación para determinar las intervenciones más eficaces y los cursos clínicos más frecuentes.
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Affiliation(s)
- Miguel Ángel Acosta-Benito
- Medicina Familiar y Comunitaria. CS Joaquín Rodrigo, Madrid. Servicio Madrileño de Salud, Madrid, España; Miembro del Grupo de Trabajo de Atención al Mayor de semFYC y Coordinador del grupo PAPPS-semFYC del Mayor.
| | - Iñaki Martín-Lesende
- Médico de familia, Centro de Salud Indautxu, Bilbao, País Vasco, España; Miembro del Grupo de Trabajo de Atención al Mayor de semFYC y del grupo PAPPS-semFYC del Mayor
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Merchant RA, Ho VWT, Chen MZ, Wong BLL, Lim Z, Chan YH, Ling N, Ng SE, Santosa A, Murphy D, Vathsala A. Outcomes of Care by Geriatricians and Non-geriatricians in an Academic Hospital. Front Med (Lausanne) 2022; 9:908100. [PMID: 35733862 PMCID: PMC9208654 DOI: 10.3389/fmed.2022.908100] [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: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction While hospitalist and internist inpatient care models dominate the landscape in many countries, geriatricians and internists are at the frontlines managing hospitalized older adults in countries such as Singapore and the United Kingdom. The primary aim of this study was to determine outcomes for older patients cared for by geriatricians compared with non-geriatrician-led care teams. Materials and Methods A retrospective cohort study of 1,486 Internal Medicine patients aged ≥75 years admitted between April and September 2021 was conducted. They were either under geriatrician or non-geriatrician (internists or specialty physicians) care. Data on demographics, primary diagnosis, comorbidities, mortality, readmission rate, Hospital Frailty Risk Score (HFRS), Age-adjusted Charlson Comorbidity Index, Length of Stay (LOS), and cost of hospital stay were obtained from the hospital database and analyzed. Results The mean age of patients was 84.0 ± 6.3 years, 860 (57.9%) females, 1,183 (79.6%) of Chinese ethnicity, and 902 (60.7%) under the care of geriatricians. Patients under geriatrician were significantly older and had a higher prevalence of frailty, dementia, and stroke, whereas patients under non-geriatrician had a higher prevalence of diabetes and hypertension. Delirium as the primary diagnosis was significantly higher among patients under geriatrician care. Geriatrician-led care model was associated with shorter LOS, lower cost, similar inpatient mortality, and 30-day readmission rates. LOS and cost were lower for patients under geriatrician care regardless of frailty status but significant only for low and intermediate frailty groups. Geriatrician-led care was associated with significantly lower extended hospital stay (OR 0.73; 95% CI 0.56–0.95) and extended cost (OR 0.69; 95% CI 0.54–0.95). Conclusion Geriatrician-led care model showed shorter LOS, lower cost, and was associated with lower odds of extended LOS and cost.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Reshma Aziz Merchant,
| | - Vanda Wen Teng Ho
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Beatrix Ling Ling Wong
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Zhiying Lim
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie Ling
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Diarmuid Murphy
- Value Driven Outcomes Office, National University Health System, Singapore, Singapore
| | - Anantharaman Vathsala
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore, Singapore
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