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Merchant RA, Aprahamian I, Woo J, Vellas B, Morley JE. Editorial: Resilience And Successful Aging. J Nutr Health Aging 2022; 26:652-656. [PMID: 35842754 PMCID: PMC9209635 DOI: 10.1007/s12603-022-1818-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Reshma A Merchant
- Dr Reshma A Merchant, Division of Geriatric Medicine. Department of Medicine, 1E Kent Ridge Road, NUHS Tower Block, Singapore 119228. , ORCID iD: 0000-0002-9032-0184
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Feliu J, Espinosa E, Basterretxea L, Paredero I, Llabrés E, Jiménez-Munárriz B, Antonio-Rebollo M, Losada B, Pinto A, Custodio AB, del Mar Muñoz M, Gómez-Mediavilla J, Torregrosa MD, Soler G, Cruz P, Higuera O, Molina-Garrido MJ. Prediction of Chemotoxicity, Unplanned Hospitalizations and Early Death in Older Patients with Colorectal Cancer Treated with Chemotherapy. Cancers (Basel) 2021; 14:cancers14010127. [PMID: 35008291 PMCID: PMC8749992 DOI: 10.3390/cancers14010127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Chemotoxicity, unplanned hospitalizations (Uhs) and early death (ED) are common among older patients with cancer who receive chemotherapy. Our objective was to determine factors predicting these complications. A predictive score for these three complications based on geriatric, tumor and laboratory variables was developed in a series of 215 older patients with colorectal carcinoma receiving chemotherapy. The use of this score may reliably identify patients at risk to have excessive toxicity with chemotherapy, UH or ED, thus helping to plan treatment, implement adaptive measures, and intensify follow-up. Abstract Purpose: To identify risk factors for toxicity, unplanned hospitalization (UH) and early death (ED) in older patients with colorectal carcinoma (CRC) initiating chemotherapy. Methods: 215 patients over 70 years were prospectively included. Geriatric assessment was performed before treatment, and tumor and treatment variables were collected. The association between these factors and grade 3–5 toxicity, UH and ED (<6 months) was examined by using multivariable logistic regression. Score points were assigned to each risk factor. Results: During the first 6 months of treatment, 33% of patients developed grade 3–5 toxicity, 31% had UH and 23% died. Risk factors were, for toxicity, instrumental activities of daily living, creatinine clearance, weight loss and MAX2 index; for UH, Charlson Comorbidity Score, creatinine clearance, weight loss, serum albumin, and metastatic disease; and for ED, basic activities in daily living, weight loss, metastatic disease, and hemoglobin levels. Predictive scores were built with these variables. The areas under receiver operation characteristic (ROC) curves for toxicity, UH and ED were 0.70 (95% CI: 0.64–0.766), 0.726 (95% IC: 0.661–0.799) and 0.74 (95% IC: 0.678–0.809), respectively. Conclusion: Simple scores based on geriatric, tumor and laboratory characteristics predict severe toxicity, UH and ED, and may help in treatment planning.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
- Correspondence: ; Tel./Fax: +3-491-727-7118
| | - Enrique Espinosa
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Laura Basterretxea
- Oncology Department, Donostia University Hospital, 20014 Donostia, Spain; (L.B.); (J.G.-M.)
| | - Irene Paredero
- Oncology Department, Doctor Peset University Hospital, 46017 Valencia, Spain; (I.P.); (M.-D.T.)
| | - Elisenda Llabrés
- Oncology Department, Insular University Hospital of Gran Canarias, 35016 Las Palmas, Spain;
| | | | - Maite Antonio-Rebollo
- Oncohematogeriatrics Unit, Institut Català d’Oncologia, IDIBELL Hospitalet, 08908 Barcelona, Spain; (M.A.-R.); (G.S.)
| | - Beatriz Losada
- Oncology Department, University Hospital of Fuenlabrada, 28942 Madrid, Spain;
| | - Alvaro Pinto
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Ana Belén Custodio
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - María del Mar Muñoz
- Oncology Department, Hospital Virgen de la Luz, 16002 Cuenca, Spain; (M.d.M.M.); (M.-J.M.-G.)
| | | | | | - Gema Soler
- Oncohematogeriatrics Unit, Institut Català d’Oncologia, IDIBELL Hospitalet, 08908 Barcelona, Spain; (M.A.-R.); (G.S.)
| | - Patricia Cruz
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
| | - Oliver Higuera
- Oncology Department, La Paz University Hospital, IDIPAZ, CIBERONC, UAM-AMGEN Cathedra, 28046 Madrid, Spain; (E.E.); (A.P.); (A.B.C.); (P.C.); (O.H.)
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Abstract
As the lifespan increases, special attention has been given to the supportive care needs of the elderly. Frailty is an important issue in third age, since it is related to poor quality of life and mortality. The prevalence of pathological conditions related to sodium levels, specifically hyponatremia, is also present in the elderly. Yet, it is unclear, if hyponatremia and frailty are related to each other. This review summarizes the current state of knowledge regarding hyponatremia and frailty and analyzes five independent studies which searched for an association between those two parameters. As indicated by this study results, hyponatremia consists a risk factor for frailty. This could be explained by an effect of hyponatremia on sarcopenia and on cognitive function, which consist components of frailty. Thus, it is essential to monitor sodium levels in the elderly and to develop related interventions (e.g. using arginine vasopressin antagonists) in order to prevent frailty.
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Affiliation(s)
- Nikolaos D Karakousis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Greece.,Department of Physiology, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos A Kostakopoulos
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.,Metropolitan General Hospital, 1 Department of Urology, Athens, Greece
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304
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Lemos JL, Welch JM, Xiao M, Shapiro LM, Adeli E, Kamal RN. Is Frailty Associated with Adverse Outcomes After Orthopaedic Surgery?: A Systematic Review and Assessment of Definitions. JBJS Rev 2021; 9:01874474-202112000-00006. [PMID: 34936580 DOI: 10.2106/jbjs.rvw.21.00065] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is increasing evidence supporting the association between frailty and adverse outcomes after surgery. There is, however, no consensus on how frailty should be assessed and used to inform treatment. In this review, we aimed to synthesize the current literature on the use of frailty as a predictor of adverse outcomes following orthopaedic surgery by (1) identifying the frailty instruments used and (2) evaluating the strength of the association between frailty and adverse outcomes after orthopaedic surgery. METHODS A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched to identify articles that reported on outcomes after orthopaedic surgery within frail populations. Only studies that defined frail patients using a frailty instrument were included. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). Study demographic information, frailty instrument information (e.g., number of items, domains included), and clinical outcome measures (including mortality, readmissions, and length of stay) were collected and reported. RESULTS The initial search yielded 630 articles. Of these, 177 articles underwent full-text review; 82 articles were ultimately included and analyzed. The modified frailty index (mFI) was the most commonly used frailty instrument (38% of the studies used the mFI-11 [11-item mFI], and 24% of the studies used the mFI-5 [5-item mFI]), although a large variety of instruments were used (24 different instruments identified). Total joint arthroplasty (22%), hip fracture management (17%), and adult spinal deformity management (15%) were the most frequently studied procedures. Complications (71%) and mortality (51%) were the most frequently reported outcomes; 17% of studies reported on a functional outcome. CONCLUSIONS There is no consensus on the best approach to defining frailty among orthopaedic surgery patients, although instruments based on the accumulation-of-deficits model (such as the mFI) were the most common. Frailty was highly associated with adverse outcomes, but the majority of the studies were retrospective and did not identify frailty prospectively in a prediction model. Although many outcomes were described (complications and mortality being the most common), there was a considerable amount of heterogeneity in measurement strategy and subsequent strength of association. Future investigations evaluating the association between frailty and orthopaedic surgical outcomes should focus on prospective study designs, long-term outcomes, and assessments of patient-reported outcomes and/or functional recovery scores. CLINICAL RELEVANCE Preoperatively identifying high-risk orthopaedic surgery patients through frailty instruments has the potential to improve patient outcomes. Frailty screenings can create opportunities for targeted intervention efforts and guide patient-provider decision-making.
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Affiliation(s)
- Jacie L Lemos
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Jessica M Welch
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Michelle Xiao
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
| | - Ehsan Adeli
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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305
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Donison V, Chesney TR, Wills A, Santos B, McLean B, Alqurini N, Hossain N, Durbano S, Lemonde M, Alibhai SMH, Puts M. Self-management interventions for issues identified in a geriatric assessment: A systematic review. J Am Geriatr Soc 2021; 70:1268-1279. [PMID: 34902156 DOI: 10.1111/jgs.17601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status. METHODS Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. RESULTS Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. CONCLUSIONS Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
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Affiliation(s)
- Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler R Chesney
- Department of Surgery, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bianca McLean
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Nazia Hossain
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada.,Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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306
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Lampignano L, Bortone I, Castellana F, Donghia R, Guerra V, Zupo R, De Pergola G, Di Masi M, Giannelli G, Lozupone M, Panza F, Boeing H, Sardone R. Impact of Different Operational Definitions of Sarcopenia on Prevalence in a Population-Based Sample: The Salus in Apulia Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412979. [PMID: 34948590 PMCID: PMC8700814 DOI: 10.3390/ijerph182412979] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022]
Abstract
Background: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP1) issued its first operational definition to diagnose sarcopenia. This was updated in 2019 with a revised sequence of muscle mass and muscle strength (EWGSOP2). The aim of the study was to investigate the impact of these different operational definitions on sarcopenia prevalence in a representative population-based sample. Methods: For each algorithm, the prevalence of sarcopenia-related categories was calculated and related to sociodemographic and lifestyle variables, anthropometric parameters, and laboratory biomarkers. The present analysis used data from the Salus in Apulia Study (Italy, 740 subjects, mean age 75.5 ± 5.9 years, 54% women). Results: The application of the EWGSOP1 adapted algorithm resulted in 85% [95% confidence intervals (CI): 82–88%] non-sarcopenic subjects, 10% (95% CI: 8–12%) pre-sarcopenic subjects, and 5% (95% CI: 3–7%) sarcopenic/severe sarcopenic subjects. The sarcopenia-related categories were inversely related to weight and body mass index (BMI), particularly in overweight/obese subjects, and these categories showed favorable metabolic biomarkers. The EWGSOP2 algorithm yielded 73% (95% CI: 69–76%) non-sarcopenic subjects, 24% (95% CI: 21–27%) probably sarcopenic subjects, and 4% (95% CI: 2–5%) sarcopenic subjects. Conclusions: The present study identified BMI as a potential confounder of the prevalence estimates of sarcopenia-related categories in population-based settings with different EWGSOP operational definitions.
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Affiliation(s)
- Luisa Lampignano
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
- Correspondence: (L.L.); (R.S.)
| | - Ilaria Bortone
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
| | - Fabio Castellana
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
| | - Rossella Donghia
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
| | - Vito Guerra
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
| | - Roberta Zupo
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
| | - Giovanni De Pergola
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
- Department of Biomedical Science and Human Oncology, School of Medicine, University of Bari Aldo Moro, 70100 Bari, Italy
| | - Marta Di Masi
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
| | - Gianluigi Giannelli
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
| | - Madia Lozupone
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70100 Bari, Italy;
| | - Francesco Panza
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
| | - Heiner Boeing
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
| | - Rodolfo Sardone
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, 70013 Bari, Italy; (I.B.); (F.C.); (R.D.); (V.G.); (R.Z.); (G.D.P.); (M.D.M.); (G.G.); (F.P.); (H.B.)
- Correspondence: (L.L.); (R.S.)
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307
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Vrbová P, Valášková S, Gažová A, Smaha J, Kužma M, Kyselovič J, Payer J, Koller T. Biomarkers of the Physical Function Mobility Domains Among
Patients Hospitalized in Internal Medicine. Physiol Res 2021. [DOI: 10.33549//physiolres.934777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hospitalized patients in internal medicine have an increased risk of low physical reserve which further declines during the hospital stay. The diagnosis requires bed-side testing of functional domains or more complex investigations of the muscle mass. Clinically useful biomarkers of functional status are needed, thus we aimed to explore the potential of microRNAs. Among hospitalized patients, we recorded the basic demographics, anthropometrics, nutritional status, and physical function domains: hand-grip strength (HGS, abnormal values M<30 kg, W<20 kg), balance (<30 s), chair-stands speed (CHSS<0.5/s) and gait speed (GS<0.8 m/s). A panel of five micro-RNAs (miRNA 1, miRNA 133a, miRNA 133b, miRNA 29a, miRNA 29b) and basic blood biochemistry and vitamin D values were recorded. We enrolled 80 patients (M40, W40), with a mean age of 68.8±8.4 years. Obesity was observed in 27.5 % and 30 %, low HGS and low CHSS in 65.0, 77.5 %, and 80, 90 % of men and women respectively. The median hospital stay was 6.5 days. MiRNA29a and miRNA29b have the strongest correlation with the triceps skinfold (miRNA 29b, r=0.377, p=0.0006) and CHSS (miRNA 29a, r=0.262, p=0.02). MiRNA 29a, miRNA 29b and 133a levels were significantly higher in patients with CHSS<0.5/s. Other anthropometric parameters, mobility domains, or vitamin D did not correlate. All miRNAs except of miRNA 1, could predict low CHSS (miRNA29b, AUROC=0.736 CI 0.56-0.91, p=0.01), particularly in patients with low HGS (miRNA 29b, AUROC=0.928 CI 0.83-0.98). Among hospitalized patients in internal medicine, low functional status was frequent. MicroRNAs were fair biomarkers of the antigravity domain, but not other domains. Larger studies with clinical endpoints are needed.
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Affiliation(s)
- P. Vrbová
- 5th Department of Internal Medicine, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
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308
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You HS, Kwon YJ, Kim S, Kim YH, Kim YS, Kim Y, Roh YK, Park B, Park YK, Park CH, Son JS, Shin J, Shin HY, Oh B, Lee JW, Shim JY, Won CW, Yoo JW, Lee SH, Kang HT, Lee DC. Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings. Korean J Fam Med 2021; 42:413-424. [PMID: 34871482 PMCID: PMC8648485 DOI: 10.4082/kjfm.21.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/08/2021] [Indexed: 01/06/2023] Open
Abstract
Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.
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Affiliation(s)
- Hyo-Sun You
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ye-Seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yonghwan Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yong-Kyun Roh
- Department of Family Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Byoungjin Park
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Young Kyu Park
- Department of Family Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang-Hae Park
- Department of Family Medicine, Haengbokhankajung Clinic, Seoul, Korea
| | - Joung Sik Son
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun-Young Shin
- Department of Family Medicine, Myongji Hospital, Goyang, Korea
| | - Bumjo Oh
- Department of Family Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae Yong Shim
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Won Yoo
- School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sang-Hyun Lee
- Department of Family Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Duk Chul Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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309
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Won CW. Implications of frailty interventions from Korean frailty and aging cohort study. Aging Med (Milton) 2021; 4:247-249. [PMID: 34964004 PMCID: PMC8711215 DOI: 10.1002/agm2.12188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chang Won Won
- Department of Family MedicineCollege of Medicine, Kyung Hee UniversitySeoulKorea
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Explaining the association between frailty and mortality in older adults: The mediating role of lifestyle, social, psychological, cognitive, and physical factors. Prev Med Rep 2021; 24:101589. [PMID: 34976648 PMCID: PMC8683887 DOI: 10.1016/j.pmedr.2021.101589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/18/2021] [Accepted: 10/03/2021] [Indexed: 01/02/2023] Open
Abstract
Frailty in older adults is associated with adverse outcomes such as mortality. Not much is known about underlying pathways of the frailty-mortality association. We assessed the mediating role of a wide range of factors. In both men and women, only polypharmacy was identified as explanatory factor. Targeting polypharmacy in frail older adults could reduce their risk of mortality.
Frailty is associated with a higher risk of mortality, but not much is known about underlying pathways of the frailty-mortality association. In this study, we explore a wide range of possible mediators of the relation between frailty and mortality. Data were used from the Longitudinal Aging Study Amsterdam (LASA). We included 1477 older adults aged 65 years and over who participated in the study in 2008–2009 and linked their data to register data on mortality up to 2015. We examined a range of lifestyle, social, psychological, cognitive, and physical factors as potential mediators. All analyses were stratified by sex. We used causal mediation analyses to estimate the indirect effects in single-mediator analyses. Statistically significant mediators were then included in multiple-mediator analyses to examine their combined effect. The results showed that older men (OR = 2.79, 95% CI = 1.23;6.34) and women (OR = 2.31, 95% CI = 1.24;4.30) with frailty had higher odds of being deceased 6 years later compared to those without frailty. In men, polypharmacy (indirect effect OR = 1.21, 95% CI = 1.03;1.50) was a statistically significant mediator in this association. In women, polypharmacy, self-rated health, and multimorbidity were statistically significant mediators in the single-mediator models, but only the indirect effect of polypharmacy remained in the multiple-mediator model (OR = 1.16, 95% CI = 1.03;1.38). In conclusion, of many factors that were considered, we identified polypharmacy as explanatory factor of the association between frailty and mortality in older men and women. This finding has important clinical implications, as it suggests that targeting polypharmacy in frail older adults could reduce their risk of mortality.
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311
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Chen LY, Fang TJ, Lin YC, Hsieh HF. Exploring the Mediating Effects of Cognitive Function, Social Support, Activities of Daily Living and Depression in the Relationship between Age and Frailty among Community-Dwelling Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312543. [PMID: 34886268 PMCID: PMC8656521 DOI: 10.3390/ijerph182312543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
With 16.15% of its total population aged 65 or above, Taiwan is already an aging society. Frailty is a natural consequence of aging, which may decrease physical strength and deteriorate physiological functioning. We examined the mediating effects of cognitive function, social support, activities of daily living (ADL), and depression in the relationship between age and frailty in older people living in the community. This cross-sectional study used a structured questionnaire to collect data from a convenience sample of 200 pre-frail to mildly frail older adults in southern Taiwan. Structural equation modeling was used for data analysis, with data collected from July to November 2020. ADL mediated the relationship between age and frailty, while cognitive function also mediated the relationship between age and frailty, indicating that ADL and cognitive function were significant determinants of frailty. The path from age to frailty was significant, indicating that age was a significant determinant of frailty. The standardized total effect of age affected frailty through the mediating roles of ADL and cognitive function. Age, depression, ADL, and cognitive function explained 59% of the variance in frailty among older adults. ADL and cognitive function are significant mediators of frailty among older adults.
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Affiliation(s)
- Lin-Yen Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Tzu-Jung Fang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Yu-Chih Lin
- Division of General Internal Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Medical University, Kaohsiung 807, Taiwan;
- Department of Medical Humanities and Education, School of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsiu-Fen Hsieh
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- School of Nursing, College of Nursing, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 2626)
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312
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Montero-Errasquín B, Cruz-Jentoft AJ. Defining and understanding frailty. Med Clin (Barc) 2021; 157:438-439. [PMID: 34598794 DOI: 10.1016/j.medcli.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
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313
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Dent E, Woo J, Scott D, Hoogendijk EO. Toward the recognition and management of sarcopenia in routine clinical care. NATURE AGING 2021; 1:982-990. [PMID: 37118343 DOI: 10.1038/s43587-021-00136-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/06/2021] [Indexed: 04/30/2023]
Abstract
Sarcopenia, the age-associated decline in skeletal muscle mass and function, is a major cause of functional decline and mortality in older adults. Despite its importance, sarcopenia often remains unrecognized and inadequately managed in routine clinical care. A major hinderance to its clinical integration is the variation in diagnostic tools for sarcopenia. Diagnostic tools include those of the European Working Group on Sarcopenia in Older People (versions 1 and 2), those of the Asian Working Group for Sarcopenia (versions 1 and 2), and that of the Sarcopenia Definition and Outcomes Consortium. The management decision process of sarcopenia warrants an evaluation of risk factors such as a sedentary lifestyle, inadequate exercise, poor nutritional intake, smoking, depression and living circumstances. Herein, we provide an evidence-based update of the prevention and management of sarcopenia and propose practical information to facilitate the disease's adoption into routine care.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia.
| | - Jean Woo
- Chinese University of Hong Kong, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Scott
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
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314
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Oude Voshaar RC, Dimitriadis M, vandenBrink RHS, Aprahamian I, Borges MK, Marijnissen RM, Hoogendijk EO, Rhebergen D, Jeuring HW. A 6-year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder. Int J Geriatr Psychiatry 2021; 36:1699-1707. [PMID: 34130356 PMCID: PMC8596411 DOI: 10.1002/gps.5588] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Depressive disorder has been conceptualised as a condition of accelerated biological ageing. We operationalised a frailty index (FI) as marker for biological ageing aimed to explore the bidirectional, longitudinal association between frailty and either depressive symptoms or depressive disorder. METHODS A cohort study with 6-year follow-up including 377 older (≥60 years) outpatients with a DSM-IV-defined depressive disorder and 132 never-depressed controls. Site visits at baseline, 2 and 6-year follow-up were conducted and included the CIDI 2.0 to assess depressive disorder and relevant covariates. Depressive symptom severity and mortality were assessed every 6 months by mail and telephone. A 41-item FI was operationalised and validated against the 6-year morality rate by Cox regression (HRFI = 1.04 [95% CI: 1.02-1.06]). RESULTS Cox regression showed that a higher FI was associated with a lower chance of remission among depressed patients (HRFI = 0.98 [95% CI: 0.97-0.99]). Nonetheless, this latter effect disappeared after adjustment for baseline depressive symptom severity. Linear mixed models showed that the FI increased over time in the whole sample (B[SE] = 0.94 (0.12), p < .001) with a differential impact of depressive symptom severity and depressive disorder. Higher baseline depressive symptom severity was associated with an attenuated and depressive disorder with an accelerated increase of the FI over time. CONCLUSIONS The sum score of depression rating scales is likely confounded by frailty. Depressive disorder, according to DSM-IV criteria, is associated with accelerated biological ageing. This argues for the development of multidisciplinary geriatric care models incorporating frailty to improve the overall outcome of late-life depression.
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Affiliation(s)
- Richard C. Oude Voshaar
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Menelaos Dimitriadis
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Rob H. S. vandenBrink
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Ivan Aprahamian
- Department of Internal MedicineGeriatrics DivisionFaculty of Medicine of JundiaíJundiaíBrazil
| | - Marcus K. Borges
- Department and Institute of PsychiatrySão PauloUniversity of São PauloBrazil
| | - Radboud M. Marijnissen
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Emiel O. Hoogendijk
- Department of Epidemiology and BiostatisticsAmsterdam UMC – Location VU University Medical CenterAmsterdamThe Netherlands
| | - Didi Rhebergen
- Department of PsychiatryNetherlands & GGZ Ingeest Specialized Mental Health CareAmsterdam UMC – Location VU University Medical CenterAmsterdamThe Netherlands
| | - Hans W. Jeuring
- Department of PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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315
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Costa NA, Minicucci MF, Pereira AG, de Paiva SAR, Okoshi MP, Polegato BF, Zornoff LAM, Villas Boas PJF, Atherton PJ, Phillips BE, Banerjee J, Gordon AL, Azevedo PS. Current perspectives on defining and mitigating frailty in relation to critical illness. Clin Nutr 2021; 40:5430-5437. [PMID: 34653819 DOI: 10.1016/j.clnu.2021.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 01/10/2023]
Abstract
Up to half of ICU survivors, many of whom were premorbidly well, will have residual functional and/or cognitive impairment and be vulnerable to future health problems. Frailty describes vulnerability to poor resolution of homeostasis after a stressor event but it is not clear whether the vulnerability seen after ICU correlates with clinical measures of frailty. In clinical practice, the scales most commonly used in critically ill patients are based on the assessment of severity and survival. Identification and monitoring of frailty in the ICU may be an alternative or complimentary approach, particularly if it helps explain vulnerability during the recovery and rehabilitation period. The purpose of this review is to discuss the use of tools to assess frailty status in the critically ill, and consider their importance in clinical practice. Amongst these, we consider biomarkers with potential to identify patients at greater or lesser risk of developing post-ICU vulnerability.
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Affiliation(s)
- N A Costa
- Faculty of Nutrition, Univ Federal de Goiás (UFG), Goiânia, Brazil.
| | - M F Minicucci
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - A G Pereira
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - S A R de Paiva
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - M P Okoshi
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - B F Polegato
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - L A M Zornoff
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - P J F Villas Boas
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - P J Atherton
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - B E Phillips
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - J Banerjee
- Geriatric Emergency Medicine, University Hospitals of Leicester, School of Health Science, University of Leicester, Leicester, UK
| | - A L Gordon
- Medical Research Council-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - P S Azevedo
- Department of Internal Medicine, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
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316
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Kositsawat J, Duque G, Kirk B. Nutrients with anabolic/anticatabolic, antioxidant, and anti-inflammatory properties: Targeting the biological mechanisms of aging to support musculoskeletal health. Exp Gerontol 2021; 154:111521. [PMID: 34428477 DOI: 10.1016/j.exger.2021.111521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/12/2021] [Accepted: 08/15/2021] [Indexed: 12/25/2022]
Abstract
Old age is associated with declines in bone density and muscle mass and function, which predisposes to mobility disability, falls, and fractures. Poor nutritional status, a risk factor for several age-related pathologies, becomes prevalent in old age and contributes to the structural and functional changes of the musculoskeletal system that increases the risk of osteoporosis, sarcopenia, osteosarcopenia, and physical frailty. The biological mechanisms underpinning these pathologies often overlap and include loss of proteostasis, impaired redox functioning, and chronic low-grade inflammation. Thus, provision of nutrients with anabolic/anticatabolic, antioxidant, and anti-inflammatory properties may be an effective strategy to offset these age-related pathologies. We searched PUBMED for pre-clinical and clinical work examining the effects of nutrients with a combined effect on muscle and bone. This review summarizes recent evidence on the mechanisms of action and potential clinical use of nutrients that concomitantly improve muscle and bone health in older persons.
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Affiliation(s)
- Jatupol Kositsawat
- Center on Aging, University of Connecticut Health Center, Farmington, CT, USA
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC 3021, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC 3021, Australia; Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia.
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317
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Zheng L, Li G, Qiu Y, Wang C, Wang C, Chen L. Clinical practice guidelines for the prevention and management of frailty: A systematic review. J Adv Nurs 2021; 78:709-721. [PMID: 34617618 DOI: 10.1111/jan.15067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/23/2021] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
AIMS To systematically search for clinical practice guidelines focusing on the prevention and management of frailty, to evaluate their methodological quality and to synthesize the consensus recommendations. DESIGN A systematic review. DATA SOURCES Guideline websites, related professional association websites and electronic databases were systematically searched through 4 November 2020. REVIEW METHODS We evaluated the methodological quality of the eligible guidelines using the Appraisal of Guidelines Research and Evaluation II (AGREE II). Two reviewers synthesized the consensus recommendations proposed by at least two guidelines. RESULTS Eight guidelines met the eligibility criteria and were included in the review. The mean scores of the six domains were as follows: the 'scope and purpose' domain scored 88.0%, the 'clarity of presentation' domain scored 81.9%, the 'stakeholder involvement' domain scored 63.4%, the 'editorial independence' domain scored 62.2%, the 'rigour of development' domain scored 61.1% and the 'applicability' domain scored 57.8%. In total, we synthesized 23 recommendations for the prevention and management of frailty that are consistent among the included guidelines. CONCLUSIONS The number of clinical practice guidelines for the prevention and management of frailty is limited. The methodological quality of existing guidelines needs to be improved. Our synthesized findings provide an intuitive, convenient and summative reference resource for frailty prevention and management. It' is worth noting that recommendations described in the included guidelines require additional detail. IMPACT Although the prevention and management of frailty is urgent, there is currently a lack of evidences guiding these processes, especially in the prevention. The methodological quality of existing guidelines is insufficient, and the recommendations described in the guidelines require additional detail. Therefore, users of these guidelines, especially nurses, should make a careful decision according to the specific situation when using. Nurses also have a key role in providing more clinical evidences for the improvement of the quality of the guidelines.
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Affiliation(s)
- Lufang Zheng
- School of Nursing, Jilin University, Changchun, China
| | - Guichen Li
- School of Nursing, Jilin University, Changchun, China
| | - Yiming Qiu
- School of Nursing, Jilin University, Changchun, China
| | - Cong Wang
- School of Nursing, Jilin University, Changchun, China
| | - Chunyan Wang
- Senior Officials Inpatient Ward, First Hospital of Jilin University, Changchun, China
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China.,Department of Pharmacology, College of Basic Medical Sciences, Jilin University, Changchun, China
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318
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Direct and Indirect Effects of COVID-19 in Frail Elderly: Interventions and Recommendations. J Pers Med 2021; 11:jpm11100999. [PMID: 34683141 PMCID: PMC8539433 DOI: 10.3390/jpm11100999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022] Open
Abstract
Frailty is a state of vulnerability to stressors because of a decreased physiological reserve, resulting in poor health outcomes. This state is related to chronic conditions, many of which are risk factors for outcomes in elderly patients having SARS-COV-2. This review aims to describe frailty as a physiological vulnerability agent during the COVID-19 pandemic in elderly patients, summarizing the direct and indirect effects caused by the SARS-COV-2 infection and its prognosis in frail individuals, as well as the interventions and recommendations to reduce their effects. Cohort studies have shown that patients with a Clinical Frailty Scale higher than five have a higher risk of mortality and use of mechanical ventilation after COVID-19; nonetheless, other scales have also associated frailty with longer hospital stays and more severe forms of the disease. Additionally, the indirect effects caused by the pandemic have a negative impact on the health status of older people. Due to the above, a holistic intervention is proposed based on a comprehensive geriatric assessment for frail patients (preventive or post-infection) with emphasis on physical activity and nutritional recommendations, which could be a potential preventive intervention in viral infections by COVID-19.
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319
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Strandberg TE, Lindström L, Jyväkorpi S, Urtamo A, Pitkälä KH, Kivimäki M. Phenotypic frailty and multimorbidity are independent 18-year mortality risk indicators in older men : The Helsinki Businessmen Study (HBS). Eur Geriatr Med 2021; 12:953-961. [PMID: 33661507 PMCID: PMC8463371 DOI: 10.1007/s41999-021-00472-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/12/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Multimorbidity, prefrailty, and frailty are frequent in ageing populations, but their independent relationships to long-term prognosis in home-dwelling older people are not well recognised. METHODS In the Helsinki Businessmen Study (HBS) men with high socioeconomic status (born 1919-1934, n = 3490) have been followed-up from midlife. In 2000, multimorbidity (≥ 2 conditions), phenotypic prefrailty and frailty were determined in 1365 home-dwelling men with median age of 73 years). Disability was assessed as a possible confounder. 18-year mortality follow-up was established from registers and Cox regression used for analyses. RESULTS Of the men, 433 (31.7%) were nonfrail and without multimorbidity at baseline (reference group), 500 (36.6%) and 82 (6.0%) men had prefrailty or frailty, respectively, without multimorbidity, 84 (6.2%) men had multimorbidity only, and 201 (14.7%) and 65 (4.8%) men had prefrailty or frailty together with multimorbidity. Only 30 (2.2%) and 86 (6.3%) showed signs of ADL or mobility disability. In the fully adjusted analyses (including ADL disability, mental and cognitive status) of 18-year mortality, frailty without multimorbidity (hazard ratio 1.62, 95% confidence interval 1.13-2.31) was associated with similar mortality risk than multimorbidity without frailty (1.55, 1.17-2.06). The presence of both frailty and multimorbidity indicated a strong mortality risk (2.93, 2.10-4.07). CONCLUSION Although multimorbidity is generally considered a substantial health problem, our long-term observational study emphasises that phenotypic frailty alone, independently of disability, may be associated with a similar risk, and a combination of multimorbidity and frailty is an especially strong predictor of mortality.
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Affiliation(s)
- Timo E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland.
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.
| | | | | | | | - Kaisu H Pitkälä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Haartmaninkatu 4, PO Box 340, 00029, Helsinki, Finland
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320
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Koduri G, Gokaraju S, Darda M, Warrier V, Duta I, Hayes F, Sayed IE, Noeman-Ahmed Y. Clinical frailty score as an independent predictor of outcome in COVID-19 hospitalised patients. Eur Geriatr Med 2021; 12:1065-1073. [PMID: 34086193 PMCID: PMC8175234 DOI: 10.1007/s41999-021-00508-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/29/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF THE STUDY We explored potential predictive variables associated with outcomes using baseline clinical parameters of 500 hospitalised patients with COVID -19 in a single centre, UK. METHODS Retrospective study collecting demographic and clinical characteristics of patients admitted at Southend University Hospital from 20th February to 7th May 2020. RESULTS The mean age of the cohort admitted to hospital with Covid-19 was 69.4 and 58% were over 70. Comorbidities were more frequently observed in non-survivors, whose mean Clinical Frailty Scale was significantly higher (5 vs 3) than survivors, p < 0.001. In addition, mean C-reactive protein was significantly higher. CONCLUSION Older and frailer patients with high inflammatory markers were at risk of poor outcomes. Integrated frailty and age-based risk stratification is essential, in addition to monitoring saturation /FiO2 ratio (SFR) and inflammatory markers throughout the disease course to allow for early intervention to improve patient outcomes. A frailty-based risk-stratification approach, rather than age may prove more valuable when considering interventions in patients with multiple comorbidities.
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Affiliation(s)
- Gouri Koduri
- Rheumatology Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Sriya Gokaraju
- Respiratory Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Maria Darda
- Respiratory Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Vinod Warrier
- Department of Medicine, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Irina Duta
- Department of Medicine, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Fiona Hayes
- Rheumatology Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Yasser Noeman-Ahmed
- Respiratory Department, Mid and South Essex NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, Essex, UK.
- Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Department of Respiratory Medicine, Lecturer Critical Care Medicine, Southend University Hospital, Alexandria University, Alexandria, Egypt.
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321
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de Jesus ITM, Orlandi FDS, Gomes GADO, Say KG, Guarisco LPC, Orlandi AADS, Pott-Junior H, Zazzetta MS. Frailty state transitions among non-frail and vulnerable older adults: Does mobility performance really matter? Geriatr Nurs 2021; 42:1367-1372. [PMID: 34583235 DOI: 10.1016/j.gerinurse.2021.09.007] [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: 08/28/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022]
Abstract
We assessed the predictors of becoming frail between non-frail and vulnerable community-dwelling older adults in a retrospective cohort study with adults (n=346) aged 60 years or older recruited from primary healthcare centers. Edmonton Frailty Scale assessed frailty status, and Kaplan-Meier estimated the frailty-free probability and compared it between groups. Cox regression models explored predictors of becoming frail. At baseline, there were 32.3% individuals classified as Frail according to the EFS, whereas 32.4% were vulnerable and 35.3% non-frail. We observed 82 incident cases of frailty, 65.8% among those classified as vulnerable and 37.8% in the non-frail group (p < 0.05). Female sex, years of education, and an overall score of < 45 on the Berg Balance Scale were the only independent predictors of becoming frail. Although frailty is not only correlated with mobility, static and dynamic balancing abilities appear to have the same impact as a vulnerable state to becoming frail.
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Affiliation(s)
| | | | | | - Karina Gramani Say
- Departament of Gerontology, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | | | | | - Henrique Pott-Junior
- Departament of Medicine, Federal University of São Carlos (UFSCar), São Carlos, Brazil.
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322
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Baritello O, Salzwedel A, Sündermann SH, Niebauer J, Völler H. The Pandora's Box of Frailty Assessments: Which Is the Best for Clinical Purposes in TAVI Patients? A Critical Review. J Clin Med 2021; 10:jcm10194506. [PMID: 34640525 PMCID: PMC8509314 DOI: 10.3390/jcm10194506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 02/07/2023] Open
Abstract
Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95% confidence interval (CI) 6.50–33.30) and lower serum albumin level (highest HR: 3.12; 95% CI 1.80–5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95% CI 2.71–86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55–4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty.
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Affiliation(s)
- Omar Baritello
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, 14469 Brandenburg, Germany;
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
| | - Annett Salzwedel
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
| | - Simon H. Sündermann
- Department of Cardiovascular Surgery, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, 13353 Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, A-5020 Salzburg, Austria;
| | - Heinz Völler
- Research Group Molecular and Clinical Life Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg, University of Potsdam, 14476 Potsdam, Germany;
- Correspondence: ; Tel.: +49-(03)-319774061
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323
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Liu P, Li Y, Ma L. Caloric Restriction May Help Delay the Onset of Frailty and Support Frailty Management. Front Nutr 2021; 8:731356. [PMID: 34552957 PMCID: PMC8450361 DOI: 10.3389/fnut.2021.731356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022] Open
Abstract
Frailty is an age-related clinical syndrome that may increase the risk of falls, disability, hospitalization, and death in older adults. Delaying the progression of frailty helps improve the quality of life in older adults. Caloric restriction (CR) may extend lifespan and reduce the risk of age-related diseases. However, few studies have explored the relationship between CR and frailty. In this review, we focused on the impact of CR on frailty and aimed to identify potential associated mechanisms. Although CR may help prevent frailty, further studies are required to determine the underlying mechanisms and specific CR regimens suitable for use in humans.
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Affiliation(s)
- Pan Liu
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yun Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Medicine, Beijing, China
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324
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Gana W, De Luca A, Debacq C, Poitau F, Poupin P, Aidoud A, Fougère B. Analysis of the Impact of Selected Vitamins Deficiencies on the Risk of Disability in Older People. Nutrients 2021; 13:3163. [PMID: 34579039 PMCID: PMC8469089 DOI: 10.3390/nu13093163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 02/07/2023] Open
Abstract
Vitamin deficiencies have a serious impact on healthy aging in older people. Many age-related disorders have a direct or indirect impact on nutrition, both in terms of nutrient assimilation and food access, which may result in vitamin deficiencies and may lead to or worsen disabilities. Frailty is characterized by reduced functional abilities, with a key role of malnutrition in its pathogenesis. Aging is associated with various changes in body composition that lead to sarcopenia. Frailty, aging, and sarcopenia all favor malnutrition, and poor nutritional status is a major cause of geriatric morbidity and mortality. In the present narrative review, we focused on vitamins with a significant risk of deficiency in high-income countries: D, C, and B (B6/B9/B12). We also focused on vitamin E as the main lipophilic antioxidant, synergistic to vitamin C. We first discuss the role and needs of these vitamins, the prevalence of deficiencies, and their causes and consequences. We then look at how these vitamins are involved in the biological pathways associated with sarcopenia and frailty. Lastly, we discuss the critical early diagnosis and management of these deficiencies and summarize potential ways of screening malnutrition. A focused nutritional approach might improve the diagnosis of nutritional deficiencies and the initiation of appropriate clinical interventions for reducing the risk of frailty. Further comprehensive research programs on nutritional interventions are needed, with a view to lowering deficiencies in older people and thus decreasing the risk of frailty and sarcopenia.
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Affiliation(s)
- Wassim Gana
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Arnaud De Luca
- Nutrition Mobile Unit, Regional University Hospital Centre, 37000 Tours, France;
- Inserm UMR 1069, Nutrition, Croissance et Cancer, 37032 Tours, France
| | - Camille Debacq
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Fanny Poitau
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
| | - Pierre Poupin
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Amal Aidoud
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Geriatrics Mobile Units, Regional University Hospital Centre, 37000 Tours, France; (C.D.); (P.P.)
| | - Bertrand Fougère
- Division of Geriatric Medicine, Regional University Hospital Centre, 37000 Tours, France; (F.P.); (A.A.); (B.F.)
- Education, Ethics, Health (EA 7505), Tours University, 37000 Tours, France
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325
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Khor PY, Vearing RM, Charlton KE. The effectiveness of nutrition interventions in improving frailty and its associated constructs related to malnutrition and functional decline among community-dwelling older adults: A systematic review. J Hum Nutr Diet 2021; 35:566-582. [PMID: 34494314 DOI: 10.1111/jhn.12943] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The present study aimed to evaluate the effectiveness of nutrition interventions on frailty and factors related to frailty, including malnutrition, sarcopenia and functional ability, among community dwelling older adults. A secondary aim was to synthesise current clinical guidelines for the identification and management of frailty, and then identify whether they aligned with the findings of the literature review. METHODS A systematic literature review was undertaken using four electronic databases to identify randomised controlled clinical trials that assessed the effect of nutrition interventions on frailty and outcomes related to frailty in community-dwelling older adults (PROSPERO #CRD42017069094). The quality of the included studies was appraised. A rapid review was conducted using the Google Scholar database to identify existing clinical recommendations relating to the second aim. RESULTS The search strategy identified 13 studies. Multifactorial interventions with nutritional education and protein-energy supplementation improved frailty stratus and physical performance in 75% and 58% of studies, respectively. Weight and nutritional status improved in 80% of studies that used oral nutritional support. The recommended process for clinical management of frailty involves screening, followed by full assessment using validated instruments and the development of a comprehensive management plan with a multidisciplinary team. CONCLUSIONS Multifactorial interventions were found to be more effective than nutrition intervention alone for improving frailty and physical performance. Protein-energy supplementation tended to be effective only in malnourished older adults. The results were inconclusive for the use of micronutrient supplementation for frailty and outcomes related to frailty. Existing clinical guidelines are aligned with the evidence recommending comprehensive interventions to improve frailty.
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Affiliation(s)
- Phay Yean Khor
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Rebecca M Vearing
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Karen E Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
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326
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Deng C, Yue J, Xue Q. Frailty: Progress update on prevention and treatment. J Evid Based Med 2021; 14:173-174. [PMID: 34170072 DOI: 10.1111/jebm.12425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Chuanyao Deng
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qianli Xue
- Department of Medicine Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
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327
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Jazbar J, Pišek Š, Locatelli I, Kos M. Prevalence and Incidence of Frailty Among Community-dwelling Older Adults in Slovenia. Zdr Varst 2021; 60:190-198. [PMID: 34249166 PMCID: PMC8256771 DOI: 10.2478/sjph-2021-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 05/27/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Frailty is recognized as one of the most important global health challenges as the population is aging. The aim of this study was to evaluate prevalence and incidence of frailty, and associated factors, among the population of older adults in Slovenia compared to other European countries. METHODS The prevalence and 4-year incidence of frailty among older adults (≥65 years) were evaluated using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Frailty was defined by the SHARE operationalization of Frailty phenotype. Multiple logistic regression model was used to explore factors associated with frailty. RESULTS Age-standardized prevalence (95% CI) of frailty and pre-frailty in Slovenia were 14.9% (13.3-16.5) and 42.5% (39.8-45.2), respectively. Factors (OR, 95% CI) associated with increased frailty in Slovenia included age (7584 years: 5.03 (3.08-8.22); ≥85 years 21.7 (10.6-44.7) vs. 65-74 years), self-rated health (fair: 4.58 (2.75-7.61), poor: 54.6 (28.1-105.9) vs. excellent/very good/good), number of chronic diseases (1.20 (1.03-1.40)), and polypharmacy (yes: 3.25 (1.93-5.48) vs. no). Female gender and lower education were significantly associated with pre-frailty, but not frailty, in the adjusted model. Independently of these characteristics, age-standardized prevalence of frailty varied among geographical regions. Age-standardized 4-year incidence of frailty and pre-frailty in Slovenia were 6.6% (3.0-10.1) and 40.2% (32.7-47.6), respectively. CONCLUSION Among the Slovenian population of older adults aged 65 years and older, the age-standardized prevalence of frailty is 15% and 4-year incidence of frailty is 7%. Regional differences in Slovenia show the lowest prevalence in central Slovenian regions and the highest in northeastern Slovenian regions.
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Affiliation(s)
- Janja Jazbar
- University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Aškerčeva cesta 7, 1000Ljubljana, Slovenia
| | - Špela Pišek
- University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Aškerčeva cesta 7, 1000Ljubljana, Slovenia
| | - Igor Locatelli
- University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Aškerčeva cesta 7, 1000Ljubljana, Slovenia
| | - Mitja Kos
- University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Aškerčeva cesta 7, 1000Ljubljana, Slovenia
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328
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Home Medicines Review and frailty among community-dwelling older women. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:548-555. [PMID: 34463322 DOI: 10.1093/ijpp/riab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Home Medicines Reviews (HMRs) can optimize medications for frail older adults. This study aimed to determine the use of HMRs according to frailty status and the association between frailty and use of HMRs. METHODS The study included 9139 female participants enrolled in the Australian Longitudinal Study on Women's Health from 2003 (aged 77-82 years) to 2017 (aged 91-96 years). Generalized estimating equations (GEEs) using log-binomial regressions were used to determine associations using repeated measures on individuals over time. KEY FINDINGS The majority of participants in the study remained non-frail and did not receive HMRs from 2003 [7116 (77.86%)] to 2017 [1240 (71.31%)]. The use of HMRs was low in both groups with 33 (1.68%; 95% CI, 1.16 to 2.36) frail and 64 (0.89%; 95% CI, 0.69 to 1.14) non-frail participants receiving HMRs in 2003; by 2017, 19 (4.19%; 95% CI, 2.54 to 6.46) frail and 45 (3.50%; 95% CI, 2.57 to 4.66) non-frail participants received HMRs. Frailty was not associated with receiving a HMR (RR 1.06; 95% CI, 0.95 to 1.20), although for every 1-year increase, participants were 10% more likely to receive a HMR (RR 1.10; 95% CI, 1.09 to 1.11). Participants with continuous polypharmacy, ≥4 chronic diseases, >4 general practitioner visits and Department of Veterans Affairs coverage were more likely to receive a HMR. CONCLUSIONS Despite the proven value of HMRs for frail older people, HMRs were not used for most frail and non-frail community-dwelling women in this study. Reasons for low use of the service should be explored, with interventions to raise awareness of the benefits of the service.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, Callaghan, NSW, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Julie Byles
- University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, Callaghan, NSW, Australia.,Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Nicholas Egan
- University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Therese Kairuz
- University of Newcastle, Callaghan, NSW, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
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329
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Fountotos R, Munir H, Goldfarb M, Lauck S, Kim D, Perrault L, Arora R, Moss E, Rudski LG, Bendayan M, Piankova P, Hayman V, Rodighiero J, Ouimet MC, Lantagne S, Piazza N, Afilalo J. Prognostic Value of Handgrip Strength in Older Adults Undergoing Cardiac Surgery. Can J Cardiol 2021; 37:1760-1766. [PMID: 34464690 DOI: 10.1016/j.cjca.2021.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Although multidimensional frailty scales have been proven to predict mortality and morbidity in cardiac surgery, there is a need for rapid tools that could be easily administered at the point of care. Handgrip strength (HGS) is an attractive option that can be measured in acutely ill and bed-bound patients, although it has yet to be validated in a large cardiac surgery cohort. METHODS This is a post hoc analysis of a multicentre prospective study in older patients undergoing coronary artery bypass grafting and/or valve surgery from 2011 to 2019. HGS was measured before surgery and classified by sex-stratified cutoffs. The primary outcome was 1-year mortality and secondary outcomes were 30-day mortality, discharge disposition, and prolonged length of stay. RESULTS There were 1245 patients included in the analysis (mean age 74.0 ± 6.6 years; 30% female). Weak HGS was associated with advanced age, heart failure, kidney disease, malnutrition, and various frailty scales. In those with weak vs normal HGS, respectively, 1-year mortality was 17% vs 6%, 30-day mortality was 10% vs 3%, prolonged length of stay was 34% vs 19%, and discharge to a health care facility was 45% vs 26% (all P < 0.001). After adjustment, HGS was predictive of 1-year and 30-day mortalities, with odds ratios of 2.44 (95% confidence interval [CI] 1.39-4.29) and 2.83 (1.38-5.81), respectively. HGS cutoffs of < 26 kg in men and < 16 kg in women had the highest predictive performance. CONCLUSIONS HGS is a simple and effective tool to identify patients at higher risk of mortality and protracted recovery after cardiac surgery.
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Affiliation(s)
- Rosie Fountotos
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Haroon Munir
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Sandra Lauck
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dae Kim
- Division of Geriatric Medicine, Beth Israel Deaconess Medical Centre, Harvard University, Boston, Massachusetts, USA
| | - Louis Perrault
- Division of Cardiac Surgery, Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Rakesh Arora
- Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emmanuel Moss
- Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Lawrence G Rudski
- Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Melissa Bendayan
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Palina Piankova
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Victoria Hayman
- Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Julia Rodighiero
- Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Marie-Claude Ouimet
- Research Institute, McGill University Health Centre, Montréal, Québec, Canada
| | - Sarah Lantagne
- Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Nicolo Piazza
- Division of Cardiology, McGill University Health Centre, Montréal, Québec, Canada
| | - Jonathan Afilalo
- Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montréal, Québec, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada; Research Institute, McGill University Health Centre, Montréal, Québec, Canada.
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330
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Qi Z, Wu BL, Chen C, Yu ZH, Shen DZ, Chen JL, Zhao HB, Sun L. Symptoms Based on Deficiency Syndrome in Traditional Chinese Medicine Might Be Predictor of Frailty in Elderly Community Dwellers. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:9918811. [PMID: 34484408 PMCID: PMC8413027 DOI: 10.1155/2021/9918811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/07/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The most widely used frailty phenotype and frailty indexes are either time-consuming or complicated, thus restricting their generalization in clinical practice; and therefore, an easier and faster screening tool is needed to be developed. OBJECTIVE To select sensitive symptoms in traditional Chinese medicine (TCM) and study whether they can improve the risk prediction of frailty. METHODS This is a cross-sectional study enrolling 2249 Chinese elderly community dwellers. Data were collected via face-to-face inquiries, anthropometric measurements, laboratory tests, and community health files. Frailty was the main outcome measure, and it was evaluated by Fried's frailty phenotype (FP). The ordinal logistic regression model was used to identify the factors associated with frailty. The risk assessment plot was used to compare the discriminative ability for frailty among models with and without TCM symptoms. RESULTS The identified sensitive influential factors for frailty included age, education level, dietary habits, chronic obstructive pulmonary disease, diabetes, cerebral infarction, osteoporosis, cold limbs, lethargy and laziness in speaking and moving, weakness of lower limbs, slow movement, dry mouth and throat, and glazed expression. The risk prediction for "frailty cumulative components ≥1" was not significantly increased, while for "frailty cumulative components ≥2", a new model developed with the above selected TCM symptoms had a higher AUC than the baseline model without it (0.79 VS 0.81, P=0.002). And the NRI and IDI for the new model were 41.4% (P=0.016) and 0.024% (P=0.041), respectively. CONCLUSION This research might provide an easier and faster way for early identification and risk prediction of frailty in elderly community dwellers.
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Affiliation(s)
- Zhen Qi
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
| | - Bei-Ling Wu
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
| | - Chuan Chen
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
| | - Zhi-Hua Yu
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
| | - Ding-Zhu Shen
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
| | - Jiu-Lin Chen
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
| | - Hong-Bin Zhao
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
| | - Lin Sun
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 365 South Xiangyang Road, Shanghai 200031, China
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331
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Experiences of Pulmonary Rehabilitation in People Living with Chronic Obstructive Pulmonary Disease and Frailty. A Qualitative Interview Study. Ann Am Thorac Soc 2021; 17:1213-1221. [PMID: 32644823 PMCID: PMC7640624 DOI: 10.1513/annalsats.201910-800oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Rationale: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from pulmonary rehabilitation but face challenges completing programs. However, research to understand ways to optimize participation in this group is lacking. Objectives: To explore the experiences, needs, and preferences of people with COPD and frailty referred for outpatient pulmonary rehabilitation. Methods: Semistructured interviews with people with COPD and physical frailty, purposively sampled by age, living status, level of frailty, and completion of pulmonary rehabilitation. Thematic analysis with a critical realist perspective was used, involving relevant stakeholders with clinical, academic, and lived experience for interpretive rigor. Results: Nineteen people with COPD and frailty were interviewed, with a median age of 78 years (range, 58–88). Nine did not complete their pulmonary rehabilitation program. Four themes were identified: striving to adapt to multidimensional loss, tensions of balancing support with independence, pulmonary rehabilitation as a challenge worth facing, and overcoming unpredictable disruptions to participation. Participants described constantly adapting to their changing health and resulting multidimensional losses (e.g., functional abilities, relationships, confidence). This involved traversing between independence and seeking support, set against a mismatch between their needs and what support is available. People with COPD and frailty can be highly motivated to participate in pulmonary rehabilitation, despite the physical and mental demands it entails, and report a range of benefits. Yet in the context of changeable health, they must often overcome multiple unpredictable disruptions to completing rehabilitation programs. Participant determination and flexibility of services can facilitate ongoing attendance, but for some, these unpredictable disruptions erode their motivation to attend. Conclusions: People with COPD and frailty experience accumulating, multidimensional loss. This group are motivated to complete pulmonary rehabilitation but often require additional support and flexibility owing to fluctuating and unpredictable health. Person-centered approaches should be considered to minimize disruptive health events and support pulmonary rehabilitation participation and completion. Service adaptations could allow more flexibility to meet the changing needs of this group and enable communication around how pulmonary rehabilitation might align with their priorities.
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332
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[Frailty in renal diseases]. Z Gerontol Geriatr 2021; 54:708-716. [PMID: 34351485 PMCID: PMC8551146 DOI: 10.1007/s00391-021-01953-0] [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: 06/07/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
Frailty beschreibt einen Zustand reduzierter Belastbarkeit gegenüber Stressfaktoren, welcher u. a. Folge altersbedingter Abbauprozesse verschiedener Organsysteme ist und mit einem erhöhten Risiko für Stürze, Hospitalisationen, funktionelle Einschränkung und Mortalität assoziiert ist. Frailty tritt bei Patienten mit CKD früher und häufiger auf als in der Allgemeinbevölkerung und ist ein wichtiger und potenziell modifizierbarer Risikofaktor für eine erhöhte Sterblichkeit und Hospitalisationsrate sowie eine reduzierte Lebensqualität. Die Erkennung von Frailty bei Patienten mit CKD ermöglicht eine Identifikation von wichtigen und potenziell modifizierbaren Risikofaktoren. Eine frühzeitige nephrologische Beurteilung sowie eine interdisziplinäre Zusammenarbeit mit Geriatern, Allgemeinmedizinern, Physiotherapeuten, Ergotherapeuten und Ernährungsberatung sind essenzielle Bausteine in der Prävention und Therapie von Frailty. Zur Messung von Frailty existieren verschiedene Instrumente, wobei keines in der Erkennung von Frailty bei CKD-Patienten als überlegen identifiziert wurde. Die Auswahl des Screeninginstruments sollte daher unter Berücksichtigung der klinischen Rahmenbedingungen und der verfügbaren Ressourcen erfolgen. In diesem Artikel wird eine Strategie zur frühen Identifikation von gebrechlichen Patienten mit CKD vorgeschlagen, welche auf einer multidiemensionalen und interdisziplinären Einschätzung beruht. Wichtiger als die Methode ist jedoch die Notwendigkeit, Patienten mit Frailty zu identifizieren.
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Costa G, Bersigotti L, Massa G, Lepre L, Fransvea P, Lucarini A, Mercantini P, Balducci G, Sganga G, Crucitti A. The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery. Aging Clin Exp Res 2021; 33:2191-2201. [PMID: 33205380 PMCID: PMC8302529 DOI: 10.1007/s40520-020-01735-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. STUDY DESIGN 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called "EmSFI". Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. RESULTS 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654-0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682-0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. CONCLUSIONS The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.
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Affiliation(s)
- Gianluca Costa
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Laura Bersigotti
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy.
- Emergency Surgery Unit, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy.
| | - Giulia Massa
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Luca Lepre
- General Surgery Unit, Santo Spirito in Sassia Hospital, ASL Roma 1, Rome, Italy
| | - Pietro Fransvea
- Division of Emergency and Trauma Surgery - Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Alessio Lucarini
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Paolo Mercantini
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Genoveffa Balducci
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency and Trauma Surgery - Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Rome, Italy
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Coelho-Júnior HJ, Uchida MC, Picca A, Bernabei R, Landi F, Calvani R, Cesari M, Marzetti E. Evidence-based recommendations for resistance and power training to prevent frailty in community-dwellers. Aging Clin Exp Res 2021; 33:2069-2086. [PMID: 33587271 DOI: 10.1007/s40520-021-01802-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/21/2021] [Indexed: 02/07/2023]
Abstract
Frailty is a reversible state of reduced resilience to stressful events resulting from a multisystem impairment of the human body. As frailty progresses, people become more vulnerable to numerous adverse events, including falls and fractures, cognitive decline, disability, hospitalization, nursing home placement, and death. As such, substantial health care costs are associated with frailty. These features have led to the recognition of frailty as a public health problem. The identification of strategies for the management of frailty has, therefore, become a topic of extensive instigation. In this context, resistance (RT) and power training (PT) have received considerable attention, and experts in the field have recently suggested that both training modalities may improve frailty-related parameters. However, most studies have only included robust people and investigated frailty as a secondary outcome, so that current literature only allows RT and PT preventive programs against frailty to be designed. Here, we provide evidence-based critical recommendations for the prescription of RT and PT programs against incident frailty in community-dwellers.
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Affiliation(s)
- Hélio José Coelho-Júnior
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
- Applied Kinesiology Laboratory-LCA, School of Physical Education, University of Campinas, Campinas, 13083-970, Brazil.
- Rehabilitation Unit, Lar Mãe Mariana Nursing Home, Poá, Brazil.
| | - Marco Carlos Uchida
- Applied Kinesiology Laboratory-LCA, School of Physical Education, University of Campinas, Campinas, 13083-970, Brazil
| | - Anna Picca
- Department of Geriatrics and Internal Medicine, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore. L.Go F, Vito 1, 00168, Rome, Italy
| | - Roberto Bernabei
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Geriatrics and Internal Medicine, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore. L.Go F, Vito 1, 00168, Rome, Italy
| | | | - Riccardo Calvani
- Department of Geriatrics and Internal Medicine, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore. L.Go F, Vito 1, 00168, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, Università di Milano, 20122, Milan, Italy
- Geriatric Unit, IRCCS Istutiti Clinici Scientifici Maugeri, 20138, Milan, Italy
| | - Emanuele Marzetti
- Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
- Department of Geriatrics and Internal Medicine, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore. L.Go F, Vito 1, 00168, Rome, Italy.
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Dent E, Woo J, Scott D, Hoogendijk EO. Sarcopenia measurement in research and clinical practice. Eur J Intern Med 2021; 90:1-9. [PMID: 34238636 DOI: 10.1016/j.ejim.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 12/15/2022]
Abstract
Sarcopenia is a disease related to accelerated loss of skeletal muscle and subsequent decline in functional capacity. It affects approximately 13% of the world's population aged over 60 years. Sarcopenia is primarily managed and prevented through a combination of exercise prescription combined with appropriate nutritional strategies. This review outlines diagnostic and case finding/screening tools for age-related (primary) sarcopenia used in research and clinical practice. Diagnostic tools critically reviewed include those of the: European Workgroup for Sarcopenia (EWGSOP) versions 1 and 2; Asian Working Group for Sarcopenia (AWGS) versions 1 and 2; Foundation for the National Institutes of Health (FNIH); and the Sarcopenia Definition and Outcomes Consortium (SDOC). Criteria used by diagnostic tools (muscle mass, muscle strength and physical functioning/performance) are also detailed. Case-finding tools include the SARC-F questionnaire, Ishii's formula and Goodman's screening grid. Additionally, this review discusses the strengths and weaknesses of each diagnostic and case-finding tool, and examines their ability to reliably predict adverse clinical outcomes and patient responses to potential therapies.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, 88 Wakefield St, Adelaide SA, 5000 Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne VIC, 3004 Australia.
| | - Jean Woo
- Chinese University of Hong Kong, The Chinese University of Hong Kong, Central Ave, Hong Kong.
| | - David Scott
- Deakin University, Melbourne VIC, 3004 Australia; Monash University, Wellington Rd, Clayton VIC, 3800 Australia.
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC - location VU University medical center, Amsterdam, the Netherlands.
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Yoo J, Ruppar T, Wilbur J, Miller A, Westrick JC. Effects of Home-Based Exercise on Frailty in Patients With End-Stage Renal Disease: Systematic Review. Biol Res Nurs 2021; 24:48-63. [PMID: 34296640 DOI: 10.1177/10998004211033031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New or worsening frailty is a common problem in patients with end-stage renal disease (ESRD) during the prolonged time awaiting kidney transplantation. Structured physical activity in the dialysis setting has been shown to mitigate frailty, but little is known about the benefits of home-based exercise. The purpose of this systematic review was to summarize the effects of home-based exercise interventions on indicators of frailty (weakness, slowness, low physical activity, perceived exhaustion, and shrinking) among patients diagnosed with ESRD. METHODS We searched PubMed, MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar using Medical Subject Heading terms and free text keywords including kidney failure, exercise, and frailty. We identified 13 relevant articles (eight randomized controlled trials, five quasi-experimental studies). RESULTS Our review found potential effectiveness of home-based exercise interventions on mitigating or preventing selected indicators of frailty (e.g., weakness, slowness, low physical activity, perceived exhaustion), particularly when the interventions combined aerobic walking, resistance exercise, and behavioral components and were delivered for at least 6 months. However, no published studies measured the effect of home-based exercise interventions on frailty as a whole. CONCLUSIONS While existing studies suggest likely benefits of home-based exercise interventions among patients with ESRD, future research is warranted to develop and test home-based physical activity interventions that address all indicators of frailty.
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Affiliation(s)
- Jongwon Yoo
- Rush University Medical Center, Chicago, IL, USA.,Advanced Practice Nurse, Transplant Nephrology, Loyola University Medical Center, Maywood, IL, USA
| | - Todd Ruppar
- Rush University Medical Center, Chicago, IL, USA
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Affiliation(s)
- Ivan Aprahamian
- Geriatrics Division, Department of Internal Medicine, Jundiai Medical School, Jundiai, Sao Paulo, Brazil
| | - Qian-Li Xue
- Department of Medicine Division of Geriatric Medicine and Gerontology, School of Medicine, and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
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Suikkanen S, Soukkio P, Aartolahti E, Kääriä S, Kautiainen H, Hupli MT, Pitkälä K, Sipilä S, Kukkonen-Harjula K. Effect of 12-month supervised, home-based physical exercise on functioning among persons with signs of frailty - Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:2283-2290. [PMID: 34283997 DOI: 10.1016/j.apmr.2021.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty. DESIGN A randomized controlled trial with a 1:1 allocation SETTING: Home-based PARTICIPANTS: Home-dwelling persons aged ≥65 years meeting at least one frailty phenotype criteria (n=300). INTERVENTION 12-month, individually tailored, progressive and physiotherapist-supervised, physical exercise twice a week (n=150) vs. usual care (n=149). MAIN OUTCOME MEASURES Functional Independence Measure (FIM), Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed four times at home over 12 months. RESULTS The mean age of the participants was 82.2 (SD 6.3), 75% were women, 61% met 1-2 frailty criteria and 39% ≥3 criteria. FIM deteriorated in both groups over 12 months, -4.1 points (95% CI: -5.6 to -2.5) in the exercise group and -6.9 (-8.4 to -2.3) in the usual care group (group p=0.014, time p<0.001, interaction p=0.56). The mean improvement in SPPB was significantly greater in the exercise group [1.6 (1.3 to 2.0)] than in the usual care group [0.01 (-0.3 to 0.3)] (group p<0.001, time p=0.11, interaction p=0.027). The exercise group reported significantly fewer falls per person-year compared to the usual care group (incidence rate ratio, IRR 0.47 [95% CI 0.40 to 0.55]; p<0.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function or self-reported physical activity. CONCLUSIONS One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL or handgrip strength.
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Affiliation(s)
- Sara Suikkanen
- South Karelia Social and Health Care District, Rehabilitation, Valto Käkelän katu 3, FI-53130 Lappeenranta, FINLAND; University of Jyväskylä, Faculty of Sport and Health Sciences, PO Box 35, FI-40014 University of Jyväskylä, FINLAND.
| | - Paula Soukkio
- South Karelia Social and Health Care District, Rehabilitation, Valto Käkelän katu 3, FI-53130 Lappeenranta, FINLAND; University of Jyväskylä, Faculty of Sport and Health Sciences, PO Box 35, FI-40014 University of Jyväskylä, FINLAND.
| | - Eeva Aartolahti
- University of Jyväskylä, Faculty of Sport and Health Sciences, PO Box 35, FI-40014 University of Jyväskylä, FINLAND.
| | - Sanna Kääriä
- Raatimiehet Oy, Raatimiehenkatu 18, FI-53100, Lappeenranta, FINLAND.
| | - Hannu Kautiainen
- University of Helsinki, Department of General Practice, and Helsinki University Hospital, Unit of Primary Health Care, Tukholmankatu 8 B, FI-00290 Helsinki, FINLAND.
| | - Markku T Hupli
- South Karelia Social and Health Care District, Rehabilitation, Valto Käkelän katu 3, FI-53130 Lappeenranta, FINLAND.
| | - Kaisu Pitkälä
- University of Helsinki, Department of General Practice, and Helsinki University Hospital, Unit of Primary Health Care, Tukholmankatu 8 B, FI-00290 Helsinki, FINLAND.
| | - Sarianna Sipilä
- University of Jyväskylä, Faculty of Sport and Health Sciences, PO Box 35, FI-40014 University of Jyväskylä, FINLAND; University of Jyväskylä, Gerontology Research Center, Faculty of Sport and Health Sciences, Rautpohjankatu 8, FI-40700 Jyväskylä, FINLAND.
| | - Katriina Kukkonen-Harjula
- South Karelia Social and Health Care District, Rehabilitation, Valto Käkelän katu 3, FI-53130 Lappeenranta, FINLAND.
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Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, Nelson MB, Chen H, Upadhya B, Reed SD, Espeland MA, Hewston L, O’Connor CM. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med 2021; 385:203-216. [PMID: 33999544 PMCID: PMC8353658 DOI: 10.1056/nejmoa2026141] [Citation(s) in RCA: 259] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Older patients who are hospitalized for acute decompensated heart failure have high rates of physical frailty, poor quality of life, delayed recovery, and frequent rehospitalizations. Interventions to address physical frailty in this population are not well established. METHODS We conducted a multicenter, randomized, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was initiated during, or early after, hospitalization for heart failure and was continued after discharge for 36 outpatient sessions. The primary outcome was the score on the Short Physical Performance Battery (total scores range from 0 to 12, with lower scores indicating more severe physical dysfunction) at 3 months. The secondary outcome was the 6-month rate of rehospitalization for any cause. RESULTS A total of 349 patients underwent randomization; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, patients in each group had markedly impaired physical function, and 97% were frail or prefrail; the mean number of coexisting conditions was five in each group. Patient retention in the intervention group was 82%, and adherence to the intervention sessions was 67%. After adjustment for baseline Short Physical Performance Battery score and other baseline characteristics, the least-squares mean (±SE) score on the Short Physical Performance Battery at 3 months was 8.3±0.2 in the intervention group and 6.9±0.2 in the control group (mean between-group difference, 1.5; 95% confidence interval [CI], 0.9 to 2.0; P<0.001). At 6 months, the rates of rehospitalization for any cause were 1.18 in the intervention group and 1.28 in the control group (rate ratio, 0.93; 95% CI, 0.66 to 1.19). There were 21 deaths (15 from cardiovascular causes) in the intervention group and 16 deaths (8 from cardiovascular causes) in the control group. The rates of death from any cause were 0.13 and 0.10, respectively (rate ratio, 1.17; 95% CI, 0.61 to 2.27). CONCLUSIONS In a diverse population of older patients who were hospitalized for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care. (Funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, NCT02196038.).
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Affiliation(s)
- Dalane W. Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - David J. Whellan
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amy M. Pastva
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Robert J. Mentz
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC
| | | | - M. Benjamin Nelson
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Bharathi Upadhya
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Shelby D. Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Mark A. Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Internal Medicine, Section on Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - LeighAnn Hewston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Philadelphia, PA
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Tosi FC, Lin SM, Gomes GC, Aprahamian I, Nakagawa NK, Viveiro L, Bacha JMR, Jacob-Filho W, Pompeu JE. A multidimensional program including standing exercises, health education, and telephone support to reduce sedentary behavior in frail older adults: Randomized clinical trial. Exp Gerontol 2021; 153:111472. [PMID: 34271135 DOI: 10.1016/j.exger.2021.111472] [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: 05/13/2021] [Revised: 06/24/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The primary aim of this study was to evaluate the effect of a multidimensional program including home-based standing exercises, health education, and telephone support for the reduction of sedentary behavior in community-dwelling frail older adults. The secondary aim of this study was to evaluate the safety and adherence of the program. STUDY DESIGN A single-blind, randomized controlled trial. METHODS A total of 43 frail older adults were randomly assigned to the intervention and control groups. The intervention consisted of combined strategies including home-based standing exercises, health education, and telephone support for 16 weeks for frail older adults. The control group received orientation regarding the harmful effects of a sedentary lifestyle. Sedentary behavior was evaluated by total sedentary time, accumulated sedentary time in bouts of at least 10 min, and by the break in sedentary time, measured by an accelerometer used for at least 600 min/day for 4 days. Safety was assessed by self-reporting of possible adverse events. Adherence was assessed based on the number of days in which standing exercises were performed by the participants. Repeated measures ANOVA and Tukeys post hoc test were used to analyze the collected data. RESULTS The intervention group reduced the sedentary time by 30 min/day (p= 0.048), but without significant maintenance after 30 days of the program. Of the total number of participants, 82% (n = 14) of the intervention group participants showed more than 70% adherence to the program. The main adverse effects faced by the intervention group participants were tiredness (53%; n = 9) and lower limb pain (47%; n = 8). CONCLUSIONS The multidimensional program reduced sedentary behavior, was safe, and showed satisfactory adherence in frail older adults.
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Affiliation(s)
- Fabiana C Tosi
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
| | - Sumika M Lin
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Gisele C Gomes
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ivan Aprahamian
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil; Group of investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Naomi K Nakagawa
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Larissa Viveiro
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Jessica M R Bacha
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob-Filho
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose E Pompeu
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Effectiveness of nutrition interventions and combined nutrition and physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis. CMAJ 2021. [PMCID: PMC8315282 DOI: 10.9778/cmajo.20200248] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Although nutrition interventions may reverse frailty, it is unclear which interventions are optimal. We conducted a systematic review and meta-analysis to identify effective nutrition interventions that improve outcomes related to frailty. Methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and CINAHL (inception to July 2019) for English-language trials of nutrition and combined-approach (nutrition and exercise) interventions (with a control group) involving prefrail or frail adults aged 65 years or more. Outcomes of interest were frailty, mobility, health (body weight, body mass index), physical function (e.g., activities of daily living, muscle strength, appendicular lean mass), use of health care services (e.g., hospital admissions), quality of life, diet quality, mortality, and caregiver and social support. After data extraction, we assessed the risk of bias using the Cochrane Collaboration risk of bias tool for randomized controlled trials, rated the certainty of evidence with the Grading of Recommendation, Assessment, Development and Evaluations (GRADE) approach, and assessed statistical and methodologic heterogeneity. In addition, we conducted subgroup analyses of studies based on the primary intervention of protein supplementation. Results: We identified 15 studies involving 1825 prefrail or frail older participants: 7 were nutrition trials, 7 were combined-approach trials, and 1 trial had both a nutrition arm and a combined-approach arm. Seven studies had low risk of bias, 2 studies had high risk of bias, and for 6 studies the risk of bias was unclear. Nutrition interventions had small but significant effects on measures of physical function (standardized mean difference [SMD] 0.16, 95% confidence interval [CI] 0.02 to 0.29), mobility (SMD 0.15, 95% CI 0.00 to 0.30) and frailty (SMD −0.22, 95% CI −0.44 to −0.01) outcomes. Nutrition interventions combined with physical activity also had small but significant effects on physical function (SMD 0.19, 95% CI 0.06 to 0.32), mobility (SMD 0.25, 95% CI 0.02 to 0.48) and frailty (SMD −0.41, 95% CI −0.68 to −0.14; risk ratio 0.72, 95% CI 0.52 to 1.00) measures. Protein supplementation (5 studies) had small but significant effects on physical function measures (SMD 0.16, 95% CI 0.01 to 0.31) and mobility measures (SMD 0.20, 95% CI 0.02 to 0.39), with moderate certainty of evidence. Interpretation: There is moderate evidence that nutrition (including protein supplementation) and combined interventions are beneficial for prefrail or frail older adults. Trials with clear definitions of frailty and outcomes that reflect frailty identification and diagnosis are needed. PROSPERO registration: CRD42020144819
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Effectiveness of physical activity interventions in older adults with frailty or prefrailty: a systematic review and meta-analysis. CMAJ 2021. [PMCID: PMC8315283 DOI: 10.9778/cmajo.20200222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Methods: Results: Interpretation: PROSPERO registration:
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Aprahamian I, Petrella M, Robello EC, Gomes HJA, Lima NA, Fernandes IC, da Silva FRD, da Costa DL, Pain A, de Oliveira Reis M, Suemoto CK, Oude Voshaar RC. The association between cardiovascular risk factors and major cardiovascular diseases decreases with increasing frailty levels in geriatric outpatients. Exp Gerontol 2021; 153:111475. [PMID: 34265412 DOI: 10.1016/j.exger.2021.111475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frailty marks a process of increasing dysregulation of physiological systems which increases the risk of adverse health outcomes. This study examines the hypothesis that the association between multiple cardiovascular risk factors (CVRF) and cardiovascular diseases (CVD) becomes stronger with increasing frailty severity. METHODS Cross-sectional analysis of 339 older adults (55.2% women; aged 75.2 ± 9.1 years) from an outpatient geriatric clinic from a middle-income country. The frailty index (FI) was calculated as the proportion of 30 possible health deficits. We assessed hypertension, diabetes, obesity, dyslipidemia, sedentarism and smoking as CVRF (determinants) and myocardial infarction, stroke, heart failure as CVD. Poisson regression models adjusted for age, sex, and education was applied to estimate the association between frailty as well as CVRF (independent variables) with CVD (dependent variable). RESULTS Of the 339 patients, 18,3% were frail (FI ≥ 0.25) and 32.7% had at least one CVD. Both frailty and CVRF were significantly associated with CVD (PR = 1.03, 95% CI 1.01 to 1.05; p = 0.001, and PR = 1.46, 95% 1.24 to 1.71; p < 0.001, respectively) adjusted for covariates. The strength of the association between CVRF and CVD decreased with increasing frailty levels, as indicated by a significant interaction term of frailty and CVRF (p < 0.001). CONCLUSION Frailty and CVRF are both associated with CVD, but the impact of CVRF decreases in the presence of frailty. When confirmed in longitudinal studies, randomized controlled trials or causal inference methods like Mendelian randomization should be applied to assess whether a shift from traditional CVRF to frailty would improve cardiovascular outcome in the oldest old.
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Affiliation(s)
- Ivan Aprahamian
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil; Department of Psychiatry, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - Marina Petrella
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Everson C Robello
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Hélder Jorge Andrade Gomes
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Natália A Lima
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Isabela C Fernandes
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Fernanda Rezende Dias da Silva
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Daniele Lima da Costa
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Andréia Pain
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Mateus de Oliveira Reis
- Department of Internal Medicine, Division of Geriatrics, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Claudia K Suemoto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
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Lee MC, Tu YT, Lee CC, Tsai SC, Hsu HY, Tsai TY, Liu TH, Young SL, Lin JS, Huang CC. Lactobacillus plantarum TWK10 Improves Muscle Mass and Functional Performance in Frail Older Adults: A Randomized, Double-Blind Clinical Trial. Microorganisms 2021; 9:microorganisms9071466. [PMID: 34361902 PMCID: PMC8305125 DOI: 10.3390/microorganisms9071466] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022] Open
Abstract
Sarcopenia is a condition in which there is a loss of muscle caused by aging and it is one of the most significant factors that affects physical fragility. In recent years, the role of the gut–muscle axis has garnered attention as, along with the gut microbiota, it potentially plays a significant role in muscle regeneration, in addition to nutritional supplements and exercise training. Past studies have found that supplementation with Lactobacillus plantarum TWK10 could effectively increase the muscle mass of animals or adult humans. Therefore, in this study, we investigated whether the supplementation of L. plantarum TWK10 produces increased muscle mass and improves the functional performance of elderly persons with mild fragility. A total of 68 elderly subjects were recruited, of which 13 subjects were excluded or withdrew from the study. We adopted a double-blind design, and the 55 subjects were randomly divided into three groups: the placebo group, the TWK10 low-dose group (2 × 1010 CFU/day) (TWK10-L), and the TWK10 high-dose group (6 × 1010 colony-forming unit (CFU)/day) (TWK10-H). For 18 weeks, all subjects were required to regularly take experimental samples, perform functional activity testing, and have their body composition analyzed before the study and every six weeks after the intervention. Finally, 17 subjects in the placebo group, 12 subjects in the TWK10-L group, and 13 subjects in the TWK10-H group finished the study. It was found that supplementation with TWK10 had a tendency to increase and improve muscle mass, left hand grip strength, lower limb muscle strength, and gait speed and balance after the sixth week, especially in the TWK10-H group, and, as the supplement time was longer up to the 18th week, it had an even greater effect (p < 0.05). In conclusion, consecutive supplementation of L. plantarum TWK10 for more than six weeks could effectively improve the muscle strength and endurance of the elderly, reducing sarcopenia and physical fragility. This trial was registered as NCT04893746.
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Affiliation(s)
- Mon-Chien Lee
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan City 333325, Taiwan; (M.-C.L.); (Y.-T.T.)
| | - Yu-Tsai Tu
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan City 333325, Taiwan; (M.-C.L.); (Y.-T.T.)
- Department of Physical Medicine and Rehabilitation, Taipei City Hospital, Zhongxiao Branch, Taipei City 11556, Taiwan
| | - Chia-Chia Lee
- Culture Collection & Research Institute, SYNBIO TECH INC., Kaohsiung City 82151, Taiwan; (C.-C.L.); (H.-Y.H.); (S.-L.Y.)
| | - Shiow-Chwen Tsai
- Institute of Sports Sciences, University of Taipei, Taipei City 112, Taiwan;
| | - Han-Yin Hsu
- Culture Collection & Research Institute, SYNBIO TECH INC., Kaohsiung City 82151, Taiwan; (C.-C.L.); (H.-Y.H.); (S.-L.Y.)
| | - Tsung-Yu Tsai
- Department of Food Science, Fu Jen Catholic University, New Taipei City 24205, Taiwan; (T.-Y.T.); (T.-H.L.)
| | - Te-Hua Liu
- Department of Food Science, Fu Jen Catholic University, New Taipei City 24205, Taiwan; (T.-Y.T.); (T.-H.L.)
| | - San-Land Young
- Culture Collection & Research Institute, SYNBIO TECH INC., Kaohsiung City 82151, Taiwan; (C.-C.L.); (H.-Y.H.); (S.-L.Y.)
| | - Jin-Seng Lin
- Culture Collection & Research Institute, SYNBIO TECH INC., Kaohsiung City 82151, Taiwan; (C.-C.L.); (H.-Y.H.); (S.-L.Y.)
- Correspondence: (J.-S.L.); (C.-C.H.); Tel.: +886-7-6955680 (J.-S.L.); +886-3-328-3201 (ext. 2604) (C.-C.H.)
| | - Chi-Chang Huang
- Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan City 333325, Taiwan; (M.-C.L.); (Y.-T.T.)
- Correspondence: (J.-S.L.); (C.-C.H.); Tel.: +886-7-6955680 (J.-S.L.); +886-3-328-3201 (ext. 2604) (C.-C.H.)
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Soytas RB. A bibliometric analysis of publications on COVID-19 and older adults. Ann Geriatr Med Res 2021; 25:197-203. [PMID: 34229370 PMCID: PMC8497949 DOI: 10.4235/agmr.21.0060] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023] Open
Abstract
Background Bibliometric analysis is important to guide future research priorities. We aimed to evaluate the most relevant scientific research on COVID-19 and older adults, analyze the current hot topics and identify the 50 most cited publications. Methods Articles published between December 2019-March 17, 2021 were analyzed. A list was obtained that contained the terms "COVID-19" or "Novel Coronavirus" or "SARS-CoV-2" or "2019-nCoV" and "geriatrics" or "older adults" or "elderly" in the title, abstract, keywords, or keywords plus. Original research articles, reviews, editorial materials, letters were included. The information for the articles contained the year, journal, title, author, country, affiliation, keywords, document type, and counts of citation. VOSviewer was used to analyze the keywords. The most cited 50 articles were identified. Results Totally 784 publications were included. The keywords that appeared most were "COVID-19" and "older adults," which had a strong link to "social isolation," "dementia," "mortality," and "loneliness." The most active (40.8%) and most cited (1,578) country was the United States. The journal with the largest number of publications (22.7%) and citations (947) was the Journal of the American Geriatric Society. The most researched (84.0%) and most cited area was geriatrics-gerontology (2,882). The median number of citations for the most cited 50 articles was 46.8. Conclusion The current bibliometric analysis provides information about the quality and research areas of the studies concerning COVID-19 and older adults that have been published so far. Social and psychological support, nutrition, vaccines, and telemedicine may be hot research topics for the future.
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Affiliation(s)
- Rabia Bag Soytas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Tavares J, Sa-Couto P, Reis JD, Boltz M, Capezuti E. The Role of Frailty in Predicting 3 and 6 Months Functional Decline in Hospitalized Older Adults: Findings from a Secondary Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137126. [PMID: 34281063 PMCID: PMC8297187 DOI: 10.3390/ijerph18137126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 01/13/2023]
Abstract
Frailty represents one of the most relevant geriatric syndromes in the 21st century and is a predictor of adverse outcomes in hospitalized older adult, such as, functional decline (FD). This study aimed to examine if frailty, evaluated with the Frailty Index (FI), can predict FD during and after hospitalization (3 and 6 months). Secondary data analysis of a prospective cohort study of 101 hospitalized older adults was performed. The primary outcome was FD at discharge, 3 and 6 months. The FI was created from an original database using 40 health deficits. Functional decline models for each time-point were examined using a binary logistic regression. The prevalence of frailty was 57.4% with an average score of 0.25 (±0.11). Frail patients had significant and higher values for functional decline and social support for all time periods and more hospital readmission in the 3 month period. Multivariable regression analysis showed that FI was a predictor of functional decline at discharge (OR = 1.07, 95% CI = 1.02–1.14) and 3-month (OR = 1.05, 95% CI = 1.01–1.09) but not 6-month (OR = 1.03, 95% CI = 0.99–1.09) follow-up. Findings suggest that frailty at admission of hospitalized older adults can predict functional decline at discharge and 3 months post-discharge.
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Affiliation(s)
- João Tavares
- School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Health Technology and Services Research, 3810-193 Aveiro, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), 3000-232 Coimbra, Portugal
- Correspondence: ; Tel.: +351-234372466
| | - Pedro Sa-Couto
- Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal; (P.S.-C.); (J.D.R.)
| | - João Duarte Reis
- Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal; (P.S.-C.); (J.D.R.)
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, PA 10927, USA;
| | - Elizabeth Capezuti
- School of Nursing, Hunter College of the City University of New York, New York, NY 10010, USA;
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Hoogendijk EO, Stolz E, Oude Voshaar RC, Deeg DJH, Huisman M, Jeuring HW. Trends in Frailty and Its Association With Mortality: Results From the Longitudinal Aging Study Amsterdam, 1995-2016. Am J Epidemiol 2021; 190:1316-1323. [PMID: 33534876 PMCID: PMC8245891 DOI: 10.1093/aje/kwab018] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to investigate trends in frailty and its relationship with mortality among older adults aged 64–84 years across a period of 21 years. We used data from 1995 to 2016 from the Longitudinal Aging Study Amsterdam. A total of 7,742 observations of 2,874 respondents in the same age range (64–84 years) across 6 measurement waves were included. Frailty was measured with a 32-item frailty index, with a cutpoint of ≥0.25 to indicate frailty. The outcome measure was 4-year mortality. Generalized estimating equation analyses showed that among older adults aged 64–84 years the 4-year mortality rate declined between 1995 and 2016, while the prevalence of frailty increased. Across all measurement waves, frailty was associated with 4-year mortality (odds ratio = 2.79, 95% confidence interval: 2.39, 3.26). There was no statistically significant interaction effect between frailty and time on 4-year mortality, indicating a stable association between frailty and mortality. In more recent generations of older adults, frailty prevalence rates were higher, while excess mortality rates of frailty remained the same. This is important information for health policy-makers and clinical practitioners, showing that continued efforts are needed to reduce frailty and its negative health consequences.
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Affiliation(s)
- Emiel O Hoogendijk
- Correspondence to Dr. Emiel O. Hoogendijk, Department of Epidemiology & Data Science, Amsterdam UMC, VU University Medical Center, P.O. Box 7057, 1007MB Amsterdam, the Netherlands (e-mail: )
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Lee SY, Wang J, Chao CT, Chien KL, Huang JW. Frailty is associated with a higher risk of developing delirium and cognitive impairment among patients with diabetic kidney disease: A longitudinal population-based cohort study. Diabet Med 2021; 38:e14566. [PMID: 33772857 DOI: 10.1111/dme.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/09/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
AIMS Delirium, a form of acute brain failure, exhibits a high incidence among older adults. Recent studies have implicated frailty as an under-recognized complication of diabetes mellitus. Whether the presence of frailty increases the risk of delirium/cognitive impairment among patients with diabetic kidney disease (DKD) remains unclear. METHODS From the longitudinal cohort of diabetes patients (LCDP) (n = 840,000) in Taiwan, we identified adults with DKD, dividing them into those without and with different severities of frailty based on a modified FRAIL scale. Cox proportional hazard regression was utilized to examine the frailty-associated risk of delirium/cognitive impairment, identified using approaches validated by others. RESULTS Totally 149,145 patients with DKD (mean 61.0 years, 44.2% female) were identified, among whom 31.0%, 51.7%, 16.0% and 1.3% did not have or had 1, 2 and >2 FRAIL items at baseline. After 3.68 years, 6613 (4.4%) developed episodes of delirium/cognitive impairment. After accounting for demographic/lifestyle factors, co-morbidities, medications and interventions, patients with DKD and 1, 2 and >2 FRAIL items had a progressively higher risk of developing delirium/cognitive impairment than those without (for those with 1, 2 and >2 items, hazard ratio 1.18, 1.26 and 1.30, 95% confidence interval 1.08-1.28, 1.14-1.39 and 1.10-1.55, respectively). For every FRAIL item increase, the associated risk rose by 9%. CONCLUSIONS Frailty significantly increased the risk of delirium/cognitive impairment among patients with DKD. Frailty screening in these patients may assist in delirium risk stratification.
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Affiliation(s)
- Szu-Ying Lee
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chia-Ter Chao
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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van den Berg KS, Hegeman JM, van den Brink RHS, Rhebergen D, Oude Voshaar RC, Marijnissen RM. A prospective study into change of vitamin D levels, depression and frailty among depressed older persons. Int J Geriatr Psychiatry 2021; 36:1029-1036. [PMID: 33559131 PMCID: PMC8248246 DOI: 10.1002/gps.5507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/31/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES While vitamin D is involved in frailty as well as depression, hardly any study has examined the course of vitamin D levels prospectively. The objective of this study is to examine whether a change of vitamin D in depressed older adults is associated with either depression course, course of frailty, or both. METHODS The study population consisted of 232 of 378 older adults (60-93 years) with a DSM-IV defined depressive disorder participating in the Netherlands Study of Depression in Older persons, a prospective clinical cohort study. Baseline and 2-year follow-up data on depressive disorder (DSM-IV diagnosis), symptom severity (inventory of depressive symptoms), frailty phenotype (and its individual components) and vitamin D levels were obtained. Linear mixed models were used to study the association of change in vitamin D levels with depression course, course of frailty, and the combination. RESULTS Vitamin D levels decreased from baseline to follow-up, independent from depression course. An increase in frailty was associated with a significantly sharper decrease of vitamin D levels over time. Post hoc analyses showed that this association with frailty might be driven by an increase of exhaustion over time and counteracted by an increase in walking speed. CONCLUSIONS Our findings generate the hypothesis that vitamin D supplementation in late-life depression may improve frailty, which may partly explain inconsistent findings of randomised controlled trials evaluating the effect of vitamin D for depression. We advocate to consider frailty (components) as an outcome in future supplementation trials in late-life depression.
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Affiliation(s)
- Karen S. van den Berg
- Department of PsychiatrySt Antonius HospitalNieuwegein/UtrechtThe Netherlands,Department of PsychiatryUniversity Centre of PsychiatryUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Johanna M. Hegeman
- Department of PsychiatrySt Antonius HospitalNieuwegein/UtrechtThe Netherlands
| | - Rob H. S. van den Brink
- Department of PsychiatryUniversity Centre of PsychiatryUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Didi Rhebergen
- Department of PsychiatryVU University Medical Centre/GGZ InGeestAmsterdamThe Netherlands
| | - Richard C. Oude Voshaar
- Department of PsychiatryUniversity Centre of PsychiatryUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Radboud M. Marijnissen
- Department of PsychiatryUniversity Centre of PsychiatryUniversity Medical Centre GroningenGroningenThe Netherlands
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Nguyen TN, Harris K, Woodward M, Chalmers J, Cooper M, Hamet P, Harrap S, Heller S, MacMahon S, Mancia G, Marre M, Poulter N, Rogers A, Williams B, Zoungas S, Chow CK, Lindley RI. The Impact of Frailty on the Effectiveness and Safety of Intensive Glucose Control and Blood Pressure-Lowering Therapy for People With Type 2 Diabetes: Results From the ADVANCE Trial. Diabetes Care 2021; 44:1622-1629. [PMID: 34035077 PMCID: PMC8323181 DOI: 10.2337/dc20-2664] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/23/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To develop a frailty index (FI) and explore the relationship of frailty to subsequent adverse outcomes on the effectiveness and safety of more intensive control of both blood glucose and blood pressure (BP), among participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. RESEARCH DESIGN AND METHODS Cox proportional hazard models were used to estimate the effectiveness and safety of intensive glucose control and BP intervention according to frailty (defined as FI >0.21) status. The primary outcomes were macro- and microvascular events. The secondary outcomes were all-cause mortality, cardiovascular mortality, severe hypoglycemia, and discontinuation of BP treatment due to hypotension/dizziness. RESULTS There were 11,140 participants (mean age, 65.8 years; 42.5% women, 25.7% frail). Frailty was an independent predictor of all primary outcomes and secondary outcomes. The effect of intensive glucose treatment on primary outcomes showed some evidence of attenuation in the frail: hazard ratios for combined major macro- and microvascular events 1.03 (95% CI 0.90-1.19) in the frail versus 0.84 (95% CI 0.74-0.94) in the nonfrail (P = 0.02). A similar trend was observed with BP intervention. Severe hypoglycemia rates (per 1,000 person-years) were higher in the frail: 8.39 (6.15-10.63) vs. 4.80 (3.84-5.76) in nonfrail (P < 0.001). There was no significant difference in discontinuation of BP treatment between frailty groups. CONCLUSIONS It was possible to retrospectively estimate frailty in a trial population, and this FI identified those at higher risk of poor outcomes. Participants with frailty had some attenuation of benefit from intensive glucose-lowering and BP-lowering treatments.
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Affiliation(s)
- Tu N Nguyen
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College, London, U.K.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Cooper
- Department of Diabetes, Monash University, Melbourne, Victoria, Australia
| | - Pavel Hamet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Stephen Harrap
- Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Simon Heller
- Academic Unit of Diabetes, Oncology & Metabolism, University of Sheffield, Sheffield, U.K
| | - Stephen MacMahon
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College, London, U.K
| | - Giuseppe Mancia
- Istituto Auxologico Italiano, University of Milan-Bicocca, Milan, Italy
| | - Michel Marre
- Department of Endocrinology, Hôpital Bichat-Claude Bernard, University of Paris, Paris, France
| | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, U.K
| | - Anthony Rogers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bryan Williams
- National Institute for Health Research, University College London, Hospitals Biomedical Research Centre, London, U.K
| | - Sophia Zoungas
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia .,The George Institute for Global Health, Sydney, New South Wales, Australia
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