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Steinmetz C, Krause L, Sulejmanovic S, Kaumkötter S, Hartog J, Scheenstra B, Stefan F, Mengden T, Grefe C, Knoglinger E, Reiss N, Bjarnason-Wehrens B, Schmidt T, Sadlonova M, von Arnim CAF, Heinemann S. Evaluation of frailty in geriatric patients undergoing cardiac rehabilitation after cardiac procedure: results of a prospective, cross-sectional study. BMC Sports Sci Med Rehabil 2024; 16:146. [PMID: 38956610 PMCID: PMC11221201 DOI: 10.1186/s13102-024-00937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Frailty is an indicator of a decline in quality of life and functional capacity in cardiac rehabilitation (CR) patients. Currently, there is no standardized assessment tool for frailty used in CR. The aim of this study was to determine if the Clinical Frailty Scale (CFS) is feasible for assessing frailty in CR. METHODS Prospective, cross-sectional study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". Patients ≥75 years undergoing CR after cardiac procedure (n=122) were recruited in four German inpatient CR facilities. Assessments included: CFS, Katz-Index, hand grip strength (HGS), Short Physical Performance Battery (SPPB) and six-minute-walk test (6MWT). Outcomes were frailty (CFS≥4) and the correlation of frailty with assessments of functional capacity, activities of daily living and clinical parameters. Statistical analysis included descriptive statistics and correlations, using the spearman correlation coefficient and chi-square test to test for significance. RESULTS Data from 101 patients (79.9±4.0 years; 63% male) were analyzed. The mean CFS score was 3.2±1.4; 41.6% were defined as frail (CFS≥4). The mean time required to assess the CFS was 0.20 minutes. The findings show that CFS correlates significantly (p<0.001) with the following factors: Katz-Index, HGS, SPPB-Score and 6MWT (r≤-0.575). In addition, CFS correlated with small to moderate effects with co-morbidities (r=0.250), as-needed medications and need for nursing assistance (r≤0.248). CONCLUSIONS The CFS assessment can be performed in under one minute and it correlates significantly with assessments of functional capacity, activities of daily living and clinical parameters in the CR setting. TRIAL REGISTRATION German Clinical Trials Register (DRKS; http:// www. drks. de; DRKS00032256). Retrospectively registered on 13 July 2023.
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Affiliation(s)
- Carolin Steinmetz
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
| | - Laura Krause
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Samra Sulejmanovic
- Department of Sports Science, University of Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Sabrina Kaumkötter
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
| | - Johanneke Hartog
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Bart Scheenstra
- Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Professor Debyelaan 25, 6229 HX, Netherlands, Maastricht
| | - Flohr Stefan
- Department of Sports Science, University of Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Thomas Mengden
- Department of Rehabilitation, Kerckhoff Heart Center, Ludwigstraße 41, 61231, Bad Nauheim, Germany
| | - Clemens Grefe
- Clinic and Rehabilitation Center Lippoldsberg, Birkenallee 1, 34399, Wesertal, Germany
| | - Ernst Knoglinger
- Kirchberg-Clinic Bad Lauterberg, Kirchberg 7-11, 37431, Bad Lauterberg, Germany
| | - Nils Reiss
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Thomas Schmidt
- Schüchtermann-Schiller'sche Clinic, Ulmenallee 11, 49214, Bad Rothenfelde, Germany
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Monika Sadlonova
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Goettingen, Robert-Koch-Straße 42a, 37075, Goettingen, Germany
| | - Christine A F von Arnim
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Goettingen, Robert-Koch-Straße 42a, 37075, Goettingen, Germany
| | - Stephanie Heinemann
- Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075, Goettingen, Germany
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Roldán-Chicano MT, García-López MM, Martínez-Pacheco MC, Rodríguez-Tello J. Prognostic value of defining characteristics in frail elderly syndrome: Hospital readmission and mortality outcomes. Int J Nurs Knowl 2024; 35:290-297. [PMID: 37700456 DOI: 10.1111/2047-3095.12445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To identify the most relevant clinical characteristics of the nursing diagnosis frail elderly syndrome (FES) in hospitalized patients aged 65 or older and analyze their impact on 9-month mortality and hospital readmission. METHODS A prospective and prognostic accuracy study was conducted in patients aged 65 or older, who were admitted to hospital more than 24 h. A consecutive convenience sampling process was used. Assessment included defining characteristics (DCs) of FES, clinical fraility scale (CFS), frail scale (FS), and 9-month mortality and hospital readmission. Statistical tests were used to verify associations between variables. Binary logistic regression analysis and area under the curve were used, to identify significant predictors for the outcomes and evaluate the prognostic accuracy of the DCs. FINDINGS This study involved 150 patients. CFS scored 65 patients (43.3%, confidence interval 95% 35.2% a 51.6) as frail and proved a prognostic value of mortality at 9 month from pre-frail state (p = 0.020). The mean number of DCs for FES nursing diagnosis was 6.35 (SD = 3.14). Validated tools for measuring frailty were associated with all DCs, excepting nutritional imbalance: below body needs. The hospital readmission during the following 9 months was only statistically related to memory impairment (p = 0.07). CONCLUSION Clinical frailty scale showed good results as a predictor of mortality. The study suggests exploring including it, in clinical manifestations of elderly frail syndrome. This study found that only memory impairment defining characteristic was predictive of hospital readmission. Further research should identify other relevant and prognostic clinical manifestations. IMPLICATION FOR NURSING PRACTICE These findings highlight the importance of being vigilant on cognitive decline during hospital admissions. The most prevalent and determinant DCs identified in this study indicate that clinical should focus on preserving functional and mental abilities as well as mobility.
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Affiliation(s)
- María T Roldán-Chicano
- Santa Lucía General University Hospital, Cartagena, Spain
- Cartagena School of Nursing, University of Murcia, Murcia, Spain
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Chen Y, Lin S, Yang S, Qi M, Ren Y, Tian C, Wang S, Yang Y, Gao J, Zhao H. Genetic and phenotypic associations of frailty with cardiovascular indicators and behavioral characteristics. J Adv Res 2024:S2090-1232(24)00249-2. [PMID: 38862035 DOI: 10.1016/j.jare.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Frailty Index (FI) is a common measure of frailty, which has been advocated as a routine clinical test by many guidelines. The genetic and phenotypic relationships of FI with cardiovascular indicators (CIs) and behavioral characteristics (BCs) are unclear, which has hampered ability to monitor FI using easily collected data. OBJECTIVES This study is designed to investigate the genetic and phenotypic associations of frailty with CIs and BCs, and further to construct a model to predict FI. METHOD Genetic relationships of FI with 288 CIs and 90 BCs were assessed by the cross-trait LD score regression (LDSC) and Mendelian randomization (MR). The phenotypic data of these CIs and BCs were integrated with a machine-learning model to predict FI of individuals in UK-biobank. The relationships of the predicted FI with risks of type 2 diabetes (T2D) and neurodegenerative diseases were tested by the Kaplan-Meier estimator and Cox proportional hazards model. RESULTS MR revealed putative causal effects of seven CIs and eight BCs on FI. These CIs and BCs were integrated to establish a model for predicting FI. The predicted FI is significantly correlated with the observed FI (Pearson correlation coefficient = 0.660, P-value = 4.96 × 10-62). The prediction model indicated "usual walking pace" contributes the most to prediction. Patients who were predicted with high FI are in significantly higher risk of T2D (HR = 2.635, P < 2 × 10-16) and neurodegenerative diseases (HR = 2.307, P = 1.62 × 10-3) than other patients. CONCLUSION This study supports associations of FI with CIs and BCs from genetic and phenotypic perspectives. The model that is developed by integrating easily collected CIs and BCs data in predicting FI has the potential to monitor disease risk.
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Affiliation(s)
- Yihan Chen
- School of Mathematical Sciences and LPMC, Nankai University, Tianjin 300071, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical research center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Siying Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical research center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; School of Computer Science and Engineering, Sun Yat-Sen University, Guangzhou 510006, China
| | - Shuangyu Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical research center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Mengling Qi
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical research center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Yu Ren
- School of Mathematical Sciences and LPMC, Nankai University, Tianjin 300071, China
| | - Chong Tian
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical research center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Shitian Wang
- School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, China
| | - Yuedong Yang
- School of Computer Science and Engineering, Sun Yat-Sen University, Guangzhou 510006, China
| | - Jianzhao Gao
- School of Mathematical Sciences and LPMC, Nankai University, Tianjin 300071, China.
| | - Huiying Zhao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical research center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China.
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El Assar M, Rodríguez-Sánchez I, Álvarez-Bustos A, Rodríguez-Mañas L. Biomarkers of frailty. Mol Aspects Med 2024; 97:101271. [PMID: 38631189 DOI: 10.1016/j.mam.2024.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
Several biomarkers have been proposed to identify frailty, a multisystemic age-related syndrome. However, the complex pathophysiology and the absence of a consensus on a comprehensive and universal definition make it challenging to pinpoint a singular biomarker or set of biomarkers that conclusively characterize frailty. This review delves into the main laboratory biomarkers, placing special emphasis on those associated with various pathways closely tied to the frailty condition, such as inflammation, oxidative stress, mitochondrial dysfunction, metabolic and endocrine alterations and microRNA. Additionally, we provide a summary of different clinical biomarkers encompassing different tools that have been proposed to assess frailty. We further address various imaging biomarkers such as Dual Energy X-ray Absorptiometry, Bioelectrical Impedance analysis, Computed Tomography and Magnetic Resonance Imaging, Ultrasound and D3 Creatine dilution. Intervention to treat frailty, including non-pharmacological ones, especially those involving physical exercise and nutrition, and pharmacological interventions, that include those targeting specific mechanisms such as myostatin inhibitors, insulin sensitizer metformin and with special relevance for hormonal treatments are mentioned. We further address the levels of different biomarkers in monitoring the potential positive effects of some of these interventions. Despite the availability of numerous biomarkers, their performance and usefulness in the clinical arena are far from being satisfactory. Considering the multicausality of frailty, there is an increasing need to assess the role of sets of biomarkers and the combination between laboratory, clinical and image biomarkers, in terms of sensitivity, specificity and predictive values for the diagnosis and prognosis of the different outcomes of frailty to improve detection and monitoring of older people with frailty or at risk of developing it, being this a need in the everyday clinical practice.
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Affiliation(s)
- Mariam El Assar
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain.
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Álvarez-Bustos A, Carnicero JA, Rueda R, Pereira SL, Santos-Fandila A, López-Pedrosa JM, Molina-Baena B, García-García FJ, Rodríguez-Mañas L. Relationship of endogenous plasma concentrations of β-hydroxy β-methyl butyrate (HMB) with frailty in community dwelling older adults with type-2 diabetes mellitus. J Nutr Health Aging 2024; 28:100229. [PMID: 38598977 DOI: 10.1016/j.jnha.2024.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Supplementation with β-hydroxy β-methyl butyrate (HMB) appears to be effective in preserving muscle in older adults. However, the association between endogenously produced HMB with frailty has not been studied in people with chronic disease. OBJECTIVES The purpose of this study is to explore whether an association exists between endogenous HMB levels and frailty status in older adults with type-2 diabetes mellitus (T2DM). METHODS Data were taken from the Toledo Study of Healthy Ageing, a community-dwelling aged (65 years+) cohort. Frailty was assessed at baseline and at 2.99 median years according to the Frailty Phenotype (FP) standardized to our population and the Frailty Trait Scale 12 (FTS12). The associations between HMB levels and frailty were assessed using three nested multivariate logistic regressions and segmented by sex. Glucose, HMB and glucose interaction, age and body composition were used as covariables. RESULTS 255 participants (mean age 75.3 years, 52.94% men) were included. HMB levels showed an inverse cross-sectional association with frailty, which was modified when the interaction term HMB*glucose was included, remaining significant only for FTS12 [OR (95% CI): 0.436 (0.253, 0.751), p-value 0.003]. The association between HMB endogenous levels and FTS12 appears to be independent of sex, in which the association was maintained after adjusting for the covariates. However, there appears to be threshold points for glucose levels, above which the protective effect of HMB is lost: 145.4 mg/dl adjusted by gender for the whole sample and 149.6 mg/dl and 138.9 mg/dl for men and women, respectively. Endogenous HMB levels were not found to be associated with incident frailty. CONCLUSIONS Cross-sectional analysis revealed that endogenous HMB levels were inversely associated with frailty as assessed by the FTS12 in older people with T2DM. This association was found to be dependent on circulating fasted glucose levels.
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Affiliation(s)
- Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Biomédica La Paz (IdiPaz), Madrid, Spain
| | - Jose A Carnicero
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación de Investigación Biomédica Hospital Universitario de Getafe, Getafe, Spain
| | | | | | | | | | | | - Francisco José García-García
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Virgen del Valle, Toledo, Spain
| | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain; Instituto de Investigación Biomédica La Paz (IdiPaz), Madrid, Spain.
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Christensen MG, Jacobsen KK, Nilsson C, Jepsen R, Thygesen L, Suetta C, Holm EA. Prevalence and population characteristics associated with frailty in a rural low socioeconomic area in Denmark: the Lolland-Falster Health Study. BMJ Open 2024; 14:e073754. [PMID: 38453201 PMCID: PMC10921517 DOI: 10.1136/bmjopen-2023-073754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Frailty is a major geriatric syndrome that predicts increased vulnerability to minor stressor events and adverse outcomes such as falls, fractures, disability and death. The prevalence of frailty among individuals above the age of 65 varies widely with an overall weighted prevalence of 10.7%. OBJECTIVES The purpose of this study was to examine the prevalence of prefrailty and frailty in community-dwelling older adults from the regions of Lolland-Falster, which is one of the most socioeconomically disadvantaged areas of Denmark with lower income and lower life expectancy compared with the general Danish population. Moreover, the objective was to find selected individual characteristics associated with frailty. DESIGN An observational, cross-sectional registry-based population study with data from the regions of Lolland-Falster collected between February 2016 and February 2020. RESULTS The study included 19 000 individuals. There were 10 154 above the age of 50 included for analysis. Prevalence of frailty in the age group of 50-64 years was 4.7% and 8.7% in the age group of 65 years and above.The study demonstrates associations between frailty and high age, female gender, low education level, low income, smoking, living alone, frequency of seeing one's children and getting help when needed. These associations are comparable with findings from other studies. CONCLUSION The syndrome of frailty consists of not only physiological and medical issues but also education, life conditions such as living alone and living in poverty and how you evaluate your own health.
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Affiliation(s)
| | - Katja Kemp Jacobsen
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark
| | - Charlotte Nilsson
- Public Health, University of Copenhagen, København K, Denmark
- Institut for Folkesundhedsvidenskab, Københavns Universitet, Kobenhavns, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Nykøbing F Sygehus, Nykobing, Denmark
| | | | - Charlotte Suetta
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Kobenhavn, Denmark
- Geriatric Research Unit, Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Kobenhavn, Denmark
| | - Ellen Astrid Holm
- Internal Medicine, Zealand University Hospital Koge, Koge, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Kobenhavns, Denmark
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Wang L, Zhang X, Liu X. Association between the frailty index and readmission risk in hospitalised elderly Chinese patients: a retrospective cohort study. BMJ Open 2024; 14:e076861. [PMID: 38417955 PMCID: PMC10900421 DOI: 10.1136/bmjopen-2023-076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES Frailty is a common and important concern of the ageing population. This study examined the association between the frailty index and negative outcomes of hospitalised elderly Chinese patients. DESIGN Retrospective cohort study. SETTING Geriatrics Department of Peking University First Hospital. PARTICIPANTS 470 hospitalised elderly patients. MAIN OUTCOMES AND MEASURES Frailty was measured using a 30-item deficit-accumulation frailty index. The outcomes were the hospitalisation duration and readmission. RESULTS The frailty index was available for 470 patients: 72 (15.32%) were categorised as robust, 272 (57.87%) as prefrail and 126 (26.81%) as frail. The frail group had a longer hospital stay than the robust and prefrail groups. After adjustment for age, sex and cause of hospitalisation at baseline, frailty remained a strong independent risk factor for all-cause readmission and cardiocerebrovascular disease readmission (HR 2.41, 95% CI 1.49 to 3.91, p<0.001; HR 4.92, 95% CI 1.47 to 6.31, p<0.001, respectively). CONCLUSIONS The frailty index predicted a longer length of stay and higher all-cause and cardiocerebrovascular disease readmission risk in hospitalised elderly patients.
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Affiliation(s)
- Lina Wang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xiaolin Zhang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- Geriatric Department, Peking University First Hospital, Beijing, China
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Checa‐López M, Costa‐Grille A, Álvarez‐Bustos A, Carnicero‐Carreño JA, Sinclair A, Scuteri A, Landi F, Solano‐Jaurrieta JJ, Bellary S, Rodríguez‐Mañas L. Effectiveness of a randomized intervention by a geriatric team in frail hospital inpatients in non-geriatric settings: FRAILCLINIC project. J Cachexia Sarcopenia Muscle 2024; 15:361-369. [PMID: 38014479 PMCID: PMC10834340 DOI: 10.1002/jcsm.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/05/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Little research has been undertaken on the benefits of frailty management within different hospital settings. The objective of this study is to provide evidence on the viability and effectiveness of frailty management in non-geriatric hospital settings on mortality and functional decline after discharge. METHODS Data from the FRAILCLINIC (NCT02643069) study were used. FRAILCLINIC is a randomized controlled trial developed in non-geriatric hospital inpatient settings (emergency room, cardiology and surgery) from Spain (2), Italy (2) and the United Kingdom (1). Inpatients must met frailty criteria (according to the Frailty Phenotype and/or FRAIL scale), ≥75 years old. The control group (CG) received usual care. The intervention group (IG) received comprehensive geriatric assessment (CGA) and a coordinated intervention consisting in recommendations to the treating physician about polypharmacy, delirium, falls, nutrition and physical exercise plus a discharge plan. The main outcomes included functional decline (worsening ≥5 points in Barthel Index) and mortality at 3 months. We used multivariate logistic regression models adjusted by age, gender and the Charlson index. Intention-to-treat (ITT) and per-protocol (PP) analyses were used. RESULTS Eight hundred twenty one participants (IG: 416; mean age 83.00 ± 4.91; 51.44% women; CG: 405; mean age 82.46 ± 6.03; 52.35% women) were included. In the IG, 77.16% of the participants followed the geriatric team's recommendations as implemented by the treating physicians. The intervention showed a benefit on functional decline and mortality [OR: 0.67(0.47-0.96), P-value 0.027 and 0.29(0.14-0.57), P-value < 0.001, respectively) when fully followed by the treating physician. A trend to benefit (close to statistical significance) in functional decline and mortality were also observed when any of the recommendations were not followed [OR (95% CI): 0.72 (0.51-1.01), P-value: 0.055; and 0.64 (0.37-1.10), P-value: 0.105, respectively]. CONCLUSIONS An individualized intervention in frail in-patients reduces the risk of functional deterioration and mortality at 3 months of follow-up when a care management plan is designed and followed.
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Affiliation(s)
| | - Alba Costa‐Grille
- Servicio de GeriatríaHospital Universitario de GetafeGetafeSpain
- Fundación para la Investigación e Innovación Biosanitaria de Atención Primaria (FIIBAP)MadridSpain
| | - Alejandro Álvarez‐Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES)Instituto de Salud Carlos IIIMadridSpain
| | - Jose A. Carnicero‐Carreño
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES)Instituto de Salud Carlos IIIMadridSpain
- Fundación de Investigación BiomédicaHospital Universitario de GetafeGetafeSpain
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes FrailMedici Medical PracticeLutonUK
- School of Life and Health SciencesAston UniversityBirminghamUK
| | - Angelo Scuteri
- Department of Clinical and Experimental MedicineUniversity of SassariSassariItaly
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and OrthopedicsCatholic University of the Sacred Heart School of MedicineRomeItaly
| | - Juan José Solano‐Jaurrieta
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) and Geriatric Service, Monte Naranco HospitalOviedoSpain
| | | | - Leocadio Rodríguez‐Mañas
- Servicio de GeriatríaHospital Universitario de GetafeGetafeSpain
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES)Instituto de Salud Carlos IIIMadridSpain
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Molina‐Baena B, Carnicero JA, Pereira SL, García‐García FJ, Santos‐Fandila A, Cabrera RR, Rodríguez‐Mañas L. Association between endogenous plasma beta-hydroxy-beta-methylbutyrate levels and frailty in community-dwelling older people. J Cachexia Sarcopenia Muscle 2024; 15:231-239. [PMID: 38087937 PMCID: PMC10834356 DOI: 10.1002/jcsm.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/15/2023] [Accepted: 11/02/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Frailty is a key element in healthy ageing in which muscle performance plays a main role. Beta-hydroxy-beta-methylbutyrate (HMB) supplementation has shown favourable effects in modulating protein synthesis, improving muscle mass and function in interventional studies. Decreased age-related endogenous HMB levels have been shown in previous studies. The aim of the present study is to assess whether there is an association between endogenous plasma HMB levels and frailty. METHODS Data from 1290 subjects (56.98% women; mean ± standard deviation age 74.6 ± 5.95 years) from the Toledo Study for Healthy Aging were obtained. Participants had their frailty status qualified according to Fried's Frailty Phenotype (FFP) score and the Frailty Trait Scale in its 12-domain version (FTS-12). Plasma HMB levels were analysed by an ultrahigh-performance liquid chromatography tandem mass spectrometry. Differences between groups (frail vs. non-frail) were tested using Mann-Whitney U test, Kruskal-Wallis test and chi-squared test. The association between HMB and frailty was assessed by multivariate linear and logistic regressions when frailty was analysed as continuous and binary, respectively. Models were adjusted by age, gender, comorbidity, body composition and protein intake. RESULTS HMB levels were lower in those aged ≥75 years than in those aged 65-74 years, with an inverse linear relationship between age and HMB levels (β = -0.031; P = 0.018), mainly accounted by males (β = -0.062; P = 0.002). HMB levels were higher in men (0.238 ± 0.065 vs. 0.193 ± 0.051 ng/mL; P ≤ 0.001). HMB levels were significantly lower in frail than in non-frail individuals: 0.204 ± 0.058 versus 0.217 ± 0.063 ng/dL (P = 0.001) according to the FFP and 0.203 ± 0.059 versus 0.219 ± 0.063 ng/mL (P < 0.001) according to FTS-12. These differences showed a dose-dependent profile when we compared them by quintiles of HMB (P for trend: 0.022; 0.012 and 0.0004, respectively, for FFP, FTS-12 binary and FTS-12 continuous). Variables associated with low HMB levels were body mass index, strength, exhaustion and weight loss. Frailty was associated with HMB levels in all the adjusted models, including the fully adjusted ones, no matter the tool used (odds ratio: 0.45 [0.26, 0.77] for FFP and 0.36 [0.20, 0.63] for FTS-12 binary; β = -4.76 [-7.29, -2.23] for FTS-12 score). This association was also observed when the analyses were done by quintiles, showing such association since Q4 (FFP), Q2 (FTS-12 binary) and Q3 (FTS-12 score). The associations were observed in the whole sample and in each gender. CONCLUSIONS There is an inverse association between HMB levels and frailty status. These findings support the design of targeted clinical trials to evaluate the effect of HMB supplementation in older frail people with low HMB levels.
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Affiliation(s)
| | - Jose Antonio Carnicero
- Geriatric Research GroupBiomedical Research Foundation at Getafe University HospitalMadridSpain
- CIBER of Frailty and Healthy Aging (CIBERFES)Institute of Health Carlos IIIMadridSpain
| | - Suzette L. Pereira
- Scientific & Medical Affairs, Research & DevelopmentAbbott NutritionColumbusOHUSA
| | - Francisco José García‐García
- CIBER of Frailty and Healthy Aging (CIBERFES)Institute of Health Carlos IIIMadridSpain
- Department of GeriatricsHospital Virgen del ValleToledoSpain
| | | | | | - Leocadio Rodríguez‐Mañas
- Geriatric Research GroupBiomedical Research Foundation at Getafe University HospitalMadridSpain
- CIBER of Frailty and Healthy Aging (CIBERFES)Institute of Health Carlos IIIMadridSpain
- Department of GeriatricsGetafe University HospitalMadridSpain
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10
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Skubiszewska A, Broczek K, Maruniak-Chudek I, Oledzka G, Jonas MI, Puzianowska-Kuznicka M, Mossakowska M. Frailty and Survivability of Polish Caucasian Nonagenarians and Centenarians. Geriatrics (Basel) 2024; 9:14. [PMID: 38247989 PMCID: PMC10801576 DOI: 10.3390/geriatrics9010014] [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: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Frailty is a major geriatric problem leading to an increased risk of disability and death. Prevention, identification, and treatment of frailty are important challenges in gerontology and public health. The study aimed to estimate the prevalence of the frailty phenotype (FP) among the oldest-old Polish Caucasians and investigate the relationship between the FP and mortality. Baseline data were collected from 289 long-lived individuals, including 87 centenarians and 202 subjects aged 94-99. Mortality was obtained from population registers over the following 5 years. Sixty percent of subjects were classified as frail, 33% as prefrail, and 7% as robust. Frailty was more common in women than men and among centenarians than nonagenarians. During the 5-year observation period, 92.6% of the frail women and all frail men died, while mortality rates were lower among prefrail, 78.8% and 66.7%, and robust individuals, 60% and 54.5%, respectively. In the survival analysis, frailty was the strongest negative risk factor: HR = 0.328 (95% CI: 0.200-0.539). The inability to perform handgrip strength measurement was an additional predictor of short survival. In conclusion, the FP is prevalent in nonagenarians and centenarians and correlates with lower survivability. Future studies should address differences between unavoidable age-associated frailty and reversible disability in long-lived individuals.
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Affiliation(s)
- Agnieszka Skubiszewska
- Department of Medical Biology, Medical University of Warsaw, 00-575 Warsaw, Poland
- Study on Ageing and Longevity, International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland
| | - Katarzyna Broczek
- Mazovia Branch, Polish Society of Gerontology, 01-826 Warsaw, Poland
| | | | - Gabriela Oledzka
- Department of Medical Biology, Medical University of Warsaw, 00-575 Warsaw, Poland
| | - Marta Izabela Jonas
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Monika Puzianowska-Kuznicka
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
- Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, 01-826 Warsaw, Poland
| | - Malgorzata Mossakowska
- Study on Ageing and Longevity, International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland
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11
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Kasiukiewicz A, Wojszel ZB. The Prevalence of the Frailty Syndrome in a Hospital Setting-Is Its Diagnosis a Challenge? A Comparison of Four Frailty Scales in a Cross-Sectional Study. J Clin Med 2023; 13:86. [PMID: 38202093 PMCID: PMC10780177 DOI: 10.3390/jcm13010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The study aimed to assess the prevalence of the frailty syndrome in older patients hospitalized in the geriatric ward depending on the diagnostic criteria used, the feasibility of particular diagnostic scales in hospitalized patients, and their compatibility; 416 patients (81.2 ± 6.91 years) admitted to the Department of Geriatrics of Hospital of the Ministry of the Interior and Administration in Bialystok within eight months were included in the study. Four diagnostic scales were used to identify the frailty syndrome: Fried criteria, 7-point Clinical Frailty Scale (CFS), 40-item Frailty Index (FI), and FRAIL Scale. Depending on the scale, the prevalence of frailty syndrome varied from 26.8% (FRAIL Scale), 52.3% (Clinical Frailty Scale), and 58.1% (Fried criteria) up to 62.9% (Frailty Index). We observed the highest feasibility for CFS (100%) and the lowest for the Fried scale (79.8%). The highest level of agreement was found between the CFS and Frailty Index, with 80.3% consistent ratings (Cohen Kappa 0.6). Patients in the geriatric ward are characterized by a high prevalence of frailty, although it differs depending on the criteria. The most difficult to use in daily practice was the Fried scale, while the Clinical Frailty Scale was determined feasible in all patients.
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Affiliation(s)
- Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Department of Geriatrics, Marian Zyndram Koscialkowski Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Department of Geriatrics, Marian Zyndram Koscialkowski Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
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12
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Doherty H, Jennings AH, Kocka M, Neichel A, Scauso J, Lionetti E, Chenhuichen C, Romero-Ortuno R. A Narrative Review of the Utilisation of the SHARE Frailty Instruments (SHARE-FI and SHARE-FI75+) in the Literature. J Frailty Sarcopenia Falls 2023; 8:221-229. [PMID: 38046443 PMCID: PMC10690129 DOI: 10.22540/jfsf-08-221] [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] [Accepted: 08/01/2023] [Indexed: 12/05/2023] Open
Abstract
This narrative literature review aimed to examine the utilisation of the Survey of Health, Ageing and Retirement in Europe (SHARE) frailty instruments: SHARE-FI and SHARE-FI75+. We used the Google Scholar "cited by" function (accessed on February 20th, 2023) to identify all citations of the original SHARE-FI and SHARE-FI75+ studies. Included articles were categorised into four themes: epidemiological studies (prevalence and associated factors); associations with geriatric syndromes, diseases and health outcomes; randomised clinical trials (RCTs); and expert consensus and practice guidelines. Of 529 articles screened (446 citing SHARE-FI and 83 citing SHARE-FI75+), 64 (12.1%) were included. Sixteen (25.0%) were epidemiological; 35 (54.7%) described associations; 10 (15.6%) were RCTs; and 3 (4.7%) were expert consensus or practice guidelines. Frailty was associated with older age; female sex; higher morbidity; lower education; social isolation; worse nutrition and mobility; rheumatological, cardiovascular, and endocrine diseases; and greater healthcare utilisation and mortality. SHARE-FI was used in RCTs as entry criterion, controlling variable, and intervention outcome. SHARE-FI and SHARE-FI75+ have been recommended to aid the management of atrial fibrillation anticoagulation and hypertension, respectively. SHARE-FI and SHARE-FI75+, two open access phenotypical frailty measurement tools, have been utilised for a range of purposes, and mostly in epidemiological/associational studies.
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Affiliation(s)
- Helen Doherty
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Matej Kocka
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | | | - Elena Lionetti
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Chenhui Chenhuichen
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Geriatric Medicine Service, University Hospital of Navarra, Pamplona, Spain
| | - Roman Romero-Ortuno
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
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13
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Muñoz-Redondo E, Morgado-Pérez A, Pérez-Sáez MJ, Pascual J, Tejero-Sánchez M, Curbelo YG, Terradellas-Fernández M, Meza-Valderrama D, Vázquez-Ibar O, Annweiler C, Sánchez-Rodríguez D, Marco E. New perspectives on frailty in light of the Global Leadership Initiative on Malnutrition, the Global Leadership Initiative on Sarcopenia, and the WHO's concept of intrinsic capacity: A narrative review. Maturitas 2023; 177:107799. [PMID: 37499428 DOI: 10.1016/j.maturitas.2023.107799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
This review gathered the evidence on the epidemiology of frailty, as well as on screening and diagnostic tools, and new perspectives, in light of the latest global frameworks in malnutrition, sarcopenia, and the World Health Organization's concept of intrinsic capacity. Frailty is a worldwide health challenge and highly prevalent in older adults and the population with chronic diseases independent of age. Regardless of the particular concept of frailty, many screening and diagnostic tools are able to identify frailty in older people, but none of them has shown superiority in every population and healthcare setting. Physical, cognitive, and social components are part of the larger context of frailty. The latest evidence-based initiatives on frailty recommend the use of validated tools to identify frailty's different components, tailored to the needs of specific populations and healthcare systems. Unintentional weight loss is a shared criterion between physical frailty and malnutrition according to the Global Leadership Initiative on Malnutrition criteria. A new definition of sarcopenia by the Global Leadership Initiative on Sarcopenia is awaited, but at present physical frailty shares with sarcopenia the criteria of low muscle function and physical performance (severity grading) according to the revised consensus of the European Working Group on Sarcopenia in Older People (EWGSOP2). The EWGSOP2 includes both muscle mass and function, with most scientific groups agreeing that function is a key hallmark of sarcopenia. The concept of intrinsic capacity features the reserves and positive aspects of aging, and responds to ageism by addressing the deficit model approach. Intrinsic capacity is an emerging, person-centered and public health indicator, aimed at preserving health at mid-life and beyond, to move towards a better aging process in the Decade of Healthy Aging 2020-2030.
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Affiliation(s)
- Elena Muñoz-Redondo
- Physical Medicine and Rehabilitation Department, Hospital del Mar - Centre Esperança, Avinguda Sant Josep de la Muntanya 12, 08024 Barcelona, Spain; Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Andrea Morgado-Pérez
- Physical Medicine and Rehabilitation Department, Hospital del Mar - Centre Esperança, Avinguda Sant Josep de la Muntanya 12, 08024 Barcelona, Spain; Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - María José Pérez-Sáez
- Nephrology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003 Barcelona, Spain
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003 Barcelona, Spain; Nephrology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Marta Tejero-Sánchez
- Physical Medicine and Rehabilitation Department, Hospital del Mar - Centre Esperança, Avinguda Sant Josep de la Muntanya 12, 08024 Barcelona, Spain; Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Yulibeth G Curbelo
- Physical Medicine and Rehabilitation Department, Hospital del Mar - Centre Esperança, Avinguda Sant Josep de la Muntanya 12, 08024 Barcelona, Spain; Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Marc Terradellas-Fernández
- Tecnocampus, Universitat Pompeu Fabra, Research group in Attention to Chronicity and Innovation in Health (GRACIS), Carrer d'Ernest Lluch, 32, 08302 Mataró, Barcelona, Spain
| | - Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003 Barcelona, Spain; Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFRE), City 0819, Panama; Geriatrics Department, Hospital del Mar - Centre Fòrum, Carrer de Llull 410, 08019 Barcelona, Spain
| | - Olga Vázquez-Ibar
- Geriatrics Department, Hospital del Mar - Centre Fòrum, Carrer de Llull 410, 08019 Barcelona, Spain; Faculty of Medicine, Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003 Barcelona, Spain; Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium; WHO Collaborating Center for Public Health aspects of musculoskeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Campus Sart Tilman, Avenue Hippocrate (Bât 23), 4000 Liège, Belgium.
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Hospital del Mar - Centre Esperança, Avinguda Sant Josep de la Muntanya 12, 08024 Barcelona, Spain; Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003 Barcelona, Spain; Faculty of Medicine, Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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14
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Qin YN, Zheng XP. Association of frailty index with congestive heart failure, all-cause and cardiovascular mortality among individuals with type 2 diabetes: a study from National Health and Nutrition Examination Surveys (NHANES), 1999-2018. Diabetol Metab Syndr 2023; 15:210. [PMID: 37875981 PMCID: PMC10594933 DOI: 10.1186/s13098-023-01165-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/18/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Both type 2 diabetes mellitus (T2DM) and frailty are strongly associated with congestive heart failure (CHF). Individuals with T2DM and CHF have a high frailty burden. The association of frailty with HF, all-cause, and cardiovascular mortality in patients with T2DM has not been thoroughly explored. METHODS This study included 2894 adults with T2DM from the National Health and Nutrition Examination Survey (NHANES) database over ten cycles (1999-2018) and followed up for all-cause and cardiovascular mortality through 31 December 2019. The frailty index (FI) was calculated using a 46-item deficit model to assess frailty status. Weighted multivariable logistic regression was performed to explore the relationship between frailty and CHF in patients with T2DM. Weighted restricted cubic splines were used to evaluate the non-linear relationship between FI and outcome. All-cause mortality and cardiovascular mortality association with FI was assessed using the Kaplan-Meier curve and COX proportional hazards regression accounting for sampling weights. Subgroup and sensitivity analyses were performed to evaluate the robustness of the results. RESULTS After the adjustment of essential confounders, a higher frailty index in T2DM was associated with increased odds of CHF (odds ratio [OR] for per 1-SD increase, 2.02, 95% confidence interval [CI] 1.67-2.45; P < 0.0001). The presence of frailty T2DM (OR, 3.60; 95% CI 2.34-5.54; P < 0.0001) was associated with a significant increase in the prevalence of CHF compared to non-frailty T2DM in a fully adjusted model. During the median follow-up of 6.75 years, per 1-SD increase in FI was associated with a 41% higher risk of all-cause mortality and a 30% higher risk of cardiovascular mortality after being adjusted for all confounders. Similar results were observed when sensitivity analyses were performed. There was also a non-linear relationship between FI and all-cause mortality. In a weighted multivariate COX proportional model adjusted for full confounders, frailty T2DM increased all-cause (HR, 1.86; 95% CI 1.55-2.24; P < 0.0001) and cardiovascular (HR 1.66; 95% CI 1.18-2.33; P = 0.003) mortality and compared to non-frailty T2DM. The positive association of frailty index and all-cause mortality was only in participants without CHF. The positive association of frailty index and cardiovascular mortality was only in non-anti-diabetic drug users. CONCLUSIONS Frailty index in T2DM was positively associated with CHF in linear fashions. The Frailty index was positively correlated with all-cause and cardiovascular death in patients with T2DM. Frailty T2DM was positively associated with CHF, all-cause mortality, and cardiovascular mortality compared to non-frailty T2DM. Promoting frailty measurement and management in T2DM may be beneficial to reduce the burden of CHF and mortality.
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Affiliation(s)
- Yu-Nan Qin
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, People's Republic of China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Xiao-Pu Zheng
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Street, Xi'an, 710061, Shaanxi, People's Republic of China.
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China.
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15
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Chi CY, Wang J, Lee SY, Chao CT, Hung KY, Chien KL. The Impact of Glucose-Lowering Strategy on the Risk of Increasing Frailty Severity among 49,519 Patients with Diabetes Mellitus: A Longitudinal Cohort Study. Aging Dis 2023; 14:1917-1926. [PMID: 37196125 PMCID: PMC10529743 DOI: 10.14336/ad.2023.0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/25/2023] [Indexed: 05/19/2023] Open
Abstract
Patients with diabetes mellitus (DM) have a higher risk of incident and aggravating frailty over time. Frailty-initiating risk factors have been identified, but modulators of frail severity over time remain poorly defined. We aimed to explore the influences of glucose-lowering drug (GLD) strategy on DM patients' risk of increasing frail severity. We retrospectively identified type 2 DM patients between 2008 and 2016, dividing them into "no GLD", oral GLD (oGLD) monotherapy, oGLD combination, and those receiving insulin without or with oGLD at baseline. Increasing frail severity, defined as ≥1 FRAIL component increase, was the outcome of interest. Cox proportional hazard regression was utilized to analyze the risk of increasing frail severity associated with GLD strategy, accounting for demographic, physical data, comorbidities, medication, and laboratory panel. After screening 82,208 patients with DM, 49,519 (no GLD, 42.7%; monotherapy, 24.0%; combination, 28.5%; and insulin user, 4.8%) were enrolled for analysis. After 4 years, 12,295 (24.8%) had increasing frail severity. After multivariate adjustment, oGLD combination group exhibited a significantly lower risk of increasing frail severity (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.86 - 0.94), while the risk of insulin users increased (HR 1.11, 95% CI 1.02 - 1.21) than no GLD group. Users receiving more oGLD exhibited a trend of less risk reduction relative to others. In conclusion, we discovered that the strategy of oral glucose lowering drugs combination might reduce the risk of frail severity increase. Accordingly, medication reconciliation in frail diabetic older adults should take into account their GLD regimens.
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Affiliation(s)
- Chun-Yi Chi
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan.
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Szu-Ying Lee
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan.
| | - Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yu Hung
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Delaire L, Courtay A, Humblot J, Aubertin-Leheudre M, Mourey F, Racine AN, Gilbert T, Niasse-Sy Z, Bonnefoy M. Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review. Nutrients 2023; 15:4100. [PMID: 37836384 PMCID: PMC10574358 DOI: 10.3390/nu15194100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.
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Affiliation(s)
- Leo Delaire
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Aymeric Courtay
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Joannès Humblot
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Mylène Aubertin-Leheudre
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC H3W 1W5, Canada;
- Groupe de Recherche en Activité Physique Adaptée, Département des Sciences de l’Activité Physique, Université du Québec à Montréal (UQÀM), Montréal, QC H2L 2C4, Canada
| | - France Mourey
- Laboratoire CAPS (Cognition, Action, et Plasticité Sensorimotrice), Inserm U1093, UFR STAPS, Université de Bourgogne, Campus Universitaire, BP 27877, 21078 Dijon, France;
| | | | - Thomas Gilbert
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
- RESHAPE Research on Healthcare Professionals and Performance, Inserm U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Zeinabou Niasse-Sy
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Marc Bonnefoy
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
- Inserm U1060-CarMeN, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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17
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Wenger NK. The Intersectionality of Frailty and Anticoagulation for Atrial Fibrillation. JACC. ADVANCES 2023; 2:100571. [PMID: 38939489 PMCID: PMC11198177 DOI: 10.1016/j.jacadv.2023.100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Nanette K. Wenger
- Emory University School of Medicine, Emory Heart and Vascular Center, Emory Women’s Heart Center, Atlanta, Georgia, USA
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18
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Denas G, Zoppellaro G, Granziera S, Pagliani L, Noventa F, Iliceto S, Pengo V. Very Elderly Patients With Atrial Fibrillation Treated With Edoxaban: Impact of Frailty on Outcomes. JACC. ADVANCES 2023; 2:100569. [PMID: 38939480 PMCID: PMC11198574 DOI: 10.1016/j.jacadv.2023.100569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/05/2023] [Accepted: 06/24/2023] [Indexed: 06/29/2024]
Abstract
Background Age and frailty are associated with underuse of anticoagulation in elderly patients with atrial fibrillation (AF). Objectives This study aimed at assessing major clinical outcomes in very elderly patients with AF treated with recommended dose edoxaban and look for a possible relation with frailty measured by a validated score. Methods This prospective multicenter cohort study enrolled consecutive very elderly (age ≥80 years) anticoagulation-naïve patients starting recommended doses of edoxaban. Upon entry into the study, patients were categorized into nonfrail, prefrail and frail with the SHARE-FI (Survey of Health, Ageing, and Retirement in Europe-Frailty Index) score. The primary outcome was a composite incidence of stroke/systemic embolism, major bleeding, clinically relevant nonmajor bleeding, and death between frail and fitter patients over 2 years follow-up. Secondary outcomes were frailty-related incidence of the individual components part of the composite outcome. Results Of the 180 screened patients, 176 were enrolled in the study. Of these, 58 (32.9%) were frail, 35 (19.8%) prefrail, and 83 (47.2%) nonfrail. The composite outcome occurred in 49 patients (18.9% per patient-year). No difference in the primary endpoint between frail and fitter patients (incidence rate ratio: 1.2; 95% CI: 0.6-2.2) was observed. On multivariable analysis, anemia was significantly related to the primary outcome (HR: 3.6; 95% CI: 1.8-7.3; P < 0.001), while frailty was not (frail vs nonfrail HR: 0.9; 95% CI: 0.5-1.8). No difference across frailty categories of the individual components of composite events was observed, except for death. Conclusions Anticoagulation with recommended dose edoxaban is feasible in very elderly patients with AF even if frail. (ESCAPE [Edoxaban and Frailty in Senior Individuals]; NCT03524924).
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Affiliation(s)
- Gentian Denas
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Cardiology Clinic, University of Padua, Padua, Italy
- Cardiology Unit, High Specialization Rehabilitation Hospital, Treviso, Italy
| | | | - Serena Granziera
- Department of Physical and Rehabilitation Medicine, “Villa Salus” Hospital, Mestre, Italy
| | - Leopoldo Pagliani
- Cardiology Unit, High Specialization Rehabilitation Hospital, Treviso, Italy
| | | | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Cardiology Clinic, University of Padua, Padua, Italy
| | - Vittorio Pengo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Cardiology Clinic, University of Padua, Padua, Italy
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19
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Álvarez-Bustos A, Carnicero JA, Rodríguez-Sánchez B, El-Assar M, Rueda R, Pereira SL, Sepúlveda-Loyola W, Garcia-Garcia FJ, Sulo S, Rodríguez-Mañas L. Association Between Pulse Wave Velocity and Frailty, Disability, and Mortality in Community-Dwelling Older Adults. JACC. ADVANCES 2023; 2:100423. [PMID: 38939008 PMCID: PMC11198582 DOI: 10.1016/j.jacadv.2023.100423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 06/29/2024]
Abstract
Background Arterial stiffness leads to several adverse events in the older population, but there is a lack of data on its association with frailty, disability, and mortality in the same population. Objectives The purpose of this study was to evaluate the role of arterial stiffness in the loss of functional ability (frailty and disability) and mortality. Methods Data were taken from community-dwelling aged 65 years participants without diabetes in the Toledo Study of Healthy Ageing cohort. Pulse wave velocity (PWV), assessed through SphygmoCor, was recorded at baseline. Median follow-up time were 2.99 years for frailty (frailty phenotype [FP] and Frailty Trait Scale-5 [FTS5]) and disability (Katz Index) and 6.2 for mortality. Logistic regressions models were built for disability and frailty and Cox proportional hazards model for death, adjusted by age and sex, comorbidity, cardiovascular risk factors, asymmetric dimethylarginine levels, and polypharmacy. Results Overall, 978 (mean age 74.5 ± 5.6 years, 56.7% female) participants were included. Different cut-off points were shown for each outcome. PWV >11.5 m/s was cross-sectionally associated with frailty (FP: OR fully-adjusted model: 1.69, 95% CI: 1.45-1.97; FTS5: OR: 1.51, 95% CI: 1.22-1.87) and disability (OR: 1.51, 95% CI: 1.26-1.79); PWV >10 m/s with incident frailty by FP (OR: 1.36, 95% CI: 1.10-1.68) and FTS5 (OR: 1.40, 95% CI: 1.12-1.75), and PWV >11 m/s with death (HR: 1.28, 95% CI: 1.09-1.50). For incident (OR: 1.28, 95% CI: 1.06-1.55) and worsening disability (OR: 1.21, 95% CI: 1.02-1.45) the threshold was 12.5 m/s. Below these cut-off points, age was the best predictor of adverse outcomes. Conclusions Arterial stiffness predicts frailty, disability, and mortality in older people, with different cut-off points, ie,severity degrees, for each of the assessed outcomes.
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Affiliation(s)
- Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose A. Carnicero
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Fundación de Investigación Biomédica, Hospital Universitario de Getafe, Getafe, Spain
| | - Beatriz Rodríguez-Sánchez
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Economía Aplicada, Economía Pública y Economía Política, Facultad de Derecho, Universidad Complutense de Madrid, Madrid, Spain
| | - Mariam El-Assar
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Fundación de Investigación Biomédica, Hospital Universitario de Getafe, Getafe, Spain
| | | | | | | | - Francisco J. Garcia-Garcia
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Geriatría, Hospital Virgen del Valle, Toledo, Spain
| | - Suela Sulo
- Abbott Nutrition, Chicago, Illinois, USA
| | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain
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20
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Bart NK, Powell A, Macdonald PS. The role of frailty in advanced HF and cardiac transplantation. Front Cardiovasc Med 2023; 10:1082371. [PMID: 37077743 PMCID: PMC10106718 DOI: 10.3389/fcvm.2023.1082371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Frailty is a complex, multi-system condition often associated with multimorbidity. It has become an important prognostic maker across a range of conditions and is particularly relevant in patients with cardiovascular disease. Frailty encompasses a range of domains including, physical, psychological, and social. There are currently a range of validated tools available to measure frailty. It is an especially important measurement in advanced HF, because frailty occurs in up to 50% of HF patients and is potentially reversible with therapies such as mechanical circulatory support and transplantation. Moreover, frailty is dynamic, and therefore serial measurements are important. This review delves into the measurement of frailty, mechanisms, and its role in different cardiovascular cohorts. Understanding frailty will help determine patients that will benefit from therapies, as well as prognosticate outcomes.
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Affiliation(s)
- Nicole K. Bart
- Heart Transplant Program, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Infiltrative Cardiomyopathy Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- Correspondence: Nicole K. Bart
| | - Alice Powell
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Peter S. Macdonald
- Heart Transplant Program, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Infiltrative Cardiomyopathy Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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21
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Arizaga-Iribarren N, Irazusta A, Mugica-Errazquin I, Virgala-García J, Amonarraiz A, Kortajarena M. Sex Differences in Frailty Factors and Their Capacity to Identify Frailty in Older Adults Living in Long-Term Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:54. [PMID: 36612378 PMCID: PMC9819974 DOI: 10.3390/ijerph20010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a phenomenon that precedes adverse health events in older people. However, there is currently no consensus for how to best measure frailty. Several studies report that women have a higher prevalence of frailty than men, but there is a gap in studies of the high rates of frailty in older people living in long-term nursing homes (LTNHs) stratified by sex. Therefore, we analyzed health parameters related to frailty and measured their capacity to identify frailty stratified by sex in older people living in LTNHs. According to the Fried Frailty Phenotype (FFP), anxiety increased the risk of frailty in women, while for men functionality protected against the risk of frailty. Regarding the Tilburg Frailty Indicator (TFI), functionality had a protective effect in men, while for women worse dynamic balance indicated a higher risk of frailty. The analyzed parameters had a similar capacity for detecting frailty measured by the TFI in both sexes, while the parameters differed in frailty measured by the FFP. Our study suggests that assessment of frailty in older adults should incorporate a broad definition of frailty that includes not only physical parameters but also psycho-affective aspects as measured by instruments such as the TFI.
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Affiliation(s)
- Nagore Arizaga-Iribarren
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
- Osakidetza Basque Health Service, Hematology Service, Donostia University Hospital, 20014 Donostia/San Sebastián, Spain
| | - Amaia Irazusta
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country, 48940 Leioa, Spain
| | - Itxaso Mugica-Errazquin
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
| | - Janire Virgala-García
- Osakidetza Basque Health Service, OSI Tolosaldea, Tolosa Primary Care Center, 20400 Tolosa, Spain
| | | | - Maider Kortajarena
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country, 20014 Donostia/San Sebastián, Spain
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22
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Sarwar T, Jimeno Yepes AJ, Zhang X, Chan J, Hudson I, Evans S, Cavedon L. Development and validation of retrospective electronic frailty index using operational data of aged care homes. BMC Geriatr 2022; 22:922. [DOI: 10.1186/s12877-022-03616-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
Abstract
Background
Although elderly population is generally frail, it is important to closely monitor their health deterioration to improve the care and support in residential aged care homes (RACs). Currently, the best identification approach is through time-consuming regular geriatric assessments. This study aimed to develop and validate a retrospective electronic frailty index (reFI) to track the health status of people staying at RACs using the daily routine operational data records.
Methods
We have access to patient records from the Royal Freemasons Benevolent Institution RACs (Australia) over the age of 65, spanning 2010 to 2021. The reFI was developed using the cumulative deficit frailty model whose value was calculated as the ratio of number of present frailty deficits to the total possible frailty indicators (32). Frailty categories were defined using population quartiles. 1, 3 and 5-year mortality were used for validation. Survival analysis was performed using Kaplan-Meier estimate. Hazard ratios (HRs) were estimated using Cox regression analyses and the association was assessed using receiver operating characteristic (ROC) curves.
Results
Two thousand five hundred eighty-eight residents were assessed, with an average length of stay of 1.2 ± 2.2 years. The RAC cohort was generally frail with an average reFI of 0.21 ± 0.11. According to the Kaplan-Meier estimate, survival varied significantly across different frailty categories (p < 0.01). The estimated hazard ratios (HRs) were 1.12 (95% CI 1.09–1.15), 1.11 (95% CI 1.07–1.14), and 1.1 (95% CI 1.04–1.17) at 1, 3 and 5 years. The ROC analysis of the reFI for mortality outcome showed an area under the curve (AUC) of ≥0.60 for 1, 3 and 5-year mortality.
Conclusion
A novel reFI was developed using the routine data recorded at RACs. reFI can identify changes in the frailty index over time for elderly people, that could potentially help in creating personalised care plans for addressing their health deterioration.
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23
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Baztán Cortés JJ, Rodríguez-Mañas L. [Effectiveness and efficiency of acute geriatric units: A classic topic revisited]. Rev Esp Geriatr Gerontol 2022; 57:230-235. [PMID: 35840443 DOI: 10.1016/j.regg.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
Previous meta-analyses have shown that the hospital admission of older patients in acute geriatric units (AGU) compared to admission to other conventional units, significantly reduced the risk of functional deterioration during hospitalization, increasing the possibility of returning home, with an added reduction in cost of hospitalization. A new meta-analysis on the subject has recently been published in Age and Aging, which adds six new studies to the five clinical trials analyzed in previous meta-analyses. This article analyzes the results of this new meta-analysis, delving into the characteristics of the new studies included and making some considerations on the implications for care in the future development of AGU.
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Affiliation(s)
- Juan José Baztán Cortés
- Servicio de Geriatría, Hospital Central Cruz Roja San José y Santa Adela, SERMAS, Madrid, España.
| | - Leocadio Rodríguez-Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Madrid, España; CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), ISCIII, Madrid, España
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24
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Frailty as a Predictor of Poor Rehabilitation Outcomes among Older Patients Attending a Geriatric Day Hospital Program: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106276. [PMID: 35627813 PMCID: PMC9140338 DOI: 10.3390/ijerph19106276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023]
Abstract
Background: The Geriatric Day Hospital (GDH) is an important outpatient geriatric service, but there are few data on the role of frailty as a potential predictor of poor outcomes in this setting. Methods: Data were analyzed from 499 patients aged ≥ 60 years attending a 12-week GDH program between 2018 and 2021. Frailty status was defined as non-frail (68, 13.6%), mild/moderate frailty (351, 70.3%), and severe frailty (80, 16.0%) based on the Clinical Frailty Scale (CFS). Outcomes were defined as (1) poor outcome (hospital readmission, death, or medical deterioration) during the program and (2) admission to permanent nursing home care upon completion of the program. Multivariate logistic models were used for predictive analyses. Results: The mean age was 80.3 (standard deviation 7.0); 58.3% were women. Overall, 77 patients (15.4%) had a poor outcome, and 48 (9.6%) were admitted to permanent nursing home care. Poor outcome was experienced by none of the non-frail patients (0%), by 49 (14.0%) patients with mild/moderate frailty, and 22 (27.5%) patients with severe frailty (adjusted OR, 2.0; 95% CI 1.3, 3.2; p < 0.01). Admission to a permanent nursing home care was experienced by none of the non-frail patients (0%), 20 (5.7%) of those with mild/moderate frailty, and 28 (35.0%) with severe frailty (adjusted OR, 2.9; 95% CI 1.3, 6.3; p < 0.01). Conclusions: The CFS is a promising risk predictor of poor outcome and admission to permanent nursing home discharge among older patients attending a GDH program.
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