1
|
Xiong X, Zhang T, Chen H, Jiang Y, He S, Qian K, Li H, Guo X, Jin J. Comparison of three frailty scales for prediction of prolonged postoperative ileus following major abdominal surgery in elderly patients: a prospective cohort study. BMC Surg 2024; 24:115. [PMID: 38627715 PMCID: PMC11020916 DOI: 10.1186/s12893-024-02391-6] [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: 10/18/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND To determine whether frailty can predict prolonged postoperative ileus (PPOI) in older abdominal surgical patients; and to compare predictive ability of the FRAIL scale, the five-point modified frailty index (mFI-5) and Groningen Frailty Indicator (GFI) for PPOI. METHODS Patients (aged ≥ 65 years) undergoing major abdominal surgery at our institution between April 2022 to January 2023 were prospectively enrolled. Frailty was evaluated with FRAIL, mFI-5 and GFI before operation. Data on demographics, comorbidities, perioperative management, postoperative recovery of bowel function and PPOI occurrence were collected. RESULTS The incidence of frailty assessed with FRAIL, mFI-5 and GFI was 18.2%, 38.4% and 32.5% in a total of 203 patients, respectively. Ninety-five (46.8%) patients experienced PPOI. Time to first soft diet intake was longer in patients with frailty assessed by the three scales than that in patients without frailty. Frailty diagnosed by mFI-5 [Odds ratio (OR) 3.230, 95% confidence interval (CI) 1.572-6.638, P = 0.001] or GFI (OR 2.627, 95% CI 1.307-5.281, P = 0.007) was related to a higher risk of PPOI. Both mFI-5 [Area under curve (AUC) 0.653, 95% CI 0.577-0.730] and GFI (OR 2.627, 95% CI 1.307-5.281, P = 0.007) had insufficient accuracy for the prediction of PPOI in patients undergoing major abdominal surgery. CONCLUSIONS Elderly patients diagnosed as frail on the mFI-5 or GFI are at an increased risk of PPOI after major abdominal surgery. However, neither mFI-5 nor GFI can accurately identify individuals who will develop PPOI. TRIAL REGISTRATION This study was registered in Chinese Clinical Trial Registry (No. ChiCTR2200058178). The date of first registration, 31/03/2022, https://www.chictr.org.cn/ .
Collapse
Affiliation(s)
- Xianwei Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Ting Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Huan Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Yiling Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Shuangyu He
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Hui Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Xiong Guo
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Juying Jin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China.
| |
Collapse
|
2
|
Loecker CN, Schmaderer MS, Wysham KD, Pozehl B, Zimmerman L, England BR. Psychometric Properties of Frailty Instruments in Adults With Rheumatoid Arthritis: A Systematic Review. ACR Open Rheumatol 2024; 6:91-102. [PMID: 38083820 PMCID: PMC10867294 DOI: 10.1002/acr2.11640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Examine psychometric properties of frailty instruments used in adults with rheumatoid arthritis (RA) to inform selection of frailty instruments for clinical and research use. METHODS A systematic review was registered in PROSPERO. Studies measuring frailty in adults with RA published before May 25, 2022, were searched in six electronic databases. Level of evidence of psychometric properties were synthesized and graded for each frailty instrument using Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. RESULTS There were 22 articles included in the review, and psychometric properties of 16 frailty instruments were examined. RA cohorts were predominantly female with moderate RA disease activity, mean age was 60.1 years, and frailty prevalence ranged widely from 10% to 85%. Construct validity was the only psychometric property routinely examined for frailty instruments in RA, and nearly all (14/16) performed favorably in this domain. Frailty correlated most frequently with older age, higher RA disease activity, and worse physical function. Internal consistency, measurement error, and content validity were examined infrequently. Reliability and responsiveness data were not reported. Six frailty instruments were rated highest in adults with RA: three adaptations of Fried's Criteria, 32-Item and 45-Item Frailty Indexes, and the Comprehensive Rheumatologic Assessment of Frailty. CONCLUSION Six frailty instruments possessed the highest-rated psychometric properties in RA. These instruments demonstrated construct validity of frailty with important outcomes in RA. Frailty assessment shows promise to inform risk stratification in RA, but studies are needed to evaluate reliability, responsiveness, and validity to support accuracy of frailty measurement in adults with RA who may have disease-related features that differentially impact outcomes.
Collapse
Affiliation(s)
| | | | - Katherine D. Wysham
- US Department of Veterans Affairs Puget Sound Health Care System and University of WashingtonSeattle
| | - Bunny Pozehl
- University of Nebraska Medical Center College of NursingOmaha
| | - Lani Zimmerman
- University of Nebraska Medical Center College of NursingLincoln
| | - Bryant R. England
- US Department of Veterans Affairs Nebraska‐Western Iowa Health Care System and University of Nebraska Medical CenterOmaha
| |
Collapse
|
3
|
Avcı O, İriağaç Y, Çavdar E, Karaboyun K, Araz M, Şakalar T, Değerli E, Özdemir Ö, İnal A, Ocak B, Ürün M, Sakin A, Yıldız Tacar S, Koçak MZ, Demir H, Özer Ö, Tanrıkulu Şimşek E, Ersoy M, Karakaş Y, Arıkan R, Eşbah O, Ön S, Şenocak Taşçı E, Molinas Mandel N, Türker S, Kaçan T, Yıldırım HÇ, Alan Ö, Akbaş S, İpek Deniz G, Aydın İsak Ö, Taşkaynatan H, Şeber ES. PROPSEA, safety evaluation of palbociclib and ribociclib in older patients with breast cancer: A prospective real-world TOG study. J Geriatr Oncol 2023; 14:101604. [PMID: 37683369 DOI: 10.1016/j.jgo.2023.101604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/21/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION In this study, the toxicities and management of palbociclib and ribociclib in older patients (≥65 years) with metastatic breast cancer patients were investigated. MATERIALS AND METHODS Among older patients receiving palbociclib and ribociclib, Geriatric 8 (G8) and Groningen Frailty Index were used to evaluate frailty status. Dose modifications, drug withdrawal and other serious adverse events (SAEs) were recorded and analyzed according to baseline patient characteristics. RESULTS A total of 160 patients from 28 centers in Turkey were included (palbociclib = 76, ribociclib = 84). Forty-three patients were ≥ 75 years of age. The most common cause of first dose modification was neutropenia for both drugs (97% palbociclib, 69% ribociclib). Liver function tests elevation (10%) and renal function impairment (6%) were also causes for ribociclib dose modification. Drug withdrawal rate was 3.9% for palbociclib and 6% for ribociclib. SAEs were seen in 11.8% of those taking palbociclib and 15.5% of those on riboclib. An ECOG performance status of ≥2 and being older than 75 years were associated with dose reductions. Severe neutropenia was more common in patients with non-bone-only metastatic disease, those receiving treatment third-line therapy or higher, coexistance of non-neutropenic hematological side effects (for ribociclib). Neutropenia was less common among patients with obesity. DISCUSSION Our results show that it can be reasonable to start palbociclib and ribociclib at reduced dose in patients aged ≥75 years and/or with an ECOG performance status ≥2.
Collapse
Affiliation(s)
- Okan Avcı
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye.
| | - Yakup İriağaç
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye
| | - Eyyüp Çavdar
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye
| | - Kubilay Karaboyun
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye
| | - Murat Araz
- Necmettin Erbakan University, Faculty of Medicine, Department of Medical Oncology, Konya, Turkiye
| | - Teoman Şakalar
- Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Türkiye
| | - Ezgi Değerli
- İstanbul University, Cerrahpaşa Faculty of Medicine, Department of Medical Oncology, İstanbul, Türkiye
| | - Özlem Özdemir
- İzmir Bozyaka Training and Research Hospital, Department of Medical Oncology, İzmir, Türkiye
| | - Ali İnal
- Mersin City Hospital, Mersin, Türkiye
| | - Birol Ocak
- Bursa Uludağ University, Faculty of Medicine, Department of Medical Oncology, Bursa, Türkiye
| | - Müslih Ürün
- Eskişehir City Hospital, Department of Medical Oncology, Eskişehir, Türkiye
| | - Abdullah Sakin
- Van Yüzüncü Yıl University, Faculty of Medicine, Deparment of Medical Oncology, Van, Türkiye
| | - Seher Yıldız Tacar
- Dr. Sadi Konuk Training and Research Hospital, Department of Medical Oncology, İstanbul, Türkiye
| | - Mehmet Zahid Koçak
- Necmettin Erbakan University, Faculty of Medicine, Department of Medical Oncology, Konya, Turkiye
| | - Hacer Demir
- Afyon Health Sciences University, Department of Medical Oncology, Afyon, Türkiye
| | - Özden Özer
- Dokuz Eylül University, Faculty of Medicine, Department of Medical Oncology, İzmir, Türkiye
| | - Eda Tanrıkulu Şimşek
- Haydarpaşa Numune Training and Research Hospital, Department of Medical Oncology, İstanbul, Türkiye
| | - Mustafa Ersoy
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Medical Oncology, Eskişehir, Türkiye
| | - Yusuf Karakaş
- Mehmet Ali Aydınlar Acıbadem University, Bodrum Hospital, Department of Medical Oncology, Muğla, Türkiye
| | - Rukiye Arıkan
- Marmara University, Faculty of Medicine, Department of Medical Oncology, İstanbul, Türkiye
| | - Onur Eşbah
- Düzce University, Faculty of Medicine, Department of Medical Oncology, Düzce, Türkiye
| | - Sercan Ön
- Ege University, Faculty of Medicine, Department of Medical Oncology, İzmir, Türkiye
| | - Elif Şenocak Taşçı
- Mehmet Ali Aydınlar Acıbadem University, Faculty of Medicine, Department of Medical Oncology, İstanbul, Türkiye
| | - Nil Molinas Mandel
- Koç University, American Hospital, Department of Medical Oncology, İstanbul, Türkiye
| | - Sema Türker
- Zonguldak Atatürk State Hospital, Department of Medical Oncology, Zonguldak, Türkiye
| | - Turgut Kaçan
- Bursa Yüksek İhtisas Training and Research Hospital, Department of Medical Oncology, Bursa, Türkiye
| | - Hasan Çağrı Yıldırım
- Hacettepe University, Faculty of Medicine, Department of Medical Oncology, Ankara, Türkiye
| | - Özkan Alan
- Tekirdağ Dr. Fehmi Cumalıoğlu City Hospital, Department of Medical Oncology, Tekirdağ, Türkiye
| | - Sinem Akbaş
- Koç University, Faculty of Medicine, Department of Medical Oncology, İstanbul, Türkiye
| | - Gülhan İpek Deniz
- Private Tansan Outpatient Clinic, Department of Medical Oncology, İstanbul, Türkiye
| | - Özlem Aydın İsak
- Dışkapı Yıldırım Beyazıd Training and Research Hospital, Department of Medical Oncology, Ankara, Türkiye
| | - Halil Taşkaynatan
- İzmir Private Ege City Hospital, Department of Medical Oncology, İzmir, Türkiye
| | - Erdoğan Selçuk Şeber
- Tekirdağ Namık Kemal University, Faculty of Medicine, Department of Medical Oncology, Tekirdağ, Türkiye
| |
Collapse
|
4
|
Jin X, Liang W, Zhang L, Cao S, Yang L, Xie F. Economic and Humanistic Burden of Osteoarthritis: An Updated Systematic Review of Large Sample Studies. PHARMACOECONOMICS 2023; 41:1453-1467. [PMID: 37462839 DOI: 10.1007/s40273-023-01296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE A previous systematic literature review demonstrated a significant economic and humanistic burden on patients with osteoarthritis (OA). The aim of this study was to systematically review and update the burden of OA reported by large sample studies since 2016. METHODS We searched Medline (via Ovid) and Embase using the updated search strategy based on the previous review. Those studies with a sample size ≥ 1000 and measuring the cost (direct or indirect) or health-related quality of life (HRQL) of OA were included. Pairs of reviewers worked independently and in duplicate. An arbitrator was consulted to resolve discrepancies between reviewers. The Kappa value was calculated to examine the agreement between reviewers. All costs were converted to 2021 US dollars according to inflation rates and exchange rates. RESULTS A total of 1230 studies were screened by title and abstract and 159 by full text, and 54 studies were included in the review. The Kappa value for the full-text screening was 0.71. Total annual OA-related direct costs ranged from US$326 in Japan to US$19,530 in the US. Total annual all-cause direct costs varied from US$173 in Italy to US$41,433 in the US. The annual indirect costs ranged from US$736 in the US to US$18,884 in the Netherlands. Thirty-four studies reported HRQL, with EQ-5D (13, 38%) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (6, 18%) being the most frequently used instruments. The EQ-VAS and utility scores ranged from 41.5 to 81.7 and 0.3 to 0.9, respectively. The ranges of WOMAC pain (range 0-20, higher score for worse health), stiffness (range 0-8), and physical functioning (range 0-68) were 2.0-3.0, 1.0-5.0, and 5.8-42.8, respectively. CONCLUSION Since 2016, the ranges of direct costs of OA became wider, while the HRQL of patients remained poor. More countries outside the US have published OA-related disease burden using registry databases.
Collapse
Affiliation(s)
- Xuejing Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Wanxian Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Lining Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Shihuan Cao
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Lujia Yang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
| |
Collapse
|
5
|
Alsaleh G, Richter FC, Simon AK. Age-related mechanisms in the context of rheumatic disease. Nat Rev Rheumatol 2022; 18:694-710. [PMID: 36329172 DOI: 10.1038/s41584-022-00863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Ageing is characterized by a progressive loss of cellular function that leads to a decline in tissue homeostasis, increased vulnerability and adverse health outcomes. Important advances in ageing research have now identified a set of nine candidate hallmarks that are generally considered to contribute to the ageing process and that together determine the ageing phenotype, which is the clinical manifestation of age-related dysfunction in chronic diseases. Although most rheumatic diseases are not yet considered to be age related, available evidence increasingly emphasizes the prevalence of ageing hallmarks in these chronic diseases. On the basis of the current evidence relating to the molecular and cellular ageing pathways involved in rheumatic diseases, we propose that these diseases share a number of features that are observed in ageing, and that they can therefore be considered to be diseases of premature or accelerated ageing. Although more data are needed to clarify whether accelerated ageing drives the development of rheumatic diseases or whether it results from the chronic inflammatory environment, central components of age-related pathways are currently being targeted in clinical trials and may provide a new avenue of therapeutic intervention for patients with rheumatic diseases.
Collapse
Affiliation(s)
- Ghada Alsaleh
- The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK.
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK.
| | - Felix C Richter
- The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| | - Anna K Simon
- The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| |
Collapse
|
6
|
Kuwakado S, Kawaguchi K, Otsuka H, Fujita A, Kusaba R, Tokieda M, Fujiyoshi D, Kamishima T, Fujino E, Motomura G, Hamai S, Nakashima Y. Prevalence and Characteristics of Frailty at 6 months FollOwing Total Hip and Knee Arthroplasty in Patients With End-Stage OA. Geriatr Orthop Surg Rehabil 2022; 13:21514593221126019. [PMID: 36177368 PMCID: PMC9513576 DOI: 10.1177/21514593221126019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Lower-limb osteoarthritis (OA) in the elderly can be a risk factor for frailty, which is the preliminary of disability, but it may be reversible with appropriate interventions. We aimed to use the Kihon Check List (KCL) to assess multiple domains of frailty and to identify the characteristics of frailty in patients with hip or knee OA following total joint arthroplasty. Materials and Methods This study included 136 ≥ 65-year-old patients (mean age: 73.0 years) who underwent total arthroplasty with end-stage hip and knee OA. We assessed frailty status, instrumental activities of daily living (IADL), and health-related quality of life (HRQoL) according to the KCL, functional ambulatory index (FAI) and EuroQol-5 Dimension (EQ5D), respectively, as well as the extent of pain preoperatively and at postoperative 6 months. Results Using KCL, seventy-eight (57.4%) patients were frail preoperatively, but the prevalence significantly decreased to 52 patients (38.2%) at postoperative 6 months. Total arthroplasty intervention provided significant improvements in the total KCL scores, including the physical domain (P < .01), pain (P < .01), FAI scores (P < .01), and EQ5D (P < .01), but not the social domain. Multivariate logistic regression analysis identified age at surgery (OR: .93, 95% CI: .86-.99) and preoperative FAI score (OR: 1.10, 95% CI: 1.03-1.19) as independent predictors of postoperative frailty. Conclusions Total arthroplasty procedures on patients with hip and knee OA reduced their KCL score, but social aspects were less improved than physical aspects in the shortterm. Older age and preoperative lower IADL score can be useful for accurately estimating less improvement of frailty in the early postoperative phase. Our results suggest that long term follow-up of OA is needed to provide comprehensive interventions, including in social aspects, especially for patients with lower activity.
Collapse
Affiliation(s)
- So Kuwakado
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichi Kawaguchi
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Otsuka
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Akio Fujita
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ryuichi Kusaba
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Miki Tokieda
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Daisuke Fujiyoshi
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takahide Kamishima
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Eijiro Fujino
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
7
|
Naumov AV, Vorobyeva NM, Khovasova NO, Moroz VI, Meshkov AD, Manevich TM, Tkacheva ON, Kotovskaya YV, Selezneva EV, Ovcharova LN. The prevalence of osteoarthritis and its association with geriatric syndromes in people over 65: data from the Russian epidemiological study EVKALIPT. TERAPEVT ARKH 2022; 93:1482-1490. [DOI: 10.26442/00403660.2021.12.201268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
Abstract
Background. Osteoarthritis (OA) in elderly and senile patients is not only common, but also one of the main diseases affecting the duration of active life, its quality, the appearance of addictions and loss of autonomy. Data on the relationship between OA and geriatric syndromes (GS) in our country are extremely scarce.
Aim. To estimate the prevalence of OA and to analyze its associations with HS in persons aged 65 years.
Materials and methods. The study included 4308 people (30% of men) aged 65 to 107 years, living in 11 regions of Russia. The patients were divided into 2 groups: with OA (n=2464) and without OA (n=1821). All patients underwent a comprehensive geriatric assessment.
Results. The prevalence of OA was 57.6%. With age, the frequency of OA increased significantly. According to the results of a comprehensive geriatric assessment, patients with OA had lower walking speed, the sum of points on the Bartel, Lawton scales and a short battery of physical functioning tests and higher the sum of points on the geriatric scale of depression and the age is not a hindrance scale. Patients with OA rated the quality of life and health status lower and higher the intensity of pain syndrome. Patients with OA were more likely to use any assistive device, with the exception of a wheelchair. In patients with OA, the most common HS were chronic pain syndrome (92%), senile asthenia syndrome (64%), basic (66%) and instrumental (56%) dependence in everyday life, cognitive impairment (62%), probable depression (51%) and urinary incontinence (50%). Univariate regression analysis showed that OA is associated with a 1.23.0-fold increase in the risk of a number of GS and a 28% decrease in the risk of malnutrition.
Conclusion. OA is widespread in the elderly population. The presence of OA is associated with a number of GS associated with loss of autonomy.
Collapse
|
8
|
Tschon M, Contartese D, Pagani S, Borsari V, Fini M. Gender and Sex Are Key Determinants in Osteoarthritis Not Only Confounding Variables. A Systematic Review of Clinical Data. J Clin Med 2021; 10:3178. [PMID: 34300344 PMCID: PMC8303951 DOI: 10.3390/jcm10143178] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
Many risk factors for osteoarthritis (OA) have been noted, while gender/sex differences have been understated. The work aimed to systematically review literature investigating as primary aim the relationship between gender/sex related discriminants and OA. The search was performed in PubMed, Science Direct and Web of Knowledge in the last 10 years. Inclusion criteria were limited to clinical studies of patients affected by OA in any joints, analyzing as primary aim gender/sex differences. Exclusion criteria were review articles, in vitro, in vivo and ex vivo studies, case series studies and papers in which gender/sex differences were adjusted as confounding variable. Of the 120 records screened, 42 studies were included. Different clinical outcomes were analyzed: morphometric differences, followed by kinematics, pain, functional outcomes after arthroplasty and health care needs of patients. Women appear to use more health care, have higher OA prevalence, clinical pain and inflammation, decreased cartilage volume, physical difficulty, and smaller joint parameters and dimensions, as compared to men. No in-depth studies or mechanistic studies analyzing biomarker differential expressions, molecular pathways and omic profiles were found that might drive preclinical and clinical research towards sex-/gender-oriented protocols.
Collapse
Affiliation(s)
| | - Deyanira Contartese
- Surgical Sciences and Tecnologies, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.T.); (S.P.); (V.B.); (M.F.)
| | | | | | | |
Collapse
|
9
|
Abstract
Frailty is a syndrome characterized by the decline in the physiologic reserve and function of several systems, leading to increased vulnerability and adverse health outcomes. While common in the elderly, recent studies have underlined the higher prevalence of frailty in chronic diseases, independent of age. The pathophysiological mechanisms that contribute to frailty have not been completely understood, although significant progresses have recently been made. In this context, chronic inflammation is likely to play a pivotal role, both directly and indirectly through other systems, such as the musculoskeletal, endocrine, and neurological systems. Rheumatic diseases are characterized by chronic inflammation and accumulation of deficits during time. Therefore, studies have recently started to explore the link between frailty and rheumatic diseases, and in this review, we report what has been described so far. Frailty is dynamic and potentially reversible with 8.3%-17.9% of older adults spontaneously improving their frailty status over time. Muscle strength is likely the most significant influencing factor which could be improved with training thus pointing at the need to maintain physical activity. Not surprisingly, frailty is more prevalent in patients affected by rheumatic diseases than in healthy controls, regardless of age and is associated with high disease activity to affect the clinical outcomes, largely due to chronic inflammation. More importantly, the treatment of the underlying condition may prevent frailty. Scales to assess frailty in patients affected by rheumatic diseases have been proposed, but larger casuistries are needed to validate disease-specific indexes, which could allow more accurate prognostic estimates than demographic and disease-related variables alone. Frail patients can be more vulnerable and more difficult to treat, due to the risk of side effects, therefore frailty should be taken into account in clinical decisions. Clinical trials addressing frailty could identify patients who are less likely to tolerate potentially toxic medications and might benefit from more conservative regimens. In conclusion, the implementation of the concept of frailty in rheumatology will allow a better understanding of the patient global health, a finest risk stratification and a more individualized management strategy.
Collapse
Affiliation(s)
- Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center– IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Antonio Sica
- Humanitas Clinical and Research Center - IRCCS - Laboratory of Molecular Immunology, Milan, Italy
- Department of Pharmaceutical Sciences, University of Piemonte Orientale “A. Avogadro”, Novara, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center– IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| |
Collapse
|
10
|
Salaffi F, Farah S, Di Carlo M. Frailty syndrome in rheumatoid arthritis and symptomatic osteoarthritis: an emerging concept in rheumatology. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:274-296. [PMID: 32420963 PMCID: PMC7569610 DOI: 10.23750/abm.v91i2.9094] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
Musculoskeletal conditions such as rheumatoid arthritis (RA) and symptomatic osteoarthritis (OA) were the leading cause of disability in developed countries and disproportionately affects older adults. Frailty is an emerging concept in rheumatology, which represents an important construct to aid in the identification of in- dividuals who are vulnerable to adverse events and less favourable outcomes. The prevalence of frailty among the community-dwelling population increases with age: it ranges from 7% to 10% in those aged over 65 years and to 20-40% among octogenarians. Among patients with RA, the prevalence of frailty is comparable to, or even greater, that of older geriatric cohorts and pre-frailty, a condition including a major health vulnerability between robust and frail, is much more prevalent in RA than in geriatric cohorts. Clinical OA is also associated with frailty and pre-frailty in older adults in European countries. The overall prevalence of clinical OA at any site was 30.4%; frailty was present in 10.2% and pre-frailty in 51.0 %. The diagnosis of frailty is usually clinical and based on specific criteria, which are sometimes inconsistent. Therefore, there is an increasing need to identify and vali- date robust biomarkers for this condition. In the literature, different criteria have been validated to identify frail older subjects, which mainly refer to two conceptual models: the Physical Frailty (PF) phenotype proposed by Fried and the cumulative deficit approach proposed by Rockwood. The purpose of this review was to quantita- tively synthesize published literature on the prevalence of frailty in RA and OA and summarize current evidence on the validity and practicality of the most commonly used screening tools for frailty.
Collapse
Affiliation(s)
| | - Sonia Farah
- Clinica Reumatologica, Ospedale Carlo Urbani di Jesi, Università Politecnica delle Marche, (Ancona), Italy..
| | - Marco Di Carlo
- Clinica Reumatologica, Ospedale Carlo Urbani di Jesi, Università Politecnica delle Marche, (Ancona), Italy..
| |
Collapse
|
11
|
O’Brien MS, McDougall JJ. Age and frailty as risk factors for the development of osteoarthritis. Mech Ageing Dev 2019; 180:21-28. [DOI: 10.1016/j.mad.2019.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/28/2019] [Accepted: 03/15/2019] [Indexed: 12/31/2022]
|
12
|
Meessen JMTA, Fiocco M, Leichtenberg CS, Vliet Vlieland TPM, Slagboom PE, Nelissen RGHH. Frailty Questionnaire Is Not a Strong Prognostic Factor for Functional Outcomes in Hip or Knee Arthroplasty Patients. Geriatr Orthop Surg Rehabil 2019; 10:2151459318808164. [PMID: 30775054 PMCID: PMC6362511 DOI: 10.1177/2151459318808164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/04/2018] [Accepted: 07/11/2018] [Indexed: 01/12/2023] Open
Abstract
Introduction Up to 33% and 25% of patients with end-stage hip and knee osteoarthritis (OA) are considered frail by the Groningen Frailty Indicator (GFI). This study aims to assess whether frail patients have lower functional gains after arthroplasty and to assess GFI as a tool to discriminate between good and adverse change score. Materials and Methods Patients with end-stage hip/knee OA scheduled for arthroplasty were recruited from the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis Study. Functional outcome was measured as change score on the Hip Osteoarthritis Outcome Score/Knee Osteoarthritis Outcome Score (HOOS/KOOS), by subtracting preoperative score from 1-year postsurgery score and then dichotomized based on a cutoff of 20 points. For each HOOS/KOOS subscale, 3 models were estimated: GFI univariate (model 1), GFI and baseline score (model 2), and baseline score univariate (model 3). A receiver operating characteristic analysis was performed to assess the discriminative ability of each model. Results Eight hundred five patients with end-stage hip OA (31.4% frail) and 640 patients with end-stage knee OA (25.4% frail) were included. Frail patients were older, had a higher body mass index, had more comorbidities, and lived more often alone. Persons considered frail by GFI had significant lower baseline score; however, except for "function in sports and recreation" and "quality of life," change scores were similar in frail and nonfrail persons. The discriminatory value of GFI was negligible for all HOOS/KOOS subscales. Baseline score, however, was adequate to discriminate between total knee arthroplasty patients with more or less than twice the minimally clinically important difference on KOOS symptoms subscale (area under the curve = 0.802). Discussion/Conclusion Although frail patients with OA have lower functioning scores at baseline, the change scores on HOOS/KOOS subscales are similar for both frail and nonfrail patients. Exploring other heath assessements may improve patient-specific outcome prediction.
Collapse
Affiliation(s)
- Jennifer M T A Meessen
- Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands.,Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Marta Fiocco
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.,Mathematical Institute Leiden University, Leiden, the Netherlands
| | | | | | - P Eline Slagboom
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|