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Winters-Stone KM, Stoyles SA, Dieckmann NF, Eckstrom E, Luoh SW, Horak FB, Roeland EJ, Li F. Can strength training or tai ji quan training reduce frailty in postmenopausal women treated with chemotherapy? A secondary data analysis of the GET FIT trial. J Cancer Surviv 2024; 18:1179-1189. [PMID: 38642204 DOI: 10.1007/s11764-024-01592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/04/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To determine whether strength training or tai ji quan can reduce frailty in older, postmenopausal women treated with chemotherapy for cancer. METHODS We conducted a secondary data analysis from a 3-arm, single-blind, randomized controlled trial where older (50-75 years), postmenopausal women cancer survivors were randomized to supervised group exercise programs: tai ji quan, strength training, or stretching control for 6 months. We assessed frailty using a 4-criteria model consisting of weakness, fatigue, inactivity, and slowness. Using logistic regression, we determined whether the frailty phenotype (pre-frailty or frailty) decreased post-intervention, how many and which frailty criteria decreased, and what characteristics identified women most likely to reduce frailty. RESULTS Data from 386 women who completed baseline and 6-month testing were used (mean age of 62.0 ± 6.4 years). The odds of reducing overall frailty over 6 months were significantly higher in the strength training group compared to controls (OR [95%CI] 1.86 [1.09, 3.17]) but not for tai ji quan (1.44 [0.84, 2.50]). Both strength training (OR 1.99 [1.10, 3.65]) and tai ji quan (OR 2.10 [1.16, 3.84]) led to significantly higher odds of reducing ≥ 1 frailty criterion compared to controls. Strength training led to a three-fold reduction in inactivity (p < 0.01) and tai ji quan to a two-fold reduction in fatigue (p = 0.08) versus control. Higher baseline BMI, comorbidity score, and frailty status characterized women were more likely to reduce frailty than other women. CONCLUSIONS Strength training appears superior to tai ji quan and stretching with respect to reducing overall frailty phenotype among postmenopausal women treated with chemotherapy for cancer, but tai ji quan favorably reduced the number of frailty criteria. TRIAL REGISTRATION ClinicalTrials.gov identifier: GET FIT was registered as a clinical trial in clinicaltrials.gov: NCT01635413. IMPLICATIONS FOR CANCER SURVIVORS Supervised, group exercise training that emphasizes strength training and/or tai ji quan may help combat accelerated aging and reduce frailty after cancer treatment.
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Affiliation(s)
- Kerri M Winters-Stone
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, 97239, USA.
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA.
| | - Sydnee A Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Shiuh-Wen Luoh
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA
- Portland Veteran's Affairs Medical Center, Portland, OR, 97239, USA
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Eric J Roeland
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Fuzhong Li
- Oregon Research Institute, Springfield, OR, 97477, USA
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Safarnavadeh M, Salehi L. Psychometric adequacy of the persian adapted version of the tilburg frailty indicator (P-TFI). BMC Geriatr 2024; 24:623. [PMID: 39034390 PMCID: PMC11265109 DOI: 10.1186/s12877-024-05161-4] [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: 08/04/2023] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Frailty is identified as the primary goal of preventing the various consequences. The present study aimed to assess validity and reliability of the Persian adapted version of the Tilburg frailty indicator (TFI) in Iran. METHOD This cross-sectional study included three phases of translating the indicator to Persian, assessing the face and content validity, completing the P-TFI by older people, who helped assess the reliability and construct validity. For construct validity, convergent and divergent validity were used. It was expected that the TFI domain scores would show the highest correlations with their related measures of frailty (convergent construct validity) and the lowest correlations with measures of the other domains (divergent construct validity). The study population consisted of 400 older people, selected from six health care centers. RESULTS The mean age of the participants was 69.05 ± 7.28 years and the majority of the participants were married woman with less than a high school education. The total mean score of TFI was 8.26 ± 1.80, and 42.75% was classified as frail. The test-retest reliability was 0.88 for the total scale, 0.80 for physical, 0.65 for psychological, and 0.81 for social domains. The mean score of frailty and its dimensions (physical, psychological, and social) varied from 4.35 ± 1.78, 1.81 ± 1.33, 1.69 ± 0.73, and 0.86 ± 0.61, respectively. The total score of the TFI was correlated with each alternative measure and the convergent validity was proved. Further, the kappa values ranging from 535 to 0.967 were significant and test- retest reliability for total, physical, psychological, and social dimension were 0.88, 080, 065, and 081, respectively. Further, the convergent or divergent validity is being discussed for clarity. CONCLUSION The Persian version of the TFI is valid and easy scored tools among Iranian's older people.
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Affiliation(s)
- Maryam Safarnavadeh
- Vice Chancellery for Education, Iran Ministry of Health and Medical Education, Tehran, Iran
| | - Leili Salehi
- Department of Health Education & Promotion, School of Public Health,Research center for health,safety and environment,Karaj, Iran, Alborz University of Medical Sciences, P.O. Box 3146-883811, Karaj, Iran.
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Nagao-Sato S, Akamatsu R, Yamamoto S, Saito E. Spending Longer Time in the Kitchen Was Associated With Healthier Diet Among Japanese Older Women With Frailty. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024:S1499-4046(24)00383-X. [PMID: 39033459 DOI: 10.1016/j.jneb.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To evaluate the conditional effect of time spent in the kitchen on the association between frailty status and healthy diet among older women. DESIGN Secondary analysis of an online cross-sectional survey conducted in January 2023. PARTICIPANTS Six hundred Japanese women (aged ≥ 65 years). MAIN OUTCOME MEASURE(S) Frailty status evaluated using the Kihon Checklist (25 affirmative questions assessing daily functions, weight status, and mental condition); healthy diet assessed by the days of consuming ≥ 2 meals that include staple, main and side dishes in a meal (SMS meal) in a day; and time spent in the kitchen. ANALYSIS Moderation analysis was used to evaluate the conditional effect of time spent in the kitchen on frailty status and SMS meal intake. Chi-square tests for independence were used to evaluate the differences in the Kihon Checklist items by frailty status. RESULTS Spending longer time in the kitchen indicated more frequent SMS meal intake and the trend was stronger among older women with frailty than those with robustness. All items except for 1 item regarding weight status (P = 0.15) were significantly associated with frailty status (P < 0.001). CONCLUSIONS AND IMPLICATIONS Further studies are needed to evaluate the causal relationship between frailty status, healthy diet, and kitchen use.
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Affiliation(s)
- Sayaka Nagao-Sato
- Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan; Department of Nutrition, Takasaki University of Health and Welfare, Takasaki, Japan.
| | - Rie Akamatsu
- Natural Science Division, Faculty of Core Research, Ochanomizu University, Tokyo, Japan.
| | - Sakiko Yamamoto
- Faculty of Education, Niigata University, Niigata City, Japan
| | - Etsuko Saito
- Institute for Gendered Innovations, Ochanomizu University, Tokyo, Japan
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Warabino H, Kaneda T, Nagata Y, Yokoi K, Nakaoka K, Higashi Y, Yuri Y, Hashimoto H, Takabatake S. Examination of reliability and validity of the Self-Assessment Burden Scale-Motor for community-dwelling older adults in Japan: a validation study. PeerJ 2024; 12:e17730. [PMID: 39035163 PMCID: PMC11260414 DOI: 10.7717/peerj.17730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
Background The aging society in Japan is progressing rapidly compared with that in the United States and European countries. Aging limits activities of daily living (ADL) in older adults, declining their lives and functions at home. Therefore, improving their ADL to effectively support their functioning at home for as long as possible is vital. Consequently, supporters need to have a common understanding, be promptly aware of the decline in ADL, and quickly introduce rehabilitation. The Functional Independence Measure (FIM) and Barthel Index (BI) are the main scales used to quantitatively assess ADL. However, previous studies have reported that FIM requires specialized knowledge for evaluation, and BI does not appropriately capture changes in ADL. The Self-Assessment Burden Scale-Motor (SAB-M) was developed as a scale for family caregivers to appropriately assess changes in ADL in older adults. Previous studies using the SAB-M have confirmed its reliability and validity in hospitalized patients as assessed by their family caregivers. Therefore, this study aimed to investigate the reliability and validity of the SAB-M among community-dwelling older adults as assessed by their family caregivers. Methods This study included community-dwelling older adults who received home-visit rehabilitation at the first author's facility between October 2020 and December 2020 in Japan. Following previous studies, the SAB-M was used by family caregivers to assess 20 older adults twice for intra-rater reliability. Furthermore, 168 older adults were evaluated by family caregivers for internal consistency using the SAB-M. For criterion validity, the SAB-M was used for the assessment by family caregivers, and therapists used the FIM-Motor (FIM-M). This study used the weighted kappa, Cronbach's alpha, and Spearman's rank correlation coefficients for the statistical analysis of intra-rater reliability, internal consistency, and criterion validity, respectively. Results The weighted kappa coefficient for the total score was 0.98 (p < 0.01) and individual item, it was 0.93 for feeding (p < 0.01), 0.91 for bathing (p < 0.01), 0.98 for dressing (p < 0.01), 0.94 for transfer (p < 0.01), 0.94 for walking/wheelchair (p < 0.01), 0.95 for stairs (p < 0.01), and 0.96 for bladder management (p < 0.01). The Cronbach's alpha was 0.93 for the seven items. The Spearman's rank correlation coefficient between the SAB-M and FIM-M scores was 0.91 (p < 0.01). Conclusion The SAB-M has sufficient reliability and validity among community-dwelling older adults. Family caregivers can routinely assess changes in the ADL of community-dwelling older adults using the SAB-M, enabling them to promptly consider introducing rehabilitation when older adults' ADL declines. Therefore, implementing SAB-M helps older adults live and function at home for as long as possible.
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Affiliation(s)
- Hiroshi Warabino
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- Medicare-Rehabili Home-Visit Nursing Station, Osaka, Japan
| | - Toshikatsu Kaneda
- Faculty of Rehabilitation, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Yuma Nagata
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Osaka, Japan
| | - Katsushi Yokoi
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Osaka, Japan
| | - Kazuyo Nakaoka
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Osaka, Japan
| | - Yasuhiro Higashi
- Faculty of Rehabilitation, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Yoshimi Yuri
- Faculty of Rehabilitation, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Hiroko Hashimoto
- Faculty of Rehabilitation, Morinomiya University of Medical Sciences, Osaka, Japan
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Urano T, Kuroda T, Shiraki M. Nutritional and inflammation factors associated with current frailty level and effect of co-morbidities on the progression of frailty. Geriatr Gerontol Int 2024; 24:523-528. [PMID: 38618879 DOI: 10.1111/ggi.14873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/16/2024]
Abstract
AIM Frailty is defined as extreme vulnerability, a syndrome that exposes the individual to a higher risk of disability. While risk factors for frailty have been gradually uncovered, the full identification of biochemical factors and co-morbidities influencing frailty remains incomplete. METHODS Cross-sectional and longitudinal analyses were performed to elucidate the risk factors for the prevalence and progression of frailty. The study included 1035 Japanese female outpatients. At baseline, biochemical markers were measured. Co-morbidities included diabetes mellitus, dyslipidemia, hypertension, vertebral osteoarthritis, and osteoporosis. Frailty levels were assessed using frailty scores ranging from 0 to 5. Prevalence of frailty was judged by a score of 3 or above, and progression was judged by an increase in the frailty score during the observation period. Multiple regression analysis was used for the cross-sectional analysis, and the Cox hazard model was used for the longitudinal analysis. RESULTS Of the 1035 selected participants, 212 were diagnosed with frailty. Advanced age and log IL-6 and branched-chain amino acids (BCAA) levels were significant independent risk factors for frailty. Subjects were followed for 7.7 ± 5.9 years and progression was observed in 130 subjects. Older age, the absence of hyperlipidemia, the presence of osteoporosis, and lower frailty scores were identified as significant risk factors for frailty progression. CONCLUSIONS Inflammatory and nutritional markers exhibited significant associations with the current frailty status, whereas co-morbidities such as osteoporosis or hyperlipidemia emerged as independent risk or protective factors of future frailty progression. Geriatr Gerontol Int 2024; 24: 523-528.
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Affiliation(s)
- Tomohiko Urano
- Department of Geriatric Medicine, International University of Health and Welfare School of Medicine, Chiba, Japan
| | | | - Masataka Shiraki
- Research Institute and Practice for Involutional Diseases, Nagano, Japan
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Gobbens RJJ, van der Ploeg T. The Prediction of Quality of Life by Frailty and Disability among Dutch Community-Dwelling People Aged 75 Years or Older. Healthcare (Basel) 2024; 12:874. [PMID: 38727431 PMCID: PMC11083472 DOI: 10.3390/healthcare12090874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
The present study aimed to examine the prediction of quality of life by frailty and disability in a baseline sample of 479 Dutch community-dwelling people aged 75 years or older using a follow-up period of 8 years. Regarding frailty, we distinguish between physical, psychological, and social frailty. Concerning physical disability, we distinguish between limitations in performing activities in daily living (ADL) and instrumental activities in daily living (IADL). The Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS) were used to assess frailty domains and types of disability, respectively. Quality of life was determined by the WHOQOL-BREF containing physical, psychological, social, and environmental domains. In our study, 53.9% of participants were woman, and the mean age was 80.3 years (range 75-93). The study showed that psychological frailty predicted four domains of quality of life and physical frailty three. Social frailty was only found to be a significant predictor of social quality of life and environmental quality of life. ADL and IADL disability proved to be the worst predictors. It is recommended that primary healthcare professionals (e.g., general practitioners, district nurses) focus their interventions primarily on factors that can prevent or delay psychological and physical frailty, thereby ensuring that people's quality of life does not deteriorate.
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Affiliation(s)
- Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Tranzo, Tilburg University, 5037 DB Tilburg, The Netherlands
| | - Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
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Hiura GT, Markossian TW, Probst BD, Tootooni MS, Wozniak G, Rakotz M, Kramer HJ. Age and Comorbidities Are Associated With Therapeutic Inertia Among Older Adults With Uncontrolled Blood Pressure. Am J Hypertens 2024; 37:280-289. [PMID: 37991224 PMCID: PMC10941084 DOI: 10.1093/ajh/hpad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/26/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Lack of initiation or escalation of blood pressure (BP) lowering medication when BP is uncontrolled, termed therapeutic inertia (TI), increases with age and may be influenced by comorbidities. METHODS We examined the association of age and comorbidities with TI in 22,665 visits with a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg among 7,415 adults age ≥65 years receiving care in clinics that implemented a hypertension quality improvement program. Generalized linear mixed models were used to determine the association of comorbidity number with TI by age group (65-74 and ≥75 years) after covariate adjustment. RESULTS Baseline mean age was 75.0 years (SD 7.8); 41.4% were male. TI occurred in 79.0% and 83.7% of clinic visits in age groups 65-74 and ≥75 years, respectively. In age group 65-74 years, prevalence ratio of TI with 2, 3-4, and ≥5 comorbidities compared with zero comorbidities was 1.07 (95% confidence interval [CI]: 1.04, 1.12), 1.08 (95% CI: 1.05, 1.12), and 1.15 (95% CI: 1.10, 1.20), respectively. The number of comorbidities was not associated with TI prevalence in age group ≥75 years. After implementation of the improvement program, TI declined from 80.3% to 77.2% in age group 65-74 years and from 85.0% to 82.0% in age group ≥75 years (P < 0.001 for both groups). CONCLUSIONS TI was common among older adults but not associated with comorbidities after age ≥75 years. A hypertension improvement program had limited impact on TI in older patients.
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Affiliation(s)
- Grant T Hiura
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Talar W Markossian
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
| | - Beatrice D Probst
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
- Department of Emergency Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Mohammad Samie Tootooni
- Department of Health Informatics and Data Science, Loyola University Chicago, Maywood, Illinois, USA
| | - Gregory Wozniak
- Department of Medicine, American Medical Association, Chicago, Illinois, USA
| | - Michael Rakotz
- Department of Medicine, American Medical Association, Chicago, Illinois, USA
| | - Holly J Kramer
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
- Department of Medicine, Loyola University Chicago, Maywood, Illinois, USA
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Atala-Acevedo C, McGrath R, Capurro D, Glenister K, Bourke L, Morgan M, Simmons D, Mariño R. Identifying Frailty in Older Adults in Rural Victoria, Australia: A Secondary Analysis of Population Health Data. J Aging Health 2024; 36:170-181. [PMID: 37260112 DOI: 10.1177/08982643231180045] [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: 06/02/2023]
Abstract
Objectives: To determine the prevalence of frailty among community-dwelling older adults in regional Victoria, Australia. Methods: Frailty status of 376 participants from the Crossroads II cross-sectional study was assessed by selected markers of frailty. The selected variables were psychometrically tested. Associations between frailty and socio-demographic, environmental and health factors were analysed using chi-square, ANOVA and binary logistic regression (BLR). Results: Estimated prevalence of frailty was 39.4%. BLR indicated that frailty decreased with higher educational attainment, (OR = .23; 95% CI: .10-.51) increased for divorced/separated participants (OR = 2.68; 95% CI: 1.29-5.56) and when having three (OR = 3.27; 95% CI: 1.07-9.98), four (OR = 7.20; 95% CI: 2.22-23.31) or five or more chronic conditions (OR = 9.18; 95% CI: 2.83-29.72). Discussion: Frailty in this Australian regional community-dwelling sample was higher than other studies conducted in urban areas of Australia. Present results highlight the importance of exploring the multidimensionality of the frailty construct to have a better understanding which factors are associated with the development of this syndrome.
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Affiliation(s)
- Claudia Atala-Acevedo
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - Roisin McGrath
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - Daniel Capurro
- School of Computing and Information Systems, Centre for the Digital Transformation of Health, The University of Melbourne, Melbourne, VIC Australia
| | - Kristen Glenister
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
| | - Mike Morgan
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
| | - David Simmons
- Department of Rural Health, The University of Melbourne, Melbourne, VIC Australia
- Macarthur Clinical School, Western Sydney University, Sydney, Australia
| | - Rodrigo Mariño
- Melbourne Dental School, The University of Melbourne, Melbourne, VIC Australia
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Gobbens RJJ, Kuiper S, Dijkshoorn H, van Assen MALM. Associations of individual chronic diseases and multimorbidity with multidimensional frailty. Arch Gerontol Geriatr 2024; 117:105259. [PMID: 37952423 DOI: 10.1016/j.archger.2023.105259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty. METHODS Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases. RESULTS The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease. CONCLUSIONS Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, the Netherlands.
| | - Sandra Kuiper
- Tranzo, Tilburg University, Tilburg, the Netherlands; Department of Research, Public Health Service of West-Brabant, Breda, the Netherlands
| | - Henriëtte Dijkshoorn
- Department of Healthy Living, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Marcel A L M van Assen
- Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
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Winters-Stone KM, Stoyles S, Dieckmann N, Eckstrom E, Luoh SW, Horak F, Roeland EJ, Li F. Can strength training or tai ji quan training reduce frailty in postmenopausal women treated with chemotherapy? A secondary data analysis of the GET FIT trial. RESEARCH SQUARE 2023:rs.3.rs-3425168. [PMID: 37886571 PMCID: PMC10602129 DOI: 10.21203/rs.3.rs-3425168/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Purpose To determine whether strength training or tai ji quan can reduce frailty in older, postmenopausal women treated with chemotherapy for cancer. Methods We conducted a secondary data analysis from a 3-arm, single-blind, randomized controlled trial where older (50+ years), postmenopausal women cancer survivors were randomized to supervised group exercise programs: tai ji quan, strength training, or stretching control for 6 months. We assessed frailty using a 4-criteria model consisting of weakness, fatigue, inactivity, and slowness. Using logistic regression, we determined whether the frailty phenotype (pre-frailty or frailty) decreased post-intervention, how many and which frailty criteria decreased, and what characteristics identified women most likely to reduce frailty. Results Data from 386 women who completed baseline and 6-month testing were used (mean age of 62.0 ± 6.4 years). The odds of improving overall frailty phenotype over 6 months was significantly higher in the strength training group compared to controls (OR [95%CI]: 1.86 [1.09, 3.17]), but not for for tai ji quan (1.44 [0.84, 2.50]). Both strength training (OR 1.99 [1.10, 3.65]) and tai ji quan (OR 2.10 [1.16, 3.84]) led to significantly higher odds of reducing ≥1 frailty criterion compared to controls. Strength training led to a three-fold reduction in inactivity (p <0.01), and tai ji quan to a two-fold reduction in fatigue (p=0.08) versus control. Higher baseline BMI, comorbidity score, and frailty status characterized women more likely to reduce frailty than other women. Conclusions Strength training appears superior to tai ji quan and stretching with respect to reducing overall frailty phenotype among postmenopausal women treated with chemotherapy for cancer, but tai ji quan favorably impacted the number of frailty criteria. Implications for Cancer Survivors Supervised, group exercise training that emphasizes strength training and/or tai ji quan may help combat accelerated aging and reduce frailty after cancer treatment.
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Nguyen AL, Park BY, Thayer E, Bailey J, Christensen C, Taylor J. Comparing advance care planning between older adults with and without HIV. AIDS Care 2023; 35:1587-1589. [PMID: 36226381 PMCID: PMC10097829 DOI: 10.1080/09540121.2022.2126961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/16/2022] [Indexed: 10/17/2022]
Abstract
We compared completion of advance directives (AD), designation of a healthcare proxy, and stage in the advance care planning process (pre-contemplation/contemplation, preparation/action) between older adults with (N = 110) and without (N = 50) HIV. Participants' mean age was 61.3, most identified as male (82%) and sexual minorities (74%), were racially/ethnically diverse (44% white, 28% Latinx, 16% Black); 37% had an AD and 44% had a healthcare proxy. In adjusted logistic regressions, HIV- individuals had higher odds of being in preparation/action for having an AD (aOR: 2.6) and healthcare proxy (aOR: 3.6) compared to people living with HIV. Older age (aOR: 1.1) and having a sense of greater purpose in life (aOR: 2.1) were also positively associated with being in the preparation/action stage for having a healthcare proxy.
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Affiliation(s)
- Annie L. Nguyen
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Bo Young Park
- Department of Public Health, California State University, Fullerton, Fullerton, CA
| | - Erin Thayer
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Jeff Taylor
- HIV+ Aging Research Project- Palm Springs, Palm Springs, CA
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12
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Bai A, Zhao M, Zhang T, Yang C, Yan J, Wang G, Zhang P, Xu W, Hu Y. Development and validation of a nomogram-assisted tool to predict potentially reversible cognitive frailty in Chinese community-living older adults. Aging Clin Exp Res 2023; 35:2145-2155. [PMID: 37477792 DOI: 10.1007/s40520-023-02494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Cognitive frailty (CF) is a complex and heterogeneous clinical syndrome that indicates the onset of neurodegenerative processes and poor prognosis. In order to prevent the occurrence and development of CF in real world, we intended to develop and validate a simple and timely diagnostic instrument based on comprehensive geriatric assessment that will identify patients with potentially reversible CF (PRCF). METHODS 750 community-dwelling individuals aged over 60 years were randomly allocated to either a training or validation set at a 4:1 ratio. We used the operator regression model offering the least absolute data dimension shrinkage and feature selection among candidate predictors. PRCF was defined as the presence of physical pre-frailty, frailty, and mild cognitive impairment (MCI) occurring simultaneously. Multivariate logistic regression was conducted to build a diagnostic tool to present data as a nomogram. The performance of the tool was assessed with respect to its calibration, discrimination, and clinical usefulness. RESULTS PRCF was observed in 326 patients (43%). Predictors in the tool were educational background, coronary heart disease, handgrip strength, gait speed, instrumental activity of daily living (IADL) disability, subjective cognitive decline (SCD) and five-times-sit-to-stand test. The diagnostic nomogram-assisted tool exhibited good calibration and discrimination with a C-index of 0.805 and a higher C-index of 0.845 in internal validation. The calibration plots demonstrated strong agreement in both the training and validation sets, while decision curve analysis confirmed the nomogram's efficacy in clinical practice. CONCLUSIONS This tool can effectively identify older adults at high risk for PRCF, enabling physicians to make informed clinical decisions and implement proper patient-centered individual interventions.
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Affiliation(s)
- Anying Bai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ming Zhao
- The outpatient Department of the Fourth Comprehensive Service Guarantee Center of the Veteran Cadre Service Administration of the Beijing Garrison District, Beijing, China
| | - Tianyi Zhang
- Institution of Hospital Management, Department of Medical Innovation and Research, Chinese PLA General Hospital, Beijing, 100853, China
| | - Cunmei Yang
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jin Yan
- Graduate School of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Guan Wang
- Department of Cardiovascular Medicine, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Peicheng Zhang
- Haidian No.51 Outpatient Department, Beijing, 100142, China
| | - Weihao Xu
- Haikou Cadre's Sanitarium of Hainan Military Region, Haikou, 570203, China
| | - Yixin Hu
- Geriatric Health Care Department 4th of The Second Medical Center & National, Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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13
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Byard RW. The relationship between chronic disease and drugs/toxins-how important is negative disease-drug synergy? Forensic Sci Med Pathol 2023; 19:477-478. [PMID: 36971894 DOI: 10.1007/s12024-023-00608-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
The interaction of diseases with drugs and toxins may result in significantly worse outcomes in a forensic context when i) chronic diseases cause toxicity by increasing drug levels due to reduced renal clearance or slowed hepatic breakdown, and ii) drugs exacerbate underlying lethal mechanisms. In other words, 'negative disease-drug synergy' may result in increased drug toxicity and/or greater organ dysfunction despite the use of standard dosages. This is yet another confounding factor to be considered in the interpretation of postmortem toxicological results, as underlying illness and disease states may significantly alter drug availability and physiological responses.
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Affiliation(s)
- Roger W Byard
- School of Biomedicine, The University of Adelaide, Helen Mayo North, Frome Rd, Level 2, Room N237, Adelaide, SA, 5000, Australia.
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14
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Li L, Wang Y, Yang C, Huang C, Duan L, Zhou J, Lu Y, Zhao G. Frailty in hypertensive population and its association with all-cause mortality: data from the National Health and Nutrition Examination Survey. Front Cardiovasc Med 2023; 10:945468. [PMID: 37180794 PMCID: PMC10167047 DOI: 10.3389/fcvm.2023.945468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives This study aimed to investigate the relationship between frailty and all-cause mortality in hypertensive population. Methods We used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 and mortality data from the National Death Index. Frailty was assessed using the revised version of the Fried frailty criteria (weakness, exhaustion, low physical activity, shrinking, and slowness). This study aimed to evaluate the association between frailty and all-cause mortality. Cox proportional hazard models were used to evaluate the association between frailty category and all-cause mortality, adjusted for age, sex, race, education, poverty-income ratio, smoking, alcohol, diabetes, arthritis, congestive heart failure, coronary heart disease, stroke, overweight, cancer or malignancy, chronic obstructive pulmonary disease, chronic kidney disease, and taking medicine for hypertension. Results We gathered data of 2,117 participants with hypertension; 17.81%, 28.77%, and 53.42% were classified as frail, pre-frail, and robust, respectively. We found that frail [hazard ratio (HR) = 2.76, 95% confidence interval (CI) = 2.33-3.27] and pre-frail (HR = 1.38, 95% CI = 1.19-1.59] were significantly associated with all-cause mortality after controlling for variables. We found that frail (HR = 3.02, 95% CI = 2.50-3.65) and pre-frail (HR = 1.35, 95% CI = 1.15-1.58) were associated with all-cause mortality in the age group ≥65 years. For the frailty components, weakness (HR = 1.77, 95% CI = 1.55-2.03), exhaustion (HR = 2.25, 95% CI = 1.92-2.65), low physical activity (HR = 2.25, 95% CI = 1.95-2.61), shrinking (HR = 1.48, 95% CI = 1.13-1.92), and slowness (HR = 1.44, 95% CI = 1.22-1.69) were associated with all-cause mortality. Conclusion This study demonstrated that frailty and pre-frailty were associated with an increased risk of all-cause mortality in patients with hypertension. More attention should be paid to frailty in hypertensive patients, and interventions to reduce the burden of frailty may improve outcomes in these patients.
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Affiliation(s)
- Li Li
- Department of Cardiovascular Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuge Wang
- Department of Medicine, Jinggangshan University, Ji'an, China
| | - Chunlei Yang
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenhui Huang
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Lanzhi Duan
- Department of Medicine, Jinggangshan University, Ji'an, China
| | - Jianghua Zhou
- Department of Cardiology, The First Affliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanyu Lu
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guojun Zhao
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
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15
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Gobbens RJ, Santiago LM, Uchmanowicz I, van der Ploeg T. Predicting Disability Using a Nomogram of the Tilburg Frailty Indicator (TFI). Healthcare (Basel) 2023; 11:healthcare11081150. [PMID: 37107984 PMCID: PMC10137888 DOI: 10.3390/healthcare11081150] [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: 02/12/2023] [Revised: 03/02/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged ≥75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. 'Difficulty in walking' and 'unexplained weight loss' appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.
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Affiliation(s)
- Robbert J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Tranzo Academic Centre for Transformation in Care and Welfare, Faculty of Behavioural and Social Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Livia M Santiago
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-912, Brazil
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands
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16
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Wijesiri HSMSK, Wasalathanthri S, De Silva Weliange S, Wijeyaratne CN. Quality of life and its associated factors among home-dwelling older people residing in the District of Colombo, Sri Lanka: a community-based cross-sectional study. BMJ Open 2023; 13:e068773. [PMID: 37045566 PMCID: PMC10106068 DOI: 10.1136/bmjopen-2022-068773] [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] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION This community-based cross-sectional study explored the factors affecting overall and domain-specific (physical health, psychological health, social relationships and environmental) quality of life (QOL) of home-dwelling older residents of the District of Colombo, Sri Lanka. METHODS A representative sample (n=723) of older adults aged >65 years was obtained by the multistage cluster sampling technique. QOL was assessed using the validated Sinhala version of WHOQOL BREF Questionnaire. Data analysis was done using SPSS V.20. RESULTS The mean±SD age was 72.23±6.3 years with the overall QOL score being (mean±SD) 56.73±12.57/100. The mean±SD QOL score of physical health, psychological health, social relationships and environmental domains were 55.81±15.80, 59.25±14.68, 46.36±20.08 and 64.61±11.96, respectively. The overall QOL in the adjusted model showed a significant positive association with the educational status, living conditions (with spouse, with spouse and children), participation in religious activities, being visited by friends or relatives and financial independence. The overall QOL was negatively associated with limitations in activities of daily living and instrumental activities of daily living, chronic arthritis and heart disease in the adjusted model. Living with the spouse was positively associated with the psychological domain of QOL. Osteoporosis and chronic arthritis affected the physical health domain, while cancer and disabling stroke affected the psychological domain of QOL negatively. All statistical significances were considered at p<0.05. CONCLUSION The overall QOL of home-dwelling elders of the Colombo District is moderate, with the lowest score being in social relationships and the highest in the environmental domain. Educational status, engaging in religious activities and financial independence are key factors associated with a better QOL. Limitations in physical activity and chronic diseases are associated with a reduced QOL. Living with the spouse is a key factor associated with the psychological health domain.
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17
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Taylor JA, Greenhaff PL, Bartlett DB, Jackson TA, Duggal NA, Lord JM. Multisystem physiological perspective of human frailty and its modulation by physical activity. Physiol Rev 2023; 103:1137-1191. [PMID: 36239451 PMCID: PMC9886361 DOI: 10.1152/physrev.00037.2021] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
"Frailty" is a term used to refer to a state characterized by enhanced vulnerability to, and impaired recovery from, stressors compared with a nonfrail state, which is increasingly viewed as a loss of resilience. With increasing life expectancy and the associated rise in years spent with physical frailty, there is a need to understand the clinical and physiological features of frailty and the factors driving it. We describe the clinical definitions of age-related frailty and their limitations in allowing us to understand the pathogenesis of this prevalent condition. Given that age-related frailty manifests in the form of functional declines such as poor balance, falls, and immobility, as an alternative we view frailty from a physiological viewpoint and describe what is known of the organ-based components of frailty, including adiposity, the brain, and neuromuscular, skeletal muscle, immune, and cardiovascular systems, as individual systems and as components in multisystem dysregulation. By doing so we aim to highlight current understanding of the physiological phenotype of frailty and reveal key knowledge gaps and potential mechanistic drivers of the trajectory to frailty. We also review the studies in humans that have intervened with exercise to reduce frailty. We conclude that more longitudinal and interventional clinical studies are required in older adults. Such observational studies should interrogate the progression from a nonfrail to a frail state, assessing individual elements of frailty to produce a deep physiological phenotype of the syndrome. The findings will identify mechanistic drivers of frailty and allow targeted interventions to diminish frailty progression.
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Affiliation(s)
- Joseph A Taylor
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Paul L Greenhaff
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - David B Bartlett
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina.,Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Thomas A Jackson
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Niharika A Duggal
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, https://ror.org/03angcq70University of Birmingham, Birmingham, United Kingdom.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom
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18
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Zhao LH, Chen J, Zhu RX. The relationship between frailty and community-acquired pneumonia in older patients. Aging Clin Exp Res 2023; 35:349-355. [PMID: 36447006 DOI: 10.1007/s40520-022-02301-x] [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: 04/29/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
PURPOSES To explore the relationship between frailty and community-acquired pneumonia (CAP) in older patients. METHODS A prospective observational study included 109 older patients(≥ 65 years) hospitalized with CAP in respiratory department of Fuxing hospital, Capital Medical University from June 2018 to December 2020. Frailty scores(Frail Scale, range 0-5) and pneumonia severity CURB-65 scale(mild = 1, modest = 2, and severe ≥ 3) were measured. We extracted clinical variables including white blood cell(WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein(CRP), hemoglobin, and albumin. Charlson Comorbidity Index(CCI) was calculated as well. The correlations between the variables and frailty scores were investigated, respectively. After adjusting for covariates, binomial logistic regression analysis was used to assess independent effect of frailty scores on the outcome(discharge or death/progression) in older CAP patients. RESULTS The subjects had a median age 87(interquartile range,8.5) years, 60.6% male, 45.9% pre-frail, and 32.1% frail. There were positive correlations between frailty scores and CURB-65 scale (p = 0.000, r = 0.542), CCI(p = 0.000, r = 0.359) and NLR(p = 0.005, r = 0.268). Negative correlations were observed between frailty scores and hemoglobin (p = 0.002, r = - 0.298), albumin (p = 0.000, r = - 0.465). In multivariable logistic regression analysis, the factors associated with discharge or death/progression of CAP were frailty scores (OR = 1.623, p = 0.037), NLR (OR = 1.086, p = 0.008) and albumin (OR = 0.869, p = 0.034). CONCLUSIONS Frailty is correlated with CURB-65 scale, CCI and hemoglobin, and albumin in older patients with CAP. Frailty is also a correlate of increased risk for death or progression in these older people.
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Affiliation(s)
- Li-Hua Zhao
- Respiratory Department, Fuxing Hospital, Capital Medical University, Fuxingmen Outer Street 20, Xicheng District, Beijing, 100038, China.
| | - Jin Chen
- Respiratory Department, Fuxing Hospital, Capital Medical University, Fuxingmen Outer Street 20, Xicheng District, Beijing, 100038, China
| | - Rui-Xia Zhu
- Respiratory Department, Fuxing Hospital, Capital Medical University, Fuxingmen Outer Street 20, Xicheng District, Beijing, 100038, China
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19
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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20
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Kim S, Won CW. Optimistic orientation and frailty in community-dwelling older adults: Results from KFACS study. Exp Gerontol 2022; 170:111963. [PMID: 36191834 DOI: 10.1016/j.exger.2022.111963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Optimistic orientation is linked to several benefits, including better-coping skills, lower stress levels, and better physical health. This study aimed to identify whether optimistic orientation is associated with physical frailty and whether it is related to each component of physical frailty. METHODS We conducted a cross-sectional analysis of 2019 survey data from the Korean Frailty and Aging Cohort Study, which included 1203 participants aged 70-84 years. Frailty was defined using the Fried frailty phenotype and optimistic orientation was assessed using the Life Orientation Test-Revised. RESULTS Optimistic orientation and frailty were negatively correlated (r = -0.214, p < 0.001). After adjusting for several variables, the relationship between optimistic orientation and physical frailty was only significant in women (odds ratio [OR] = 2.960, 95 % confidence interval [CI]:2 1.375-6.371). Regarding the relationship with the five components of the physical frailty phenotype, the least optimistic women were more exhausted (OR = 1.829, 95 % CI: 1.224-2.732) and weaker (OR = 1.955, 95 % CI: 1.197-3.192) after adjusting for age, body mass index, alcohol consumption, smoking, education, marital status, social activity, living alone, family income, cognitive state, nutritional status, comorbidity, and depression. DISCUSSION Optimistic orientation was negatively associated with physical frailty only in women. Among the components of physical frailty, exhaustion and weakness are associated with optimistic orientation in women.
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Affiliation(s)
- Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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21
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Bevilacqua G, Laskou F, Patel HP, Westbury LD, Fuggle NR, Cooper C, Dennison EM. What impact does osteoarthritis have on ability to self-care and receipt of care in older adults? Findings from the Hertfordshire Cohort Study. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100310. [PMID: 36474798 PMCID: PMC9718070 DOI: 10.1016/j.ocarto.2022.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022] Open
Abstract
Objectives Living independently remains the aim of older adults, but musculoskeletal conditions and frailty may hamper this. We examined relationships between osteoarthritis with ability to self-care and access to formal/informal care among community-dwelling older adults, comparing results to relationships between other musculoskeletal conditions of ageing (frailty, sarcopenia, osteoporosis) and these outcomes. Design Data from the Hertfordshire Cohort Study were used. Osteoarthritis (hand, hip or knee) was defined by clinical examination. Osteoporosis was assessed using dual-energy X-ray absorptiometry and medication use. Sarcopenia was assessed using EWSGOP2 criteria, frailty using Fried criteria. Ability to self-care and access to formal/informal care were self-reported. Results 443 men and women aged approximately 75 years participated. Osteoarthritis was reported by 26.8% participants; 11.8% had low grip strength; 21.4% had osteoporosis; 8.6% had sarcopenia; 7.6% were identified as frail. Most participants (90.7%) reported no problems with self-care, but more than one-fifth (21.4%) reported having received formal or informal care at home in the previous year. Odds of reporting difficulties with self-care were significantly greater (p < 0.05) for participants with osteoarthritis and for those with frailty, but not for those with osteoporosis or sarcopenia. Odds of receiving care at home in the past year were significantly greater among participants with osteoarthritis and among those with frailty, but not among those with osteoporosis or sarcopenia. Conclusions Frailty and osteoarthritis were associated with both difficulties with self-care and receipt of care; osteoporosis and sarcopenia were not. These results highlight the contribution of clinical osteoarthritis to ability to live independently in later life, and the need to actively manage the condition in older adults.
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Affiliation(s)
- Gregorio Bevilacqua
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Faidra Laskou
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Harnish P. Patel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Academic Geriatric Medicine, University of Southampton, Southampton, UK
- Medicine for Older People, University Hospital Southampton, Southampton, UK
| | - Leo D. Westbury
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Nicholas R. Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- The Alan Turing Institute, London, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
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22
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Physical fitness and its correlation with handgrip strength in active community-dwelling older adults. Sci Rep 2022; 12:17227. [PMID: 36241763 PMCID: PMC9568649 DOI: 10.1038/s41598-022-21736-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 09/30/2022] [Indexed: 01/06/2023] Open
Abstract
In this cross-sectional study, we assessed the physical fitness levels of active community-dwelling older adults. Moreover, we investigated the correlation of their (stratified by age and sex) fitness levels with handgrip strength (HGS). Comprehensive physical fitness tests, including sarcopenia screening, were conducted with a total of 2,130 older adults residing in a rural area of Taiwan. The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of age- and sex-specific physical fitness levels were determined. Furthermore, we identified the key parameters for assessing the physical fitness of older adults and performed stepwise multiple linear regression analysis. Both men and women exhibited age-related decreases in all aspects of functional fitness, a trend indicating that older adults in Taiwan may lose their independence in the future. Furthermore, the regression analysis revealed that HGS was positively correlated with sex, body mass index, and the results of 30-s arm curl and back scratch tests but negatively correlated with age and the result of 8-foot up-and-go test. Our reference values for physical fitness may help assess the fitness levels of active community-dwelling older adults and design community-based health programs to prevent the early loss of independence in community-dwelling older adults in Taiwan.
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Venturini C, Moreira BDS, Silva SLAD, Sampaio RF. Physical frailty, activity limitation and mortality in older Brazilians: longitudinal findings from FIBRA-BH study (2009-2019). CIENCIA & SAUDE COLETIVA 2022; 27:4015-4023. [PMID: 36134807 DOI: 10.1590/1413-812320222710.08492022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022] Open
Abstract
The aim was to investigate the longitudinal association between physical frailty and change in the profile of limitation to perform basic and instrumental activities of daily living (BADL and IADL) and mortality in a 10-year period in Brazilian community-dwelling older people. A longitudinal study was conducted with data from the Frailty in Brazilian Older People (FIBRA) study, 2009-2019. Physical frailty was categorized into vulnerability (pre-frail and frail) and robustness (non-frail). The generalized estimating equation and the Cox proportional hazards models were used in the data analysis. Out of 200 older people evaluated in 2009 (moment 1), 139 were located in 2019 (moment 2). Of these, 102 were interviewed and 37 deaths were recorded. The chance of vulnerable older people at moment 1 being dependent on performing BADL at moment 2 was 4.19-fold the chance of robust older people. For IADL, the chance of vulnerable older people at moment 1 being dependent at moment 2 was 3.12-fold the chance of robust older people. Cox's analysis showed that the risk of death among vulnerable older people was 2.50-fold that among robust older people. The results reinforce the importance of monitoring and early intervention to prevent frailty, and the limitation to performing activities of daily living and death among Brazilian older people.
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Affiliation(s)
- Claudia Venturini
- Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais. Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
| | - Bruno de Souza Moreira
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou (Fiocruz Minas). Belo Horizonte MG Brasil
| | | | - Rosana Ferreira Sampaio
- Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Universidade Federal de Minas Gerais. Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG Brasil.
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Li S, Fan W, Zhu B, Ma C, Tan X, Gu Y. Frailty Risk Prediction Model among Older Adults: A Chinese Nation-Wide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148410. [PMID: 35886260 PMCID: PMC9322778 DOI: 10.3390/ijerph19148410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Numerous studies have been performed on frailty, but rarely do studies explore the integrated impact of socio-demographic, behavioural and social support factors on frailty. This study aims to establish a comprehensive frailty risk prediction model including multiple risk factors. METHODS The 2018 wave of the Chinese Longevity and Health Longitudinal Survey was used. Univariate and multivariate logistic regressions were performed to identify the relationship between frailty and multiple risk factors and establish the frailty risk prediction model. A nomogram was utilized to illustrate the prediction model. The area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test and calibration curve were used to appraise the prediction model. RESULTS Variables from socio-demographic, social support and behavioural dimensions were included in the final frailty risk prediction model. Risk factors include older age, working as professionals and technicians before 60 years old, poor economic condition and poor oral hygiene. Protective factors include eating rice as a staple food, regular exercise, having a spouse as the first person to share thoughts with, doing physical examination once a year and not needing a caregiver when ill. The AUC (0.881), Hosmer-Lemeshow test (p = 0.618), and calibration curve showed that the risk prediction model was valid. CONCLUSION Risk factors from socio-demographic, behavioural and social support dimensions had a comprehensive effect on frailty, further supporting that a comprehensive and individualized intervention is necessary to prevent frailty.
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Affiliation(s)
- Siying Li
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
| | - Wenye Fan
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
| | - Boya Zhu
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
| | - Chao Ma
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
| | - Xiaodong Tan
- School of Public Health, Wuhan University, Wuhan 430071, China; (S.L.); (W.F.); (B.Z.); (C.M.)
- Correspondence: (X.T.); (Y.G.)
| | - Yaohua Gu
- School of Nursing, Wuhan University, Wuhan 430071, China
- Correspondence: (X.T.); (Y.G.)
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Jędrzejczyk M, Foryś W, Czapla M, Uchmanowicz I. Relationship between Multimorbidity and Disability in Elderly Patients with Coexisting Frailty Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063461. [PMID: 35329148 PMCID: PMC8950513 DOI: 10.3390/ijerph19063461] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 12/11/2022]
Abstract
Background: Multimorbidity is a common problem worldwide. It carries the risk of reduced quality of life, disability, frequent hospitalizations, and death. The present study was designed to assess the relationships that exist between multimorbidity and disability in elderly patients. Methods: The study included 100 patients and was conducted between October 2020 and January 2021. Inclusion criteria included age >65 years, presence of a minimum of two comorbidities in the subject, and consent to participate in the study. Standardized survey instruments such as Tilburg Frailty Indicator (TFI), Charlson Comorbidities Index (CCI), Assessment of Basic Activities of Daily Living—Katz Scale (ADL), and Assessment of Complex Activities of Daily Living—Lawton Scale (IADL) were used in the study. Results: The majority of the subjects (92) had a frailty syndrome (TFI). A small group of respondents (8%) suffered from severe comorbidities (CCI). Among the subjects surveyed, 71% maintained full function in performing simple activities of daily living (ADL), while 29% demonstrated moderate disability on the scale. Full independence in performing complex activities of daily living (IADL) was present in 33% of the respondents, and 67% were partially independent. Independence in complex activities of daily living (IADL) was significantly higher in patients with fewer comorbidities. The severity of comorbidities (CCI) had a significant effect on the decrease in the level of independence (ADL and IADL). Independence in performing complex activities (IADL) was worse among older patients. Conclusions: An increase in the number of comorbidities contributes to a decrease in the level of performance of complex activities of daily living. The severity of comorbidities significantly reduces the level of independence of the subjects in simple and complex activities of daily living. In patients with a higher level of independence in performing simple and complex activities, the co-occurrence of frailty syndrome was less severe. As the age of the subjects increases, the frequency in which they show moderate dependence on third parties in performing complex activities of daily living increases.
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Affiliation(s)
- Maria Jędrzejczyk
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland; (M.J.); (I.U.)
| | - Weronika Foryś
- Harvard Division of Continuing Education, Harvard University, Cambridge, MA 02138-3722, USA;
| | - Michał Czapla
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
- Faculty of Nursing, Group in Research in Care (GRUPAC), University of La Rioja, 26006 Logroño, Spain
- Correspondence:
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland; (M.J.); (I.U.)
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
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Abstract
As the most phenotypically diverse mammalian species that shares human environments and access to sophisticated healthcare, domestic dogs have unique potential to inform our understanding of the determinants of aging. Here we outline key concepts in the study of aging and illustrate the value of research with dogs, which can improve dog health and support translational discoveries. We consider similarities and differences in aging and age-related diseases in dogs and humans and summarize key advances in our understanding of genetic and environmental risk factors for morbidity and mortality in dogs. We address health outcomes ranging from cancer to cognitive function and highlight emerging research opportunities from large-scale cohort studies in companion dogs. We conclude that studying aging in dogs could overcome many limitations of laboratory models, most notably, the ability to assess how aging-associated pathways influence aging in real-world environments similar to those experienced by humans.
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Affiliation(s)
- Audrey Ruple
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA;
| | - Evan MacLean
- School of Anthropology and College of Veterinary Medicine, University of Arizona, Tucson, Arizona, USA;
| | - Noah Snyder-Mackler
- School of Life Sciences, Center for Evolution and Medicine, and School for Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA;
| | - Kate E. Creevy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Daniel Promislow
- Department of Laboratory Medicine & Pathology and Department of Biology, University of Washington School of Medicine, Seattle, Washington, USA;
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The Contribution of Frailty to Participation of Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031616. [PMID: 35162637 PMCID: PMC8835014 DOI: 10.3390/ijerph19031616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023]
Abstract
Background: Participation, which is involvement in life situations, is an important indicator of human health and well-being of older adults. Frailty is known to be related to difficulties in activities of daily living (ADL) but the association with participation restriction has not been sufficiently researched. Therefore, we aimed to (1) to assess the correlations between frailty, ADL, and participation; and (2) to identify the contribution of frailty to explaining the participation restriction of older adults. Methods: A cross-sectional study included home visits to community-dwelling older adults aged 75 and older. The Reintegration to Normal Living Index (RNL-I) assessed participation, PRISMA-7 assessed frailty, and the Functional Independence Measure and IADL questionnaire assessed the basic and instrumental ADL. Cognition, which may explain participation, was also assessed (The Montreal Cognitive Assessment) and demographic information was collected. Results: Older adults (N = 121, 60 women), aged 75 to 91 years (mean (SD)—79.6 (3.1)), were included. Older adults demonstrated full to restricted participation (RNL-I-mean (SD)—78.2 (18.0)/100). Frailty was identified in 39 (32%) older adults (mean (SD) PRISMA-7—2.9 (1.4)/7points). A negative moderate significant correlation was found between participation and frailty (r = −0.634, p < 0.001). The variance of participation was significantly explained by frailty, 31.5%, and basic ADL, 5.6% (after controlling for age and cognition); the total model explained 44.6% (F = 23.29, p < 0.001). Conclusions: Frailty is significantly associated with participation restriction. Since participation has many health benefits, understanding which factors are associated to participation is central to developing interventions for older adults. These findings may help health professionals in the future develop interventions for maintaining and promoting the participation of older adults.
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Venturini C, Moreira BDS, Ferriolli E, Liberalesso Neri A, Lourenço RA, Sampaio RF. Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty? J Appl Gerontol 2022; 41:1445-1453. [PMID: 35025622 DOI: 10.1177/07334648211064267] [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] [Indexed: 11/16/2022] Open
Abstract
The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = -.074 (95% CI=-.101; -.046) and β = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.
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Affiliation(s)
- Claudia Venturini
- Graduate Program in Rehabilitation Science, Department of Physical Therapy, 28114Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Bruno de Souza Moreira
- Graduate Program in Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | | | | | - Rosana Ferreira Sampaio
- Graduate Program in Rehabilitation Science, Department of Physical Therapy, 28114Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Kosoku A, Iwai T, Kabei K, Nishide S, Maeda K, Kumada N, Uchida J. Hyperpolypharmacy and Frailty in Kidney Transplant Recipients. Transplant Proc 2022; 54:367-373. [PMID: 35033367 DOI: 10.1016/j.transproceed.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Kidney transplant recipients (KTRs) take multiple medications including immunosuppressants every day. Although polypharmacy is associated with frailty, the situation remains unknown in KTRs. The aim of the present study is to investigate the association between hyperpolypharmacy and frailty in KTRs. METHODS This study was a single-center, cross-sectional investigation carried out on KTRs between August 2018 and February 2019 at Osaka City University Hospital. Frailty was evaluated using the Kihon Checklist (KCL). The number of medications was determined from the regular medicines the participants took by mouth every day. Hyperpolypharmacy was defined as 10 or more medications. Statistical analyses were performed using multivariable logistic regression analyses and multivariable linear regression analyses. RESULTS Of 211 KTRs enrolled in this study, the mean (SD) number of medicines taken orally regularly was 9.4 (3.4), and hyperpolypharmacy participants accounted for 41%. Hyperpolypharmacy was associated with both the total KCL score (odds ratio, 1.13; P = .016) and being frail compared with being robust (odds ratio, 5.70; P = .007) after adjustments for age, sex, and body mass index. The number of medications was associated with both the total KCL score (β = 0.20; P < .001) and being frail compared with being robust (β = 2.51; P < .001) after adjustments for age, sex, body mass index, dialysis vintage, time after transplant, serum albumin, and estimated glomerular filtration rate. The optimal cutoff value for the number of medications to detect frailty was 12 (area under the curve, 0.81). CONCLUSIONS In KTRs, hyperpolypharmacy was prevalent and was associated with frailty.
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Affiliation(s)
- Akihiro Kosoku
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Tomoaki Iwai
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Kabei
- Department of Urology, Minamiosaka Hospital, Osaka, Japan
| | - Shunji Nishide
- Department of Urology, Osaka City General Hospital, Osaka, Japan
| | - Keiko Maeda
- Department of Nursing, Osaka City University Hospital, Osaka, Japan
| | - Norihiko Kumada
- Department of Urology, Suita Municipal Hospital, Suita, Japan
| | - Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Bevilacqua G, Jameson KA, Zhang J, Bloom I, Fuggle NR, Patel HP, Ward KA, Cooper C, Dennison EM. Relationships between non-communicable disease, social isolation and frailty in community dwelling adults in later life: findings from the Hertfordshire Cohort Study. Aging Clin Exp Res 2022; 34:105-112. [PMID: 34845651 PMCID: PMC8628832 DOI: 10.1007/s40520-021-02026-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Social relationships play a fundamental role in individuals' lives and health, and social isolation is prevalent among older people. Chronic non-communicable diseases (NCDs) and frailty are also common in older adults. AIMS To examine the association between number of NCDs and social isolation in a cohort of community-dwelling older adults in the UK, and to consider whether any potential association is mediated by frailty. METHODS NCDs were self-reported by 176 older community-dwelling UK adults via questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale. Frailty was assessed by the Fried phenotype of physical frailty. RESULTS The median (IQR) age of participants in this study was 83.1 (81.5-85.5) years for men and 83.8 (81.5-85.9) years for women. The proportion of socially isolated individuals was 19% in men and 20% in women. More women (18%) than men (13%) were identified as frail. The number of NCDs was associated with higher odds of being isolated in women (unadjusted odds ratio per additional NCD: 1.65, 95% CI 1.08, 2.52, p = 0.021), but not in men, and the association remained robust to adjustment, even when accounting for frailty (OR 1.85, 95% CI 1.06, 3.22, p = 0.031). DISCUSSION Number of self-reported NCDs was associated with higher odds of social isolation in women but not in men, and the association remained after considering frailty status. CONCLUSIONS Our observations may be considered by healthcare professionals caring for community-dwelling older adults with multiple NCDs, where enquiring about social isolation as part of a comprehensive assessment may be important.
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Affiliation(s)
- Gregorio Bevilacqua
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Karen A. Jameson
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Jean Zhang
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Ilse Bloom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas R. Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Harnish P. Patel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Medicine for Older People, University Hospital Southampton, Southampton, UK
| | - Kate A. Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LE UK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD UK
- Victoria University of Wellington, Wellington, New Zealand
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Tazzeo C, Rizzuto D, Calderón-Larrañaga A, Roso-Llorach A, Marengoni A, Welmer AK, Onder G, Trevisan C, Vetrano DL. Multimorbidity patterns and risk of frailty in older community-dwelling adults: a population-based cohort study. Age Ageing 2021; 50:2183-2191. [PMID: 34228784 PMCID: PMC8581386 DOI: 10.1093/ageing/afab138] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND the aim of this study was to examine the cross-sectional and longitudinal associations of different multimorbidity patterns with physical frailty in older adults. METHODS we used data from the Swedish National study on Aging and Care in Kungsholmen to generate a physical frailty measure, and clusters of participants with similar multimorbidity patterns were identified through fuzzy c-means cluster analyses. The cross-sectional association (n = 2,534) between multimorbidity clusters and physical frailty was measured through logistic regression analyses. Six- (n = 2,122) and 12-year (n = 2,140) longitudinal associations were determined through multinomial logistic regression analyses. RESULTS six multimorbidity patterns were identified at baseline: psychiatric diseases; cardiovascular diseases, anaemia and dementia; sensory impairments and cancer; metabolic and sleep disorders; musculoskeletal, respiratory and gastrointestinal diseases; and an unspecific pattern lacking any overrepresented diseases. Cross-sectionally, each pattern was associated with physical frailty compared with the unspecific pattern. Over 6 years, the psychiatric diseases (relative risk ratio [RRR]: 3.04; 95% confidence intervals [CI]: 1.59-5.79); cardiovascular diseases, anaemia and dementia (RRR 2.25; 95% CI: 1.13-4.49) and metabolic and sleep disorders (RRR 1.99; 95% CI: 1.25-3.16) patterns were associated with incident physical frailty. The cardiovascular diseases, anaemia and dementia (RRR: 4.81; 95% CI: 1.59-14.60); psychiatric diseases (RRR 2.62; 95% CI: 1.45-4.72) and sensory impairments and cancer (RRR 1.87; 95% CI: 1.05-3.35) patterns were more associated with physical frailty, compared with the unspecific pattern, over 12 years. CONCLUSIONS we found that older adults with multimorbidity characterised by cardiovascular and neuropsychiatric disease patterns are most susceptible to developing physical frailty.
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Affiliation(s)
- Clare Tazzeo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Campus de la UAB, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Caterina Trevisan
- National Research Council-Neuroscience Institute, Aging Branch, Padova, Italy
- Geriatric Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
Background Considering the relatively high 5-yr survival rate (76.9%) for bladder cancer (BC), its overall prevalence will probably continue to increase. Therefore, it is important to understand the effects of BC diagnosis and management, including psychological sequelae. Objective To determine the prevalence of depression among elderly patients with BC and identify patient characteristics associated with depression. Design setting and participants Survey responses from a population-based sample of 5787 patients older than 65 yr with a history of BC were retrieved from the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey registry, spanning 1999-2014. Outcome measurements and statistical analysis The primary outcome measured is the prevalence of a positive depression screen. Cancer characteristics and demographic, socioeconomic, health-related, and activities of daily living (ADL)-related data were reviewed. Univariate analysis was conducted to identify correlation between a positive depression screen and patient characteristics. Multivariate analysis was performed to identify independent predictors of depression. Results and limitations The prevalence of a positive depression screen was 14.0%. Poor general health (p < 0.001), impairment of ADL (p < 0.001), greater number of comorbidities (p < 0.001), and income <$30 000 (p < 0.001) were identified as correlates of depression. Univariate analysis found no association between a positive depression screen and time since the initial cancer diagnosis (p = 0.858) or cancer stage (p = 0.90). Multivariate analysis showed higher levels of education (p = 0.0097), increasing age (p = 0.0027), and marriage (p < 0.0001) were protective against the development of depression. Limitations include the lack of consideration of treatment outcomes and whether patients have active disease or only a history of cancer. Conclusions Depression affects a substantial percentage (14%) of elderly patients with BC. Poor general health and impaired ability to complete ADL were the greatest risk factors for depression. Acknowledgment of sociodemographic factors may improve awareness of depression in patients with BC and a potential need for psychosocial support. Patient summary Depression affects a significant proportion of patients with bladder cancer. Social and demographic factors influence a patient's risk of depression. Acknowledgment of these factors may improve the detection of depression and a possible need for intervention.
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Kurnat-Thoma EL, Murray MT, Juneau P. Frailty and Determinants of Health Among Older Adults in the United States 2011-2016. J Aging Health 2021; 34:233-244. [PMID: 34470533 PMCID: PMC9100462 DOI: 10.1177/08982643211040706] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To characterize frailty phenotype in a representative cohort of older
Americans and examine determinants of health factors. Methods Retrospective analysis of data from 5,553 adults ≥60 years old in the
2011–2016 cross-sectional National Health and Nutrition Examination Survey
(NHANES). World Health Organization “Determinants of
Health” conceptual model was used to prioritize variables for
multinomial logistic regression for the outcome of modified Fried frailty
phenotype. Results 482 participants (9%) were frail and 2432 (44%) prefrail. Four factors were
highly associated with frailty: difficulty with ≥1 activity of daily living
(77%; OR 24.81 p < 0.01), ≥2 hospitalizations in the
previous year (17%, OR 3.94 p < 0.01), having >2
comorbidities (27%; OR 3.33 p < 0.01), and polypharmacy
(66%; OR 2.38 p < 0.01). Discussion A modified Fried frailty assessment incorporating five self-reported criteria
may be useful as a rapid nursing screen in low-resource settings. These
assessments can streamline nursing care coordination and case management
activities, thereby facilitating targeted frailty interventions to support
healthy aging in vulnerable populations.
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Affiliation(s)
- Emma L Kurnat-Thoma
- National Institute of Nursing Research, 35047National Institutes of Health, Bethesda, MD, USA.,Georgetown University School of Nursing & Health Studies, Department of Professional Nursing Practice, Washington, DC, USA
| | - Meghan T Murray
- National Institute of Nursing Research, 35047National Institutes of Health, Bethesda, MD, USA.,Columbia University, School of Nursing, New York, NY, USA
| | - Paul Juneau
- Division of Data Services, NIH Library, Office of Research Services, National Institutes of Health, 10952Bethesda, MD, USA
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Shin HR, Choi EY, Kim SK, Lee HY, Kim YS. Health Literacy and Frailty in Community-Dwelling Older Adults: Evidence from a Nationwide Cohort Study in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7918. [PMID: 34360213 PMCID: PMC8345707 DOI: 10.3390/ijerph18157918] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022]
Abstract
Health literacy is closely associated with poor health outcomes and mortality. However, only a handful of studies have examined the association between health literacy and frailty status. The current study used data from a nationwide sample of Korean adults aged 70-84 collected from 10 cities, each of which represents a different region of South Korea (n = 1521). We used the propensity score matching (PSM) method to minimize the potential selection bias and confounding factors that are present in observational studies. After PSM, demographic and health-related characteristics between the limited health literacy (n = 486) and the nonlimited health literacy (n = 486) groups were not significantly different. Multinomial logistic regression analyses were conducted for the PSM-matched sample to examine the association between health literacy and frailty outcomes, where the robust group was set as a reference. Limited health literacy significantly increased the risk of pre-frailty (RRR = 1.45, p = 0.02) and frailty (RRR = 2.03, p = 0.01) after adjusting for demographic and health-related factors. Our findings underscore the need to foster health literacy programs and provide preliminary evidence to inform tailored intervention programs so that we might attenuate the risk of frailty in the older population.
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Affiliation(s)
- Hye-Ri Shin
- Department of Gerontology, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
| | - Eun-Young Choi
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA;
| | - Su-Kyung Kim
- AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
| | - Hee-Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL 35487, USA;
| | - Young-Sun Kim
- AgeTech-Service Convergence Major, Graduate School of East-West Medical Science, Kyung Hee University, Yongin 17104, Korea;
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Delbari A, Zanjari N, Momtaz YA, Rahim F, Saeidimehr S. Prevalence of frailty and associated socio-demographic factors among community-dwelling older people in southwestern Iran: a cross-sectional study. J Diabetes Metab Disord 2021; 20:601-610. [PMID: 34222080 PMCID: PMC8212196 DOI: 10.1007/s40200-021-00787-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/20/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This community-based cross-sectional study aimed to identify the frailty prevalence and associated socio-demographic factors among older adults in five cities of the south west of Iran. METHODS We selected a random sample of adults aged 60 years and above from five Southwest cities in Iran. Data for this study were retrospectively collected from 540 community-dwelling older adults. To measure frailty, we utilized the frailty index of cumulative deficit (FICD). Data were collected from medical records and socio-demographic factors, including gender, age, marital status, education level, lifestyle, income, and job status. The chi-square test and Spearman's correlation coefficient test were used to assess the relationship between the demographic variables and frailty status (SPSS version 22). Also, multiple binary logistic regression models were used to estimate the effects of demographic characteristics on the frailty recurrence. RESULTS The overall frailty prevalence was as follows: 77 (14.3%) frail, 139 (25.7%) pre-frail, and 324 (60%) not frail. The findings showed that all variables except education level and marital status are significantly associated with frailty status (P < 0.05). Multiple ridge logistic regression model indicated that age, gender, marital status, job status have significant, and education level, living arrangement, and economic status have no considerable effect on the frailty. CONCLUSIONS This study has shown that age and gender significantly contributed to the frailty process in older adults. The research also has shown the syndrome's occurrence affected by the aging process, and it supports the biological characteristics of frailty.
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Affiliation(s)
- Ahmad Delbari
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nasibeh Zanjari
- Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Fakher Rahim
- Research Center of Thalassemia & Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeid Saeidimehr
- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Sidhu SS, Saggar K, Goyal O, Varshney T, Kishore H, Bansal N, Sidhu SS. Muscle strength and physical performance, rather than muscle mass, correlate with mortality in end-stage liver disease. Eur J Gastroenterol Hepatol 2021; 33:555-564. [PMID: 32433422 DOI: 10.1097/meg.0000000000001761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Sarcopenia is characterized by the loss of skeletal muscle mass, strength and performance. The study aimed to provide cut off values of various Sarcopenia parameters [computerized tomography skeletal muscle index (SMI), handgrip strength (HGS), gait velocity and chair stand] to predict mortality in end-stage liver disease (ESLD). METHODS The inclusion criteria were age 18-75 years, model for end-stage liver disease > 15. All patients with advanced heart, lung, kidney diseases, active malignancy were excluded from the study. Sarcopenia indices were compared between survivors and non-survivors to find cut off value for prediction of mortality in ESLD patients. RESULTS One hundred sixty-one subjects suffering from ESLD were enrolled. The cutoff value of the SMI to identify high risk of mortality in sarcopenia patients is ≤21.2 cm2/m2, area under the curve (AUC) 0.537 [95% confidence interval (CI) 0.456-0.616]. The cutoff value of the hand grip strength to identify high-risk mortality is ≤25.3 kilogram-force, AUC 0.682 (95% CI 0.604-0.753). The cutoff value of the gait velocity for the same is as ≤0.84 m/s, AUC 0.551 (95% CI 0.459-0.641). The cutoff value of the chair stand is ≥20.9 seconds, AUC 0.956 (95% CI 0.910-0.983). In the multivariate analysis, HGS, gait velocity and chair stand correlated with mortality. CONCLUSION The current study is a comprehensive Asian study that gives the cut off values of Sarcopenia: muscle mass, strength and performance which identify high risk of mortality in ESLD patients. Muscle strength and performance correlated with mortality.
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Affiliation(s)
| | - Kavita Saggar
- Radiodiagnosis, Dayanand Medical College and Hospital
| | | | | | | | - Namita Bansal
- Department of Gastroenterology, Dayanand Medical College and Hospital Ludhiana, India
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Banning LBD, Visser L, Zeebregts CJ, van Leeuwen BL, El Moumni M, Pol RA. Transition in Frailty State Among Elderly Patients After Vascular Surgery. World J Surg 2021; 44:3564-3572. [PMID: 32494998 PMCID: PMC7458900 DOI: 10.1007/s00268-020-05619-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frailty in the vascular surgical ward is common and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state in elderly patients after vascular surgery and to evaluate influence of patient characteristics on this transition. METHODS Between 2014 and 2018, 310 patients, ≥65 years and scheduled for elective vascular surgery, were included in this cohort study. Transition in frailty state between preoperative and follow-up measurement was determined using the Groningen Frailty Indicator (GFI), a validated tool to measure frailty in vascular surgery patients. Frailty is defined as a GFI score ≥4. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. RESULTS Mean age was 72.7 ± 5.2 years, and 74.5% were male. Mean follow-up time was 22.7 ± 9.5 months. At baseline measurement, 79 patients (25.5%) were considered frail. In total, 64 non-frail patients (20.6%) shifted to frail and 29 frail patients (9.4%) to non-frail. Frail patients with a high Charlson Comorbidity Index (HR = 0.329 (CI: 0.133-0.812), p = 0.016) and that underwent a major vascular intervention (HR = 0.365 (CI: 0.154-0.865), p = 0.022) had a significantly higher risk to remain frail after the intervention. CONCLUSIONS The results of this study, showing that after vascular surgery almost 21% of the non-frail patients become frail, may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of patients.
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Affiliation(s)
- Louise B D Banning
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Linda Visser
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Clark J Zeebregts
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Singh N, Khan M, Choudhary P, Gupta A, Kaul S. A prospective study for the assessment of frailty in elderly chronic kidney disease patients. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jung H, Kim M, Lee Y, Won CW. Prevalence of Physical Frailty and Its Multidimensional Risk Factors in Korean Community-Dwelling Older Adults: Findings from Korean Frailty and Aging Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217883. [PMID: 33121159 PMCID: PMC7662797 DOI: 10.3390/ijerph17217883] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023]
Abstract
Frailty is defined as a state of increased vulnerability to stressors, and it predicts disability and mortality in the older population. This study aimed to investigate the standardized prevalence and multidimensional risk factors associated with frailty among Korean community-dwelling older adults. We analyzed the baseline data of 2907 adults aged 70-84 years (mean age 75.8 ± 3.9 years, 57.8% women) in the Korean Frailty and Aging Cohort Study. The Fried frailty phenotype was used to define frailty. Analyzed data included sociodemographic, physical, physical function, biological, lifestyle, health condition, medical condition, psychological, and social domains. Data were standardized using the national standard population composition ratio based on the Korean Population and Housing Census. The standardized prevalence of frailty and prefrailty was 7.9% (95% confidence interval (CI) 6.8-8.9%) and 47.0% (95% CI, 45.1-48.8%), respectively. The following 14 risk factors were significantly associated with frailty: at risk of malnutrition, sarcopenia, severe mobility limitation, poor social capital, rural dwellers, depressive symptoms, poor self-perceived health, polypharmacy, elevated high-sensitivity C-reactive protein, elevated glycosylated hemoglobin, low 25-hydroxy vitamin D level, longer Timed Up and Go, and low Short Physical Performance Battery score (p < 0.05). Physiconutritional, psychological, sociodemographic, and medical factors are strongly associated with frailty.
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Affiliation(s)
- Heeeun Jung
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (M.K.); (C.W.W.); Tel.: +82-2-958-2840 (M.K.); +82-2-958-8700 (C.W.W.); Fax: +82-2-958-2836 (M.K.); +82-2-958-8699 (C.W.W.)
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon 16499, Korea;
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (M.K.); (C.W.W.); Tel.: +82-2-958-2840 (M.K.); +82-2-958-8700 (C.W.W.); Fax: +82-2-958-2836 (M.K.); +82-2-958-8699 (C.W.W.)
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Abstract
PURPOSE OF REVIEW Different factors contribute to the decreased overall long-term survival in treated people living with HIV (PLWH). This paper will review the state of physical frailty which limits successful aging in PLWH. RECENT FINDINGS Identifiable events on the continuum from clinical normality to heightened risk of adverse health outcomes contribute to frailty. These center on chronic inflammation leading to destabilization of autoregulated physiologic systems challenged by environmental and biologic challenges. Frailty assessment can inform the profile of aging PLWH at increased risk of common age-related disorders and geriatric syndromes. Biologic and psychosocial risk factors promoting progression to and reversion from a dynamic state of frailty are being investigated, allowing for preventative interventions to be considered. Insights gained from studying frail PLWH will help adapt an interdisciplinary geriatric model of health care for selected PLWH. This will improve the health and well-being of aging PLWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatrics, Director, Comprehensive HIV and Aging Initiative, McGill University Health Centre, Montreal, Quebec, Canada.
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Gobbens RJJ, van der Ploeg T. The Prediction of Mortality by Disability Among Dutch Community-Dwelling Older People. Clin Interv Aging 2020; 15:1897-1906. [PMID: 33116444 PMCID: PMC7547136 DOI: 10.2147/cia.s271800] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older. Methods A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values <0.001, respectively. The AUCs were <0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality. Conclusion Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tjeerd van der Ploeg
- Faculty of Engineering, Design and Computer Technology, Inholland University of Applied Sciences, Alkmaar, the Netherlands
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Delirium in Older People with COVID-19: Clinical Scenario and Literature Review. ACTA ACUST UNITED AC 2020; 2:1790-1797. [PMID: 32904497 PMCID: PMC7455775 DOI: 10.1007/s42399-020-00474-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 01/08/2023]
Abstract
Delirium is a potentially fatal acute brain dysfunction that is characterised by inattention and fluctuating mental changes. It is indicative of an acute serious organ failure or acute infection. Delirium is also associated with undesirable health outcomes that include prolonged hospital stay, long-term cognitive decline and increased mortality. The new SARS-CoV-2 shows, not only pulmonary tropism but also, neurotropism which results in delirium in the acute phase illness particularly in the older age groups. The current assessment for COVID-19 in older people does not routinely include screening for delirium. Implementation of a rapid delirium screening tool is necessary because, without screening, up to 75% of cases can be missed. Delirium can also be exaggerated by health care policies that recommend social isolation and wearing personal protective equipment in addition to less interaction with patients. Non-pharmacological intervention for delirium prevention and management may be helpful if implemented as early and as often as possible in hospitalised older people with COVID-19. A holistic approach that includes psychological support in addition to medical care is needed for older people admitted to hospital with COVID-19.
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Frailty status and cardiovascular disease risk profile in middle-aged and older females. Exp Gerontol 2020; 140:111061. [PMID: 32814098 DOI: 10.1016/j.exger.2020.111061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Frailty and pre-frailty are known to increase the risk of developing cardiovascular disease (CVD). However, the risk profiles of females are not well characterized. The aim of this study is to characterize the CVD risk profiles of robust, pre-frail and frail females. METHODS Cross-sectional analysis of 985 females ≥55 years with no self-reported history of CVD were recruited. Frailty was assessed using the Fried Criteria with the cut-points standardized to the cohort. Framingham risk scores (FRS), the 4-test Rasmussen Disease Score (RDS), and the CANHEART health index were used to characterize composite CVD risk. Individual measures of CVD risk included blood lipids, artery elasticity assessments, exercise blood pressure response, 6-min walk test (6MWT), sedentary time and PHQ-9 score. RESULTS The cohort comprised of 458 (46.4%) robust, 464 (47.1%) pre-frail and 63 (6.4%) frail females with a mean age of 66 ± 6 (SD) years. Pre-frail females were at increased odds of taking diabetes medications (OR 3.04; 95% CI 1.27-7.27), hypertension medications (OR 2.02; 95% CI 1.44-2.82), having an exaggerated blood pressure response to exercise (OR 1.878; 95% CI 1.39-2.50), mild depression symptoms (OR 2.38; 95% CI 1.68-338), and lower fitness as assessed by 6MWT (OR 5.74; 95% CI 3.18-10.37), even after controlling for age and relevant medications. Pre-frail females were also at increased odds for having CVD risk scores indicating higher risk with the FRS (OR 1.52; 95% CI 1.12-2.05), the RDS (OR 1.60; 95% CI 1.21-2.10) and the CANHEART risk score (OR 3.07; 95% CI 2.04-4.62). These odds were higher when frail females were compared to their robust peers. CONCLUSION Frailty and pre-frailty were associated with higher odds of presenting with CVD risk factors as compared to robust females, even after controlling for age.
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Furtado GE, Caldo A, Vieira-Pedrosa A, Letieri RV, Hogervorst E, Teixeira AM, Ferreira JP. Emotional Well-Being and Cognitive Function Have Robust Relationship With Physical Frailty in Institutionalized Older Women. Front Psychol 2020; 11:1568. [PMID: 32765358 PMCID: PMC7378677 DOI: 10.3389/fpsyg.2020.01568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Frailty associated to core dimensions of psychological well-being (PwB) has appeared as a possible new frailty phenotype named psychological frailty, implying a parallel to physical frailty (PF). Very little is known about the associations between mental well-being, especially emotional, mood, and self-perception dimensions, and the frailty syndrome in institutionalized older populations. The present study aims to examine the interlink between the PF phenotype and the core dimensions of PwB in Portuguese institution-dwelling older women. Methods Cross-sectional data were collected. A total of 358 older women, aged 75 years or more, were recruited from four nursing homes within the city of Coimbra and asked to complete a sociodemographic and a general health assessment survey. The main PwB dimensions were assessed in all participants: (i) global cognitive status was assessed using The Montreal Cognitive Assessment (MoCA) Neuropsychology Test, (ii) self-perception was screened using the General Self-Efficacy Scale (GSES) and Global Self-Esteem Scale, (iii) CES-D of depression and Perceived Stress Scale (PSS) were used to screen mood states, and (iv) subjective happiness, satisfaction with life, and attitudes to aging psychometric rating scales were used to screen for emotional well-being. The syndrome of PF was assessed using Fried’s PF phenotype that includes weight loss, weakness, slowness, exhaustion, and low physical activity (PA) level assessments. Results Frail older women had a poor score in all PwB outcomes, except for global self-esteem and satisfaction with life. A hierarchical regression model analysis showed that global cognitive status and emotional well-being of subjective happiness and attitude to aging showed a significant negative relationship with PF in both unadjusted and adjusted models (explaining 34 and 40% of variance, respectively). Conclusion Emotional well-being and global cognitive performance are strongly associated with PF. Implementing active lifestyle interventions to improve positive psychological outcomes using geriatric assessments could assist in the older institutionalized patients’ physical and mental health care.
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Affiliation(s)
- Guilherme Eustáquio Furtado
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Adriana Caldo
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Ana Vieira-Pedrosa
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - Rubens Vinícius Letieri
- Multidisciplinary Research Nucleus in Physical Education (NIMEF), Physical Education Department, Federal University of Tocantins (UFT), Tocantinópolis, Brazil
| | - Eef Hogervorst
- Applied Cognitive Research NCSEM, Loughborough University, Loughborough, United Kingdom
| | - Ana Maria Teixeira
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
| | - José Pedro Ferreira
- University of Coimbra - Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Science and Physical Education (FCDEF-UC), Coimbra, Portugal
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Siriwardhana DD, Weerasinghe MC, Rait G, Scholes S, Walters KR. Association between frailty and disability among rural community-dwelling older adults in Sri Lanka: a cross-sectional study. BMJ Open 2020; 10:e034189. [PMID: 32229521 PMCID: PMC7170600 DOI: 10.1136/bmjopen-2019-034189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We examined the association between frailty and disability in rural community-dwelling older adults in Kegalle district of Sri Lanka. DESIGN A population-based cross-sectional study. PARTICIPANTS A total of 746 community-dwelling adults aged ≥60 years. PRIMARY AND SECONDARY OUTCOME MEASURES Frailty was assessed using the Fried phenotype. Disability was operationalised in terms of having one or more activity limitation/s in instrumental activities of daily living (IADL) and basic activities of daily living (BADL). RESULTS The median age of the sample was (median 68; IQR 64-75) years and 56.7% were female. 15.2% were frail and 48.5% were prefrail. The prevalence of ≥1 IADL limitations was high, 84.4% among frail adults. 38.7% of frail adults reported ≥1 BADL limitations. Over half of frail older adults (58.3%) reported both ≥1 physical and cognitive IADL limitations. Being frail decreased the odds of having no IADL limitations, and was associated with a higher count of IADL limitations. No significant association was found between prefrailty and number of IADL limitations. CONCLUSIONS The prevalence of ≥1 IADL limitations was high among rural community-dwelling frail older adults. Findings imply the greater support and care required for rural Sri Lankan frail older adults to live independently in the community.
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Affiliation(s)
- Dhammika Deepani Siriwardhana
- Research Department of Primary Care and Population Health, University College London, London, UK
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Shaun Scholes
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Kate R Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
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Vetrano DL, Palmer K, Marengoni A, Marzetti E, Lattanzio F, Roller-Wirnsberger R, Lopez Samaniego L, Rodríguez-Mañas L, Bernabei R, Onder G. Frailty and Multimorbidity: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci 2020; 74:659-666. [PMID: 29726918 DOI: 10.1093/gerona/gly110] [Citation(s) in RCA: 320] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/30/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Multimorbidity and frailty are complex syndromes characteristics of aging. We reviewed the literature and provided pooled estimations of any evidence regarding (a) the coexistence of frailty and multimorbidity and (b) their association. METHODS We searched PubMed and Web of Science for relevant articles up to September 2017. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity (I2), risk of bias, and publication bias were assessed. PROSPERO registration: 57890. RESULTS A total of 48 studies involving 78,122 participants were selected, and 25 studies were included in one or more meta-analyses. Forty-five studies were cross-sectional and 3 longitudinal, with the majority of them including community-dwelling participants (n = 35). Forty-three studies presented a moderate risk of bias and five a low risk. Most of the articles defined multimorbidity as having two or more diseases and frailty according to the Cardiovascular Health Study criteria. In meta-analyses, the prevalence of multimorbidity in frail individual was 72% (95% confidence interval = 63%-81%; I2 = 91.3%), and the prevalence of frailty among multimorbid individuals was 16% (95% confidence interval = 12%-21%; I2 = 96.5%). Multimorbidity was associated with frailty in pooled analyses (odds ratio = 2.27; 95% confidence interval = 1.97-2.62; I2 = 47.7%). The three longitudinal studies suggest a bidirectional association between multimorbidity and frailty. CONCLUSIONS Frailty and multimorbidity are two related conditions in older adults. Most frail individuals are also multimorbid, but fewer multimorbid ones also present frailty. Our findings are not conclusive regarding the causal association between the two conditions. Further longitudinal and well-designed studies may help to untangle the relationship between frailty and multimorbidity.
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Affiliation(s)
- Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.,Department of Geriatrics, Catholic University of Rome, Italy
| | | | | | | | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Centre on Aging, Ancona, Italy
| | | | - Luz Lopez Samaniego
- Andalusian Public Foundation of Progress and Health, Regional Ministry of Health of Andalusia, Spain
| | | | | | - Graziano Onder
- Department of Geriatrics, Catholic University of Rome, Italy
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47
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Obbia P, Graham C, Duffy FJR, Gobbens RJJ. Preventing frailty in older people: An exploration of primary care professionals' experiences. Int J Older People Nurs 2019; 15:e12297. [DOI: 10.1111/opn.12297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 11/15/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Paola Obbia
- Piedmont Region Health Service Local Health Agency ASLCN1 Cuneo Italy
- Department of Clinical and Biological Sciences University of Turin Turin Italy
| | - Clair Graham
- School of Health and Life Sciences University of the West of Scotland Lanarkshire Campus UK
| | - F. J. Raymond Duffy
- School of Health and Life Sciences University of the West of Scotland Lanarkshire Campus UK
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work Inholland University of Applied Sciences Amsterdam The Netherlands
- Zonnehuisgroep Amstelland Amstelveen The Netherlands
- Department of Primary and Interdisciplinary Care Faculty of Medicine and Health Sciences University of Antwerp Antwerp Belgium
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48
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Kojima G, Walters K, Iliffe S, Taniguchi Y, Tamiya N. Marital Status and Risk of Physical Frailty: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2019; 21:322-330. [PMID: 31740150 DOI: 10.1016/j.jamda.2019.09.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Evidence on associations between marital status and frailty is limited. The objectives of this study were to perform a systematic review for associations between marital status and physical frailty and to perform a meta-analysis to combine findings. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Community-dwelling older people with mean age ≥60 years. METHODS Systematic literature search using 5 databases was conducted in February 2019 to identify longitudinal and cross-sectional studies examining associations between marital status and Fried's phenotype-based frailty status. Additional studies were searched for by reviewing the reference lists of relevant articles and conducting forward citation tracking of included articles. Odds ratio (OR) of marital status and frailty was pooled using a random-effects meta-analysis. Subgroup analysis and analyses stratified by gender and marital status (married, widowed, divorced or separated, and never married) were completed. RESULTS A total of 1565 studies were found, from which 3 studies with longitudinal data and 35 studies with cross-sectional data were included. Although longitudinal studies suggested that married men had lower frailty risks than unmarried men while married women had higher frailty risks than widowed women, meta-analysis was not possible because of different methodologies. Meta-analyses of cross-sectional data from 35 studies including 80,754 individuals showed that unmarried individuals were almost twice more likely to be frail than married individuals (pooled odds ratio = 1.88, 95% confidence interval = 1.70-2.07). A high degree of heterogeneity was observed (I2 = 69%) and was partially explained by reasons for not being married and study location. Stratified analyses showed that pooled risks of frailty in the unmarried compared with the married were not statistically different between women and women (P for difference = .62). CONCLUSIONS AND IMPLICATIONS Three and 35 studies, respectively, were found providing longitudinal and cross-sectional data regarding associations between marital status and frailty among community-dwelling older people. A meta-analysis of cross-sectional data showed almost twice higher frailty risk in unmarried individuals compared with married individuals. Marital status should be recognized as an important factor, and more longitudinal studies controlling for potential confounding factors are needed.
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Affiliation(s)
- Gotaro Kojima
- Videbimus Toranomon Clinic, Tokyo, Japan; Department of Primary Care and Population Health, University College London, London, UK; Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan.
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Yu Taniguchi
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Nanako Tamiya
- Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan
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Hegendörfer E, Vaes B, Van Pottelbergh G, Matheï C, Verbakel J, Degryse JM. Predictive Accuracy of Frailty Tools for Adverse Outcomes in a Cohort of Adults 80 Years and Older: A Decision Curve Analysis. J Am Med Dir Assoc 2019; 21:440.e1-440.e8. [PMID: 31678074 DOI: 10.1016/j.jamda.2019.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the predictive performance of 3 frailty identification tools for mortality, hospitalization, and functional decline in adults aged ≥80 years using risk reclassification statistics and decision curve analysis. DESIGN Population-based, prospective cohort. SETTING BELFRAIL study, Belgium. PARTICIPANTS 560 community-dwelling adults aged ≥80 years. MEASUREMENTS Frailty by Cardiovascular Health Study (CHS) phenotype, Longitudinal Aging Study Amsterdam (LASA) markers, and Groeningen Frailty Indicator (GFI); mortality until 5.1 ± 0.25 years from baseline and hospitalization until 3.0 ± 0.25 years; and functional status assessed by activities of daily living at baseline and after 1.7 ± 0.21 years. RESULTS Frailty prevalence was 7.3% by CHS phenotype, 21.6% by LASA markers, and 22% by GFI. Participants determined to be frail by each tool had a significantly higher risk for all-cause mortality and first hospitalization. For functional decline, only frail by GFI had a higher adjusted odds ratio. Harrell 's C-statistic for mortality and hospitalization and area under receiver operating characteristic curve for functional decline were similar for all tools and <0.70. Reclassification statistics showed improvement only by LASA markers for hospitalization and mortality. In decision curve analysis, all tools had higher net benefit than the 2 default strategies of "treat all" and "treat none" for mortality risk ≥20%, hospitalization risk ≥35%, and functional decline probability ≥10%, but their curves overlapped across all relevant risk thresholds for these outcomes. CONCLUSIONS AND IMPLICATIONS In a cohort of adults aged ≥80 years, 3 frailty tools based on different conceptualizations and assessment sources had comparable but unsatisfactory discrimination for predicting mortality, hospitalization, and functional decline. All showed clinical utility for predicting these outcomes over relevant risk thresholds, but none was significantly superior. Future research on frailty tools should include a focus on the specific group of adults aged ≥80 years, and the predictive accuracy for adverse outcomes of different tools needs a comprehensive assessment that includes decision curve analysis.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain, Belgium.
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Catharina Matheï
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium
| | - Jan Verbakel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain, Belgium
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50
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Roberts PS, Aronow HU, Parker J, Riggs RV. Measuring Frailty in Inpatient Rehabilitation. PM R 2019; 12:356-362. [PMID: 31622049 DOI: 10.1002/pmrj.12263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 10/07/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND In response to the global aging population, there has been increasing research on frailty. How frailty is conceptualized is shifting with the development of frailty models, especially in the acute care arena. OBJECTIVE To explore frailty/vulnerability risk factors available at admission that were associated with salient patient outcomes within the context of inpatient rehabilitation. DESIGN Methodologies in acute care are not easily adapted for a typical admission evaluation or a rehabilitation patient. In this study, the concept of frailty among patients admitted to rehabilitation was developed from risk factors available at admission that were associated with two patient outcomes, adverse hospital outcomes and 30-day hospital readmissions. SETTING Inpatient rehabilitation. PATIENTS Data were included on all patients (n = 768) discharged from an inpatient rehabilitation unit of an academic medical center from 1 January 2012 through 31 December 2012. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Adverse events within the inpatient rehabilitation stay and 30-day hospital readmissions. RESULTS Significant independent factors associated with adverse events in the rehabilitation unit included African American (1.77 OR; 95% CI 1.06-2.96), Hispanic (3.17 OR; 95% CI 1.13-8.94), having >9 total comorbid conditions (1.44 OR; 95% CI 1.244-1.66), and sphincter control domain (including bladder and bowel management) ≤ 9 FIM (0.92 OR; 95% CI 0.86-0.98). For 30-day readmission three variables were found to be significant: onset ≥7 days (2.31 OR; 95% CI 1.28-4.22), requiring a tube for feeding (3.45 OR; 95% CI 1.433-11.12), and being obese (4.72 OR; 95% CI 1.433-15.58). CONCLUSIONS The findings highlight the need for early admission screening and identification of risk factors which can provide the time in the rehabilitation setting for the clinical team to treat and prevent the potential for poor outcomes.
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Affiliation(s)
- Pamela S Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA.,Department of Enterprise Information Services, Cedars-Sinai, Los Angeles, CA
| | - Harriet U Aronow
- Department of Nursing Research and Performance Improvement, Cedars-Sinai, Los Angeles, CA
| | - Jordan Parker
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA
| | - Richard V Riggs
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA.,Department of Enterprise Information Services, Cedars-Sinai, Los Angeles, CA
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