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Gaston M, Bouazzi L, Ecarnot F, Collard M, Novella JL, Sanchez S, Chrusciel J. Association between hospital admission either directly or via the emergency department, and readmission rates at 30 days in older adults in two rural hospitals: a retrospective cohort study. Aging Clin Exp Res 2023; 35:2703-2710. [PMID: 37676428 DOI: 10.1007/s40520-023-02543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Older patients are frequently re-admitted to the hospital after attending the emergency department (ED). We investigated whether direct admission to the hospital was associated with a lower risk of readmission at 30 days compared to admission via the ED, in patients aged ≥ 75 years. METHODS Retrospective multicenter cohort study from 01/01/2018 to 31/12/2019, including patients aged ≥ 75 years from two hospitals. Patients admitted directly were matched 1:1 with patients admitted via the ED for center, age category, sex, major diagnosis category, type of stay (medical/surgical), and severity. We compared readmission at 30 days (primary outcome) and length of stay (secondary outcome) between groups. RESULTS A total of 1486 matched patients with an available outcome measure were included for analysis. We observed no significant difference in 30-day readmission rate between those admitted directly (102/778, 13.1%) and those admitted via the ED (87/708, 12.3%, p = 0.63). There was a significant difference in length of stay between both groups: median 5 days [Q1-Q3: 2-8] vs 6 days [2-11] for direct and ED admissions, respectively (effect size: 0.11, p < 0.001). By multivariate analysis, only moderate to severe denutrition was associated with the risk of readmission at 30 days (Odds Ratio 2.133, 95% Confidence Interval 1.309-3.475). CONCLUSION The mode of entry to the hospital of patients aged 75 years and older was not associated with the risk of readmission at 30 days. However, those admitted directly had a significantly shorter length of stay than those admitted via the ED.
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Affiliation(s)
- Michaël Gaston
- General Medicine Department, Champagne Ardennes University, Reims, France
| | - Leila Bouazzi
- University Committee of Resources for Research in Health (CURRS), University of Reims Champagne-Ardenne, Reims, France
| | - Fiona Ecarnot
- EA3920, University of Franche-Comté, Besancon, France.
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besancon, France.
| | - Michèle Collard
- Geriatric Medicine Department, Troyes Hospital Center, Troyes, France
| | - Jean-Luc Novella
- URCA, EA3797, VieFra, Reims, France
- Geriatric Medicine Department, Reims University Hospital, Reims, France
| | - Stéphane Sanchez
- University Committee of Resources for Research in Health (CURRS), University of Reims Champagne-Ardenne, Reims, France
- URCA, EA3797, VieFra, Reims, France
- Department of Public Health, Champagne Sud Hospital, Troyes, France
| | - Jan Chrusciel
- Department of Public Health, Champagne Sud Hospital, Troyes, France
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Choi JH, Koo BH, Seo WS, Cheon EJ, Sung HM, Kim JY, Jeong HS, Kim Y, Kim HG. Characteristics of Cognitive Function Changes and Related Factors in Individuals With Cognitive Impairment During the Pandemic of COVID-19: A Retrospective Chart Review Study. Psychiatry Investig 2023; 20:109-119. [PMID: 36891595 PMCID: PMC9996141 DOI: 10.30773/pi.2022.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/13/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID-19 and tested regularly at least three times within the last 5 years were included (1st, the initial screening; 2nd, the test immediately before the COVID-19 pandemic; 3rd, the most recent test after the pandemic). Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID-19. RESULTS When comparing CDR changes before and after COVID-19, there was no significant difference between the two groups (p=0.317). Alternatively, the main effect of the time when the test was conducted was significant (p<0.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/ improved group significantly decreased before COVID-19 (1st-2nd) (p=0.045). After COVID-19 (2nd-3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<0.001). Mini-Mental State Examination recall memory and changes in activity during COVID-19 were significantly associated with CDR deterioration. CONCLUSION Memory dysfunction and decreased activity during the COVID-19 pandemic are strongly related to the deterioration of cognitive impairment.
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Affiliation(s)
- Jin-Hui Choi
- Gimcheon Medical Center, Gimcheon, Republic of Korea
| | - Bon-Hoon Koo
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Wan-Seok Seo
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Eun-Jin Cheon
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Hyung-Mo Sung
- Department of Psychiatry, Soonchunhyang University College of Medicine, Soonchunhyang University Medical Center, Gumi, Republic of Korea
| | - Ji Yean Kim
- Department of Psychology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Hyun-Seok Jeong
- Department of Psychology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Younggyo Kim
- Department of Psychology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Hye-Geum Kim
- Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
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Rueegg M, Nissen SK, Brabrand M, Kaeppeli T, Dreher T, Carpenter CR, Bingisser R, Nickel CH. The clinical frailty scale predicts 1-year mortality in emergency department patients aged 65 years and older. Acad Emerg Med 2022; 29:572-580. [PMID: 35138670 PMCID: PMC9320818 DOI: 10.1111/acem.14460] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022]
Abstract
Objective To validate the Clinical Frailty Scale (CFS) for prediction of 1‐year all‐cause mortality in the emergency department (ED) and compare its performance to the Emergency Severity Index (ESI). Methods Prospective cohort study at the ED of a tertiary care center in Northwestern Switzerland. All patients aged ≥65 years were included from March 18 to May 20, 2019, after informed consent. Frailty status was assessed using CFS, excluding level 9 (palliative). Acuity level was assessed using ESI. Both CFS and ESI were adjusted for age, sex and presenting condition in multivariable logistic regression. Prognostic performance was assessed for discrimination and calibration separately. Estimates were internally validated by Bootstrapping. Restricted mean survival time (RMST) was determined for all levels of CFS. Results In the final study population of 2191 patients, 1‐year all‐cause mortality was 17% (n = 372). RMST values ranged from 219 days for CFS 8 to 365 days for CFS 1. The adjusted CFS model had an area under receiver operating characteristic of 0.767 (95% confidence interval [CI]: 0.741–0.793), compared to 0.703 (95% CI: 0.673–0.732) for the adjusted ESI model. Conclusion The CFS predicts 1‐year all‐cause mortality for older ED patients and predicts survival time in a graded manner. The CFS is superior to the ESI when adjusted for age, sex, and presenting condition.
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Affiliation(s)
- Marco Rueegg
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
| | - Søren Kabell Nissen
- Institute of Regional Health Research, Centre South‐West Jutland University of Southern Denmark Odense Denmark
| | - Mikkel Brabrand
- Institute of Regional Health Research, Centre South‐West Jutland University of Southern Denmark Odense Denmark
- Department of Emergency Medicine Odense University Hospital, University of Southern Denmark Odense Denmark
| | - Tobias Kaeppeli
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
| | - Thomas Dreher
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
| | - Christopher R. Carpenter
- Department of Emergency MedicineWashington University in St. Louis School of Medicine, Emergency Care Research CoreSt. LouisMichiganUSA
| | - Roland Bingisser
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
| | - Christian H. Nickel
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
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Cunha AIL, Veronese N, de Melo Borges S, Ricci NA. Frailty as a predictor of adverse outcomes in hospitalized older adults: A systematic review and meta-analysis. Ageing Res Rev 2019; 56:100960. [PMID: 31518686 DOI: 10.1016/j.arr.2019.100960] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/25/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Abstract
Frailty syndrome is prevalent among hospitalized older adults as are the occurrence of adverse outcomes. This systematic review and meta-analysis investigated whether frailty in older adults at hospital admission predicts adverse outcomes. Manual (ProQuest, conferences annals and references) and electronic searches (PUBMED, EMBASE, Web of Science, Lilacs, CINAHL, PsycINFO and Google Scholar) were performed. We included prospective studies of hospitalized older adults. Primary outcomes were functional decline at hospital discharge and mortality after discharge. Other data were considered secondary outcomes. Methodological quality was evaluated by the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twenty-eight papers were included, corresponding to 19 cohorts (5 cohorts for functional decline and 16 for mortality), with moderate to good methodological quality. Being frail [RR: 1.32 (95%CI: 1.04; 1.67)] and pre-frail [RR: 1.51 (95%CI: 1.05; 2.17)] are risk factors for functional decline compared with being nonfrail. Frail individuals had a relative risk for in-hospital mortality and mortality in medium- and long-term compared to nonfrail (in-hospital RR: 8.20, medium RR: 9.49 and long RR: 7.94) and pre-frail (in-hospital RR: 3.19, medium RR: 3.31 and long RR: 3.72). The overall mortality risk in frail individuals is 3.49 and 2.14 times compared to nonfrail and pre-frail, respectively. Length of hospital stay was higher for frail older adults (13.5 days) compared with pre-frail (10.5 days) and nonfrail (8.3 days). Therefore, being frail at hospital admission is a risk factor for in-hospital mortality, long hospital stay, functional decline at hospital discharge, and mortality in the medium- and long-term.
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Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, Armstrong JJ, Rockwood K. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 2018; 18:139. [PMID: 29898673 PMCID: PMC6000922 DOI: 10.1186/s12877-018-0823-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. Methods This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors. We searched Medline, CINAHL, Embase, PsycINFO, Eric, and Cochrane from January 2000 to September 2015. Results Our database search initially resulted in 8658 articles and 617 were eligible. In 67% of the articles the authors identified their participants as frail but did not report on how they measured frailty. Among the 204 articles that did measure frailty, the most common disciplines were geriatrics (14%), emergency department (14%), and general medicine (11%). In total, 89 measures were used. This included 13 established tools, used in 51% of the articles, and 35 non-frailty tools, used in 24% of the articles. The most commonly used tools were the Clinical Frailty Scale, the Frailty Index, and the Frailty Phenotype (12% each). Most often (44%) researchers used frailty tools to predict adverse health outcomes. In 74% of the cases frailty predicted the outcome examined, typically mortality and length of stay. Conclusions Most studies (83%) were conducted in non-geriatric disciplines and two thirds of the articles identified participants as frail without measuring frailty. There was great variability in tools used and more recently published studies were more likely to use established frailty tools. Overall, frailty appears to be a good predictor of adverse health outcomes. For frailty to be implemented in clinical practice frailty tools should help formulate the care plan and improve shared decision making. How this will happen has yet to be determined. Electronic supplementary material The online version of this article (10.1186/s12877-018-0823-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Theou
- Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada. .,Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.
| | - Emma Squires
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Kayla Mallery
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Jacques S Lee
- Sunnybrook Health Service, 2075 Bayview Avenue, BG-04, Toronto, ON, M4N 3M5, Canada
| | - Sherri Fay
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
| | - Judah Goldstein
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, B3B 2B2, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada
| | - Kenneth Rockwood
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada.,Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Building, 5955 Veterans' Memorial Lane, Halifax, NS, B3H 2E1, Canada
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Chen S, Honda T, Narazaki K, Chen T, Kishimoto H, Haeuchi Y, Kumagai S. Physical Frailty Is Associated with Longitudinal Decline in Global Cognitive Function in Non-Demented Older Adults: A Prospective Study. J Nutr Health Aging 2018; 22:82-88. [PMID: 29300426 DOI: 10.1007/s12603-017-0924-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the relationship between physical frailty and subsequent decline in global cognitive function in the non-demented elderly. DESIGN AND SETTING A prospective population-based study in a west Japanese suburban town, with two-year follow-up. PARTICIPANTS Community-dwellers aged 65 and older without placement in long-term care, and not having a history of dementia, Parkinson's disease and depression at baseline, who participated in the cohort of the Sasaguri Genkimon Study and underwent follow-up assessments two years later (N = 1,045). MEASUREMENTS Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Physical frailty was identified according to the following five components: weight loss, low grip strength, exhaustion, slow gait speed and low physical activities. Linear regression models were used to examine associations between baseline frailty status and the MoCA scores at follow-up. Logistic regression models were used to estimate the risk of cognitive decline (defined as at least two points decrease of MoCA score) according to baseline frailty status. RESULTS Seven hundred and eight non-demented older adults were included in the final analyses (mean age: 72.6 ± 5.5 years, male 40.3%); 5.8% were frail, and 40.8% were prefrail at baseline. One hundred and fifty nine (22.5%) participants experienced cognitive decline over two years. After adjustment for baseline MoCA scores and all confounders, being frail at baseline was significantly associated with a decline of 1.48 points (95% confidence interval [CI], -2.37 to -0.59) in MoCA scores, as compared with non-frailty. Frail persons were over two times more likely to experience cognitive decline (adjusted odds ratio 2.28; 95% CI, 1.02 to 5.08), compared to non-frail persons. CONCLUSION Physical frailty is associated with longitudinal decline in global cognitive function in the non-demented older adults over a period of two years. Physically frail older community-dwellers should be closely monitored for cognitive decline that can be sensitively captured by using the MoCA.
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Affiliation(s)
- S Chen
- Dr. Shuzo Kumagai, Department of Behavior and Health Sciences, Graduate School of Human-Environment Studies, Kyushu University, 6-1 Kasuga Koen, Kasuga City, Fukuoka Prefecture, 816-8580, Japan, Telephone number: +81 92-583-7853, Fax number: +81 92-583-7853, E-mail:
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Mauthner O, Claes V, Deschodt M, Jha SR, Engberg S, Macdonald PS, Newton PJ, De Geest S. Handle with care: A systematic review on frailty in cardiac care and its usefulness in heart transplantation. Transplant Rev (Orlando) 2017; 31:218-224. [DOI: 10.1016/j.trre.2017.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/11/2017] [Accepted: 03/13/2017] [Indexed: 01/10/2023]
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Validation of a new mortality risk prediction model for people 65 years and older in northwest Russia: The Crystal risk score. Arch Gerontol Geriatr 2017; 71:105-114. [PMID: 28415034 DOI: 10.1016/j.archger.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prediction models help to make decisions about further management in clinical practice. This study aims to develop a mortality risk score based on previously identified risk predictors and to perform internal and external validations. METHODS In a population-based prospective cohort study of 611 community-dwelling individuals aged 65+ in St. Petersburg (Russia), all-cause mortality risks over 2.5 years follow-up were determined based on the results obtained from anthropometry, medical history, physical performance tests, spirometry and laboratory tests. C-statistic, risk reclassification analysis, integrated discrimination improvement analysis, decision curves analysis, internal validation and external validation were performed. RESULTS Older adults were at higher risk for mortality [HR (95%CI)=4.54 (3.73-5.52)] when two or more of the following components were present: poor physical performance, low muscle mass, poor lung function, and anemia. If anemia was combined with high C-reactive protein (CRP) and high B-type natriuretic peptide (BNP) was added the HR (95%CI) was slightly higher (5.81 (4.73-7.14)) even after adjusting for age, sex and comorbidities. Our models were validated in an external population of adults 80+. The extended model had a better predictive capacity for cardiovascular mortality [HR (95%CI)=5.05 (2.23-11.44)] compared to the baseline model [HR (95%CI)=2.17 (1.18-4.00)] in the external population. CONCLUSION We developed and validated a new risk prediction score that may be used to identify older adults at higher risk for mortality in Russia. Additional studies need to determine which targeted interventions improve the outcomes of these at-risk individuals.
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Mauthner O, Claes V, Walston J, Engberg S, Binet I, Dickenmann M, Golshayan D, Hadaya K, Huynh-Do U, Calciolari S, De Geest S. ExplorinG frailty and mild cognitive impairmEnt in kidney tRansplantation to predict biomedicAl, psychosocial and health cost outcomeS (GERAS): protocol of a nationwide prospective cohort study. J Adv Nurs 2016; 73:716-734. [DOI: 10.1111/jan.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Oliver Mauthner
- Institute of Nursing Science; University of Basel; Switzerland
| | - Veerle Claes
- Institute of Nursing Science; University of Basel; Switzerland
| | - Jeremy Walston
- Center on Aging and Health; Johns Hopkins University; Baltimore Maryland USA
| | - Sandra Engberg
- Institute of Nursing Science; University of Basel; Switzerland
- School of Nursing; University of Pittsburgh; Pennsylvania USA
| | - Isabelle Binet
- Clinic of Nephrology and Transplantation Medicine; Cantonal Hospital St Gallen; Switzerland
| | - Michael Dickenmann
- Department for Transplantation-Immunology and Nephrology; University Hospital Basel; Switzerland
| | - Déla Golshayan
- Transplantation Centre and Transplantation Immunopathology Laboratory; University Hospital Lausanne; Switzerland
| | - Karine Hadaya
- Department of Nephrology; University Hospital Geneva; Switzerland
| | - Uyen Huynh-Do
- University Clinic for Nephrology, Hypertension and Clinical Pharmacology; University Hospital Bern; Switzerland
| | | | - Sabina De Geest
- Institute of Nursing Science; University of Basel; Switzerland
- Academic Center for Nursing and Midwifery; KU Leuven; Belgium
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Turusheva A, Frolova E, Korystina E, Zelenukha D, Tadjibaev P, Gurina N, Turkeshi E, Degryse JM. Do commonly used frailty models predict mortality, loss of autonomy and mental decline in older adults in northwestern Russia? A prospective cohort study. BMC Geriatr 2016; 16:98. [PMID: 27160275 PMCID: PMC4862060 DOI: 10.1186/s12877-016-0276-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 05/05/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Frailty prevalence differs across countries depending on the models used to assess it that are based on various conceptual and operational definitions. This study aims to assess the clinical validity of three frailty models among community-dwelling older adults in north-western Russia where there is a higher incidence of cardiovascular disease and lower life expectancy than in European countries. METHODS The Crystal study is a population-based prospective cohort study in Kolpino, St. Petersburg, Russia. A random sample of the population living in the district was stratified into two age groups: 65-75 (n = 305) and 75+ (n = 306) and had a baseline comprehensive health assessment followed by a second one after 33.4 +/-3 months. The total observation time was 47 +/-14.6 months. Frailty was assessed according to the models of Fried, Puts and Steverink-Slaets. Its association with mortality at 5 years follow-up as well as dependency, mental and physical decline at around 2.5 years follow up was explored by multivariable and time-to-event analyses. RESULTS Mortality was predicted independently from age, sex and comorbidities only by the frail status of the Fried model in those over 75 years old [HR (95 % CI) = 2.50 (1.20-5.20)]. Mental decline was independently predicted only by pre-frail [OR (95 % CI) = 0.24 (0.10-0.55)] and frail [OR (95 % CI) = 0.196 (0.06-0.67)] status of Fried model in those 65-75 years old. The prediction of dependency and physical decline by pre-frail and frail status of any the three frailty models was not statistically significant in this cohort of older adults. CONCLUSIONS None of the three frailty models was valid at predicting 5 years mortality and disability, mental and physical decline at 2.5 years in a cohort of older adults in north-west Russia. Frailty by the Fried model had only limited value for mortality in those 75 years old and mental decline in those 65-75 years old. Further research is needed to identify valid frailty markers for older adults in this population.
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Affiliation(s)
- Anna Turusheva
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30 bte 30.05, 1200, Woluwe-Saint-Lambert, Brussels, Belgium
| | - Elena Frolova
- The North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Elena Korystina
- The North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Dmitry Zelenukha
- The North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Pulodjon Tadjibaev
- The North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Natalia Gurina
- The North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Eralda Turkeshi
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30 bte 30.05, 1200, Woluwe-Saint-Lambert, Brussels, Belgium
| | - Jean-Marie Degryse
- Institut de Recherche Santé et Société, Université Catholique de Louvain, Clos Chapelle-aux-Champs, 30 bte 30.05, 1200, Woluwe-Saint-Lambert, Brussels, Belgium.
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
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Panza F, Solfrizzi V, Barulli MR, Santamato A, Seripa D, Pilotto A, Logroscino G. Cognitive Frailty: A Systematic Review of Epidemiological and Neurobiological Evidence of an Age-Related Clinical Condition. Rejuvenation Res 2015; 18:389-412. [PMID: 25808052 DOI: 10.1089/rej.2014.1637] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Advancing age is the focus of recent studies on familial and sporadic Alzheimer's disease (AD), suggesting a prolonged pre-clinical phase several decades before the onset of dementia symptoms. Influencing some age-related conditions, such as frailty, may have an impact on the prevention of late-life cognitive disorders. Frailty reflects a nonspecific state of vulnerability and a multi-system physiological change with increased risk for adverse health outcomes in older age. In this systematic review, frailty indexes based on a deficit accumulation model were associated with late life cognitive impairment and decline, incident dementia, and AD. Physical frailty constructs were associated with late-life cognitive impairment and decline, incident AD and mild cognitive impairment, vascular dementia, non-AD dementias, and AD pathology in older persons with and without dementia, thus also proposing cognitive frailty as a new clinical condition with co-existing physical frailty and cognitive impairment in non-demented older subjects. Considering both physical frailty and cognitive impairment as a single complex phenotype may be central in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects. The mechanisms underlying the cognitive-frailty link are multi-factorial, and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. There is a critical need for randomized controlled trials of intervention investigating the role of nutrition and/or physical exercise on cognitive frail subjects with the progression to dementia as primary outcome. These preventive trials and larger longitudinal population-based studies targeting cognitive outcomes could be useful in further understanding the cognitive-frailty interplay in older age.
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Affiliation(s)
- Francesco Panza
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- 2 Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro , Bari, Italy
| | - Maria Rosaria Barulli
- 3 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,4 Department of Clinical Research in Neurology, University of Bari Aldo Moro , "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Andrea Santamato
- 5 Department of Physical Medicine and Rehabilitation,"OORR Hospital", University of Foggia , Italy
| | - Davide Seripa
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Alberto Pilotto
- 1 Geriatric Unit & Laboratory of Gerontology and Geriatrics , Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy .,6 Geriatric Unit, Azienda ULSS 16 Padova, Hospital S. Antonio , Padova, Italy
| | - Giancarlo Logroscino
- 3 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,4 Department of Clinical Research in Neurology, University of Bari Aldo Moro , "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
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Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills TF, Rothman RE, Hogan TM. Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. Acad Emerg Med 2015; 22:1-21. [PMID: 25565487 DOI: 10.1111/acem.12569] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/21/2014] [Accepted: 08/24/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED-validated screening instruments to distinguish patients more or less likely to experience short-term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death. METHODS A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand-searched relevant specialty society research abstracts. Two physicians independently reviewed all abstracts and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical test-treatment threshold analysis was constructed based on the meta-analytic summary estimate of prognostic accuracy for one outcome. RESULTS A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post-ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self-rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1-year mortality (LR- = 0.27) and nursing home placement (LR- = 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta-analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR- range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3-month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%. CONCLUSIONS Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the risk of 1-year mortality, no individual risk factor, frailty construct, or risk assessment instrument accurately predicts risk of adverse outcomes in older ED patients. Existing instruments designed to risk stratify older ED patients do not accurately distinguish high- or low-risk subsets. Clinicians, educators, and policy-makers should not use these instruments as valid predictors of post-ED adverse outcomes. Future research to derive and validate feasible ED instruments to distinguish vulnerable elders should employ published decision instrument methods and examine the contributions of alternative variables, such as health literacy and dementia, which often remain clinically occult.
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Affiliation(s)
- Christopher R. Carpenter
- The Department of Emergency Medicine; Washington University in St. Louis School of Medicine; St. Louis MO
| | - Erica Shelton
- The Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Susan Fowler
- The Department of Emergency Medicine; Washington University in St. Louis School of Medicine; St. Louis MO
| | - Brian Suffoletto
- The Department of Emergency Medicine; University of Pittsburgh Medical Center; Pittsburgh PA
| | - Timothy F. Platts-Mills
- The Department of Emergency Medicine; University of North Carolina-Chapel Hill; Chapel Hill NC
| | - Richard E. Rothman
- The Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Teresita M. Hogan
- The Department of Emergency Medicine; University of Chicago; Chicago IL
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Panza F, Solfrizzi V, Tortelli R, Resta F, Sabbà C, Logroscino G. Prevention of Late-life Cognitive Disorders: Diet-Related Factors, Dietary Patterns, and Frailty Models. Curr Nutr Rep 2014. [DOI: 10.1007/s13668-014-0080-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Evans SJ, Sayers M, Mitnitski A, Rockwood K. The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment. Age Ageing 2014; 43:127-32. [PMID: 24171946 DOI: 10.1093/ageing/aft156] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND prognostication for frail older adults is complex, especially when they become seriously ill. OBJECTIVES to test the measurement properties, especially the predictive validity, of a frailty index based on a comprehensive geriatric assessment (FI-CGA) in an acute care setting in relation to the risk of death, length of stay and discharge destination. DESIGN AND SETTING prospective cohort study. Inpatient medical units in a teaching, acute care hospital. SUBJECTS individuals on inpatient medical units in a hospital, n = 752, aged 75+ years, were evaluated on their first hospital day; to test reliability, a subsample (n = 231) was seen again on Day 3. MEASUREMENTS all frailty data collected routinely as part of a CGA were used to create the FI-CGA. Mortality data were reviewed from hospital records, claims data, Social Security Death Index and interviews with Discharge Managers. RESULTS thirty-day mortality was 93 (12.4%; 95% confidence interval (CI) = 10-15%) of whom 52 died in hospital. The risk of dying increased with each 0.01 increment in the FI-CGA: hazard ratio (HR) = 1.05, (95% CI = 1.04-1.07). People who were discharged home had the lowest admitting mean FI-CGA = 0.38 (±standard deviation 0.11) compared with those who died, FI-CGA = 0.51 (±0.12) or were discharged to nursing home, FI-CGA = 0.49 (±0.11). Likewise, increasing FI-CGA values on admission were significantly associated with a longer length of hospital stay. CONCLUSIONS frailty, measured by the FI-CGA, was independently associated with a higher risk of death and other adverse outcomes in older people admitted to an acute care hospital.
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Affiliation(s)
- Stephen J Evans
- Catholic Health System, Catholic Health System of Western New York, Buffalo, NY, USA
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Lang PO, Mahmoudi R, Novella JL, Tardieu E, Bertholon LA, Nazeyrollas P, Blanchard F, Jolly D, Dramé M. Is obesity a marker of robustness in vulnerable hospitalized aged populations? Prospective, multicenter cohort study of 1 306 acutely ill patients. J Nutr Health Aging 2014; 18:66-74. [PMID: 24402392 DOI: 10.1007/s12603-013-0352-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The "obesity paradox" is poorly understood in vulnerable older hospitalized populations. OBJECTIVES To prospectively analyze the impact of body mass index (BMI) and comorbidities on early (6-week), one- and two-year mortality. DESIGN Prospective multicenter study with a two-year follow-up of old patients participating in the SAFES cohort study. SETTINGS Nine university hospitals in France. PARTICIPANTS Patients aged 75 or older hospitalized in medical divisions through the emergency department. MEASUREMENT Inpatients' characteristics were obtained through a comprehensive geriatric assessment of inpatients, conducted in the first week of hospitalization. All-cause mortalities at 6-week, one- and two-year were determined using bivariable and multivariable Cox proportional hazard model. RESULTS The SAFES cohort included 1,306 patients, aged 85±6 years, with a majority of women (65%). One- and two-year mortality were inversely associated with BMI ≥30 kg/m2 while early mortality was not, and positively associated with age, burden of comorbidities, walking disorders, level of dependency and presence of a dementia syndrome. Survival rates between patients in low (< 18.0 kg/m2) and intermediate (18-24.9 and 25-29.9 kg/m2) BMI categories were not significant. CONCLUSION While our findings seem to confirm the reality of the "obesity paradox" in vulnerable older hospitalized population, the exact understanding of underlying mechanisms and even the truthfulness of this paradoxical relationship are still fraught with considerable methodological, epidemiological and metabolic challenges.
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Affiliation(s)
- P-O Lang
- Pierre Olivier Lang, MD, MPH, PD, PhD. Nescens Centre of Preventive Medicine, Clinic of Genolier, Route du Muids, 3, CH-1272 Genolier, Switzerland, Phone: + 412236693 09 - fax: + 4122 36693 49-E-mail:
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Frailty and cognitive impairment--a review of the evidence and causal mechanisms. Ageing Res Rev 2013; 12:840-51. [PMID: 23831959 DOI: 10.1016/j.arr.2013.06.004] [Citation(s) in RCA: 473] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/14/2013] [Accepted: 06/25/2013] [Indexed: 12/23/2022]
Abstract
Incidence rates of cognitive impairment and dementia are rising with the ageing population. Meanwhile, the limited success of current treatments has led to a search for early markers of dementia which could predict future progression or improve quality of life for those already suffering from the disease. One focus has been on the correlation between physical and cognitive measures with an increasing interest in the association between frailty and cognitive decline. Frailty is an age-related syndrome described as the decreased ability of an organism to respond to stressors. A number of epidemiological studies have reported that frailty increases the risk of future cognitive decline and that cognitive impairment increases the risk of frailty suggesting that cognition and frailty interact within a cycle of decline associated with ageing. This paper reviews the evidence for an association between frailty and cognitive impairment and outlines some of the mechanisms that potentially underpin this relationship from brain neuropathology and hormonal dysregulation to cardiovascular risk and psychological factors.
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Malmstrom TK, Morley JE. Frailty and cognition: linking two common syndromes in older persons. J Nutr Health Aging 2013; 17:723-5. [PMID: 24154641 DOI: 10.1007/s12603-013-0395-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- T K Malmstrom
- John E. Morley, MB, BCh, Director, Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, Missouri 63104,
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Helvik AS, Selbæk G, Engedal K. Cognitive decline one year after hospitalization in older adults without dementia. Dement Geriatr Cogn Disord 2013; 34:198-205. [PMID: 23128048 DOI: 10.1159/000343932] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We studied cognitive functioning 1 year after hospitalization (T2) in patients at least 65 years old without cognitive impairment at baseline (T1). METHODS Cognition was assessed using the Mini-Mental State Examination (MMSE) at both time points. We included 211 (114 women) patients with a mean age of 78.3 (SD 7.0) years and an MMSE score of 24 and above. RESULTS At T2, 69 (32.7%) patients had an MMSE score below 24. In participants with MMSE 24-26 at T1, cognitive decline was related to impaired physical self-maintenance, a decline in the performance of the instrumental activities of daily living, impaired hearing and less reading ability. In participants with MMSE 27-30, cognitive decline was associated with higher comorbidity (Charlson Index) and impaired physical self-maintenance and hearing. CONCLUSION A reduced functioning level and increased comorbidity predicted a decline in cognitive functioning.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Malmstrom TK, Morley JE. The Frail Brain. J Am Med Dir Assoc 2013; 14:453-5. [DOI: 10.1016/j.jamda.2013.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
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Shatenstein B. Frailty and cognitive decline: links, mechanisms and future directions. J Nutr Health Aging 2011; 15:665-6. [PMID: 21968861 DOI: 10.1007/s12603-011-0337-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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