1
|
Passarelli JL, Al Hamad H. Geriatric frailty determinants in India. Aging Med (Milton) 2023; 6:450-451. [PMID: 38239712 PMCID: PMC10792337 DOI: 10.1002/agm2.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Jorge Luis Passarelli
- Geriatrics and Long‐Term Care DepartmentRumailah Hospital, Hamad Medical CorporationDohaQatar
| | - Hanadi Al Hamad
- Geriatrics and Long‐Term Care DepartmentRumailah Hospital, Hamad Medical CorporationDohaQatar
| |
Collapse
|
2
|
Orkaby AR, Huan T, Intrator O, Cai S, Schwartz AW, Wieland D, Hall DE, Figueroa JF, Strom JB, Kim DH, Driver JA, Kinosian B. Comparison of Claims-Based Frailty Indices in U.S. Veterans 65 and Older for Prediction of Long-Term Institutionalization and Mortality. J Gerontol A Biol Sci Med Sci 2023; 78:2136-2144. [PMID: 37395654 PMCID: PMC10613003 DOI: 10.1093/gerona/glad157] [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] [Received: 01/18/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Frailty is increasingly recognized as a useful measure of vulnerability in older adults. Multiple claims-based frailty indices (CFIs) can readily identify individuals with frailty, but whether 1 CFI improves prediction over another is unknown. We sought to assess the ability of 5 distinct CFIs to predict long-term institutionalization (LTI) and mortality in older Veterans. METHODS Retrospective study conducted in U.S. Veterans ≥65 years without prior LTI or hospice use in 2014. Five CFIs were compared: Kim, Orkaby (Veteran Affairs Frailty Index [VAFI]), Segal, Figueroa, and the JEN-FI, grounded in different theories of frailty: Rockwood cumulative deficit (Kim and VAFI), Fried physical phenotype (Segal), or expert opinion (Figueroa and JFI). The prevalence of frailty according to each CFI was compared. CFI performance for the coprimary outcomes of any LTI or mortality from 2015 to 2017 was examined. Because Segal and Kim include age, sex, or prior utilization, these variables were added to regression models to compare all 5 CFIs. Logistic regression was used to calculate model discrimination and calibration for both outcomes. RESULTS A total of 3 million Veterans were included (mean age 75, 98% male participants, 80% White, and 9% Black). Frailty was identified for between 6.8% and 25.7% of the cohort with 2.6% identified as frail by all 5 CFIs. There was no meaningful difference between CFIs in the area under the receiver operating characteristic curve for LTI (0.78-0.80) or mortality (0.77-0.79). CONCLUSIONS Based on different frailty constructs, and identifying different subsets of the population, all 5 CFIs similarly predicted LTI or death, suggesting each could be used for prediction or analytics.
Collapse
Affiliation(s)
- Ariela R Orkaby
- New England GRECC (Geriatric Research, Education, and Clinical Center) VA Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tianwen Huan
- Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Public Health Sciences, University of Rochester, Rochester, New York, USA
| | - Orna Intrator
- Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Public Health Sciences, University of Rochester, Rochester, New York, USA
| | - Shubing Cai
- Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Public Health Sciences, University of Rochester, Rochester, New York, USA
| | - Andrea W Schwartz
- New England GRECC (Geriatric Research, Education, and Clinical Center) VA Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Darryl Wieland
- Geriatrics and Extended Care Data and Analysis Center, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Biodemography of Aging Research Unit, Duke University, Durham, North Carolina, USA
| | - Daniel E Hall
- Center for Health Equity Research and Promotion; and Pittsburgh GRECC, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jose F Figueroa
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Boston, Massachusetts, USA
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dae H Kim
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane A Driver
- New England GRECC (Geriatric Research, Education, and Clinical Center) VA Boston Healthcare System, Boston, Massachusetts, USA
- Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce Kinosian
- Geriatrics and Extended Care Data Analysis Center and Center for Health Equity Research and Promotion, Cpl. Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Gao J, Wang Y, Xu J, Jiang J, Yang S, Xiao Q. Life expectancy among older adults with or without frailty in China: multistate modelling of a national longitudinal cohort study. BMC Med 2023; 21:101. [PMID: 36927351 PMCID: PMC10021933 DOI: 10.1186/s12916-023-02825-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Little is known about life expectancy (LE) with or without frailty. We aimed to estimate the total LE and duration of the state of frailty in China. METHODS This study included older adults aged 65 years and older from the Chinese Longitudinal Healthy Longevity Study (CLHLS). Frailty status was classified into robust, pre-frailty and frailty based on a cumulative deficit model. Total and specific frailty state LEs at 65 years of age were estimated and stratified by demographic characteristics, behaviours, and psychosocial factors using continuous-time multistate modelling. RESULTS The total LE of older adults aged 65 years in China was 14.74 years on average (95% CI: 14.52-14.94), of which 4.18 years (95% CI: 4.05-4.30) were robust, 7.46 years (95% CI: 7.31-7.61) pre-frail and 3.10 years (95% CI: 3.01-3.20) frail. Older adults with higher robust LE included men (4.71 years, 95% CI: 4.56-4.88), married older adults (4.41 years, 95% CI: 4.27-4.56), those engaging in physical activity (4.41 years, 95% CI: 4.23-4.59), those consuming fruits daily (4.48 years, 95% CI: 4.22-4.77) and those with high social participation (4.39 years, 95% CI: 4.26-4.53). Increased educational attainment were gradually associated with increased robust LE. CONCLUSIONS Frailty may lead to a reduced total LE and robust LE of older adults in China. In addition to finding inequalities in total and robust LEs by socioeconomic status, our findings also highlight that healthy behaviours and social participation may ease frailty-related reductions in total and robust LE. Our findings imply that national life-course strategies aimed at frailty screening and psychosocial and behavioural interventions could be important for health aging in China.
Collapse
Affiliation(s)
- Junling Gao
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, 200032 China
- Collaborative Innovation Cooperative Unit of National Clinical Research Center for Geriatric Diseases, Shanghai, 200032 China
- grid.452344.0Core Unit of Shanghai Clinical Research Center for Aging and Medicine, Shanghai, 200040 China
| | - Yujie Wang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, 200032 China
| | - Jixiang Xu
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, 200032 China
| | - Junjia Jiang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, 200032 China
| | - Shitong Yang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, 200032 China
| | - Qianyi Xiao
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, 200032 China
| |
Collapse
|
4
|
Hellemans L, Mertens B, Hias J, Tournoy J, Van der Linden LR. Age is just a number: the concept of time to benefit in older adults. Eur J Hosp Pharm 2023; 30:117-119. [PMID: 33863810 PMCID: PMC9986927 DOI: 10.1136/ejhpharm-2020-002561] [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: 10/12/2020] [Revised: 02/05/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022] Open
Abstract
A female nursing home resident aged >70 years was admitted to the geriatric ward with de novo dysphagia 6 days after being discharged from the stroke unit. Metformin and ezetimibe had been added to her treatment regimen which already consisted of clopidogrel, atorvastatin, denosumab, calcium and vitamin D. At the geriatric ward a multidisciplinary team involving clinical pharmacists reviewed all treatments and appraised the time to benefit, ascertaining whether there was sufficient time left to experience therapeutic benefits. As a result, metformin, ezetimibe, denosumab, calcium and vitamin D were discontinued. This case report illustrates that both mortality risk assessment and evaluation of the time to benefit should be part of any medication review in frail older adults. Conversely, with limited available data pertaining to the concept of time to benefit, we advocate a broader awareness among pharmacists and a systematic assessment in future clinical trials.
Collapse
Affiliation(s)
- Laura Hellemans
- Pharmacy Department, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Beatrijs Mertens
- Pharmacy Department, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
| | - Julie Hias
- Pharmacy Department, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Jos Tournoy
- Department of Geriatric Medicine, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Lorenz Roger Van der Linden
- Pharmacy Department, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| |
Collapse
|
5
|
Al Snih S, Chen NW, Chou LN, Markides KS, Ottenbacher KJ. Life Expectancy in Pre-Frail and Frail States with and without Disability: 18-Years of Follow-Up Data from the HEPESE Study Using the Markov Chain Method. J Frailty Aging 2023; 12:311-315. [PMID: 38008982 PMCID: PMC10682511 DOI: 10.14283/jfa.2023.37] [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] [Indexed: 11/28/2023]
Abstract
We estimated the total life expectancy (TLE), frailty-free life expectancy (FFLE), frail life expectancy (FLE), pre-frail life expectancy (PFLE), and FLE with and without disability among 2,000 Mexican Americans aged ≥67 years over an 18-year period. Frailty was defined as the presence of ≥2 criteria (weight loss, weakness, self-reported exhaustion, slowness). We used the Markov chain method to estimate the TLE, FFLE, FLE, PFLE, and FLE with and without disability by age and gender. TLE at age 67 was 17.49 years (women) and 15.54 years (men); FFLE was 6.50 years (women) and 6.45 years (men); PFLE was 6.48 years (women) and 5.42 years (men); FLE was 4.51 years (women) and 3.67 years (men); and FLE with disability was 2.13 years (women) and 1.13 years (men). In conclusion, Mexican American older women had fewer years of non-frail LE, more pre-frail or frail years, and more years with disability than men.
Collapse
Affiliation(s)
- S Al Snih
- Soham Al Snih, MD, PhD. Professor, Department of Population Health and Health Disparities. 301 University Blvd Rt. 0177. Phone: 409-266-9691. Fax: 409-772-8931.
| | | | | | | | | |
Collapse
|
6
|
van der Valk AM, Theou O, Wallace LM, Andrew MK, Godin J. Physical demands at work and physical activity are associated with frailty in retirement. Work 2022; 73:695-705. [DOI: 10.3233/wor-210859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The relationship between occupational physical activity and frailty is complex and understudied. OBJECTIVE: We explore whether moderate-vigorous physical activity (MVPA) in retirement and main lifetime occupation physical demands (OPD) are associated with frailty in retirement. METHODS: Retired adults aged 50 + who participated in waves 3-4 of the Survey of Health, Ageing and Retirement in Europe were included. We constructed a 65-item frailty index (FI; Wave 4). Linear regressions tested the independent associations between OPD (Wave 3) and retirement MVPA (Wave 4) with FI (B: 95% CI) controlling for occupation characteristics (Wave 3) and demographics (Wave 4). These models were repeated across country groups (Nordic; Mediterranean; Continental) and sexes. RESULTS: We included 8,411 adults (51.1% male) aged 72.4 years (SD 8.0). Frequent MVPA was consistently associated with lower FI (-0.09 : 0.10–-0.08, p < .001) while OPD was associated with higher FI (0.02 : 0.01-0.03, p < .001). The MVPA*OPD interaction (-0.02: -0.04–-0.00, p = .043) was weakly associated with FI, but did not explain additional model variance or was significant among any country group or sex. CONCLUSIONS: For a sample of European community-dwelling retirees, a physically demanding main lifetime occupation independently predicts worse frailty, even in individuals who are physically active in retirement.
Collapse
Affiliation(s)
| | - Olga Theou
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
- Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Lindsay M.K. Wallace
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
| | - Melissa K. Andrew
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
| | - Judith Godin
- Geriatric Medicine Research, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
7
|
Meinow B, Li P, Jasilionis D, Oksuzyan A, Sundberg L, Kelfve S, Wastesson JW. Trends over two decades in life expectancy with complex health problems among older Swedes: implications for the provision of integrated health care and social care. BMC Public Health 2022; 22:759. [PMID: 35421981 PMCID: PMC9012017 DOI: 10.1186/s12889-022-13099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. METHODS CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n≈2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP. RESULTS Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%). CONCLUSIONS The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.
Collapse
Affiliation(s)
- Bettina Meinow
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden. .,Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Peng Li
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Anna Oksuzyan
- Max Planck Institute for Demographic Research, Rostock, Germany.,Chair of Demography and Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Louise Sundberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Susanne Kelfve
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Division of Ageing and Social Change, Department of Culture and Society, Linköping University, Linköping, Sweden
| | - Jonas W Wastesson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| |
Collapse
|
8
|
Solé-Auró A, Deeg DJH. New thinking about health expectancy: introduction to the special section. Eur J Ageing 2021; 18:439-441. [PMID: 34790083 PMCID: PMC8563872 DOI: 10.1007/s10433-021-00630-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Aïda Solé-Auró
- DemoSoc Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, C/Ramon Trias Fargas, 25-27, 08005 Barcelona, Spain
| | - Dorly J. H. Deeg
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Education, wealth, and duration of life expected in various degrees of frailty. Eur J Ageing 2021; 18:393-404. [PMID: 34483803 DOI: 10.1007/s10433-020-00587-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 10/21/2022] Open
Abstract
Multistate life tables are used to estimate life expected in three frailty states: frailty free, mild/moderate frailty, severe frailty. Estimates are provided for the combination of education and wealth by age, stratified by sex. Data consider 17,115 cases from the Health and Retirement Study, 2000-2014. Frailty is measured using a 59 item frailty index based on deficit accumulation. Estimates are derived using stochastic population analysis for complex events. Population-based and status-based results are reported. Findings confirm a hypothesis that the combination of higher education and wealth results in longer lives in more favorable degrees of frailty. Also, as hypothesized, wealth generally affords a greater advantage than does education among those with severe frailty at baseline. For instance, high wealth provides a 70-year-old woman with severe frailty at baseline 0.70 more total years and 0.81 more frailty free years then her counterpart with low wealth, compared to gains of 0.39 and 0.54, respectively, for those with high education. Unexpectedly, wealth also has a greater role among those frailty free at baseline. A 70-year-old woman frailty free at baseline with high wealth lives 3.19 more net years and 4.13 more years frailty free than her counterpart with low wealth, while the same comparison for high versus low education indicates advantages of 2.00 total and 1.96 frailty free years. Relative change ratios also indicate more robust results for wealth versus education. In sum, there is evidence that inequality in duration of life in degrees of frailty is socially patterned.
Collapse
|
10
|
Nielsen CR, Ahrenfeldt LJ, Jeune B, Christensen K, Lindahl-Jacobsen R. Healthy life expectancy by frailty state in Europe from 2004 to 2015: findings from SHARE. Eur J Public Health 2021; 31:554-560. [PMID: 33615329 PMCID: PMC8485734 DOI: 10.1093/eurpub/ckab012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As populations age, the possible consequences of increased frailty are a major concern for the health sector. Here, we investigate how life expectancy with and without frailty has changed during a 10-11-year-period across Europe. METHODS The Sullivan method was used to investigate changes in life expectancy with and without frailty in 10 European countries. Frailty status (non-frail, pre-frail and frail) was determined by use of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI). Data on frailty prevalence was obtained from 21 698 individuals in wave 1 (2004-05) and 38 859 individuals in wave 6 (2015) of the SHARE. Information on mortality was obtained from the Eurostat Database. RESULTS In 2015, women aged 70 spent 25.0% (95% CI: 24.0-26.1) of their remaining life expectancy in a frail state, and the number for men was 11.5% (95% CI: 10.7-12.3). Southern Europeans spent 24.2% (95% CI: 22.9-25.4) of their remaining life expectancy in a frail state and the numbers for Central Europeans and Northern Europeans were 17.0% (95% CI: 16.0-17.9) and 12.2% (95% CI: 10.9-13.5), respectively. From 2004-05 to 2015, life expectancy increased by 1.1 years (from 15.3 to 16.4 years) for 70-year-old Europeans. Similarly, non-frail life expectancy increased by 1.1 years (95% CI: 0.8-1.4), whereas no significant changes in life expectancy in frail states were observed. CONCLUSIONS This study suggests that Europeans today spend more years in a non-frail state than Europeans did 10-11 years ago. Our findings reflect a considerable inequality by gender and region.
Collapse
Affiliation(s)
- Camilla Riis Nielsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Interdisiciplinary Center on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Bernard Jeune
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Interdisiciplinary Center on Population Dynamics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
11
|
Faateh M, Kuo PL, Dakour-Aridi H, Aurshina A, Locham S, Malas M. Frailty as a predictor of outcomes for patients undergoing carotid artery stenting. J Vasc Surg 2021; 74:1290-1300. [PMID: 33887428 DOI: 10.1016/j.jvs.2021.03.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 03/18/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The concept of frailty has been proposed to capture the vulnerability resulting from aging and has been implemented for the prediction of perioperative outcomes. Carotid artery stenting (CAS) is considered an appropriate minimally invasive procedure for patients considered to high risk to undergo carotid endarterectomy. Recently, the predictive accuracy for perioperative outcomes using the five-item modified frailty index (5mFI) has been reported to be relatively poor for cardiovascular surgery compared with other surgeries. The effects of functional status and the 5mFI on the outcomes after CAS remain unknown. Thus, in the present study, we investigated the relationship between 5mFI, functional status, and perioperative outcomes. METHODS All the patients who had undergone CAS in the Vascular Quality Initiative from November 15, 2016 to December 31, 2018 were included. Good functional status was defined as the ability to perform all predisease activities without restriction using a new variable added to the Vascular Quality Initiative from November 15, 2016 onward. The 5mFI was calculated using functional status and a history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. The perioperative outcomes included in-hospital stroke or death within 30 days after CAS, a prolonged postoperative stay (≥2 days), and non-home discharge. The associations between functional status, 5mFI, and perioperative outcomes were examined using univariate and multivariable logistic regression, adjusting for sex, age, race, degree of stenosis, symptomatic status, and the usage of preoperative medications. An analysis stratified by functional status was also performed. RESULTS Of the 7836 patients, 188 (2.4%) had experienced perioperative stroke or death, 765 (9.8%) had required a non-home discharge, and 2584 (33.0%) had required a prolonged postoperative stay. A higher (≥0.6 vs <0.6) 5mFI score was associated with greater odds of perioperative stroke or death (adjusted odds ratio [aOR], 2.75; 95% confidence interval [CI], 1.42-5.28; P = .003), non-home discharge (aOR, 2.70; 95% CI, 1.89-3.85; P < .001), and a prolonged postoperative length of stay (aOR, 1.96; 95% CI, 1.56-2.46; P < .001). For the predictive accuracy of the perioperative outcomes, the 5mFI model had an area under the curve for in-hospital stroke or death, non-home discharge, and prolonged postoperative length of stay of 0.714, 0.767, and 0.668, respectively. The functional status model was not inferior to the 5mFI model for any of these outcomes. In the subgroup analysis, of the asymptomatic patients, a higher 5mFI score was associated with greater odds of perioperative stroke or death (aOR, 7.08; 95% CI, 2.02-24.48; P = .002), non-home discharge (aOR, 5.87; 95% CI, 2.45-13.90; P < .001), and a prolonged postoperative stay (aOR, 2.60; 95% CI, 1.82-3.71; P < .001). CONCLUSIONS Frailty, as measured using the 5mFI, and functional status were independent predictors of perioperative stroke or death, non-home discharge, and an increased length of stay for patients undergoing CAS. These results were greatly pronounced in asymptomatic patients. The results from the present study, thus, caution against the use of CAS for asymptomatic frail patients.
Collapse
Affiliation(s)
- Muhammad Faateh
- Department of General Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Pei-Lun Kuo
- Division of Vascular Surgery, Johns Hopkins University, Baltimore, Md
| | - Hanaa Dakour-Aridi
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, La Jolla, Calif
| | - Afsha Aurshina
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, La Jolla, Calif
| | - Satinderjit Locham
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, La Jolla, Calif
| | - Mahmoud Malas
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, La Jolla, Calif.
| |
Collapse
|
12
|
Fritz H, Hu YL, Tarraf W, Patel P. Feasibility of a Habit Formation Intervention to Delay Frailty Progression Among Older African Americans: A Pilot Study. THE GERONTOLOGIST 2020; 60:1353-1363. [PMID: 31688909 DOI: 10.1093/geront/gnz143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Older African Americans are at high risk for becoming frail in later life. Interventions can reverse or delay frailty, yet African Americans have largely been excluded from such research. Many interventions are also time- and resource-intensive, and thus inaccessible to socially disadvantaged older African Americans. We evaluated the feasibility of a low-dose frailty prevention intervention integrated with primary care among 60 community-dwelling, prefrail older African Americans aged 55+ recruited from a primary care clinic. RESEARCH DESIGN AND METHODS We conducted a 2-arm randomized control trial. Participants were assigned to a 4-session intervention (1 session per month), delivered by an occupational therapist, or enhanced usual care. Feasibility criteria were set a priori at 75% for participant retention (including attrition due to death/hospitalization), 80% for session engagement, 2 participants/week for mean participant accrual, and 90% for program satisfaction. RESULTS Participants were 65% female with an average age of 76.6 years, 51.7% lived alone and 39.1% reported <$10,000 in yearly income. Feasibility metrics were met. The study recruited, a mean of, 2.5 participants per week and retained 75% of participants who attended 95% of scheduled sessions. The mean satisfaction score was 29.75 (range = 0-32; SD .25). Changes in physical activity and dietary habit formation as well as changes in secondary outcomes were largely in the expected direction. DISCUSSION AND IMPLICATIONS The intervention was feasible to deliver. Qualitative findings from exit interviews suggested changes to the program dose, structure, and content that could improve it for future use.
Collapse
Affiliation(s)
- Heather Fritz
- Institute of Gerontology, Detroit, Michigan.,Eugene Applebaum College of Pharmacy and Health Care Sciences, Department of Health Care Sciences, Detroit, Michigan
| | - Yi-Ling Hu
- Institute of Gerontology, Detroit, Michigan.,Eugene Applebaum College of Pharmacy and Health Care Sciences, Department of Health Care Sciences, Detroit, Michigan
| | - Wassim Tarraf
- Institute of Gerontology, Detroit, Michigan.,Eugene Applebaum College of Pharmacy and Health Care Sciences, Department of Health Care Sciences, Detroit, Michigan
| | - Pragnesh Patel
- School of Medicine, Wayne State University, Detroit, Michigan
| |
Collapse
|
13
|
Abstract
Objective: To examine whether we live healthier as we live longer in Hong Kong, which has one of the highest life expectancies in the world. Methods: Sullivan's method was used to evaluate the chronic disease-free life expectancy (CDFLE), life expectancy in good self-perceived health (GPHLE), and impairment-free life expectancy (IFLE) among population aged 50 years and older in Hong Kong in 2007-2016. Results: In spite of the marked improvement in life expectancy in Hong Kong, the increase in GPHLE was much smaller, while CDFLE and IFLE even declined for both genders. The situation was more severe among older population. Discussion: People in Hong Kong live longer but with worsening health. The expansion of chronic diseases, self-perceived poor health, and impairments among older adults calls for more fiscal investments, government attention, and public health policies.
Collapse
Affiliation(s)
- Yan Zheng
- Department of Social Work and Social Administration, Faculty of Social Sciences, 25809The University of Hong Kong, Hong Kong
| | - Karen Siu Lan Cheung
- Mindlink Research Centre, Hong Kong.,Sau Po Centre on Ageing, 25809The University of Hong Kong, Hong Kong
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, 25809The University of Hong Kong, Hong Kong.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, 25809The University of Hong Kong, Hong Kong
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Alves LC, Andrade FCD, Corona LP, Santos JLF, Duarte YADO. Inequalities in Life Expectancy With Frailty Among Brazilian Older Adults: A Multistate Approach. Innov Aging 2019; 3:igz032. [PMID: 31528717 PMCID: PMC6736330 DOI: 10.1093/geroni/igz032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 01/05/2023] Open
Abstract
Background and Objectives Frailty is considered one of the major conditions faced by aging societies. Little has been reported about the effect of becoming frail on life expectancy among older adults in developing countries. The aim was to estimate total life expectancy and life expectancy with or without frailty by age, sex, and education among older adults in Brazil. Data and Methods: The study was developed based on information provided by the Health, Well-being, and Aging (SABE) Study. The sample included 1,399 older adults (≥60 years old) followed up from 2006 to 2010. Frailty status was classified according to the Fried criteria. Additional variables include age (in years), gender, and years of education. Estimates of total life expectancy, frailty-free life expectancy, and frailty life expectancy were obtained using the multistate life table method. Results At the baseline, the proportion of individuals with frailty was 13.7% and participants had, on average, 4.0 years of education. Men had more years of education than women (4.6 vs. 3.7, p < .001). Older adults with higher education live fewer years with frailty. Compared with older adults with no education, those with 6 years of education have higher frailty-free life expectancy. At age 70, men with no education expect to live 9.1 years (95% confidence interval [CI] = 7.8, 10.4) without frailty compared with 10.6 years (95% CI = 9.4, 11.8) among those with 6 years of education. Among women age 70, frailty-free life expectancy reaches 11.7 years (95% CI = 10.6, 12.8) among those with no education, but 13.9 years (95% CI = 12.5, 15.3) among those with 6 years. Implications Given the recent changes in educational achievement in Brazil, we believe that educational policies are powerful ways in addressing inequalities in healthy life expectancy. Public health policies aimed at avoiding the development of frailty among elderly at risk should be encouraged.
Collapse
Affiliation(s)
- Luciana Correia Alves
- Department of Demography, Institute of Philosophy and Human Sciences (IFCH), University of Campinas (UNICAMP), Brazil
| | | | | | | | | |
Collapse
|
16
|
Abbasi M, Khera S, Dabravolskaj J, Vandermeer B, Theou O, Rolfson D, Clegg A. A cross-sectional study examining convergent validity of a frailty index based on electronic medical records in a Canadian primary care program. BMC Geriatr 2019; 19:109. [PMID: 30991943 PMCID: PMC6469123 DOI: 10.1186/s12877-019-1119-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/27/2019] [Indexed: 12/01/2022] Open
Abstract
Background An electronic frailty index (eFI) has been developed and validated in the UK; it uses data from primary care electronic medical records (EMR) for effective frailty case-finding in primary care. This project examined the convergent validity of the eFI from Canadian primary care EMR data with a validated frailty index based on comprehensive geriatric assessment (FI-CGA), in order to understand its potential use in the Canadian context. Methods A cross-sectional validation study, using data from an integrated primary care research program for seniors living with frailty in Edmonton, AB. Eighty-five patients 65 years of age and older from six primary care physicians’ practices were recruited. Patients were excluded if they were under 65 years of age, did not provide consent to participate in the program, or were living in a long term care facility at the time of enrolment. We used scatter plots to assess linearity and Pearson correlation coefficients to examine correlations. Results Results indicate a strong statistically significant correlation between the eFI and FI-CGA (r = 0.72, 95% CI 0.60–0.81, p < 0.001). A simple linear regression showed good ability of the eFI scores to predict FI-CGA scores (F (1,83) = 89.06, p < .0001, R2 = 0.51). Both indices were also correlated with age, number of chronic conditions and number of medications. Conclusions The study findings support the convergent validity of the eFI, which further justifies implementation of a case-finding tool that uses routinely collected primary care data in the Canadian context.
Collapse
Affiliation(s)
- Marjan Abbasi
- Department of Family Medicine, University of Alberta, Suite 205 College Plaza, 8215 - 112 St, Edmonton, AB, T6G 2C8, Canada.
| | - Sheny Khera
- Department of Family Medicine, University of Alberta, Suite 205 College Plaza, 8215 - 112 St, Edmonton, AB, T6G 2C8, Canada
| | - Julia Dabravolskaj
- School of Public Health, University of Alberta, 8303 112 St NW, Edmonton, AB, T6G 2T4, Canada
| | - Ben Vandermeer
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, 5955 Veterans' Memorial Lane, Rm 1313, CHVMB, Halifax, B3H2E1, Nova Scotia, Canada
| | - Darryl Rolfson
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, 1-198 Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB, T6G 2P4, Canada
| | - Andrew Clegg
- NIHR CLAHRC Older People's Theme Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| |
Collapse
|