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Donnell DO, Romero-Ortuno R, Kennelly SP, O’Neill D, Donoghue PO, Lavan A, Cunningham C, McElwaine P, Kenny RA, Briggs R. The 'Bermuda Triangle' of orthostatic hypotension, cognitive impairment and reduced mobility: prospective associations with falls and fractures in The Irish Longitudinal Study on Ageing. Age Ageing 2023; 52:afad005. [PMID: 36735845 PMCID: PMC9897301 DOI: 10.1093/ageing/afad005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Orthostatic hypotension (OH), cognitive impairment (Cog) and mobility impairment (MI) frequently co-occur in older adults who fall. This study examines clustering of these three geriatric syndromes and ascertains their relationship with future falls/fractures in a large cohort of community-dwelling people ≥ 65 years during 8-year follow-up. METHODS OH was defined as an orthostatic drop ≥ 20 mmHg in systolic blood pressure (from seated to standing) and/or reporting orthostatic unsteadiness. CI was defined as Mini Mental State Examination ≤ 24 and/or self-reporting memory as fair/poor. MI was defined as Timed Up and Go ≥12 s. Logistic regression models, including three-way interactions, assessed the longitudinal association with future falls (explained and unexplained) and fractures. RESULTS Almost 10% (88/2,108) of participants had all three Bermuda syndromes. One-fifth of participants had an unexplained fall during follow-up, whereas 1/10 had a fracture. There was a graded relationship with incident unexplained falls and fracture as the number of Bermuda syndromes accumulated. In fully adjusted models, the cluster of OH, CI and MI was most strongly associated with unexplained falls (odds ratios (OR) 4.33 (2.59-7.24); P < 0.001) and incident fracture (OR 2.51 (1.26-4.98); P = 0.045). Other clusters significantly associated with unexplained falls included OH; CI and MI; MI and OH; CI and OH. No other clusters were associated with fracture. DISCUSSION The 'Bermuda Triangle' of OH, CI and MI was independently associated with future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.
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Affiliation(s)
- Desmond O Donnell
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Roman Romero-Ortuno
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Sean P Kennelly
- Age-Related Health Care, Tallaght University Hospital, Dublin 24, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Desmond O’Neill
- Age-Related Health Care, Tallaght University Hospital, Dublin 24, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Patrick O Donoghue
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Amanda Lavan
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Conal Cunningham
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Paul McElwaine
- Age-Related Health Care, Tallaght University Hospital, Dublin 24, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Rose Anne Kenny
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Robert Briggs
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin 8, Ireland
- Discipline of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
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Ye B, Wang Y, Chen H, Chen Y, Yan H, Fu H, Bao Z, Gao J. Development and Validation of the Chinese Frailty Screening Scale: A Study among Community-Dwelling Older Adults in Shanghai. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811811. [PMID: 36142085 PMCID: PMC9517433 DOI: 10.3390/ijerph191811811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Based on intrinsic capacity (IC) as defined by the World Health Organization, an accelerated decline may be an important precursor of frailty among older adults; however, there is a lack of validated instruments that both screen for frailty and monitor IC. This study aims to develop a comprehensive and acculturative frailty screening scale to determine healthy aging among older Chinese adults. SETTING AND PARTICIPANTS A cross-sectional and a cohort study both based on community-dwelling older adults aged 65 and older. METHODS This study mainly consisted of two parts. First, the selection and revision of 20 items related to frailty based on a literature review, expert consultation, and stakeholder analysis; second, a cross-sectional study was conducted to simplify the scale and test the reliability and validity of the new frailty screening tool. The fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale, the Tilburg frailty indictor (TFI), and a 49-item Frailty Index (FI) were investigated as criteria. Additionally, a cohort study in Shanghai was conducted to verify the predictive validity of the new screening scale. The disability measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and all-cause mortality were documented as outcomes. RESULTS A 10-item Chinese frailty screening scale (CFSS-10) was successfully developed and validated. It presented a Cronbach's α of 0.63 and an intraclass correlation coefficient of 0.73, which indicated good reliability. Taking the other frailty tools as criteria, Kappa values of 0.54-0.58 and an area under the curve of 0.87-0.91 showed good validity. The results of the log-binomial and Poisson models showed a high score, which predicted a higher risk of disability and all-cause mortality. An optimal cut-off point of 5 gave an excellent prediction of one-year disability. CONCLUSIONS The CFSS-10 has good validity and reliability as a quick and acculturative frailty screening scale for community-dwelling older adults in Shanghai. It may also supplement existing frailty screening tools.
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Affiliation(s)
- Bo Ye
- Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yi Wang
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Hao Chen
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Yingwei Chen
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Huihui Yan
- School of Public Health, Fudan University, Shanghai 200032, China
| | - Hua Fu
- School of Public Health, Fudan University, Shanghai 200032, China
- Health Communication Institute, Fudan University, Shanghai 200032, China
| | - Zhijun Bao
- Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Shanghai 200040, China
| | - Junling Gao
- School of Public Health, Fudan University, Shanghai 200032, China
- Collaborative Innovation Cooperative Unit, National Clinical Research Center for Geriatric Diseases, Shanghai 200032, China
- Core Unit, Shanghai Clinical Research Center for Geriatric Diseases, Shanghai 200032, China
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Yuan Y, Li J, Fu P, Jing Z, Wang Y, Zhou C. Association between physical activity and falls among older adults in rural China: are there gender and age related differences? BMC Public Health 2022; 22:356. [PMID: 35183149 PMCID: PMC8858519 DOI: 10.1186/s12889-022-12773-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/15/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The relationship between physical activity (PA) and falls among older adults is inconsistent, and little is known about the gender-specific association between falls and PA. Moreover, age may modify this relationship. This study aimed to test the association between PA and falls and to investigate the gender and age differences in the association among rural older adults. METHODS This cross-sectional data were derived from the baseline survey of Shandong Rural Elderly Health Cohort (SREHC). In total, 3,242 rural older adults aged 60 years and above were included in the analysis. PA was measured by the International Physical Activity Questionnaire Short Form (IPAQ-S). PA levels were classified as low, moderate, elevated and high according to quartiles. Volume of moderate-to-vigorous physical activity (MVPA) was categorized into low, moderate, elevated, and high level based on global recommendations. Information on falls was determined from in-person interviews. Falling was defined to participants as ending up on the floor or ground because they were unable to stop themselves. Logistic regression analysis was employed to explore the association between falls and PA. RESULTS Of 3,242 rural older adults, the incidence of falls was 13.1%. In older adults, high levels of PA [odds ratio (OR) = 0.65, 95% confidence interval (CI): 0.47-0.90] or MVPA (OR = 0.68, 95% CI: 0.50-0.94) were related to falls. Moderate (OR = 4.84, 95% CI: 1.68-13.94) or high (OR = 0.54, 95% CI: 0.30-0.99) levels of MVPA were associated with falls in older men. But elevated levels of PA were associated with falls (OR = 0.60, 95% CI: 0.42-0.87) in older women. Among older people younger than 75 years, elevated (OR = 0.54, 95% CI: 0.37-0.79) or high (OR = 0.68, 95% CI: 0.48-0.98) levels of PA were associated with falls. CONCLUSIONS Among Chinese rural older adults, PA and MVPA are associated with falls, and there are gender and age differences. To prevent falls, measures need to account for individuals' gender and age to encourage rural older adults to participate more actively in PA. We will conduct longitudinal studies to clarify the causal relationship between PA and fall.
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Affiliation(s)
- Yemin Yuan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Peipei Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Zhengyue Jing
- School of Health Policy and Management, Nanjing Medical University, Nanjing, 211166, China
| | - Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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The Relationship between Modified Short Physical Performance Battery and Falls: A Cross-Sectional Study of Older Outpatients. Geriatrics (Basel) 2021; 6:geriatrics6040106. [PMID: 34842725 PMCID: PMC8628810 DOI: 10.3390/geriatrics6040106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
The Short Physical Performance Battery (SPPB) is a physical fall-risk screening tool and predictor of adverse health effects for the older. Its limited use in Japan is due to the relative ease for high-functioning older adults to achieve perfect scores. Japanese researchers thus created a community-based SPPB (SPPB-com). This study investigated whether the SPPB-com score can distinguish between older patients classified as "fallers" and "non-fallers." Participants comprised 185 older outpatients aged 65 and above who self-reported their history of accidental falls and relevant physical activity. Fall risk was assessed using SPPB and SPPB-com. Handgrip strength, maximum isometric knee extensor strength, and maximum walking speed were measured as physical functions. Multivariate logistic regression and receiver-operating characteristic analyses determined criteria indicating faller status. Fallers were older and had lower physical function, physical activity, SPPB, and SPPB-com scores than non-fallers. Multivariate logistic regression analysis showed SPPB (OR 0.76, 95% CI 0.59-0.99, p = 0.045) and SPPB-com (OR 0.63, 95% CI 0.45-0.87, p = 0.005) scores were both independently associated with prior falls. The SPPB-com score may function as a fall-risk assessment tool for older outpatients, and its combined use with SPPB can increase the accuracy and precision of distinction between fallers and non-fallers.
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Song Y, Deng Y, Li J, Hao B, Cai Y, Chen J, Shi H, Xu W. Associations of falls and severe falls with blood pressure and frailty among Chinese community-dwelling oldest olds: The Chinese Longitudinal Health and Longevity Study. Aging (Albany NY) 2021; 13:16527-16540. [PMID: 34160365 PMCID: PMC8266320 DOI: 10.18632/aging.203174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Falls are a leading cause of death among Chinese oldest olds. However, studies on Chinese community-dwelling older adults are lacking. We aimed to identify the associations of falls and severe falls with blood pressure and frailty among Chinese community-dwelling oldest olds. METHODS Cross-sectional analyses were conducted with 6,595 community-dwelling oldest olds (aged ≥80 years) from 22 Chinese provinces from the Chinese Longitudinal Health and Longevity Study (CLHLS). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at participants' homes, and a 38-item frailty index was used to assess the frailty status of participants. Falls and severe falls were confirmed through face-to-face interviews. Multivariate logistic regression was used to investigate the associations of BP and frailty with falls and severe falls. RESULTS The mean participant age was 91.0 years, and 56.1% were female. In total, 24.2% participants had a history of fall and 8.3% had a history of severe falls. The multivariate-adjusted odds ratio (OR) for falls among the oldest old with SBP ≥140 mm Hg compared to those with an SBP of 120-129 mm Hg was 1.20 (95% confidence interval [CI], 1.01-1.44). The adjusted OR for falls among frail participants compared to robust participants was 1.39 (95% CI, 1.02-1.89). DBP and pre-frailty were not associated with falls after multivariate adjustment. SBP, DBP, and frailty status were not associated with severe falls after multivariate adjustment. CONCLUSIONS SBP and frailty but not DBP and pre-frailty are associated with increased odds of falls among Chinese community-dwelling oldest olds.
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Affiliation(s)
- Yujian Song
- Graduate School of Medical School of Chinese PLA, Beijing 100853, China
| | - Yujiao Deng
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jianhua Li
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Benchuan Hao
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Yulun Cai
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianqiao Chen
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Haiyan Shi
- Department of Gastroenterology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Weihao Xu
- Haikou Cadre's Sanitarium of Hainan Military Region, Haikou 570203, China
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Wang X, Shen K. The Reciprocal Relationship between Frailty and Depressive Symptoms among Older Adults in Rural China: A Cross-Lag Analysis. Healthcare (Basel) 2021; 9:healthcare9050593. [PMID: 34067906 PMCID: PMC8156888 DOI: 10.3390/healthcare9050593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/01/2021] [Accepted: 05/13/2021] [Indexed: 12/02/2022] Open
Abstract
(1) Objective: This study aimed to investigate the reciprocal relationship between frailty and depressive symptoms using longitudinal data among older adults in China. (2) Methods: Data derived from 2014 and 2017 waves of a longitudinal study of 1367 older adults aged 70–84 years, living in rural areas of Jiangsu Province, China. Cross-lagged panel model and a multiple group model were used to examine the temporal effect of frailty on depressive symptoms and vice versa. (3) Results: Frailty was associated with subsequent increase in depressive symptoms, such that participants with higher levels of frailty increase the risks of depressive symptoms (b = 0.090, p < 0.01). Depressive symptoms were significant predictors of increased frailty (b = −0.262, p <0.001). However, older men and older women had no significant differences in the reciprocal relationship between frailty and depressive symptoms. (4) Conclusions: In conclusion, we find a significant bi-directional relationship between frailty and depressive symptoms. This finding confirms the dyadic model of frailty and depression. Implications for interventions and policy to help frail and depressive older adults are discussed.
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Affiliation(s)
- Xuehui Wang
- Center for Population and Development Policy Studies, School of Social Development and Public Policy, Fudan University, Shanghai 200433, China;
| | - Kaijun Shen
- School of Social Development and Public Policy, Fudan University, Shanghai 200433, China
- Correspondence:
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Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
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Zhang Q, Zhao X, Liu H, Ding H. Frailty as a predictor of future falls and disability: a four-year follow-up study of Chinese older adults. BMC Geriatr 2020; 20:388. [PMID: 33023480 PMCID: PMC7539482 DOI: 10.1186/s12877-020-01798-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty, which is defined as aging-related multisystem impairments, can lead to adverse health outcomes. However, evidence for such a connection in Chinese older adults remains lacking. This study examined the association between frailty and future falls and disability among community-dwelling Chinese older adults. METHODS Data were obtained from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. Participants were aged 60 years and above at baseline in 2011 and completed the follow-up survey in 2015. Outcome measures were future falls, incident disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and worsening performance of ADLs and IADLs. A multivariate logistic regression was conducted to examine the association between frailty phenotype and falls, incident disability, and worsening disability during a four-year period. RESULTS We found that frail participants were at increased risk at follow-up for: falls (OR 1.54, 95% CI, 1.14-2.08); developing new ADL difficulties (OR 4.10, 95% CI, 2.79-6.03) and IADL difficulties (OR 3.06, 95% CI, 2.03-4.61); and worsening ADLs performance (OR 2.27, 95% CI, 1.27-4.06), after adjusting for potential confounders. Prefrailty was also significantly associated with future falls, incident disability in ADLs and IADLs, but with a lower magnitude of effect. CONCLUSIONS Frailty phenotype is an independent predictor of future falls, incident disability, and worsening performance in ADLs among Chinese older adults. The association suggests the need to pay special attention in caring for frail and prefrail elders and improving individuals' frailty status.
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Affiliation(s)
- Quan Zhang
- School of Health Humanities, Peking University, No. 38 Xueyuan Road, Beijing, 100191, China.,National School of Development, Peking University, No. 5 Yiheyuan Road, Beijing, 100871, China
| | - Xinyi Zhao
- School of Health Humanities, Peking University, No. 38 Xueyuan Road, Beijing, 100191, China.
| | - Huiying Liu
- Department of Sociology, Central South University, No. 932 Lushannan Road, Changsha, 410083, Hunan Province, China.,Social Survey and Opinion Research Centre, Central South University, No. 932 Lushannan Road, Changsha, 410083, Hunan Province, China
| | - Hua Ding
- Institute of Social Science Survey, Peking University, No. 5 Yiheyuan Road, Beijing, 100871, China
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Zucchelli A, Marengoni A, Rizzuto D, Calderón-Larrañaga A, Zucchelli M, Bernabei R, Onder G, Fratiglioni L, Vetrano DL. Using a genetic algorithm to derive a highly predictive and context-specific frailty index. Aging (Albany NY) 2020; 12:7561-7575. [PMID: 32343260 PMCID: PMC7202492 DOI: 10.18632/aging.103118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/08/2020] [Indexed: 11/25/2022]
Abstract
The frailty index (FI) is one of the most widespread tools used to predict poor, health-related outcomes in older persons. The selection of clinical and functional deficits to include in a FI is mostly based on the users’ clinical experience. However, this approach may not be sufficiently accurate to predict health outcomes in particular subgroups of individuals. In this study, we implemented an optimization algorithm, the genetic algorithm, to create a highly performant (FI) based on our prediction goals, rather than on a predetermined clinical selection of deficits, using data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) and 109 potential deficits identified in the dataset. The algorithm was personalized to obtain a FI with high discrimination ability in the prediction of mortality. The resulting FI included 40 deficits and showed areas under the curve consistently higher than 0.80 (range 0.81-0.90) in the prediction of 3-year and 6-year mortality in the whole sample and in sex and age subgroups. This methodology represents a promising opportunity to optimize the exploitation of medical and administrative databases in the construction of clinically relevant frailty indices.
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Affiliation(s)
- Alberto Zucchelli
- Aging Research Center, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm 17165, Sweden.,Department of Information Engineering, University of Brescia, Brescia 25123, Italy
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm 17165, Sweden.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm 17165, Sweden.,Stockholm Gerontology Research Center, Aldrecentrum, Stockholm 11346, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm 17165, Sweden
| | | | - Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico "A. Gemelli" IRCCS and Catholic University of Rome, Rome 00168, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome 00161, Italy
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm 17165, Sweden.,Stockholm Gerontology Research Center, Aldrecentrum, Stockholm 11346, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm 17165, Sweden.,Department of Geriatrics, Fondazione Policlinico "A. Gemelli" IRCCS and Catholic University of Rome, Rome 00168, Italy
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10
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Kasim NF, Veldhuijzen van Zanten J, Aldred S. Tai Chi is an effective form of exercise to reduce markers of frailty in older age. Exp Gerontol 2020; 135:110925. [PMID: 32184194 DOI: 10.1016/j.exger.2020.110925] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 02/07/2023]
Abstract
Frailty affects the quality of life of older age adults by limiting mobility, reducing physiological reserve and reducing independence. The frailty phenotype is typically characterised by exhaustion, loss or lack of physical activity, weight loss and weakness, although more recently there have been proposals to extend the frailty criteria to include physiological characteristics such as inflammation, oxidative stress and vascular function. Exercise has the potential to prevent, delay or even reverse frailty, but not all exercise is perceived as suitable for an older age population. The purpose of this study was to test Tai Chi and Zumba Gold® as exercise interventions in older age adults (65 to 75 years old) to improve characteristics related to the frailty phenotype. Muscle strength and flexibility (functional fitness as a measure of weakness), cardiorespiratory fitness, blood pressure, vascular function (FMD), markers of oxidative stress (total antioxidant capacity, malondialdehyde, 8-isoprostane, protein carbonyl), inflammation (CRP) and aspects of wellbeing related to exhaustion were assessed at baseline (pre-), 6 weeks (mid-) and 12 weeks (post-intervention). Both Tai Chi and Zumba Gold® improved systolic blood pressure, vascular function, and functional fitness following the 12 week intervention to a similar extent. Furthermore Antioxidant capacity was significantly increased (303 ± 15.56 vs. 336 ± 18.82 μm; p = 0.0028) and lipid oxidation significantly reduced (36.41 ± 6.4 vs 13.49 ± 2.5 pg/ml; p = 0.0042) after 12 weeks of Tai Chi compared to baseline. Anxiety, physical and mental fatigue decreased in both groups, with a greater decrease in mental fatigue in the Tai Chi group. Taken together, these changes suggest that Tai Chi has the potential to reduce outcomes related to the extended frailty phenotype in older age adults.
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Affiliation(s)
- Nor Fadila Kasim
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Faculty of Sport Science and Coaching, Sultan Idris Education University Malaysia
| | - Jet Veldhuijzen van Zanten
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Centre for Musculoskeletal Ageing Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sarah Aldred
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Centre for Human Brain Health, University of Birmingham, Edgbaston, Birmingham, UK.
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Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients. Aging Clin Exp Res 2019; 31:1435-1442. [PMID: 30515724 DOI: 10.1007/s40520-018-1082-y] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The capacity of Short-Physical Performance Battery (SPPB) test to discriminate between fallers and non-fallers is controversial, and has never been compared with fall risk assessment-specific tools, such as Performance-Oriented Mobility Assessment (POMA). AIM To verify the association of SPPB and POMA scores with falls in older outpatients. METHODS 451 older subjects (150 males, mean age 82.1 ± 6.8) evaluated in a geriatric outpatient clinic for suspected frailty were enrolled in this cross-sectional study. Self-reported history of falls and medication history were carefully assessed. Each participant underwent comprehensive geriatric assessment, including SPPB, POMA, Geriatric Depression Scale (GDS), mini-mental state examination (MMSE) and mini-nutritional assessment-short form (MNA-SF). Multivariate logistic regression and receiver-operating characteristic (ROC) analyses were performed to determine the factors associated with the status of faller. RESULTS 245 (54.3%) subjects were identified as fallers. They were older and had lower SPPB and POMA test scores than non-fallers. At ROC analysis, SPPB (AUC 0.676, 95% CI 0.627-0.728, p < 0.001) and POMA (AUC 0.677, 95% CI 0.627-0.726, p < 0.001) scores were both associated with falls. At multivariate logistic regression models, SPPB total score (OR 0.83, 95% CI 0.76-0.92, p < 0.001), POMA total score (OR 0.94, 95% CI 0.91-0.98, p = 0.002) and SPPB balance score alteration (OR 2.88, 95% CI 1.42-5.85, p = 0.004), but not POMA balance subscale score alteration, were independently associated with recorded falls, as also GDS, MMSE and MNA-SF scores. CONCLUSIONS SPPB total score was independently associated with reported falls in older outpatients, resulting non-inferior to POMA scale. The use of SPPB for fall risk assessment should be implemented.
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12
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Frailty phenotype, frailty index and risk of mortality in Chinese elderly population- Rugao longevity and ageing study. Arch Gerontol Geriatr 2019; 80:115-119. [DOI: 10.1016/j.archger.2018.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 01/24/2023]
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13
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Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc 2018. [PMID: 28648901 DOI: 10.1016/j.jamda.2017.04.018] [Citation(s) in RCA: 374] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. METHODS An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RECOMMENDATIONS Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. CONCLUSIONS The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
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Affiliation(s)
- Elsa Dent
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Christopher Lien
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Chin Wong
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jean Woo
- The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Birong Dong
- Geriatrics Center Huaxi Hospital, Sichuan University, Chengdu, China
| | - Shelley de la Vega
- University of the Philippines College of Medicine, Manila, Philippines; Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Philip Jun Hua Poi
- Division of Geriatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Chang Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Li Cao
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Piu Chan
- Department of Geriatrics, Neurology, and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Edward Leung
- Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | | | - Linda P Fried
- Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University, St. Louis, MO
| | | | - Leon Flicker
- Western Australia Center for Health and Aging, University of Western Australia, Perth, Australia
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14
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Li J, Zhao D, Dong B, Yu D, Ren Q, Chen J, Qin Q, Bi P, Sun Y. Frailty index and its associations with self-neglect, social support and sociodemographic characteristics among older adults in rural China. Geriatr Gerontol Int 2018; 18:987-996. [DOI: 10.1111/ggi.13280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/12/2017] [Accepted: 01/24/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Jie Li
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Dongdong Zhao
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Bao Dong
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Dandan Yu
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Qiongqiong Ren
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
| | - Jian Chen
- Ma’anshan Center for Disease Control and Prevention; Ma’anshan China
| | - Qirong Qin
- Ma’anshan Center for Disease Control and Prevention; Ma’anshan China
| | - Peng Bi
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
- The University of Adelaide, School of Public Health; Adelaide South Australia Australia
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health; Anhui Medical University; Hefei China
- Center for Evidence-Based Practice; Anhui Medical University; Hefei China
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15
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Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Liu ZY, Shen YY, Ji LJ, Jiang XY, Wang XF, Shi Y. Association between serum β2-microglobulin levels and frailty in an elderly Chinese population: results from RuLAS. Clin Interv Aging 2017; 12:1725-1729. [PMID: 29081654 PMCID: PMC5652941 DOI: 10.2147/cia.s142507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the association between serum β2-microglobulin (B2M) levels and frailty in an elderly Chinese population. DESIGN A population-based cohort study. SETTING AND PARTICIPANTS We used data on 1,663 elderly participants (aged 70-84 years) from the aging arm of the Rugao Longevity and Ageing study, a population-based observational two-arm cohort study conducted in Rugao, China. MEASUREMENTS The serum B2M was measured with chemiluminescence immunoassay by a technician in the biochemistry laboratory of the Rugao People's Hospital. Information on the frailty index and phenotype was collected. RESULTS The mean B2M levels and frailty index were 1.8 mg/L and 0.16, respectively; 188 (11.3%) participants were classified as frail (frailty phenotype). For a standard deviation increase in B2M, the adjusted odds ratio for frailty phenotype was 1.20 (95% CI: 1.05, 1.39; P=0.009) and the standardized coefficient for frailty index was 0.07 (95% CI: 0.02, 0.11; P=0.004). Relative to the lowest quartile, the highest B2M quartile had a greater risk of prevalent frailty with adjusted odds ratios of 1.68 (95% CI: 1.04, 2.71; P=0.034) for frailty phenotype and 1.51 (95% CI: 1.01, 2.27; P=0.044) for frailty index (≥0.25). In addition, estimated glomerular filtration rate (based on B2M) or chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2) was significantly associated with frailty phenotype and index. CONCLUSION B2M was significantly associated with both frailty phenotype and index in elderly Chinese population. The findings underscore the promising kidney relevant biomarkers for identifying vulnerable elderly Chinese population.
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Affiliation(s)
- Zu-Yun Liu
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yan-Yu Shen
- Department of Nephrology, People's Hospital of Xuyi, Xuyi, Jiangsu, China
| | - Li-Juan Ji
- Department of Sport Medicine and Pain Clinic, Center of Sports Rehabilitation, School of Sport Science, Shanghai University of Sport
| | - Xiao-Yan Jiang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine
| | - Xiao-Feng Wang
- Unit of Epidemiology, Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Yan Shi
- Department of Emergency, Huai'an Second People's Hospital, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
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17
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Ludwig C, Busnel C. Derivation of a frailty index from the resident assessment instrument - home care adapted for Switzerland: a study based on retrospective data analysis. BMC Geriatr 2017; 17:205. [PMID: 28882127 PMCID: PMC5590146 DOI: 10.1186/s12877-017-0604-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/30/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers. Such a screening can be based on a frailty index (FI) derived from data collected with interRAI instruments used in clinical routines to define care plans. The objective of this study was to assess the feasibility of deriving an FI from the Resident Assessment Instrument - Home Care adapted for Switzerland (Swiss RAI-HC). METHODS Data were collected by the Geneva Institution for Homecare and Assistance in clinical routines. The sample consisted of 3714 individuals aged 65 or older (67.7% females) who had each received a Swiss RAI-HC upon admission in the year of 2015. The FI was derived from 52 variables identified and scored according to published guidelines. Adverse health outcomes were either assessed during follow-up assessments (falls, hospitalizations) or documented from administrative records (mortality). RESULTS The results showed that the FI was distributed normally, with a mean of 0.24 (± 0.13), an interquartile range of 0.16, and values of 0.04 at percentile 1 and 0.63 at percentile 99. The effect of Age was significant (R2 = 0.011) with a slope of β = 0.002, 95% CI = [0.001-0.002]. Sex as well as the Age × Sex interaction were not significant. The FI predicted deaths (OR = 9.99, 95% CI = [3.20-29.99]), hospitalizations (OR = 3.40, 95% CI = [1.78-6.32]), and falls (OR = 5.00, 95% CI = [2.68-9.38]). CONCLUSIONS The results support the feasibility of an FI derivation from the Swiss RAI-HC, hence replicating previous demonstrations based on interRAI instruments. The results also replicated findings showing that the FI is a good predictor of adverse health outcomes. Yet, the results suggest that home care recipients demonstrate a frailty pattern different from the one reported in community dwellers but comparable to clinical samples. Further work is needed to assess the characteristics of the proposed index in community-dwelling, non-clinical samples for comparability with the existing literature and external validation TRIAL REGISTRATION: ClinicalTrials.gov NCT03139162 . Retrospectively registered May 2, 2017.
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Affiliation(s)
- Catherine Ludwig
- University of Applied Sciences and Arts of Western Switzerland, School of Health Sciences - Geneva, Avenue de Champel 47, 1206, Geneva, Switzerland.
| | - Catherine Busnel
- Geneva Institution for Homecare and Assistance (imad), Avenue du Cardinal Mermillod 36, 1227, Carouge, Switzerland
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Ritt M, Jäger J, Ritt JI, Sieber CC, Gaßmann KG. Operationalizing a frailty index using routine blood and urine tests. Clin Interv Aging 2017; 12:1029-1040. [PMID: 28721031 PMCID: PMC5500540 DOI: 10.2147/cia.s131987] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Uncomplicated frailty instruments are desirable for use in a busy clinical setting. The aim of this study was to operationalize a frailty index (FI) from routine blood and urine tests, and to evaluate the properties of this FI compared to other frailty instruments. Materials and methods We conducted a secondary analysis of a prospective cohort study on 306 patients aged ≥65 years hospitalized on geriatric wards. An FI comprising 22 routine blood parameters and one standard urine parameter (FI-Lab), a 50-item FI based on a comprehensive geriatric assessment (FI-CGA), a combined FI (FI-combined [items from the FI-Lab + others from the FI-CGA]), the Clinical Frailty Scale, rule-based frailty definition, and frailty phenotype were operationalized from data obtained during patients’ hospital stays (ie, before discharge [baseline examination]). Follow-up data were obtained up to 1 year after the baseline examination. Results The mean FI-Lab score was 0.34±15, with an upper limit of 0.74. The FI-Lab was correlated with all the other frailty instruments (all P<0.001). The FI-Lab revealed an area under the receiver-operating characteristic curve (AUC) for 6-month and 1-year mortality of 0.765 (0.694–0.836) and 0.769 (0.706–0.833), respectively (all P<0.001). Each 0.01 increment in FI-Lab increased the risk (adjusted for age and sex) for 6-month and 1-year mortality by 7.2% and 7.1%, respectively (all adjusted P<0.001). When any of the other FIs (except the FI-combined) were also included in the models, each 0.01 increment in FI-Lab score was associated with an increase in the risk of 6-month and 1-year mortality by 4.1%–5.4% (all adjusted P<0.001). Conclusion The FI-Lab showed key characteristics of an FI. The FI-Lab can be applied as a single frailty measure or in combination with/in addition to other frailty instruments.
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Affiliation(s)
- Martin Ritt
- Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nuremberg, Germany.,Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen, Erlangen, Germany
| | - Jakob Jäger
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen, Erlangen, Germany
| | - Julia Isabel Ritt
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen, Erlangen, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nuremberg, Germany.,Department of General Internal Medicine and Geriatrics, Hospital of the Order of St John of God, Regensburg, Germany
| | - Karl-Günter Gaßmann
- Institute for Biomedicine of Ageing (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nuremberg, Germany.,Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Hospital of the Congregation of St Francis Sisters of Vierzehnheiligen, Erlangen, Germany
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Associations of triglyceride levels with longevity and frailty: A Mendelian randomization analysis. Sci Rep 2017; 7:41579. [PMID: 28134330 PMCID: PMC5278549 DOI: 10.1038/srep41579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 12/23/2016] [Indexed: 11/29/2022] Open
Abstract
Observational studies suggest associations of triglyceride levels with longevity and frailty. This study aimed to test whether the associations are causal. We used data from the Rugao Longevity and Ageing Study, a population-based cohort study performed in Rugao, China. A variant in the APOA5 gene region (rs662799) was used as the genetic instrument. Mendelian randomization (MR) analyses were performed to examine the associations of genetically predicted triglycerides with two ageing phenotypes – longevity ( ≥95 years) and frailty (modified Fried frailty phenotype and Rockwood frailty index). C allele of rs662799 was robustly associated with higher triglyceride levels in the comparison group (β = 0.301 mmol/L per allele, p < 0.001), with an F statistic of 95.3 and R2 = 0.040. However MR analysis did not provide strong evidence for an association between genetically predicted triglyceride levels and probability of longevity (OR: 0.61; 95% CI: 0.35, 1.07 per 1 mmol/L increase in triglycerides). In the ageing arm (70–84 years), genetically predicted triglyceride levels were not associated with the frailty index (β = 0.008; 95% CI: −0.013, 0.029) or the frailty phenotype (OR: 1.91; 95% CI: 0.84, 4.37). In conclusion, there is currently a lack of sufficient evidence to support causal associations of triglyceride levels with longevity and frailty in elderly populations.
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Liu ZY, Wang ZD, Li LZ, Chu XF, Zhu YS, Shi JM, Xie XJ, Jin L, Wang Y, Wang XF. Association of CRP gene polymorphisms with CRP levels, frailty and co-morbidity in an elderly Chinese population: results from RuLAS. Age Ageing 2016; 45:360-5. [PMID: 27016573 DOI: 10.1093/ageing/afw041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 01/27/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES to examine the associations of two common CRP gene polymorphisms with CRP levels, frailty and co-morbidity in an elderly Chinese population. DESIGN a population-based cohort study. SETTING AND PARTICIPANTS we obtained data on 1,723 elderly participants aged 70-84 from the ageing arm of the Rugao Longevity and Ageing study (RuLAS), a population-based observational cohort study conducted in Rugao, Jiangsu province, China. MEASUREMENTS the genotyping of two common CRP gene polymorphisms (rs1205 and rs3093059) was performed. Items concerning the frailty index and co-morbidity were collected. RESULTS the mean age of the study population was 75.3 ± 3.9 years, and 53.5% (n = 922) were women. The minor allele frequencies of rs1205 and rs3093059 were 42.4% (C allele) and 16.9% (C allele), respectively. The polymorphisms rs1205 and rs3093059 were significantly associated with CRP levels (β = 0.113 and 0.222, all P < 0.001). Non-significant association between rs1205 and rs3093059 and frailty, as well as between rs3093059 and co-morbidity was observed. However, SNP rs1205 CC genotype had an increased odds of co-morbidity compared with the TT genotype (odds ratio (OR):1.53; 95% confidence interval (CI): 1.16-2.02). Each additional copy of the C allele of SNP rs1205 was associated with 1.23 times (95% CI: 1.07-1.41) odds of co-morbidity. The significance remained after controlling for covariates such as education level, etc. CONCLUSIONS among elderly Chinese individuals, two CRP gene polymorphisms were significantly associated with CRP levels. However, none of them was associated with frailty. The preliminary findings warrant further validations.
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Affiliation(s)
- Zu-Yun Liu
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | | | - Lin-Zi Li
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Xue-Feng Chu
- Rugao People's Hospital, Rugao 226500, Jiangsu, China
| | - Yin-Sheng Zhu
- Rugao People's Hospital, Rugao 226500, Jiangsu, China
| | - Jian-Ming Shi
- Rugao People's Hospital, Rugao 226500, Jiangsu, China
| | - Xue-Juan Xie
- Rugao People's Hospital, Rugao 226500, Jiangsu, China
| | - Li Jin
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Yong Wang
- Rugao People's Hospital, Rugao 226500, Jiangsu, China
| | - Xiao-Feng Wang
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
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