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Çavuşoğlu Ç, Deniz O, Tuna Doğrul R, Çöteli S, Öncül A, Kızılarslanoğlu MC, Gçker B. Frailty is associated with poor sleep quality in the oldest old. Turk J Med Sci 2021; 51:540-546. [PMID: 32950043 PMCID: PMC8203150 DOI: 10.3906/sag-2001-168] [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] [Received: 01/20/2020] [Accepted: 09/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background/aim Sleep disorders and frailty increase with advancing age, along with physical disabilities, cognitive dysfunction, mood disorders, and social vulnerability. Thus, the study objective was to evaluate the relationship between frailty and sleep quality in the oldest old patients. Materials and methods In this study, 100 patients aged ≥80 years were assessed using comprehensive geriatric assessment (CGA) including basic activities of daily living (ADL), instrumental ADL, handgrip strength, the Geriatric Depression Scale-15, the Mini-Mental State Examination, and the Mini-Nutritional Assessment-Short Form. The sleep quality and frailty status of the patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Fried Frailty Index, respectively. Results The median age of the participants was 84 years (80–92), 55% of them were women, and 41% of them were frail. There was no statistically significant difference between the frail and nonfrail groups in terms of age, sex, and comorbidities (P > 0.050). The frail patients scored poorly according to the CGA tests when compared to the nonfrail ones (P < 0.050). The median score for the PSQI was significantly higher in the frail group, 12 points (3–19) versus 6 points (1–19) in the nonfrail patients (P < 0.001). The PSQI score (odds ratio [OR] of 1.308, 95% confidence interval [CI]: 1.092–1.566, P = 0.004), female sex (OR of 5.489, 95% CI: 1.063–28.337; P = 0.042), and the basic ADL score (OR of 0.383; 95% CI: 0.207–0.706; P = 0.002) were found to be independently associated with frailty using multivariate analysis. Conclusion Sleep quality was significantly decreased in the oldest old frail patients compared to the nonfrail ones, and poor sleep quality was independently associated with frailty. Evaluating the sleep patterns of the oldest old patients with CGA in daily geriatric practice might help to improve the quality of life of frail patients.
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Affiliation(s)
- Çağatay Çavuşoğlu
- Division of Geriatric Medicine, Department of Internal Medical Sciences, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Olgun Deniz
- Division of Geriatric Medicine, Department of Internal Medical Sciences, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Rana Tuna Doğrul
- Division of Geriatric Medicine, Department of Internal Medical Sciences, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Süheyla Çöteli
- Division of Geriatric Medicine, Department of Internal Medical Sciences, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ali Öncül
- Division of Geriatric Medicine, Department of Internal Medical Sciences, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Muhammet Cemal Kızılarslanoğlu
- Division of Geriatrics and Palliative Care, Department of Internal Medical Sciences, University of Health Sciences, Konya Education and Research Hospital, Konya, Turkey
| | - Berna Gçker
- Division of Geriatric Medicine, Department of Internal Medical Sciences, Faculty of Medicine, Gazi University, Ankara, Turkey
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352
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Li Q, Chen X, Han B. Effect Modification by Sex of the Hemoglobin Concentration on Frailty Risk in Hospitalized Older Patients. Clin Interv Aging 2021; 16:687-696. [PMID: 33911857 PMCID: PMC8075178 DOI: 10.2147/cia.s298672] [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: 12/23/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hemoglobin concentration differs by sex, possibly affecting any association between hemoglobin and frailty. This study aimed to evaluate the potential interaction effect of hemoglobin and sex on frailty in Chinese older inpatients. Methods A cross-sectional study was conducted between February 2015 and November 2017 in a tertiary hospital. Frailty was defined by the Fried phenotype. Hemoglobin concentration was measured with a standard procedure. Covariates included demographics, clinical characteristics, and serum biomarkers. Logistic regression was applied to examine the association between hemoglobin concentration and frailty. The relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were used to evaluate the additive interaction. Results A total of 619 older inpatients [mean age 69.26±7.44 years; 334 men, 285 women] were included. The mean hemoglobin concentration was significantly lower in the elderly who were frail (11.9 g/L in frail versus 13.1g/L in non-frail; p<0.001). In the multivariable regression models, lower hemoglobin in patients was significantly associated with frailty (adjusted odds ratio (OR) = 2.51, 95% CI:1.37, 4.60). The stratified analyses indicated that lower hemoglobin was associated with frailty among older inpatients with different characteristics. Female inpatients with lower hemoglobin had the highest risk of frailty (adjusted OR=6.43, 95%: 2.38, 17.3); there were interactions between hemoglobin and sex on the development of frailty (RERI=4.30, 95% CI=−1.41, 10.01; AP=0.67, 95% CI=0.37, 0.97;SI=4.80, 95% CI=1.22, 18.84). Conclusions and Implications Our study provided evidence that sex and lower hemoglobin have an interaction effect on frailty; it is suggested that clinicians may consider sex-specific strategies for the elderly to conform the concept of precision medicine.
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Affiliation(s)
- Qiuping Li
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xi Chen
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Binru Han
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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353
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Farrés-Godayol P, Jerez-Roig J, Minobes-Molina E, Yildirim M, Goutan-Roura E, Coll-Planas L, Escribà-Salvans A, Molas-Tuneu M, Moreno-Martin P, Rierola-Fochs S, Rierola-Colomer S, Romero-Mas M, Torres-Moreno M, Naudó-Molist J, Bezerra de Souza DL, Booth J, Skelton DA, Giné-Garriga M. Urinary incontinence and sedentary behaviour in nursing home residents in Osona, Catalonia: protocol for the OsoNaH project, a multicentre observational study. BMJ Open 2021; 11:e041152. [PMID: 33879481 PMCID: PMC8061864 DOI: 10.1136/bmjopen-2020-041152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/14/2021] [Accepted: 03/24/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Several studies have shown that physical activity (PA) levels and sedentary behaviour (SB) are independent risk factors for many health-related issues. However, there is scarce evidence supporting the relationship between SB and urinary incontinence (UI) in community-dwelling older adults, and no information on any possible association in institutionalised older adults. Stage I of this project has the main objective of determining the prevalence of UI and its associated factors in nursing home (NH) residents, as well as analysing the association between UI (and its types) and SB. Stage II aims to investigate the incidence and predictive factors of functional and continence decline, falls, hospitalisations, mortality and the impact of the COVID-19 pandemic among NH residents. METHODS AND ANALYSIS Stage I is an observational, multicentre, cross-sectional study with mixed methodology that aims to explore the current status of several health-related outcomes in NH residents of Osona (Barcelona, Spain). The prevalence ratio will be used as an association measure and multivariate analysis will be undertaken using Poisson regression with robust variance. Stage II is a 2-year longitudinal study that aims to analyse functional and continence decline, incidence of falls, hospitalisations, mortality and the impact of the COVID-19 pandemic on these outcomes. A survival analysis using the actuarial method for functional decline and continence, evaluated every 6 months, and the Kaplan-Meier method for falls, hospitalisations and deaths, and Cox regression for multivariate analysis will be undertaken. ETHICS AND DISSEMINATION The study received the following approvals: University of Vic - Central University of Catalonia Ethics and Research Committee (92/2019 and 109/2020), Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (FORES) (code 2020118/PR249). Study results will be disseminated at conferences, meetings and through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04297904.
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Affiliation(s)
- Pau Farrés-Godayol
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Eduard Minobes-Molina
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Meltem Yildirim
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Ester Goutan-Roura
- Research group on Tissue Repair and Regeneration Laboratory (TR2Lab), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Laura Coll-Planas
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Escribà-Salvans
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Miriam Molas-Tuneu
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Pau Moreno-Martin
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Sandra Rierola-Fochs
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Sergi Rierola-Colomer
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Montse Romero-Mas
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Miriam Torres-Moreno
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Jordi Naudó-Molist
- Research group on Mental Health and Social Innovation (SAMIS), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
| | - Dyego Leandro Bezerra de Souza
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Barcelona, Spain
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Joanne Booth
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maria Giné-Garriga
- Faculty of Psychology, Education and Sport Sciences Blanquerna, Ramon Llull University, Barcelona, Spain
- Faculty of Health Sciences Blanquerna, Ramon Llull University, Barcelona, Spain
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354
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Merchant RA, Chan YH, Hui RJY, Tsoi CT, Kwek SC, Tan WM, Lim JY, Sandrasageran S, Wong BLL, Chen MZ, Ng SE, Morley JE. Motoric cognitive risk syndrome, physio-cognitive decline syndrome, cognitive frailty and reversibility with dual-task exercise. Exp Gerontol 2021; 150:111362. [PMID: 33887381 DOI: 10.1016/j.exger.2021.111362] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/28/2021] [Accepted: 04/17/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cognitive frailty (CF) is associated with dementia and disability. It was initially proposed in 2013 by the International Institute of Nutrition and Aging and the International Geriatrics Association. Over the years, there have been many emerging definitions e.g., Motoric Cognitive Risk Syndrome (MCR), Physio-cognitive Decline Syndrome (PCDS), reversible CF and potentially reversible CF. OBJECTIVE Our objective was to determine the demographics including physical, functional, and psychosocial factors for the four CF definitions amongst community-dwelling older adults. In addition, the effect of dual-task exercise on the reversibility of different definitions of CF was also studied. METHODS Participants were community-dwelling older adults aged ≥60 years recruited between August 2017 and December 2019. Older adults screened to be frail, prefrail or have cognitive impairment were invited to participate in dual-task exercise program called HAPPY (Healthy Ageing Promotion Program for You). Improvement in cognition, frailty, and physical performance after a 3-month dual-task exercise intervention program was compared with controls. RESULTS The prevalence of CF depending on definition ranged from 8.8% to 28.7% with minimal overlap. The cognitive scores were significantly lower in all the groups predominantly affecting non-memory domains except for reversible CF. Frailty was three to seven times more prevalent in CF. MCR group had higher prevalence of functional limitation, pain and depression. All four groups had significant increase in global cognition scores especially in the attention domain where the control group declined, and reduction in the prevalence of frailty post intervention. MCR and reversible CF were significantly associated with increased odds of cognitive improvement after 3 months of intervention compared with control. CONCLUSION CF is a novel concept and regardless of the definitions, is a target for reversing frailty, functional limitation and cognitive impairment through dual-task exercise. Long-term prospective studies are needed to evaluate the effectiveness of dual-task interventions in delaying the conversion to dementia and reduction of disability.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Richard Jor Yeong Hui
- National University Polyclinics, National University Health System, Singapore, Singapore
| | - Chris Tung Tsoi
- Department of Psychological Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Sing Cheer Kwek
- National University Polyclinics, National University Health System, Singapore, Singapore
| | - Weng Mooi Tan
- Integrated Health Division, MOH Office for Healthcare Transformation, Singapore
| | - Jia Yi Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Surein Sandrasageran
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Beatrix Ling Ling Wong
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO, USA
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355
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Harris W, Stirling C, Williams AM, Lucas P. Care of frail and older adults: A content analysis of paramedic operational clinical practice guidelines. Int Emerg Nurs 2021; 56:101007. [PMID: 33872941 DOI: 10.1016/j.ienj.2021.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 02/25/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Frailty rates are increasing with population ageing. In paramedicine, Clinical Practice Guidelines (CPGs) are essential documents that support decision making, yet little evidence exists regarding the support CPGs provide paramedics in the care of frail and older adults. AIM To investigate how CPGs support paramedics' care of frail and older adults. METHODS CPGs from nine Australasian paramedic services were collected in 2019. Content analysis was used to explore two hundred and thirty-seven individual CPGs for decision support information regarding frail and older adults. RESULTS Evidence-based content relating to older adults was sparse compared to paediatric content. Two overarching decision support domains were identified, patient assessment and management. Inconsistent age descriptors were widespread, particularly in pharmacological guidelines. Five service providers' CPGs contained validated assessment instruments for use with older adults. CONCLUSION Decision support documentation regarding frail and older adults varies across Australasian paramedic services. Frailty and older adult specific CPGs, and validated assessment instruments suitable to the paramedicine environment could improve paramedic decision making and minimise patient risk. A collaborative approach encompassing service providers and educational institutions is crucial to develop consistent, evidence-based CPGs relevant to older adults.
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Affiliation(s)
- Wayne Harris
- Tasmanian School of Medicine, College of Health and Medicine, Division of Paramedicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
| | - Christine Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Private Bag 135, Hobart 7001, Tasmania, Australia.
| | - Anne-Marie Williams
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
| | - Peter Lucas
- Tasmanian School of Medicine, College of Health and Medicine, Division of Paramedicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia.
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356
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Mello BHD, Lenardt MH, Moraes DC, Setoguchi LS, Seima MD, Betiolli SE. Cognitive impairment and physical frailty in older adults in secondary health care. Rev Esc Enferm USP 2021; 55:e03687. [PMID: 33886914 DOI: 10.1590/s1980-220x2019029803687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/17/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the association between cognitive impairment and physical frailty in older adults in secondary health care. METHOD This is a cross-sectional study carried out with people aged ≥ 60 years, assisted at a geriatric and gerontology outpatient clinic. For cognitive screening, the Mini Mental State Examination, the semantic verbal fluency test, and frailty assessment using the physical frailty phenotype were used. The likelihood ratio test was applied to the predictive model. RESULTS 407 older adults participated in the study. Cognitive impairment was observed in 58.5% (n=238) of the sample, being higher in frail (n=66; 75%). A change in the semantic verbal fluency test was identified in 22% (n=90), with a higher prevalence in pre-frail patients (55.5%; n=226). It was identified 2.5 times more chance of a frail older person, when compared to a non-frail one, to have cognitive impairment (95% CI, +0.947 - 0.322). The chance for alteration in the semantic verbal fluency test was 5.4 times higher in frail compared to non-frail ones (95% CI, 1.68 - 0.38). CONCLUSION A relationship was observed between cognitive impairment and physical frailty. Screening for frailty in geriatric nursing practice and the implementation of specific care is recommended.
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Affiliation(s)
- Bruno Henrique de Mello
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Maria Helena Lenardt
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Dayana Cristina Moraes
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | | | - Marcia Daniele Seima
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
| | - Susanne Elero Betiolli
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brazil
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357
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Venturini C, Sampaio RF, de Souza Moreira B, Ferriolli E, Neri AL, Lourenço RA, Lustosa LP. A multidimensional approach to frailty compared with physical phenotype in older Brazilian adults: data from the FIBRA-BR study. BMC Geriatr 2021; 21:246. [PMID: 33853524 PMCID: PMC8045180 DOI: 10.1186/s12877-021-02193-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Frailty is a predictor of negative health outcomes in older adults. The physical frailty phenotype is an often used form for its operationalization. Some authors have pointed out limitations regarding the unidimensionality of the physical phenotype, introducing other dimensions in the approach to frailty. This study aimed to create a multidimensional model to evaluate frailty in older Brazilian adults and to compare the dimensions of the model created among the categories of the physical frailty phenotype. METHODS A cross-sectional study was conducted using data from 3569 participants (73.7 ± 6.6 years) from a multicenter and multidisciplinary survey (FIBRA-BR). A three-dimensional model was developed: physical dimension (poor self-rated health, vision impairment, hearing impairment, urinary incontinence, fecal incontinence, and sleeping disorder), social dimension (living alone, not having someone who could help when needed, not visiting others, and not receiving visitors), and psychological dimension (depressive symptoms, concern about falls, feelings of sadness, and memory problems). The five criteria of the phenotype created by Fried and colleagues were used to evaluate the physical frailty phenotype. The proposed multidimensional frailty model was analyzed using factorial analysis. Pearson's chi-square test was used to analyze the associations between each variable of the multidimensional frailty model and the physical phenotype categories. Analysis of variance compared the multidimensional dimensions scores among the three categories of the physical frailty phenotype. RESULTS The factorial analysis confirmed a model with three factors, composed of 12 variables, which explained 38.6% of the variability of the model data. The self-rated health variable was transferred to the psychological dimension and living alone variable to the physical dimension. The vision impairment and hearing impairment variables were dropped from the physical dimension. The variables significantly associated with the physical phenotype were self-rated health, urinary incontinence, visiting others, receiving visitors, depressive symptoms, concern about falls, feelings of sadness, and memory problems. A statistically significant difference in mean scores for physical, social, and psychological dimensions among three physical phenotype categories was observed (p < 0.001). CONCLUSIONS These results confirm the applicability of our frailty model and suggest the need for a multidimensional approach to providing appropriate and comprehensive care for older adults.
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Affiliation(s)
- Claudia Venturini
- Department of Physical Therapy, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, EEFFTO, Pampulha, Belo Horizonte, Minas Gerais Brazil
| | - Rosana Ferreira Sampaio
- Department of Physical Therapy, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, EEFFTO, Pampulha, Belo Horizonte, Minas Gerais Brazil
| | - Bruno de Souza Moreira
- Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | | | | | | | - Lygia Paccini Lustosa
- Department of Physical Therapy, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos 6627, EEFFTO, Pampulha, Belo Horizonte, Minas Gerais Brazil
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358
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Andrés-Esteban EM, Quintana-Diaz M, Ramírez-Cervantes KL, Benayas-Peña I, Silva-Obregón A, Magallón-Botaya R, Santolalla-Arnedo I, Juárez-Vela R, Gea-Caballero V. Outcomes of hospitalized patients with COVID-19 according to level of frailty. PeerJ 2021; 9:e11260. [PMID: 33954054 PMCID: PMC8051355 DOI: 10.7717/peerj.11260] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background The complications from coronavirus disease 2019 (COVID-19) have been the subject of study in diverse scientific reports. However, many aspects that influence the prognosis of the disease are still unknown, such as frailty, which inherently reduces resistance to disease and makes people more vulnerable. This study aimed to explore the complications of COVID-19 in patients admitted to a third-level hospital and to evaluate the relationship between these complications and frailty. Methods An observational, descriptive, prospective study was performed in 2020. A sample of 254 patients from a database of 3,112 patients admitted to a high-level hospital in Madrid, Spain was analyzed. To assess frailty (independent variable) the Clinical Frailty Scale (CFS) was used. The outcome variables were sociodemographic and clinical, which included complications, length of stay, intensive care unit (ICU) admission and prognosis. Results A total of 13.39% of the patients were pre-frail and 17.32% were frail. Frail individuals had a shorter hospital stay, less ICU admission, higher mortality and delirium, with statistical significance. Conclusion Frailty assessment is a crucial approach in patients with COVID-19, given a higher mortality rate has been demonstrated amongst frail patients. The CFS could be a predictor of mortality in COVID-19.
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Affiliation(s)
- Eva María Andrés-Esteban
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Universidad Rey Juan Carlos, Madrid, Madrid, Spain
| | - Manuel Quintana-Diaz
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Karen Lizzette Ramírez-Cervantes
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Departamento de Prevención, Asociación Española contra el Cáncer, Madrid, Madrid, Spain
| | | | - Alberto Silva-Obregón
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Servicio de Medicina Intensiva, Hospital Universitario de Guadalajara, Guadalajara, Guadalajara, Spain
| | - Rosa Magallón-Botaya
- Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zargoza, Aragón, Spain
| | - Ivan Santolalla-Arnedo
- Universidad de La Rioja, Centro de Investigación Biomédica de La Rioja-CIBIR, Logroño, La Rioja, Spain
| | - Raúl Juárez-Vela
- Grupo PBM, Instituto de Investigación-IdiPaz, Madrid, Madrid, Spain.,Universidad de La Rioja, Centro de Investigación Biomédica de La Rioja-CIBIR, Logroño, La Rioja, Spain
| | - Vicente Gea-Caballero
- Nursing School La Fe., Adscript center of Universidad de Valencia., Valencia, Valencia, Spain.,Research Group GREIACC, Health Research Institute La Fe., Valencia, Valencia, Spain
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Kupisz-Urbańska M, Płudowski P, Marcinowska-Suchowierska E. Vitamin D Deficiency in Older Patients-Problems of Sarcopenia, Drug Interactions, Management in Deficiency. Nutrients 2021; 13:nu13041247. [PMID: 33920130 PMCID: PMC8069639 DOI: 10.3390/nu13041247] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
Abstract
Vitamin D deficiency frequently occurs in older people, especially in individuals with comorbidity and polypharmacotherapy. In this group, low vitamin D plasma concentration is related to osteoporosis, osteomalacia, sarcopenia and myalgia. Vitamin D levels in humans is an effect of the joint interaction of all vitamin D metabolic pathways. Therefore, all factors interfering with individual metabolic stages may affect 25-hydroxyvitamin D plasma concentration. The known factors affecting vitamin D metabolism interfere with cytochrome CYP3A4 activity. There is another group of factors that impairs intestinal vitamin D absorption. The phenomenon of drugs and vitamin D interactions is observed first and foremost in patients with comorbidity. This is a typical situation, where the absence of "hard evidence" is not synonymous with the possible lack of adverse effects. Osteoporosis and sarcopenia (generalized and progressive decrease of skeletal muscle mass and strength) are some of the musculoskeletal consequences of hypovitaminosis D. These consequences are related to an increased risk of adverse outcomes, including bone fractures, physical disabilities, and a lower quality of life. This can lead not only to an increased risk of falls and fractures but is also one of the main causes of frailty syndrome in the aging population. Generally, Vitamin D plasma concentration is significantly lower in subjects with osteoporosis and muscle deterioration. In some observational and uncontrolled treatment studies, vitamin D supplementation resulted in a reduction of proximal myopathy and muscle pain. The most conclusive results were found in subjects with severe vitamin D deficiency and in patients avoiding large doses of vitamin D. However, the role of vitamin D in muscle pathologies is not clear and research has provided conflicting results. This is plausibly due to the heterogeneity of the subjects, vitamin D doses and environmental factors. This report presents data on some problems with vitamin D deficiency in the elderly population and the management of vitamin D deficiency D in successful or unsuccessful aging.
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Affiliation(s)
| | - Paweł Płudowski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
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360
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Li CM, Lin CH, Li CI, Liu CS, Lin WY, Li TC, Lin CC. Frailty status changes are associated with healthcare utilization and subsequent mortality in the elderly population. BMC Public Health 2021; 21:645. [PMID: 33794860 PMCID: PMC8017879 DOI: 10.1186/s12889-021-10688-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 03/23/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study determined (1) whether a change in frailty status after a 1 year follow up is associated with healthcare utilization and evaluated (2) whether a change in frailty status after a 1 year follow up and health care utilization are associated with all-cause mortality in a sample of Taiwan population. METHODS This work is a population-based prospective cohort study involving residents aged ≥65 years in 2009. A total of 548 elderly patients who received follow-ups in the subsequent year were included in the current data analysis. Fried frailty phenotype was measured at baseline and 1 year. Information on the outpatient visits of each specialty doctor, emergency care utilization, and hospital admission during the 2 month period before the second interview was collected through standardized questionnaires administered by an interviewer. Deaths were verified by indexing to the national database of deaths. RESULTS At the subsequent 1 year follow-up, 73 (13.3%), 356 (64.9%), and 119 (21.7%) elderly participants exhibited deterioration, no change in status, and improvement in frailty states, respectively. Multivariate logistic analysis showed the high risk of any type of outpatient use (odds ratios [OR] 1.94, 95% confidence interval [CI] 1.02-3.71) among older adults with worse frailty status compared with those who were robust at baseline and had unchanged frailty status after 1 year. After multivariate adjustment, participants with high outpatient clinic utilization had significantly higher mortality than those with low outpatient clinic visits among unchanged pre-frail or frail (hazard ratios [HR] 2.79, 95% CI: 1.46-5.33) and frail to pre-frail/robust group (HR 9.32, 95% CI: 3.82-22.73) if the unchanged robustness and low outpatient clinic visits group was used as the reference group. CONCLUSIONS The conditions associated with frailty status, either after 1 year or at baseline, significantly affected the outpatient visits and may have increased medical expenditures. Combined change in frailty status and number of outpatient visits is related to increased mortality.
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Affiliation(s)
- Chia-Ming Li
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan ROC. .,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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361
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Bortone I, Sardone R, Lampignano L, Castellana F, Zupo R, Lozupone M, Moretti B, Giannelli G, Panza F. How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review. J Cachexia Sarcopenia Muscle 2021; 12:274-297. [PMID: 33590975 PMCID: PMC8061366 DOI: 10.1002/jcsm.12667] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/30/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.
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Affiliation(s)
- Ilaria Bortone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Rodolfo Sardone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Luisa Lampignano
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Fabio Castellana
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Roberta Zupo
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Madia Lozupone
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Biagio Moretti
- Orthopaedics and Trauma Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Gianluigi Giannelli
- Scientific DirectionNational Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
| | - Francesco Panza
- Population Health Unit – “Salus In Apulia Study”National Institute of Gastroenterology “Saverio de Bellis”, Research HospitalCastellana Grotte, BariItaly
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
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362
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Position statement on oncology and cancer nursing care for older adults with cancer and their caregivers of the International Society of Geriatric Oncology Nursing and Allied Health Interest Group, the Canadian Association of Nurses in Oncology Oncology & Aging Special Interest Group, and the European Oncology Nursing Society. J Geriatr Oncol 2021; 12:1000-1004. [PMID: 33775576 DOI: 10.1016/j.jgo.2021.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
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363
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De K, Banerjee J, Rajan SP, Chatterjee P, Chakrawarty A, Khan MA, Singh V, Dey AB. Development and Psychometric Validation of a New Scale for Assessment and Screening of Frailty Among Older Indians. Clin Interv Aging 2021; 16:537-547. [PMID: 33790548 PMCID: PMC8007478 DOI: 10.2147/cia.s292969] [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: 12/03/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background Frailty is a major challenge for healthcare systems in ageing societies. This dynamic state of health is a reflection of reduced reserve in various organ systems and enhanced vulnerability to stressors. Research in this area of geriatrics and gerontology is limited in low- and middle-income countries (LMICs) like India. This study is directed at development of a culturally appropriate and validated assessment scale for frailty among older Indians. Methods After extensive review of the literature on existing scales, a preliminary draft scale was formed. This draft was pre- and pilot-tested to check feasibility and modified accordingly. The final scale was validated on 107 older adults by confirmatory factor analysis and was named the Frailty Assessment and Screening Tool (FAST). The Fried’s frailty phenotype was also administered on the same 107 older adults and scores of both were co-related. Suitable cut-off scores were found for frail and pre-frail older adults. Results The final version of the FAST consisted of 14 questions pertaining to 10 domains. It has good reliability. Cronbach’s alpha co-efficient was 0.99; test–retest reliability was 0.97 and validity by confirmatory factor analysis was adequate. The Kaiser–CMeyer–Olkin (KMO) of sampling adequacy was 0.699, and Bartlett’s test of sphericity was significant (χ2 = 353.471, p < 0.001). FAST scores had a cut-off of ≥ 7/14 for frail and ≥ 5/14 for pre-frail elderly. Conclusion The FAST is a validated tool with good psychometric properties. It is expected that it will be helpful in screening pre-frail and frail older adults in India and other LMICs and guide in clinical decision making for intervention.
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Affiliation(s)
- Karishma De
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Joyita Banerjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sreerag P Rajan
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prasun Chatterjee
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Chakrawarty
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof A Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aparajit B Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
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364
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Spiers GF, Kunonga TP, Hall A, Beyer F, Boulton E, Parker S, Bower P, Craig D, Todd C, Hanratty B. Measuring frailty in younger populations: a rapid review of evidence. BMJ Open 2021; 11:e047051. [PMID: 33753447 PMCID: PMC7986767 DOI: 10.1136/bmjopen-2020-047051] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/11/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Frailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care. DESIGN A rapid review of primary studies was conducted. DATA SOURCES Four databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020. ELIGIBILITY CRITERIA Eligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English. DATA EXTRACTION AND SYNTHESIS Records were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach. RESULTS We identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18-59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care. CONCLUSIONS Limited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.
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Affiliation(s)
- Gemma F Spiers
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tafadzwa Patience Kunonga
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Hall
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fiona Beyer
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Boulton
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stuart Parker
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Craig
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Barbara Hanratty
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Tou NX, Wee SL, Seah WT, Ng DHM, Pang BWJ, Lau LK, Ng TP. Effectiveness of Community-Delivered Functional Power Training Program for Frail and Pre-frail Community-Dwelling Older Adults: a Randomized Controlled Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:1048-1059. [PMID: 33742266 PMCID: PMC7978459 DOI: 10.1007/s11121-021-01221-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 02/06/2023]
Abstract
Translation of community-based functional training for older adults to reduce frailty is still lacking. We evaluated the effectiveness and implementation of a community-delivered group-based functional power training (FPT) program for frail older adults within their neighborhoods. A two-arm, multicenter assessor-blind stratified randomized controlled trial was conducted at four local senior activity centers in Singapore. Sixty-one community-dwelling older adults with low handgrip strength were randomized to intervention (IG) or control (CG) group. The IG underwent the FPT program (power and balance exercises using simple equipment) delivered by a community service provider. The 12-week program comprised 2 × 60 min sessions/week. CG continued usual activities at the centers. Functional performance, muscle strength, and frailty status were assessed at baseline and 3 months. Program implementation was evaluated using RE-AIM framework. The program was halted due to Coronavirus Disease 2019-related suspension of senior center activities. Results are reported from four centers, which completed the program. IG showed significantly greater improvement in the Short Physical Performance Battery test as compared to CG (p = 0.047). No effects were found for timed up and go test performance, muscle strength, and frailty status. The community program exhibited good reach, effectiveness, adoption, and implementation. Our study demonstrated that FPT was associated with greater improvement in physical function in pre-frail/frail participants as compared to exercise activities offered at local senior activity centers. It is a feasible intervention that can be successfully implemented for frail older adults in their neighborhoods. Trial registration ClinicalTrials.gov, NCT04438876. Registered 19 June 2020-retrospectively registered.
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Affiliation(s)
- Nien Xiang Tou
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | - Shiou-Liang Wee
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore. .,Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore. .,Graduate Medical School, Program of Health Services and System Research, Duke-National University of Singapore, Singapore, Singapore.
| | - Wei Ting Seah
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | - Daniella Hui Min Ng
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | - Benedict Wei Jun Pang
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | - Lay Khoon Lau
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore.,Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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366
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Marques DL, Neiva HP, Pires IM, Zdravevski E, Mihajlov M, Garcia NM, Ruiz-Cárdenas JD, Marinho DA, Marques MC. An Experimental Study on the Validity and Reliability of a Smartphone Application to Acquire Temporal Variables during the Single Sit-to-Stand Test with Older Adults. SENSORS 2021; 21:s21062050. [PMID: 33803927 PMCID: PMC8000467 DOI: 10.3390/s21062050] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
Smartphone sensors have often been proposed as pervasive measurement systems to assess mobility in older adults due to their ease of use and low-cost. This study analyzes a smartphone-based application’s validity and reliability to quantify temporal variables during the single sit-to-stand test with institutionalized older adults. Forty older adults (20 women and 20 men; 78.9 ± 8.6 years) volunteered to participate in this study. All participants performed the single sit-to-stand test. Each sit-to-stand repetition was performed after an acoustic signal was emitted by the smartphone app. All data were acquired simultaneously with a smartphone and a digital video camera. The measured temporal variables were stand-up time and total time. The relative reliability and systematic bias inter-device were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. In contrast, absolute reliability was assessed using the standard error of measurement and coefficient of variation (CV). Inter-device concurrent validity was assessed through correlation analysis. The absolute percent error (APE) and the accuracy were also calculated. The results showed excellent reliability (ICC = 0.92–0.97; CV = 1.85–3.03) and very strong relationships inter-devices for the stand-up time (r = 0.94) and the total time (r = 0.98). The APE was lower than 6%, and the accuracy was higher than 94%. Based on our data, the findings suggest that the smartphone application is valid and reliable to collect the stand-up time and total time during the single sit-to-stand test with older adults.
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Affiliation(s)
- Diogo Luís Marques
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (D.L.M.); (H.P.N.); (D.A.M.)
| | - Henrique Pereira Neiva
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (D.L.M.); (H.P.N.); (D.A.M.)
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 6201-001 Covilhã, Portugal
| | - Ivan Miguel Pires
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal; (I.M.P.); (N.M.G.)
- Computer Science Department, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
- Health Sciences Research Unit: Nursing, School of Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Eftim Zdravevski
- Faculty of Computer Science and Engineering, University Ss Cyril and Methodius, 1000 Skopje, North Macedonia;
| | - Martin Mihajlov
- Laboratory for Open Systems and Networks, Jozef Stefan Institute, 1000 Ljubljana, Slovenia;
| | - Nuno M. Garcia
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal; (I.M.P.); (N.M.G.)
| | - Juan Diego Ruiz-Cárdenas
- Physiotherapy Department, Faculty of Health Sciences, Catholic University of Murcia, 30107 Murcia, Spain;
| | - Daniel Almeida Marinho
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (D.L.M.); (H.P.N.); (D.A.M.)
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 6201-001 Covilhã, Portugal
| | - Mário Cardoso Marques
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (D.L.M.); (H.P.N.); (D.A.M.)
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 6201-001 Covilhã, Portugal
- Correspondence:
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Villani A, Barrett M, McClure R, Wright H. Protein intake is not associated with functional biomarkers of physical frailty: A cross-sectional analysis of community-dwelling older adults with type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2021; 31:827-833. [PMID: 33549458 DOI: 10.1016/j.numecd.2020.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Frailty has emerged as a third category of complication in patients with type 2 diabetes mellitus (T2DM). It has been suggested that adequate protein intake is an important dietary strategy for counteracting frailty. Therefore, we explored the association between protein intake and functional biomarkers of frailty in older adults with T2DM. METHODS AND RESULTS Frailty was operationalized as the presence of three of the following: exhaustion, low muscle strength, low physical activity, slow gait speed, and weight loss. Functional biomarkers included handgrip strength (HGS), chair stands, the short physical performance battery and gait speed. Eighty-seven older adults (71.2 ± 8.2 years; 66.7% males) were included. A total of n = 6 (~7%) and n = 32 (~37%) participants were identified as frail and pre-frail respectively. No significant difference was observed for protein intake across staging of frailty (pre-frail/frail: 1.3 ± 0.4 g/kg BW; non-frail: 1.4 ± 0.4 g/kg BW; P = 0.320). A significant association was observed for total protein intake and HGS (β = 0.44; 95% CI: 0.23-1.8; P = 0.01). However, this was no longer significant after adjusting for age, gender, physical activity, energy intake and total appendicular lean muscle (β = 0.03; 95% CI: -0.45-0.60; P = 0.78). Nil other associations were observed between total protein intake and functional biomarkers of frailty. CONCLUSION Adequate protein intake was not associated with functional biomarkers in older adults with T2DM. Future research should focus on the efficacy of protein on attenuating functional decline in vulnerable older adults with low protein intake.
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Affiliation(s)
- Anthony Villani
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland Australia.
| | - Michelle Barrett
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland Australia
| | - Rebecca McClure
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland Australia
| | - Hattie Wright
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland Australia
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Viljanen A, Salminen M, Irjala K, Korhonen P, Wuorela M, Isoaho R, Kivelä SL, Vahlberg T, Viitanen M, Löppönen M, Viikari L. Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people. Aging Clin Exp Res 2021; 33:547-554. [PMID: 32306371 PMCID: PMC7943499 DOI: 10.1007/s40520-020-01551-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/01/2020] [Indexed: 01/07/2023]
Abstract
Background In clinical practice, there is a need for an instrument to screen older people at risk of institutionalization. Aims To analyze the association of frailty, walking-ability and self-rated health (SRH) with institutionalization in Finnish community-dwelling older people. Methods In this prospective study with 10- and 18-year follow-ups, frailty was assessed using FRAIL Scale (FS) (n = 1087), Frailty Index (FI) (n = 1061) and PRISMA-7 (n = 1055). Walking ability was assessed as self-reported ability to walk 400 m (n = 1101). SRH was assessed by a question of general SRH (n = 1105). Cox regression model was used to analyze the association of the explanatory variables with institutionalization. Results The mean age of the participants was 73.0 (range 64.0‒97.0) years. Prevalence of institutionalization was 40.8%. In unadjusted models, frailty was associated with a higher risk of institutionalization by FS in 10-year follow-up, and FI in both follow-ups. Associations by FI persisted after age- and gender-adjustments in both follow-ups. By PRISMA-7, frailty predicted a higher risk of institutionalization in both follow-ups. In unadjusted models, inability to walk 400 m predicted a higher risk of institutionalization in both follow-ups and after adjustments in 10-year follow-up. Poor SRH predicted a higher risk of institutionalization in unadjusted models in both follow-ups and after adjustments in 10-year follow-up. Discussion Simple self-reported items of walking ability and SRH seemed to be comparable with frailty indexes in predicting institutionalization among community-dwelling older people in 10-year follow-up. Conclusions In clinical practice, self-reported walking ability and SRH could be used to screen those at risk. Electronic supplementary material The online version of this article (10.1007/s40520-020-01551-x) contains supplementary material, which is available to authorized users.
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Gallamini M, Piastra G, Lucarini S, Porzio D, Ronchi M, Pirino A, Scoppa F, Masiero S, Tognolo L. Revisiting the Instrumented Romberg Test: Can Today's Technology Offer a Risk-of-Fall Screening Device for Senior Citizens? An Experience-Based Approach. Life (Basel) 2021; 11:life11020161. [PMID: 33672455 PMCID: PMC7923416 DOI: 10.3390/life11020161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022] Open
Abstract
Risk of fall (ROF) is a worldwide major concern for its prevalence and consequent dramatic outcomes in the elderly population. The growing age-related risk appears to be associated with increasing motor, sensory, and cognitive problems in the elderly population. There is a consensus on the need to screen for these balance dysfunctions, but the available methods are largely based on subjectively assessed performances. The instrumented Romberg test using a force plate represents a validated assessment process for the evaluation of balance performances. The purpose of this study is to propose an innovative instrumental method to identify balance deficits, assess their severity, and give an automated indication of the most likely etiology. The proposed new method was applied to the instrumented Romberg test, using force plate data recorded in a cohort of 551 females aged >65 participating in adapted physical activity courses. The method allowed us to identify 145 dysfunctional subjects and to determine the likely origin of their deficit: 21 central, 5 vestibular, 9 visual, 59 proprioceptive (musculoskeletal etiology), and 51 functional. Based on the preliminary findings of the study, this test could be an efficient and cost-effective mass screening tool for identifying subjects at risk of fall, since the procedure proves to be rapid, non-invasive, and apparently devoid of any contraindications.
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Affiliation(s)
- Michele Gallamini
- Eng. Freelance MD Consultant, Sal. Maggiolo di Nervi, 16167 Genoa, Italy;
- Ben-Essere Sport and Wellness Association Rapallo, Third-Sector Liguria Region Registry, 16135 Genoa, Italy; (D.P.); (M.R.)
| | - Giorgio Piastra
- ASL 4 Liguria (Liguria Regional Health Service), Sports Medicine, N.S. di Montallegro Hospital, 16035 Rapallo, Italy;
| | - Simonetta Lucarini
- ASL 4 Liguria (Liguria Regional Health Service), Geriatric Service, Chiavari, 16043 Chiavari, Italy;
| | - Debora Porzio
- Ben-Essere Sport and Wellness Association Rapallo, Third-Sector Liguria Region Registry, 16135 Genoa, Italy; (D.P.); (M.R.)
| | - Matteo Ronchi
- Ben-Essere Sport and Wellness Association Rapallo, Third-Sector Liguria Region Registry, 16135 Genoa, Italy; (D.P.); (M.R.)
| | - Alessio Pirino
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Fabio Scoppa
- Faculty of Medicine and Dental Surgery, Sapienza University of Rome, 00185 Rome, Italy;
- Chinesis I.F.O.P. Istituto di Formazione in Osteopatia e in Posturologia, Osteopathy School, 00152 Rome, Italy
| | - Stefano Masiero
- Department of Neurosciences, Physical Medicine and Rehabilitation School, University of Padua, 35128 Padua, Italy;
- Rehabilitation Unit, Laboratory of Robotic and Bioengineering and Clinical of Movement, Padua University-General Hospital, 35128 Padua, Italy
| | - Lucrezia Tognolo
- Department of Neurosciences, Physical Medicine and Rehabilitation School, University of Padua, 35128 Padua, Italy;
- Correspondence: ; Tel.: +39-0498-213-353
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Jyväkorpi SK, Ramel A, Strandberg TE, Piotrowicz K, Błaszczyk-Bębenek E, Urtamo A, Rempe HM, Geirsdóttir Ó, Vágnerová T, Billot M, Larreur A, Savera G, Soriano G, Picauron C, Tagliaferri S, Sanchez-Puelles C, Cadenas VS, Perl A, Tirrel L, Öhman H, Weling-Scheepers C, Ambrosi S, Costantini A, Pavelková K, Klimkova M, Freiberger E, Jonsson PV, Marzetti E, Pitkälä KH, Landi F, Calvani R. The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans. Eur Geriatr Med 2021; 12:303-312. [PMID: 33583000 PMCID: PMC7990826 DOI: 10.1007/s41999-020-00438-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The "Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies" (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. METHODS SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3-9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0-1.2 g/kg body weight, energy intake of 25-30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. RESULTS Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. CONCLUSION The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations.
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Affiliation(s)
- S K Jyväkorpi
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland.
| | - A Ramel
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Reykjavik, Iceland
| | - T E Strandberg
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland.,University of Oulu, Center for Life Course Health Research, Oulu, Finland
| | - K Piotrowicz
- Faculty of Medicine, Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - E Błaszczyk-Bębenek
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - A Urtamo
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland
| | - H M Rempe
- Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ó Geirsdóttir
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Reykjavik, Iceland
| | - T Vágnerová
- 1St Faculty of Medicine, Department of Gerontology & Geriatrics, Charles University in Prague, General University Hospital Prague, Nové Město, Czech Republic
| | - M Billot
- PRISMATICS Lab (Predictive Research In Spine/Neuromodulation Management And Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - A Larreur
- Department of Geriatrics, University Hospital of Limoges, Limoges, France
| | - G Savera
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Soriano
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - C Picauron
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - S Tagliaferri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - A Perl
- Medical University of Graz, Graz, Austria
| | - L Tirrel
- Diabetes Frail, Medici Medical Practice, Luton, UK
| | - H Öhman
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland
| | | | | | | | | | - M Klimkova
- Silesian Hospital, Opava, Czech Republic
| | - E Freiberger
- 1St Faculty of Medicine, Department of Gerontology & Geriatrics, Charles University in Prague, General University Hospital Prague, Nové Město, Czech Republic
| | - P V Jonsson
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Reykjavik, Iceland
| | - E Marzetti
- Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - K H Pitkälä
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland
| | - F Landi
- Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - R Calvani
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Saad F, Bögemann M, Suzuki K, Shore N. Treatment of nonmetastatic castration-resistant prostate cancer: focus on second-generation androgen receptor inhibitors. Prostate Cancer Prostatic Dis 2021; 24:323-334. [PMID: 33558665 PMCID: PMC8134049 DOI: 10.1038/s41391-020-00310-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined as a rising prostate-specific antigen concentration, despite castrate levels of testosterone with ongoing androgen-deprivation therapy or orchiectomy, and no detectable metastases by conventional imaging. Patients with nmCRPC progress to metastatic disease and are at risk of developing cancer-related symptoms and morbidity, eventually dying of their disease. While patients with nmCRPC are generally asymptomatic from their disease, they are often older and have chronic comorbidities that require long-term concomitant medication. Therefore, careful consideration of the benefit-risk profile of potential treatments is required. METHODS In this review, we will discuss the rationale for early treatment of patients with nmCRPC to delay metastatic progression and prolong survival, as well as the factors influencing this treatment decision. We will focus on oral pharmacotherapy with the second-generation androgen receptor inhibitors, apalutamide, enzalutamide, and darolutamide, and the importance of balancing the clinical benefit they offer with potential adverse events and the consequential impact on quality of life, physical capacity, and cognitive function. RESULTS AND CONCLUSIONS While the definition of nmCRPC is well established, the advent of next-generation imaging techniques capable of detecting hitherto undetectable oligometastatic disease in patients with nmCRPC has fostered debate on the criteria that inform the management of these patients. However, despite these developments, published consensus statements have maintained that the absence of metastases on conventional imaging suffices to guide such therapeutic decisions. In addition, the prolonged metastasis-free survival and recently reported positive overall survival outcomes of the three second-generation androgen receptor inhibitors have provided further evidence for the early use of these agents in patients with nmCRPC in order to delay metastases and prolong survival. Here, we discuss the benefit-risk profiles of apalutamide, enzalutamide, and darolutamide based on the data available from their pivotal clinical trials in patients with nmCRPC.
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Affiliation(s)
- Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal Cancer Institute/CRCHUM, Montreal, QC, Canada.
| | - Martin Bögemann
- Department of Urology, Münster University Medical Center, Münster, Germany
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Neal Shore
- Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC, USA
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Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, De Souto Barreto P, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won Won C, Woo J, Vellas B. Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2021; 24:920-927. [PMID: 33155616 PMCID: PMC7568453 DOI: 10.1007/s12603-020-1492-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J G Ruiz
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
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Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C. Predictive performance of 7 frailty instruments for short-term disability, falls and hospitalization among Chinese community-dwelling older adults: A prospective cohort study. Int J Nurs Stud 2021; 117:103875. [PMID: 33621721 DOI: 10.1016/j.ijnurstu.2021.103875] [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: 05/27/2020] [Revised: 12/26/2020] [Accepted: 01/01/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Frailty becomes a great challenge with population aging. The proactive identification of frailty is considered as a rational solution in the community. Previous studies found that frailty instruments had insufficient predictive accuracy for adverse outcomes, but they mainly focused on long-term outcomes and constructed frailty instruments based on available data not original forms. The predictive performance of original frailty instruments for short-term outcomes in community-dwelling older adults remains unknown. OBJECTIVE To examine the predictive performance of seven frailty instruments in their original forms for 1-year incident outcomes among community-dwelling older adults. DESIGN A prospective cohort study. SETTINGS A total of 22 communities were selected by a stratified sampling method from one Chinese city. PARTICIPANTS A total of 749 older adults aged ≥ 60 years (mean age of 69.2 years, 69.8% female) were followed up after 1 year. METHODS Baseline frailty was assessed by three purely physical dimensional instruments (i.e. Frailty Phenotype, the Study of Osteoporotic Fracture and FRAIL Scale) and four multidimensional instruments (i.e. Frailty Index, Groningen Frailty Indicator, Tilburg Frailty Indicator and Comprehensive Frailty Assessment Instrument), respectively. Outcomes included incident disability, falls, hospitalization and the combined outcome at 1-year follow-up. The receiver operating characteristic curves were plotted to assess the predictive performance of frailty instruments. RESULTS The areas under the curves of seven frailty instruments in predicting incident outcomes ranged from 0.55 [95% confidence interval (CI): 0.51-0.60] to 0.67 (95% CI: 0.61-0.72), with high specificity (72.3-99.2%) and low sensitivity (4.0-49.6%). Four multidimensional instruments had much higher sensitivity (20.9-49.6% versus 4.0-11.7%) than three purely physical dimensional instruments. Overall, the Frailty Index was more accurate than some instruments in predicting incident outcomes, while several self-report instruments had comparable predictive accuracy to the Frailty Index for all (FRAIL Scale) or some (Groningen Frailty Indicator and Tilburg Frailty Indicator) of the incident outcomes. CONCLUSIONS All frailty instruments have inadequate predictive accuracy for short-term outcomes among community-dwelling older adults. The Frailty Index roughly performs better but self-report instruments are comparable to the Frailty Index for all or some of the outcomes. An accurate frailty instrument needs to be developed, and the simple self-report instruments could be used temporarily as practical and efficient tools in primary care.
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Affiliation(s)
- Huaxin Si
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yaru Jin
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaoxia Qiao
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Xiaoyu Tian
- School of Nursing, Shandong University, No. 44 Wenhuaxi Road, Lixia District, Jinan 250012, China
| | - Xinyi Liu
- School of Nursing, Shandong University, No. 44 Wenhuaxi Road, Lixia District, Jinan 250012, China
| | - Cuili Wang
- School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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Petrella M, Aprahamian I, Mamoni RL, de Vasconcellos Romanini CF, Lima NA, de Cássio Robello E, da Costa DL, An VN, Aguirre BN, Galdeano JR, Fernandes IC, Soleman Hernandez SS, Cesari M, Morley JE, Izquierdo M, Oude Voshaar RC. The effect of a multicomponent exercise protocol (VIVIFRAIL©) on inflammatory profile and physical performance of older adults with different frailty status: study protocol for a randomized controlled trial. BMC Geriatr 2021; 21:83. [PMID: 33514329 PMCID: PMC7844975 DOI: 10.1186/s12877-021-02030-2] [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: 12/10/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background To investigate whether an exercise intervention using the VIVIFRAIL© protocol has benefits for inflammatory and functional parameters in different frailty status. Methods/design This is a randomized clinical trial in an outpatient geriatrics clinic including older adults ≥60 years. For each frailty state (frail, pre-frail and robust), forty-four volunteers will be randomly allocated to the control group (n = 22) and the intervention group (n = 22) for 12 weeks. In the control group, participants will have meetings of health education while those in the intervention group will be part of a multicomponent exercise program (VIVIFRAIL©) performed five times a week (two times supervised and 3 times of home-based exercises). The primary outcome is a change in the inflammatory profile (a reduction in inflammatory interleukins [IL-6, TNF- α, IL1beta, IL-17, IL-22, CXCL-8, and IL-27] or an increase in anti-inflammatory mediators [IL-10, IL1RA, IL-4]). Secondary outcomes are change in physical performance using the Short Physical Performance Battery, handgrip strength, fatigue, gait speed, dual-task gait speed, depressive symptoms, FRAIL-BR and SARC-F scores, and quality of life at the 12-week period of intervention and after 3 months of follow-up. Discussion We expect a reduction in inflammatory interleukins or an increase in anti-inflammatory mediators in those who performed the VIVIFRAIL© protocol. The results of the study will imply in a better knowledge about the effect of a low-cost intervention that could be easily replicated in outpatient care for the prevention and treatment of frailty, especially regarding the inflammatory and anti-inflammatory pathways involved in its pathophysiology. Trial registration Brazilian Registry of Clinical Trials (RBR-9n5jbw; 01/24/2020). Registred January 2020. http://www.ensaiosclinicos.gov.br/rg/RBR-9n5jbw/.
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Affiliation(s)
- Marina Petrella
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Ivan Aprahamian
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil. .,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Ronei Luciano Mamoni
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Carla Fernanda de Vasconcellos Romanini
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Natália Almeida Lima
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Everson de Cássio Robello
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Daniele Lima da Costa
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Vinicius Nakajima An
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Bianca Nobre Aguirre
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Júlia Riccetto Galdeano
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Isabela Cunha Fernandes
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Salma S Soleman Hernandez
- Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine of Jundiaí, 250 Francisco Telles st, Jundiaí, 13202-550, Brazil
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - John E Morley
- Division of Geriatrics, St louis University Medical School, St Louis, MO, USA
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Grupo GICAEDS, Programa de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, 110311, Bogotá, Colombia
| | - Richard C Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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O’Caoimh R, Sezgin D, O’Donovan MR, Molloy DW, Clegg A, Rockwood K, Liew A. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50:96-104. [PMID: 33068107 DOI: 10.1093/ageing/afaa219] [Citation(s) in RCA: 333] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The prevalence of frailty at population level is unclear. We examined this in population-based studies, investigating sources of heterogeneity. METHODS PubMed, Embase, CINAHL and Cochrane Library databases were searched for observational population-level studies published between 1 January 1998 and 1 April 2020, including individuals aged ≥50 years, identified using any frailty measure. Prevalence estimates were extracted independently, assessed for bias and analysed using a random-effects model. RESULTS In total, 240 studies reporting 265 prevalence proportions from 62 countries and territories, representing 1,755,497 participants, were included. Pooled prevalence in studies using physical frailty measures was 12% (95% CI = 11-13%; n = 178), compared with 24% (95% CI = 22-26%; n = 71) for the deficit accumulation model (those using a frailty index, FI). For pre-frailty, this was 46% (95% CI = 45-48%; n = 147) and 49% (95% CI = 46-52%; n = 29), respectively. For physical frailty, the prevalence was higher among females, 15% (95% CI = 14-17%; n = 142), than males, 11% (95% CI = 10-12%; n = 144). For studies using a FI, the prevalence was also higher in females, 29% (95% CI = 24-35%; n = 34) versus 20% (95% CI = 16-24%; n = 34), for males. These values were similar for pre-frailty. Prevalence increased according to the minimum age at study inclusion. Analysing only data from nationally representative studies gave a frailty prevalence of 7% (95% CI = 5-9%; n = 46) for physical frailty and 24% (95% CI = 22-26%; n = 44) for FIs. CONCLUSIONS Population-level frailty prevalence varied by classification and sex. Data were heterogenous and limited, particularly from nationally representative studies making the interpretation of differences by geographic region challenging. Common methodological approaches to gathering data are required to improve the accuracy of population-level prevalence estimates. PROTOCOL REGISTRATION PROSPERO-CRD42018105431.
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Affiliation(s)
- Rónán O’Caoimh
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork, Ireland
| | - Duygu Sezgin
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Mark R O’Donovan
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Ireland
| | - D William Molloy
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr’s Hospital, Cork, Ireland
| | - Andrew Clegg
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Ireland
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Lobato ZM, Almeida da Silva AC, Lima Ribeiro SM, Biella MM, Santos Silva Siqueira A, Correa de Toledo Ferraz Alves T, Machado-Vieira R, Borges MK, Oude Voshaar RC, Aprahamian I. Nutritional Status and Adverse Outcomes in Older Depressed Inpatients: A Prospective Study. J Nutr Health Aging 2021; 25:889-894. [PMID: 34409967 DOI: 10.1007/s12603-021-1638-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Significant weight loss and/or loss of appetite is a criterion of a depressive episode. While malnutrition is associated with many adverse health outcomes, the impact of malnutrition in late-life depression has hardly been examined. The present study aims to (1) evaluate the prevalence of malnutrition in depressed older inpatients, and (2) whether and which indices of malnutrition predict adverse health outcomes in late-life depression. DESIGN A prospective study at 6 months follow-up. SETTING A University-based psychiatric hospital. PARTICIPANTS 105 older adults (psychiatric inpatients suffering from unipolar MDD). MEASUREMENTS Participants were evaluated according the Mini Nutritional Assessment (MNA) and anthropometric measures to assess their nutritional status. Multiple regression analyses were used to evaluate the association between the MNA score as well as anthropometric measures with either falls or rehospitalization for any reason. RESULTS Based on the MNA score, 78 (74.3%) patients were at risk of malnutrition and 13 (12.4%) actually presented malnutrition. Malnutrition was associated with a higher age, frailty, lower body mass index, and smaller calf circumference. During follow-up, 21 (20%) patients fell, 27 (25.7%) were rehospitalized, and 3 died (2.9%). The MNA score was associated with adverse health outcomes, but a low calf circumference predicted falling (OR 4.93 [95% CI: 1.42-17.2], p=.012) and a higher calf circumference rehospitalization (OR 1.17 [95% CI: 1.01-1.35], p=.032). CONCLUSION Malnutrition is prevalent in older depressed inpatients. In contrast to subjective proxies for malnutrition, which are common in depression, only objective measures of malnutrition predict adverse health outcomes such as falls and rehospitalization.
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Affiliation(s)
- Z M Lobato
- Ivan Aprahamian, MD, MS, PhD, FACP. Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil. R. Dr. Ovídio Pires de Campos, 785, 1º andar, sala 1C 015. ZIP: 05403-903. Phone: (11) 2661-6963. São Paulo, Brazil, E-mail:
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379
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Merchant RA, Seetharaman S, Au L, Wong MWK, Wong BLL, Tan LF, Chen MZ, Ng SE, Soong JTY, Hui RJY, Kwek SC, Morley JE. Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre-Frail Older Adults. Front Endocrinol (Lausanne) 2021; 12:765415. [PMID: 35002957 PMCID: PMC8741276 DOI: 10.3389/fendo.2021.765415] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Body mass index (BMI) is an inadequate marker of obesity, and cannot distinguish between fat mass, fat free mass and distribution of adipose tissue. The purpose of this study was twofold. First, to assess cross-sectional relationship of BMI with fat mass index (FMI), fat free mass index (FFMI) and ratio of fat mass to fat free mass (FM/FFM). Second, to study the association of FMI, FFMI and FM/FFM with physical function including sarcopenia, and cognition in pre-frail older adults. METHODS Cross-sectional study of 191 pre-frail participants ≥ 65 years, 57.1% females. Data was collected on demographics, cognition [Montreal Cognitive Assessment (MoCA)], function, frailty, calf circumference, handgrip strength (HGS), short physical performance battery (SPPB) and gait speed. Body composition was measured using InBody S10. FMI, FFMI and FM/FFM were classified into tertiles (T1, T2, T3) with T1 classified as lowest and T3 highest tertile respectively and stratified by BMI. RESULTS Higher FFMI and lower FM/FFM in the high BMI group were associated with better functional outcomes. Prevalence of low muscle mass was higher in the normal BMI group. FMI and FM/FFM were significantly higher in females and FFMI in males with significant gender differences except for FFMI in ≥ 80 years old. Small calf circumference was significantly less prevalent in the highest tertile of FMI, FM/FMI and FFMI. Prevalence of sarcopenic obesity and low physical function (HGS, gait speed and SPPB scores) were significantly higher in the highest FMI and FM/FFM tertile. Highest FFMI tertile group had higher physical function, higher MoCA scores, lower prevalence of sarcopenic obesity and sarcopenia, After adjustment, highest tertile of FFMI was associated with lower odds of sarcopenia especially in the high BMI group. Highest tertile of FM/FFM was associated with higher odds of sarcopenia. Higher BMI was associated with lower odds of sarcopenia. CONCLUSION FFMI and FM/FFM may be a better predictor of functional outcomes in pre-frail older adults than BMI. Cut-off values for healthy BMI values and role of calf circumference as a screening tool for sarcopenia need to be validated in larger population. Health promotion intervention should focus on FFMI increment.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- *Correspondence: Reshma Aziz Merchant, orcid.org/0000-0002-9032-018
| | - Santhosh Seetharaman
- Healthy Ageing Programme, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Lydia Au
- Department of Geriatrics Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Michael Wai Kit Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Beatrix Ling Ling Wong
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Li Feng Tan
- Healthy Ageing Programme, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - John Tshon Yit Soong
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Richard Jor Yeong Hui
- National University Polyclinics, National University Health System, Singapore, Singapore
| | - Sing Cheer Kwek
- National University Polyclinics, National University Health System, Singapore, Singapore
| | - John E. Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
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380
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Merchant RA, Morley JE. Editorial: Rapid Geriatric Assessment in Primary Care Practice. J Nutr Health Aging 2021; 25:1034-1036. [PMID: 34725656 DOI: 10.1007/s12603-021-1681-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Reshma A Merchant
- Dr. J. E. Morley, Dammert Professor of Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110 USA,
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Mehta P, Lemon G, Hight L, Allan A, Li C, Pandher SK, Brennan J, Arumugam A, Walker X, Waters DL. A Systematic Review of Clinical Practice Guidelines for Identification and Management of Frailty. J Nutr Health Aging 2021; 25:382-391. [PMID: 33575732 DOI: 10.1007/s12603-020-1549-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aims to appraise and summarize consistent recommendations from clinical practice guidelines (CPGs) for identification and management of frailty to maintain and improve functional independence of elderly population. METHODS A systematic search of Ovid MEDLINE, Embase, PubMed, PsycINFO, and CINAHL electronic databases using database-specific search terms in two broad areas "guidelines" and "frailty", and a manual search of websites with the key phrase "frailty guideline" was performed. The inclusion criteria included CPGs focusing on identifying and managing frailty in population >65 years old, published in English since January 2010. Three reviewers independently assessed guideline quality using the AGREE II instrument. Data extraction was performed, followed by compilation and comparison of all recommendations to identify the key consistent recommendations. RESULTS Six CPGs met the inclusion criteria; however, only three CPGs had high methodological quality in accordance with AGREE II appraisal. The average AGREE II scores of all six CPGs were: 84.5%, 68%, 46.5%, 81.5%, 56.3%, and 60.2% for domains 1-6 (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence) respectively. A total of 54 recommendations were identified, with 12 key recommendations suggested frequently by the CPGs. CONCLUSION The AGREE II instrument identified strengths and weaknesses of the CPGs, but failed to assess clinical implications and feasibility of the guidelines. Further research is needed to improve clinical relevance of CPGs in the identification and management of frailty. The feasibility in implementing these guidelines with regards to cost-effectiveness of frailty screening warrants further investigation.
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Affiliation(s)
- P Mehta
- Professor Debra L. Waters PhD, Director of Gerontology Research, University of Otago, School of Physiotherapy and Department of Medicine, PO Box 56, Dunedin, New Zealand 9054, , Phone: 0064 03 479 7222
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Barbiero MMA, Lenardt MH, Betiolli SE, Hammerschmidt KSDA, Binotto MA, Leta PRG. Marcadores de fragilidade física preditivos de sintomas depressivos em pessoas idosas da atenção primária à saúde. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo identificar quais os marcadores de fragilidade física predizem os sintomas depressivos (SD) em pessoas idosas assistidas na Atenção Primária à Saúde. Método estudo quantitativo de corte transversal e correlacional desenvolvido em uma Unidade Básica de Saúde em Curitiba, (PR), Brasil, com amostra de 389 pessoas idosas. Coletaram-se os dados de janeiro a outubro de 2019, por meio de questionário sociodemográfico e clínico, escala de depressão (Center for Epidemiological Studies) e testes que compõem o fenótipo da fragilidade física. Para as análises, utilizou-se estatística descritiva, inferencial (qui-quadrado de Pearson), nível de significância de p≤0,05), e regressão logística reportado a estimativa, valor p (teste de Wald). Razão de Prevalência com intervalo de confiança 95%. Resultados das 389 pessoas idosas, 103 (26,5%) apresentaram SD; entre eles 63 (61,2%) eram pré-frágeis, 19 (18,4%) frágeis e 21 (20,4%) não frágeis. Associaram-se aos SD os marcadores fadiga/exaustão (p≤0,001), redução do nível de atividade física (p≤0,001), perda de peso não intencional (p=0,003) e a condição de pré-fragilidade e fragilidade (p≤0,001). O modelo preditivo para os SD incluiu os marcadores fadiga/exaustão (RP: 5,12; IC95%; 3,81-6,87; p<0,0001) e redução do nível de atividade física (RP: 2,16, IC95%; 1,45- 3,22; p<0,0001). Conclusão os marcadores do fenótipo fadiga/exaustão e redução da atividade física são preditores dos SD em pessoas idosas. Esse resultado ressalta a importância e a necessidade da avaliação desses marcadores e da efetividade de ações para o combate ao sedentarismo em pessoas idosas da atenção primária à saúde.
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Vellas BJ. Editorial: The Geriatrician, the Primary Care Physician, Aducanumab and the FDA Decision: From Frustration to New Hope. J Nutr Health Aging 2021; 25:821-823. [PMID: 34409960 DOI: 10.1007/s12603-021-1657-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- B J Vellas
- Bruno J Vellas, Gerontopole and Alzheimer's Disease Research and Clinical Center, INSERM UMR 1295 , Toulouse University Hospital, France,
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Lee CT, Chen MZ, Yip CYC, Yap ES, Lee SY, Merchant RA. Prevalence of Anemia and Its Association with Frailty, Physical Function and Cognition in Community-Dwelling Older Adults: Findings from the HOPE Study. J Nutr Health Aging 2021; 25:679-687. [PMID: 33949637 DOI: 10.1007/s12603-021-1625-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The prevalence of anemia and its impact on frailty and physical function amongst the multiethnic older populations in the Southeast Asian (SEA) countries are often not well studied. Singapore, a nation comprised of multiethnic communities, is one of the most rapidly aging population globally. We aim to evaluate the prevalence of anemia and its impact on frailty, and physical function in Healthy Older People Everyday (HOPE)- an epidemiologic population-based study on community-dwelling older adults in Singapore. DESIGN Cross-sectional study. SETTING Community. PARTICIPANTS 480 adults ≥ 65 years old. MEASUREMENTS Data were collected from interviewers-administered questionnaires on socio-demographics, FRAIL scale, Mini-Mental State Examination, EQ-5D, Barthel Index, and Lawton index. Hemoglobin concentration and physical assessments, including anthropometry, grip strength, timed up-and-go (TUG) were measured. RESULTS The overall prevalence of anemia was 15.2% (73 out of 480). The Indian ethnic group had the highest prevalence of anemia (32%, OR=3.02; 95%CI= 1.23-7.41) with the lowest hemoglobin concentration compared to the overall population (13.0±1.3g/L and 13.5±1.4g/L, p=0.02). Hemoglobin levels and anemia were significantly associated with frailty (OR=2.28; 95% CI=1.02-5.10), low grip strength (OR=1.79; 95% CI=1.01-3.03), ≥ one IADL impairment (OR=2.35; 95% CI=1.39-3.97). Each 1 g/dL increase in hemoglobin was associated with a 6% decrease in frailty odds after adjusting for potential covariates (OR = 0.94, 95% CI: 0.90-0.99). There was a significant difference in the mean TUG between the non-anemic (11.0±3.4 seconds) and anemic (12.3±6.0 seconds, p=0.01) counterparts, but no difference in the number of falls. CONCLUSION In our multiethnic Asian population, anemia was adversely associated with frailty, decreased muscle strength, and IADL impairment. Health policies on anemia screening should be employed to avoid or potentially delay or reverse these adverse outcomes associated with anemia. Recognition, evaluation, and treatment of anemia amongst this vulnerable population is warranted.
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Affiliation(s)
- C-T Lee
- Chun-Tsu Lee, MBBS(Mal.), M.Med (S'pore), MRCP(UK), FRCPath (UK), FAMS, Fast and Chronic Program, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore 159964. Telephone: +65 64722000.
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385
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 341] [Impact Index Per Article: 113.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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Lenardt MH, Falcão ADS, Hammerschmidt KSDA, Barbiero MMA, Leta PRG, Sousa RLD. Sintomas depressivos e fragilidade física em pessoas idosas: revisão integrativa. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.210013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo identificar a relação entre sintomas depressivos e fragilidade física em pessoas idosas por meio de uma revisão integrativa de literatura. Método Foram realizadas buscas em portais e bases de dados: Biblioteca Virtual em Saúde, SciELO, Resultados dos 486 artigos encontrados, 126 foram excluídos por duplicidade, 339 por não se adequarem aos critérios pré-estabelecidos, restando 21 artigos que compuseram o corpus da revisão. Conclusão os sintomas depressivos e fragilidade física estão presentes entre
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387
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Kim MJ, Jang SY, Cheong HK, Oh IH. Association of Frailty with Healthcare Costs Using Claims Data in Korean Older Adults Aged 66. J Nutr Health Aging 2021; 25:653-659. [PMID: 33949633 DOI: 10.1007/s12603-021-1612-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the association of frailty and its eight components with claims-based healthcare costs among South Korean older adults aged 66 from 2009 to 2012. DESIGN A cross-sectional design. SETTING Data were obtained from administrative claims, Regular Biennial General and Cancer Screening Examinations, and the 66-year Lifetime Transitional Period Health Examination. PARTICIPANTS South Korean older adults aged 66 (N = 818,337). MEASUREMENTS Frailty was measured using eight components (i.e., hospital admission, self-assessed health status, polypharmacy, weight loss, depressed mood, incontinence, visual and auditory problems, and performance on the Timed Up and Go test). Healthcare costs included those associated with inpatient and outpatient care and pharmaceuticals. Multiple Tobit regression was used to assess the association between frailty and healthcare costs before and after propensity score matching. RESULTS The mean annual total healthcare cost was $1,403.24 in robust participants, $2,364.78 in pre-frail participants, and $3,655.13 in frail participants. Among participants after propensity score matching, total healthcare costs were higher by $959.58 in the pre-frail (P < 0.001) and by $2,249.70 in the frail group (P < 0.001) compared to the robust group. The presence of each of the eight frailty components was significantly associated with higher total healthcare costs. CONCLUSION By comparing the variables of interest using claims data, our study showed that frailty and each of its eight symptoms was associated with increased healthcare costs. This provides evidence of the need for identifying and managing frailty to reduce healthcare costs among South Korean older adults.
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Affiliation(s)
- M J Kim
- In-Hwan Oh, Kyung Hee University College of Medicine, Kyung Hee University School of Medicine, Korea,
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Yang Y, Luo K, Jiang Y, Yu Q, Huang X, Wang J, Liu N, Huang P. The Impact of Frailty on COVID-19 Outcomes: A Systematic Review and Meta-analysis of 16 Cohort Studies. J Nutr Health Aging 2021; 25:702-709. [PMID: 33949641 PMCID: PMC7933604 DOI: 10.1007/s12603-021-1611-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Frail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. OBJECTIVE We aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. DESIGN A systematic review and Meta-analysis of 16 cohort studies. PARTICIPANTS Patients with COVID-19. METHODS A systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects. RESULTS According to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay. CONCLUSIONS In this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all- cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.
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Affiliation(s)
- Y Yang
- Nanhai Liu, Department of neurology, the first affiliated hospital of Gannan medical university,Ganzhou, Jiangxi province, China. ; Pan Huang, College of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang province, China.
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Chen MZ, Wong MWK, Lim JY, Merchant RA. Frailty and Quality of Life in Older Adults with Metabolic Syndrome - Findings from the Healthy Older People Everyday (HOPE) Study. J Nutr Health Aging 2021; 25:637-644. [PMID: 33949631 DOI: 10.1007/s12603-021-1609-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Metabolic syndrome (MetS) and frailty are both associated with increased morbidity and mortality. Frailty is associated with reduced quality of life (QoL) but association of QoL with MetS have produced mixed results suggesting that other factors such as disease burden, obesity and depression may have a more significant influence. We aim to investigate the demographics of frail participants with MetS, and relationship between frailty and QoL in MetS. METHODS Cross-sectional population study involving 292 older adults ≥ 65 years with MetS. MetS was defined using the Modified ATP III for Asians which requires the presence of 3 or more of the following 5 components 1) waist circumference ≥ 90cm for males or ≥ 80cm for females, 2) TG ≥ 150mg/dL, 3) HDLc < 40mg/dL in males or < 50mg/dL in females, 4) blood pressure ≥ 130/85mmHg or use of anti-hypertensive medication, and 5) fasting plasma glucose ≥ 100mg/dL or use of pharmacological treatment for diabetes mellitus. Data were collected on demographics, frailty (FRAIL), QoL (Euroqol-5D), perceived health, functional status, cognition, Timed-Up-and-Go (TUG), and hand-grip strength (HGS). RESULTS 40.4% of the participants were pre-frail (MetSprefrail) and 7.2% were frail (MetSfrail). MetSfrail were significantly older, had lower education level, higher polypharmacy burden and higher prevalence of diabetes. The prevalence of at least 1 activity of daily living impairment was 4 times higher, and depression 9 times higher than their robust counterparts. MetSfrail also had longer TUG, higher prevalence of poor grip strength and poor perceived health. After adjusting for age, gender and education, MetSfrail was significantly associated with much higher odds of EQ-5D moderate to extreme problems with mobility (Odds Ratio (OR) =10.99, CI 2.62-46.14), usual activities (OR=37.82, CI 3.77-379.04) and pain (OR=10.79, CI 3.18-36.62). EQ-5D Index Value and Perceived Health improved by 0.1 (Mean Difference (MD) =0.07, CI 0.04-0.10) and 6.0 (MD=6.01, CI 3.29-8.73) respectively as frailty status improved. CONCLUSION Frailty in MetS is associated with depression, polypharmacy, greater functional impairment, poorer QoL and perceived health. Frailty screening and personalized management is crucial in MetS as frailty may be a mediator for negative outcomes in MetS, and frailty may be reversible.
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Affiliation(s)
- M Z Chen
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore 119228, , Telephone number: +65 6779 5555
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Merchant RA, Tsoi CT, Tan WM, Lau W, Sandrasageran S, Arai H. Community-Based Peer-Led Intervention for Healthy Ageing and Evaluation of the 'HAPPY' Program. J Nutr Health Aging 2021; 25:520-527. [PMID: 33786571 PMCID: PMC7883995 DOI: 10.1007/s12603-021-1606-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Population ageing impacts many areas of society from health and social care cost to housing and future workforce, and whole-of-society approach is required to promote healthy ageing. The Decade of Healthy Ageing report has called upon multi-sectoral collaboration to promote age-friendly communities. The Healthy Ageing Promotion Program for You (HAPPY) is a community-based dual-task exercise program for older adults led by health coaches (HC) or trained volunteers (HAPPY leaders) to promote healthy ageing. The primary objective was to observe improvement in cognition. The secondary objective was to observe improvement in frailty status, functional status, perceived health and reduction of social isolation. We also aim to evaluate the effectiveness and describe the implementation of the HAPPY program. DESIGN To engage older adults with prefrailty, frailty and/or cognitive impairment in dual-task exercise program. Recruitment and publicity were through country-wide multisectoral collaboration. SETTING Community setting. PARTICIPANTS More than 700 older adults participated in ≥ 50 different sites including senior activity centres. Five hundred and sixty-nine participants attended phase 1 screening. Pre-frail or frail ambulant participants or those with underlying cognitive impairment were invited to participate in phase 2 screening. Among them 296 participants enrolled in phase 2 with 66.6% follow up rate at 3 months. MEASUREMENTS Phase 1 and 2 screening consisted of screening for frailty (FRAIL), cognition (Montreal Cognitive Assessment [MoCA]), falls, vision, grip strength, perceived health (EuroQol vertical visual analogue scale), depression (geriatric depression scale), social network (6-item Lubben Social Network Scale), gait speed and physical function (Short physical performance battery [SPPB]). RESULTS HC led 61.7% of the participants, and HAPPY was conducted twice weekly for 64% of the participants. There was significant improvement in the MoCA scores both in the HC and HAPPY leaders' led groups. Overall physical function, chair-stand and balance domain improved significantly especially in the groups led by HC and those participating in twice-weekly exercises. There was significant improvement in perceived health, reduction in social isolation, improvement in frailty status and reduction of falls at 3 months. CONCLUSION Community embedded peer-led program to promote healthy ageing like HAPPY can improve cognition, physical function, and frailty status, reduce social isolation, and improve perceived health. It takes a "village" to promote healthy ageing, and the need to have a life course approach to healthy longevity which must involve local government and ministerial organisations, non-profit organisations, industries, academia, and community to redesign health.
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Affiliation(s)
- Reshma A Merchant
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, , ORCID iD: 0000-0002-9032-0184
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Moreno-Useche LD, Urrego-Rubio J, Cadena-Sanabria M, Rodríguez Amaya R, Maldonado-Navas S, Ruiz-González C. Frailty syndrome in patients with chronic kidney disease at a dialysis Centre from Santander, Colombia. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tan LF, Chan YH, Tay A, Jayasundram J, Low NA, Merchant RA. Practicality and Reliability of Self Vs Administered Rapid Geriatric Assessment Mobile App. J Nutr Health Aging 2021; 25:1064-1069. [PMID: 34725662 PMCID: PMC8432277 DOI: 10.1007/s12603-021-1672-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/22/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop and cross-validate self-administered Rapid Geriatric Assessment (SA-RGA) app against administered Rapid Geriatric Assessment (A-RGA) to identify seniors with geriatric syndromes such as frailty, sarcopenia, and anorexia of ageing who may benefit from targeted intervention. DESIGN Prospective observational study. SETTING Primary Care and Community. PARTICIPANTS A-RGA and SA-RGA app were administered to older adults ≥ 60 years old from December 2020 to April 2021. MEASUREMENTS The RGA app screens for frailty (FRAIL), sarcopenia (SARC-F), anorexia of aging (SNAQ) and cognition (Rapid Cognitive Screen) with assisted management pathway. Patient Health Questionnaire 9 is administered for those who score positive for fatigue. The diagnostic performance of SA-RGA was compared against A-RGA as a reference by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and positive likelihood ratio (+LR). RESULTS 123 participants with a mean age of 71 ± 5.9 years completed both the SA-RGA and A-RGA. Questions on fatigue, 5 or more illnesses, loss of weight and falls in the past year performed better with high sensitivity, specificity, NPV and +LR than self-functional assessment where SA-RGA participants reported lower prevalence on the FRAIL scale aerobic and resistance components, and higher prevalence on the SARC-F strength and rising from a chair components. CONCLUSION The SA-RGA app performed well in certain domains such as assessment for weight loss, falls, number of chronic illness and fatigue. Self-functional assessment can be improved further by removing ambiguity in wordings such as "some" or "a lot" and replacing it with functional difficulty scale. SA-RGA has the potential to be incorporated in the eHEALTH platforms worldwide for early identifications of older adults at risk and to reduce health inequalities, at the same time building community resilience in the era of Covid-19 pandemic.
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Affiliation(s)
- L F Tan
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, , ORCID iD: 0000-0002-9032-0184
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Chew J, Lim JP, Yew S, Yeo A, Ismail NH, Ding YY, Lim WS. Disentangling the Relationship between Frailty and Intrinsic Capacity in Healthy Community-Dwelling Older Adults: A Cluster Analysis. J Nutr Health Aging 2021; 25:1112-1118. [PMID: 34725670 DOI: 10.1007/s12603-021-1679-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Frailty and intrinsic capacity (IC) are distinct but interrelated constructs. Uncertainty remains regarding how they are related and interact to influence health outcomes. We aim to understand the relationship between frailty and IC by identifying subgroups based on frailty criteria and IC domains and studying one-year outcomes. METHODS We studied 200 independent community-dwelling older adults (mean age 67.9±7.9 years, Modified Barthel Index (MBI) score 99±2.6). Frailty was defined by modified Fried criteria. Scores (range: 0-2) were assigned to individual IC domains (cognition, psychological, locomotion, and vitality) to yield a total IC score of 8. To identify subgroups, two-step cluster analysis was performed with age, frailty and IC domains. Cluster associations with one-year outcomes (frailty, muscle strength (grip strength, repeated chair stand test), physical performance (gait speed, Short Physical Performance Battery), function (MBI) and quality-of-life (EuroQol (EQ)-5D)) were examined using multiple linear regression adjusted for age, gender and education. RESULTS Three distinct clusters were identified - Cluster 1: High IC/Robust (N=74, 37%); Cluster 2: Intermediate IC/Prefrail (N=73, 36.5%); and Cluster 3: Low IC/Prefrail-Frail (53, 26.5%). Comparing between clusters, IC domains, cognition, depressive symptoms, nutrition, strength and physical performance were least impaired in Cluster 1, intermediate in Cluster 2 and most impaired in Cluster 3. At one year, the proportion transitioning to frailty or remaining frail was highest in Cluster 3 compared to Cluster 2 and Cluster 1 (39% vs 6.9% vs 2.8%, P<0.001). Compared to Cluster 1, Cluster 3 experienced greatest declines in grip strength (β=-4.1, P<.001), MBI (β=-1.24, P=0.045) and EQ-5D utility scores (β=-0.053, P=0.005), with Cluster 2 intermediate between Cluster 1 and Cluster 3. CONCLUSIONS Amongst independent community-dwelling older adults, IC is complementary to frailty measures through better risk-profiling of one-year outcomes amongst prefrail individuals into intermediate and high-risk groups. The intermediate group merits follow-up to ascertain longer-term prognosis.
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Affiliation(s)
- J Chew
- Justin Chew, Tan Tock Seng Hospital, Singapore,
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Merchant RA, Au L, Seetharaman S, Ng SE, Nathania J, Lim JY, Koh GCH. Association of Pain and Impact of Dual-Task Exercise on Function, Cognition and Quality of Life. J Nutr Health Aging 2021; 25:1053-1063. [PMID: 34725661 DOI: 10.1007/s12603-021-1671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to assess the factors associated with pain and evaluate the impact of dual-task exercise on pain improvement, quality of life (QOL), cognition and function in older adults. PATIENTS AND METHODS This study is a secondary data analysis of the HAPPY (Healthy Ageing Promotion Program for You) study. At risk older adults ≥ 60 years old were enrolled in a community dual-task exercise program. Assessments for frailty, sarcopenia, falls, quality of life (QOL) and perceived health, depression, cognition and physical function were performed at baseline and 3 months. Pain intensity was derived from EQ-5D and stratified into no pain, slight pain and moderate to extreme pain. RESULTS Out of 296 participants, 37.2% had slight pain and 11.1% had moderate to severe pain. Both slight and moderate to extreme pain compared with no pain group were significantly associated with lower perceived health (68.2,63.6 vs 76.0) and QOL index (0.70,0.59 vs 0.93); moderate to extreme pain was also significantly associated with depression, low mental vitality, frailty, sarcopenia and poorer physical performance. After 3 months of dual-task exercise, pain improved in 70.8% of the moderate to extreme pain group and 50.8% of slight pain group. Significant improvement in perceived health, QOL, physical function and cognition were also observed. CONCLUSION Proactive efforts are required to screen for pain and manage frailty, sarcopenia and depression. Dual-task exercise proved safe and possibly effective in reducing pain and improving QOL, physical and cognitive function in older adults. Prospective randomized studies are needed to validate the effectiveness of dual-task vs single-task exercise, including impact of reversal of frailty and sarcopenia in pain management.
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Affiliation(s)
- Reshma A Merchant
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore 119228, , ORCID iD: 0000-0002-9032-018413-8510, Japan, Tel: +81-3-5803-4560, Fax: +81-3-5803-4560, E-mail:
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Ding L, Miao X, Lu J, Hu J, Xu X, Zhu H, Xu Q, Zhu S. Comparing the Performance of Different Instruments for Diagnosing Frailty and Predicting Adverse Outcomes among Elderly Patients with Gastric Cancer. J Nutr Health Aging 2021; 25:1241-1247. [PMID: 34866152 DOI: 10.1007/s12603-021-1701-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the diagnostic performance of the Tilburg Frailty Indicator (TFI), 11-factor modified frailty index (mFI-11), and 5-factor modified frailty index (mFI-5) for frailty defined by Frailty Phenotype (FP), as well as to compare the predictive ability of TFI, mFI-11, and mFI-5 for adverse outcomes in hospital among elderly patients undergoing gastric cancer surgery. DESIGN A prospective cohort study. SETTING Hospitalization setting, Nanjing, China. PARTICIPANTS We recruited 259 elderly patients undergoing gastric cancer surgery from a tertiary hospital. MEASUREMENTS Frailty was assessed by the FP, TFI, mFI-11, and mFI-5 before surgery, respectively. The receiver operating characteristic (ROC) curves were plotted to compared the diagnostic performance of TFI, mFI-11, and mFI-5 using FP as the reference. ROC curves were used to examine the performance of TFI, mFI-11, and mFI-5 in predicting adverse outcomes. The area under the curve (AUC)>0.70 was regarded as an indicator of good performance. RESULTS The prevalence of frailty ranged from 8.5% (mFI-11) to 45.9% (TFI). The AUCs of TFI (AUC: 0.764, p<0.001) was significantly greater than that of mFI-11 (AUC: 0.600, p=0.033) and mFI-5 (AUC: 0.600, p=0.0311) in the detection of frailty defined by FP, with quite different sensitivity and specificity at their original cutoffs. TFI and mFI-11 both had statistically significant but similarly inadequate predictive accuracy for adverse outcomes in hospital, including total complications (AUCs: 0.618; 0.621), PLOS (AUCs: 0.593; 0.639), increased hospital costs (AUCs: 0.594; 0.624), and hypoproteinemia (AUCs: 0.573; 0.600). For the mFI-5, only the predictive ability for hypoproteinemia was statistically significant, with poor accuracy (AUC: 0.592, p<0.0055). CONCLUSION The TFI performed slightly better than mFI-11 and mFI-5 in our study. Moreover, future studies are needed to further determine an optimal frailty instrument with great diagnostic and predictive accuracy.
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Affiliation(s)
- L Ding
- Qin Xu, Professor, School of Nursing, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, China, ; Shuqin Zhu, Associate Professor, School of Nursing, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, China,
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Rondanelli M, Cereda E, Klersy C, Faliva MA, Peroni G, Nichetti M, Gasparri C, Iannello G, Spadaccini D, Infantino V, Caccialanza R, Perna S. Improving rehabilitation in sarcopenia: a randomized-controlled trial utilizing a muscle-targeted food for special medical purposes. J Cachexia Sarcopenia Muscle 2020; 11:1535-1547. [PMID: 32961041 PMCID: PMC7749532 DOI: 10.1002/jcsm.12532] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/19/2019] [Accepted: 12/02/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sarcopenia is a disease associated with aging and a negative prognosis. Consensus-based treatment consists in targeting muscle mass and function through physical exercise, optimization of protein intake, and vitamin D supplementation, but evidence is lacking. We evaluated the safety and efficacy of a muscle-targeted nutritional support on the outcome of a physical exercise rehabilitation programme. METHODS In a single-site, double-blind, randomized, controlled trial (NCT03120026; May 2017 to December 2018), old (≥65 years) adults [N = 140 (63% female patients; age, 81 ± 6 years)] without severe cognitive impairment, who were found to have sarcopenia by European Working Group on Sarcopenia in Older People 2010 criteria and hospitalized for physical rehabilitation, were randomized to receive until discharge (for at least 4 weeks and up to 8 weeks) a whey protein-based nutritional formula enriched with leucine and vitamin D or an iso-caloric control formula twice daily in addition to a standard hospital diet. The primary endpoint was the change in 4 m gait speed per month. Key secondary endpoints addressed the change in physical performance: chair-stand test, timed up and go test, and short physical performance battery. Other secondary outcomes were the change in functional status, muscle strength and mass, cognitive status, and quality of life. The proportion of patients who improved their rehabilitation intensity profile and overall economic benefits (using length of stay and duration of rehabilitation as surrogate measures) were also evaluated. RESULTS A total of 161 patients were screened and 140 were randomized to study interventions. Thirteen patients (experimental, n = 6; placebo, n = 7) discontinued the intervention because they disliked the product and intention-to-treat analyses were based on patients reassessed at discharge [n = 127 (66% female patients; age, 81 ± 6 years)]. Supplementation with the experimental formula (n = 64) resulted in greater increase in mean gait speed {0.061 m/s/month [95% confidence interval (CI), 0.043 to 0.080]} than placebo [n = 63; -0.001 m/s/month (95%CI, -0.008 to 0.006)]: mean difference, 0.063 m/s/month (95%CI, 0.043 to 0.082) (P < 0.001). A significant effect was also found for muscle mass (P < 0.03) and all key secondary outcomes, functional and cognitive endpoints (P < 0.001 for all). Supplementation resulted also in higher proportion of patients improving their rehabilitation intensity profile (P = 0.003) and being discharged home (P = 0.002); shorter rehabilitation (P < 0.001); and hospital stay (P < 0.001). CONCLUSIONS In old adults with sarcopenia admitted to hospital for rehabilitation the consumption of a whey protein-based nutritional formula enriched with leucine and vitamin D improved physical performance and function, as well as muscle mass, and reduced the intensity and costs of care.
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Affiliation(s)
- Mariangela Rondanelli
- IRCCS, Mondino Foundation, Pavia, Italy.,Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, University of Pavia, Pavia, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Milena Anna Faliva
- Azienda di Servizi alla Persona (ASP) di Pavia, University of Pavia, Pavia, Italy
| | - Gabriella Peroni
- Azienda di Servizi alla Persona (ASP) di Pavia, University of Pavia, Pavia, Italy
| | - Mara Nichetti
- Azienda di Servizi alla Persona (ASP) di Pavia, University of Pavia, Pavia, Italy
| | - Clara Gasparri
- Azienda di Servizi alla Persona (ASP) di Pavia, University of Pavia, Pavia, Italy
| | - Giancarlo Iannello
- Directorate General, Azienda di Servizi alla Persona (ASP) di Pavia, Pavia, Italy
| | - Daniele Spadaccini
- Azienda di Servizi alla Persona (ASP) di Pavia, University of Pavia, Pavia, Italy
| | - Vittoria Infantino
- Azienda di Servizi alla Persona (ASP) di Pavia, University of Pavia, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Kingdom of Bahrain
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Aprahamian I, Mamoni RL, Cervigne NK, Augusto TM, Romanini CV, Petrella M, da Costa DL, Lima NA, Borges MK, Oude Voshaar RC. Design and protocol of the multimorbidity and mental health cohort study in frailty and aging (MiMiCS-FRAIL): unraveling the clinical and molecular associations between frailty, somatic disease burden and late life depression. BMC Psychiatry 2020; 20:573. [PMID: 33261579 PMCID: PMC7706060 DOI: 10.1186/s12888-020-02963-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/16/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To explore the mutual relationship between multimorbidity, mental illness and frailty, we have set-up the Multimorbidity and Mental health Cohort Study in FRAILty and Aging (MiMiCS-FRAIL) cohort. At the population level, multimorbidity, frailty and late-life depression are associated with similar adverse outcomes (i.e. falls, disability, hospitalization, death), share the same risk factors, and partly overlap in their clinical presentation. Moreover, these three variables may share a common underlying pathophysiological mechanism like immune-metabolic dysregulation. The overall objectives of MiMiCS-FRAIL are 1) to explore (determinants of) the cross-sectional and longitudinal relationship between multimorbidity, depression, and frailty among non-demented geriatric outpatients; 2) to evaluate molecular levels of senoinflammation as a broad pathophysiological process underlying these conditions; and 3) to examine adverse outcomes of multimorbidity, frailty and depression and their interconnectedness. METHODS MiMiCS-FRAIL is an ongoing observational cohort study of geriatric outpatients in Brazil, with an extensive baseline assessment and yearly follow-up assessments. Each assessment includes a comprehensive geriatric assessment to identify multimorbidity and geriatric syndromes, a structured psychiatric diagnostic interview and administration of the PHQ-9 to measure depression, and several frailty measures (FRAIL, Physical Phenotype criteria, 36-item Frailty Index). Fasten blood samples are collected at baseline to assess circulating inflammatory and anti-inflammatory cytokines, leukocytes' subpopulations, and to perform immune-metabolic-paired miRome analyses. The primary outcome is death and secondary outcomes are the number of falls, hospital admissions, functional ability, well-being, and dementia. Assuming a 5-year mortality rate between 25 and 40% and a hazard rate varying between 1.6 and 2.3 for the primary determinants require a sample size between 136 and 711 patients to detect a statistically significant effect with a power of 80% (beta = 0.2), an alpha of 5% (0.05), and an R2 between the predictor (death) and all covariates of 0.20. Local ethical board approved this study. DISCUSSION Frailty might be hypothesized as a final common pathway by which many clinical conditions like depression and chronic diseases (multimorbidity) culminate in many adverse effects. The MiMiCS-FRAIL cohort will help us to understand the interrelationship between these variables, from a clinical perspective as well as their underlying molecular signature.
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Affiliation(s)
- Ivan Aprahamian
- Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Ronei Luciano Mamoni
- Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Nilva Karla Cervigne
- Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Taize Machado Augusto
- Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | | | - Marina Petrella
- Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Daniele Lima da Costa
- Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Natalia Almeida Lima
- Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
| | - Marcus K. Borges
- grid.11899.380000 0004 1937 0722Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Richard C. Oude Voshaar
- grid.11899.380000 0004 1937 0722Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil ,grid.4494.d0000 0000 9558 4598University Medical Center Groningen, University Center for Psychiatry and Interdisciplinary Center for Psychopathology of Emotion Regulation, Groningen, Netherlands
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Adja KYC, Lenzi J, Sezgin D, O'Caoimh R, Morini M, Damiani G, Buja A, Fantini MP. The Importance of Taking a Patient-Centered, Community-Based Approach to Preventing and Managing Frailty: A Public Health Perspective. Front Public Health 2020; 8:599170. [PMID: 33282818 PMCID: PMC7689262 DOI: 10.3389/fpubh.2020.599170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Across the world, life expectancy is increasing. However, the years of life gained do not always correspond to healthy life years, potentially leading to an increase in frailty. Given the extent of population aging, the association between frailty and age and the impact of frailty on adverse outcomes for older people, frailty is increasingly being recognized to be a significant public health concern. Early identification of the condition is important to help older adults regain function and to prevent the negative outcomes associated with the syndrome. Despite the importance of diagnosing frailty, there is no definitive evidence or consensus of whether screening should be routinely implemented. A broad range of screening and assessment instruments have been developed taking a biopsychosocial approach, characterizing frailty as a dynamic state resulting from deficits in any of the physical, psychological and social domains, which contribute to health. All these aspects of frailty should be identified and addressed using an integrated and holistic approach to care. To achieve this goal, public health and primary health care (PHC) need to become the fulcrum through which care is offered, not only to older people and those that are frail, but to all individuals, favoring a life-course and patient-centered approach centered around integrated, community-based care. Public health personnel should be trained to address frailty not merely from a clinical perspective, but also in a societal context. Interventions should be delivered in the individuals' environment and within their social networks. Furthermore, public health professionals should contribute to education and training on frailty at a community level, fostering community-based interventions to support older adults and their caregivers to prevent and manage frailty. The purpose of this paper is to offer an overview of the concept of frailty for a public health audience in order to raise awareness of the multidimensional aspects of frailty and on how these should be addressed using an integrated and holistic approach to care.
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Affiliation(s)
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Duygu Sezgin
- School of Nursing and Midwifery, College of Medicine Nursing & Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Rónán O'Caoimh
- Mercy University Hospital, Grenville Place, Cork, Ireland.,Clinical Research Facility Cork, University College Cork, Cork, Ireland
| | - Mara Morini
- Italian Scientific Society of Hygiene and Preventive Medicine - Primary Care Group, Bologna, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Buja
- Laboratory of Health Care Services and Health Promotion, Evaluation Unit of Hygiene and Public Health Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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399
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Kojima M, Kojima T, Waguri-Nagaya Y, Takahashi N, Asai S, Sobue Y, Nishiume T, Suzuki M, Mitsui H, Kawaguchi Y, Kuroyanagi G, Yasuoka M, Watanabe M, Suzuki S, Arai H. Depression, physical function, and disease activity associated with frailty in patients with rheumatoid arthritis. Mod Rheumatol 2020; 31:979-986. [PMID: 33066713 DOI: 10.1080/14397595.2020.1838402] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the clinical and psychosocial backgrounds of frailty in rheumatoid arthritis (RA) patients. METHODS Patients with RA between 40 and 79 years of age who visited university hospitals in an urban area were recruited. Well-validated self-reported questionnaires were used to evaluate patient physical function (Health Assessment Questionnaire, HAQ), depressive symptoms (Beck Depression Inventory-II, BDI-II), and frailty (Kihon Checklist). A 28-point Disease Activity Score (DAS-28) was calculated to evaluate RA disease activity. RESULTS A total of 375 RA patients, 323 of whom were women, were enrolled (average age: 65.2 ± 9.7 years; average disease duration: 16.6 ± 11.9 years). The prevalence rates of frailty, working-age (40-64 years), young-old (65-74 years), and old-old (≥75 years) patients were 18.5, 28.8, and 36.6%, respectively. Higher age and longer disease duration were associated with frailty. Multivariable logistic regression analysis revealed that HAQ, DAS-28, and BDI-II scores were independently associated with frailty in RA patients. CONCLUSION Frailty is common, even among working-age RA patients. Physical function, disease activity, and depressive symptoms were independently associated with frailty. A multidisciplinary intervention approach, along with adequate pharmacological therapy, may promote successful aging in patients with RA.
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Affiliation(s)
- Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Toshihisa Kojima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Center of Joint Surgery for Rheumatic Diseases and Osteoporosis, Nagoya City East Medical Center, Nagoya, Japan
| | - Nobunori Takahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuji Asai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasumori Sobue
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Tsuyoshi Nishiume
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Orthopaedic Surgery, Okazaki City Hospital, Okazaki, Japan
| | - Mochihito Suzuki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroto Mitsui
- Department of Orthopaedic Surgery, Aichi Medical University, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Gen Kuroyanagi
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mikako Yasuoka
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Miki Watanabe
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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400
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Chong E, Chan M, Tan HN, Lim WS. Heterogeneity in functional status among moderately frail older adults: improving predictive performance using a modified approach of subgrouping the Clinical Frailty Scale. Eur Geriatr Med 2020; 12:275-284. [PMID: 33095431 PMCID: PMC7582023 DOI: 10.1007/s41999-020-00418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/08/2020] [Indexed: 12/01/2022]
Abstract
Aims To establish if dependency in basic activities of daily living (bADL) amongst moderately frail older adults predict poorer health outcomes including mortality and institutionalisation. We also examined the utility of subgrouping category 6 of the Clinical Frailty Scale (CFS) by level of functional dependency to improve predictive performance. Findings We observed a wider range in functional dependency among CFS 6 patients when compared to other frail categories. Incorporating CFS 6 subcategories based on bADL functional status increased predictive performance for longitudinal adverse outcomes compared with the original CFS scoring. Message This study corroborates the heterogeneity of bADL functional status in CFS 6 individuals and validates the use of a modified approach to subgrouping the CFS via bADL dependency for improved predictive performance. Electronic supplementary material The online version of this article (10.1007/s41999-020-00418-8) contains supplementary material, which is available to authorized users. Purpose Moderately frail individuals [Clinical Frailty Scale (CFS) 6] demonstrate heterogeneity in basic activities of daily living (bADL). We aimed to establish whether functional dependency in moderate frailty predicts poorer outcomes and examined the utility of subgrouping the CFS in predicting mortality and institutionalisation. Methods We prospectively studied 201 hospitalised frail patients (89.5 ± 4.7 years, female 70.1%). We examined Katz Index (KI) against adverse outcomes in CFS6 (n = 106). We then compared predictive performances of a modified CFS version 1 (mCFS-1; category 6A: CFS6 and KI ≥ 2; 6B: CFS6 and KI ≤ 1) and modified CFS version 2 (mCFS-2; category 6A: CFS6 and KI ≥ 2; 6B1: CFS6, KI ≤ 1 and feeding independent; 6B2: CFS6, KI ≤ 1 and feeding dependent) against the CFS. Multivariate analysis was used to compare each tool against mortality and institutionalisation. Receiver operator characteristic analysis was performed to determine area under curve and optimal cut-points for each tool. Results KI ≤ 1 in CFS6 was associated with higher 12-month mortality (39.3% vs. 15.6%, p = 0.01); amongst KI items, feeding dependent predicted 12-month mortality (p < 0.05). Using mCFS-1, category 6A did not increase 12-month mortality compared with category 5 (OR 1.83, 95% CI 0.52–6.47), unlike category 6B (OR 6.33, 95% CI 2.07–19.33). mCFS-2 produced higher mortality in category 6B1 (OR 5.19, 95% CI 1.30–20.69) and 6B2 (OR 6.92, 95% CI 2.14–22.35). Similar observations were seen for institutionalisation. Optimal cut-point for 12-month mortality was category 6 for CFS, and 6B and 6B1 for mCFS-1 and mCFS-2, respectively. Conclusion This study corroborates the heterogeneity of functional status in moderately frail individuals and validates the use of a modified approach to subgrouping the CFS6 via bADL functional status for improved predictive performance. Electronic supplementary material The online version of this article (10.1007/s41999-020-00418-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward Chong
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Mark Chan
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Huei Nuo Tan
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
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