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Liu Y, Huang L, Hu F, Zhang X. Frailty, polypharmacy, malnutrition, chronic conditions, and quality of life in the elderly: Large population-based study. JMIR Public Health Surveill 2024. [PMID: 39145920 DOI: 10.2196/50617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Aging, a significant public health issue, is associated with multiple concurrent chronic diseases and aging-related conditions (geriatric syndromes). OBJECTIVE To investigate the impact of age and chronic conditions on geriatric syndromes and the intercorrelations between multiple geriatric syndromes and quality of life (QoL) in the elderly (≥65 years) at the population level. METHODS A large representative sample was randomly selected from a county with 17 towns and 811,867 residents, with multiple chronic conditions, geriatric syndromes (frailty, polypharmacy, and malnutrition), and QoL assesses and compared between geriatric and nongeriatric populations and among subgroups of the elderly. Associations of demographic information and chronic conditions with geriatric conditions and QoL in the elderly were assessed using multivariable-adjusted logistic regression. Intercorrelations between age, multiple geriatric syndromes, and QoL were investigated using both correlation analysis and restricted cubic splines (RCS)-based multivariable-adjusted dose-response analysis. RESULTS Elderly people comprised 43.4% of the whole population, and prevalence of frailty, (pre-)malnutrition, polypharmacy, and impaired QoL among the elderly (median age, 73 years; male proportion, 51.0%) was 8.3%, 15.6%, 3.2%, and 10.8%, respectively. Prevalence of geriatric syndromes mostly did not significantly differ among different age subgroups of the elderly (except that frailty occurred more often with older age) or by gender. (Pre-)malnutrition was significantly associated with less often obesity and more frequent constipation, polypharmacy with more often diabetes and constipation, frailty with more frequent constipation and hernia, and impaired QoL with more often hypertension, diabetes, physical disability, and constipation. MNA-SF, GFI, and EQ-5D-5L scores and number of drugs used mostly significantly predicted the other geriatric syndromes and QoL. Impaired QoL was significantly associated with more often frailty, (pre-)malnutrition, and polypharmacy, and frailty with more frequent (pre-)malnutrition and polypharmacy. At 1.5-year follow-up, impaired QoL was significantly linked to polypharmacy and frailty at baseline; (pre-)malnutrition was significantly associated with frailty at baseline; polypharmacy was significantly linked to frailty at baseline; frailty was significantly linked to both (pre-)malnutrition and polypharmacy at baseline. Causal mediation analyses showed that frailty mediated the linkage between polypharmacy and worse QoL, and also that polypharmacy mediated the linkage between frailty and worse QoL. CONCLUSIONS In this large population-based study of the elderly with prospective follow-up, multiple chronic conditions were associated with one or more of the investigated geriatric syndromes. Geriatric syndromes were mostly significantly intercorrelated with and well predictive of each other and QoL, and there existed causal relationships between geriatric syndromes and QoL with other geriatric syndromes being mediators. The findings might be subject to some bias due to residual confounding factors not available in the dataset. It would be important to perform personalized geriatric syndromes stratified by chronic conditions, and active prevention or intervention of any syndrome might help to reduce the others and improve QoL. CLINICALTRIAL
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Affiliation(s)
- Yunmei Liu
- School of Cultural Heritage and Information Management, Shanghai University, Shanghai, CN
| | - Lei Huang
- National Key Laboratory of Immunity and Inflammation, Changhai Clinical Research Unit, The First Affiliated Hospital of Naval Medical University/Changhai Hospital, Naval Medical University, Shanghai, CN
- Department of Gastroenterology, Shanghai Institute of Pancreatic Diseases, The First Affiliated Hospital of Naval Medical University/Changhai Hospital, Naval Medical University, Shanghai, CN
| | - Fei Hu
- Department of General Surgery, Feidong People's Hospital, East District of the First Affiliated Hospital of Anhui Medical University, Cuozhen Road 20, Dianpu Town, Hefei 231600, Anhui Province, China, Hefei, CN
| | - Xiuwen Zhang
- Department of General Surgery, Feidong People's Hospital, East District of the First Affiliated Hospital of Anhui Medical University, Cuozhen Road 20, Dianpu Town, Hefei 231600, Anhui Province, China, Hefei, CN
- School of Clinical Medicine, Anhui Medical University, Hefei, CN
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Samper-Ternent R, Razjouyan J, Dindo L, Halaszynski J, Silva J, Fried T, Naik AD. Patient Priorities Care Increases Long-Term Service and Support Use: Propensity Match Cohort Study. J Am Med Dir Assoc 2024; 25:751-756. [PMID: 38320742 PMCID: PMC11137700 DOI: 10.1016/j.jamda.2023.12.014] [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: 07/18/2023] [Revised: 12/11/2023] [Accepted: 12/25/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Patient priorities care (PPC) is an evidence-based approach designed to help patients achieve what matters most to them by identifying their health priorities and working with clinicians to align the care they provide to the patient's priorities. This study examined the impact of the PPC approach on long-term service and support (LTSS) use among veterans. DESIGN Quasi-experimental study examining differences in LTSS use between veterans exposed to PPC and propensity-matched controls not exposed to PPC adjusting for covariates. SETTING AND PARTICIPANTS Fifty-six social workers in 5 Veterans Health Administration (VHA) sites trained in PPC in 2018, 143 veterans who used the PPC approach, and 286 matched veterans who did not use the PPC approach. METHODS Veterans with health priorities identified through the PPC approach were the intervention group (n = 143). The usual care group included propensity-matched veterans evaluated by the same social workers in the same period who did not participate in PPC (n = 286). The visit with the social worker was the index date. We examined LTSS use, emergency department (ED), and urgent care visits, 12 months before and after this date for both groups. Electronic medical record notes were extracted with a validated natural language processing algorithm (84% sensitivity, 95% specificity, and 92% accuracy). RESULTS Most participants were white men, mean age was 76, and 30% were frail. LTSS use was 48% higher in the PPC group compared with the usual care group [odds ratio (OR), 1.48; 95% CI, 1.00-2.18; P = .05]. Among those who lived >2 years after the index date, new LTSS use was higher (OR, 1.69; 95% CI, 1.04-2.76; P = .036). Among nonfrail individuals, LTSS use was also higher in the PPC group (OR, 1.70; 95% CI, 1.06-2.74; P = .028). PPC was not associated with higher ED or urgent care use. CONCLUSIONS AND IMPLICATIONS PPC results in higher LTSS use but not ED or urgent care in these veterans. LTSS use was higher for nonfrail veterans and those living longer. The PPC approach helps identify health priorities, including unmet needs for safe and independent living that LTSS can support.
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Affiliation(s)
- Rafael Samper-Ternent
- Department of Management, Policy, and Community Health, UTHealth Houston, Houston, TX, USA; Institute on Aging, UTHealth Houston, Houston, TX, USA.
| | - Javad Razjouyan
- VA Health Services Research and Development Service, Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, USA
| | - Lilian Dindo
- VA Health Services Research and Development Service, Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jaime Halaszynski
- Social Work Service, Butler VA Health Care System, Butler, PA, USA; VA National Social Work Program, Care Management and Social Work Services, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
| | - Jennifer Silva
- VA National Social Work Program, Care Management and Social Work Services, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA; Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Terri Fried
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA; Connecticut Veterans Administration Health System, West Haven, CT, USA
| | - Aanand D Naik
- Department of Management, Policy, and Community Health, UTHealth Houston, Houston, TX, USA; Institute on Aging, UTHealth Houston, Houston, TX, USA; VA Health Services Research and Development Service, Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Sun Y, Guo N, Zhang M, Liu M, Gao Z, Sun T, Gao X, Xu L, Zhang H, Wei C, Liu P, Liu Y, Zhang X, Guo Y, Chen L, Zhou Z, Su Z, Hu Y, Shi X, Huang L, Wang Y. Association between preoperative frailty and myocardial injury after noncardiac surgery in geriatric patients: study protocol for a prospective, multicentre, real-world observational, cohort trial. BMC Geriatr 2024; 24:271. [PMID: 38504166 PMCID: PMC10953137 DOI: 10.1186/s12877-024-04847-z] [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: 06/14/2023] [Accepted: 02/24/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Frailty has become a worldwide health burden that has a large influence on public health and clinical practice. The incidence of frailty is anticipated to increase as the ageing population increases. Myocardial injury after noncardiac surgery (MINS) is associated with short-term and long-term mortality. However, the incidence of MINS in frail geriatric patients is unknown. METHODS AND ANALYSIS This prospective, multicentre, real-world observational cohort study will be conducted at 18 designated centres in China from January 2023 to December 2024, with an anticipated sample size of 856 patients aged 65 years and older who are scheduled to undergo noncardiac surgery. The primary outcome will be the incidence of MINS. MINS is defined as a fourth-generation plasma cardiac troponin T (cTnT) concentration ≥ 0.03 ng/mL exhibited at least once within 30 days after surgery, with or without symptoms of myocardial ischaemia. All data will be collected via electronic data acquisition. DISCUSSION This study will explore the incidence of MINS in frail patients. The characteristics, predictive factors and 30-day outcomes of MINS in frail patients will be further investigated to lay the foundation for identifying clinical interventions. CLINICAL TRIAL REGISTRATION https://beta. CLINICALTRIALS gov/study/NCT05635877 , NCT05635877.
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Affiliation(s)
- Yongtao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Na Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Mengjie Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Zhongquan Gao
- Department of Anesthesiology, Shandong Public Health Clinical Center, Shandong University, Shandong, 250013, China
| | - Tao Sun
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Xiaojun Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Lingling Xu
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Haixia Zhang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Chuansong Wei
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Peng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Yang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Xiaoning Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Yongle Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Lina Chen
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Zheng Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Zhenqiang Su
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Yanmei Hu
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Xin Shi
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Linlin Huang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China.
| | - Yuelan Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, 250021, China.
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China.
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Arévalo Lorido JC, Carretero Gomez J, Vazquez Rodriguez P, Gómez Huelgas R, Marín Silvente C, Sánchez Lora FJ, Isaba Ares E, Pardo I Pelegrín A, Pérez Hernández O, Ena J. Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty. Eur J Intern Med 2024; 121:103-108. [PMID: 37872036 DOI: 10.1016/j.ejim.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
AIM This work aims to characterize the clinical profile of individuals with frailty syndrome, diabetes mellitus (DM), and hyperglycemia during hospitalization in regard to glycemic control and treatment regimen. METHODS This cross-sectional multicentric study included patients with DM or hyperglycemia at admission. Demographic data, blood glucose values, treatment administered during hospitalization, and treatment indicated at discharge were analyzed. The sample was divided into three groups according to score on a frailty questionnaire. Generalized additive models were used to describe the relationship between either glycemic variability (GV) or minimum capillary blood glucose and hypoglycemia. Models were adjusted for age, comorbidity, and sarcopenia. RESULTS A total of 1,137 patients were analyzed. Patients with frailty syndrome had more comorbidity and sarcopenia, worse renal function, and lower albumin and lymphocyte levels. A GV between 21% and 60% was related to a higher probability of hypoglycemia, especially in patients with frailty. Regarding minimum capillary blood glucose, patients with frailty had the highest probability of hypoglycemia. This probability remained significant even in the group with frailty in which, with a reference value of 200 mg/dl, the adjusted odds ratio of a minimum capillary blood glucose of 151 mg/dL was 1.08 (95% confidence interval (1.12-1.05)). Baseline treatments showed a significant predominance of insulin use in the frailest groups. CONCLUSIONS Patients with frailty had more sarcopenia and undernourishment. These patients were managed in a similar manner during hospitalization to patients without frailty, despite their higher risk of hypoglycemia according to GV or minimum capillary blood glucose levels.
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Affiliation(s)
| | - Juana Carretero Gomez
- Internal Medicine Service, Hospital Universitario de Badajoz, Avda de Elvas, s/n, Badajoz 06080, Spain.
| | | | - Ricardo Gómez Huelgas
- Internal Medicine Service, Hospital Universitario de Málaga, Av. de Carlos Haya, 84, Málaga 29010, Spain
| | - Carmen Marín Silvente
- Internal Medicine Service, Hospital General Universitario Morales Meseguer, Av. Marqués de Los Vélez, s/n, Murcia 30008, Spain
| | | | - Elena Isaba Ares
- Internal Medicine Service, Hospital Universitario de Móstoles, C. Dr. Luis Montes, s/n, Móstoles, Madrid 28935, Spain
| | - Anna Pardo I Pelegrín
- Internal Medicine Service, Hospital Sant Rafael, Pg. de la Vall d'Hebron, 107, Barcelona 08035, Spain
| | - Onán Pérez Hernández
- Internal medicine Service, Hospital Universitario Nuestra Señora de la Candelaria, Ctra. Gral. del Rosario, 145, Santa Cruz de Tenerife 38010, Spain
| | - Javier Ena
- Internal Medicine Service, Hospital Marina Baixa, Av. Alcalde En Jaume Botella Mayor, 7, Villajoyosa, Alicante 03570, Spain
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Lin YC, Yan HT. Dietary Sodium Restriction and Frailty among Middle-Aged and Older Adults: An 8-Year Longitudinal Study. Nutrients 2024; 16:580. [PMID: 38474709 DOI: 10.3390/nu16050580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Frailty is a common geriatric syndrome. However, there is little information about the relationship between dietary sodium restriction (DSR) and frailty in later life. This study aimed to elucidate the relationship between DSR and frailty in middle-aged and older adults. The 8-year follow-up data from the Taiwan Longitudinal Study on Aging, including 5131 individuals aged ≥50 years, were analyzed using random-effects panel logit models. DSR was evaluated by assessing whether the participants were told by a physician to reduce or avoid sodium intake from food. Three indices were used to measure frailty: the Study of Osteoporotic Fractures (SOF) index, the Fried index, and the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) index. Individuals with DSR were more likely to report frailty compared with those with non-DSR (SOF: adjusted odds ratio [AOR] = 1.82, 95% confidence interval [CI] = 1.46-2.27; Fried: AOR = 2.55, 95% CI = 1.64-3.98; FRAIL: AOR = 2.66, 95% CI = 1.89-3.74). DSR was associated with a higher likelihood of SBF (AOR = 2.61, 95% CI = 1.61-4.22). We identified a temporal trajectory in our study, noting significant participant reactions to both short- and mid-term DSR. Future research should address the balance between frailty risk and cardiovascular risk related to DSR.
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Affiliation(s)
- Yu-Chun Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung City 40447, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung City 40402, Taiwan
| | - Huang-Ting Yan
- Institute of Political Science, Academia Sinica, Taipei City 11529, Taiwan
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Genzel D, Katz LH, Safadi R, Rozenberg A, Milgrom Y, Jacobs JM, Shafrir A. Patients with low ALT levels are at increased risk for severe COVID-19. Front Med (Lausanne) 2023; 10:1231440. [PMID: 37828943 PMCID: PMC10566294 DOI: 10.3389/fmed.2023.1231440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/21/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Frailty is a known risk factor for many diseases, including COVID-19. However, many frail patients are undiagnosed as the diagnosis can be cumbersome. Alanine transaminase (ALT) is found not only in the liver but also in the muscle tissue, and multiple studies show that frail sarcopenic patients have lower ALT. Frail patients are at increased risk for severe COVID-19. We evaluated the association between pre-infection low ALT and the risk for severe COVID-19. Methods We collected data regarding all subjects tested for SARS-CoV-2 between 1 March 2020 and 31 December 2021 from a national state-mandatory HMO in Israel, serving more than 1.3 million patients. Clinical and laboratory data were collected, including ALT from the year prior to infection. Severe COVID-19 was defined either as death, ICU admission, or ≥10 hospitalization days. Patients with low ALT (ALT ≤ 10 IU/l) were compared with patients with normal ALT (11-40 IU/l). Patients younger than 18 years with a diagnosis of liver disease and with ALT > 40 IU/l were excluded. Results During the study period, 58,961 patients tested positive for SARS-CoV-2. The patients in the low ALT group were younger (40.53 vs. 42.73, p < 0.001), less likely to be males (12.3 vs. 38.7%, p < 0.001), and had lower BMI (25.97 vs. 27.15, p < 0.001). The patients in the low ALT group had higher mortality (2.36 vs. 0.57%, p < 0.001), more ICU hospitalizations (0.49 vs. 0.41%, p = 0.47), and more prolonged hospitalizations [2.63% (95% CI 2-3.2%) vs. 0.98% (95% CI 0.86-1.1%) p < 0.001]. In multivariate logistic regression analyses, low ALT was associated with an increased risk of severe COVID-19, with increased mortality (OR 1.88, 95% CI 1.37-2.56) and prolonged hospitalization (OR 1.78, 95% CI 1.33-2.35). Conclusion Low ALT level prior to infection is a significant risk factor for morbidity and mortality from COVID-19 infection. Further studies are warranted to address treatment options for this population.
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Affiliation(s)
- Dor Genzel
- Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior H. Katz
- Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
- Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rifaat Safadi
- Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
- Liver Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aliza Rozenberg
- Geriatrics and Geriatric Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Milgrom
- Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
- Liver Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jeremy M. Jacobs
- Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
- Geriatrics and Geriatric Rehabilitation, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asher Shafrir
- Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel
- Gastroenterology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Meuhedet Health Maintenance Organization, Tel Aviv, Israel
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Kaskirbayeva D, West R, Jaafari H, King N, Howdon D, Shuweihdi F, Clegg A, Nikolova S. Progression of frailty as measured by a cumulative deficit index: A systematic review. Ageing Res Rev 2023; 84:101789. [PMID: 36396032 DOI: 10.1016/j.arr.2022.101789] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Frailty is a risk factor for adverse health outcomes. There is a paucity of literature on frailty progression defined by a cumulative deficit model among community dwelling older people. The objective of this review was to synthesise evidence on these changes in health and mortality among community-dwelling older people. METHODS Six databases (Medline, Embase, CINAHL, Cochrane, PsycInfo, Web of Science) and a clinical trials registry were searched in July 2021. The inclusion criteria were studies using a frailty index and providing information on transition between frailty states or to death in community-dwelling older people aged ≥ 50. Exclusion criteria were studies examining specific health conditions, conference abstracts and non-English studies. To standardise the follow-up period and facilitate comparison, we converted the transition probabilities to annual transition rates. RESULTS Two reviewers independently screened 5078 studies and 61 studies were included for analysis. Of these, only three used the same frailty state cut-points to facilitate cross-cohort comparison. This review found that frailty tends to increase with time, people who are frail at baseline have greater likelihood to progress in frailty and die, and the main factor that accelerates frailty progression is age. Other risk factors for progression are having chronic disease, smoking, obesity, low-income or/and low-education levels. A frailty index is an accurate predictor of adverse outcomes and death. DISCUSSION This systematic review demonstrated that worsening in frailty was a common frailty transition, and older people who are frail at baseline are more likely to die. A frailty index has significant power to predict adverse health outcomes. It is a useful tool for within-cohort comparison but there are challenges comparing different cohorts due to dependence of frailty progression on age and differences in how frailty index is defined and measured.
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Affiliation(s)
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hussain Jaafari
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Natalie King
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew Clegg
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Li X, Schöttker B, Holleczek B, Brenner H. Association of longitudinal repeated measurements of frailty index with mortality: Cohort study among community-dwelling older adults. EClinicalMedicine 2022; 53:101630. [PMID: 36119560 PMCID: PMC9475257 DOI: 10.1016/j.eclinm.2022.101630] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Frailty indices (FIs), defined by accumulation of health deficits, have been shown to be strongly related to mortality in older adults. However, previous studies mostly relied on FI measurement at a single point of time. We aimed to investigate the association of frailty with mortality according to longitudinal repeated measurements of FI in a large population-based cohort study in Germany. METHODS Among 9912 men and women aged 50-75 years living in Saarland, Germany and recruited in the ESTHER study in 2000-2002, a FI based on 30 deficits was determined at baseline, 2-, 5-, 8-, and 11-year follow-up. Hazard ratios (HRs) were calculated to assess the associations of FI with all-cause mortality and cause-specific mortality during 14 years of follow-up using Cox proportional hazards models that included FI as a time-varying covariate. FINDINGS During the 14-year follow-up, a total of 2483 deaths were observed, of which 859 and 863 were due to cancer and cardiovascular diseases (CVD), respectively. The time-varying FI showed consistently strong associations with mortality throughout 14 years of follow-up, with HRs (95% confidence intervals) for frail (FI≥ 0·35) versus non-frail (FI≤ 0·11) participants of 4·72 (4.05-5.51), 2·55 (1·95-3·34) and 7·52 (5·69-9·94) for all-cause, cancer, and CVD mortality, respectively. Gradually decreasing associations with increasing length of follow-up would have been obtained by using baseline FI only. INTERPRETATION Longitudinal repeated measures of FI show strong, consistent associations with mortality, especially CVD mortality, throughout extended periods of follow-up among community-dwelling older adults. FUNDING The ESTHER study was funded by grants from the Baden-Württemberg state Ministry of Science, Research and Arts (Stuttgart, Germany), the Federal Ministry of Education and Research (Berlin, Germany), the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (Berlin, Germany), and the Saarland State Ministry of Health, Social Affairs, Women and the Family (Saarbrücken, Germany).
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Affiliation(s)
- Xiangwei Li
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
- German Cancer Consortium, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Corresponding author.
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Daum N, Kiselev J, Schaller SJ. Der fraile Patient: fiktives Fallbeispiel. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:674-681. [DOI: 10.1055/a-1760-8119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Beneficial Effect of H 2S-Releasing Molecules in an In Vitro Model of Sarcopenia: Relevance of Glucoraphanin. Int J Mol Sci 2022; 23:ijms23115955. [PMID: 35682634 PMCID: PMC9180606 DOI: 10.3390/ijms23115955] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023] Open
Abstract
Sarcopenia is a gradual and generalized skeletal muscle (SKM) syndrome, characterized by the impairment of muscle components and functionality. Hydrogen sulfide (H2S), endogenously formed within the body from the activity of cystathionine-γ-lyase (CSE), cystathionine- β-synthase (CBS), and mercaptopyruvate sulfurtransferase, is involved in SKM function. Here, in an in vitro model of sarcopenia based on damage induced by dexamethasone (DEX, 1 μM, 48 h treatment) in C2C12-derived myotubes, we investigated the protective potential of exogenous and endogenous sources of H2S, i.e., glucoraphanin (30 μM), L-cysteine (150 μM), and 3-mercaptopyruvate (150 μM). DEX impaired the H2S signalling in terms of a reduction in CBS and CSE expression and H2S biosynthesis. Glucoraphanin and 3-mercaptopyruvate but not L-cysteine prevented the apoptotic process induced by DEX. In parallel, the H2S-releasing molecules reduced the oxidative unbalance evoked by DEX, reducing catalase activity, O2− levels, and protein carbonylation. Glucoraphanin, 3-mercaptopyruvate, and L-cysteine avoided the changes in myotubes morphology and morphometrics after DEX treatment. In conclusion, in an in vitro model of sarcopenia, an impairment in CBS/CSE/H2S signalling occurs, whereas glucoraphanin, a natural H2S-releasing molecule, appears more effective for preventing the SKM damage. Therefore, glucoraphanin supplementation could be an innovative therapeutic approach in the management of sarcopenia.
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Hajek A, Kretzler B, König HH. Prevalence of Prefrailty and Frailty Among Older Adults in Germany: A Systematic Review, Meta-Analysis and Meta-Regression. Front Med (Lausanne) 2022; 9:870714. [PMID: 35530037 PMCID: PMC9072860 DOI: 10.3389/fmed.2022.870714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Various studies have identified the prevalence of prefrailty and frailty among older adults in Germany. Nevertheless, there is no review systematically synthesizing these studies. Thus, our aim was to close this gap in knowledge. Moreover, another aim was to perform a meta-analysis to synthesize the pooled prevalence of prefrailty and frailty. A further aim was to explore potential sources of heterogeneity based on a meta-regression. Methods A number of three electronic databases (PubMed, PsycINFO, and CINAHL) were searched (plus an additional hand search). The observational studies that determine the prevalence of frailty among older adults aged 65 years and above in Germany were included, whereas disease-specific samples were excluded. Data extraction included the description of the sample, operationalization of frailty, statistical analysis, sample characteristics and main findings. The established Joanna Briggs Institute (JBI) standardized critical appraisal instrument for prevalence studies was used for evaluating the quality of the studies. Important steps were performed by two reviewers. Results In sum, a number of 12 studies were included. The prevalence of frailty varied from about 2.4 to 25.6%. The pooled prevalence of frailty was 13.7% (95% CI: 9.0 to 18.5%). There was a significant heterogeneity among the studies (I2 = 98.9%, p < 0.001). The pooled prevalence of prefrailty was 40.2% (95% CI: 28.3 to 52.1%; I2 = 99.6%, p < 0.001). Some evidence of a publication bias exists. Meta-regressions showed that some of the heterogeneity was explained by the tool to quantify frailty and the average age of the respective sample. Conclusion Particularly, the high prevalence of prefrailty should be highlighted since it is important to prevent individuals in old age from developing to frail status. This knowledge is important for the German society as a whole and for relevant stakeholders. Systematic Review Registration PROSPERO, identifier: CRD42021293648.
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12
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Adherence to Medication in Older Adults with Type 2 Diabetes Living in Lubuskie Voivodeship in Poland: Association with Frailty Syndrome. J Clin Med 2022; 11:jcm11061707. [PMID: 35330032 PMCID: PMC8953376 DOI: 10.3390/jcm11061707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/09/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose: Diabetic patients aged 65 years or older are more likely to be frail than non-diabetic older adults. Adherence to therapeutic recommendations in the elderly suffering from diabetes and co-existent frailty syndrome may prevent complications such as micro- or macroangiopathy, as well as significantly affect prevention and reversibility of frailty. The study aimed at assessing the impact of frailty syndrome (FS) on the level of adherence to medication in elderly patients with type 2 diabetes (DM2). Patients and Methods: The research was carried out among 175 DM2 patients (87; 49.71% women and 88; 50.29% men) whose average age amounted to 70.25 ± 6.7. Standardized research instruments included Tilburg frailty indicator (TFI) to assess FS and adherence in chronic disease scale questionnaire (ACDS) to measure adherence to medications. Results: The group of 101 (57.71%) patients displayed medium, 39 (22.29%)—low, and 35 (20.00%)—high adherence. As many as 140 of them (80.00%) were diagnosed with frailty syndrome. The median of the average result of TFI was significantly higher in the low adherence group (p ˂ 0.001) (Mdn = 9, Q1–Q3; 7–10 pt.) than in the medium (Mdn = 6, Q1–Q3; 5–9 pt.) or high adherence (Mdn = 6.00, Q1–Q3; 4.5–8 pt.) ones. The independent predictors of the chance to be qualified to the non-adherence group included three indicators: TFI (OR 1.558, 95% CI 1.245–1.95), male gender (OR 2.954, 95% CI 1.044–8.353), and the number of all medications taken daily (each extra pill decreased the chance of being qualified to the non-adherence group by 15.3% (95% CI 0.728–0.954). Conclusion: Frailty syndrome in elderly DM2 patients influenced medical adherence in this group. The low adhesion group had higher overall TFI scores and separately higher scores in the physical and psychological domains compared to the medium and high adhesion groups.
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Wiegand S, Dietz A, Wichmann G, Kunz V. [Frailty in Head and Neck Oncology]. Laryngorhinootologie 2022; 101:249-258. [PMID: 35226958 DOI: 10.1055/a-1525-6600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since treatment of elderly patients with head and neck cancer is often challenging due to preexisting comorbidities, continuous efforts are required to raise awareness for frailty, which is a multidimensional state of diminished physiologic reserve resulting in decreased resiliency and increased vulnerability to stressors. Frailty is a predictor of poor clinical outcomes in head and neck cancer patients, but until now there is no standardization of frailty assessment. Pretherapeutic frailty assessment among head and neck cancer patients should be incorporated into routine multidisciplinary management to predict adverse outcomes and tailor a personalized treatment. This article would like to explain the complex syndrome frailty and its importance for head and neck oncology.
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Affiliation(s)
- Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig
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Comparative validation of three DNA methylation algorithms of ageing and a frailty index in relation to mortality: results from the ESTHER cohort study. EBioMedicine 2021; 74:103686. [PMID: 34808433 PMCID: PMC8609015 DOI: 10.1016/j.ebiom.2021.103686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/13/2021] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Background Three DNA methylation (DNAm) based algorithms, DNAm PhenoAge acceleration (AgeAccelPheno), DNAm GrimAge acceleration (AgeAccelGrim), and mortality risk score (MRscore), based on methylation in 513, 1030, and 10 CpGs, respectively, were established to predict health outcomes and mortality. We aimed to compare and validate the predictive ability of these scores and frailty in relation to mortality in a population-based cohort from Germany. Methods DNA methylation in whole blood was measured by the Infinium Methylation EPIC BeadChip kit (EPIC, Illumina, San Diego, CA, USA) in two random subsets of the ESTHER cohort study (n = 741 and n = 1030). AgeAccelPheno, AgeAccelGrim, and a revised MRscore to adapt EPIC, the MRscore with 8 CpGs (MRscore-8CpGs), were calculated. Frailty was assessed by a frailty index (FI). Findings During 17 years of follow-up, 458 deaths were observed. All DNAm algorithms and FI were positively correlated with each other. AgeAccelPheno, AgeAccelGrim, MRscore, and FI showed independent associations with all-cause mortality [hazard ratio (95% CI) per SD increase = 1·32 (1·19-1·46), 1·47 (1·32-1·64), 1·73 (1·49-2·01), and 1·31 (1·20-1·43), respectively]. Harrell's C-statistic was 0·710 for a model predicting mortality by age, sex, and leukocyte composition and increased to 0·759 in a model including MRscore-8CpGs and FI. The predictive performance was further improved (Harrell's C-statistic = 0·766) when additionally including AgeAccelPheno and AgeAccelGrim into the model. Interpretation The combination of a DNA methylation score based on 8 CpGs only and an easy to ascertain frailty index may strongly enhance mortality prediction beyond age and sex. Funding The ESTHER study was funded by grants from the Baden-Württemberg state Ministry of Science, Research and Arts (Stuttgart, Germany), the Federal Ministry of Education and Research (Berlin, Germany), the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (Berlin, Germany), and the Saarland State Ministry of Health, Social Affairs, Women and the Family (Saarbrücken, Germany). The work of Xiangwei Li was supported by a grant from Fondazione Cariplo (Bando Ricerca Malattie invecchiamento, #2017-0653).
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Khuc AHT, Doan VT, Le TT, Ngo TT, Dinh NT, Tran TP, Nguyen PH. Determinants of Frailty among Patients with Type 2 Diabetes In Urban Hospital. Hosp Top 2021; 101:215-222. [PMID: 34812701 DOI: 10.1080/00185868.2021.2005501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: Frailty and diabetes are on the rise due to the aging population. This study was conducted to examine frailty conditions among patients with Type 2 diabetes (T2DM) in Hanoi, Vietnam, as well as determine its associated factors. Methods: A cross-sectional study on T2DM patients at an urban hospital. This study assessed the frailty status using the FRAIL questionnaire. Socio-demographic, clinical, and paraclinical characteristics were obtained. Multivariate regression models were performed to detect factors associated with frailty. Results: Of 379 patients, the FRAIL scale results showed that 8/379 patients were at the frailty level (2.1%), and 33/379 patients were at the pre-frailty level (8.7%). Patients who had above high school education and were retired were at lower risk of pre-frailty/frailty than those with high school education or below, and self-employed, respectively. Conversely, patients with a higher number of comorbidities were more likely to develop pre-frailty and frailty. Conclusion: This study showed a low prevalence of pre-frailty and frailty among T2DM patients. It is necessary to manage diabetes carefully and strictly control the comorbidities in this population. Interventions should focus on higher risk populations, such as those with low education levels and self-employment.
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Affiliation(s)
| | - Van Thi Doan
- Nursing Faculty, Hanoi Medical College, Hanoi, Vietnam
| | - Thuy Thi Le
- Nursing Faculty, Hanoi Medical College, Hanoi, Vietnam
| | - Tam Thi Ngo
- Faculty of Health Sciences, Thang Long University, Hanoi, Vietnam
| | - Nham Thi Dinh
- Nursing Faculty, Hanoi Medical College, Hanoi, Vietnam
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Moody E, Ganann R, Martin-Misener R, Ploeg J, Macdonald M, Weeks LE, Orr E, McKibbon S, Jefferies K. Out-of-pocket expenses related to aging in place for frail older people: a scoping review. JBI Evid Synth 2021; 20:537-605. [PMID: 34738979 PMCID: PMC8860225 DOI: 10.11124/jbies-20-00413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: The objective of this scoping review was to map and describe the available evidence reporting out-of-pocket expenses related to aging in place for older people with frailty and their caregivers. Introduction: As the global population ages, there has been increasing attention on supporting older people to live at home in the community as they experience health and functional changes. Older people with frailty often require a variety of supports and services to live in the community, yet the out-of-pockets costs associated with these resources are often not accounted for in health and social care literature. Inclusion criteria: Sources that reported on the financial expenses incurred by older people (60 years or older) with frailty living in the community, or on the expenses incurred by their family and friend caregivers, were eligible for inclusion in the review. Methods: We searched for published and unpublished (ie, policy papers, theses, and dissertations) studies written in English or French between 2001 and 2019. The following databases were searched: CINAHL, MEDLINE, Scopus, Embase, PsycINFO, Sociological Abstracts, and Public Affairs Index. We also searched for gray literature in a selection of websites and digital repositories. JBI scoping review methodology was used, and we consulted with a patient and family advisory group to support the relevance of the review. Results: A total of 42 sources were included in the review, including two policy papers and 40 research papers. The majority of the papers were from the United States (n = 18), with others from Canada (n = 6), the United Kingdom (n = 3), Japan (n = 2), and one each from Australia, Brazil, China, Denmark, Israel, Italy, The Netherlands, Poland, Portugal, Singapore, South Korea, Taiwan, and Turkey. The included research studies used various research designs, including cross-sectional (n = 18), qualitative (n = 15), randomized controlled trials (n = 2), longitudinal (n = 2), cost effectiveness (n = 1), quasi-experimental (n = 1), and mixed methods (n = 1). The included sources used the term “frailty” inconsistently and used various methods to demonstrate frailty. Categories of out-of-pocket expenses found in the literature included home care, medication, cleaning and laundry, food, transportation, medical equipment, respite, assistive devices, home modifications, and insurance. Five sources reported on out-of-pocket expenses associated with people who were frail and had dementia, and seven reported on the out-of-pocket expenses for caregivers of people with frailty. While seven articles reported on specific programs, there was very little consistency in how out-of-pocket expenses were used as outcome measures. Several studies used measures of combined out-of-pocket expenses, but there was no standard approach to reporting aggregate out-of-pocket expenses. Conclusions: Contextual factors are important to the experiences of out-of-pocket spending for older people with frailty. There is a need to develop a standardized approach to measuring out-of-pocket expenses in order to support further synthesis of the literature. We suggest a measure of out-of-pocket spending as a percentage of family income. The review supports education for health care providers to assess the out-of-pocket spending of community-dwelling older people with frailty and their caregivers. Health care providers should also be aware of the local policies and resources that are available to help older people with frailty address their out-of-pocket spending.
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Affiliation(s)
- Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Canada Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, Canada School of Nursing, McMaster University, Hamilton, Canada WK Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada
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Abstract
Frailty is a geriatric syndrome characterized by decreased daily living activity, weight loss, weakness, and dependency caused by the cumulative decline in many physiological systems over the life span. This study examined older adults' perceptions of frailty. The study used a descriptive qualitative design. Data were collected using semistructured interviews with 14 older adults admitted to the geriatrics outpatient clinic in one Turkish institution from September to December 2019. The interviews were transcribed and analyzed using the MAXQDA data analysis software. Codes were combined into themes. The respondents were aged 74.5 ± 8.7 years. Two themes emerged from the qualitative data: (i) the conceptualization of frailty; and (ii) coping with frailty. Some of the participants self-identified as frail, a natural consequence of aging. Another group of participants emphasized the feelings of hopelessness and hopefulness in coping with frailty in their remaining lives. This study provides insights into older Turkish adults' opinions regarding frailty, including the development of frailty and its relationship with health status and daily life. This understanding may be used to detect frailty in older adults and to improve frail older adults' care interventions.
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Affiliation(s)
- Cigdem Canbolat Seyman
- Cigdem Canbolat Seyman, PhD, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Yasemin Sara, MSc, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
| | - Yasemin Sara
- Cigdem Canbolat Seyman, PhD, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Yasemin Sara, MSc, RN, Research Assistant, Department of Surgical Nursing, Faculty of Nursing, Selçuk University, Konya, Turkey
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Kremer KM, Braisch U, Rothenbacher D, Denkinger M, Dallmeier D. Systolic Blood Pressure and Mortality in Community-Dwelling Older Adults: Frailty as an Effect Modifier. Hypertension 2021; 79:24-32. [PMID: 34689594 DOI: 10.1161/hypertensionaha.121.17530] [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] [Indexed: 01/10/2023]
Abstract
Current evidence is insufficient to support different hypertension treatment targets in older adults. We evaluated whether frailty modifies the association between systolic blood pressure (SBP) and 8-year all-cause mortality in community-dwelling older adults. Longitudinal data from the ActiFE Ulm study (Activity and Function in the Elderly in Ulm; Germany) was collected. The association between SBP and mortality was analyzed using Cox proportional hazards models adjusted for age, sex, education, smoking, alcohol consumption, sleep disturbance, diastolic blood pressure, and antihypertensive medications, evaluating the presence of effect modification by frailty according to a frailty index based on the accumulation of deficits. Among 1170 participants (median age 73.9 years, 41.6% women), the prevalence of history of hypertension was 53.8% (median SBP, 144.0 mm Hg [interquartile range, 135.0-149.5], median diastolic blood pressure 78.0 mm Hg [interquartile range, 71.0-86.5]). The median follow-up time was 8.1 years, detecting 268 deaths. We identified 251 (21.5%, 114 deaths) frail participants (frailty index ≥0.2). Effect modification by frailty was detected. Among non-frail a J-shaped association was found with hazard ratio, 4.01 (95% CI, 1.13-14.28) for SBP<110 mm Hg, hazard ratio, 0.92 (95% CI, 0.53-1.59) for SBP 140-150 mm Hg, and hazard ratio, 1.98 (95% CI, 0.75-5.27) for SBP≥160 mm Hg. For frail older adults, a tendency toward lower risk among those with SBP≥130 mm Hg was observed. Our results suggest the presence of effect modification by frailty indicating a possible protective effect for elevated SBP in frail older adults with respect to all-cause mortality even after adjusting for diastolic blood pressure and antihypertensive treatment.
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Affiliation(s)
- Kaj-Marko Kremer
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Geriatric Research, Ulm University, Germany. (K.-M.K., M.D.)
| | - Ulrike Braisch
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Epidemiology and Medical Biometry, Ulm University, Germany. (U.B., D.R.)
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany. (U.B., D.R.)
| | - Michael Denkinger
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Geriatric Research, Ulm University, Germany. (K.-M.K., M.D.)
| | - Dhayana Dallmeier
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Department of Epidemiology, Boston University School of Public Health, Boston, MA (D.D.)
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Bąk E, Młynarska A, Marcisz C, Bobiński R, Sternal D, Młynarski R. The influence of frailty syndrome on quality of life in elderly patients with type 2 diabetes. Qual Life Res 2021; 30:2487-2495. [PMID: 33834352 PMCID: PMC8405487 DOI: 10.1007/s11136-021-02829-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There have been no comprehensive studies that assess the impact of frailty syndrome on quality of life (QoL) of patients with diagnosed type 2 diabetes. The purpose of the study was to assess the impact of frailty syndrome on QoL and depression symptoms of patients with type 2 diabetes. METHODS The study included 148 consecutive patients (aged ≥ 60y). The patients were divided into two groups according to the prevalence of the frailty syndrome: robust and frailty. For all of the patients that were included in the study, we used the Polish version of validated instruments: ADDQoL, TFI and BDI. RESULTS In the study group, 43.2% had been diagnosed with frailty syndrome. An analysis of QoL assessment depending on the prevalence of the frailty syndrome showed that patients who were robust (without recognized frailty syndrome) assessed QoL significantly better than patients with coexisting frailty syndrome. Robust patients did not have any severe depressive symptoms, whereas in the group of patients with the frailty syndrome 43.8% of the patients had a depression. 70.2% of the patients without any depressive symptoms were robust patients, meanwhile only 14% of the patients had frailty syndrome recognized. CONCLUSIONS Frailty syndrome occurred in 43 percent of the patients with type 2 diabetes. This has a negative impact on QoL of patients. Depression is more common in patients with the frailty syndrome and diabetes.
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Affiliation(s)
- E. Bąk
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - A. Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - C. Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - R. Bobiński
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - D. Sternal
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - R. Młynarski
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
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Möllers T, Stocker H, Perna L, Nabers A, Rujescu D, Hartmann AM, Holleczek B, Schöttker B, Gerwert K, Brenner H. Aβ misfolding in blood plasma is inversely associated with body mass index even in middle adulthood. Alzheimers Res Ther 2021; 13:145. [PMID: 34461995 PMCID: PMC8406782 DOI: 10.1186/s13195-021-00889-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND To understand the potential for early intervention and prevention measures in Alzheimer's disease, the association between risk factors and early pathological change needs to be assessed. Hence, the aim of this study was to determine whether risk factors of Alzheimer's clinical syndrome (clinical AD), such as body mass index (BMI), are associated with Aβ misfolding in blood, a strong risk marker for AD among older adults. METHODS Information on risk factors and blood samples were collected at baseline in the ESTHER study, a population-based cohort study of older adults (age 50-75 years) in Germany. Aβ misfolding in blood plasma was analyzed using an immuno-infrared-sensor in a total of 872 participants in a nested case-control design among incident dementia cases and matched controls. Associations between risk factors and Aβ misfolding were assessed by multiple logistic regression. For comparison, the association between the risk factors and AD incidence during 17 years of follow-up was investigated in parallel among 5987 cohort participants. RESULTS An inverse association with Aβ misfolding was seen for BMI at age 50 based on reported weight history (aOR 0.64, 95% CI 0.43-0.96, p = 0.03). Similar but not statistically significant associations were seen for BMI at baseline (i.e., mean age 68) and at age 40. No statistically significant associations with Aβ misfolding were found for other risk factors, such as diabetes, smoking, and physical activity. On the other hand, low physical activity was associated with a significantly reduced risk of developing clinical AD compared to physical inactivity. CONCLUSIONS Our results support that AD pathology may be detectable and associated with reduced weight even in middle adulthood, many years before clinical diagnosis of AD. Physical activity might reduce the risk of onset of AD symptoms.
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Affiliation(s)
- Tobias Möllers
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, Germany.
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, Heidelberg, Germany.
| | - Hannah Stocker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, Heidelberg, Germany
- Medical Faculty, Heidelberg University, Im Neuenheimer Feld 572, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, Germany
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, München, Germany
| | - Andreas Nabers
- Department of Biophysics, Ruhr-University Bochum, Universitätsstraße 150, Bochum, Germany
- Department of Biophysics, Center for Protein Diagnostics (ProDi), Biospectroscopy, Ruhr-University Bochum, Universitätsstraße 150, Bochum, Germany
| | - Dan Rujescu
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Julius-Kühn-Straße 7, Halle (Saale), Germany
| | - Annette M Hartmann
- University Clinic and Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Julius-Kühn-Straße 7, Halle (Saale), Germany
| | - Bernd Holleczek
- Saarland Cancer Registry, Präsident-Baltz-Straße 5, Saarbrücken, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, Heidelberg, Germany
| | - Klaus Gerwert
- Department of Biophysics, Ruhr-University Bochum, Universitätsstraße 150, Bochum, Germany
- Department of Biophysics, Center for Protein Diagnostics (ProDi), Biospectroscopy, Ruhr-University Bochum, Universitätsstraße 150, Bochum, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, Germany
- Network Aging Research, Heidelberg University, Bergheimer Straße 20, Heidelberg, Germany
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21
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Ryan J, Espinoza S, Ernst ME, Ekram ARMS, Wolfe R, Murray AM, Shah RC, Orchard SG, Fitzgerald S, Beilin LJ, Ward SA, Williamson JD, Newman AB, McNeil JJ, Woods RL. Validation of a Deficit-Accumulation Frailty Index in the ASPirin in Reducing Events in the Elderly Study and Its Predictive Capacity for Disability-Free Survival. J Gerontol A Biol Sci Med Sci 2021; 77:19-26. [PMID: 34338761 PMCID: PMC8751791 DOI: 10.1093/gerona/glab225] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Frailty is a state of heightened vulnerability and susceptibility to physiologic stressors that increases with age. It has shown increasing utility in predicting a range of adverse health outcomes. Here, we characterize a 67-item deficit-accumulation frailty index (FI) in 19 110 community-dwelling individuals in the ASPirin in Reducing Events in the Elderly clinical trial. Participants aged 65-98 years were recruited from the United States and Australia and were without diagnosed dementia and cardiovascular disease, and major physical disability. The median FI score was .10 (interquartile range: .07-.14) at baseline, and the prevalence of frailty (FI > .21) increased from 8.1% to 17.4% after 6 years. FI was positively associated with age, and women had significantly higher scores than men at all ages. The FI was negatively correlated with gait speed (r = -.31) and grip strength (r = -.46), and strongly associated with a modified Fried's frailty phenotype (p < .0001, for all comparisons). Frailty was associated with the primary composite outcome capturing independent life lived free of major disability and dementia, and increased the rate of persistent physical disability (hazard ratio: 21.3, 95% confidence interval: 15.6-28.9). It added significantly to the predictive capacity of these outcomes above age, sex, and ethnicity alone. The FI is thus a useful biomarker of aging even among relatively healthy older individuals and provides important information about an individual's vulnerability to and risk of disease.
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Affiliation(s)
- Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,Address correspondence to: Joanne Ryan, PhD, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, 3004 Victoria, Australia. E-mail:
| | - Sara Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, Texas, USA,Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, USA,Department of Family Medicine, Carver College of Medicine, University of Iowa, USA
| | - A R M Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Clinical Outcomes and Research, Hennepin Health Research Institute and Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, USA
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sharyn Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeff D Williamson
- Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anne B Newman
- Center for Aging and Population Health, University of Pittsburgh, Pennsylvania, USA
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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22
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Kane AE, Howlett SE. Sex differences in frailty: Comparisons between humans and preclinical models. Mech Ageing Dev 2021; 198:111546. [PMID: 34324923 DOI: 10.1016/j.mad.2021.111546] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/18/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
Frailty can be viewed as a state of physiological decline that increases susceptibility to adverse health outcomes. This loss of physiological reserve means that even small stressors can lead to disability and death in frail individuals. Frailty can be measured with various clinical tools; the two most popular are the frailty index and the frailty phenotype. Clinical studies have used these tools to show that women are frailer than men even though they have longer lifespans. Still, factors responsible for this frailty-mortality paradox are not well understood. This review highlights evidence for male-female differences in frailty from both the clinical literature and in animal models of frailty. We review evidence for higher frailty levels in female animals as seen in many preclinical models. Mechanisms that may contribute to sex differences in frailty are highlighted. In addition, we review work that suggests frailty may play a role in susceptibility to chronic diseases of aging in a sex-specific fashion. Additional mechanistic studies in preclinical models are needed to understand factors involved in male-female differences in frailty in late life.
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Affiliation(s)
- Alice E Kane
- Blavatnik Institute, Dept. of Genetics, Paul F. Glenn Center for Biology of Aging Research at Harvard Medical School, Boston, MA, United States.
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada; Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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Abstract
There is growing interest in conceptualizing and diagnosing frailty. Less is understood, however, about older adults' perceptions of the term "frail", and the implications of being classified as "frail". The purpose of this scoping review was to map the breadth of primary studies; and describe the meaning, perceptions, and perceived implications of frailty language amongst community-dwelling older adults. Eight studies were included in the review and three core themes were identified: (1) understanding frailty as inevitable age-related decline in multiple domains, (2) perceiving frailty as a generalizing label, and (3) perceiving impacts of language on health and health care utilization. Clinical practice recommendations for health care professionals working with individuals with frailty include: (1) maintaining a holistic view of frailty that extends beyond physical function to include psychosocial and environmental constructs, (2) using person-first language, and (3) using a strengths-based approach to discuss aspects of frailty.
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24
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Zhu Y, Ge J, Huang C, Liu H, Jiang H. Application of mesenchymal stem cell therapy for aging frailty: from mechanisms to therapeutics. Theranostics 2021; 11:5675-5685. [PMID: 33897874 PMCID: PMC8058725 DOI: 10.7150/thno.46436] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Aging frailty is a complex geriatric syndrome that becomes more prevalent with advancing age. It constitutes a major health problem due to frequent adverse outcomes. Frailty is characterized by disruption of physiological homeostasis and progressive decline of health status. Multiple factors contribute to development of frailty with advancing age, including genome instability, DNA damage, epigenetic alternations, stem cell exhaustion, among others. These interrelated factors comprehensively result in loss of tissue homeostasis and diminished reserve capacity in frailty. Therefore, the aged organism gradually represents symptoms of frailty with decline in physiological functions of organs. Notably, the brain, cardiovascular system, skeletal muscle, and endocrine system are intrinsically interrelated to frailty. The patients with frailty may display the diminished reserves capacity of organ systems. Due to the complex pathophysiology, no specific treatments have been approved for prevention of this syndrome. At such, effective strategies for intervening in pathogenic process to improve health status of frail patients are highly needed. Recent progress in cell-based therapy has greatly contributed to the amelioration of degenerative diseases related to age. Mesenchymal stem cells (MSCs) can exert regenerative effects and possess anti-inflammatory properties. Transplantation of MSCs represents as a promising therapeutic strategy to address the pathophysiologic problems of frail syndrome. Currently, MSC therapy have undergone the phase I and II trials in human subjects that have endorsed the safety and efficacy of MSCs for aging frailty. However, despite these positive results, caution is still needed with regard to potential to form tumors, and further large-scale studies are warranted to confirm the therapeutic efficacy of MSC therapy.
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25
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Kang S, Oh TJ, Cho BL, Park YS, Roh E, Kim HJ, Lee S, Kim BJ, Kim M, Won CW, Jang HC. Sex differences in sarcopenia and frailty among community-dwelling Korean older adults with diabetes: The Korean Frailty and Aging Cohort Study. J Diabetes Investig 2021; 12:155-164. [PMID: 32627923 PMCID: PMC7858110 DOI: 10.1111/jdi.13348] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS/INTRODUCTION We aimed to examine the prevalence of sarcopenia and frailty in Korean older adults with diabetes compared with individuals without diabetes. MATERIALS AND METHODS We analyzed the data of 2,403 participants aged 70-84 years enrolled in the Korean Frailty and Aging Cohort Study. Sarcopenia was defined using the Asian Working Group for Sarcopenia and the Foundation for the National Institutes of Health. Frailty was assessed by the Cardiovascular Health Study frailty phenotype criteria. RESULTS The mean age of the participants was 76.0 ± 3.9 years, and 47.2% were men. The prevalence of diabetes was 30.2% in men and 25.8% in women. Adults with diabetes showed a lower muscle mass index (appendicular skeletal muscle mass/body mass index) and handgrip strength in both sexes, but only the women showed decreased physical performance. Women with diabetes presented a higher prevalence of sarcopenia diagnosed by the Foundation for the National Institutes of Health criteria, and frailty compared with participants without diabetes (sarcopenia 14.7% vs 8.5%, P = 0.001; frailty 9.5% vs 4.9%, P = 0.003). Men in the high and middle tertiles for homeostatic model assessment of insulin resistance presented a significantly higher prevalence of sarcopenia, compared with men in the low tertile homeostatic model assessment of insulin resistance (high tertile 16.6%, middle tertile 13.3%, low tertile 8.6%). CONCLUSIONS In older adults with diabetes, muscle mass index and muscle strength were lower than in those without diabetes. However, the prevalence of sarcopenia and frailty was higher and physical performance was lower only in women with diabetes.
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Affiliation(s)
- Sunyoung Kang
- Department of Internal MedicineSeoul National University HospitalSeoulKorea
- Department of Internal MedicineSeoul National University College of MedicineSeoulKorea
| | - Tae Jung Oh
- Department of Internal MedicineSeoul National University College of MedicineSeoulKorea
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamKorea
| | - Be Long Cho
- Department of Family MedicineSeoul National University HospitalSeoulKorea
| | - Yong Soon Park
- Department of Family MedicineChuncheon Sacred Heart HospitalChuncheonKorea
| | - Eun Roh
- Department of Internal MedicineKorea University Guro HospitalSeoulKorea
| | - Hyeon Ju Kim
- Department of Family MedicineJeju National University HospitalJejuKorea
| | - Sam‐Gyu Lee
- Department of Physical & Rehabilitation MedicineChonnam National University HospitalGwangjuKorea
| | - Bong Jo Kim
- Department of PsychiatryGyeongsang National University HospitalJinjuKorea
| | - Miji Kim
- Department of Biomedical Science and TechnologyKyung Hee UniversitySeoulKorea
| | - Chang Won Won
- Department of Family MedicineKyung Hee University HospitalSeoulKorea
| | - Hak Chul Jang
- Department of Internal MedicineSeoul National University College of MedicineSeoulKorea
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamKorea
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26
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Zhang J, Xu L, Sun L, Li J, Qin W. Gender difference in the association of frailty and health care utilization among Chinese older adults: results from a population-based study. Aging Clin Exp Res 2020; 32:1985-1991. [PMID: 31745830 DOI: 10.1007/s40520-019-01410-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frailty is a public health concern in the ageing population. Little is known about the role of gender in the relationship between frailty and health care utilization in older adults. AIMS The study aims to examine gender differences in the association between different frailty status and health care utilization among Chinese older people. METHODS A total of 7070 older adults (60+) from Shandong Province, China, were enrolled in this study. Frailty was assessed by frailty index constructed using 45 health deficits. Multivariate logistic regression models were employed separately for men and women to examine the impact of frailty on self-care, outpatient, and inpatient utilization. RESULTS Overall, the prevalence of frailty was 7.9% in older adults, with 7.1% and 8.3% in men and women, respectively. 49.4% respondents reported they had self-care in the previous 2 weeks, and women were more likely to have self-care than men. Being pre-frail and frail was significantly associated with utilization of all types of health care among older men and women, and the relationship was stronger in the frail groups than that in the pre-frail groups except for self-care. Respective odds ratios for outpatient utilization were higher in men than that in women. CONCLUSIONS Frailty is a frequent condition in Chinese older adults. The association between frailty and health care utilization (except outpatient) tended to be stronger in women than men. The gender differences should be considered when designing the preventing or delaying the installation of frailty and geriatric care plans.
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Affiliation(s)
- Jiao Zhang
- School of Public Health, Shandong University, Jinan, 250012, China
- NHC, Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan, 250012, China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan, 250012, China.
- NHC, Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan, 250012, China.
| | - Long Sun
- School of Public Health, Shandong University, Jinan, 250012, China
- NHC, Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Jiajia Li
- School of Public Health, Shandong University, Jinan, 250012, China
- NHC, Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan, 250012, China
| | - Wenzhe Qin
- School of Public Health, Shandong University, Jinan, 250012, China
- NHC, Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan, 250012, China
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Dallmeier D, Braisch U, Rapp K, Klenk J, Rothenbacher D, Denkinger M. Frailty Index and Sex-Specific 6-Year Mortality in Community-Dwelling Older People: The ActiFE Study. J Gerontol A Biol Sci Med Sci 2020; 75:366-373. [PMID: 30789659 DOI: 10.1093/gerona/glz051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Considering that mortality rate and deficit accumulation varies considerably in men and women, we performed a sex-stratified analysis of the association between an estimated frailty index (eFI) with 6-year mortality in the Activity and Function in the Elderly (ActiFE) Study. METHODS We constructed an eFI using a score (0 [no deficit] to 1 [deficit]) from 32 baseline items representing multiple domains. eFI represents the sum of all scores divided by 32. Cox proportional hazards models adjusted for age, smoking, alcohol intake, and education were used to evaluate this association. RESULTS Among 1,204 participants (57.5% men), 18.5% men and 26.0% women were frail (eFI ≥ 0.2) with an age-adjusted mean eFI of 0.13 (95% confidence interval [CI] 0.12, 0.13) and 0.15 (95% CI 0.15, 0.16), respectively. Mortality rate in men (146 deaths) was 34.4 (95% CI 29.3, 40.5) and in women (50 deaths) 15.1 (95% CI 11.5, 19.9) per 1,000 person-years. A 0.1 increment of eFI was associated with a hazard ratio (HR) of 1.94 (95% CI 1.60, 2.35) in men and 2.06 (95% CI 1.58, 2.69) in women. Frail versus nonfrail men and women had a HR of 2.46 (95% CI 1.74, 3.48), and 2.98 (95% CI 1.55, 5.70), respectively. We detected sex differences in the order of the eight common contributor items to the eFI. CONCLUSIONS We observed a statistically significant difference for the age-adjusted eFI and the frailty prevalence in men and women. However, our analysis does not suggest the presence of effect modification by sex in the association with mortality.
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Affiliation(s)
- Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Research Unit on Aging, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm University, Germany
| | - Ulrike Braisch
- Agaplesion Bethesda Clinic, Research Unit on Aging, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm University, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany.,Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | | | - Michael Denkinger
- Agaplesion Bethesda Clinic, Research Unit on Aging, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm University, Germany
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The joint effects of frailty and telomere length for predicting mortality in older adults: the National Health and Nutrition Examination Survey 1999-2002. Aging Clin Exp Res 2020; 32:1839-1847. [PMID: 31646458 DOI: 10.1007/s40520-019-01376-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/04/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Frailty and short telomere length, which address different aspects of biological aging, are separately associated with mortality in older adults. AIMS To evaluate whether the combination of these two biomarkers would be a better predictor of mortality than either alone. METHODS This present study included participants 60 years of age or older from the National Health and Nutrition Examination Survey in the 1999-2002 phase. The frailty phenotype was identified based on the Fried definition. Telomere length relative to standard reference DNA (T/S ratio) was assessed using quantitative polymerase chain reaction (PCR). Cox proportional hazards regression models were used to estimate the individual and combined effects of frailty phenotype and telomere length on all-cause and cardiovascular mortality. RESULTS Compared with participants with neither impairment, the mortality risks increased slightly among participants with short telomere length only (hazard ratio [HR] 1.19, 95% confidence interval [CI]: 1.00-1.42) or pre-frailty only (HR 2.16, 95% CI 1.80-2.60) and gradually elevated approximately 3 folds with both short telomere length and pre-frailty (HR 2.23, 95% CI 1.81-2.74) or frailty (HR 3.57, 95% CI 2.56-4.98). Moreover, participants with both short telomere length and frailty had the highest increased all-cause mortality (HR 5.16, 95% CI 3.38-7.85) and cardiovascular mortality (HR 4.67, 95% CI 2.02-10.82). DISCUSSION AND CONCLUSIONS The combined predictor had more capability of predicting mortality, which suggested that integrating both molecular biomarkers and physiological functional parameters would be a more informative measure of biological aging.
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Fan Y, Huang J, Zhou Y, Gu X, Gong D. Does the Impact of Frailty on All-Cause Mortality in Older Persons Differ between Women and Men? A Meta-Analysis. J Am Med Dir Assoc 2020; 22:606.e1-606.e6. [PMID: 32682600 DOI: 10.1016/j.jamda.2020.05.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Sex-specific impact of frailty on all-cause mortality in older age population remains controversial. This meta-analysis aimed to evaluate the association between frailty and all-cause mortality in older age women vs men from the general population. DESIGN Meta-analysis. SETTING AND PARTICIPANTS PubMed and Embase databases were searched until March 25, 2020 for studies reporting sex-specific association of frailty phenotype or index with all-cause mortality among the older general population (age ≥60 years) in the same study. MEASUREMENTS All-cause mortality for the frail vs robust individuals. RESULTS Eight studies enrolling a total of 87, 000 individuals were identified. Using the frailty phenotype, the pooled risk ratio of all-cause mortality was 2.41 [95% confidence interval (CI) 2.07-2.80] for frail women and 2.94 (95% CI 2.12-4.09) for frail men. Using the frailty index, the pooled risk ratio of all-cause mortality was 3.23 (95% CI 2.16-4.83) for frail women and 2.63 (95% CI 2.33-2.98) for frail men. The pooled female-to-male ratio of relative risks was 0.93 (95% CI 0.76-1.13) for the frailty phenotype and 1.22 (95% CI 0.79-1.88) for the frailty index. CONCLUSIONS AND IMPLICATIONS Older men and women with frailty confer a higher risk of all-cause mortality in the general population from the same source. However, there is no significant sex difference in the association between phenotype or index and all-cause mortality.
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Affiliation(s)
- Yu Fan
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jiabin Huang
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yongjing Zhou
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xuyu Gu
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Dandan Gong
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China.
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30
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Pilotto A, Custodero C, Maggi S, Polidori MC, Veronese N, Ferrucci L. A multidimensional approach to frailty in older people. Ageing Res Rev 2020; 60:101047. [PMID: 32171786 PMCID: PMC7461697 DOI: 10.1016/j.arr.2020.101047] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/13/2020] [Accepted: 03/10/2020] [Indexed: 12/13/2022]
Abstract
Frailty is an important factor determining a higher risk of adverse health outcomes in older adults. Although scientific community in the last two decades put a lot of effort for its definition, to date no consensus was reached on its assessment. The mainstream thinking describes frailty as a loss of physical functions or as accumulation of multiple deficits. Recently, a novel conceptual model of frailty has emerged based on the loss of harmonic interaction between multiple domains (also referred as dimensions) including genetic, biological, functional, cognitive, psychological and socio-economic domain that ultimately lead to homeostatic instability. Therefore, the multidimensional aspects of frailty condition could be captured by the comprehensive geriatric assessment (CGA) and its derived Multidimensional Prognostic Index (MPI). This instrument has been applied in different clinical settings and in several cohorts of older adults with specific acute and chronic diseases, showing always excellent accuracy in stratifying population according the mortality risk and other negative health outcomes, i.e. hospitalization, institutionalization or admission to homecare services. This MPI "plasticity" provides a single numerical prognostic index which could be helpful in clinical decision making for the management of frail older adults.
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Affiliation(s)
- Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy; Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy.
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Maggi
- National Research Council (CNR), Aging Section, Padova, Italy
| | | | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy
| | - Luigi Ferrucci
- National Institute on Aging, NIH, Baltimore, MD, United States
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The impact of frailty on acute care general surgery patients: A systematic review. J Trauma Acute Care Surg 2020; 86:148-154. [PMID: 30399129 DOI: 10.1097/ta.0000000000002084] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Frailty may predict negative health outcomes more accurately than chronological age alone. This review examines evidence for the impact of frailty on adverse outcomes in patients admitted with an acute care general surgery (ACS) diagnosis. METHODS A systematic literature search for studies reporting frailty and outcomes after admission with an ACS diagnosis was performed. We searched PubMed and SCOPUS from inception until September 2017. RESULTS A total of 8,668 records were screened, of which seven studies examined the relationship between frailty and outcomes in ACS patients. Frailty was associated with higher 30-day mortality patients (odds ratio, 3.04; 95% confidence interval, 2.67-3.46; p < 0.01), postoperative complications, length of stay, institutional discharge, and critical care admission. CONCLUSIONS There is emerging evidence that frailty is associated with worse outcomes in patients with an unplanned admission due to an ACS diagnosis. Further investigation is warranted with regard to how frailty may impact patients with an acute illness more severely. LEVEL OF EVIDENCE Systematic review, level III.
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Characteristics of factors for decreased lung function in elderly patients with type 2 diabetes. Sci Rep 2019; 9:20206. [PMID: 31882983 PMCID: PMC6934766 DOI: 10.1038/s41598-019-56759-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) often accompanies type 2 diabetes mellitus (T2DM). However, background factors affecting these diseases in the elderly remain unclear. Eligible patients with T2DM were divided into two age groups—non-elderly (<65 years) and elderly (≥65 years); COPD, ratio of forced expiratory volume in one second to forced expiratory volume (FEV1/FVC ratio), and percent predicted forced expiratory volume in one second (FEV1% predicted) were examined, and factors related to reduced respiratory function according to age group were evaluated. In total, 371 patients with T2DM were analysed. COPD was found in 9 patients (5.3%) in the non-elderly group and 45 (22.5%) in the elderly group. In the elderly, male sex, low body mass index (BMI), insulin therapy, and high C-peptide immunoreactivity levels were factors related to COPD. In the non-elderly, age, female sex, high BMI were factors related to decreased FEV1% predicted. Female sex was factor related to decreased FEV1% predicted in both age groups. Low BMI was a factor related to reduced respiratory function in elderly patients and high BMI was a factor related to reduced respiratory function in non-elderly patients. Thus, BMI needs to be managed according to the age and general condition of T2DM patients.
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Yoon SJ, Kim KI. Frailty and Disability in Diabetes. Ann Geriatr Med Res 2019; 23:165-169. [PMID: 32743307 PMCID: PMC7370756 DOI: 10.4235/agmr.19.0036] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 12/25/2022] Open
Abstract
Diabetes is an important health problem with the population aging. Previously, it is well established that diabetes is associated with microvascular and macrovascular complications, but recently, several data suggest that diabetes is accompanied with frailty as well as disability among the older adults. Considering the clinical significance of frailty and disability, it is important to understand the pathway from diabetes to frailty and/or disability. Additionally, it is strongly recommended to find a new therapeutic intervention are required to meet the increasing demand of managing older diabetic patients with the population aging.
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Affiliation(s)
- Sol-Ji Yoon
- Departement of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Corbi G, Cacciatore F, Komici K, Rengo G, Vitale DF, Furgi G, Pagano G, Bencivenga L, Davinelli S, Ferrara N. Inter-relationships between Gender, Frailty and 10-Year Survival in Older Italian Adults: an observational longitudinal study. Sci Rep 2019; 9:18416. [PMID: 31804552 PMCID: PMC6895198 DOI: 10.1038/s41598-019-54897-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/15/2019] [Indexed: 02/04/2023] Open
Abstract
Aim of the present study was to assess the impact of gender on the relationship between long-term mortality and clinical frailty. In an observational, longitudinal study on 10-year mortality, we examined 1284 subjects. The Frailty Staging System was used to assess frailty. The Cox model was employed to assess variables independently associated with survival using a backward stepwise algorithm. To investigate the possible interactions between gender and the selected variables, an extension of the multivariable fractional polynomial algorithm was adopted. Women were more likely to be older, have a higher disability, present with more comorbidities, consume more drugs, be frail and have a higher rate of survival at the follow-up than were men. At the Cox multivariate analysis only age (HR 2.26), female gender (HR 0.43), and number of drugs (HR 1.57) were significant and independent factors associated with all-cause mortality. In the survival analyses, only frailty (vs no frailty) showed significant interaction with gender (p < 0.001, HR = 1.92). While the presence of frailty reduced the survival rate in women, no effect was observed in men. Importantly, frail women showed higher survival rates than did both frail and no frail men. The main finding of the present study is that gender shapes up the association between frailty and long-term survival rates.
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Affiliation(s)
- Graziamaria Corbi
- Dept of Medicine and Health Sciences, University of Molise, and Italian Society of Gerontology and Geriatrics (SIGG), Campobasso, Italy.
| | - Francesco Cacciatore
- Dept of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Klara Komici
- Dept of Medicine and Health Sciences, University of Molise, and Italian Society of Gerontology and Geriatrics (SIGG), Campobasso, Italy
| | - Giuseppe Rengo
- Dept of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
- Istituti Clinici Scientifici Maugeri SpA Società Benefit" (ICS Maugeri SpA SB), Telese Terme, (BN), Italy
| | | | - Giuseppe Furgi
- Istituti Clinici Scientifici Maugeri SpA Società Benefit" (ICS Maugeri SpA SB), Telese Terme, (BN), Italy
| | - Gennaro Pagano
- Dept of Basic & Clinical Neuroscience Institute of Psychiatry, Psychology & Neuroscience (IoPPN) King's College, London, UK
| | - Leonardo Bencivenga
- Dept of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Sergio Davinelli
- Dept of Medicine and Health Sciences, University of Molise, and Italian Society of Gerontology and Geriatrics (SIGG), Campobasso, Italy
| | - Nicola Ferrara
- Dept of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
- Istituti Clinici Scientifici Maugeri SpA Società Benefit" (ICS Maugeri SpA SB), Telese Terme, (BN), Italy
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Ge F, Liu W, Liu M, Tang S, Lu Y, Hou T. Accessing the discriminatory performance of FRAIL-NH in two-class and three-class frailty and examining its agreement with the frailty index among nursing home residents in mainland China. BMC Geriatr 2019; 19:296. [PMID: 31666011 PMCID: PMC6822433 DOI: 10.1186/s12877-019-1314-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 10/11/2019] [Indexed: 01/13/2023] Open
Abstract
Background FRAIL-NH has been commonly used to assess frailty in nursing home residents and validated in many ethnic populations; however, it has not been validated in mainland China, where such an assessment tool is lacking. This study aimed to (1) assess the discriminatory performance of FRAIL-NH in two-class frailty (non-frail+ pre-frail vs. frail) and three-class frailty (non-frail vs. pre-frail vs. frail), based on the Frailty Index (FI), (2) determine the appropriate cutoff points for FRAIL-NH that distinguish two-class and three-class frailty, and (3) examine the agreement in classification between FRAIL-NH and FI. Methods A cross-sectional study of 302 residents aged 60 years or older from six nursing homes in Changsha was conducted. The FRAIL-NH scale and 34-item FI were used to measure frailty. Two-way and three-way receiver operating characteristic (ROC) curves were used to estimate the performance of FRAIL-NH. Cohen’s Kappa statistics were used to examine the agreement between these two measures. Results The agreement between FRAIL-NH and FI ranged from 0.33 to 0.55. Regardless of what FI cutoff points were based on, the volume under the ROC surface (VUS) for FRAIL-NH from the three-way ROC were higher than the VUS of a useless test (1/6), and the area under the ROC curve (AUC) for FRAIL-NH from the two-way ROC were higher than the clinically meaningless value (0.5). When using FI cutoff points of 0.20 for pre-frail and 0.45 for frail, FRAIL-NH cutoff points of 1 and 9 in classifying three-class frailty had the highest VUS and the largest correct classification rates. Whichever FI was chosen, the performance of FRAIL-NH in distinguishing between pre-frailty and frailty, and between non-frailty and pre-frailty was equivalent. According to FRAIL-NH, the proportion of individuals with frailty misclassified as pre-frailty was higher than that of individuals with non-frailty misclassified as pre-frailty. Conclusion FRAIL-NH can be used as a preliminary frailty screening tool in nursing homes in mainland China. FI should be further used especially for those classified as pre-frailty by FRAIL-NH. It is not advisable to simply combine adjacent two classes of FRAIL-NH to create a new frailty variable in research settings.
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Affiliation(s)
- Feng Ge
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Weiwei Liu
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Minhui Liu
- Xiangya Nursing School, Central South University, Changsha, Hunan, China. .,Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Siyuan Tang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yongjin Lu
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Tianxue Hou
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
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Lachmann R, Stelmach-Mardas M, Bergmann MM, Bernigau W, Weber D, Pischon T, Boeing H. The accumulation of deficits approach to describe frailty. PLoS One 2019; 14:e0223449. [PMID: 31613904 PMCID: PMC6793873 DOI: 10.1371/journal.pone.0223449] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/20/2019] [Indexed: 01/10/2023] Open
Abstract
The advancing age of the participants of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study was the incentive to investigate frailty as a major parameter of ageing. The aim of this study was to develop a multidimensional tool to measure frailty in an ageing, free-living study population. The "accumulation of deficits approach" was used to develop a frailty index (FI) to characterize a sub-sample (N = 815) of the EPIC-Potsdam (EPIC-P) study population regarding the aging phenomenon. The EPIC-P frailty index (EPIC-P-FI) included 32 variables from the following domains: health, physical ability, psychosocial and physiological aspects. P-values were calculated for the linear trend between sociodemographic and life style variables and the EPIC-P-FI was calculated using regression analysis adjusted for age. The relationship between the EPIC-P-FI and age was investigated using fractional polynomials. Some characteristics such as age, education, time spent watching TV, cycling and a biomarker of inflammation (C-reactive protein) were associated with frailty in men and women. Interestingly, living alone, having no partner and smoking status were only associated with frailty in men, and alcohol use and physical fitness (VO2max) only in women. The generated, multidimensional FI, adapted to the EPIC-P study, showed that this cohort is a valuable source for further exploration of factors that promote healthy ageing.
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Affiliation(s)
- Raskit Lachmann
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - Marta Stelmach-Mardas
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
- Department of Biophysics, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail:
| | - Manuela M. Bergmann
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - Wolfgang Bernigau
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - Daniela Weber
- Department of Molecular Toxicology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin-Buch, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
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Sargeant JA, Henson J, King JA, Yates T, Khunti K, Davies MJ. A Review of the Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors on Lean Body Mass in Humans. Endocrinol Metab (Seoul) 2019; 34:247-262. [PMID: 31565876 PMCID: PMC6769337 DOI: 10.3803/enm.2019.34.3.247] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/16/2022] Open
Abstract
Weight loss is an important goal in the management of several chronic conditions, including type 2 diabetes mellitus, and pharmacological therapies that aid weight loss are appealing. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) are novel glucose-lowering therapies that have been shown to induce clinically significant reductions in body weight. However, this weight loss may not be attributed solely to fat mass (FM). Given the importance of skeletal muscle and lean body mass (LBM) on cardio-metabolic health and physical function, we reviewed the available literature reporting the effects of GLP-1RAs and SGLT2is on body composition. Results demonstrate that, in most circumstances, the weight loss associated with both therapies predominantly comprises a reduction in FM, although significant heterogeneity exists between studies. In over half of the studies identified, the proportion of LBM reduction ranged between 20% and 50% of total weight lost, which is consistent with diet-induced weight loss and bariatric surgery. No clear differences existed between GLP-1RAs and SGLT2is. Consequently, the loss of LBM and skeletal muscle associated with weight loss induced by GLP-1RAs and SGLT2is warrants attention. Strategies to preserve skeletal muscle and improve physical function, for example through structured exercise, are of great importance.
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Affiliation(s)
- Jack Alistair Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - James Adam King
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC), Leicester, UK
| | - Melanie Jane Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK.
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Ahrenfeldt LJ, Möller S, Thinggaard M, Christensen K, Lindahl-Jacobsen R. Sex Differences in Comorbidity and Frailty in Europe. Int J Public Health 2019; 64:1025-1036. [PMID: 31236603 PMCID: PMC7237816 DOI: 10.1007/s00038-019-01270-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To examine sex differences in prevalent comorbidity and frailty across age and European regions. METHODS This is a cross-sectional study based on 113,299 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe from 2004-2005 to 2015. Sex differences in the Comorbidity Index and the Frailty Phenotype were investigated using ordinal logistic regressions. RESULTS European women had generally higher odds of prevalent comorbidity (OR 1.11, 95% CI 1.07-1.15) and frailty (OR 1.56, 95% CI 1.51-1.62). Sex differences increased with advancing age. No overall sex difference in comorbidity was found in Western Europe, but women had more comorbidity than men in Eastern (OR 1.30, 95% CI 1.18-1.44), Southern (OR 1.23, 95% CI 1.15-1.30), and Northern (OR 1.08, 95% CI 1.01-1.16) Europe. Women were frailer than men in all regions, with the largest sex difference in Southern Europe (OR 1.84, 95% CI 1.72-1.96). CONCLUSIONS European women are frailer and have slightly more comorbidity than European men lending support for the male-female health survival paradox.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark.
| | - Sören Möller
- OPEN - Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikael Thinggaard
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
- 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
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
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Older women are frailer, but less often die then men: a prospective study of older hospitalized people. Maturitas 2019; 128:81-86. [PMID: 31561828 DOI: 10.1016/j.maturitas.2019.07.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/17/2019] [Accepted: 07/30/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital. STUDY DESIGN We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up. MAIN OUTCOME MEASURES People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and co-habitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year. RESULTS Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27-4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50-2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34-0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06-1.91) during the year after hospital discharge. CONCLUSION Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the 'male-female health-survival paradox' to acutely ill patient groups.
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Braun T, Thiel C, Ziller C, Rasche J, Bahns C, Happe L, Retzmann T, Grüneberg C. Prevalence of frailty in older adults in outpatient physiotherapy in an urban region in the western part of Germany: a cross-sectional study. BMJ Open 2019; 9:e027768. [PMID: 31230015 PMCID: PMC6597098 DOI: 10.1136/bmjopen-2018-027768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of frailty in older people in outpatient physiotherapy services in an urban region in the western part of Germany. DESIGN Cross-sectional study. SETTING Outpatient physiotherapy clinics were recruited in the municipal area of the city of Bochum, Germany, and selected randomly. PARTICIPANTS Older adults aged 65 years and older seeking outpatient physiotherapy. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of frailty was assessed based on the frailty phenotype model of physical frailty and the accumulation of deficit model, expressed as a Frailty Index. Prevalence was calculated for the whole sample and according to age-related, sex-related and diagnosis-related subgroups. RESULTS A total of 258 participants (74±6 years, 62% female) from 11 out of 130 (8%) different physiotherapy clinics were included. Participants' main indication for physiotherapy was an orthopaedic or surgical condition (75%). According to the model of a physical frailty phenotype, 17.8% (95% CI 13.2 to 22.5) participants were frail and 43.4% (95% CI 37.4 to 49.5) were prefrail. The Frailty Index identified 31.0% (95% CI 25.4 to 36.7) of individuals as frail. In both models, prevalence increased with age and was higher in women than in men. Slow gait speed (34%), reduced muscle strength (34%) and exhaustion (28%) were the most prevalent indicators of physical frailty. CONCLUSIONS Frailty is comparatively common in older patients attending physiotherapy care in Germany, with one out of three individuals being frail and every second individual being physically frail or prefrail. TRIAL REGISTRATION NUMBER DRKS00009384; Results.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
| | - Christian Thiel
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
- Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany
| | - Carina Ziller
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
| | - Julia Rasche
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
| | - Carolin Bahns
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
| | - Lisa Happe
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
| | - Theresa Retzmann
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
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Ida S, Kaneko R, Imataka K, Murata K. Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol 2019; 18:81. [PMID: 31215496 PMCID: PMC6582520 DOI: 10.1186/s12933-019-0885-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022] Open
Abstract
Background In patients with diabetes, death and cardiovascular diseases are attributed to classical risk factors such as hypertension, dyslipidemia, and smoking habit, whereas these events are attributed to frailty in the remaining patients. In this meta-analysis, we examined the relationship between frailty and mortality, hospitalization, and cardiovascular diseases in patients with diabetes. Methods Literature search was conducted using databases such as MEDLINE, Cochrane Controlled Trials Registry, and ClinicalTrials.gov. Studies that examined the relationship between frailty and mortality, hospitalization, and cardiovascular disease and included hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were included. Statistical analysis was performed using a random effects model, and pooled HRs, pooled ORs, and 95% CIs were calculated. Results The literature search extracted 8 studies (565,039 patients) that met our inclusion criteria, which were included in this meta-analysis. The pooled HR of prefrailty and frailty related to mortality was 1.09 (95% CI 1.01–1.17; P = 0.02) and 1.35 (95% CI 1.05–1.74; P = 0.02), respectively, indicating a significant relationship between them. The pooled OR of prefrailty and frailty related to hospitalization was 2.15 (95% CI 1.30–3.54; P = 0.003) and 5.18 (95% CI 2.68–9.99; P < 0.001), respectively, indicating a significant relationship. Although a significant relationship was found between frailty and cardiovascular diseases, we found only few related studies; thus, robust results could not be obtained. Conclusions In patients with diabetes, a significant relationship was observed between frailty and mortality and hospitalization. However, only few heterogeneous studies were included, warranting further examination.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2, Funae, 1-chome, Ise-shi, Mie, 516-8512, Japan.
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2, Funae, 1-chome, Ise-shi, Mie, 516-8512, Japan
| | - Kanako Imataka
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2, Funae, 1-chome, Ise-shi, Mie, 516-8512, Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2, Funae, 1-chome, Ise-shi, Mie, 516-8512, Japan
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Li X, Ploner A, Karlsson IK, Liu X, Magnusson PKE, Pedersen NL, Hägg S, Jylhävä J. The frailty index is a predictor of cause-specific mortality independent of familial effects from midlife onwards: a large cohort study. BMC Med 2019; 17:94. [PMID: 31088449 PMCID: PMC6518710 DOI: 10.1186/s12916-019-1331-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/29/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Frailty index (FI) is a well-established predictor of all-cause mortality, but less is known for cause-specific mortality and whether familial effects influence the associations. Middle-aged individuals are also understudied for the association between FI and mortality. Furthermore, the population mortality impact of frailty remains understudied. METHODS We estimated the predictive value of FI for all-cause and cause-specific mortality, taking into account familial factors, and tested whether the associations are time-dependent. We also assessed the proportion of all-cause and cause-specific deaths that are attributable to increased levels of frailty. We analyzed 42,953 participants from the Screening Across the Lifespan Twin Study (aged 41-95 years at baseline) with up to 20 years' mortality follow-up. The FI was constructed using 44 health-related items. Deaths due to cardiovascular disease (CVD), respiratory-related causes, and cancer were considered in the cause-specific analysis. Generalized survival models were used in the analysis. RESULTS Increased FI was associated with higher risks of all-cause, CVD, and respiratory-related mortality, with the corresponding hazard ratios of 1.28 (1.24, 1.32), 1.31 (1.23, 1.40), and 1.23 (1.11, 1.38) associated with a 10% increase in FI in male single responders, and 1.21 (1.18, 1.25), 1.27 (1.15, 1.34), and 1.26 (1.15, 1.39) in female single responders. No significant associations were observed for cancer mortality. No attenuation of the mortality associations in unrelated individuals was observed when adjusting for familial effects in twin pairs. The associations were time-dependent with relatively greater effects observed in younger ages. Before the age of 80, the proportions of deaths attributable to FI levels > 0.21 were 18.4% of all-cause deaths, 25.4% of CVD deaths, and 20.4% of respiratory-related deaths in men and 19.2% of all-cause deaths, 27.8% of CVD deaths, and 28.5% of respiratory-related deaths in women. After the age of 80, the attributable proportions decreased, most notably for all-cause and CVD mortality. CONCLUSIONS Increased FI predicts higher risks of all-cause, CVD, and respiratory-related mortality independent of familial effects. Increased FI presents a relatively greater risk factor at midlife than in old age. Increased FI has a significant population mortality impact that is greatest through midlife until the age of 80.
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Affiliation(s)
- Xia Li
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Alexander Ploner
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Ida K Karlsson
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden.,Institute of Gerontology and Aging Research Network - Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Xingrong Liu
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Patrik K E Magnusson
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Nancy L Pedersen
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Sara Hägg
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden
| | - Juulia Jylhävä
- The Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 17165, Stockholm, Sweden.
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Moody E, Martin-Misener R, Warner G, Macdonald M, Weeks LE, Shaw L, McKibbon S. Out-of-pocket expenses related to aging in place for frail older people: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:2326-2333. [PMID: 30864982 DOI: 10.11124/jbisrir-2017-003921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to describe the available evidence reporting out-of-pocket expenses for aging-in-place for frail older people and their caregivers. INTRODUCTION There has been an increased focus on supporting frail older people to live in the community, rather than in costly long-term residential care. The out-of-pocket expenses associated with supporting older people with frailty to remain in their homes and communities contribute to caregiver burden and can influence decisions about where to live. INCLUSION CRITERIA This scoping review will consider literature on community-dwelling older people 60 years and older who have been identified as frail. Research and policy papers that report the out-of-pocket expenses incurred by older people with frailty or by their family or friend caregivers to support aging well at home will be included. Studies in English will be considered with no date restriction. METHODS The search strategy aims to find both published and unpublished literature (e.g. policy papers, theses and dissertations). Search databases include CINAHL, PubMed, Scopus, Embase, PsycINFO, Sociological Abstracts, and Public Affairs Index, as well as databases of unpublished sources. The language will be limited to English or French. Title and abstract screening, as well as full-text screening, will be completed by two reviewers. Data will be charted to describe the body of literature focusing on elements such as type of literature, methods used, setting and out-of-pocket expenses. Data will be presented graphically when possible, and accompanied by a narrative that describes the characteristics of the body of literature.
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Affiliation(s)
- Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Canada.,School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: A Joanna Briggs Institute Centre of Excellence
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: A Joanna Briggs Institute Centre of Excellence
| | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Canada.,Aligning Health Needs and Evidence for Transformative Change: A Joanna Briggs Institute Centre of Excellence
| | - Lynn Shaw
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Shelley McKibbon
- Aligning Health Needs and Evidence for Transformative Change: A Joanna Briggs Institute Centre of Excellence.,WK Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada
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Hohls JK, Wild B, Heider D, Brenner H, Böhlen F, Saum KU, Schöttker B, Matschinger H, Haefeli WE, König HH, Hajek A. Association of generalized anxiety symptoms and panic with health care costs in older age-Results from the ESTHER cohort study. J Affect Disord 2019; 245:978-986. [PMID: 30562680 DOI: 10.1016/j.jad.2018.11.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Little is known specifically about the association between generalized anxiety symptoms or panic and health care costs in older age. The aim of this study was to examine the association between generalized anxiety symptoms, panic and health care costs in people aged 65 and over. METHODS Cross-sectional data from the 8-year follow-up of a large, prospective cohort study, the ESTHER study, was used. Individuals aged 65 and over, who participated in the study's home assessment, were included in this analysis (n = 2348). Total and sectoral costs were analyzed as a function of either anxiety symptoms, probable panic disorder, or a panic attack, while controlling for selected covariates, using Two Part and Generalized Linear Models. Covariates were chosen based on Andersen's Behavioral Model of Health Care Use. RESULTS There was no significant association between either of the anxiety or panic measures and total health care costs. Stratified by health care sectors, only the occurrence of a panic attack was significantly associated with incurring costs for outpatient non-physician services (OR: 1.99; 95% CI: 1.15-3.45) and inpatient services (OR: 2.14; 95% CI: 1.07-4.28). Other illness-related factors, such as comorbidities and depressive symptoms, were associated with health care costs in several models. LIMITATIONS This was a cross-sectional study relying on self-reported data. CONCLUSION This study points to an association between a panic attack and sector-specific health care costs in people aged 65 and over. Further research, especially using longitudinal data, is needed.
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Affiliation(s)
- J K Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
| | - B Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - D Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - F Böhlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - K U Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - H Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - W E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Yang L, Jiang Y, Xu S, Bao L, Parker D, Xu X, Li J. Evaluation of frailty status among older people living in urban communities by Edmonton Frail Scale in Wuhu, China: a cross-sectional study. Contemp Nurse 2018; 54:630-639. [PMID: 30479179 DOI: 10.1080/10376178.2018.1552525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Few studies have explored the factors that are associated with frailty among older people. OBJECTIVE To investigate the frailty status and examine the sociodemographic factors that are associated with of older peoples' frailty status in China. DESIGN Cross-sectional study. METHODS We used convenience sampling to recruit the participants (aged 60 and above) from four communities in an urban area of Wuhu, Anhui, China. Participants completed a questionnaire which included the Edmonton Frail Scale (EFS) and sociodemographic factorsWe used convenience sampling to recruit the participants (aged 60 and above) from four communities in an urban area of Wuhu, Anhui, China. Participants completed a questionnaire which included the Edmonton Frail Scale (EFS) and sociodemographic factors. RESULTS Of 306 participants, the percentage of participants with a robust score (0-4) on the EFS was 71.9%, 14.1% had an apparently vulnerable score (5-6), and 14.0% had a frail score (7-17). Age, chronic disease status and marital status were significantly associated with frailty. CONCLUSIONS There are a high percentage of frail older Chinese adults in the urban area. The present study findings could provide better understanding of the factors associated with frailty status of this population.
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Affiliation(s)
- Liu Yang
- a School of Nursing , Wannan Medical College , Wuhu , Anhui , People's Republic of China
| | - Yumin Jiang
- b Department of Nursing , Bengbu Medical College , No. 2600, the East China Sea Road, Bengbu , Anhui 233030 , People's Republic of China
| | - Shuxiu Xu
- b Department of Nursing , Bengbu Medical College , No. 2600, the East China Sea Road, Bengbu , Anhui 233030 , People's Republic of China
| | - Lihua Bao
- c The First Affiliated Hospital , School of Medicine, Zhejiang University , 79 Qingchun Road, Hangzhou , People's Republic of China
| | - Deborah Parker
- d Faculty of Health , University of Technology , Sydney , Australia
| | - Xiaoyue Xu
- d Faculty of Health , University of Technology , Sydney , Australia
| | - Jinzhi Li
- b Department of Nursing , Bengbu Medical College , No. 2600, the East China Sea Road, Bengbu , Anhui 233030 , People's Republic of China
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Mousa A, Savva GM, Mitnitski A, Rockwood K, Jagger C, Brayne C, Matthews FE. Is frailty a stable predictor of mortality across time? Evidence from the Cognitive Function and Ageing Studies. Age Ageing 2018; 47:721-727. [PMID: 29905755 PMCID: PMC6108394 DOI: 10.1093/ageing/afy077] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background age-specific mortality reduction has been accompanied by a decrease in the prevalence of some diseases and an increase in others. Whether populations are becoming ‘healthier’ depends on which aspect of health is being considered. Frailty has been proposed as an integrative measure to quantify health status. Objective to investigate changes in the near-term lethality of frailty before and after a 20-year interval using the frailty index (FI), a summary of age-related health deficit accumulation. Design baseline data from the Cognitive Function and Ageing Studies (CFAS) in 1991 (n = 7,635) and 2011 (n = 7,762). Setting three geographically distinct UK centres (Newcastle, Cambridgeshire and Nottingham). Subjects individuals aged 65 and over (both institutionalised and community-living). Methods a 30-item frailty score was used, which includes morbidities, risk factors and subjective measures of disability. Missing items were imputed using multiple imputations by chained equations. Binomial regression was used to investigate the relationship between frailty, age, sex and cohort. Two-year mortality was modelled using logistic regression. Results mean frailty was slightly higher in CFAS II (0.19, 95% confidence interval (CI): 0.19–0.20) than CFAS I (0.18, 95% CI: 0.17–0.18). Two-year mortality in CFAS I was higher than in CFAS II (odds ratio (OR) = 1.16, 95% CI: 1.03–1.30). The association between frailty and 2-year mortality was non-linear with an OR of ~1.6 for each 0.10 increment in the FI. Conclusions the relationship between frailty and mortality did not significantly differ across the studies. Severe frailty as an indicator of mortality is shown to be a stable construct.
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Affiliation(s)
- Andria Mousa
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Arnold Mitnitski
- Department of Medicine, Dalhousie University, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Carol Jagger
- Institute of Health and Society, Newcastle University Institute for Ageing, Newcastle University, Newcastle, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK
| | - Fiona E Matthews
- Institute of Health and Society, Newcastle University Institute for Ageing, Newcastle University, Newcastle, UK
- MRC Biostatistics Unit, Cambridge University, Cambridge, UK
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47
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It's What’s Inside that Counts: Body Composition and Lung Transplantation. CURRENT PULMONOLOGY REPORTS 2018. [DOI: 10.1007/s13665-018-0206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cao Dinh H, Bautmans I, Beyer I, Mets T, Onyema OO, Forti LN, Renmans W, Vander Meeren S, Jochmans K, Vermeiren S, Vella-Azzopardi R, Njemini R. Association Between Immunosenescence Phenotypes and Pre-frailty in Older Subjects: Does Cytomegalovirus Play a Role? J Gerontol A Biol Sci Med Sci 2018; 74:480-488. [DOI: 10.1093/gerona/gly135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Indexed: 02/02/2023] Open
Affiliation(s)
- Hung Cao Dinh
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
| | - Ivan Bautmans
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
- Department of Geriatric Medicine, Belgium
| | - Ingo Beyer
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
- Department of Geriatric Medicine, Belgium
| | - Tony Mets
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
- Department of Geriatric Medicine, Belgium
| | | | | | - Wim Renmans
- Laboratory of Hematology, Universitair Ziekenhuis Brussel, Belgium
| | | | - Kristin Jochmans
- Laboratory of Hematology, Universitair Ziekenhuis Brussel, Belgium
| | | | | | - Rose Njemini
- Frailty in Ageing Research Group, Belgium
- Gerontology Department, Vrije Universiteit Brussel, Belgium
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Oppenheim H, Paolillo EW, Moore RC, Ellis RJ, Letendre SL, Jeste DV, Grant I, Moore DJ. Neurocognitive functioning predicts frailty index in HIV. Neurology 2018; 91:e162-e170. [PMID: 29875216 DOI: 10.1212/wnl.0000000000005761] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 04/05/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To evaluate the association between a frailty index (i.e., scale of accumulated deficits) and neurocognitive functioning among persons living with HIV/AIDS (PLWHA). METHODS Observational, cross-sectional data were gathered from the University of California, San Diego, HIV Neurobehavioral Research Program from 2002 to 2016. Eight hundred eleven PLWHA aged 18 to 79 years completed comprehensive physical, neuropsychological, and neuromedical evaluations. The frailty index was composed of 26 general and HIV-specific health maintenance measures, and reflects the proportion of accumulated deficits from 0 (no deficits) to 1 (all 26 deficits). Multiple linear regression was used to examine the association between continuous frailty index scores and neurocognitive functioning. RESULTS Participants had a mean age of 44.6 years (11.2), and were mostly male (86.9%) and white (60.2%) with a mean frailty index of 0.26 (0.11). Over the study period, prevalence of HIV-related components (e.g., low CD4) decreased, while non-HIV comorbidities (e.g., diabetes) increased. There were no changes in the frailty index by study year. Higher frailty index was associated with worse global neurocognitive functioning, even after adjusting for covariates (age, employment, and premorbid intellectual functioning; b = -0.007; 95% confidence interval [CI] = -0.0112 to -0.003; p < 0.001). The cognitive domains of verbal fluency (b = -0.004; 95% CI = -0.006 to -0.002), executive functioning (b = -0.004; 95% CI = -0.006 to -0.002), processing speed (b = -0.005; 95% CI = -0.007 to -0.003), and motor skills (b = -0.006; 95% CI = -0.007 to -0.005) also significantly predicted worse frailty index score (p values <0.001). CONCLUSION A frailty index can standardize how clinicians identify PLWHA who may be at higher risk of neurocognitive impairment.
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Affiliation(s)
- Hannah Oppenheim
- From the University of California, San Diego, School of Medicine (H.O.); San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (E.W.P.); Departments of Psychiatry (R.C.M., D.V.J., I.G., D.J.M.), Neurosciences (R.J.E.), and Medicine (S.L.L.), University of California, San Diego; VA San Diego Healthcare System (R.C.M.), CA; and Sam and Rose Stein Institute for Research on Aging (D.V.J.), University of California, San Diego
| | - Emily W Paolillo
- From the University of California, San Diego, School of Medicine (H.O.); San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (E.W.P.); Departments of Psychiatry (R.C.M., D.V.J., I.G., D.J.M.), Neurosciences (R.J.E.), and Medicine (S.L.L.), University of California, San Diego; VA San Diego Healthcare System (R.C.M.), CA; and Sam and Rose Stein Institute for Research on Aging (D.V.J.), University of California, San Diego
| | - Raeanne C Moore
- From the University of California, San Diego, School of Medicine (H.O.); San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (E.W.P.); Departments of Psychiatry (R.C.M., D.V.J., I.G., D.J.M.), Neurosciences (R.J.E.), and Medicine (S.L.L.), University of California, San Diego; VA San Diego Healthcare System (R.C.M.), CA; and Sam and Rose Stein Institute for Research on Aging (D.V.J.), University of California, San Diego
| | - Ronald J Ellis
- From the University of California, San Diego, School of Medicine (H.O.); San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (E.W.P.); Departments of Psychiatry (R.C.M., D.V.J., I.G., D.J.M.), Neurosciences (R.J.E.), and Medicine (S.L.L.), University of California, San Diego; VA San Diego Healthcare System (R.C.M.), CA; and Sam and Rose Stein Institute for Research on Aging (D.V.J.), University of California, San Diego
| | - Scott L Letendre
- From the University of California, San Diego, School of Medicine (H.O.); San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (E.W.P.); Departments of Psychiatry (R.C.M., D.V.J., I.G., D.J.M.), Neurosciences (R.J.E.), and Medicine (S.L.L.), University of California, San Diego; VA San Diego Healthcare System (R.C.M.), CA; and Sam and Rose Stein Institute for Research on Aging (D.V.J.), University of California, San Diego
| | - Dilip V Jeste
- From the University of California, San Diego, School of Medicine (H.O.); San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (E.W.P.); Departments of Psychiatry (R.C.M., D.V.J., I.G., D.J.M.), Neurosciences (R.J.E.), and Medicine (S.L.L.), University of California, San Diego; VA San Diego Healthcare System (R.C.M.), CA; and Sam and Rose Stein Institute for Research on Aging (D.V.J.), University of California, San Diego
| | - Igor Grant
- From the University of California, San Diego, School of Medicine (H.O.); San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (E.W.P.); Departments of Psychiatry (R.C.M., D.V.J., I.G., D.J.M.), Neurosciences (R.J.E.), and Medicine (S.L.L.), University of California, San Diego; VA San Diego Healthcare System (R.C.M.), CA; and Sam and Rose Stein Institute for Research on Aging (D.V.J.), University of California, San Diego
| | - David J Moore
- From the University of California, San Diego, School of Medicine (H.O.); San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology (E.W.P.); Departments of Psychiatry (R.C.M., D.V.J., I.G., D.J.M.), Neurosciences (R.J.E.), and Medicine (S.L.L.), University of California, San Diego; VA San Diego Healthcare System (R.C.M.), CA; and Sam and Rose Stein Institute for Research on Aging (D.V.J.), University of California, San Diego.
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Ensrud KE, Kats AM, Schousboe JT, Taylor BC, Cawthon PM, Hillier TA, Yaffe K, Cummings SR, Cauley JA, Langsetmo L. Frailty Phenotype and Healthcare Costs and Utilization in Older Women. J Am Geriatr Soc 2018; 66:1276-1283. [PMID: 29684237 DOI: 10.1111/jgs.15381] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the association of the frailty phenotype with subsequent healthcare costs and utilization. DESIGN Prospective cohort study (Study of Osteoporotic Fractures (SOF)). SETTING Four U.S. sites. PARTICIPANTS Community-dwelling women (mean age 80.2) participating in SOF Year 10 (Y10) examination linked with their Medicare claims data (N=2,150). MEASUREMENTS At Y10, frailty phenotype defined using criteria similar to those used in the Cardiovascular Health Study frailty phenotype and categorized as robust, intermediate stage, or frail. Participant multimorbidity burden ascertained using claims data. Functional limitations assessed by asking about difficulty performing instrumental activities of daily living. Total direct healthcare costs and utilization ascertained during 12 months after Y10. RESULTS Mean total annualized cost±standard deviation (2014 dollars) was $3,781±6,920 for robust women, $6,632±12,452 for intermediate stage women, and $10,755 ± 16,589 for frail women. After adjustment for age, site, multimorbidity burden, and cognition, frail women had greater mean total (cost ratio (CR)=1.91, 95% confidence interval (CI)=1.59-2.31) and outpatient (CR=1.55, 95% CI=1.36-1.78) costs than robust women and greater odds of hospitalization (odds ratio (OR)=2.05, 95% CI=1.47-2.87) and a skilled nursing facility stay (OR=3.85, 95% CI=1.88-7.88). There were smaller but significant effects of the intermediate stage category on these outcomes. Individual frailty components (shrinking, poor energy, slowness, low physical activity) were also each associated with higher total costs. Functional limitations partially mediated the association between the frailty phenotype and total costs (CR further adjusted for self-reported limitations=1.32, 95% CI=1.07-1.63 for frail vs robust; CR=1.35, 95% CI=1.18-1.55 for intermediate stage vs robust women). CONCLUSION Intermediate stage and frail older community-dwelling women had higher subsequent total healthcare costs and utilization after accounting for multimorbidity and functional limitations. Frailty phenotype assessment may improve identification of older adults likely to require costly, extensive care.
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Affiliation(s)
- Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Allyson M Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - John T Schousboe
- HealthPartners Institute, Bloomington, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Teresa A Hillier
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, San Francisco, California.,Department of Neurology, University of California, San Francisco, San Francisco, California.,Department of Epidemiology, University of California, San Francisco, San Francisco, California
| | - Steve R Cummings
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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