1
|
Qin Y, Hao X, Lv M, Zhao X, Wu S, Li K. A global perspective on risk factors for frailty in community-dwelling older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 105:104844. [PMID: 36335672 DOI: 10.1016/j.archger.2022.104844] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frailty has become an important determinant of a series of adverse health outcomes. We explored the risk factors for frailty in older adults in the community from a global perspective and explore whether there are ethnic differences in these risk factors. METHODS The systematic review and meta-analysis (PROSPERO registration number: CRD42022323342) was searched using six electronic databases, including PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO (EBSCO) and CINAHL (EBSCO) from inception to October 2021. We assessed study eligibility by inclusion and excluded criteria. Cohort studies included were assessed according to the Newcastle-Ottawa Scale. Cross-sectional studies were assessed by the bias risk evaluation standard recommended by the Agency for Health care Research and Quality. The results were reported by a narrative synthesis and pooled analyses. Statistical analyses were performed in Review Manager 5.3 software. RESULTS We reviewed 10870 studies, and 62 studies were included. The results showed a significant association between multidomain risk factors and the frailty of global older adults, including demographic factors, health-related factors, and physical factors. Marital status, depression, risk of malnutrition, history of falls and disease-related symptoms are also risk factors for frailty among older people in Asia. CONCLUSION Multiple domain factors were associated with frailty among older people around the world. Compared with the rest of the world, Asian populations are exposed to more risk factors for frailty. Therefore, health care providers should consider the characteristics of risk factors for frailty in this region when formulating intervention measures related to frailty.
Collapse
Affiliation(s)
- Yuan Qin
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xiaonan Hao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Miaohua Lv
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Shuang Wu
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China
| | - Kun Li
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, Jilin 130021, China.
| |
Collapse
|
2
|
Perazza LR, Brown-Borg HM, Thompson LV. Physiological Systems in Promoting Frailty. Compr Physiol 2022; 12:3575-3620. [PMID: 35578945 DOI: 10.1002/cphy.c210034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.
Collapse
Affiliation(s)
- Laís R Perazza
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Holly M Brown-Borg
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - LaDora V Thompson
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Bąk E, Młynarska A, Marcisz C, Bobiński R, Sternal D, Młynarski R. The influence of frailty syndrome on quality of life in elderly patients with type 2 diabetes. Qual Life Res 2021; 30:2487-2495. [PMID: 33834352 PMCID: PMC8405487 DOI: 10.1007/s11136-021-02829-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There have been no comprehensive studies that assess the impact of frailty syndrome on quality of life (QoL) of patients with diagnosed type 2 diabetes. The purpose of the study was to assess the impact of frailty syndrome on QoL and depression symptoms of patients with type 2 diabetes. METHODS The study included 148 consecutive patients (aged ≥ 60y). The patients were divided into two groups according to the prevalence of the frailty syndrome: robust and frailty. For all of the patients that were included in the study, we used the Polish version of validated instruments: ADDQoL, TFI and BDI. RESULTS In the study group, 43.2% had been diagnosed with frailty syndrome. An analysis of QoL assessment depending on the prevalence of the frailty syndrome showed that patients who were robust (without recognized frailty syndrome) assessed QoL significantly better than patients with coexisting frailty syndrome. Robust patients did not have any severe depressive symptoms, whereas in the group of patients with the frailty syndrome 43.8% of the patients had a depression. 70.2% of the patients without any depressive symptoms were robust patients, meanwhile only 14% of the patients had frailty syndrome recognized. CONCLUSIONS Frailty syndrome occurred in 43 percent of the patients with type 2 diabetes. This has a negative impact on QoL of patients. Depression is more common in patients with the frailty syndrome and diabetes.
Collapse
Affiliation(s)
- E. Bąk
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - A. Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - C. Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - R. Bobiński
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - D. Sternal
- Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland
| | - R. Młynarski
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
4
|
Two-Year Follow-up of a Multimodal Intervention on Functional Capacity and Muscle Power in Frail Patients With Type 2 Diabetes. J Am Med Dir Assoc 2021; 22:1906-1911. [PMID: 34265268 DOI: 10.1016/j.jamda.2021.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To analyze the effects of a program composed of resistance training and nutritional interventions on functional capacity, maximal strength, and power output after 2 years of follow-up, including 2 periods of 16 weeks of intervention followed by several weeks of intervention cessation in frail patients with type 2 diabetes. DESIGN MIDPOW is a substudy of a multicenter, multimodal intervention composed of resistance training combined with a structured diabetes and nutritional education program in frail and prefrail older people with type 2 diabetes (MID-Frail). SETTING AND PARTICIPANTS This study recruited 52 participants (mean age: 79 ± 5.6, 63% women), with type 2 diabetes mellitus, frail or prefrail using Fried's frailty phenotype. METHODS Primary outcomes of this substudy were Short Physical Performance Battery (SPPB) and maximal power output at 30% and 80% of 1RM. RESULTS Each set of 16 weeks of intervention resulted in significant improvements in SPPB performance by a mean of 36.1% at week 18 (P < .001) and 10.2% at week 68 (P < .05). Maximal power output improvements at 30% and 80% of the 1RM ranged from 45.2% to 57.2% at week 18 (P < .01-.001); and no significant changes were observed after the second period of intervention. After 2 years of follow-up, the SPPB and maximal power values observed remained significantly higher than the baseline. CONCLUSIONS AND IMPLICATIONS Resistance training combined with nutritional program improved SPPB, maximal strength, and power output in older frail patients with diabetes. These improvements were maintained above the basal levels after several weeks of intervention cessation during a 2-year follow-up.
Collapse
|
5
|
|
6
|
Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, De Souto Barreto P, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won Won C, Woo J, Vellas B. Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2021; 24:920-927. [PMID: 33155616 PMCID: PMC7568453 DOI: 10.1007/s12603-020-1492-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J G Ruiz
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Frailty modifies the association between opioid use and mortality in chronic kidney disease patients with diabetes: a population-based cohort study. Aging (Albany NY) 2020; 12:21730-21746. [PMID: 33176279 PMCID: PMC7695426 DOI: 10.18632/aging.103978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
The prevalence of chronic pain in patients with chronic kidney disease (CKD) and diabetes mellitus is high and correlates with higher frailty risk, but satisfactory pain control frequently fails, necessitating opioid initiation. We aimed to examine whether opioid use affected their outcomes and whether such a relationship was modified by frailty. From the longitudinal cohort of diabetes patients (n = 840,000), we identified opioid users with CKD (n = 26,029) and propensity score-matched them to opioid-naïve patients in a 1:1 ratio. We analyzed the associations between opioid use and long-term mortality according to baseline frailty status, defined by the modified FRAIL scale. Among all, 20.3% did not have any FRAIL items, while 57.2%, 20.6%, and 1.9% had 1, 2, and at least 3 positive FRAIL items, respectively. After 4.2 years, 16.4% died. Cox proportional hazard regression showed that opioid users exhibited an 18% higher mortality risk (HR 1.183, 95% CI 1.13-1.24) with a dose- and duration-responsive relationship, compared to opioid-naive ones. Furthermore, the mortality risk posed by opioids was observed only in CKD patients without frailty but not in those with frailty. In conclusion, opioid use increased mortality among patients with CKD, while this negative outcome influence was not observed among frail ones.
Collapse
|
8
|
Burroni L, Chiti A. PET/CT in senior patients: "cui prodest?". Eur J Nucl Med Mol Imaging 2020; 48:661-663. [PMID: 32840667 DOI: 10.1007/s00259-020-05010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Luca Burroni
- Department of Nuclear Medicine, "Ospedali Riuniti di Torrette" Hospital, Via Conca 71, 60126 Ancona, Italy.
| | - Arturo Chiti
- Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| |
Collapse
|
9
|
Ofori-Asenso R, Chin KL, Sahle BW, Mazidi M, Zullo AR, Liew D. Frailty Confers High Mortality Risk across Different Populations: Evidence from an Overview of Systematic Reviews and Meta-Analyses. Geriatrics (Basel) 2020; 5:geriatrics5010017. [PMID: 32178338 PMCID: PMC7151473 DOI: 10.3390/geriatrics5010017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 01/03/2023] Open
Abstract
We performed an overview of systematic reviews and meta-analyses to summarize available data regarding the association between frailty and all-cause mortality. Medline, Embase, CINAHL, Web of Science, PsycINFO, and AMED (Allied and Complementary Medicine) databases were searched until February 2020 for meta-analyses examining the association between frailty and all-cause mortality. The AMSTAR2 checklist was used to evaluate methodological quality. Frailty exposure and the risk of all-cause mortality (hazard ratio [HR] or relative risk [RR]) were displayed in forest plots. We included 25 meta-analyses that pooled data from between 3 and 20 studies. The number of participants included in these meta-analyses ranged between <2000 and >500,000. Overall, 56%, 32%, and 12% of studies were rated as of moderate, low, and critically low quality, respectively. Frailty was associated with increased risk of all-cause mortality in 24/24 studies where the HR/RRs ranged from 1.35 [95% confidence interval (CI) 1.05-1.74] (patients with diabetes) to 7.95 [95% CI 4.88-12.96] (hospitalized patients). The median HR/RR across different meta-analyses was 1.98 (interquartile range 1.65-2.67). Pre-frailty was associated with a significantly increased risk of all-cause mortality in 7/7 studies with the HR/RR ranging from 1.09 to 3.65 (median 1.51, IQR 1.38-1.73). These data suggest that interventions to prevent frailty and pre-frailty are needed.
Collapse
Affiliation(s)
- Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3181, Australia; (K.L.C.); (D.L.)
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 2 2300 Universitetsparken, Copenhagen, Denmark
- Correspondence: ; Tel.: +61411092470
| | - Ken Lee Chin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3181, Australia; (K.L.C.); (D.L.)
- Melbourne Medical School, University of Melbourne, Parkville, VIC 3010, Australia
| | - Berhe W. Sahle
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3053, Australia;
| | - Mohsen Mazidi
- Twin Research and Genetic Epidemiology, Kings College London, London SE1 7EH, UK;
| | - Andrew R. Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, RI 02912, USA;
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3181, Australia; (K.L.C.); (D.L.)
| |
Collapse
|
10
|
Sargeant JA, Henson J, King JA, Yates T, Khunti K, Davies MJ. A Review of the Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors on Lean Body Mass in Humans. Endocrinol Metab (Seoul) 2019; 34:247-262. [PMID: 31565876 PMCID: PMC6769337 DOI: 10.3803/enm.2019.34.3.247] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/16/2022] Open
Abstract
Weight loss is an important goal in the management of several chronic conditions, including type 2 diabetes mellitus, and pharmacological therapies that aid weight loss are appealing. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) are novel glucose-lowering therapies that have been shown to induce clinically significant reductions in body weight. However, this weight loss may not be attributed solely to fat mass (FM). Given the importance of skeletal muscle and lean body mass (LBM) on cardio-metabolic health and physical function, we reviewed the available literature reporting the effects of GLP-1RAs and SGLT2is on body composition. Results demonstrate that, in most circumstances, the weight loss associated with both therapies predominantly comprises a reduction in FM, although significant heterogeneity exists between studies. In over half of the studies identified, the proportion of LBM reduction ranged between 20% and 50% of total weight lost, which is consistent with diet-induced weight loss and bariatric surgery. No clear differences existed between GLP-1RAs and SGLT2is. Consequently, the loss of LBM and skeletal muscle associated with weight loss induced by GLP-1RAs and SGLT2is warrants attention. Strategies to preserve skeletal muscle and improve physical function, for example through structured exercise, are of great importance.
Collapse
Affiliation(s)
- Jack Alistair Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - James Adam King
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC), Leicester, UK
| | - Melanie Jane Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospital of Leicester NHS Trust and the University of Leicester, Leicester, UK.
| |
Collapse
|
11
|
Ofori-Asenso R, Chin KL, Mazidi M, Zomer E, Ilomaki J, Zullo AR, Gasevic D, Ademi Z, Korhonen MJ, LoGiudice D, Bell JS, Liew D. Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e198398. [PMID: 31373653 PMCID: PMC6681553 DOI: 10.1001/jamanetworkopen.2019.8398] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Frailty is a common geriatric syndrome of significant public health importance, yet there is limited understanding of the risk of frailty development at a population level. OBJECTIVE To estimate the global incidence of frailty and prefrailty among community-dwelling adults 60 years or older. DATA SOURCES MEDLINE, Embase, PsycINFO, Web of Science, CINAHL Plus, and AMED (Allied and Complementary Medicine Database) were searched from inception to January 2019 without language restrictions using combinations of the keywords frailty, older adults, and incidence. The reference lists of eligible studies were hand searched. STUDY SELECTION In the systematic review, 2 authors undertook the search, article screening, and study selection. Cohort studies that reported or had sufficient data to compute incidence of frailty or prefrailty among community-dwelling adults 60 years or older at baseline were eligible. DATA EXTRACTION AND SYNTHESIS The methodological quality of included studies was assessed using The Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence and Incidence Studies. Meta-analysis was conducted using a random-effects (DerSimonian and Laird) model. MAIN OUTCOMES AND MEASURES Incidence of frailty (defined as new cases of frailty among robust or prefrail individuals) and incidence of prefrailty (defined as new cases of prefrailty among robust individuals), both over a specified duration. RESULTS Of 15 176 retrieved references, 46 observational studies involving 120 805 nonfrail (robust or prefrail) participants from 28 countries were included in this systematic review. Among the nonfrail individuals who survived a median follow-up of 3.0 (range, 1.0-11.7) years, 13.6% (13 678 of 100 313) became frail, with the pooled incidence rate being 43.4 (95% CI, 37.3-50.4; I2 = 98.5%) cases per 1000 person-years. The incidence of frailty was significantly higher in prefrail individuals than robust individuals (pooled incidence rates, 62.7 [95% CI, 49.2-79.8; I2 = 97.8%] vs 12.0 [95% CI, 8.2-17.5; I2 = 94.9%] cases per 1000 person-years, respectively; P for difference < .001). Among robust individuals in 21 studies who survived a median follow-up of 2.5 (range, 1.0-10.0) years, 30.9% (9974 of 32 268) became prefrail, with the pooled incidence rate being 150.6 (95% CI, 123.3-184.1; I2 = 98.9%) cases per 1000 person-years. The frailty and prefrailty incidence rates were significantly higher in women than men (frailty: 44.8 [95% CI, 36.7-61.3; I2 = 97.9%] vs 24.3 [95% CI, 19.6-30.1; I2 = 8.94%] cases per 1000 person-years; prefrailty: 173.2 [95% CI, 87.9-341.2; I2 = 99.1%] vs 129.0 [95% CI, 73.8-225.0; I2 = 98.5%] cases per 1000 person-years). The incidence rates varied by diagnostic criteria and country income level. The frailty and prefrailty incidence rates were significantly reduced when accounting for the risk of death. CONCLUSIONS AND RELEVANCE Results of this study suggest that community-dwelling older adults are prone to developing frailty. Increased awareness of the factors that confer high risk of frailty in this population subgroup is vital to inform the design of interventions to prevent frailty and to minimize its consequences.
Collapse
Affiliation(s)
- Richard Ofori-Asenso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ken L. Chin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Mohsen Mazidi
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomaki
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew R. Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maarit J. Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Dina LoGiudice
- Department of Aged Care, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - J. Simon Bell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Research Excellence in Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Furtado GE, Patrício M, Loureiro M, Hogervorst E, Theou O, Ferreira JP, Teixeira AMB. Physical frailty and health outcomes of fitness, hormones, psychological and disability in institutionalized older women: an exploratory association study. Women Health 2019; 60:140-155. [DOI: 10.1080/03630242.2019.1621978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Guilherme Eustáquio Furtado
- Research Unit of Sport and Physical Activity at Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Miguel Patrício
- Laboratory of Biostatistics and Medical Informatics and IBILI, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Marisa Loureiro
- Laboratory of Biostatistics and Medical Informatics and IBILI, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - Eef Hogervorst
- School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - José Pedro Ferreira
- Research Unit of Sport and Physical Activity at Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Ana Maria Botelho Teixeira
- Research Unit of Sport and Physical Activity at Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
13
|
Yang F, Chen QW. Evaluation of frailty and influencing factors in old people in hospital institution: Evidence for a phenotype of frailty. Medicine (Baltimore) 2018; 97:e9634. [PMID: 29504994 PMCID: PMC5779763 DOI: 10.1097/md.0000000000009634] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We assessed the frailty status of inpatients and analyzed the factors influencing frailty status to explore the reasons for frailty and identify feasible intervention strategies.A total of 1494 geriatric patients aged ≥60 years were recruited as subjects. All patients were hospitalized between September 2014 and August 2015 in the internal medicine units of 3 hospitals in Chongqing and Zunyi in the southwestern area of China. Patients' frailty status was evaluated using the Phenotype of Frailty scale, via face-to-face interviews coupled with physical examinations using simple equipment.Of the 1494 cases, 1400 (93.71%) were eligible for analysis. Participants' mean age was 75.52 ± 9.28 years. The overall prevalence of frailty was 18.0%, and was higher for frail females (9.4%) than males (8.6%). Increasing age and body mass index, low income (<1000 Ren Min Bi for per month), poor self-rated health, cognitive impairment, depression, polypharmacy (≥5 medications), disability, and a history of fall in the past 1 year were independently significantly correlated with frailty (P < .05 for each comparison).Numerous factors were associated with frailty. As treatment for frailty is focused on prevention in this study, intervention strategies should target a comprehensive list of physiological and psychological aspects of the older people.
Collapse
|
14
|
Tabue-Teguo M, Barreto de Souza P, Cantet C, Andrieu S, Simo N, Fougère B, Dartigues JF, Vellas B. Effect of Multidomain Intervention, Omega-3 Polyunsaturated Fatty Acids Supplementation or their Combinaison on Cognitive Function in Non-Demented Older Adults According to Frail Status: Results from the MAPT Study. J Nutr Health Aging 2018; 22:923-927. [PMID: 30272094 DOI: 10.1007/s12603-018-1024-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Aim: The aim of this study was to explore whether multidomain intervention (MI) and Omega-3 Polyunsaturated Fatty Acids supplementation can modify the cognitive function on elderly according to frail status. METHOD Data are from a secondary exploratory analysis of the Multidomain Alzheimer Preventive Trial (MAPT), a French community-dwellers aged 70 or over reporting subjective memory complaints, but free from clinical dementia. The multidomain intervention consisted of 2 hours group sessions focusing on three domains (cognitive stimulation, physical activity, and nutrition) and a preventive consultation (at baseline, 12 months, and 24 months). For Omega-3 Polyunsaturated Fatty Acids supplementation, participants took two capsules of either placebo or polyunsaturated fatty acids daily. Linear mixed-model repeated-measures analyses were used including baseline, 6, 12, 24 and 36-month follow-up data to assess between-group differences in the change in cognitive tests over 36 months. RESULTS The overall mean age of the MAPT study population was 75.25(±4.38). A tend toward significant differences in TMT-A were found for the effect of the multidomain intervention on the prefrail group compared to non-frail group. The MI and n3 PUFA program could not significantly have reduced cognitive function in a sample of pre-frailty elders. CONCLUSION This population-based study in community-dwellers aged 70 years or over suggested that multidomain intervention and n3 PUFA supplementation have not significant effects on cognitive function change in frail older adults with memory complaints. The beneficial effect of multidomain intervention and n3 PUFA supplementation on cognitive function did not differ between frail and nonfrail participants.
Collapse
Affiliation(s)
- M Tabue-Teguo
- Maturin Tabue-Teguo, MD, PhD. CHU de Pointe-à-Pitre (Guadeloupe), Université des Antilles (Guadeloupe), Centre de Recherche INSERM, U1219, 146 rue Léo Saignat, 33076 Bordeaux cedex, France, E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Liccini A, Malmstrom TK. Frailty and Sarcopenia as Predictors of Adverse Health Outcomes in Persons With Diabetes Mellitus. J Am Med Dir Assoc 2017; 17:846-51. [PMID: 27569712 DOI: 10.1016/j.jamda.2016.07.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Diabetes mellitus is associated with premature aging, and chronic diabetes is associated with significant physical and cognitive complications. We aimed to examine frailty and sarcopenia rates and 6-month health outcomes in a clinic-based sample of patients with diabetes. DESIGN This study was an observational study. Participants were recruited from June 2014 to August 2014, and follow-up was conducted 6 months after day of screening. SETTING Participants were recruited at outpatient endocrinology, geriatric, and internal medicine clinics affiliated with Saint Louis University in St. Louis, Missouri. PARTICIPANTS Participants were persons with diabetes mellitus ages 50 to 90. MEASUREMENTS Frailty and sarcopenia were identified using the FRAIL and SARC-F screens, respectively. A chart review of the patient's health record was performed on day of screening and at follow-up. A 6-month phone questionnaire was performed to evaluate health outcomes. Logistic regressions were used to evaluate health outcomes. RESULTS A total of 198 persons with diabetes were recruited. Of the sample, 32.3% of sample was nonfrail, 38.9% was prefrail, and 28.8% was frail; 29.3% of the sample was identified to have sarcopenia. Prefrail [odds ratio (OR) 2.92, 95% confidence interval (CI) 1.15-7.42; P = .025] and frail (OR 4.70, 95% CI 1.67-13.19; P = .003) participants were more likely to be hospitalized overnight at 6-month follow-up. Frail (OR 3.57 95% CI 1.27-10.04; P = .016) participants were more likely to have a new activities of daily living (ADL) disability at follow-up; this association was not present for prefrail participants (OR 1.30, 95% CI .50-3.37; P = .59). Participants with sarcopenia were more likely to be hospitalized (OR 3.80, 95% CI 1.67-8.61; P = .001) and to have a new ADL disability (OR 4.24, 95% CI 1.76-10.18; P = .001) at 6-month follow-up. CONCLUSIONS Among clinic patients with diabetes mellitus ages 50-90 year old, frailty and sarcopenia prevalence is high, and both syndromes are predictors of being hospitalized overnight and new ADL disability after 6 months.
Collapse
Affiliation(s)
- Anthony Liccini
- Department of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Theodore K Malmstrom
- Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, MO
| |
Collapse
|
16
|
Tan LF, Lim ZY, Choe R, Seetharaman S, Merchant R. Screening for Frailty and Sarcopenia Among Older Persons in Medical Outpatient Clinics and its Associations With Healthcare Burden. J Am Med Dir Assoc 2017; 18:583-587. [DOI: 10.1016/j.jamda.2017.01.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
|
17
|
Frailty and Multimorbidity: Different Ways of Thinking About Geriatrics. J Am Med Dir Assoc 2017; 18:361-364. [DOI: 10.1016/j.jamda.2016.12.086] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 12/23/2016] [Indexed: 12/23/2022]
|
18
|
Izquierdo M, Rodriguez-Mañas L, Sinclair AJ. Editorial: What Is New in Exercise Regimes for Frail Older People - How Does the Erasmus Vivifrail Project Take Us Forward? J Nutr Health Aging 2016; 20:736-7. [PMID: 27499307 DOI: 10.1007/s12603-016-0702-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra (Navarra) SPAIN , Campus of Tudela, Av. de Tarazona s/n. 31500 Tudela (Navarra) Spain, Tel + 34 948 417876,
| | | | | |
Collapse
|
19
|
Chode S, Malmstrom TK, Miller DK, Morley JE. Frailty, Diabetes, and Mortality in Middle-Aged African Americans. J Nutr Health Aging 2016; 20:854-859. [PMID: 27709235 DOI: 10.1007/s12603-016-0801-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Older adult frail diabetics have high mortality risk, but data are limited regarding frail late middle-aged diabetics, especially for African-Americans. The aim of this study is to examine the association of diabetes with health outcomes and frailty in the African American Health (AAH) study. METHODS AAH is a population-based longitudinal cohort study. Participants were African Americans (N=998) ages 49 to 65 years at baseline. Cross-sectional comparisons for diabetes included disability, function, physical performance, cytokines, and frailty. Frailty measures included the International Academy of Nutrition and Aging [FRAIL] frailty scale, Study of Osteoporotic Fractures [SOF] frailty scale, Cardiovascular Health Study [CHS] frailty scale, and Frailty Index [FI]). Longitudinal associations for diabetes included new ADLs ≥ 1 and mortality at 9-year follow-up. RESULTS Diabetics were more likely to be frail using any of the 4 frailty scales than were non-diabetics. Frail diabetics, compared to nonfrail diabetics, reported significantly increased falls in last 1 year, higher IADLs and higher LBFLs. They demonstrated worse performance on the SPPB, one-leg stand, and grip strength; and higher Tumor Necrosis Factor receptors (sTNFR1 and sTNFR2). Mortality and 1 or more new ADLs also were increased among frail compared to nonfrail diabetics when followed for 9 years. CONCLUSIONS Frailty in middle-aged African American persons with diabetes is associated with having more disability and functional limitations, worse physical performance, and higher cytokines (sTNFR1 and sTNFR2 only). Middle-aged African Americans with diabetes have an increased risk of mortality and frail diabetics have an even higher risk of death, compared to nonfrail diabetics.
Collapse
Affiliation(s)
- S Chode
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Boulevard, M238, St Louis, MO 63104, E-mail address: ; Phone: 314-977-8462; Fax: 314-771-8571
| | | | | | | |
Collapse
|
20
|
Perkisas S, Vandewoude M. Where frailty meets diabetes. Diabetes Metab Res Rev 2016; 32 Suppl 1:261-7. [PMID: 26453435 DOI: 10.1002/dmrr.2743] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/13/2015] [Accepted: 10/06/2015] [Indexed: 12/11/2022]
Abstract
Diabetes is a chronic illness that has an effect on multiple organ systems. Frailty is a state of increased vulnerability to stressors and a limited capacity to maintain homeostasis. It is a multidimensional concept and a dynamic condition that can improve or worsen over time. Frailty is either physical or psychological or a combination of these two components. Sarcopenia, which is the age-related loss of skeletal muscle mass and strength, is the main attributor to the physical form of frailty. Although the pathophysiology of diabetes is commonly focused on impaired insulin secretion, overload of gluconeogenesis and insulin resistance, newer insights broaden this etiologic horizon. Immunologic factors that create a chronic state of low-grade inflammation--'inflammaging'--have an influence on both the ageing process and diabetes. Persons with diabetes mellitus already tend to have an accelerated ageing process that places them at greater risk for developing frailty at an earlier age. The development of frailty--and sarcopenia--is multifactorial and includes nutritional, physical and hormonal elements; these elements are interlinked with those of diabetes. A lower muscle mass will lead to poorer glycaemic control through lower muscle glucose uptake. This leads to higher insulin secretion and insulin resistance, which is the stepping stone for diabetes itself.
Collapse
Affiliation(s)
- Stany Perkisas
- Department of Geriatrics, University of Antwerp, Antwerp, Belgium
| | | |
Collapse
|
21
|
Morley JE. Psychoimmunology and Aging: A Tribute to George Freeman Solomon. J Am Med Dir Assoc 2015; 16:901-4. [PMID: 26432626 DOI: 10.1016/j.jamda.2015.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St Louis, MO.
| |
Collapse
|
22
|
Pires Corona L, Drumond Andrade FC, de Oliveira Duarte YA, Lebrao ML. The Relationship between Anemia, Hemoglobin Concentration and Frailty in Brazilian Older Adults. J Nutr Health Aging 2015; 19:935-40. [PMID: 26482696 DOI: 10.1007/s12603-015-0502-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE to explore the relationship between anemia, hemoglobin concentration and frailty syndrome in older adults. RESEARCH METHODS AND PROCEDURES This was a cross-sectional population-based study, with adults ≥60 years (n=1,256) from the third wave of the SABE Cohort Study (Health, Well-being and Aging) conducted in 2010 in São Paulo, Brazil. Frailty syndrome was evaluated according to Fried´s phenotype. Anemia was defined using the WHO criteria (hemoglobin concentration <12 g/dL for women and <13 g/dL for men). Four approaches were used to verify the associations between anemia, hemoglobin concentration and frailty status or number of frailty criteria. We used logistic regression and Poisson regression in the analyses, and they were adjusted in three hierarchical models using three blocks of variables: basic characteristics; clinical characteristics; cognitive status. RESULTS Mean hemoglobin concentration was significantly lower in frail elderly (13.3g/dL, versus 14.3g/dL in non-frail; p<0.001). Prevalence of anemia was also significantly higher in frail when compared to non-frail elderly (24.2% and 3.8%; p<0.001). Anemia was significantly associated to low physical activity, weakness and slowness. In the fully adjusted regression models, anemia was strongly associated to frailty (OR=3.27, 95%IC=1.89,5.65; p<0.001), and lower levels of hemoglobin were associated to higher number of frailty criteria. CONCLUSIONS We found important associations between anemia, hemoglobin concentration and frailty; anemic older adults were more likely to be frail, and lower levels of hemoglobin were associated to higher number of frailty criteria showing a clear dose-response effect.
Collapse
Affiliation(s)
- L Pires Corona
- Ligiana Pires Corona, University of Campinas, Nutrition, R. Pedro Zaccaria, 1300, Limeira, Sao Paulo 13484-35, 0, Brazil,
| | | | | | | |
Collapse
|
23
|
|
24
|
|
25
|
Morley JE. Nutritional Supplementation and Sarcopenia: The Evidence Grows. J Am Med Dir Assoc 2015; 16:717-9. [DOI: 10.1016/j.jamda.2015.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 12/25/2022]
|
26
|
Nowson C, O'Connell S. Protein Requirements and Recommendations for Older People: A Review. Nutrients 2015; 7:6874-99. [PMID: 26287239 PMCID: PMC4555150 DOI: 10.3390/nu7085311] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/27/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022] Open
Abstract
Declines in skeletal muscle mass and strength are major contributors to increased mortality, morbidity and reduced quality of life in older people. Recommended Dietary Allowances/Intakes have failed to adequately consider the protein requirements of the elderly with respect to function. The aim of this paper was to review definitions of optimal protein status and the evidence base for optimal dietary protein. Current recommended protein intakes for older people do not account for the compensatory loss of muscle mass that occurs on lower protein intakes. Older people have lower rates of protein synthesis and whole-body proteolysis in response to an anabolic stimulus (food or resistance exercise). Recommendations for the level of adequate dietary intake of protein for older people should be informed by evidence derived from functional outcomes. Randomized controlled trials report a clear benefit of increased dietary protein on lean mass gain and leg strength, particularly when combined with resistance exercise. There is good consistent evidence (level III-2 to IV) that consumption of 1.0 to 1.3 g/kg/day dietary protein combined with twice-weekly progressive resistance exercise reduces age-related muscle mass loss. Older people appear to require 1.0 to 1.3 g/kg/day dietary protein to optimize physical function, particularly whilst undertaking resistance exercise recommendations.
Collapse
Affiliation(s)
- Caryl Nowson
- School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong 3220, VIC, Australia.
| | - Stella O'Connell
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne 3125, VIC, Australia.
| |
Collapse
|
27
|
Moinard C, Le Plenier S, Noirez P, Morio B, Bonnefont-Rousselot D, Kharchi C, Ferry A, Neveux N, Cynober L, Raynaud-Simon A. Citrulline Supplementation Induces Changes in Body Composition and Limits Age-Related Metabolic Changes in Healthy Male Rats. J Nutr 2015; 145:1429-37. [PMID: 26019250 DOI: 10.3945/jn.114.200626] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 04/28/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Aging is associated with profound metabolic disturbances, and citrulline may be of use to limit them. OBJECTIVE The aim of this work was to evaluate the long-term effect of citrulline supplementation on metabolism in healthy aged rats. METHODS Twenty-month-old male rats were randomly assigned to be fed (ad libitum) for 12 wk with either a citrulline-enriched diet (1 g ⋅ kg(-1) ⋅ d(-1)) or a standard diet [rendered isonitrogenous by addition of nonessential amino acids (NEAAs)]. Motor activity and muscle strength were measured, body composition was assessed, and muscle metabolism (protein structure, mitochondrial exploration, and transductional factors) and lipid metabolism (lipoprotein composition and sensitivity to oxidative stress) were explored. RESULTS Compared with the NEAA-treated group, citrulline supplementation was associated with lower mortality (0% vs. 20%; P = 0.05), 9% higher lean body mass (P < 0.05), and 13% lower fat mass (P < 0.05). Compared with the NEAA-treated group, citrulline-treated rats had greater muscle mass (+14-48% depending on type of muscle; P < 0.05 for tibialis, gastrocnemius, and plantaris). Susceptibility to oxidation of lipoproteins, as measured by the maximal concentration of 7-ketocholesterol after copper-induced VLDL and LDL oxidation, was lower in citrulline-treated rats than in NEAA-treated rats (187 ± 8 μmol/L vs. 243 ± 7 μmol/L; P = 0.0005). CONCLUSIONS Citrulline treatment in male aged rats favorably modulates body composition and protects against lipid oxidation and, thus, emerges as an interesting candidate to help prevent the aging process.
Collapse
Affiliation(s)
| | | | - Philippe Noirez
- Department of Experimental, Metabolic, and Clinical Biology, EA 4466
| | - Béatrice Morio
- National Institute for Agronomic Research, Mixed Research Unit 1019, Human Nutrition Unit, Human Nutrition Research Center Auvergne and Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine, Clermont-Ferrand, France
| | - Dominique Bonnefont-Rousselot
- Faculty of Pharmaceutical and Biological Sciences, University Paris Descartes, Sorbonne Paris Cité, Paris, France; Public Assistance of Parisian Hospital (AP-HP), Hôpitaux Universitaires Hôpital Pitié-Salpêtrière-Charles Foix, Service de Biochimie Métabolique, Paris, France
| | - Caroline Kharchi
- Animalerie Centrale, Faculté des Sciences Pharmaceutiques et Biologiques de l'Université Paris Descartes, Paris, France
| | - Arnaud Ferry
- National Institute for Medical Research U974, National Scientific Research Center, Mixed Research Unit 7215, Institut de Myologie, Université Pierre et Marie Curie, Université Paris Descartes, Paris, France
| | - Nathalie Neveux
- Department of Experimental, Metabolic, and Clinical Biology, EA 4466, Service Biochimie Interhospitalier Hôtel-Dieu et Cochin, Public Assistance of Parisian Hospital, Paris, France; and
| | - Luc Cynober
- Department of Experimental, Metabolic, and Clinical Biology, EA 4466, Service Biochimie Interhospitalier Hôtel-Dieu et Cochin, Public Assistance of Parisian Hospital, Paris, France; and
| | - Agathe Raynaud-Simon
- Department of Experimental, Metabolic, and Clinical Biology, EA 4466, Département de Gériatrie, Hôpitaux Universitaires Bichat et Beaujon, AP-HP, Faculté de Médecine Paris Diderot, Paris, France
| |
Collapse
|
28
|
Abstract
Purpose
– The purpose of this paper is to explore common usage and understanding of the term “frailty”, which is increasingly used in health care debates in England.
Design/methodology/approach
– This is a commentary from the perspectives of health and social care researchers. Recent policy and research are drawn upon in the arguments presented.
Findings
– Most research on the subject of frailty comes from clinical practice although a parallel sociological or gerontological critique of the social construction is emerging. The public is likely to come across the term frailty through the media’s adoption of the term. Different definitions of frailty mean that estimates of the numbers of “frail people” will vary.
Research limitations/implications
– The commentary draws on material in the English language and on policy, commentary, and research material.
Practical implications
– The commentary may prompt reflection in practice and policy development on the usage of the term frailty and promote efforts to ensure that its meaning is clear and that it is acceptable to those to whom it is applied.
Originality/value
– The paper contributes to debates about frailty by considering the implications of using the term across health and social care and in integrated settings and encounters. It draws on medical presentations of the term frailty and on critiques of it as a powerful discourse.
Collapse
|
29
|
Cadore EL, Izquierdo M. Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life. AGE (DORDRECHT, NETHERLANDS) 2015; 37:64. [PMID: 26054595 PMCID: PMC4493714 DOI: 10.1007/s11357-015-9800-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/28/2015] [Indexed: 05/15/2023]
Abstract
In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.
Collapse
Affiliation(s)
- Eduardo Lusa Cadore
- />Exercise Research Laboratory, Physical Education School, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Mikel Izquierdo
- />Department of Health Sciences, Public University of Navarre, Av. de Tarazona s/n., 31500 Tudela, Navarra Spain
| |
Collapse
|
30
|
Buckinx F, Rolland Y, Reginster JY, Ricour C, Petermans J, Bruyère O. Burden of frailty in the elderly population: perspectives for a public health challenge. ACTA ACUST UNITED AC 2015; 73:19. [PMID: 25866625 PMCID: PMC4392630 DOI: 10.1186/s13690-015-0068-x] [Citation(s) in RCA: 248] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/21/2015] [Indexed: 12/13/2022]
Abstract
Frailty is a major health condition associated with ageing. Although the concept is almost universally accepted, its operational definition remains controversial. Anyway, this geriatric condition represents a huge potential public health issue at both the patient and the societal levels because of its multiple clinical, societal consequences and its dynamic nature. Here, we review existing definitions and assessment tools for frailty, we highlight consequences of this geriatric condition and we discuss the importance of its screening and prevention to limit its public health burden.
Collapse
Affiliation(s)
- Fanny Buckinx
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Avenue de l'Hôpital 3 - CHUB23, 4000 Liège, Belgium ; Support Unit in Epidemiology and Biostatistics, University of Liège, Liège, Belgium
| | | | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Avenue de l'Hôpital 3 - CHUB23, 4000 Liège, Belgium ; Support Unit in Epidemiology and Biostatistics, University of Liège, Liège, Belgium ; Bone and cartilage Metabolism Unit, CHU of Liège, Liège, Belgium
| | | | | | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Avenue de l'Hôpital 3 - CHUB23, 4000 Liège, Belgium ; Support Unit in Epidemiology and Biostatistics, University of Liège, Liège, Belgium ; Department of Motricity Sciences, University of Liège, Liège, Belgium
| |
Collapse
|
31
|
Moulis F, Moulis G, Balardy L, Gérard S, Montastruc F, Sourdet S, Rougé-Bugat ME, Lapeyre-Mestre M, Montastruc JL, Rolland Y, Vellas B. Exposure to atropinic drugs and frailty status. J Am Med Dir Assoc 2014; 16:253-7. [PMID: 25548029 DOI: 10.1016/j.jamda.2014.11.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/21/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Atropinic drugs can increase the risk of falls, cognitive impairment, and mortality in older patients; however, whether exposure to atropinic drugs is associated with frailty status remains unknown. Our aim was to assess the association between frailty status and exposure to atropinic drugs in a geriatric day hospital population. METHODS We carried out a cross-sectional study that included all the patients consulting for the first time at the Geriatric Frailty Clinic for Assessment of Frailty and Prevention of Disability in Toulouse, France, from January 2013 to October 2013. Frailty was defined by 3 or more of Fried et al's criteria. Atropinic drugs were those with clinical antimuscarinic effect from the Anticholinergic Drug Scale (excluding drugs weighted 1 point and not listed by Durán et al) and from Laroche et al list (to include drugs marketed in France not present in the Anticholinergic Drug Scale). To explore a dose-effect relationship, we calculated the atropinic burden using the Anticholinergic Drug Scale weights. We performed logistic regression models adjusted for age, gender, comorbidities, being community dwelling or not, cognitive status, educational level, and polypharmacy (≥6 drugs). RESULTS We included 437 patients (227 frail and 210 robust or prefrail). Exposure to at least one atropinic drug was associated with frailty (odds ratio 1.97, 95% confidence interval 1.10-3.53, P = .02). Due to a statistically significant interaction between age and atropinic burden, a dose-effect relationship for atropinic burden was explored in patients younger than 85 years, showing a significant association between atropinic burden score and frailty (P = .01). The Odds ratio for an atropinic burden greater than or equal to 3 versus 0 was 3.84, 95% confidence interval 1.43-10.34 (P < .01). CONCLUSIONS In a geriatric day hospital, population frailty is associated with a high atropinic burden.
Collapse
Affiliation(s)
- Florence Moulis
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France; Département Universitaire de Médecine Générale, Toulouse, France
| | - Guillaume Moulis
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Service de Médecine Interne, CHU de Toulouse, Toulouse, France.
| | | | - Stéphane Gérard
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France
| | - François Montastruc
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France; Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, CHU de Toulouse, Toulouse, France
| | - Sandrine Sourdet
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France
| | - Marie-Eve Rougé-Bugat
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France; Département Universitaire de Médecine Générale, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Jean-Louis Montastruc
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France; Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, CHU de Toulouse, Toulouse, France
| | - Yves Rolland
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France
| | - Bruno Vellas
- Université de Toulouse, UMR 1027, Faculté de Médecine, Toulouse, France; UMR 1027, Inserm, Toulouse, France; Gerontopôle, CHU de Toulouse, Toulouse, France
| |
Collapse
|
32
|
|
33
|
Inappropriate Drug Prescribing and Polypharmacy Are Major Causes of Poor Outcomes in Long-Term Care. J Am Med Dir Assoc 2014; 15:780-2. [DOI: 10.1016/j.jamda.2014.09.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 01/14/2023]
|
34
|
Morley JE, Sanford AM. The God Card: Spirituality in the Nursing Home. J Am Med Dir Assoc 2014; 15:533-5. [DOI: 10.1016/j.jamda.2014.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/02/2014] [Indexed: 12/31/2022]
|
35
|
Messinger-Rapport BJ, Gammack JK, Thomas DR, Morley JE. Clinical update on nursing home medicine: 2013. J Am Med Dir Assoc 2014; 14:860-76. [PMID: 24286710 DOI: 10.1016/j.jamda.2013.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 12/18/2022]
Abstract
This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.
Collapse
|
36
|
Morley JE. Why Have the Complications of Diabetes Mellitus Declined Over the Past 30 Years? J Am Med Dir Assoc 2014; 15:449-453. [DOI: 10.1016/j.jamda.2014.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/21/2022]
|
37
|
Sanford A, Morley JE. Are the New Guidelines for Cholesterol and Hypertension Age Friendly? J Am Med Dir Assoc 2014; 15:373-5. [DOI: 10.1016/j.jamda.2014.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 01/08/2023]
|
38
|
Affiliation(s)
- J E Morley
- J.E. Morley, Division of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, Missouri USA. Corresponding author: John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, Missouri 63104, , Ph 314-977-8462, Fax 314-771-8575
| |
Collapse
|
39
|
Waters DL, Wayne SJ, Andrieu S, Cesari M, Villareal DT, Garry P, Vellas B. Sexually dimorphic patterns of nutritional intake and eating behaviors in community-dwelling older adults with normal and slow gait speed. J Nutr Health Aging 2014; 18:228-33. [PMID: 24626748 DOI: 10.1007/s12603-014-0004-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Assess sex-specific nutritional intake and dietary habits of independently living older adults with normal and slow gait speeds. DESIGN New Mexico Aging Process Study, cross-sectional, secondary data analysis. SETTING Albuquerque, New Mexico USA. PARTICIPANTS Three-hundred fifteen adults 60 years and older (194 women and 121 men). MEASUREMENTS Gait speed test, 3-day diet records, Mini-Mental State Examination, and body mass index. RESULTS Slow gait speed was associated with lower total calories (-154 kcal/day) and zinc (1 mg/day) (.05 < p < .1). Slower men consumed less protein (-4.1 g/day), calcium (-140 mg), fiber (-2.8 g/day) and iron (-2.5 mg/day) (p≤.05). Slower women consumed less, protein (-5.5 g/day), carbohydrate (-19.1 g/day), fiber (-2.7 gm/day), vitamin C (-18.4 mg/day) and higher fat intake (p=0.03). Slower women snacked less, had trouble chewing/biting, and lived alone (p= .04). Slower men were less likely to snack. CONCLUSIONS We found sex-specific nutritional differences associated with gait speed. Those presenting with slow gait speed may need encouragement to increase meat and whole grain breads/cereal. Those with trouble eating should be advised on adapting diet to maintain adequate nutrition and encouraged on regular snacking to achieve higher nutrient intake. Prospective and randomized controlled studies are needed to confirm these findings and provide further evidence for putting these suggestions into practice.
Collapse
Affiliation(s)
- D L Waters
- Debra L. Waters, University of New Mexico, School of Medicine, Albuquerque, New Mexico 87131, New Mexico VA Health Care System, Section of Geriatrics, Albuquerque, New Mexico 87108, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand 9054, or
| | | | | | | | | | | | | |
Collapse
|
40
|
Guerrero-Escobedo P, Tamez-Rivera O, Amieva H, Avila-Funes JA. Frailty is Associated with Low Self-Esteem in Elderly Adults. J Am Geriatr Soc 2014; 62:396-8. [DOI: 10.1111/jgs.12679] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Oscar Tamez-Rivera
- Department of Geriatrics; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Hélène Amieva
- Centre de recherche Inserm; Bordeaux France
- Université Victor Segalen Bordeaux 2; Bordeaux France
| | - José Alberto Avila-Funes
- Department of Geriatrics; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| |
Collapse
|
41
|
Abstract
PURPOSE OF REVIEW Aging is associated with a decline in cognition. This review examines the available data on the effects of nutrition on cognitive impairment. It also explores the mechanism(s) by which food may enhance memory. RECENT FINDINGS An increasing body of evidence has supported the role of the Mediterranean diet and extra-virgin olive oil in protecting cognition. A number of nutritional formulations to improve deteriorating memory are being studied. Undernutrition is associated with cognitive decline. Hyperglycemia and hypertriglyceridemia cause cognitive impairment. SUMMARY There are increasing data to support the role of nutrition in maintaining cognition.
Collapse
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
42
|
Meuser TM, Carr DB, Berg-Weger M, Irmiter C, Peters KE, Schwartzberg JG. The instructional impact of the American Medical Association's Older Drivers Project online curriculum. GERONTOLOGY & GERIATRICS EDUCATION 2013; 35:64-85. [PMID: 24266732 DOI: 10.1080/02701960.2013.823603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Older Drivers Project (ODP) of the American Medical Association has provided evidence-based training for clinicians since 2003. More than 10,000 physicians and other professionals have been trained via an authoritative manual, the Physician's Guide to Assessing & Counseling Older Drivers, and an associated continuing medical education five-module curriculum offered formally by multidisciplinary teams from 12 U.S. States from 2003 to 2008. An hour-long, online version was piloted with medical residents and physicians (N = 259) from six academic and physician office sites from 2010 to 2011. Pre/postsurveys were completed. Most rated the curriculum of high quality and relevant to their practice. A majority (88%) reported learning a new technique or tool, and 89% stated an intention to incorporate new learning into their daily clinical practice. More than one half (62%) reported increased confidence in addressing driving. This transition from in-person to online instruction will allow the ODP to reach many more clinicians, at all levels of training, in the years to come.
Collapse
Affiliation(s)
- Thomas M Meuser
- a Gerontology Graduate Program, School of Social Work, University of Missouri-St. Louis , St. Louis , Missouri , USA
| | | | | | | | | | | |
Collapse
|
43
|
Ma HM, Yu RHY, Woo J. Recurrent hospitalisation with pneumonia is associated with higher 1-year mortality in frail older people. Intern Med J 2013; 43:1210-5. [PMID: 23941077 DOI: 10.1111/imj.12258] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 07/27/2013] [Indexed: 11/29/2022]
Affiliation(s)
- H. M. Ma
- Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong China
| | - R. H. Y. Yu
- SH Ho Centre for Gerontology and Geriatrics; The Chinese University of Hong Kong; Hong Kong China
| | - J. Woo
- Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong China
- SH Ho Centre for Gerontology and Geriatrics; The Chinese University of Hong Kong; Hong Kong China
| |
Collapse
|
44
|
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, Cesari M, Chumlea WC, Doehner W, Evans J, Fried LP, Guralnik JM, Katz PR, Malmstrom TK, McCarter RJ, Gutierrez Robledo LM, Rockwood K, von Haehling S, Vandewoude MF, Walston J. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14:392-7. [PMID: 23764209 DOI: 10.1016/j.jamda.2013.03.022] [Citation(s) in RCA: 2489] [Impact Index Per Article: 226.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 02/07/2023]
Abstract
Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty.
Collapse
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
How to Manage Diabetes Mellitus in Older Persons in the 21st Century: Applying These Principles to Long Term Diabetes Care. J Am Med Dir Assoc 2013; 14:777-80. [DOI: 10.1016/j.jamda.2013.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 12/25/2022]
|
46
|
von Haehling S, Anker SD, Doehner W, Morley JE, Vellas B. Frailty and heart disease. Int J Cardiol 2013; 168:1745-7. [DOI: 10.1016/j.ijcard.2013.07.068] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 07/01/2013] [Indexed: 01/10/2023]
|
47
|
|
48
|
Kelaiditi E, Cesari M, Canevelli M, van Kan GA, Ousset PJ, Gillette-Guyonnet S, Ritz P, Duveau F, Soto ME, Provencher V, Nourhashemi F, Salvà A, Robert P, Andrieu S, Rolland Y, Touchon J, Fitten JL, Vellas B. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. J Nutr Health Aging 2013; 17:726-34. [PMID: 24154642 DOI: 10.1007/s12603-013-0367-2] [Citation(s) in RCA: 585] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. An International Consensus Group on "Cognitive Frailty" was organized by the International Academy on Nutrition and Aging (I.A.N.A) and the International Association of Gerontology and Geriatrics (I.A.G.G) on April 16th, 2013 in Toulouse (France). The present report describes the results of the Consensus Group and provides the first definition of a "Cognitive Frailty" condition in older adults. Specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. The consensus panel proposed the identification of the so-called "cognitive frailty" as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent AD dementia or other dementias. Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.
Collapse
Affiliation(s)
- E Kelaiditi
- Eirini Kelaiditi, Institut du Vieillissement, Gérontopôle, Université de Toulouse III-Paul Sabatier. 37 Allées Jules Guesde, 31000 Toulouse, France. Phone: +33 (0) 56114-5668;
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Villani AM, Miller MD, Cameron ID, Kurrle S, Whitehead C, Crotty M. Development and relative validity of a new field instrument for detection of geriatric cachexia: preliminary analysis in hip fracture patients. J Cachexia Sarcopenia Muscle 2013; 4:209-16. [PMID: 23686412 PMCID: PMC3774920 DOI: 10.1007/s13539-013-0108-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/14/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Geriatric cachexia is distinct from other age-related muscle wasting syndromes; however, detection and therefore treatment is challenging without the availability of valid instruments suitable for application in the clinical setting. This study assessed the sensitivity and specificity of a newly developed screening instrument utilising portable assessments against previously defined and commonly accepted diagnostic criteria for detection of geriatric cachexia. METHODS Cross-sectional analyses from 71 older adults' post-surgical fixation for hip fracture were performed. The diagnostic criteria required measures of appendicular skeletal muscle index derived from dual-energy X-ray absorptiometry and anorexia assessed by ≤70 % of estimated energy requirements. These assessments were replaced with mid-upper arm muscle circumference and the Simplified Nutritional Appetite Questionnaire, respectively, to create a field instrument suitable for screening geriatric cachexia. Sensitivity, specificity and positive and negative predictive values were calculated. RESULTS The current diagnostic algorithm identified few patients as cachectic (4/71; 5.6 %). The sensitivity and specificity of the geriatric cachexia screening tool was 75 and 97 %, respectively. The screening tool had a positive predictive value of 60 % and a negative predictive value of 99 %. CONCLUSIONS Given the unexpected prevalence of cachexia in such a vulnerable group, these results may suggest problems in operationalising of the consensus definition and diagnostic criteria. Although the application of a newly developed screening tool using portable field measures looks promising, the authors recommend additional research to identify the prevalence of geriatric cachexia, which captures all diagnostic criteria from the consensus definition. Future investigation may then be positioned to explore the predictive validity of screening tools using portable field measures, which potentially achieve higher sensitivity.
Collapse
Affiliation(s)
- Anthony M Villani
- Department of Nutrition and Dietetics, School of Medicine, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | | | | | | | | | | |
Collapse
|
50
|
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: 60] [Impact Index Per Article: 5.5] [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,
| | | |
Collapse
|