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Mayo A, O'Brien MW, Godin J, Kehler DS, Kimmerly DS, Theou O. Can an active lifestyle offset the relationship that poor lifestyle behaviours have on frailty? Arch Gerontol Geriatr 2024; 127:105556. [PMID: 39032315 DOI: 10.1016/j.archger.2024.105556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To examine the association of lifestyle behaviours (LSB) with physical activity (PA) and frailty; also, to examine if associations differ by sex and age. METHODS 24,828 individuals [49.6 ± 17.6 years (range: 20-85), 51.6 % female] from the National Health and Nutrition Examination Survey (cycles 2009-2018) were included. Individuals were divided into Active (≥150 min/week of moderate-to-vigorous physical activity (MVPA)) and Inactive (<150 min/week MVPA) based on self-reported PA. Frailty was measured by a 46-item Frailty Index (FI). LSB consisted of stationary time, sleep, diet quality, and alcohol and smoking habits. LSB was summed into a score [0-5]. Linear regression models were used with each LSB in isolation and the summed LSB with frailty. RESULTS There were 7,495 (30.1 %) Active and 17,333 (69.8 %) Inactive individuals. The FI was lower in the Active participants (Active: 0.10 ± 0.08; Inactive: 0.15 ± 0.12; p < 0.01). A worse LSB score was associated with an increased FI in all behaviours but females who binge drink and smoke (p-all>0.14). For inactive individuals, all LSBs were associated with an increased FI except those who binge drink and male smokers (p = 0.08). There was a significant association between increased summed LSB and an increased FI (β range: Active, 0.024-0.037; Inactive, 0.028, 0.046. p-all<0.01); the Active group had a lower FI at every age group than the Inactive group (p < 0.001). CONCLUSION PA was associated with a lower FI even among those with a poor LSB score. This association is dependent on age, with older individuals reporting a stronger association.
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Affiliation(s)
- A Mayo
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - M W O'Brien
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada
| | - J Godin
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - D S Kehler
- School of Physiotherapy (Faculty of Health), Dalhousie University, Halifax, Nova Scotia, Canada
| | - D S Kimmerly
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - O Theou
- Geriatric Medicine Research, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia, Canada; School of Physiotherapy (Faculty of Health), Dalhousie University, Halifax, Nova Scotia, Canada.
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Balas N, Richman JS, Landier W, Shrestha S, Bruxvoort KJ, Hageman L, Meng Q, Ross E, Bosworth A, Wong FL, Bhatia R, Forman SJ, Armenian SH, Weisdorf DJ, Bhatia S. Pre-frailty after blood or marrow transplantation and the risk of subsequent mortality. Leukemia 2024; 38:1592-1599. [PMID: 38580835 PMCID: PMC11217001 DOI: 10.1038/s41375-024-02238-2] [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: 02/29/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024]
Abstract
We examined the prevalence, risk factors, and association between pre-frailty and subsequent mortality after blood or marrow transplantation (BMT). Study participants were drawn from the BMT Survivor Study (BMTSS) and included 3346 individuals who underwent BMT between 1974 and 2014 at one of three transplant centers and survived ≥2 years post-BMT. Participants completed the BMTSS survey at a median of 9 years from BMT and were followed for subsequent mortality for a median of 5 years after survey completion. Closest-age and same-sex biological siblings also completed the survey. Previously published self-reported indices (exhaustion, weakness, low energy expenditure, slowness, unintentional weight loss) classified participants as non-frail (0-1 indices) or pre-frail (2 indices). National Death Index was used to determine vital status and cause of death. Overall, 626 (18.7%) BMT survivors were pre-frail. BMT survivors had a 3.2-fold higher odds of being pre-frail (95% CI = 1.9-5.3) compared to siblings. Compared to non-frail survivors, pre-frail survivors had higher hazards of all-cause mortality (adjusted hazard ratio [aHR] = 1.6, 95% CI = 1.4-2.0). Female sex, pre-BMT radiation, smoking, lack of exercise, anxiety, and severe/life-threatening chronic health conditions were associated with pre-frailty. The novel association between pre-frailty and subsequent mortality provides evidence for interventions as pre-frail individuals may transition back to their robust state.
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Affiliation(s)
- Nora Balas
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Wendy Landier
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Qingrui Meng
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Ross
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Ravi Bhatia
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL, USA.
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Martinez-Aristizábal JD, Curcio CL, Fernandes J, Vafael A, Gomes CDS, Gomez F. Cardiovascular risk burden and disability: findings from the International Mobility in Aging Study (IMIAS). J Geriatr Cardiol 2024; 21:331-339. [PMID: 38665284 PMCID: PMC11040056 DOI: 10.26599/1671-5411.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The association of cardiovascular risk burden with disability is unclear. We examined the association between trajectories of the Framingham general cardiovascular disease risk score (FGCRS) with the trajectories of limitations of physical function in older adults. METHODS A total of 1219 participants with no disabilities from the International Mobility in Aging Study (IMIAS) study who had up to three repeated measures of FGCRS between 2012-2016 and without a history of stroke or coronary heart disease at baseline and follow-up were included. FGCRS at baseline was assessed and categorized into tertiles. Physical function was evaluated with the Short Physical Performance Battery (SPPB). The data were analyzed using linear mixed-effects models. RESULTS At baseline, FGCRS ranged between 3-94 (mean score: 24 ± 15.8), participants were 32 (2.6%), 502 (41.2%) and 685 (56.2%) in lowest, middle, and highest tertiles, respectively. In the trajectories of limitations of physical function, the lowest FGCRS had no differences, while the middle and highest had a decrease in physical performance between 2012-2014 (P = 0.0001). Age, being female, living in Andes Mountains, having middle and highest FGCRS, higher alcohol consumption, being obese, lack of exercise and cognitive impairment increase the probability of disability (P < 0.05). Alternatively, living in more developed regions and having a higher educational level reduced the probability of disability during the follow-up time (P < 0.05). CONCLUSIONS Higher cardiovascular risk burden is associated with decreased physical performance, especially in gait. Results suggest SPPB may provide a measure of cardiovascular health in older adults.
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Affiliation(s)
| | - Carmen-Lucia Curcio
- Research Group in Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - Juliana Fernandes
- Laboratory of Physical Therapy and Collective Health, Physical Therapy Department, Federal University of Pernambuco, Jornalista Aníbal Fernandes Avenue Recife, Brazil
| | - Afshin Vafael
- Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | | | - Fernando Gomez
- Research Group in Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
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4
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Pai M, Muhammad T. Examining factors contributing to the socioeconomic inequalities in handgrip strength among older adults in India: a decomposition analysis. Sci Rep 2024; 14:442. [PMID: 38172263 PMCID: PMC10764745 DOI: 10.1038/s41598-023-50613-3] [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: 01/25/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
The purpose of this study was to examine (a) the socioeconomic status (SES)-related inequalities associated with handgrip strength (HGS); and (b) the extent to which several demographic, health, and behavioral factors contributed to such SES disparities in HGS among older adults in India. Data were drawn from the 2017-2018 wave 1 of the Longitudinal Ageing Study of India (LASI). The study sample included 27,707 older adults (13,199 men and 14,508 women) aged 60 years and older. HGS was assessed using a handheld Smedley's Hand Dynamometer with a cut-off of 19.5 kg for men and 12.5 kg for women. Bivariate analysis showed the weighted percentage distribution of weak HGS across respondent characteristics. Multivariate logistic regression assessed factors linked to weak HGS. The concentration curve and index (CCI) was used to determine the inequalities in the prevalence of weak HGS by wealth index scores. Wagstaff's decomposition approach was used to test the contribution of each explanatory variable to weak HGS. Around 9% of older adults in this study reported a weak HGS. It was significantly higher among those aged 80 or older (19.21%) and males (15.55%). Weak HGS was concentrated among older adults from poor SES (CCI: 0.05, p < 0.001). A higher percentage of wealth-based inequality in weak HGS was explained by being underweight (38.83%), belonging to the richest wealth quintile (27.95%), and having a higher subjective social status (32.20%). Moreover, about 23.29% of the inequality in weak HGS was explained by Western region and 22.54% by female gender. Additionally, having a secondary level of education explained a higher percentage (22.09%) of inequality, followed by current working status (- 20.68%). Rural residence (13.08%), limitations in instrumental activities of daily living (IADL) (12.21%), and engagement in yoga-related activities (11.55%) explained a higher percentage of wealth-based inequalities. The findings provide evidence of significant SES-related inequalities in HGS and the contribution of various demographic, health, and behavioral factors to such inequality. As such, public health policies and programs focusing on reducing the burden of disability must consider the contribution of social and economic equity to the preservation of muscle strength among older adults.
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Affiliation(s)
- Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| | - T Muhammad
- Pennsylvania State University, University Park, PA, 16802, USA.
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Ruderman SA, Odden MC, Webel AR, Fitzpatrick AL, Crane PK, Nance RM, Drumright LN, Whitney BM, Mixson LS, Ma J, Willig AL, Haidar L, Eltonsy S, Mayer KH, O'Cleirigh C, Cropsey KL, Eron JJ, Napravnik S, Greene M, McCaul M, Chander G, Cachay E, Lober WB, Kritchevsky SB, Austad S, Landay A, Pandya C, Cartujano-Barrera F, Saag MS, Kamen C, Hahn AW, Kitahata MM, Delaney JAC, Crane HM. Tobacco Smoking and Pack-Years Are Associated With Frailty Among People With HIV. J Acquir Immune Defic Syndr 2023; 94:135-142. [PMID: 37368939 PMCID: PMC10527292 DOI: 10.1097/qai.0000000000003242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Tobacco smoking increases frailty risk among the general population and is common among people with HIV (PWH) who experience higher rates of frailty at younger ages than the general population. METHODS We identified 8608 PWH across 6 Centers for AIDS Research Network of Integrated Clinical Systems sites who completed ≥2 patient-reported outcome assessments, including a frailty phenotype measuring unintentional weight loss, poor mobility, fatigue, and inactivity, and scored 0-4. Smoking was measured as baseline pack-years and time-updated never, former, or current use with cigarettes/day. We used Cox models to associate smoking with risk of incident frailty (score ≥3) and deterioration (frailty score increase by ≥2 points), adjusted for demographics, antiretroviral medication, and time-updated CD4 count. RESULTS The mean follow-up of PWH was 5.3 years (median: 5.0), the mean age at baseline was 45 years, 15% were female, and 52% were non-White. At baseline, 60% reported current or former smoking. Current (HR: 1.79; 95% confidence interval: 1.54 to 2.08) and former (HR: 1.31; 95% confidence interval: 1.12 to 1.53) smoking were associated with higher incident frailty risk, as were higher pack-years. Current smoking (among younger PWH) and pack-years, but not former smoking, were associated with higher risk of deterioration. CONCLUSIONS Among PWH, smoking status and duration are associated with incident and worsening frailty.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jimmy Ma
- University of Washington, Seattle, WA, USA
| | | | - Lara Haidar
- University of Manitoba, Winnipeg, Manitoba, CA
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Liu W, Yang H, Lv L, Song J, Jiang Y, Sun X, Ye D, Mao Y. Genetic predisposition to smoking in relation to the risk of frailty in ageing. Sci Rep 2023; 13:2405. [PMID: 36765104 PMCID: PMC9918446 DOI: 10.1038/s41598-023-28780-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
Frailty causes emerging global health burden due to its high prevalence and mortality. In this study, we used Mendelian randomization (MR) approach to examine the potential causal relationship between smoking and frailty in ageing. Using inverse-variance weighted (IVW) method, genetically predicted smoking initiation was associated with an increased risk of frailty in ageing (odd ratio (OR) 1.23, 95% confidence interval (CI) 1.19-1.27, P = 3.21 × 10-39). Similarly, per year increase in age of initiation of regular smoking was associated with a 25% decrease in the risk of frailty (95% CI 7-39%, P = 7.79 × 10-3, per year), while higher number of cigarettes per day was associated with a 12% increased risk (95% CI 4-20%, P = 1.76 × 10-3). Compared with former smokers, current smokers were associated with an increased risk of frailty (OR 1.12, 95% CI 1.02-1.22, P = 0.01). Lifetime smoking was associated with a 46% higher risk of frailty (95% CI 37-56%, P = 2.63 × 10-29). Sensitivity analysis using alternative MR methods yielded similar results. Our study indicates that genetic predisposition to smoking is associated with the risk of frailty in ageing. Further studies are warranted to examine the exact role of smoking in the development of frailty.
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Affiliation(s)
- Wei Liu
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Hong Yang
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Linshuoshuo Lv
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Jie Song
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yuqing Jiang
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Xiaohui Sun
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Ding Ye
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Yingying Mao
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
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7
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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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Wang Z, Cui K, Song R, Li X, Qi X, Buchman AS, Bennett DA, Xu W. Influence of Cardiovascular Risk Burden on Motor Function Among Older Adults: Mediating Role of Cardiovascular Diseases Accumulation and Cognitive Decline. Front Med (Lausanne) 2022; 9:856260. [PMID: 35559338 PMCID: PMC9087801 DOI: 10.3389/fmed.2022.856260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to investigate the association of the cardiovascular risk burden assessed by the Framingham General Cardiovascular Risk Score (FGCRS) with the trajectories of motor function over time and to assess the mediating effects of cardiovascular diseases (CVDs) accumulation and cognitive decline in such association. Methods In Rush Memory and Aging Project, a total of 1,378 physical health participants (mean age: 79.3 ± 7.3 years) were followed up for up to 22 years. FGCRS at baseline was assessed and categorized into tertiles (lowest, middle, and highest). Global motor function (including dexterity, gait, and hand strength) was assessed annually with 10 motor tests. CVDs (including stroke, congestive heart failure, and other heart diseases) were ascertained at baseline and follow-ups, and the number of CVDs accumulation over time was assessed. Global cognitive function was tested annually by 19 tests. Data were analyzed using the linear mixed-effects models and mediation analysis. Results At baseline, FGCRS ranged from 4 to 28 (mean score: 15.6 ± 3.7). Over the follow-up (median: 5.3 years; interquartile range: 2.9-9.0 years), in multi-adjusted mixed-effects models, the highest FGCRS was associated with faster decline in global motor function (β = -0.0038; 95% confidence interval [CI]: -0.0069 to -0.0008), dexterity (β = -0.0056; 95% CI: -0.0093 to -0.0020), gait (β = -0.0039; 95% CI: -0.0077 to -0.0001), and hand strength (β = -0.0053; 95% CI: -0.0098 to -0.0008) compared with the lowest tertile. In mediation analysis, CVDs accumulation and cognitive decline mediated 8.4% and 42.9% of the association between FGCRS and global motor function over time, respectively. Conclusion Higher cardiovascular risk burden is associated with a faster decline in motor function including dexterity, gait, and hand strength. CVDs accumulation and cognitive decline may partially mediate the association between cardiovascular risk burden and global motor function decline.
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Affiliation(s)
- Zhangyu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Kaiwang Cui
- Department of Respiratory and Critical Care Medicine, The Fifth People's Hospital of Ganzhou, Ganzhou Institute of Respiratory Diseases, Ganzhou, China
| | - Ruixue Song
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China
| | - Xuerui Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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9
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Yamada Y, Kobayashi T, Condo A, Sangarlangkarn A, Ko F, Taniguchi Y, Kojima G. Prevalence of Frailty and Prefrailty in People With Human Immunodeficiency Virus Aged 50 or Older: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2022; 9:ofac129. [PMID: 35415198 PMCID: PMC8995074 DOI: 10.1093/ofid/ofac129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
Background With effective antiretroviral therapy, there is an emerging population of adults aged 50 years or older with human immunodeficiency virus (HIV). Frailty is an increasingly recognized clinical state of vulnerability associated with disability, hospitalization, and mortality. However, there is a paucity of large studies assessing its prevalence in people with HIV (PWH) aged 50 or older. Methods PubMed was systematically searched for studies published between January 2000 and August 2020 reporting the prevalence of frailty in PWH aged 50 or older. The pooled prevalence of frailty and prefrailty was synthesized using a random-effects meta-analysis. Results Of the 425 studies identified, 26 studies were included in the analysis, with a total of 6584 PWH aged 50 or older. The included studies were published between 2012 and 2020, and all studies used the Fried frailty phenotype to define frailty. The overall pooled prevalence of frailty and prefrailty was 10.9% (95% confidence interval [CI], 8.1%–14.2%) and 47.2% (95% CI, 40.1%–54.4%), respectively. A high degree of heterogeneity was observed (I2 = 93.2%). In the subgroup analysis, HIV-related variables and other demographic variables were examined, and heterogeneity disappeared only in the group of a longer duration since HIV diagnosis (I2 = 0%). Conclusions The pooled prevalence of frailty and prefrailty defined by the Fried frailty phenotype was assessed in PWH aged 50 or older. Findings from this study quantified the proportion of this specific population with this common geriatric syndrome. Future studies identifying effective strategies for frailty screening and intervention are required for this vulnerable population.
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Affiliation(s)
- Yuji Yamada
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Takaaki Kobayashi
- Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Angela Condo
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Fred Ko
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Yu Taniguchi
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - Gotaro Kojima
- Department of Research, Dr. AGA Clinic, Minato-ku, Tokyo, Japan
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10
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Rahman MM, Jagger C, Princehorn EM, Holliday EG, Leigh L, Loxton DJ, Beard J, Kowal P, Byles JE. Onset and progression of chronic disease and disability in a large cohort of older Australian women. Maturitas 2022; 158:25-33. [DOI: 10.1016/j.maturitas.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/31/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
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11
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Reid N, Weerasekera S, Hubbard RE, Gordon EH. Frailty in ethnic minority women. Maturitas 2021; 152:26-31. [PMID: 34674805 DOI: 10.1016/j.maturitas.2021.07.005] [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: 04/11/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
In majority populations in high- and middle-income countries, women live longer yet experience higher levels of frailty than men of the same age. It is unclear whether this 'sex-frailty paradox' is present in ethnic minority populations. In this narrative review, we explore biological, behavioural and social factors associated with mortality, morbidity and frailty in women, particularly ethnic minority women. We ascertain that natural menopause occurs earlier in women of particular ethnicities. Ethnic minority women (living in high-income countries) have more children and higher rates of chronic disease and disability, all of which are associated with frailty. In some ethnic minorities, women are less likely to engage in deleterious health behaviours such as smoking and alcohol consumption. However, in others the reverse is true. Women from migrant ethnic minorities tend to have lower levels of physical activity. With time, they can also adopt adverse behavioural patterns of the majority population. Although the evidence is sparse, sex differences in health reporting and social assets, as well as gender roles, are likely to contribute to sex differences in frailty in ethnic minorities. Overall, ethnic minority women are a particularly vulnerable group, but the majority of risk factors for frailty appear to be mutable rather than fixed. Future research may examine interventions that target frailty in different races and ethnicities at individual, population and global levels.
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Affiliation(s)
- Natasha Reid
- Faculty of Medicine, The University of Queensland, Queensland, Australia.
| | - Shavini Weerasekera
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia; School of Medicine, Griffith University, Queensland, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia
| | - Emily H Gordon
- Faculty of Medicine, The University of Queensland, Queensland, Australia; Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia
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Galbarczyk A, Klimek M, Blukacz M, Nenko I, Jabłońska M, Jasienska G. Inflammaging: Blame the sons. Relationships between the number of sons and the level of inflammatory mediators among post-reproductive women. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175:656-664. [PMID: 33929754 DOI: 10.1002/ajpa.24295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/08/2021] [Accepted: 04/17/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Reproduction is costly, but sons and daughters differently influence maternal physiology, also in older age. In particular, having sons may negatively influence maternal health and may be associated with a shorter life span of mothers. Sons may also contribute to increased inflammaging, a chronic sub-clinical systemic inflammatory state characterized by elevated levels of serum inflammatory mediators. The aim of this study was to examine the impact of the total number of children, and the number of daughters and sons separately on concentrations of C-reactive protein (CRP), and proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α). MATERIALS AND METHODS The participants were 378 women aged 45-92 who had 3.9 (SD 2.12, median = 4, range = 0-13) children, including 2.1 (SD 1.46, median = 2, range = 0-8) sons and 1.8 (SD 1.44, median = 2, range = 0-7) daughters on average. RESULTS We found a positive relationship between the overall number of children and IL-6 levels. CRP and IL-6 concentrations were positively associated with the number of sons but not with the number of daughters. Each son increased maternal CRP level by 11%, and IL-6 level by 6%. Neither the total number of children nor the number of daughters or sons were related to the TNF-α concentration. DISCUSSION Aging-associated inflammation in post-reproductive mothers with a higher number of sons supports the hypothesis of trade-offs between reproduction and health. Furthermore, these results provide new evidence contributing to the idea that having sons may have more detrimental effects on the maternal organism than having daughters.
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Affiliation(s)
- Andrzej Galbarczyk
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Klimek
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Blukacz
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.,Institute of Psychology, University of Silesia in Katowice, Katowice, Poland
| | - Ilona Nenko
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Jabłońska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Grazyna Jasienska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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13
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Tembo MC, Holloway-Kew KL, Sui SX, Dunning T, Low ACH, Yong SJ, Ng BL, Brennan-Olsen SL, Williams LJ, Kotowicz MA, Pasco JA. Prevalence of Frailty in Older Men and Women: Cross-Sectional Data from the Geelong Osteoporosis Study. Calcif Tissue Int 2020; 107:220-229. [PMID: 32617612 DOI: 10.1007/s00223-020-00713-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
Few studies have investigated the prevalence of frailty in the Australian general population. This study determined the prevalence of frailty in a population-based sample of older adults and examined the relationship between frailty and comorbid conditions. Men (n = 347) and women (n = 360) aged ≥ 60 year from the Geelong Osteoporosis Study (GOS) were assessed between 2016-2019 and 2011-2014, respectively. Frailty was identified using a modified Fried frailty phenotype. Prevalence estimates were standardised to the 2011 Australian population. Kruskal-Wallis test and χ2 test were used to analyse data. For women, mean standardised prevalence estimates were 18.3% (14.1-22.5) for frail, 54.1% (47.3-60.8) pre-frail and 22.9% (18.9-26.8) robust. Corresponding estimates for men were 13.1% (9.8-16.3) frail, 47.8% (42.0-53.6) pre-frail and 27.3% (22.7-31.8) robust. Women who were frail were older, shorter, tended to have a higher body mass index (BMI) and used more medications compared to other groups. Compared to robust women, those who were frail were more likely to have cardio-metabolic (OR 3.5 (0.7-20.0)), pulmonary (OR 3.5 (1.5-8.4)) and musculoskeletal (OR 10.1 (2.1-48.0)) conditions. Frail men were older, had a higher BMI and were more likely to have musculoskeletal conditions (OR 5.8 (2.8-12.3)) and tended to be from a lower SES. No further associations were observed. This study reported the prevalence of frail and pre-frail individuals in a population-based sample of Australian men and women. Frailty was associated with musculoskeletal conditions for both men and women; however, associations with cardio-metabolic and pulmonary comorbidities were evident in women only.
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Affiliation(s)
- Monica C Tembo
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia.
| | - Kara L Holloway-Kew
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Sophia X Sui
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Trisha Dunning
- Barwon Health, Geelong, VIC, Australia
- Quality and Patient Safety Research, Deakin University and Barwon Health, School of Nursing and Midwifery, Geelong, VIC, Australia
| | | | | | - Boon L Ng
- Barwon Health, Geelong, VIC, Australia
| | - Sharon L Brennan-Olsen
- Australian Institute for Musculoskeletal Science, University of Melbourne and Western Health, Melbourne, Australia
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Australia
- Institute for Health Transformation, Deakin University, Waterfront Campus, Geelong, VIC, Australia
- School of Health and Social Development, Deakin University, Waterfront Campus, Geelong, VIC, Australia
| | - Lana J Williams
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Mark A Kotowicz
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Australia
| | - Julie A Pasco
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
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14
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DeClercq V, Duhamel TA, Theou O, Kehler S. Association between lifestyle behaviors and frailty in Atlantic Canadian males and females. Arch Gerontol Geriatr 2020; 91:104207. [PMID: 32781378 DOI: 10.1016/j.archger.2020.104207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/06/2020] [Accepted: 07/23/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim of this study was to identify lifestyle factors in males and females that are associated with a greater degree of frailty in a Canadian cohort. METHODS Cross-sectional data analysis from participants aged 30-74 yrs of the Atlantic PATH cohort. Inclusion criteria included completion of mental health questionnaires and ≥1 vital measure (n = 9133, 70% female, mean age 55 yrs). A frailty index was created based on 38 items with higher values indicating increasing frailty. The association between lifestyle factors and frailty was assessed by logistic regression. RESULTS 805 participants had a high level of frailty (frailty index ≥0.30). There was a significant interaction among sex, age, and lifestyle factors such as smoking status (P < 0.001), alcohol consumption (P < 0.001), physical activity level (P = 0.005), time spent sitting (P < 0.001) and sleeping (P < 0.001) on frailty. Smoking was harmful whereas sleep was protective for both males and females (<60 yrs). Females (<60yrs) that sat for ≥4 h/day were more likely to be highly frail whereas females (all ages) that consumed alcohol at least occasionally were less likely to be highly frail. Males, but not females, that engaged in a high level of physical activity were less likely to have a high level of frailty. CONCLUSIONS Higher frailty is more prevalent among participants with unhealthy lifestyle behaviors related to smoking, alcohol consumption, sedentary and physical activity level, diet, and sleep. Differences in lifestyle behaviors of males and females of specific ages should be considered for managing frailty levels.
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Affiliation(s)
- Vanessa DeClercq
- Atlantic PATH, Dalhousie University, 1494 Carlton Street, Halifax, NS B3H 3B7, Canada.
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, 208 Active Living Centre, Winnipeg, MB R3T 2N2, Canada; Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre R4012, 351 Tache Ave, Winnipeg, Manitoba R2H 2A6, Canada.
| | - Olga Theou
- Faculty of Health, School of Physiotherapy, Dalhousie University, PO Box 15000 5869 University Ave, Halifax, Nova Scotia B3H 4R2, Canada; Department of Medicine, Division of Geriatric Medicine, QEII Health Sciences Centre - Camp Hill Veterans Memorial Building, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada.
| | - Scott Kehler
- Faculty of Health, School of Physiotherapy, Dalhousie University, PO Box 15000 5869 University Ave, Halifax, Nova Scotia B3H 4R2, Canada; Department of Medicine, Division of Geriatric Medicine, QEII Health Sciences Centre - Camp Hill Veterans Memorial Building, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada.
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15
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Hubbard RE, Maier AB, Hilmer SN, Naganathan V, Etherton-Beer C, Rockwood K. Frailty in the face of COVID-19. Age Ageing 2020; 49:499-500. [PMID: 32374368 PMCID: PMC7239250 DOI: 10.1093/ageing/afaa095] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/20/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ruth E Hubbard
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Sarah N Hilmer
- Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Australia
| | | | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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16
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Shin J, Kim KJ, Choi J. Smoking, alcohol intake, and frailty in older Korean adult men: cross-sectional study with nationwide data. Eur Geriatr Med 2020; 11:269-277. [PMID: 32297188 DOI: 10.1007/s41999-019-00271-4] [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: 07/11/2019] [Accepted: 11/19/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Smoking and alcohol intake are major causes of negative health outcomes and may be co-inherited traits. However, little is known about the association of frailty with smoking and alcohol intake in older adults. METHODS Community-dwelling older men (N = 1426) aged 70-84 years were divided into four groups: 1) non-smoking (< 100 cigarettes in life-time) and non-alcohol intake (< one time/month); 2) smoking (≥ 100 cigarettes) and alcohol intake (≥ one time/month); 3) non-smoking with alcohol intake; and 4) smoking and no alcohol intake. Frailty was assessed with a modified version of the Cardiovascular Health Study (CHS) frailty index, the Korean version of the Fatigue, Resistance, Ambulation, Illness, and Loss of Weight (KFRAIL) index, the Korean Frailty Index (KFI), and the Study of Osteoporotic Fracture (SOF) frailty index. Frailty risks were estimated with multiple logistic regression models after adjusting for age, income, education, residence, marital status, hospitalization, physical activity, comorbidities, and levels of vitamin B12, aspartate aminotransferase, and gamma-glutamyl transferase. RESULTS Frailty differed according to smoking and alcohol status. Frailty in the smoking and non-alcohol-intake group was significantly higher according to the CHS frailty index (Odds ratio = 1.592; 95% confidence interval [CI] 1.032-2.455), KFRAIL (CI 1.613, 1.037-2.509), and KFI (CI 1.869, 1.115-3.131) compared with the non-smoking and alcohol-intake group. However, there was no increased frailty risk in the other study groups. CONCLUSION Frailty prevalence differed depending on smoking status and alcohol intake in older Korean men. Therefore, we should adopt a comprehensive approach to understanding frailty in older adults that considers both smoking and alcohol intake.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Research Institute on Healthy Aging, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Kyoung Jin Kim
- Department of Family Medicine, Research Institute on Healthy Aging, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
| | - Jaekyung Choi
- Department of Family Medicine, Research Institute on Healthy Aging, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea.
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Pincus D, Jenkinson R, Paterson M, Leroux T, Ravi B. Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty. JAMA 2020; 323:1070-1076. [PMID: 32181847 PMCID: PMC7078797 DOI: 10.1001/jama.2020.0785] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Controversy exists about the preferred surgical approach for total hip arthroplasty (THA). OBJECTIVE To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study of all adults in Ontario, Canada, who had undergone primary THA for osteoarthritis between April 1, 2015, and March 31, 2018. All patients were followed up over a 1-year period (study end date, March 31, 2019). EXPOSURES Surgical approach (anterior vs lateral/posterior) for THA. MAIN OUTCOMES AND MEASURES Major surgical complications within 1 year (composite of deep infection requiring surgery, dislocation requiring closed or open reduction, or revision surgery). Outcomes were compared among propensity-score matched groups using Cox proportional hazards regression. RESULTS Of the 30 098 patients (mean [SD] age, 67 years [10.7 years]; 16 079 women [53.4%]) who underwent THA, 2995 (10%) underwent the anterior approach; 21 248 (70%), the lateral approach; and 5855 (20%) the posterior approach performed at 1 of 73 hospitals by 1 of 298 surgeons. All patients were followed up for 1 year. Compared with those undergoing the lateral or posterior approach, patients undergoing an anterior approach were younger (mean age, 65 vs 67 years; standardized difference, 0.17); had lower rates of morbid obesity (4.8% vs 7.6%; standardized difference, 0.12), diabetes (14.2% vs 19.9%; standardized difference, 0.15), and hypertension (53.4% vs 62.9%; standardized difference, 0.19); and were treated by higher-volume surgeons (median range, 111 procedures; interquartile range, 69-172 vs 77 procedures, interquartile range, 50-119 in the prior year; standardized difference, 0.55). Compared with 2993 propensity-score matched patients undergoing a lateral or posterior approach, the 2993 matched patients undergoing anterior approaches had a significantly greater risk of a major surgical complication (61 patients [2%] vs 29 patients [1%]; absolute risk difference, 1.07%; 95% CI, 0.46%-1.69%; hazard ratio, 2.07; 95% CI, 1.48 to 2.88). CONCLUSIONS AND RELEVANCE Among patients undergoing total hip arthroplasty, an anterior surgical approach compared with a posterior or lateral surgical approach was associated with a small but statistically significant increased risk of major surgical complications. The findings may help inform decisions about surgical approach for hip arthroplasty, although further research is needed to understand pain and functional outcomes.
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Affiliation(s)
- Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Richard Jenkinson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada
| | | | - Timothy Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital, Division of Orthopaedic Surgery, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Division of Orthopaedic Surgery, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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18
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Sinclair AJ, Abdelhafiz AH. Cardiometabolic disease in the older person: prediction and prevention for the generalist physician. Cardiovasc Endocrinol Metab 2020; 9:90-95. [PMID: 32803140 DOI: 10.1097/xce.0000000000000193] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/13/2020] [Indexed: 12/17/2022]
Abstract
Ageing is associated with chronic inflammation and oxidative stress that increase the risk of cardiovascular disease. Frailty and sarcopenia, which are associated with increased visceral obesity and muscle mass loss, are now emerging as new potential risk factors for cardiovascular disease. Increased muscle visceral fat leads to increased secretion of harmful proinflammatory adipokines and reduced muscle mass leads to reduced secretion of the protective myokines creating an abnormal cardiometabolic state increasing the risk of cardiovascular disease. This review: (1) explore traditional and newly emerging cardiometabolic risk factors in older people; (2) investigate methods of prediction and prevention of cardiovascular disease in those with diabetes; and (3) concludes that the development of a subspeciality of Cardiometabolic Medicine should be considered.
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Affiliation(s)
- Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd.,Kings College, London
| | - Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
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19
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Lozupone M, La Montagna M, Di Gioia I, Sardone R, Resta E, Daniele A, Giannelli G, Bellomo A, Panza F. Social Frailty in the COVID-19 Pandemic Era. Front Psychiatry 2020; 11:577113. [PMID: 33240129 PMCID: PMC7669751 DOI: 10.3389/fpsyt.2020.577113] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
Special attention and efforts to protect from or reduce health-related outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus triggering coronavirus disease 2019 (COVID-19), should be applied in susceptible populations, including frail older people. In particular, the early death cases occurred primarily in older people with a frailty status, possibly due to a weaker immune system fostering faster progression of the viral infection. Frailty is an age-related multidimensional clinical condition defined as a non-specific state of vulnerability, identifying older people at increased risk of falls, institutionalization, hospitalization, disability, dementia, and death. Among frailty phenotypes, social frailty has been least studied. It considers the role of socioeconomic context as a vulnerability status later in life. COVID-19 does not affect all populations equally, and social inequalities contribute to drive the spread of infections. It was known that the perception of social isolation, e.g., loneliness, affects mental and physical health, but the implicated molecular mechanisms, also related to the immune system, and its associated cognitive and health-related sequelae, are poorly understood. The increasing psychological distress derived by prolonged exposure to stress due to the lockdown scenario, and the reduced sources of support, contributed to making heavy demands on personal resources, i.e., self-efficacy and interpersonal variables. So, perceived loneliness may be a factor associated with psychological distress and an outcome in itself. In the COVID-19 pandemic era, a correct assessment of social frailty may be essential in terms of the prevention of late-life neuropsychiatric disorders.
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Affiliation(s)
- Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Maddalena La Montagna
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Ilaria Di Gioia
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rodolfo Sardone
- Population Health Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Bari, Italy
| | - Emanuela Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, University of Bari Aldo Moro, Bari, Italy.,Translational Medicine and Management of Health Systems, University of Foggia, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy.,Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Gianluigi Giannelli
- Population Health Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Bari, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesco Panza
- Population Health Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Bari, Italy
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Abstract
Frailty describes an individual's vulnerability to adverse health outcomes and is a useful construct that assists health professionals to understand the heterogeneity of the ageing population. While the pathophysiological pathways that lead to frailty are not well defined, an individual's sex appears to be a key factor influencing the ageing trajectory. Compared with age-matched men, women tend to have poorer health status (ie, they are more frail) but longer life expectancy (ie, they are more resilient). It seems likely that a combination of biological, behavioural and social factors underpin this male-female health-survival paradox. Randomised controlled trial data for frailty interventions in older adults are emerging, with multicomponent programs incorporating exercise and nutrition-based strategies showing promise. Pharmaceutical and other innovative therapeutic strategies for frailty are highly anticipated. Sex differences in the effectiveness of frailty interventions have not been addressed in the research literature to date. In the future, successful interventions may target many (if not all) biopsychosocial domains, with careful consideration of issues relevant to each sex.
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Affiliation(s)
- Emily H Gordon
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Ruth E Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
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21
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Hayek S, Gibson TM, Leisenring WM, Guida JL, Gramatges MM, Lupo PJ, Howell RM, Oeffinger KC, Bhatia S, Edelstein K, Hudson MM, Robison LL, Nathan PC, Yasui Y, Krull KR, Armstrong GT, Ness KK. Prevalence and Predictors of Frailty in Childhood Cancer Survivors and Siblings: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2019; 38:232-247. [PMID: 31800343 DOI: 10.1200/jco.19.01226] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To estimate the prevalence of frailty among childhood cancer survivors and to determine the direct and indirect effects of treatment exposures, lifestyle factors, and severe, disabling, and life-threatening chronic condition on frailty. METHODS Childhood cancer survivors (≥ 5 years since diagnosis), treated between 1970 and 1999 when < 21 years old (n = 10,899; mean age, 37.6 ± 9.4 years; 48% male, 86% white) and siblings were included (n = 2,097; mean age, 42.9 ± 9.4 years). Frailty was defined as ≥ 3 of the following: low lean mass, exhaustion, low energy expenditure, walking limitations, and weakness. Generalized linear models were used to evaluate direct and indirect associations between frailty and treatment exposures, sociodemographic characteristics, lifestyle factors, and chronic condition. RESULTS The overall prevalence of frailty among survivors was 3 times higher compared with siblings (6.4%; 95% CI, 4.1% to 8.7%; v 2.2%; 95% CI, 1.2% to 3.2%). Survivors of CNS tumors (9.5%; 95% CI, 5.2% to 13.8%) and bone tumors (8.1%; 95% CI, 5.1% to 11.1%) had the highest prevalence of frailty. Survivors exposed to cranial radiation, pelvic radiation ≥ 34 Gy, abdominal radiation > 40 Gy, cisplatin ≥ 600 mg/m2, amputation, or lung surgery had increased risk for frailty. These associations were partially but not completely attenuated when sociodemographic characteristics, lifestyle factors, and chronic conditions were added to multivariable models. Cranial radiation (prevalence ratio [PR], 1.47; 95% CI, 1.20 to 1.76), pelvic radiation ≥ 34 Gy (PR, 1.46; 95% CI, 1.01 to 2.11), and lung surgery (PR, 1.75; 95% CI, 1.28 to 2.38) remained significant after sociodemographic, lifestyle, and chronic conditions were accounted for. CONCLUSION Childhood cancer survivors reported a higher prevalence of frailty compared with siblings. Radiation and lung surgery exposures were associated with increased risk for frailty. Interventions to prevent, delay onset, or remediate chronic disease and/or promote healthy lifestyle are needed to decrease the prevalence of frailty and preserve function in this at-risk population.
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Affiliation(s)
- Samah Hayek
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | | | | | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Yutaka Yasui
- St Jude Children's Research Hospital, Memphis, TN
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22
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Caldwell JT, Lee H, Cagney KA. Disablement in Context: Neighborhood Characteristics and Their Association With Frailty Onset Among Older Adults. J Gerontol B Psychol Sci Soc Sci 2019; 74:e40-e49. [PMID: 31529128 PMCID: PMC6748803 DOI: 10.1093/geronb/gbx123] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/12/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Frailty, an aggregate expression of risk resulting from age- or disease-associated physiologic accumulation, is responsible for large economic and societal costs. Little is known about how the context in which older adult's live may contribute to differences in frailty. This study clarifies the role of neighborhood structural characteristics and social processes for understanding declines in health status. METHOD Data from two waves of the National Social Life, Health and Aging Project were linked to tract-level information from the 2000 Census (n = 1,925). Frailty was measured with in-home assessments and self-report. Ordered logistic regressions were employed to estimate the role of tract-level structural and social process indicators at baseline on frailty at follow-up. RESULTS Living in a neighborhood characterized with a higher density of African Americans and with more residential instability was associated with higher odds of frailty. Adults in neighborhoods with increasing levels of physical disorder had higher odds of frailty (adjusted odds ratio [AOR]: 1.20, 95% confidence interval [CI]: 1.03, 1.39), while those exposed to more social cohesion had lower odds (AOR: 0.87, CI: 0.78, 0.97). DISCUSSION For older adults, both neighborhood structural and social process characteristics appear to be independently associated with frailty.
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Affiliation(s)
- Julia T Caldwell
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Illinois
| | - Haena Lee
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Gordon EH, Hubbard RE. Do sex differences in chronic disease underpin the sex-frailty paradox? Mech Ageing Dev 2019; 179:44-50. [PMID: 30825457 DOI: 10.1016/j.mad.2019.02.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 12/21/2022]
Abstract
The 'male-female health-survival paradox' is a well-described clinical phenomenon. More recently, it has been conceptualized as a 'sex-frailty paradox': females may be considered to be more frail (because they have poorer health status) but also less frail (because they are less vulnerable to death) than males of the same age. Here, we review potential biological, behavioral and social mechanisms underpinning sex differences in morbidity, mortality and frailty before considering the question at the center of the sex paradox - why is it that females are able to tolerate poor health better than males? We explore, in detail, a frequently cited explanation for the sex paradox that centers on sex differences in chronic disease and conclude by presenting a new approach to this old hypothesis.
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Affiliation(s)
- E H Gordon
- Centre for Health Services Research, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - R E Hubbard
- Centre for Health Services Research, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
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Abstract
The life expectancy of people living with HIV (PLHIV) has dramatically improved with effective and well-tolerated antiretroviral therapy. This presents a new challenge in caring for this patient population, with up to 28% of older PLHIV being identified as frail. Studies suggest that the prevalence of frailty is higher in PLHIV compared to the general population, and that the onset of frailty occurs at an earlier age. Frail individuals often present with multiple and non-specific health complaints, fluctuating disability, falls and delirium, and are at higher risk for multiple adverse outcomes, post-operative complications, poor responses to vaccination and functional decline. They tend to require longer hospital admissions, are more likely to require nursing home care, and are at greater risk of mortality. The degree of frailty can fluctuate over time. Limited evidence exists to support the reversal of frailty, but epidemiological evidence suggests that interventions to assess and manage co-morbidities, reducing risk factors such as smoking, increasing exercise and optimising BMI, and improving personal and community resources, are all likely to reduce the risk of frailty. Physicians who care for PLHIV need to recognise and manage frailty in this patient population. This includes an understanding of: when to intervene aggressively in the management of an older patient with a new HIV diagnosis to delay or prevent permanent debility and frailty; when to acknowledge that the patient has become frail; and the role of geriatric medicine in addressing the specific issues and needs of this patient, such as maximising functional ability, preventing falls, reducing social isolation and improving quality of life.
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Marcus-Varwijk AE, Peters LL, Visscher TLS, Smits CHM, Ranchor AV, Slaets JPJ. Impact of a Nurse-Led Health Promotion Intervention in an Aging Population: Results From a Quasi-Experimental Study on the "Community Health Consultation Offices for Seniors". J Aging Health 2018; 32:83-94. [PMID: 30326768 PMCID: PMC7322977 DOI: 10.1177/0898264318804946] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: The study evaluated the nurse-led intervention "Community Health Consultation Offices for Seniors (CHCO)" on health-related and care needs-related outcomes in community-dwelling older people (⩾60 years). Method: With a quasi-experimental design, the CHCO intervention was evaluated on health-related and care needs-related outcomes after 1-year follow-up. Older people who received the intervention were frail, overweight, or were smoking. The comparison group received care as usual. In both groups, similar data were collected on health status, falls and fractures, and care needs. In the intervention group, additional data were collected on biometric measures and health-related behavior. Results: The intervention group and the care-as-usual group included 403 seniors and 984 seniors, respectively. Health-related outcomes, behaviors, and biometric measures, remained stable. After 1 year, care needs increased for both groups, but at a lower rate for the care-as-usual group. Discussion: The CHCO intervention showed no significant improvement on health-related outcomes or stability in care needs-related outcomes.
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Affiliation(s)
- Anne Esther Marcus-Varwijk
- Windesheim University of Applied Sciences, Research Group Innovating with Older Adults, Zwolle, The Netherlands.,University of Groningen, University Medical Center Groningen, Department Internal Medicine, the Netherlands
| | - Lilian L Peters
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, The Netherlands
| | - Tommy L S Visscher
- Windesheim University of Applied Sciences, Research Group Healthy Cities, Zwolle, The Netherlands
| | - Carolien H M Smits
- Windesheim University of Applied Sciences, Research Group Innovating with Older Adults, Zwolle, The Netherlands
| | - Adelita V Ranchor
- University of Groningen, University Medical Center Groningen, Health Psychology Section, The Netherlands
| | - Joris P J Slaets
- University of Groningen, University Medical Center Groningen, Department Internal Medicine, the Netherlands.,Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
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Brinkman S, Voortman T, Kiefte-de Jong JC, van Rooij FJ, Ikram MA, Rivadeneira F, Franco OH, Schoufour JD. The association between lifestyle and overall health, using the frailty index. Arch Gerontol Geriatr 2018; 76:85-91. [DOI: 10.1016/j.archger.2018.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 11/26/2022]
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Kehler DS, Clara I, Hiebert B, Stammers AN, Hay JL, Schultz A, Arora RC, Tangri N, Duhamel TA. The association between bouts of moderate to vigorous physical activity and patterns of sedentary behavior with frailty. Exp Gerontol 2018; 104:28-34. [PMID: 29421349 DOI: 10.1016/j.exger.2018.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/20/2017] [Accepted: 01/10/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine if bouts of moderate-vigorous physical activity (MVPA) and patterns of sedentary behavior are associated with frailty. METHOD Accelerometry from community-dwelling adults ≥50 years old (n = 2317) enrolled in the 2003-04 and 2005-06 National Health and Nutrition Examination Survey were used. Bouted (≥10 min) and sporadic (<10 min) durations of MVPA were analyzed based on meeting 0%, 1-49%, 50-99%, and ≥100% of physical activity guidelines (150 min/week of MVPA). Prolonged sedentary behavior were bouts lasting ≥30 min. Breaks from sedentary behavior were defined as any ≥1 min interruption in sedentary behavior. Average intensity (counts/min) and duration (minutes) during breaks were also analyzed. Frailty was measured with a 46-item frailty index. RESULTS Multivariable linear regression models adjusting for age, sex, education, ethnicity, income, marital status, smoking, alcohol consumption, body mass index, total sedentary time and accelerometer wear time indicated that meeting any percentage of the activity guidelines with bouted and sporadic MVPA was associated with reduced frailty. This relationship peaked at meeting 50-99% of guidelines and was associated with a 1.5 and 2.0 point reduction in the frailty index for bouted and sporadic MVPA, respectively. Two additional prolonged sedentary behavior bouts/day were associated with an additional frailty index deficit while every additional 100 cpm in average break intensity and every 2 min in average break duration were associated with one less deficit. Total sedentary breaks were not associated with frailty. CONCLUSION These population-level data give justification for determining if interventions which target short bouts of MVPA and interrupting prolonged, uninterrupted time spent in sedentary behaviors can treat or prevent frailty worsening.
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Affiliation(s)
- D Scott Kehler
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada.
| | - Ian Clara
- Department of Community Health Sciences, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Brett Hiebert
- Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Andrew N Stammers
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada
| | - Jacqueline L Hay
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada
| | - Annette Schultz
- College of Nursing, Max Rady Faculty of Heath Sciences, University of Manitoba Winnipeg, Canada
| | - Rakesh C Arora
- Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Canada
| | | | - Todd A Duhamel
- Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Canada; Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Canada
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Gale CR, Mõttus R, Deary IJ, Cooper C, Sayer AA. Personality and Risk of Frailty: the English Longitudinal Study of Ageing. Ann Behav Med 2018; 51:128-136. [PMID: 27658915 PMCID: PMC5250640 DOI: 10.1007/s12160-016-9833-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background There is evidence that the personality traits conscientiousness, extraversion and neuroticism are associated with health behaviours and with risk of various health outcomes. We hypothesised that people who are lower in conscientiousness or extraversion or higher in neuroticism may be at greater risk of frailty in later life. Methods We used general linear models to examine the prospective relation between personality, assessed using the Midlife Development Inventory, and change in frailty, modelled by a frailty index, in 5314 men and women aged 60 to over 90 years from the English Longitudinal Study of Ageing. Results Men and women with higher levels of neuroticism or lower levels of extraversion or conscientiousness had an increased frailty index score at follow-up. After adjustment for potential confounding or mediating variables, including frailty index score at baseline, the frailty index score at follow-up—which potentially ranges from 0 to 1—was higher by 0.035 (95 % confidence interval 0.018, 0.052) for a standard deviation increase in neuroticism and lower by 0.061 (0.031, 0.091) or 0.045 (0.020, 0.071) for a standard deviation increase in extraversion or conscientiousness, respectively. There was some evidence that the association between extraversion and frailty may be due to reverse causation whereby poorer health affected responses to items in the personality inventory. Conclusions Higher levels of neuroticism or lower levels of conscientiousness or extraversion may be risk factors for the onset or progression of frailty. Future studies need to replicate these observations in other populations and explore the mechanisms underlying these associations.
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Affiliation(s)
- Catharine R Gale
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - René Mõttus
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Tartu, Tartu, Estonia
| | - Ian J Deary
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Avan Aihie Sayer
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
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29
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Rietman ML, van der A DL, van Oostrom SH, Picavet HSJ, Dollé MET, van Steeg H, Verschuren WMM, Spijkerman AMW. The Association between BMI and Different Frailty Domains: A U-Shaped Curve? J Nutr Health Aging 2018; 22:8-15. [PMID: 29300416 DOI: 10.1007/s12603-016-0854-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Previous studies showed a U-shaped association between BMI and (physical) frailty. We studied the association between BMI and physical, cognitive, psychological, and social frailty. Furthermore, the overlap between and prevalence of these frailty domains was examined. DESIGN Cross-sectional study. SETTING The Doetinchem Cohort Study is a longitudinal population-based study starting in 1987-1991 examining men and women aged 20-59 with follow-up examinations every 5 yrs. PARTICIPANTS For the current analyses, we used data from round 5 (2008-2012) with 4019 participants aged 41-81 yrs. MEASUREMENTS Physical frailty was defined as having ≥ 2 of 4 frailty criteria from the Frailty Phenotype (unintentional weight loss, exhaustion, physical activity, handgrip strength). Cognitive frailty was defined as the < 10th percentile on global cognitive functioning (based on memory, speed, flexibility). Psychological frailty was defined as having 2 out of 2 criteria (depression, mental health). Social frailty was defined as having ≥ 2 of 3 criteria (loneliness, social support, social participation). BMI was divided into four classes. Analyses were adjusted for sex, age, level of education, and smoking. RESULTS A U-shaped association was observed between BMI and physical frailty, a small linear association for BMI and cognitive frailty and no association between BMI and psychological and social frailty. The four frailty domains showed only a small proportion of overlap. The prevalence of physical, cognitive and social frailty increased with age, whereas psychological frailty did not. CONCLUSION We confirm that not only underweight but also obesity is associated with physical frailty. Obesity also seems to be associated with cognitive frailty. Further, frailty prevention should focus on multiple domains and target individuals at a younger age (<65yrs).
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Affiliation(s)
- M L Rietman
- M. Liset Rietman, MSc, National Institute for Public Health and the Environment, Bilthoven, the Netherlands, E-mail address: , Telephone number: +31302742709
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Gordon EH, Peel NM, Hubbard RE. The male-female health-survival paradox in hospitalised older adults. Maturitas 2017; 107:13-18. [PMID: 29169574 DOI: 10.1016/j.maturitas.2017.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 09/09/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine whether the 'male-female health-survival paradox' is present in older hospitalised adults and to examine whether sex differences in the 'lethality' of acute medical conditions influence the relationship between sex and mortality. STUDY DESIGN AND OUTCOME MEASURES This study was a secondary analysis of prospective cohort data collected from 1418 Australian inpatients aged 70 years and over. Frailty was measured using a 39-variable Frailty Index (FI-AC). Analyses examined the relationship between sex, age, FI-AC and 28-day mortality. Survival models were adjusted for 'lethality' of acute conditions (high versus low mortality risk). RESULTS The FI-AC had a normal distribution in both sexes (female mean=0.34 (±0.13); male mean=0.31 (±0.15)). When adjusted for age, females had similar FI-AC scores to males (β coefficient=0.014, 95% confidence interval (CI)=0.00-0.028, p=0.056). There were 80 deaths in the sample, with females facing a significantly lower mortality risk than males of the same FI-AC and age (HR=0.39, 95% CI=0.25-0.63, p<0.001). Females were less likely than males to be admitted with a high-risk acute condition. Even so, this did not significantly reduce their survival advantage (HR=0.46, 95% CI=0.29-0.73, p=0.001). CONCLUSION The male-female health-survival paradox was not demonstrated in this study of older inpatients. Whilst females faced a significantly lower risk of near-term mortality, the sexes were found to have similar levels of frailty on admission to hospital. The sex mortality gap was not explained by sex differences in the 'lethality' of acute medical conditions.
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Affiliation(s)
- Emily H Gordon
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Nancye M Peel
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia
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31
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Franco I, Chen YH, Chipidza F, Agrawal V, Romano J, Baldini E, Chen A, Colson Y, Hou Y, Kozono D, Wee J, Mak R. Use of frailty to predict survival in elderly patients with early stage non-small-cell lung cancer treated with stereotactic body radiation therapy. J Geriatr Oncol 2017; 9:130-137. [PMID: 28941581 DOI: 10.1016/j.jgo.2017.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/31/2017] [Accepted: 09/01/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Frailty has been shown to increase morbidity and mortality independent of age, but studies are lacking in radiation oncology. This study evaluates a modified frailty index (mFI) in predicting overall survival (OS) and non-cancer death for Stage I/II [N0M0] Non-Small-Cell Lung Cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT). MATERIALS AND METHODS Medical records for all patients with Stage I/II NSCLC treated at our institution with SBRT from 2009 to 2014 were reviewed. A validated mFI score, consisting of 11 variables was calculated, classifying patients as non-frail (0-1) or frail (≥2). Primary endpoint (OS) was analyzed using Kaplan-Meier method and log-rank. Secondary endpoint, non-cancer death, was analyzed using Fine-Gray's method, with death from lung cancer as a competing risk. RESULTS Patient cohort consisted of 38 (27.3%) non-frail and 101 (72.7%) frail [median total mFI score 3.0 (range 0-7)]. Median age and pack-year history was 74 and 46years, respectively. Median follow-up among survivors was 38.5months (range 4.0-74.1months). Frailty was associated with a lower 3-year OS (37.3% vs. 74.7%; p=0.003) and 3-year cumulative incidence of non-cancer death (36.7% vs. 12.5%; p=0.02). Frailty remained significant in the multivariate model [OS HR for mFI ≥2: 2.25 (1.14-4.44); p=0.02]. CONCLUSION Frailty is associated with lower OS in older patients with early stage NSCLC treated with SBRT, yet frail patients survived a median 2.5years, and were more likely to die of causes unrelated to the primary lung cancer, suggesting SBRT should be considered even in older patients deemed unfit for surgery.
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Affiliation(s)
- Idalid Franco
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
| | - Yu-Hui Chen
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02115, United States
| | - Fallon Chipidza
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Vishesh Agrawal
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - John Romano
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Elizabeth Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Aileen Chen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Yolonda Colson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA 02115, United States
| | - Ying Hou
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - David Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Jon Wee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA 02115, United States
| | - Raymond Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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Hsu WC, Tsai AC, Chen YC, Wang JY. Predicted factors for older Taiwanese to be healthy octogenarians: Results of an 18-year national cohort study. Geriatr Gerontol Int 2017; 17:2579-2585. [PMID: 28744971 DOI: 10.1111/ggi.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
AIM To identify factors that predict the 62-69 years old Taiwanese to be healthy octogenarians. METHODS We analyzed the 1989 (baseline), and 2003 and 2007 (end-point) datasets of the Taiwan Longitudinal Survey on Aging, a national cohort study. A total of 1977 participants aged 62-69 years at baseline were tracked for 14-18 years. The outcome measure was "being healthy octogenarians", defined as participants who were aged ≥80 years, free from activities of daily living dependency, depressive symptoms or cognitive impairment, and able to provide social support. A logistic regression model was used to identify the predictors. RESULTS The results showed that higher educational level, conjugal living, absence of smoking or betel quid chewing, moderate alcohol drinking, routine physical activity, more leisure activities, no hypertension, no diabetes, sleeping well and satisfied with economic condition were the positive predictors for becoming a healthy octogenarian. CONCLUSIONS Using a multidimensional criterion, the present study identified a list of factors in predicting older Taiwanese becoming healthy octogenarians. The findings highlight the need to identify potential factors for various populations. Many of the predictors are modifiable factors. The present results would be valuable for planning effective health promotion strategies to achieve healthy aging for older adults. Geriatr Gerontol Int 2017; 17: 2579-2585.
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Affiliation(s)
- Wei-Chung Hsu
- Department of Radiation Oncology, Chung-Kang Branch, Cheng-Ching General Hospital, Taichung, Taiwan
| | - Alan C Tsai
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Yu-Chia Chen
- Department of Senior Citizen Services, National Tainan Institute of Nursing, Tainan, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Lekan DA, Wallace DC, McCoy TP, Hu J, Silva SG, Whitson HE. Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record. Biol Res Nurs 2017; 19:213-228. [PMID: 27913742 DOI: 10.1177/1099800416679730] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. PURPOSE The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. METHODS The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. RESULTS The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). DISCUSSION Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.
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Affiliation(s)
- Deborah A Lekan
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Debra C Wallace
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Thomas P McCoy
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jie Hu
- 2 College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Susan G Silva
- 3 School of Nursing, Duke University, Durham, NC, USA
| | - Heather E Whitson
- 4 Departments of Medicine and Opthalmology, School of Medicine, Duke University, Durham, NC, USA.,5 Durham VA Geriatrics Research Education and Clinical Center (GRECC), Durham, NC, USA
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Gao X, Zhang Y, Saum KU, Schöttker B, Breitling LP, Brenner H. Tobacco smoking and smoking-related DNA methylation are associated with the development of frailty among older adults. Epigenetics 2016; 12:149-156. [PMID: 28001461 DOI: 10.1080/15592294.2016.1271855] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Tobacco smoking is a preventable environmental factor that contributes to a wide spectrum of age-related health outcomes; however, its association with the development of frailty is not yet well established. We examined the associations of self-reported smoking indicators, serum cotinine levels and smoking-related DNA methylation biomarkers with a quantitative frailty index (FI) in 2 independent subsets of older adults (age 50-75) recruited in Saarland, Germany in 2000 - 2002 (discovery set: n = 978, validation set: n = 531). We obtained DNA methylation profiles in whole blood samples by Illumina HumanMethylation450 BeadChip and calculated the FI according to the method of Mitnitski and Rockwood. Mixed linear regression models were implemented to assess the associations between smoking indicators and the FI. After controlling for potential covariates, current smoking, cumulative smoking exposure (pack-years), and time after smoking cessation (years) were significantly associated with the FI (P-value < 0.05). In the discovery panel, 17 out of 151 previously identified smoking-related CpG sites were associated with the FI after correction for multiple testing (FDR < 0.05). Nine of them survived in the validation phase and were designated as frailty-associated loci. A smoking index (SI) based on the 9 loci manifested a monotonic association with the FI. In conclusion, this study suggested that epigenetic alterations could play a role in smoking-associated development of frailty. The identified CpG sites have the potential to be prognostic biomarkers of frailty and frailty-related health outcomes. Our findings and the underlying mechanisms should be followed up in further, preferably longitudinal studies.
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Affiliation(s)
- Xu Gao
- a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Yan Zhang
- a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Kai-Uwe Saum
- a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Ben Schöttker
- a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany.,b Network Aging Research , University of Heidelberg , Heidelberg , Germany
| | - Lutz Philipp Breitling
- a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Hermann Brenner
- a Division of Clinical Epidemiology and Aging Research , German Cancer Research Center (DKFZ) , Heidelberg , Germany.,b Network Aging Research , University of Heidelberg , Heidelberg , Germany.,c Division of Preventive Oncology , German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) , Heidelberg , Germany.,d German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) , Heidelberg , Germany
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The Identification of Hereditary and Environmental Determinants of Frailty in a Cohort of UK Twins. Twin Res Hum Genet 2016; 19:600-609. [DOI: 10.1017/thg.2016.72] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Our study examines the contribution of genetic and environmental factors (both shared and unique) to frailty, measured using the Rockwood Frailty Index (FI) in a sample of twins from the St Thomas’ UK Adult Twin Registry. The FI was based on 39 items of potential health deficit. Study participants were 3,375 volunteer adult twins (840 monozygotic and 802 dizygotic twin-pairs) 40.0–84.5 years old. First, we used structural equation modeling to estimate the relative contribution of genetics and of the shared and unique environment to variance in FI adjusted for age. In a second analysis, multiple linear regression was used to examine variance in FI as a function of father's occupational class (a component of shared environment and a measure of childhood socioeconomic status [SES]), adjusting for age, birth weight, marital status, and health behaviors (smoking, alcohol consumption, and physical activity). Statistical analyses were conducted using IBM SPSS® Version 22 software and Mx open source software. Findings showed that 45% (95% confidence intervals [CIs] 30–53%) of the inter-individual variation in FI was heritable and 52% (95% CIs 47–57%) was due to the individual's unique environment. Multiple linear regression also showed a small but statistically significant inverse association between father's occupational class and FI, mediated by one's own educational attainment and birth weight. Our results indicate that frailty is both genetically and environmentally determined. Thus, its prevention and management call for a multifaceted approach that includes addressing deleterious environmental factors, some of which, like childhood SES, may act across the life course.
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Wade KF, Lee DM, McBeth J, Ravindrarajah R, Gielen E, Pye SR, Vanderschueren D, Pendleton N, Finn JD, Bartfai G, Casanueva FF, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Punab M, Wu FCW, O'Neill TW. Chronic widespread pain is associated with worsening frailty in European men. Age Ageing 2016; 45:268-74. [PMID: 26679698 PMCID: PMC4776622 DOI: 10.1093/ageing/afv170] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/23/2015] [Indexed: 12/21/2022] Open
Abstract
Background: we hypothesised that chronic widespread pain (CWP), by acting as a potential stressor, may predispose to the development of, or worsening, frailty. Setting: longitudinal analysis within the European Male Ageing Study (EMAS). Participants: a total of 2,736 community-dwelling men aged 40–79. Methods: subjects completed a pain questionnaire and shaded a manikin, with the presence of CWP defined using the American College of Rheumatology criteria. Physical activity, smoking, alcohol consumption and depression were measured. Repeat assessments took place a median of 4.3 years later. A frailty index (FI) was used, with frail defined as an FI >0.35. The association between CWP at baseline and the new occurrence of frailty was examined using logistic regression; the association between CWP at baseline and change in FI was examined using negative binomial regression. Results: at baseline, 218 (8.3%) men reported CWP. Of the 2,631 men who were defined as non-frail at baseline, 112 (4.3%) were frail at follow-up; their mean FI was 0.12 (SD 0.1) at baseline and 0.15 (SD 0.1) at follow-up, with a mean change of 0.03 (SD 0.08) P ≤ 0.001. Among men who were non-frail at baseline, those with CWP were significantly more likely to develop frailty. After adjustment for age and centre, compared with those with no pain, those with CWP at baseline had a 70% higher FI at follow-up; these associations remained significant after further adjustment for smoking, body mass index, depression, physical activity and FI at baseline. Conclusion: the presence of CWP is associated with an increased risk of frailty in older European men.
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Affiliation(s)
- Katie Fredrika Wade
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust-Manchester Academic Health Science Centre, Manchester, UK
| | - David M Lee
- Cathie Marsh Institute for Social Research, The University of Manchester, Manchester, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rathi Ravindrarajah
- Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Evelien Gielen
- Geriatric Medicine Department, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stephen R Pye
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Catholic University of Leuven, Leuven, Belgium
| | - Neil Pendleton
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Salford, UK
| | - Joseph D Finn
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - György Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Felipe F Casanueva
- Department of Medicine, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Gianni Forti
- Department of Experimental Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | | | - Ilpo T Huhtaniemi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Frederick C W Wu
- Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust-Manchester Academic Health Science Centre, Manchester, UK
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Gale CR, Booth T, Starr JM, Deary IJ. Intelligence and socioeconomic position in childhood in relation to frailty and cumulative allostatic load in later life: the Lothian Birth Cohort 1936. J Epidemiol Community Health 2015; 70:576-82. [PMID: 26700299 PMCID: PMC4820036 DOI: 10.1136/jech-2015-205789] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 11/27/2015] [Indexed: 01/10/2023]
Abstract
Background Information on childhood determinants of frailty or allostatic load in later life is sparse. We investigated whether lower intelligence and greater socioeconomic disadvantage in childhood increased the risk of frailty and higher allostatic load, and explored the mediating roles of adult socioeconomic position, educational attainment and health behaviours. Methods Participants were 876 members of the Lothian Birth Cohort 1936 whose intelligence was assessed at age 11. At age 70, frailty was assessed using the Fried criteria. Measurements were made of fibrinogen, triglyceride, total and high-density lipoprotein cholesterol, albumin, glycated haemoglobin, C reactive protein, body mass index and blood pressure, from which an allostatic load score was calculated. Results In sex-adjusted analyses, lower intelligence and lower social class in childhood were associated with an increased risk of frailty: relative risks (95% CIs) were 1.57 (1.21 to 2.03) for a SD decrease in intelligence and 1.48 (1.12 to 1.96) for a category decrease in social class. In the fully adjusted model, both associations ceased to be significant: relative risks were 1.13 (0.83 to 1.54) and 1.19 (0.86 to 1.61), respectively. Educational attainment had a significant mediating effect. Lower childhood intelligence in childhood, but not social class, was associated with higher allostatic load. The sex-adjusted coefficient for allostatic load for a SD decrease in intelligence was 0.10 (0.07 to 0.14). In the fully adjusted model, this association was attenuated but remained significant (0.05 (0.01 to 0.09)). Conclusions Further research will need to investigate the mechanisms whereby lower childhood intelligence is linked to higher allostatic load in later life.
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Affiliation(s)
- Catharine R Gale
- Department of Psychology, Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Tom Booth
- Department of Psychology, Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Department of Psychology, Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK Geriatric Medicine Unit, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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Hubbard R, Ng K. Australian and New Zealand Society for Geriatric Medicine: position statement - frailty in older people. Australas J Ageing 2015; 34:68-73. [PMID: 25735472 DOI: 10.1111/ajag.12195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kojima G, Iliffe S, Walters K. Smoking as a predictor of frailty: a systematic review. BMC Geriatr 2015; 15:131. [PMID: 26489757 PMCID: PMC4618730 DOI: 10.1186/s12877-015-0134-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/15/2015] [Indexed: 01/10/2023] Open
Abstract
Background Evidence on longitudinal associations between smoking and frailty is scarce. The objective of this study was to systematically review the literature on smoking as a predictor of frailty changes among community-dwelling middle-aged and older population. Methods A systematic search was performed using three electronic databases: MEDLINE, Embase and Scopus for studies published from 2000 through May 2015. Reference lists of relevant articles, articles shown as related citations in PubMed and articles citing the included studies in Google Scholar were also reviewed. Studies were included if they were prospective observational studies investigating smoking status as a predictor and subsequent changes in frailty, defined by validated criteria among community-dwelling general population aged 50 or older. A standardised data collection tool was used to extract data. Methodological quality was examined using the Newcastle-Ottawa Scale for cohort studies. Results A total of 1020 studies were identified and systematically reviewed for their titles, abstracts and full-text to assess their eligibilities. Five studies met inclusion criteria and were included in this review. These studies were critically reviewed and assessed for validity of their findings. Despite different methodologies and frailty criteria used, four of the five studies consistently showed baseline smoking was significantly associated with developing frailty or worsening frailty status at follow-up. Although not significant, the other study showed the same trend in male smokers. It is of note that most of the estimate measures were either unadjusted or only adjusted for a limited number of important covariates. Conclusions This systematic review provides the evidence of smoking as a predictor of worsening frailty status in community-dwelling population. Smoking cessation may potentially be beneficial for preventing or reversing frailty.
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Affiliation(s)
- Gotaro Kojima
- Department of Primary Care and Population Health, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK.
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK.
| | - Kate Walters
- Department of Primary Care and Population Health, University College London (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK.
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John G, Louis C, Berner A, Genné D. Tobacco Stained Fingers and Its Association with Death and Hospital Admission: A Retrospective Cohort Study. PLoS One 2015; 10:e0138211. [PMID: 26375287 PMCID: PMC4573751 DOI: 10.1371/journal.pone.0138211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/27/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Among smokers, the presence of tobacco stains on fingers has recently been associated with a high prevalence of tobacco related conditions and alcohol abuse. OBJECTIVE we aimed to explore tobacco stains as a marker of death and hospital readmission. METHOD Seventy-three smokers presenting tobacco-tar staining on their fingers and 70 control smokers were followed during a median of 5.5 years in a retrospective cohort study. We used the Kaplan-Meier survival analysis and the log-rank test to compare mortality and hospital readmission rates among smokers with and smokers without tobacco stains. Multivariable Cox models were used to adjust for confounding factors: age, gender, pack-year unit smoked, cancer, harmful alcohol use and diabetes. The number of hospital admissions was compared through a negative binomial regression and adjusted for the follow-up time, diabetes, and alcohol use. RESULTS Forty-three patients with tobacco-stained fingers died compared to 26 control smokers (HR 1.6; 95%CI: 1.0 to 2.7; p 0.048). The association was not statistically significant after adjustment. Patients with tobacco-stained fingers needed a readmission earlier than smokers without stains (HR 2.1; 95%CI: 1.4 to 3.1; p<0.001), and more often (incidence rate ratio (IRR) 1.6; 95%CI: 1.1 to 2.1). Associations between stains and the first hospital readmission (HR 1.6; 95%CI: 1.0 to 2.5), and number of readmissions (IRR 1.5; 95%CI: 1.1 to 2.1) persisted after adjustment for confounding factors. CONCLUSIONS Compared to other smokers, those presenting tobacco-stained fingers have a high unadjusted mortality rate and need early and frequent hospital readmission even when controlling for confounders.
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Affiliation(s)
- Gregor John
- Department of Internal Medicine, Hôpital neuchâtelois, 2300, La Chaux-de-Fonds, Switzerland
- Department of Internal medicine geriatrics and rehabilitation, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland
| | - Céline Louis
- Department of Internal Medicine, Hôpital neuchâtelois, 2300, La Chaux-de-Fonds, Switzerland
| | - Amandine Berner
- Department of Internal Medicine, Hôpital neuchâtelois, 2300, La Chaux-de-Fonds, Switzerland
| | - Daniel Genné
- Department of Internal Medicine, Centre Hospitalier de Bienne, 2501, Bienne, Switzerland
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García-Esquinas E, Navas-Acien A, Rodríguez-Artalejo F. Exposure to secondhand tobacco smoke and the frailty syndrome in US older adults. AGE (DORDRECHT, NETHERLANDS) 2015; 37:26. [PMID: 25773068 PMCID: PMC4359696 DOI: 10.1007/s11357-015-9762-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/26/2015] [Indexed: 06/04/2023]
Abstract
Exposure to secondhand tobacco smoke (SHS) is a well-established risk factor for cardiovascular disease and lung cancer in nonsmoking adults. However, few studies have focused on the health consequences of exposure to SHS in older adults. This is the first study to assess the association between SHS and the frailty syndrome in the nonsmoking older adult population. Cross-sectional study was conducted among 2059 nonsmoking adults aged ≥60 years who participated in the third US National Health and Nutrition Examination Survey and had completed a physical examination. Exposure to SHS was assessed by serum cotinine concentrations and by self-reported data from the home questionnaire. Frailty was ascertained with a slight modification of the Fried criteria. Analyses were performed with logistic regression and adjusted for the main confounders. The median (interquartile range) concentration of serum cotinine was 0.095 (IQR 0.035-0.211) ng/mL. The prevalence of frailty was 6.0 %. The odds ratios (95 % confidence interval [CI]) of frailty comparing the second, third, and fourth to the lowest quartile of serum cotinine were, respectively, 1.44 (0.67-3.06), 1.46 (0.75-2.85), and 2.51 (1.06-5.95), p value for trend 0.04. An increased frequency of frailty was also observed in participants reporting to live with ≥2 smokers at home (odds ratio 5.37; 95 % CI 1.13-25.5). In the US nonsmoking older adult population, exposure to SHS was associated with an increased frequency of frailty. More efforts are needed to protect older adults from SHS, especially at home and in other areas not covered by smoke-free regulations.
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Affiliation(s)
- Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain,
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Abstract
PURPOSE OF REVIEW Effective therapies have transformed HIV infection into a chronic disease, and new problems are arising related to aging. This article reviews the aging process, age-related deficit accumulation and frailty, and how these might be affected by chronic HIV infection. RECENT FINDINGS Aging is characterized by acceleration in the rate of unrepaired physiologic damage an organism accumulates. HIV infection is associated with many factors that might affect the aging process, including extrinsic behavioral risk factors and co-infections, and multiple intrinsic factors, including intercellular communication, inflammation, and coagulation pathways. Whether each factor affects the aging process, they likely result in an increase in the risk of adverse health outcomes, and so give rise to frailty, likely with several clinical manifestations. SUMMARY Age-related deficit accumulation is influenced by both the background or environmental rate of insults an organism sustains and the efficacy of intrinsic damage control and repair mechanisms. Both processes are likely affected in people living with HIV infection.
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Chen C, Sia I, Ma HM, Tai BC, Cheong A, Fong NP, Tan SYJ, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Ng YS, Teo YY, Ma S, Heng D, Koh GCH. The synergistic effect of functional status and comorbidity burden on mortality: a 16-year survival analysis. PLoS One 2014; 9:e106248. [PMID: 25170612 PMCID: PMC4149557 DOI: 10.1371/journal.pone.0106248] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/29/2014] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The relationship between disability and comorbidity on mortality is widely perceived as additive in clinical models of frailty. DESIGN National data were retrospectively extracted from medical records of community hospital. DATA SOURCES There were of 12,804 acutely-disabled patients admitted for inpatient rehabilitation in Singapore rehabilitation community hospitals from 1996 through 2005 were followed up for death till 31 December 2011. OUTCOME MEASURE Cox proportional-hazards regression to assess the interaction of comorbidity and disability at discharge on all-cause mortality. RESULTS During a median follow-up of 10.9 years, there were 8,565 deaths (66.9%). The mean age was 73.0 (standard deviation: 11.5) years. Independent risk factors of mortality were higher comorbidity (p<0.001), severity of disability at discharge (p<0.001), being widowed (adjusted hazard ratio [aHR]: 1.38, 95% confidence interval [CI]:1.25-1.53), low socioeconomic status (aHR:1.40, 95%CI:1.29-1.53), discharge to nursing home (aHR:1.14, 95%CI:1.05-1.22) and re-admission into acute care (aHR:1.54, 95%CI:1.45-1.65). In the main effects model, those with high comorbidity had an aHR = 2.41 (95%CI:2.13-2.72) whereas those with total disability had an aHR = 2.28 (95%CI:2.12-2.46). In the interaction model, synergistic interaction existed between comorbidity and disability (p<0.001) where those with high comorbidity and total disability had much higher aHR = 6.57 (95%CI:5.15-8.37). CONCLUSIONS Patients with greater comorbidity and disability at discharge, discharge to nursing home or re-admission into acute care, lower socioeconomic status and being widowed had higher mortality risk. Our results identified predictive variables of mortality that map well onto the frailty cascade model. Increasing comorbidity and disability interacted synergistically to increase mortality risk.
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Affiliation(s)
- Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Isaac Sia
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
| | - Hon-ming Ma
- Departments of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Shi Yu Julia Tan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kin Ming Chan
- Medical Services, Ang Mo Kio Thye Hua Kwan Hospital, Singapore, Singapore
| | - Boon Yeow Tan
- Medical Services, St Luke's Hospital, Singapore, Singapore
| | - Edward Menon
- Medical Services, St Andrew's Community Hospital, Singapore, Singapore
| | - Chye Hua Ee
- Bright Vision Hospital, Singapore, Singapore
| | | | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Genome Institute of Singapore, Agency for Science, Technology, and Research, Singapore, Singapore
- Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
| | - Stefan Ma
- Ministry of Health, Singapore, Singapore
| | | | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- * E-mail:
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Etman A, Kamphuis CBM, van der Cammen TJM, Burdorf A, van Lenthe FJ. Do lifestyle, health and social participation mediate educational inequalities in frailty worsening? Eur J Public Health 2014; 25:345-50. [PMID: 25061232 DOI: 10.1093/eurpub/cku093] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lower educated older persons are at increased risk of becoming frail as compared with higher educated older persons. To reduce educational inequalities in the development of frailty, we investigated whether lifestyle, health and social participation mediate this relationship. METHODS Longitudinal data of 14 082 European community-dwelling persons aged 55 years and older participating in the Survey on Health, Ageing, and Retirement in Europe (SHARE) in 2004 and 2006, were used. Associations of lifestyle (smoking behaviour and alcohol consumption), health (depression, memory function, chronic diseases) and social participation, with educational level and frailty worsening were investigated using regression models. In multinomial logistic regression analysis, mediators were added to models in which educational level was associated with worsening in frailty over 2 years follow-up. RESULTS In all countries, frailty worsening was more prevalent among lower as compared with higher educated persons, although odds ratios were only statistically significant in five of the 11 countries included [ORs varying from 1.40 (95% CI: 1.06-1.84) to 1.61 (95% CI: 1.21-2.14)]. Except for smoking behaviour and memory function, the factors under study all showed associations with educational level and frailty worsening that met the conditions for mediation. After inclusion of the four relevant mediators, attenuation of odds ratios varied between 4.9 and 31.5%. CONCLUSION While lifestyle, health and social participation were associated with frailty worsening over 2 years among European community-dwelling older persons, only small to moderate parts of educational inequalities in frailty worsening were explained by these factors.
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Affiliation(s)
- Astrid Etman
- 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands
| | - Carlijn B M Kamphuis
- 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands
| | - Tischa J M van der Cammen
- 2 Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands 3 Department of Medicine, Brighton and Sussex Medical School, Brighton, UK 4 Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alex Burdorf
- 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands
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Ravi B, Jenkinson R, Austin PC, Croxford R, Wasserstein D, Escott B, Paterson JM, Kreder H, Hawker GA. Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ 2014; 348:g3284. [PMID: 24859902 PMCID: PMC4032026 DOI: 10.1136/bmj.g3284] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify a cut point in annual surgeon volume associated with increased risk of complications after primary elective total hip arthroplasty and to quantify any risk identified. DESIGN Propensity score matched cohort study. SETTING Ontario, Canada. PARTICIPANTS 37,881 people who received their first primary total hip arthroplasty during 2002-09 and were followed for at least two years after their surgery. MAIN OUTCOME MEASURE The rates of various surgical complications within 90 days (venous thromboembolism, death) and within two years (infection, dislocation, periprosthetic fracture, revision) of surgery. RESULTS Multivariate splines were developed to visualize the relation between surgeon volume and the risk for various complications. A threshold of 35 cases a year was identified, under which there was an increased risk of dislocation and revision. 6716 patients whose total hip arthroplasty was carried out by surgeons who had done ≤ 35 such procedure in the previous year were successfully matched to patients whose surgeon had carried out more than 35 procedures. Patients in the former group had higher rates of dislocation (1.9% v 1.3%, P=0.006; NNH 172) and revision (1.5% v 1.0%, P=0.03; NNH 204). CONCLUSIONS In a cohort of first time recipients of total hip arthroplasty, patients whose operation was carried by surgeons who had performed 35 or fewer such procedures in the year before the index procedure were at increased risk for dislocation and early revision. Surgeons should consider performing 35 cases or more a year to minimize the risk for complications. Furthermore, the methods used to visualize the relationship between surgeon volume and the occurrence of complications can be easily applied in any jurisdiction, to help inform and optimize local healthcare delivery.
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Affiliation(s)
- Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Richard Jenkinson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Ruth Croxford
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Benjamin Escott
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Hans Kreder
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Gillian A Hawker
- Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Division of Rheumatology, Department of Medicine, Women's College Hospital, Toronto, Canada
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Wang C, Song X, Mitnitski A, Fang X, Tang Z, Yu P, Rockwood K. Effect of Health Protective Factors on Health Deficit Accumulation and Mortality Risk in Older Adults in the Beijing Longitudinal Study of Aging. J Am Geriatr Soc 2014; 62:821-8. [PMID: 24749784 DOI: 10.1111/jgs.12792] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Chunxiu Wang
- Department of Evidence‐based Medicine Xuanwu Hospital Capital Medical University Beijing China
| | - Xiaowei Song
- Department of Medicine Dalhousie University Halifax Nova Scotia Canada
- National Research Council Institute for Biodiagnostics‐AtlanticHalifax Nova Scotia Canada
| | - Arnold Mitnitski
- Department of Medicine Dalhousie University Halifax Nova Scotia Canada
- Department of Mathematics and Statistics Dalhousie University Halifax Nova Scotia Canada
| | - Xianghua Fang
- Department of Evidence‐based Medicine Xuanwu Hospital Capital Medical University Beijing China
| | - Zhe Tang
- Department of Evidence‐based Medicine Xuanwu Hospital Capital Medical University Beijing China
| | - Pulin Yu
- Geriatrics Beijing Hospital Ministry of Health Beijing China
| | - Kenneth Rockwood
- Department of Medicine Dalhousie University Halifax Nova Scotia Canada
- Central for Health Care of the Elderly QE Health Sciences Centre Capital District Health Authority Halifax Nova Scotia Canada
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Drubbel I, Numans ME, Kranenburg G, Bleijenberg N, de Wit NJ, Schuurmans MJ. Screening for frailty in primary care: a systematic review of the psychometric properties of the frailty index in community-dwelling older people. BMC Geriatr 2014; 14:27. [PMID: 24597624 PMCID: PMC3946826 DOI: 10.1186/1471-2318-14-27] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 02/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background To better accommodate for the complex care needs of frail, older people, general practitioners must be capable of easily identifying frailty in daily clinical practice, for example, by using the frailty index (FI). To explore whether the FI is a valid and adequate screening instrument for primary care, we conducted a systematic review of its psychometric properties. Methods We searched the Cochrane, PubMed and Embase databases and included original studies focusing on the criterion validity, construct validity and responsiveness of the FI when applied in community-dwelling older people. We evaluated the quality of the studies included using the Quality in Prognosis Studies (QUIPS) tool. This systematic review was conducted based on the PRISMA statement. Results Of the twenty studies identified, eighteen reported on FIs derived from research data, one reported upon an FI derived from an administrative database of home-care clients, and one reported upon an FI derived from routine primary care data. In general, the FI showed good criterion and construct validity but lacked studies on responsiveness. When compared with studies that used data gathered for research purposes, there are indications that the FI mean score and range might be different in datasets using routine primary care data; however, this finding needs further investigation. Conclusions Our results suggest that the FI is a valid frailty screening instrument. However, further research using routine Electronic Medical Record data is necessary to investigate whether the psychometric properties of the FI are generalizable to a primary care setting and to facilitate its interpretation and implementation in daily clinical practice. Trial registration PROSPERO systematic review register number: CRD42013003737.
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Affiliation(s)
- Irene Drubbel
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str, 6,131, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands.
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Hubbard RE, Story DA. Patient frailty: the elephant in the operating room. Anaesthesia 2014; 69 Suppl 1:26-34. [PMID: 24303858 DOI: 10.1111/anae.12490] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2013] [Indexed: 12/21/2022]
Abstract
For most surgeons and many anaesthetists, patient frailty is currently the 'elephant in the (operating) room': it is easy to spot, but is often ignored. In this paper, we discuss different approaches to the measurement of frailty and review the evidence regarding the effect of frailty on peri-operative outcomes. We explore the limitations of 'eyeballing' patients to quantify frailty, and consider why the frail older patient, challenged by seemingly minor insults in the postoperative period, may suffer falls or delirium. Frailty represents a state of increased vulnerability to stressors, and older inpatients are exposed to multiple stressors in the peri-operative setting. Quantifying frailty is likely to increase the precision of peri-operative risk assessment. The Frailty Index derived from Comprehensive Geriatric Assessment is a simple and robust way to quantify frailty, but is yet to be systematically investigated in the pre-operative setting. Furthermore, the optimal care for frail patients and the reversibility of frailty with prehabilitation are fertile areas for future research.
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Affiliation(s)
- R E Hubbard
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Salem BE, Nyamathi A, Phillips LR, Mentes J, Sarkisian C, Brecht L. Development of a frailty framework among vulnerable populations. ANS Adv Nurs Sci 2014; 37:70-81. [PMID: 24469090 PMCID: PMC4162317 DOI: 10.1097/ans.0000000000000013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Frailty is a public health issue that is experienced by homeless and other vulnerable populations; to date, a frailty framework has not been proposed to guide researchers who study hard-to-reach populations. The Frailty Framework among Vulnerable Populations has been developed from empirical research and consultation with frailty experts in an effort to characterize antecedents, that is, situational, health-related, behavioral, resource, biological, and environmental factors that contribute to physical, psychological, and social frailty domains and impact adverse outcomes. As vulnerable populations continue to age, a greater understanding of frailty will enable the development of nursing interventions.
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Affiliation(s)
| | - Adeline Nyamathi
- Associate Dean for International Research and Scholarly Activities, University of California, Los Angeles School of Nursing
| | | | - Janet Mentes
- University of California, Los Angeles School of Nursing
| | - Catherine Sarkisian
- UCLA Division of Geriatrics, VA Greater Los Angeles Healthcare System, Geriatric Research Education Clinical Center (GRECC)
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Amer MS, Farid TM, El-Rahman EEA, EL-Maleh DM, Omar OH, Mabrouk RA. Homocystiene and C-Reactive Protein in Detection of Frailty. ADVANCES IN AGING RESEARCH 2014; 03:102-108. [DOI: 10.4236/aar.2014.32016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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